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22 CABOT STREET - BUILDING JACKET ^-zz CABOT sIREF nn No. 153L-2 HASTINGS. MN 'LOS ANGELES-CHICAGO-LOGAN.ON MCGREGOR.TX-LOCUST GROVE.GA U.S.A. CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT fis 120 WASHINGTON STREET, 3'D FLOOR TEL: 978-745-9595 FAx: 978-740-9846 KIMBERLEY DRISCOLL MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTIES/BUILDING COMMISSIONER Cease and Decist — Zoning Violation 22 CABOT STREET June 14, 2012 Cyril and Summer Baidak 22 Cabot Street Salem, Massachusetts 01970 Mr. and Ms. Baidak An inspection -of the basement of your building was conducted at 22 Cabot Street was conducted after receiving complaints about the number of units at the property. Present at said inspection were Mr. David Greenbaum and Ms. Elizabeth Gagakis of the Salem Health Department and myself representing the Salem Building Department. The basement contained two (2)- separate units.Neither is legal under Salem zoning and neither unit has any record of Building,Electrical, Gas or Plumbing permits and did not have the required smoke and carbon monoxide detectors. Under the authority of The Massachusetts State Building Code, 780 CMR you are directed to cease and desist using the basement spaces. You are further hereby directed to apply for the appropriate permits including Building permits to remove all of the construction in the basement that is unpermitted. Failure to respond to this notification will be construed as non- compliance, with issuance of Municipal tickets and possibly up to a Criminal Complaint in Salem District Court. The Required Inspection shall be conducted by this office on Tuesday, June 26, 2012 at 2:00 p.m.; if you feel aggrieved by the order your appeal is to the Board of Buildings,Regulations and Standards, One Ashburton Place, Boston,Massachusetts. If you have any further questions regarding this letter,please call this office at(978) 619-5648. Michael Lutrzykowski Assistant Building Inspecto cc: file,Jason Silva 7 CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT 120 WASHINGTON STREET,3 FLOOR Br> TEL. (978) 745-9595 FAx(978) 740-9846 KIMBERLEY DRISCOLL MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER September 15, 2008 R.E. 22 Cabot Street Cyril and Summer Baidak 22 Cabot Street Salem Ma. 01970 Dear Owners, An inspection of the basement of your building was conducted today. Present were, Fire Marshall, Lt Griffin,Health agent David Greenbaum ,and Building Commissioner,Tom St.Pierre. The basement contained two separate units. Neither unit is legal under Salem zoning and neither unit has any record of Building, Electrical,Gas or Plumbing permits and did not have required Smoke and Carbon Monoxide detectors. Under the authority of the Mass State Building code 780 C.M.R you are directed to cease and decist using the basement space. You are further directed to pull the appropriate permits including building permits to remove all of the construction in the basement. Failure to comply will result in City Ordinance tickets and possibly a Complaint in Salem District Court.Addittionally; you are directed to contact this office to arrange for an Inspection of the rest of the building within ten days of this notice. If you feel you are aggrieved by this order, you Appeal is to the Board of Buildings ,Regulations and Standards in Boston T as St.Pi e Building Commissioner/Director of Inspectional Services Cc Jason Silva, Lt. Griffin,David Greenbaum,Councilor Veno • SENDER: Complete items 1 and 2 when additional services are desired, and complete items 3 and 4. Put your address in the"RETURN TO'' Space on the reverse side. Failure to do this will prevent this card from being returned to you.The return recei t fee will rovide ou the name of the erM delivered to and the date of delivery. For additional Tees t e ollowrng sery ces are ave ale able. onsult postmaster for fees and check boxles)for additional service(s) requested. 1. ❑ Show to whom delivered, date, and addressee's address. 2. ❑ Restricted Delivery (Extra charge) (Extra charge) 3. Article Addressed to: �� rticle N tuber —W x/ T❑ ❑ Type of Service:: egistered Insured ertified 11 COD /S 7� El Express Mail ❑ Return Receipt d! / far rse 'P,yw•ays obtain signature of addressee �r ant and DATE DELIVERED. 