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003D FLETCHER WAY - BUILDING INSPECTION
CKILI74 The Commonwealth of MassachuKtUtl setts If�$PECTIOHAL S RVIGEiSY OF Board of Building Regulations and Standar s SALEM �It Massachusetts State Building Code, 730 CMtRe't,yMy WAR v SSd LMarEN/2011 Building Permit Application To Construct, Repair, Renovar!R D2thAR aA D One- or Two-Family Divelling 1 This Section For Official Qse Only ,. y..� Building Permit Number* - bate::ppliedr 17 Building Official(Print Name) Tignature - Date SECTION I:SITE INFORMATION 1.1 Pro Sr.` ress: 1.2 Assessors Map&Parcel Numbers "Y'� 1'lefa-cher' 11dc�,'ri 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 fu Frontage(11) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: LS Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑ Check if yes[] SECTION 2: PROPERTY OWNERSHIP' 2.1 Ownert of Record: k KL"-L10'J Cbc VlfUV1 Q 1 019(70 Mm`eint) City,State,ZIP 1 a 3d �el�lwr�tk�.l ��PIl7 l09✓1 9b9L Vd C*JIraV. jJ On. (mq'i , CID No.mid Street I Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction❑ Existing Building H" Owner-Occupied Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work'-: ew. o - C 2 err U SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) I. Building $ Of✓O I. Building Permit Fee:$ Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier - x 3. Plumbing $ 2. Other Fees: S 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ —pa 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction SupervisorLicense(CSL) GC rd�,Yfl (( -,w —Zof� VO W� -JeSut� License Number Expiration Date Name of CSL-Holder r 1w+11 E1115 List CSL Type(see below) n,c-, No. and Street e `Description t� (Buildings Family U Unrestricted B a s u 35,000 cu. ft.) R Restricted I&2 amil Dwelling Cityfrown,State,ZIP M Masonry RC Rooting Covering WS Window and Siding _ Gm IS <.-Il�'JS}lUck SF Solid Fuel Burning Appliances puf-o C2 Cg 6wrt 1 Insulation Telephone Email address D Demolition 5.2 Registered home Improvement Contractor(HIC) i GC -s&u try C:5,-J5J C 0 HIIC Registration Number E,pira ion Dule HIC Company Nvne or f IC Registrant Name /y Gnr�J �✓�, No. and Street Email address L- /J,. Of_So Z / 5�S� So6a Cit /T wn, State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 25C(6))- Workers Compensation Insurance affidavit must be compisled and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance a building permit. Signed Affidavit Attached? Yes .......... No...........❑ SECTION 7a:.OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR B-UfILDING PERMIT:' 1,as Owner of the subject property,hereby authorizee,J C- c�'� t9 act on my behalf,in all matters relative to work authorized by this building permit application. rint 0 vner's Nvne(Electronic Signature) Ddte SECTION 7b:OWNEW 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. Print Owners or Authorized Agent's Name(Electronic Signature) Due r 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(FIIC) Program), will not have access to the arbitration program or guaranty fund under M.G.L.c. I42A. Other important information on the FIIC Program can be found at www.mass.g,ov^oca Information on the Construction Supervisor License can be found at www.mass.,,ov/dps �. 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 coma 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" ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 11/04/2014 PRODUCER (978) 745-6464 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rose Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 66 Loring Avenue - ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 958 Salem MA 01970- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:ESSEX INSURANCE COMPANY Serven, John X.dba Boston Porch INSURERBGuard Insurance 387 Atlantic Avenue INSURER C INSURER D: Marblehead MA 01945- INSURER E: COVERAGES 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADUL POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE MMIDDrM DATE(MMX)NYIT LIMITS A GENERAL LIABILITY 3DU5402 05/19/2014 05/19/2015 EACH OCCURRENCE $ 1000000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100000 PREMISES Ea incurrence $ CLAIMS MADE F—IOCCUR / / / / MED EXP(My ore .) $ 5000 PERSONAL B ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2000000 POUCV JECOT LOC AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS / / / / BODILY INJURY SCHEDULED AUTOS (Pef pensen) $ HIRED AUTOS / / / / BODILY INJURY NON-OWNED AUTOS (Peraccidenq $ PROPERTY DAMAGE (Per axidenq $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / I I / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSRUMBRELLA LIABILITY - / / / / EACH OCCURRENCE $ OCCURCLAIMS MADE AGGREGATE $ $ DEDUCTIBLE / / / / $ RETENTION $ $ B WORKERS COMPENSATION AND JOWC561905 09/30/2014 09/30/2015 X VJC STATU- ETR H- EMPLOYERS'LIABILITY TORY LIMITS E ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? / / / / EL.DISEASE-EA EMPLOYE $ 100000 It yes,des rite under SPECIALPROVISIONSbr, w EL.DISEASE-POUCY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONSILOCATIONS ICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECWL WOMS1014S CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT Matthew Cochrane FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 3 Fletcher Way 32AD INSURER,IT TS OR REPRESENTATIVES. Salem, MA 01970 AUTHORIZED NTATNE ( /W ,, ACORD 26(2001/08) ©ACORD CORPORATION 1988 INS026(wCaTGS Peg.I e2 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-074086 J01 NKSERVEPI-` 14 GRIFFIN TER$ # LYNN MA 0190E r Expiration Commissioner 111 2016 a/b/�ttoaar/ga'etta i Ofrice of consumer Affairs&Business-Regulatio6 kjE OME IMPROVEMENT CONTRACTORType:egistrabon69560.xpiration W7j2015' DBA t J.SERVEN AND SON p , JOHN SERVEN j 14 GRIFFIN TERR. % ----6� LYNN,MA 01902 Undersecretary i CITY OF SALEM, T%LiSSACHUSETI•S BUMI)INIG DEPARMEDiT } `- Y • 120 %V.iSHINGTON STREET, 3'a FtOOR TEL (978) 745-9595 FAx(978) 740-9846 KINtgFRi EY DRISC011 MAYORTHOMAS ST.PTERRs DIRECTOR OF PUBLIC PROPERTY/BUMDL1NIG CONMISSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electriefans/Plumbers Anplicant Information Please PrintLegibly xy NaIT1C(BusityOrpniiatiomindividual): (�C> Address: c3�S �a>`l�ot_ e9 e _ City/Stato/Zip: Phone lt: ��' �f — �e) Are y n employer?Check the appropriate box: Type of project(requiredk LCTI am a employer with 4. ❑ I am a general contractor and I —�---- have hired the sub-contractors fi. ❑New construction employees(fultand/orpon-time). 2.❑ I ran a sole proprietor or partner- listed on the attached sheet,t 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working r , for me in any capacity. worke 'comp.insurance. 9. Building addition [No worker'comp.insurance 5.'❑ We area corporation and its. required.) officers have exercised their 10.0 Electrical repairs or additions J.❑ I am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions myself. [No worker'comp, c. 152,§1(41.and we have no 12.0 Roof repairs insurance required.)t employees.[No worlem'; comp:insurance required.]. 13.❑Other Any appllaum that chocks box MI must alto fill out xctim beloer showing their workers'compensation polity infunnadon t I bvnuowncn who submit this affidavit indicating they am doing all work and then him outside contmcton matt submit a new amdavil indicating such. :C,mtractors that check this box mutt aaachod an additional,heel showing the cents of this submoniraeton and their workers"comp.put Icy information. fain an-employer that is providing workers'compensation lnsurancerfor my employees- Below/s deep pollty and job site fofornrafiotr. insurance Company Name:. t—55E:� u1 Policy B or Snif-ins. Lie. U S Y0--1-- Expiration Date:/ -0 r Sr Job Site Address: 35] r City/State/Zip: e ice,( . �tS0 2-- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of 4fGL c. 152 can lead to the imposition of criminal penalties of a tine up to SI,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of up to$250.00 a day against the violator. ❑e advised that a copy of this statement may be rorwnrcicd to the Off ice of Investigutiuns of the DIA far insurance covcraga verification. /do Iter y ce;1lez rat to pains and t nary that file in/armaflon provided above is true and correct. sl; - But • t •Zo I I,bg at: (-5t4 _ %0000 OJfria/as nly. Do not write in this area,to be completed by city or Iowa oJJlclal. Cityar'rown: _ Permi11f.1eense# _ Issuing Authority(circlo one): 1. Board of health 2. Building Department 3.Cityffown Clerk 4, Electrical Inspector 5. Plumbing Inspector 6. Other_ Contact Person: . Phoned I CITY OF SALEIi, XWSACHUSETTS ' Bummu4G DEPkR—nMNT 130 WASHINGTON STREET, 3" FLOOR T EL (978) 745-9595 FA.Y(978) 740-9846 KlNiB Ri FY DRISCOLL MAYOR THO1f.►S ST.PIERRE DIRECTOR OF PGBLIC PROPERTY/BCtmD4r,COJL\QSSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section It 1.5 Debris, and the provisions of MGL c 40, S 54; Building Permit At is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: (name of hauler) The debris will be disposed of in JLvi d P Cry r - (name of facility) .;r address of facility) plicant �r ate kbiis�lf dux NOV-10-2014 13:38 FROM: TO: 19787409846 P. 1/1 American Properties Team, Inc. TO: 3D Fletcher Way FROM: Jennifer Pappas, Property Manager RE: Deck Replacement DATE: November 10, 2014 w+wwwwwww+++++ww+++ww++wwwwwwr+wwwwwwwwwwww++ww+wwwwwwwwwwwwwwwwwwwww+ww Please be advised that the Board of Trustees for Pickman Park has approved the replacement of the deck at the above referenced unit. This approval is contingent upon it matching the existing deck(composite materials can be used). The Board will not allow any design alterations. We also require that permits be pulled in advance (regardless of what your contractor may tell you),and then a copy of the final approved permit once completed must be sent to APT for the unit File as well, You will need to bring a copy of this letter to the Salem Building Department in order to receive your permit. Should you have any questions or require additional information, please feel free to call the APT Service Team at (781)932-9229. cc: Unit File 500 WEST CUMMINGS PARK-SUITE 5050- WOBURN .MA •01801-781.93Z9229 -FAX 781-935,4289 t