329 ESSEX ST - BUILDING PERMIT APP t The Commonwealth of Massachusetts
t Board of Building Regulations and Standards
4 Massachusetts State Building Code. 780 C NIR. 7"' edition I ltil'.
Building Permit Application To Construct. Repair, Renovate Or Demolish a Rrriscd,huw.u,
One-or Tit o-h' c umdv Dtrlling l; =rm,A'
This Section For Official Use Only
PI Building Permit Number. Date Applied Cam' 6`0
rSignature:
— Building C mmiuiuned Inspector ut Buildings Dale
r SECTION t: SITE INFORMATION
✓ LI Property Address: 1.2 Assessors Map & Parcel Numbers —
_�329
r Li Ma Numher P:ucel `'umber
L(a L•; this Lin accepted street'. yes_ nu_ P j
1.3 zoning Information: --- 1.4 Property Dimensions:
I
IZoning Dt3aticl Pmposcd Use I_u.P..w ,_q .t; I
FL_ Building Setbacks (ft) SIJa Yards -- —_— —__ Rear Yard -�
Pront
ard
!� Rcyuired Provided Requited —Provided Rrnuued PruvidrJ -
j I
1.6 Water Supply: (M G L c. 40, §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone' Municipal ❑ On Jis posal s . cm ❑
Puh!ic ❑ Private❑ Check if yes❑ I p+' n s I Y t'
SECTION 2: PROPERTY OW'NERSHIPt ---I
✓I 2.1 Ownert of Re' rd:
oeo-V-ir
Name iPr nt Address for Service: —
_ �q - --
IS nattoe _ Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORKZ (check all that apply) I
F--
✓� New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repnirs(s) l�Alteruionts) G Addition Li
Demolition ❑ Accessory Bldg. ❑ Number of Units _ Other ❑
--'—
I Prier Description of Proposed Work": — — ------
- --- -- r�-PAPA/Z- - - ----
SECTION 4: ESTIMATED CONSTRUCTION COSTS
item Estimated Costs: Official Use Only
(Labor and Materials)
I. Building $ L Building Permit Fee: $Z Indicate how fee is determined: 1
AStandard City/Town Application Fee
2. Electrical $ ❑Total Project Cost' (Item 6) x multiplier x
i
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) .$ List'
-. Mechanical (Fire S
Suppression) Total All Fees: $ � Oels
Check No.S i3 Check ,\mount: Cash Annxnll:
b, Total Project Cost: $ n�UW fk!Paid to Full ❑ Outstanding Balance Due:_—.-__
7
SECTION 5: CONSTRUCTION SERVICES -
5.1 Licensed Construction 1\Su(1pervisor ICSL) C5 ZS 9047 -q Z.7 201p
)Ayka � - �r->_��� License Number G�pi is L ate• .
Name of CSI_- IIuIJ r
List C'SL Tcpe(see below))
\ddrrNs .I.' c Ucscn Nion
U �� O\95 ( L Lnteslncted lot to 35.000 Or FI.I
R Restricted 1&2 Famih D\\elhnc
Signatt \t .blasonn Only
RC ResiJrmial Routine CU\erinit
Telephone \\'S Residential \timdtm .iud Sirim_
978 - �ra2-93/ 2 SF KesiJemial Solid Fuel Burnine \ >>li:m.e htsl,dl:nnni
U I Reeldeuoal Demolition
5.2 Registered home Improvement Contractor(HIC)
o 00�:;-9
HIC Company ..":;a:c or HIC Regisuanl Name Regislralir n Numher
-- 7 21 20 1 0
.�•i�.l f•...1
F.xpir[tun Date
Signature _—_— _—. — Telephone
SECTIO S 6: WORRE:t+R' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. § 25C(6))
Workers Compensation Insurarn_e affidavit must be completed and submitted with this application. Failure at provide I
this affidavit will result in the dc,tial .:`the Issuance of the building permit.
Signed Affid::vit Attached'? Yes ......_.. ❑ Not -........ ❑
SECTION 7a: OY YNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
( L rt c �. q-/el — as Owner of the str: cxt property hereby
j authorize A✓t Inl<S5 _ _—__ to act tin my behalf, in all matters j
I el' �v to work authorized by this building permu application.
I
j Siena ore of wrier Date
SECTION 7h_ OWNER OR AUTHORIZED AGEti7_DECLARATION - 1
I. _�' !'I e � ��5 .-... .—.___. as Owner or Authorized Agent hereby declare
that the statements and information on t,he forego t g alpaca ton are true and accurate, to the best of my knowledge and
j behalf. 99
Print Name 47,
p DrSignature of Owner or Autho V ed.4g Date d
(Signed under the pains and penalties of perjury)
NOTES:
I. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor
(nut registered in the Home Improvement Contractor (HIC) Program), will not have access to the arhitr:nion
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and j
Construction Supervisor Licensing (CSL) can be t0t.md in 730 C•MR Regulations I MR6 and 1 10 R5, respectively.