5. Signature — Addressee 61 .1 dressbe's Address (ONLY if x n J- re nested and fee paid) 6. Signature 6 X 7. Date of Del i PS Form 3811, Apr. 1989 +U.S.G.P.o.1989-238-815 DOMESTIC RETURN RECEIPT < E �- S5F4 I II UNITED STA'T'ES POSTAL SERVI ,' f M OFFICIAL BUSINESS .a. SENDER INSTRUCTIONS ~' 9 22R 0� Print your name,address and ZIP Code y� ' �i�„��•'_� in the space below. • Complete Items 1,2.3,and 4 on the reverse. U. • Attach to front of article if space permits. otherwise affix to back of article. PENALTY FOR PRIVATE • Endorse article "Return Receipt USE, $300 Requested” adjacent to number. RETURN Print Sender's name, address, In ZIP Code in the space below. TO LQ,' n �l / >� City of batem, AlaggacbUzettg Public Propertp Blepartment mpg, Auitbing Mepartment One *alem Oreen 745-9595 Cxt. 380 William H. Munroe Director of Public Property Inspector of Buildings Zoning Enforcement Officer April 3, 1991 Mr. Cyril Baidak 8 Ropes Street Salem, MA 01970 RE: 22 Cabot Street Dear Mr. Baidak: On April 2, 1991 this office posted a stop-work order on the above referenced property. You are working on the property without benefit of a building permit. On April 3, 1991 you were in our office, at that time you were in- formed that you had asbestos siding, which you were covering over with vinyl siding. Covering asbestos siding is not allowed and you have to remove it. At that time I gave you all the information you would need to re- move the asbestos siding by law. You have twenty one days from receipt of this letter to obtain a permit and to remove the asbestos siding. Failure to cca ply with this notice will result in this office taking legal action. If you have any questions, please contact me at this office. Sincerely, �ames D. Santo Assistant Building Inspector JDS:eaf cc: City Solicitor David Shea Ward Councillor Citp of *aiem, AaggacbU!5ettg Vublie jropertp Mepartment rG�mg A3uilbing Mepartment One balem Orren 745-9595 Cxt. 380 William H. Munroe Director of Public Property Inspector of Buildings I Zoning Enforcement Officer i ti April 30, 1991 Mr. Cyril Baidak 8 Ropes Street Salem, MA 01970 �-- ARE: , 22 Cabot St. , Salem, MA—, Dear Mr. Baidak, This is in reference to your permit to side the above referenced property. At this time you should reapply for your permit and have your contractor submit a statement indicating what preventative measures will be taken so as not to disturb the asbestos shingles while working on the new siding. We will review the new application and your statement to see if it will be sufficient to issue a permit for the siding. The money you have already submitted for the first permit will be a credit towards the new permit. If I can be of any further help, please contact me at this office. Sincerely, // James Santo Assistant Building Inspector JDS/eaf dc: City Solicitor Ward Councillor Notice of Alleged Safety or Healtr '-lazards U.S. Department Labor //� -- Occupational Safety and Heai.ministration MOD I Date 1. Complaint Number ' 75094102 l2 2.Jm IgeName 08 r eramics 3.21�e�AVS� ,%-Si State. ZIP) Salem MA 01970 a. Maui�l�$rEss�lt d �)(street. City. State ZIP) - Salem MA 01970 5.C1� rtperL icLt r V &Teleip oynt!jnnlf, 3030 z� 0o4"s amic Dinnerware & Hazard Description. Describe briefly the hazard(s)which you believe exist Include the approximate number of employees exposed to or threatened by each hazard: _.1..._...No- venti.la.t.ion..in_.wo.rk_-area---where---cer-amic_kilns-are be-i.ng--used--to- --- make and glaze ceramic dinnerware ( lead fumes) . 1910.1000 .......... - --------------—------------- - ------- - - - 2. No personal protective equipment such as respirators are not. existent. _191.0.132---------- 3. Work area is --------3. Worl_ areais ir!_the s?-me_bjs-ement---l.Q.Cat1Qn--wbp:e_t.he heating units_far the apartment house is located. 5(a) (1) ---------------------- ---- -- 4. No fire extinguishers available. 1910.157 5. Bathroom facilities were not kept in proper sanitary conditions. -1310_141._----- 6--No....di.rect-exat.-f"mbasement--a.rza.—Empl-oyees-haves +�_to-ex_�:"pa flight of stairs to hallway on first floor. 