35 FLINT ST - #110 BP 12-617 i a
The Commonwealth of M 1setts
Board of Building Regulationsand Standards CITY OF
I�,I MassaohusF#tsRateBuildingCode, 780CMR SALEM
I ReAsed 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 Nun bi 1er: Applied:
-f4t)A'AS / �/- J
Building Official(Print Nam) 9 D >,«
SECTION 1: SITE INFORM ATI O
1.1 Property Address:
1.2 Assessors Map&Parcel Numbers
3S FLruT ST. UN/T //O (P[" "cowOor
1.1a 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 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
CAU2iE_ �6/r fcHGv/LE� SAL�/n� mA. 0070
Name;(Priat) - City,State,Z[P
-?.S F4 Mee olviT //O 0 3-�(90-SS02 LAG zs-r. @
G GOrn cAsT. rvLT
No.and Street Telephone Email Address
`'SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply)
New Construction❑ -Existing Building Owner-Occupied ❑ I Repairs(s) O Alteration(s Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of UnitS__J_ Other ❑ Specify:
Brief Description of Proposed Work2: tTGNE NET A 14 c1 E /aeenr�
Rem oy, .rm. N0A/-LMD 62r )0ART/TwN, + B Yi(A NTr✓ I- --I I t// n Pup�DYY PQN/Nf �4
eTkt• Top- AD.O A C6rL,NG ( /GNTS i Re-wurek FLfeT, oI![F7f"AS /LEC -
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
1.Building $ i 1. 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. : ,• $ r O 2. Othei Fees: $ hh J(
4",Mechanical4(HVAC) $ . — List: ( U�
5.Mechanical (Fire $ _
Suppression) (7 . Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project cost: $ 2� ❑Paid in Full ❑Outstanding Balance Due:
5 {
_4
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) m 311 11 —30-gD 13
PA U L. J , 'E�O AJ License Number Espimtion Date
Name of CSL Holder
( Q) Te- n l vF-P- RID
I List CSL Type(see below) (�
No.and Street rC. 1 ` Type Description
mE2121rv,A e_ 7 mA • 01%o U Unrestricted 2Fami(Buildings up Dwellto ing
cu.tt.)
R Restricted 1&2 Family Dwellin
City/Town,State.ZIP M Mason
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
R1VER.V�I�QC �-Co7"�a 51.AUCT I Insulation
Telephone mad address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 2 '
j21VEli V/LLACrt-CA P.P>;.nJfERS INC • HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
lo�n/ ILE RD Rrv�eu1((ovtg� comcaa`�'-Nei
No.aml SUeet Email address
ir,t:✓zt2 I Y2 Ate., MA, OI R6o 978-.3y6-t'M7
CA,frown.State.Z Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(PA.G.L.c. 151 § 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 PA U L S. LL o n/x--
to act on my behalf,in all matters relative to Work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
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.
PAUL S , 1_�on/� (�� s
Print Owner's or Authorized Agent's Name(Electronic Si nature) Date
NOTES:
1. 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. I42A.Other important information on the HIC Program can be found at
wnvw.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos
2. When substantial work is planned,provide the infannation below:
Total floor area(sq.ft.) (including garage,finished basementfattics,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" r Z I Sfl
v
SECIION5: CONSFRUMONSF.RVICES
5.1 CaD,dructtonSupewl.wrUttnX(CSL) na.4 3 ! � !l-30-aol3
i�AV L— J F.agoaboa Dale
No.,,fC:SL Ho40.
10 P,I VFIZ Lim eSr.Type lore bchn\) t/
No.and a ct ��--- are Doenplion
YT')A_c�l aCx�_ a Uialdand(HmUai Nlza)dca.R)
crc�na\.n.stain.zlr R Rc dWlA r ab,Undlioa
M Mac
RC Rmo6ne Coting
W5 Windoaeand Sidi
/I SF S.did Fuel B.,Appliam
' Gzz (�lvERVI Igr_�, rain ee zt•f•M�' 1 lnalolion
T.kph. mad mWrccs D matoliton
CS Registered Home lmpro% went ConMetue(HIC)
RIV£RVIt LA/. G P.P NT 5 INc �0��<`
H7('.Caan Nmue or RIC Reaimmm Nome —_ _ - -. WC Raeianafi�w Nnmhe� Cslnmuon Dak
va\.
io y=� Rh R:vtr v:Iioc-f-L0cdaddre. -/,)=I__
No and Saccl Rmail adrcxa
%f1Ft2P.. 1 mA— ma. OIA6n
mt
Cnv/1'.....Se,ZIp Telc me
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFEDAVIT(MG.L c 151§25C(6N7
Workers Compmumtiim Inmlmmc al7idaait mast he mmM'sed and mthmiacrl\rilh Ihis appli Ilion. Failure to procidc
Ihis nl7idavil\rill reavll in Ere dmdal of the L�wtme uClhe IaJditrl permit.