'. When substantial work is planned, provide the information below:
Total floors area(Sq. Ft.) (including garage, finished basement/attics. decks or porch)
j Gross living area i Sq. Ft.) Habitable room count _
Number of tireplaces Number of bedrooms _
Number of bathrooms _ .. Number of half/baths _.
l}pe of heating system _ Number of decks/ porches
rype of cooling system - Enclosed - Open _
3. "Total Project Square Footage- may be substituted for 'Tord Project Cost"
o
Salem Historical Commission
120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970
(978) 745-9595 EXT. 311 FAX (978) 740-0404
CERTIFICATE OF NON-APPLICABILITY
It is hereby certified that the Salem Historical Commission has determined that the proposed:
❑ Construction ❑ Moving
Reconstruction ❑ Alteration
❑ Demolition ❑ Painting
❑ Signage ',U� Other Work
as described below does not involve an exterior architectural feature or involves a feature covered by the
exemptions or limitations set forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic
Districts Ordinance.
District: McIntire
Address of Property: 329 Essex Street
Name of Record Owner: Eric & Dorothy Hayes
Description of Work Proposed:
Repair wood trim, replace missing or severely deteriorated elements, repair window frames and sills, repair
window sash, repair basement window, reset granite pier at west faoade and repair as needed, and
repair/replace main cornice. All work to replicate existing. No changes in color, material, design or outward
appearance. Non-applicable due to being in kind maintenance/replacement.
Temporary covering of a few windows at a time while under repair. Temporary covering to be grey painted
plywood
Installation of white aluminum downspouts where some are missing as temporary measure to get through
Winter. Conditional that replacement with approved downspout be completed within one year.
Dated: July 30, 2008 SALE SSION
By: 7tt
The homeowner has the option not to commence the work (unless it relates to resolving an outstanding
violation). All work commenced must be completed within one year from this date unless otherwise indicated.
THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of
Buildings (or any other necessary permits or approvals) prior to commencing work.
Q The Commonwealth of Massachusetts
Townof
Board of Building Regulations and Standards
Massachusetts State Building Code, 780 CMR, 71"edition Building Dept
Building Permit Application To Construct, Repair. Renovate Or Demolish a
One- or Two-Fa
mil � e ling
This Secti mFor Official Use Only
Building Permit Number: Da Ap lied: J
/&M -
Signature:
Building Commissioner/Ins for Buildings Date
SECTIO ITE INFORMATION
1. r�e`�rty ddress•�
ST. 1.2 Assessors Map& Parcel Numbers
1.1 a Is this an accepted street?yes_ no Map Number Parcel Number
x 1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(R)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
x Required Provided Required Provided Required Provided
1.6 Water Supply:(M.O.1.C.40,9541 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑
Public❑ Private❑ Check if yesE3
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: ����_IV
ire--1 (. f�0Xb1f H 1l NAY E S Addr��r Service:
Nam/el Print)
rl 7!d 7 YY
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction❑ Existing Building Owner-Occupied R' Repairs(s) JA Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ 1 Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work': 6 fz- SLC Fes.-or'll-]`T�l:,-:)
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item Labor and Materials
I. Building S 1. Building Permit Fee: S Indicate how fee is determined:
❑ Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S /� /�-�
4. Mechanical (HVAC) S List: "Ami ✓lF) L- `tE-
5. .Mechanical (Fire S Total All Fees: S
$u ression
G Check No. _Check Amount: Cash Amount:_
6. Total Project Cost: S I /0 �(��. 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) ,a-1�� n oA '
�" ",O, q , W u G l.'-'T License Number ED.xpiranon Date r
N me u SL HpWer !! �, t`���
Nymc4�d �fJSI DE 5-C�MA a2.t31 List CSL Type(see below) (f
V V ' Description
Unrestricted u to 35,000 Cu. FL)
R Restricted 1&2 Family Dwellin
Si nature .V1 Siason Only
3 RC I Residential Rooting Covering
Telephone W$ Residential Window and Siding
SF Residential Solid fuel Burning A liance Installation
D I Residential Demolition
5.2 Regi Bred Home i provement ontractor(HIC)
�9 T E ,�_ �� 1(03 537 V
HIC Comp N or ltscant N e 9 Registration Number
Ada S7-614016
V�? 3 Expiration Date
Si re Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Afdavit Attached? Yes ..........x' No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. as Owner of the subject property hereby
authorize to act on my behalf,in all matters
relative to work authorized by this building permit pplicat' .