1910.37 9. Hazard Location. Specify the particular building or worksite where the alleged violation exists: B a s e m ent Area nCHG.]Ina. 11PAI ItkGt.1V t'` ,gOh � U KEGIO A 5 C�i J�F� ��� PA 1,1 . ._• Zoogy Ceramics 22 Cabot St . Salem, MA. 01970 Valley Office Park 13 Branch St . Methuen , MA. 01844 Janurary 18 , 1995 Dear Sirs ; In respones to your letter dated Janurary 9 , 1995 we would like to inform you of our current status . We are a sole proprietorship, my husband and I are the only employees on site . We have only independent contractors as employees , and that is around the unusually busy time of christmas . We do use independent contractors more regularly thur the year to go to outdoor craft fairs and art shows , where selling is done direct . Although all products are done in our home studio . The studio has been dully inspected and has the necessary permits issued through the City of Salem. This would include, two means of egress , (one exiting in first floor hallway, second exiting directly from basement to outside) Fire extingishers ( inclosed recent update slip) Bathroom facilities (My own personal bathroom) Masks along with proper ventilation ( In addition no glazes are sprayed , everything is brushed on , also all glazes are 100% non toxic , including lead free) . Enclosed are pictures of our work area along with 1 ) fact sheet stating to customers that the product is leadfree. 2) A recent update slip indcating fire extingishers in good work condition . 3) Labels off of the glazes used stating that they are non toxic . Please feel free to contact me at the number below if I can be of any further assistance. (508) 741 -3030 Sincerely, Summer Baidak ; . About the Artist e Fine artist Summer Baidak is the owner and creative force behind the ceramics company"Zoogy% She has studied at both Massachusetts College of Art and Salem State College,from which she obtained herl ;(3achelor of Fine Arts with a concentration in sculpting. Along with a classroom education,she studied and traveled abroad for several years in England and Mexico. She now devotes her creative energies'toward, her business in making unique,affordable art for the public. Summer prides her busyness on its roach.;. and concentration on custom orders to match'any decor. i i � Summer is most often found enjoying her work in her Salem stu M1i ,dio which is•o en to visits b a mtment There her staff.includes three P Y PPo. a k: - creative consultants;Sake (the German Shepherd),the famous Pup alina^� and,Zoogy the cat,for whom the company-Is named Zoogy of course;=eained this honor from hours of hard work and artist o input .. Zoogy and company thrive onlheir custom order business for which no request is' ". too large or too small.'For adding a creative touch to your home or an artistic,gift fora friend: keep Zoogy in Mind. Y. " Our .goal is to make art thof is fun, affordable and accessable to:all Other ZOOgy. Information ' ' • �i . All of Zoogys work is individually hand worked and hand painted to perfection. No job is � too small or too large, welcome custom orders and also specialize in wedding plates ` Anniversary plates, andd other special events. Please be advised that some of Zoogys designs are more time consuming than others, prices will vary accordingly • All products are food safe and dishwater safe. ` /• Microwavable dishwasher safe Payments ryVe food safe . We accept Master Card, Visa, Personal Checks and always CASH Uo . Custom orders must be pre-paid � . C.O.D only . There will be an extra charge per box on C.O.D orders Terms. • When Placing order please allow six to eight weeks for delivery. , If you are ordering custom work please allow ten to twelve weeks for delivery. • Shipping charges will vary according to piece, note we must take extra care in packing pottery y k ,ZOOgy P.O Box 8853 Salem M.A 01971 508-741-3030 OIV� O� A kAJP SR � . . DELIVERY RECEIPT BOSTON FIRE EXTINGUISHER CO., INC. OSO84 168 COMMERCIAL ST. LYNN, MASS. 01905 Tel. 529-1670 DATE Your n i Order To Address City RECEIVED IN APPARENT GOOD O PACKAGES Soo � ` y- Told Received by P W-49Mrm — u�w ae.o. rt- swruno ronNe ec Nie�n ,e,oeser a. Lear SAFE'FOR FO K GLAZE Doxr x. s ^y S 7RAN PARENT _ Directions:She and sip well. o 111 cone 04 btsque,a smooth coats.Rre to ' cone .Thin with water or Duncan. Shade S needed.Clean brushes wit water. r OVERGLAZE COMPATIBLE ;;n i D 17754 97330 774III3I0 6 Fresno _ �... CA 937TT m%wiliu , 111111 l�- �Vfi f J A b 'y � e`= _ <:. . ,_ _.. .� �Av+.H+Paw,,...T,v�' ,.., . . � ; �� ... _ �w; .. . �w. �.,. s:-i( F ...,,b� nNS W� � � � tY C� � h k {{r[�� i q F ; °- r �` � h r n� 1 % [ v c� ' � Y d ; �� M i u { jj r � '; n , x y i < " S,' E � � � r t � �. [ i � t »(6 » . \ will . . . . - . . . a . . . > , . dC. /\ { ; [[ '{/i »�� �� f 11 k r.� c1�Si M��\ �� � � � 1 .._ .yr�pYILL[OM�L I �3 (lzW _ . �1i / 1'�Q /J O 7 /11 L LcJGi S �C� / ( N 3 �f2 Q�✓e �S c7 Yr �'� cS'h'-'L ✓i-c X51 �-t � � cl - n a f �y�� zcS ecSo , OL-S' a r,f- �" c-cL cx s-st/ / c� o, c�(c f 4-1,' 11-1, '`o m LA, C ly! �! ! vt.