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41 FLINT ST - BUILDING INSPECTION Tom" LI _l 2_0 `-- 1 c)S0a The Commonwealth of Massachusetts ° Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct, Repair,Renovate Or Demolish a One-or Two-Family Dwelling = This Section For Official Use Only © o Building Permit Number: Date lied: n 1 /�.-,,.ram �i��fGrH✓,o?� t��i' Building Official(Print Name) Signature 9&e t—rn SECTION 1:SITE INFORMATION 1.1 Property Address: P tY 1.2 Assessors Map&Parcel Numbers L l a Is this an accepted street?yeses no Map Number Parcel Number 1L_y�1 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 Required Provided Req mud 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: r�,a e'1 �s Si M J s o N S/at�inn M A d l 9 o Name(Print) City,State,ZIP - If/ FL11VT 57- No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORIO(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other 16 Specify: Brief Description of Proposed Work': 4f6^A C_ 1 i 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: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ 117 � Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ _, 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Cs O 9/6 y 3 �a1.O J�-- 65 PAT/2 id< I- 0560,0D License Number Expiration Date Name of CSL Holder Po /3,aX 1 1 1 1 List CSL Type(see below) U No.and Street Type Description Mtd/tBJlIEA/� /H!a D �Rys U Unrestricted Build n s u to 35,000 cu. ft. City/Town,State,ZIP R Restricted 1&2 Famil Dwellin _ M Maso RC Roofm Coverin WS Window and Siding It ` Lk.TI"r GN(y SF Solid Fuel Burning Appliances ?4b A(fQ I0p7 0Sym off,"into ci i�Go I Insulation Telephone ( / Email address D I Demolition 5.22.Registered Home Improvement Contractor(HIC) 13 t/'d'a D I o /2: 1S r RA I KICK d 56Go17 HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name q ip CK OStSoo CO 4113,4.4 les co M Ng�and tree[ Email address o lao MA 01QQ� 99a' ��p. /a�7 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 74: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize PA iX I(OK 0 SS oc9 6 to act on t y behalf ' matters the to wor uthorized by this building permit application. Print Owner's Name(ElectronicSignature) fate SECTI 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering m name belo ,I hereby attest under the pains and penalties of perjury that all of the information contai is appl' ati is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) 7 d 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. 142A.Other important information on the HIC Program can be found at wwnv.mass.eov/oca Information on the Construction Supervisor License can be found at www.ntasssov/dos 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" ACORD CERTIFICATE OF LIABILITY INSURANCE OAT/05/2014 12/ 5/2014 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 NAICN INSURED INSURER A ESSEX INSURANCE COMPANY Osgood Painting LLC INSuRE2E .A.M_7,M 7UAL INS. CO. P.O. Box 1111 INSURER C: INSURER 0' Marblehead MA 01945- INSURERS COVERAGES THE POLICIES OF INSURANCE LI$TED 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 CERTIRCATE 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADVL TYPE OF INSURANCE POLICY NUMBER PM EYMMIDDM'1 DATE MIND TION LIMITS LTR NSRO A GENERAL LIABILITY 3D00017 04/11/2014 04/11/2015 EACH OCCURRENCE S 1000000 X COMM6KIAL GENERAL LIABILITY PREMISE,Mce�na $ CLAIMSMAOE O OCCUR / / / / MEDEXP(An owpemm) S PERSONAL&ADV IN S 100DO06 / / / / GENERAL AGGREGATE S 2000000 OEN'L AGGREGATE ppLRRW��IT APPLIES PER+ PRODUCTS COMPIOPAGG S 2000000 