Si nature of Owner Date �
SECTION 7b:OWNE Rt O`R AUTHORIZED AGENT DECLARATION
1, r o-b kc, I"ie/ a L ,as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
Print Name ( �23161
4
Signature of Owner or Authorized crit Date
(Signed under the pains and penalties of perjury)
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I O.R6 and I MRS,respectively.
2. When
substantial work is planned,provide the information below:
Total Floors area(Sq. Ft.) (including garage, finished basement/artics,decks or porch)
Gross living area(Sq. Ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
J. "Total Project Syuare Footage"may be substituted for"Total Project Cost'
I N
F E m .4
PE11 NE/BOR
.AR P E NT
Brooks Wright
173 NORFOLK AVENUE; BOSTON,MA 02119 -
`(617)445.4323 •F:(617)445-5691
C:(617)293-1474
bw ight@paynebouchier.com .
CITY OF SALEM
;j ,.j. PUBLIC PROPRERTY
DEPART"VIENT
Construction Debris Disposal Affidavit
(required lbr all demolition and renovation work)
In accordance %%i Ill the sixth edition ol'the State Building Code, 780 C NIR section 1 1 1.5
Dcbris, and the provisions of'IvIGL c 40, S 54;
Building Permit K is issued with the condition that the debris resulting from
this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c
I 11. S 150A.
The debris
will be transported by:
(name ul'hau� '
I he debris will be disposed of in
V _
(namr u(Iacdrty)
l ad,lre<v ul'gcllity)
LIId101t .,r pi unit phcant
Ln L?
329 ESSEX STREET 107-09
GIS#: 8340 COMMONWEALTH OF MASSACHUSETTS
Map: 26
Block: CITY OF SALEM
Lot: 0483
Category:
Perrnit:-# 107-09 - BUILDING PERMIT
Project# 7S-2009-000115
Est. Cost: $150,000.00
Fee Charged: $1,055.00
Balance Due: $.00 PERMISSION IS HEREBY GRANTED TO: ..
Const. Class: Contractor: License: Expires:
Use Group: xxxxxx
Lot Size(sq.R.): 6844.1472 Owner: HAYES ERIC &DOROTHY
Zoning: R2
Units Gained: Applicant: HAYES ERIC&DOROTHY
Units Lost: AT. 329 ESSEX STREET
Dig Safe#:
ISSUED ON. 01-Aug-2008 AMENDED ON. EXPIRES ON: 01-Feb-2009
TO PERFORM THE.FOLLOWING WORK:
EXTERIOR RENOVATIONS,INTERIOR DEMO,NEW ROOF,CHIMNEY REPAIRS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Electric Gas Plumbin¢ Buildine
Underground: - Underground: Underground: Excavation:
Service: Meter: Footings:
Rough: Rough: Rough: Foundation:
Final: Final: Final: Rough Frame:
Fireplace/Chimney:
D.P.W. Fire Health
Insulation:
Meter: Oil:
Final:
House# Smoke:
Water: Alarm:
Assessor Treasury:
Sewer: Sprinklers: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS
RULES AND REGULATIONS.
Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
BUILDING REC-2009-000139 01-Aug-08 5433 $1,055.00
GeoTMS®2009 Des Lauriers Municipal Solutions,Inc.
Salem Historical Commission
120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970
j978) 7459595 EXT. 311 FAX (978) 740-0404
CERTIFICATE OF NON-APPLICABILITY
It is hereby certified that the Salem Historical Commission has determined that the proposed:
❑ Construction ❑ Moving
Reconstruction ❑ Alteration
❑ Demolition ❑ Painting
❑ Signage >k Other Work
as described below does not involve an exterior architectural feature or involves a feature covered by the
exemptions or limitations set forth in the Historic District's Act(M.G.L. Ch. 40C) and the Salem Historic
Districts Ordinance.
District: McIntire
Address of Property:329 Essex Street
Name of Record Owner: Fric Dorothy Hayes
Description of Work Proposed:
Repair wood trim, replace missing or severely deteriorated elements, repair window frames and sills, repair
t west
re)pair/replace main sash, repair
anr basement window, reset granite pier
cornice. All ork o replicate existing.aN changes en color,and pmmaterial, design or outward
appearance. Non-applicable due to being in kind maintenance/replacement.
Temporary covering of a few windows at a time while under repair. Temporary covering to be grey painted
Plywood
Installation of white aluminum downspouts where some are missing as temporary measure to get through
Winter. Conditional that replacement with approved downspout be completed within one year.
Dated: July 30. 2008 SALE
ALSSION
By:
The homeowner has the option not to commence the work (unless it relates to resolving an outstanding
violation). All work commenced must be completed within one year from this date unless otherwise indicated.
THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of
Buildings (or any other necessary permits or approvals) prior to commencing work.
CITY OF SMENI, NLASSACHi;SETTS
BUILDING DEPARTMENT
• p 120 WASHINGTON STREET, Seo FLOOR
• �"'
TEL (978) 745-9595
F.-x(978) 740.9846
KI,
iBERLEY DRISCOLL
MAYOR THO&L\S ST.PMM
DIRECTOR OF PUBLIC PROPERTY/BUILD[.NG CO%L%DSSIONElt
Workers' Compensation Insurance Affidavit: Duilders/Contractors/Electricians/Plumbers
Annlicant Information fJ Please Print Legibly
Name (Dusinc%s,Orwizanorvindiv;dual): r(A�t'L= w Ga ✓ 6VtN
Address: .17 ; A�6 v �f le �tve I
City/statc/zip: OZ119 Phonell: :_6� 445 .4 23 -
Are you an employer?Chee the appropriate box: Type of project(required): -
I..MI am a employer with U 4. 0 1 am a general contractor and 1 6. 0 New construction
employees(full and/or pan-time).' have hired the sub-contnerora
2.0 1 am a sole proprietor or partner- listed on the attached sheet : 7• ❑Remodeling
,hip and have no employees These subcontractors have g. Cl Demolition
working for me in any capxiry. workers'comp.insttrsnce. 9. 0 building addition
[No workers' comp. insurance S. 0 We are a corporation and its !0❑ Electrical repairs or additions
required.] officers have exercised their
3.0 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself. (No workers'comp. c. 152,q 1(4),and we have no 12.0 Roof repairs
insurance required.]t cmploycca. LNo workers' 13
Other
comp. insurance required.) 0
'Any applicar that checks boa rl mual also fill out the seetim below showing their waken•compensation policy information.
'I h meownen who submit this affidavit indicting they an,doing all work and then hire onlaid,comtseton insists submit a new affidavit indicating suck.
=('.mtrsnor chat cheek this boa must attached an additionni sheet skewing the name of the sub•conuactor and their worker'comp.put icy information.
I um an employer that is providin,T workers'compensation insurance jar my employees Below/s rhe poll y and fab r16r
information. /
/ / f�
Insurance Company Name: C-�\, _b� mei'^ e• i n q � /� �,
Policy Nur Self-its. Lic. firsn: k1r-, 3 ,995's-23 Expiration Date:—,Z//
Job Site Address: 3a 7 S City/Statrizip: ���1 P_✓t JIM
Attack a copy of the workers'compensatloa policy declaration page(showing the policy number and expiration date).
Failure to wcure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5230.00 a day against the violator. Ile advised that a copy of this statement may be: forwarded to the Office of
Invcsugutiunx of the DIA for insurance coverage verification.
1,10 hereby certify under the pubts and yenta/rkr a perjury that rhe information provided above is true and correct
" 3 O
�iwruureData _
Phone;: k 1 / - Z513 !' 147+
Official use duly. Do not write in that urea,to be completed by city or town officiul
i
City or Town: __. Permit/Llcense ls _
Issuing Authority (circle one):
I. Iluard of Ilealth 2. Building Department 3.City/town Clerk a. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: _ _ __ __ Phone N:
6 clLS1Lq (D
The Commonwealth of Massachusetts
/
Board of Building Regulation s and Standards CITY OF Massachusetts State BuildingCode, 780 CMR SdMar
Revised Mar 2011
Building Permit Application To Construct, Repai Renovate r Demolish a
^ ' One- or Two-Family Dwelling
lv This Section For Official Use Only
Building Permit Number: Date Appf d:
Building Official(Print Name) Signal re Date
1
I SECTION 1: SITE INFORMATION
1.1 Property Address: 6SSCX S7 t 1.2 Assessors Map & Parcel Numbers
�— 1.1 a Is this an accepted street? yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Wate Supply- (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone'?
Public Private❑ Check if yes❑ Municipal'❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP[
2.1 OwnertofRecord:`JASon MohM. J� S IcAI (A 0ri7'3
Name(Print) /I' City,State,ZIP
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK' (check all that apply)
New Construction ❑ Existing Building Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) Addition ❑
Demolition ❑ Accessory Bldg. ❑ 1 Number of Units I Other c' 1
Brief Description of Pro osed Work': DV, E I . AI A.