Signed Affidavit Attached? Yes......... No...........❑
SECTION 7o:OWNER AUTEOP17ATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLI ES FOR BU ILDING PERMIT
1,as Chwer of Ute auF,icct pmperh.hereto'autMarae PA UL
to act on all Ichtlf,at aE amHets telatice to,mk aWho[aeA b this h d' pwwit application.
C141Ji /7-�a
Ponff.e' N e(Elammie Siprm Dale
SECTION nu OWNER'OR AUTHORIZED AGENT DECLARATION
11,entering my name bek v.l heeebv lest rmderthe poem and penalties of pages,then all'Aft iufimnation
-named in this application is hue and aamate W the h v ofmr knmledge and mmlemmMik,
Print Owner•r mAulhorized Agevt'a Nome(Elocmmic Sigswure) D:ne
NOTES:
1. Anlhttlel'\\inl nFlainselmihlnlgpell11itlodoluwbefn\\n a...Or811 pRThY P'h(I IY23 anwnCgwtvred VnlraC r
(end regi.l ovd in tltc Hmme Im(xnvement Cmnmctoe(HIC)1'rouam»,,ill no,have accat m the alhitmtiou
pmgmm th guaranty fuW under M01.,142A.Vtba impmanat mRmuati.. nu the I DC Program usn he timndot
n3 mass covfoca Iafomation\m the Coos ,ti m Superviar Liam¢cwl he fimnd at m\xmass ernddM
3 Whrn mhmanlial\mrk iv plamai,ptovnk the intinmalion F�ela\v:
Toml lhwramllsq.tT.) IhNhrdmg gamil,blvroo couaad/allitt decks orinnxh)
Umay IivF;g area(sy.IT.) Habitable ra\m anent
Nwubu of Iilepla,es Ntunberofbedrooms
Number of hadowa s Nutute. lu-df%valta
T'vpeofhrdingsymem Nwnher of drakd po beer
.Type ol'anding""I. EndnsN Ory-n
3. "Total Project S ume Foo aJ 1
J 9 rage"maybe substituted for"Total Ptojed Coss" f Z $'O
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interpretation of the general appearance or Printed: 12/12/201.1
the design. It is not meant to be an exact --!
!rendition.
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--w1 RIVER11 OP ID:CA
'°�:�D' CERTIFICATE OF LIABILITY INSURANCE DATE 0115M2
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 Wan 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).
PRODUCER 978-46234 CONTACT NAME:
Chase&Lunt LLC 978 485$204 PHO NE No:
P O Box 600
47 State Street ADDRESS:
Newbur MA 01060
Marcos W Shaner INSUREMS)AFFORDING COVERAGE MAK:s
INSURER A:Northland Insurance Companies
INSURED River Village Carpenters Inc. INSURER e:
Cheryl Leone
108 River Rd. NsvRER c:
Merrimac,MA 01860 INSURERD:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS 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.OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE -INSq INVID POLICY NUMBER (MMRvYYYY) (MM'DONYYY) UMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,8OOA6D
A X COMMERCIAL GE4ERAL UABILITY 1f2664 B6I02111 08A]J12 PREMISESTO
ao:urranoe $ 50,000
CLAIMS-MADE FX�OCCUR MED EXP(Any one Person) S 5,000
PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000
X POLICY PP LOC S
AUTOMOBILE LUIBILRY COM TIED LE LIMIT
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY 0Nw awbem) $
AUTOS AUTOS
HIRED AUTOS A OAWNED P raE TYDAMAGE $
UMBRELLA LMB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE - AGGREGATE $
DED RETENTION$ S
WORKERS COMPENSATION WC STATU- TH.
ANDEMPLOYHtSLWBNJTY YIN TORY LIMITS ER
ANY PROPRIETORIPARTNERIEIlECUTIVE NIA EL EACH ACCIDENT $
RI OFRCEMEMBEREXCLUDEDT
(Mandatory In NH) EL DISEASE-EA EMPLOY S
11 you desalbe under
DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMB $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,AddNbnal Remains Schedule,N mole space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Paul Connell ACCORDANCE WITH THE POLICY PROVISIONS.