POUCV JECf F7 LOC / / / / MO1NU AUTOMOBILE LIABILITY / / / / COMBINED SINGLE UMR S ANY AVTO (EA ycrvdelAl ALL OVUJED AUTOS / / / / BODILY INJURY S SCHEDULED AUTOS (Par IHveml HIRED AUTOS / / / / BODILY INJURY (Pa s¢eerAl S NONONNED AUTD9 PROPERTY DAMAGE (Per eRNBn(1 E OAMOE LIABILITY AUTOONLY.EAACCMENT S ANYAUTO / / / / OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESSNMBR LLA LIABILITY / / / / EACH OCCURRENCE S OCCUR CLAIMSMADE AGOREGATE S s DEDUCTIBLE / / / / S RETENTION S S $ WORKERS COMPENSATION AND vwC-300-SOS& 09/15/2014 05/15/2015 X TORYL VICSTAVT% ER EMPLOYERS LIABILITY ANY MOPRIETOR/PARTNEWEXECUTIVE E,L EACH ACCIDENT S 100000 III OFFICERMIEMSER EXCLUDEM / / / / E.L.DISEASE-EA EMPLOYEE S 3,00000 IT Tea,deea,Iee Wdel SOODOO SPECIAL PROVISIONS tebw E.L.DISEASE-POLICY LIMIT 6 OTHER DESCRIPTION OF OPMATIONWLOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION of ) 71/0 - VG 3 , ( ) - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE FXPIRATHJN DATE THEREOF, THE ISSUINO INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE ROL MED TO THE LEFT,BUT City OP Salem FAILURE TO Do SO SHALL IMPOSE NO O P LIPS ITY OF ANY KIND UPON THE 1323 Washington St INSURER.ITS AGENTS OR REPRE ATN Salem, MA 01970 AUTHORIZED REPRESENTATIVE 1 I ACORD 25(20011081 Qf ACCIPMORPORATION 198! INC1gA Imwl ru 1 Page I of QTY OF SALEM, MASSACHUSEM BUILDING DEPARTMENT 120WASHNGTON STREET,31DFLOOR TEL. (978) 745-9595 F KIMBERLEY DRISCOLL FAX(978) 740-9846 MAYOR THOMAS STTIERRE DIREcroR OF PUBLIC PROPERTY/BUILDING COMMISSIONER 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 111.5 Debris, and the provisions of MGL c40, S 54; Building Permit # is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste deposit facility as defined by MGL c 111, S 150A. The debris will be transported by: 41 (name of hauler) The debris will be disposed of in: W-Vd 6,F AP5AL (name of facility) (address of facility) r' ,� Signature of appl ca lo r2/ 3 / t Date Massachusetts -Department of Public Safety Board of Building Regulations and Standards COnrtrUction Supervisor _ License: CS-091645 J I l " PATRICK M OSG¢O PO BOX 1111 't MA"LEHEAD MA . Expiration Commissioner 05/28/2015 Office of Consumer Affairs and Business Regulation 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 134220 Type: DBA Expiration: 10/12/2015 Tr# 245802 OSGOOD PAINTING SERVICES PATRICK OSGOOD - -- - -- - - - PO BOX 1111 ---...------ -- - ------- .. MARBLEHEAD, MA 01945 -----------------_-_.-_-___—_._._ Update Address and return card. Mark reason for change. SCA 1 6 20M-0Wl1 [] Ad ress Renewal n Employment ❑ Lost Card IL (YTr *•avun..... vr�ll r�P/dr2ruzlucluee/(- - Office of Consumer Affairs&Business Regulation License or registration val for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. f found return to: istration: 134220 Type: Office,of Consumer Affairs nd Business Regulation Expiration: 10/12/2015 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 OSGOOD PAINTING SERVICES PATRICK OSGOOD 44 FOX RUN RD. a� TOPSFIELD,MA 01983 ----._---.- --- ---- —._....---------- - Undersecretary o alid ut signat re - r , r ��_- �;: I'��," �,��,/ 1 \ / �` � I/ ///I � �/� . 