Alan o V
r
SECTION 4: ESTIMATED CONSTRUCTION C STS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I. Building $ ( 0 / a o 0 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ Oa p ❑ Standard City/Town Application Fee
02) ❑ Total Project Cost}(Item 6) x multiplier 2yo a a x 7•d 01& y ��
3. Plumbing $ la p u o 2. Other Fees: $
4. Mechanical (HVAC) S List: '01&ff 00
5. Mechanical (Fire
Su ression) $ Total All Fees: $ /(p f{ , 00
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ `p� / 0 0 u 0 Paid in Full 0 Outstanding Balance Due:
SECTIONS: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
I q CS-- 0�(03�J `r -1`l -(7 Ik MA ���/G q — O 14 O 3� 1 License Number Expiration Date
Name of CSL Holder u
List CSL Type(see below)
No.and Street Type Description
5�� ,C'b,/t ' OI 0 U Unrestricted(Buildings u to 35,000 cu. ft.)
o v R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I J 7J 1 e >7 G15 erS k-N @,�f�ornG. I insulation
Telephone I Email auddrescsl D Demolition
5.2 Registered Home Improvement Contractor(HIC) p i I q 1 g
`i'7 d'O a yh Co/35a-r(/d 1,onl CO HIC Registration Number Expiration Date
HIC Company Name or HIC Reg'strant Name n
Id 5W AY 40 S� D'U bl'LILO . (sue M
No.and Street J 541{� M f} D/J1 o 70 �- 2 313 S- I ' ail address
City/Town, State,ZIP Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes ....... .. No ........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property, hereby authorize 6 rb b h4 a 4ruL'N
to act on my behalf, in all matters relative to work authorized by this building permit application.
!�6 N `140/- J Print Owner's Name(Electronic Signature) � /J D to
SECTION 7b: OWNERS OR AUTHORIZED AGENT DECLARATION
By entering my name below,1 hereby attest under the pains and penalties of perjury that all of the information
contained in this application
ji�ss true
and accurate to the best of my knowledge and understanding.
OZ,®� 6 ..
Print O is or Authorized Agent's Nam (Electronic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at
www.mass. og v/oca Information on the Construction Supervisor License can be found at www.mass.e�
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage, finished basement/attics, decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches-
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
The Commonwealth ofMassachusetls
I3epartinent of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/organuationnndividuaq: Groom Construction Co. , Inc.
Address: 96 Swampscott Road
Salem, MA 781 -592-3135
City/State/Zip: Phone*:
Are you an employer?Check the appropriate box: Type of project(required):
1.® I am a employer with 7 5 4. ❑ I am a general contractor and I 6. ®New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner-, listed on the attached sheet 7. ❑Remodeling -
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers' 9. ❑Building addition
[No workers'comp. insurance comp. insurance.t
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs
insurance required.)t c. 152, §1(4),and we have no
employees.[No workers' 13.❑Other
comp.insurance required.]
!My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside egnttacWts must submit anew affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the suh w tractors and state wheaw or not those entities have
employees. If the subcontractors have employees,they must provide their workers'comp.policy number.
ram an employer that is provtding workers'compensation insurance for my employees Below is the policy and fob site
information.
Insurance Company Name: Hanover Tnsurancif, ComnanU
I
Policy#oiSelf-ins.Lic.#:_ WHNA552476 ExpirationDgte- 3/10/17
Job Site Address: a SSEk ( City/StatelZip: Sree H M h 0101 l°
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
i
Failure,to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one:year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for instance coverage verification. j
I do herebycert under the pains and penalties of perjury that the information Provided above is true and correc4
Date 7�7 LP I (p
Phone 5U- �I3S
Official use only. Do not write in this area,to be camp e y-c For town official
City or Town: Permit/License#
Issuing Authority(circle one): I
1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6, Other
Contact Person: Phone#:
i
(� Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supen-ierr
License CS-040379 a
THOMAS GROOM'
96 SWAMPScoTT RD s
Salem MA 01970;
; i.NIIJ'
y �d
Expiration
Commissioner 04/19/2017
Vow P Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 104999
�—x =_ _ rttType: Private Corporation
Expi
��ll ;,I,Y•\IT ration: 7/16/2018 Tr# 288382
lv
GROOM CONSTRUCTION, INC. �.
Thomas Groom
96 SWAMPSCOTT RD #6 - F (r;/
SALEM, MA 01970
\ Fl
�Update Address and return card.Mark reason for change.
❑ Address ❑ Renewal ❑ Employment Lost Card
SCA 1 Co 20M-05/11
CFIXe (pomvnarnveoe¢//z oimaac%rae/X� License or registration valid for individual use only
Ov
Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTORbefore the expiration date. If found return to:
Registration .104999 Type: Office of Consumer Affairs and Business Regulation
Expiration 7/?I6/2018 Private Corporation
�(p 10 Park Plaza-Suite 5170
_ Boston,MA 02116
GROOM CONSTRUCTION IN C
Thomas Groom
96 SWAMPSCOTT RD
SALEM, MA 01970 Undersecretary Not valid without signature
Official Use Only
l,ommanweat°th a/
ccyy�� Permit No.
vUeP ,t...t o/5<re�eruice!