25 Keyes Road
Westford, MA 01886 AUTHOR®REPRESENTATIVE
i
01988-2010 ACORD CORPORATION. All rights reserved.
RightFax N1-2 2/28/2011 6 : 21 : 33 AM PAGE 2/002 Fax Server
ACORD. CERTIFICATE OF LIABILITY INSURANCE 02/28/2011 . .
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. 11 SUBROGATION IS WAIVED,subject to the -
terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not center rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
PHONE FAX
CHASE&LUNT LLC - (A/C,No,EA): FAX
.. . (A/C,No):
P O BOX 590 E-MAIL
ADDRESS:
PRODUCER
NEWBURYPORT,MA 01950 CUSTOMER ID p:
722MF INSURER(S) AFFORDING COVERAGE NAIC#
INSURED INSURER A: TRAVELERS INDEMINTTY CONMANY
INSURER B: -
RIVER VILLAGE CARPENTERS INC INSURERC: s
INSURER D:
108 RIVER ROAD INSURER E:
MERRIMAC,MA 01860 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS 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 SUBJECTTO ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADDLSUSR POLICY EFF DATE POLICY EXP DATE
TYPE OF INSURANCE POLICY NUMBER (MMDD\YYYY) (MMOD\YYYY) LIMITS
LTR INSR WVO
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY
DAMAGFT TO RENTED $
CLAIMS MADE OCCUR. - PREMISES(Ea occurrence)
MED EXP(Any one person) $
PERSONAL RR ADV INJURY $
GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY PROJECT LOG PRODUCTS COMP/OPAGG $
AUTOMOBILE LIABILITY COMBINED SINGLE $
ANY AUTO LIMIT(Ea accident)
ALL OWNED AUTOS BODILY INJURY $
SCHEDULE AUTOS (Per person)
HIRED AUTOS BODILY INJURY $
(Per accident)
NON OWNED AUTOS PROPERTY DAMAGE $
(Per accident)
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
$ $
WC STATUTORY LIMITS OTHER
WORKER'S COMPENSATION AND
EMPLOYERS LIABILITY WIN UB-008BN296-11 01/31/2011 01/31/2012 E. L. EACH ACCIDENT $ 500,000
ERITOR/PARTNER/EXECLRIVE Y E.L. DISEASE EA EMPLOYEE $ 500,000
OFFICEPUMEMBER EXCL
(ManCmoryln NHi E.L. DISEASE-POLICY LIMIT $ 500,000
11 yea,descllba under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE.
CERTIFICATE HOLDER CANCELLATION
ADVANTAGE PROPERTY MANAGEMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE
77 MAIN STREET WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
AMESBURY,MA 01913 Charles 7 Clark
ACORD 25(2009109) 1988-2009 ACORD CORPORATION. All rights reserved.
Massachusetts-Department of Public Safety -
Board of Building Regulations and Standards
` Construction Supen isor
License:CS-029311 .i. .,
PAUL S LEONe' w, _qz�
108 RIVER RD
MERRIMAFMAUUIB�w' :n
Y
Expiration
Canmissioner 11/30/2013
Office ofer ARairs&&llli(siness Regulation License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration .102735 Type: tE Office of Consumer Affairs and Business Regulation I
Expiration 7/2I2012 Private Corporaticn 10 Park Plaza-Suite 5170 `1
Boston,MA 02116
WRIVIILAGE CARPENTERS ,n
Paul Leone _
108 River R6zd' ' ��s�®+e__
Merrimac,MA 01860--, Undersecretary Not[valid without signature 1
From Markwood Management to 9787409846 at 1/26/2012 11:15 AM 002/002
Markwood
Management
Incorporated
26 January 2012
Inspectional Services
City of Salem
120 Washington St
Salem, MA 01970
FAX:978-740-9846
RE: Bowditch Place Condominium Trust
35 Flint Street Unit 110
Salem MA 01970
River Village Construction is hereby authorized to do kitchen remodeling in Unit 110 of the Bowditch
Place Condominium at 35 Flint Street,Salem, MA.
Mark W. Livermore
Markwood Management Incorporated
Post Office Box900 Marblehead, Massachusetts 01945
Telephone(781) 639-4080'Facsimile (781) 639-0228
markwoodmgt@hotmail.com
I I
From Markwood Management to 9787409846 at 1/26/2012 11:15 AM 001/002
TRANSMISSION FROM Markwood Management
TO Inspectional Services
City of Salem
PO Box 900
01945 Marblehead Page(s) 2
MA
12 / 112612012 11:15 AM
NI-Message