1 `�f` '�i.4 / ��. (,�,, , , �� ' \ \ 1 o � , ,; ,:. - J'� . / �. � 1 1 1 �` ,J� : � / A ; Y��% 4�,�� '�'1 �a 4 ��A\ l /..7YL�1`P� : C:`��l ., �i t�.. �� ....,, � � ��J ' ;�� `\\� \`' ' � �\ j , �� '�� :... •v:: ... .' �. � � �. CITY OF SALEM. %L-kss:ICHL;SETTS �i D(:ILDINIG DEPARTMEINT 3 4 4,i 120 WASH TREETLNGTON S 3'a FLOOR ICI- -- - —• ; �)a _ TM 978 745-9595 F.Lc(978) 740-9846 ICI\I13ERLEY DR)SCOLI. c-�LAYOR 'MOAUS ST.PIF-RRB DIRECTOR OF PLOLIC PROPERTY/BUM-Dr\G CO\l\IISSfONER Workers' Compensation Insurance Affidavit: builders/Contractors/Electricians/PluIn hers Applicant Information q Q �/ Please Print Le ibl V llln L' InminesOrg.vsiominn.'I mlividual): 056ew /0A/N:/AIL; Address: to B oX ///// City/State/Zip:-- hone !f: Are yny.on employer:'Check the appropriate boa: ]M ,L Type of project(required): I. l am a employer with_.�_ 4. �] I am a general ctor and I ctnployees(full and/or pan-time).• have hired the ntractors 6' ❑New constnlction 2.❑ i ant a sole proprietor or partner- listed on the att shcct. I 7• ❑Remodeling ,hip and have no employees These sub-conts have 8. Cl Demolition working formic in any capacity. work.,'comp. nce. 9. Building addition [No workcn'comp. insurance 5. 0 We are a corpoand its required.] officers have exd their 10.0 Electrical repairs or additions J.❑ 1 am a homeowner doing all work right of exempti MGL 11.0 Plumbing repuirs or additions myself, (No workers' cutup. c. 152, §1(4),anhave no 12.0 Roofrepairs insurancerequired.] t employees. (Nor' 15T camp. insurancered,f IIETOther LA Any applivvn Ilw chucks but 01 mull its,fill ,,1 Ih¢...lion bcluw,hawing their workcn'cumpenaaliun policy inlnnnaliun. I Inmmlwn n.rho submit Ihit atntlnvit indicating ihcy are doing all work and Ihcn hire uuuida commcton mlul auhmit a new altldavil indiaatine such f•.ou. 'lens,It al chuck Ibis bull must anache l an adduiuwl:hul ahnwiny the n:une of the aubtamncbn and their worker'sump.pulley information. f ant on employer that is provid!s rK Ivorkers'compensation insurance jor my employees. lleloly is the policy and Job site irtJirrnrulinn• N rAl M t/i t/A L e f4.S t1J,4,,/eF Insurance Company Name: Policy q or Self-inn. Lic. n: t't^'C 'rOV— b O f p Expiration Date:.Oy/rSIZ Old fob Site Address: 4L A—le r 5rjjF,_,f - City/State/Zip: S D /y JD Attach a copy of the t.urfacn'compensation policy declaratloa page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A f\IGL c. 152 can lead to the imposition oferintinal penaltica ofa line up to S 1,500.00 and/or one-year imprisonment,as we I as civil penalties in the form of a STOP WORK ORDER and aline of up to S250.00 a day against the viul.tror. Ile advised lh t a copy of this sratcment may be funvardcd to the 011icc of IIIYI"�IIgaIIt111i UI tic for if iuranee coverage vcritical on. l do hereby cer i uu •e t puins a enables of peri ry that the hifurmatlon provided ubuve iv/Thor u d c•orrra•t / O//iciu!use unfy. Da nag sire iu Ibis area, to be completed by city ur town oJJicial City nr Town: Permit/l.lccntc 4 Issuing Autllurity (circle one): -- -- - -- I 1. Board ul'HeAll 2. Iluilding I)cllartutent 1,('ity!(nnu f_'lcrk J. Flectrical hl.pccrur 5, flnmbiug Impector 1 b. Uther Contact Pe rtnn: - o Salem Historical Commission 120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970 (978)619-5685 FAX(978)740-0404 CERTIFICATE OF NON-APPLICABILITY It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving [71 Reconstruction ❑ Alteration ❑ Demolition ❑ Painting ❑ Signage ❑ 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: 41 Flint Street Name of Record Owner: Mary Simpson & Wayne Sousa Description of Work Proposed: Rebuild porch on second floor level that sits on Pfloor roofporch. Porch was removed to facilitate emergency roof repairs. Porch will be rebuilt as per original 1985 SHC approve and as shown in application. Dated: December 15, 2014 SALEM HISTORICAL COMMISSION 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.