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leaveblank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00
(PLEASE PRINT IN INK OR TYPE A&L INFORMATION) Date: 01 L h�
City or Town of: To the Inspector of Wires:
By this application the undersigned gives notice of his or her mtennon to perform the electricaldesc�rork ed below.
'ib
Location(Street&Number)
C Telephone No.
Owner or Tenant SA A 3 �� O ..,,
Owner's Address
Is this permit in conjunction with a building permit? Yes ❑ No. OR' (Check Appropriate Box)
Purpose of Building Utility Authorization No.
Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity �
Location and Nature of Proposed Electrical Work: '(G, Pr. 14 e, Cx LCl7, 4 -0
Completion o the following able mai,be waived by the Ins ector o Wires.
o.or
otal
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans Transformers KVA
No.of Luminaire Outlets
No.of Hot Tubs Generators KVA
ove In- o.o Emergency Lighting
No.of Luminaires Swimming Pool rod. ❑ rnd. ❑ Battery Units
No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
o.of Detection an
No.of Switches No.of Gas Burners initiating Devices
Total of Alerting No.of Ranges No.of Air Cond. Tons No. g No.
Heat Pump Number Tons No.of Sel -Contained
No.of Waste Disposers Totals: Local[:)
Municipal
Devices
unmipal
No.of Dishwashers Space/Area Heating KW Local❑ Connection ❑ Other
Heating Appliances KW SecuritySystems:*
No.of Dryers No.of Devices or Equivalent
No.of ater 0.0 No.of Data Wiring:
Heaters KW Signs Ballasts No.of Devices or Equivalent
...... mumcations irtng:
No.Hydromassage Bathtubs No.of Motors Total HP No.of Devices or E uivalent
OTHER:
Attach additional detail iit desired.ar n.c required by the Inspector a(Wires.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
I cerfift,under the pains and penalties of perjury,that the information on this application is true and complete
FBMNAME: R+/L' Is2fUbt E1ec-ftiL -tr nC - LIC.NO.: AIZ171
Ramses: 1pflru t 13 AP t Signature /� I7�Z� LIC.NO.:
,f§(r�ipiisnble,en r "exempt"in the license number line.} Bus.Tel.No:97Q
- : VQ CSOK S37 D-Mfat- d1 $LL Alt.Tel.No.:
310axMG.L.c. 147,s. 57-61,security work requires Department of Public Safety S License. Lic.No.
4yWN 1.S INSURANCE WAIVER: 1 am aware that the Licensee does not have the liability insurance coverage normally
respimill.byy law. By my signature below,1 hereby waive this requirement. I am the(check one)[Iowner ❑owner
OnmWfteat Telephone No. PERMIT FEE:Fi
The Commonwealth of Massachusetts
v -_- Department of Industrial Accidents
- Ogee of Investigations
1 Congress Street, Suite 100
- Boston, MA 02114-2017
www mass.gov/dia
Workers Compensation InsuranceAffidavit: Builders/Contr actors/Elect ricians(Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
1�d !` 'Iscrc ye �� . . Ir.� -Tor -
Address: D >-�- 3:
y 2-C Phone #: r/7b ��5'2- 31'�
City/State/Zip: �Tcu � /n 4 v`3
Are you an employer? Check the appropriate box: t-: Type of project(required):
1.❑ I am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑ New construction
employees(full and/or pa have hired the sub-contractors
rt-time).
listed on the attached sheet. 7. ❑ Remodeling
2.❑ I am a sole proprietor or partner- These sub-contractors have R. ❑ Demolition
ship and have no employees employees and hate workers
working for me in any capacity. comp. msurance.x 9. ❑ Building addition
[Noworkers comp. insurance 10.❑ Electrical repairs or additions
required.] 5. ❑ We are a corporation and its
3.❑ I a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions
myself. [Noowner o comp right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152. ](4),and have no 13.❑ Other
employeees [No woror kers
comp. insurance required.]
*Any applicant that chsdts box#1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating the)are doing all work and then hire outside contractors must submit a new anidavit indicating such.
tContraetors that check this has must attached an additional sheet showing the name of[lie sub-contractors and state whether nr not those entities have
employees. if the sub-contractorshaveenployess,they must provide their workers comp.policy number. -
Iamanemployerthatisprovidingworkers! compensation insuranoe for myemployees. Bel ow is the poll icy and jobsite
'' lnformatton.