�J4_ /� oi0{'-c.._- l�? a'LI//Q�f�► �1t"®��sn C/1'lf ✓1,► i )? QR 7 SCJ `�. �R l G/ v�b o Y✓l L.��S �`cf.� CJ� e-/LL�(�0 �,( -J2 Q-� � //1 T7/Le 46 4 S`(Q ,2o i �� 4��-✓� oas J.S J4 / ,02_ r-T o rt A ® lGz/ H /71-QT� ��-- 6 Ga z -e- -C� y G� IQs Citp of balem, f agncbugettg Public Propertp Mepartment jguilbing Mcpartment One Oalem Green 745-9595 text. 380 William H. Munroe Director of Public Property Inspector of Buildings Zoning Enforcement Officer April 30, 1991 Mr. Cyril Baidak 8 Ropes Street Salem, MA 01970 RE: 22 Cabot St. , Salem, MA Dear Mr. Baidak, This is in reference to your permit to side the above referenced property. At this time you should reapply for your permit and have your contractor submit a statement indicating what preventative measures will be taken so as not to disturb the asbestos shingles while working on the new siding. We will review the new application and your statement to see if it will be sufficient to issue a permit for the siding. The money you have already submitted for the first permit will be a credit towards the new permit. If I can be of any further help, please contact me at this office. Sincerely, acme 15. Santo vvv Assistant Building Inspector JDS/eaf dc: City Solicitor Ward Councillor (fitid of 0�ttlem, Massac4usetts � s Public Propertg Department �i Nuilbing Department (One *stem (5reen 508-745-9595 Ext. 380 Leo E. Tremblay Director of Public Property February 22, 1995 Inspector of Building Zoning Enforcement Officer Zoogy Ceramics c/o Summer Baidak 22 Cabot Street Salem, Mass. 01970 RE: Illegal Business Dear Ms. Baidak: The ceramic business being run in the basement of 22 Cabot Street is not an allowed use in a R-2 Zone. To accommodate this business in this zoning district you must do the following: 1. Stop using the basement for this business. 2. Apply for permission through the Zoning Board of Appeals. 3. Secure a variance from the Zoning Board of Appeals. 4. Acquire a Certificate of Inspection from the Salem Building Department. 5. Return to use after all the above are completed. When you went to the City Clerks office, you were registering your business only. This should not be misconstrued as a license to operate a business. Please contact this office within (48) forty-eight hours upon receipt of this letter as to inform us of your course of action you will be take. Thank you in advance for your anticipated cooperation in this matter. Sin�erely, ^ JhnoJ. Je ings �1 Local Building Inspector JJJ: scm \��` �\s: � �� ' ���. �\� �������� f" " ��� � � �� � � � y '.� � Titg of 0$tt1Em, Mass arhusetts Public Prupertq i3e}tnrtment Nuilbing Department (One dalem (breen 5 0 8-745-9 5 95 1Ext. 3011 Leo E. Tremblay Director of Public Property February 22, 1995 Inspector of Building Zoning Enforcement Officer Zoogy Ceramics c/o Summer Baidak 22 Cabot Street Salem, Mass. 01970 RE: Illegal Business Dear Ms. Baidak: The ceramic business being run in the basement of 22 Cabot Street is not an allowed use in a R-2 Zone. To accommodate this business in this zoning district you must do the following: 1. Stop using the basement for this business. 2. Apply for permission through the Zoning Board of Appeals. 3. Secure a variance from the Zoning Board of Appeals. 4. Acquire a Certificate of Inspection from the Salem Building Department. 5. Return to use after all the above are completed. When you went to the City Clerks office, you were registering your business only. This should not be misconstrued as a license to operate a business. Please contact this office within (48) forty-eight hours upon receipt of this letter as to inform us of your course of action you will be take. Thank you in advance for your anticipated cooperation in this matter. Sinere�, i /John] J. Jerthings Local Building Inspector JJJ: scm The Commonwealth of Massachusetts Town of A►� Board of Building Regulations and Standards Massachusetts State Building Code, 780 CMR, 7'"edition Bwklmg Dept Building Permit.Application To Construct, Repair, Renovate Or Demolish a !dam VI One- or Two-Fum' it 400mu This Sectio or Officiilt Use my ` Building Permit Number: �, frl t A plied eY O Signature: -"""v % 101 Building Commissioner/ Ins for of Buildi ate SECTION 1: ITE INFORMATION 1.1 P�ery;Adljress;,o —��—��— 1.2 Assessors Map& Parcel Numbers 1.la Is this an accepted