` Insurance Company Name: --- —
... polity#orSelf--ins. Lie. #: t1 1st Li KI :::1 So Z 6 2 Expiration Dale
Job Site Address: C i ty/State/Z i p:_
Attach a copy of the workers compensation policy declaration page(showing t h a policy number and expiration date).
Faihmz to sectQe coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
_ fine up to s caTe.o0 and/or one-year imprisonment, as well as civil penalties in [he form of a STOP WORK ORDER and a tine
ofup to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations ofthe DIA for insurance coverage verification.
Fdo hereby certify under the pains and penalties of perjury filar the information provider/above is trueand correct.
Signature
a Phone#: 7
pOkial use only. Do not write in this area,to be completer/by city or town official.
r Permit/License #
City or Town:
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk J. Electrical Inspector 5. Plumbing Inspector
6.Other
Phone#:
Contact Person:
PLEASE DETACH THIS PORTION AND RETAIN FOR YOUR RECORDS.
GROOM CONSTRUCTION.,INC. 51440
DATE INVOICE NO. ' I I EAMOUN7 E AtNAG DEDUCTION .BALANCE,
7-07-16 329 ESSEX 168 . 00 . 00 . 00 168 . 00
T
CHECK
7-07-1 CHECK 51440 9 168 . 00 . 00 . 00 168 . 00
DATE(MWDD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 8/3/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
CNT
PRODUCER NAOMEA CT Select Dept.
Eastern Insurance Group LLC PNONEHips BOO-333-7234 x66807 p/C No:TBl-SB6-e2a4
233 West Central Street A'ppglEg .selectwork@easterninsurance.com
INSURE S AFFORDING COVERAGE NAICN
Natick MA 01760 INSURER A:Travelers Inc of America 25666
INSURED INSURER B:Travelers Indemnity CO 25658
R. & L. Berube Electric Service Inc. INSURERC:Trav Ind of CT 25682
P.O. BOX 537 INSURER D:
INSURER E
Dracut MA 01826 INSURER F:
COVERAGES CERTIFICATE NUMBER�L157661269 REVISION NUMBER:
THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INS. TYPE OF INSURANCE POKY NUMBER MIMIOOY EFF MhVD�IYEYXYY LIMITS
TR
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
-15AWAGE70 RENTED
X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 300,000
A CLAIMS-MADE FX OCCUR 680123313982 7/31/2015 7/31/2016 MED EXP(My one person) $ 5,000
PERSONAL S ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000
X POLICY PRO- LOC CBM $
AUTOMOBILE LIABILITY Ea accc,d nntSINGLE LIMIT $ 11000,000
ANY AUTO BODILY INJURY(Per person) $
B ALL OWNED X SCHEDULED 4A261616 7/31/2015 7/31/2016 BODILY INJURY(Per accident) $
AUTOS AUTOS
NONO MED PROPERTY DAMAGE $
X HIREDAUTOS X AUTOS (Per sodded
Metlical payments $
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000
B EXCESS LIAB CLAIMS-MAD[N/
AGGREGATE $ 1,000,000
DED X RETENTIONS 5,00 �UIP0296YOS3 7/31/2015 7/31/2016 S
C WORKERS COMPENSATION X WCI TOR
STATU- OTH-
AND EMPLOYERS'LIABILITY YI
ANY PROPRIETOR/PARTNER/EXEOUTIVEOE.L.EACH ACCIDENT $ 500 OOO
OFFICERNEMBER EXCLUDED? 4A250767 7/31/2015 7/31/2016
(Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,000
If yes,describe under
DE SCRIPTION OF OPERATIONS below E.L.DISEASE
DESCRIPTIONLIMIT $ 500 000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required)
Electrician
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
n ACCORDANCE WITH THE POLICY PROVISIONS.
Town of Salem
Attn: Electrical Inspector AUTHORREp REPRESENTATIVE
44 Lafayette Street
Salem, MA 01970
John Koegel/KH3 �����f-y— _
ACORD 25(2010105) 01988-2010 ACORD CORPORATION. All rights reserved.
INS025 mmrnm rn The Ar.npn name end Innn ern rnnicfernd mvkc of A('-nPn
3
i � t
F
tv
Rll;Xl 'f3�1:'
•� ����� a�a�a��.�dw �a3a��. `���� erg �, ; '.