street?yes_ n✓ o Map Number Parcel Number 13 Zoning tnforrnatior.: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(tt) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Et��� 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 site disposal system ❑ Public❑ Private❑ Check if es❑ SECTION 2: PROPERTY OWNERSHIP' 2.2�Owner'of Record: .) ..1YlmCr � i dCi� of Name(Pri Address for Service: Signature Telephone SECTION J: DES PTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ 1 Number of Units_ Other ❑ Specify: oPBrief Description of eroposed Work': S7C�t�-./J SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and Materials I. Building Permit Fee: S Indicate how fee is determined: I. Building 5 ❑Standard City/Town Application Fee 2. Electrical 5 ❑Total Project Cost'(Item 6)x multiplier x J. Plumbing S 2. Other Fees: S 4. Mechanical (HVAC) 5 List: 5. Mechanical (Fire 5 Total All Fees: S Suppression) Check No. Check Amount: Cash Amount: 0*0 6. Total Project Cost: b 0 Paid in Full 13 Outstanding Balance Due: i SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) License Number Expiration Date N.4mc of CSL-Hplder List CSL Type(see below) Address Type Description U Unrestricted(up to 35,000 Cu. Ft.) Signature R Restricted 1&2 Family Dwelling M Masonry Only RC Residential RoofingCovering Telephone WS Residential Window and Siding SF Residential Solid Fuel 3uming Appliance Installation D I Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Registrant Name Registration Number Address Expiration Date Signature Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.4 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 ro subject� property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION as Owner or Authorized Agent hereby declare 400 that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. Print Name Signature of Owner or Authorized Agent Date Si ned under the pains and penalties ofperjury) 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 I O.RS, respectively. 2. When substantial work is planned, provide the information below: Total floors 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 J. "Total Project Square Footage"may he.substituted for"Total Project Cost' The Commonwealth of Massachusetts Board of Building Regulations and Standards Town of Massachusetts State Building Code, 780 CMR, 7'" edition Wilbraham Building Dept Building Permit Application To Construct, Repair, Renovate Or Demolish a 413-596-2800 One-or Two-Family Dive/ling Ext 118 This Section For Official Use Only Building Permit N ber: Date Applied: Signature: 411' p ' Building ammissioner/Inspector of Buildings Date SECTION 1: SITE INFORMATION IA Property Address: 1.2 Assessors Map& Parcel Numbers as cam f-- S+ L l a Is this an accepted street?yes . no .Map N�-rnber Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) 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: � ' �D' 0ai -CkcLC 2Z Cct��E fi Name(PrtH, Address for Service: Signatu� Telephone SECTION 3:D RIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description 4Proposed Work 2: TLe cwu--r, 40=00 c�c4l��r � L�7dLt�7il✓i U.tP2i 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 g ❑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: $ Z S Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ — 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) t; License Number Expiration Date Name of CSL- Holder List CSL Type(see below) Type Description Address U Unrestricted(up to 35,000 Cu. Ft.) R Restricted I&2 Family Dwelling Signature M Masonry Only RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolilion 5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Registrant Name Registration Number Address Expiration Date Signature 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 1 as Owner of the subject property hereby authorize to act on my behalf, in all matters r ati to work th 'zed by this building permit application. Si n ture of Owner Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION 1 ,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 Signature of Owner or Authorized Agent Date (Signed under the pains and penalties of perjury 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 and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 1 10.116 and I IO.RS, respectively. 2. When substantial work is planned, provide the information below: Total Floors 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"