In
r OQYY/IDBv.- d s air•
• / A}
,s1,. sn �as�Yw �o HlM N o
,RECEIVED
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITpY OF
Massachusetts State Building Code, 780 CMR . i01b MAR 28 P OA4 &
Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
�—. This Section For Official Use Only
Building Permit Number: Dale plied:
3
n Building Official(Print Name) Signature Date
�y SECTION 1:SITE INFORMATION
1 1 Property Address: 1.2 Assessors Map&Parcel Numbers
isse3o
srl-
1 a Is this an accepted street?yes ,v-- no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L e.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public JI Private❑ Zone: _ Outside Flood Zone? Municipal,Q' On site disposal system ❑
Check if yesO -
SECTION 2: PROPERTY OWNERSHIP'
2.1 wner'of Record:
.� l4 r7 f�/u viG4hel� O/r�r (cvy Y41A Oil�-o
Names(Print)) City,State,ZIP (,pp
3. / Z5✓a, eSJ, Jb�—� /d �($U✓I Ih Jk r, cAeSj N JNNG./ Ccn—
No.and Street Telephone Email Addresls--��
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction ❑ Existing Building fl. Owner-Occupied Ja Repairs(s) ❑ 1 Alteration(s)Ad I Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
rtef Descr/iption of Proposed Work:
Pad / k I t/z`c m /2 u WC- 101e, S owc� 6� fZ SM
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials) -
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: t
G Z ❑Standard City/Town Application Fee +�
2.Electrical $ 3
❑Total Project Cost (Item 6)x multiplier x
3.Plumbing $ ZOD 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:,$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 9/ ❑Paid in Full ❑ Outstanding Balance Due:
L C Zi1 11e � e /oua
I r4
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration Date
Name of CSL Holder
E? List CSL Type(see below)
No.and Street
Type Description
Geo r5��a ✓.i t Q/�33 U Unrestricted(Buildings up to 35.000 cu.ft.)
Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
�j 1 / / SF Solid Fuel Burning Appliances
L' �// tf /C(O!/ 1�� C�9✓//11HtCO.CO 1 Insulation
Tele hone Email add D Demolition
5.2 Registered Home Improvement Contractor(HIC)
/� /Otsq99 7--/G -1/6Gl nomy ( pnnC�UC7[tM HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name /
Si./�.�/�; -0 tf , ��yU9LJ4f r-v4YLY�mGO,CaM
No.an Street t 'email address
SGIc� 01A 0t'/� �l'�ia- 3/3.t'
City/Town:State,ZIP Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes ..........P No ...........❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
V 1,as Owner of the subject property,hereby authorize rom7 L, C 51vvc,�iut�
to act on my behalf, in all matters relative to work authorized by this building permit application.
\r.50/7 /�D�raO✓1 t"G� .j—ZY—/(o
Print Owners Name(Electro is Signature) Dale
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
%in inf�Y C >ou lterly 3 - 2y -/�
Print Own re s or Authorized Agent's Nam (Electronic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
e
231'
17" 37" 29;" " 48" 29a"' - 37:" 24"—
21" 2's" 11 k3 323-"�6;"
i�
N
N
�e � � �WC345 ODRH4842 WC34� n
N USSF342542L W2742 W2742 LCW2d42R
in
M
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e
M
1U
M
M N BC3 EB33-FH fDB33_ RANGE.PR0.48 _DB33_ B30-FH BC3
177" 3412" 34-a' 47 34�"�34' 23"
118,"
All dimensions size designations �SPOTLIGHT This is an original design and must Designed:3/5/2016
given are, to verification on ' not be released or copied unless Printed:3/6/2016
job site and adjustment to fit job KITCHEN 8 BATH applicable fee has been paid or job
conditions. 86sbrawsburyst. order placed.
womestor,ma 01604
(508)353-6112
MohagheghKichenPival Ell\1 Drawing#: 1 No Scale.
146'
24„ O-T- 42" _. SOa 15-,-,,.
rn to
M M
CW2442R W942L WIEUSSF342
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BC3US:B9L-FH
N �30-FH PBOFFUS1F330
24" 1� -4 —32a"--J-32;"
All dimensions size designations
TL�NT This is an original design and must Designed:3/5/2016
--given are subject to verification on not be released or copied unless Printed:3/6/2016
job site and adjustment to fit job KITCHEN&BATH applicable fee has been paid orjob
conditions. 86 shrewsbury sl. order placed.
wwceslet,M 0160C
(508)353-6112
MohagheghKichenFinal 1111 1\2 1 Drawing#: 1 No Scale.
115;"
1 3 15" 81 a" 15"1
16:" 27- 27a" 27; 16i"
rn rn
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U QTRRNDVAL36
343" _ 36' 342
z
All dimensions size designations SPOTLIGHT This is an original design and most Designed:3/5/2016
given are subject to verification on �— -- - not be released or copied unless printed:3/6/2016
job site and adjustment to fitjob KITCHEN 8 BATH applicable fee has been paid orjob
conditions. 86 shrewsbury st. order placed.
wawstu ms8/684
(508)353-6112
MohagheghKicbenFinal El 1\3 Drawing#: 1 I No Scale.
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