3 FLYNN ST - BUILDING INSPECTION The Commonwealth of Nfassaehusetts
OF
Board of Building Regulations and Standards
CAL M
Bl tl
1 g g SALEM
Massachusetts State Building Code, 730 CL'vIR Revised Mar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This 3dctiori Fbr O fficial Usa Only.
Building Permit Numberr Date Ap0lied:`.
c as'j e,
G
Building Official(Print Name) ., �$ignature,.. : Date
SECTION I:SITE INFORMATION
1..11_PPrro�>e��rgsr. 1.2 Assessors rINTap& Parcel Numbers
1. Is this an accepted street?yeLx. no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zaning 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.01 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 yesC1
�+ SECTION 2., PROPER TOWNERSHIF.
rr of�rt'y S��C 10L ►'1�f�
Name(Print) City,State,ZIP _
_3 )eWW 70' 27.3 a
No.and St et Telephone Email Address
SECTION 3: DESCRIPTION OF,PROPOSED WORW'(check all that apply).
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition X1 Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Warkt:
SECTION 4: ESTENIATED CONSTRUCTION COSTS
Estimated Costs:
Item Ofticlal Use Only..,
Labor and Materials
I. Building S 1..Building Permit Feer S' ' Indicate how fee is determined:
�. f cctrieal $ ❑Standard.City/Putvn Application Fe&.
❑Total.Pioject Cose.(Item.6)x multiplier. x
3. Plumbing S 2. Other FBes: S
I. Mechanical (IIVAC) S List:
i. Medmoical (Fira $
Snp ncssion) _ I'otal All Fees:.S_
'ect Cost S
Check No. _Check Amount: Cash Anroint.
n 1'ntal Prn G�
yy,� ❑ I'aid in Pill— __ — 0 Outstanding lialanca
t ,
SEc,rION 5: cONs'i-RUc'1'IoN SERVICES
5.1 Construction Supervisor License(CSL) d��
License Number G.epirttiun Uate
Name of CSL I lolder List CSL Type(see below)
�r ' /� Type Description
No. and Street
. �d � U Unrestricted Duildin s u to 35,000 cis. Ill.
1 -e 4-p41 tM4— R RestrictedlSt?F.unil Dwellin
City/"town,State, ZIP M Nlasonr
RC Rootin Covering
WS Window and Sidin
SF Solid Fuel Bunting Appliances
g�.3 �0a I Insulation
role hone Email address D Demolition
Yegistered Home Improvement Contractor(HIC) ` 7�f
M! S' Iw► �C — FIIC Registration Number spiration Date
I IC Cum 'y jJa e r fIl Registrant Nmn
N Stray / N I m� Email address
Ci /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 DE 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 relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: OWNEW OR AUTHORIZEDAGENC 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 Owner's or Authorized AM it's Name(Electronic Signature) Dat
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 Hontc Improvement Contractor(HIC) Program), will trot 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 m;us.euvhxa Information on the Construction Supervisor License can be found at www.utas .w�dl_
2 When substantial work is planned,provide the information below:
Tool floor area(sq. 11.) _(including garage, finished basemenVattics,decks or porch)
tiros; living area(ml. It.) -_ Ifabitable room count
Number of tirephccs. --_----- Nundter of bedrooms --- -----------_--_--
Numher of bathrooms Number of halbbaths —lie of of homing syatent _—__--
I\pe ofcooling ;y;teitt Enclo;cd._ (tpen
i. "1')?,11 Plol,Ct �yu.ne Foo(A"'a"MAY hc ;nb;titntal t)r"I' rt.i I'n jcd l'u;t"
1V
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$',•yy{� ✓* i .., m 4 '#t rase'h
° CITY OF Ssst . am, iNa8SACHUSETTS
BUILDING DEPARTMENT
' 120 WASHQJGTON STREET,31D FLOOR
' TEL (978)745-959'5
FAX(978)440-9846•
K1.% BERLEY DRISCOLL
MAYOR' Ttioms ST.NERRS
DIRECTOR OF PUBLIC PROPERTY/BUILDING CON061MIONER
Workers' Compensation Insurance Affidavit:Buiiders/ContractoislElectricians/Plumbers
Anniicant Inihrmation Picase Print Le'ihty
Name(BusineswOrganizatiooNindividuap/: \\gM C T
Address:
A e
City/State/Zip:YW1� #`c 1,e '-O ✓ rAA- Ithonie r
Are you an empiayer7 Ctieck the appropriate box:
'type of project(requtred):
1.❑ I am a employer witfi 4. Cl i am a general contractoi and I 6, New cons�rtutdon
unployees(fltll and/or part-time).* have hired the sub-Lcquractota
2. I am a sole proprietor partner-' listed on the attached'sheet t ❑Remodeling
ship and have no employees : These sub-contractors have S. []Dernolition
work ng;�for ma m airy capacity:r workers'comp.insurance " g [iuitiiing addition
[No wcekcra comp,insurance 5. [] We are a coiparadon and its, :. 10.❑E(eoirical repairs or additions
required.): 0tticenhave..axercistict err' _
3. 1 am a:homcowncr doing all work right of ezeinplion per INGL, 11 ❑Plumbing repairs or additions
;myself.'s[Noworkers:icomp, c.,152 g1(4) and wehayeno' 12dItgofrepairs
irourancc required 1•,t. employees:(No workers's .
comp instiiance requiied.J 17 0 Oilier
'Any upplicud ual chucka boX 01 most also rill out section Wowshowina thew worksts"cpmpetisatiun policy inr1.urrtiatiom'
I r,"towners who submil this affidavit indicating they am doing all work and Ihea him mmsidecantmmersraull submit ,new afRJ.1 1 indicating such.lComm uirs that chick this box meat mtachod an uddidunal sheet showing the name orthe sutl4c'mrado0 and the4`worinra'.comp;policy infominaon:.
"' %urn un mnploysr thuds proVlrling ivorken'compansadoa lusurbtus jar,dreg employee 'Beloly!s!/ie policy odd fob site
Insurance Company dame:
Policy#or Self-ins.Lic.q; Expiration Date:
Job Site Address: City/St¢te/Zip:
,lttach a copy.of the workers'compensation policy declaration page(showing the'
pohcy number and expiration date).
Failure to secure coverage as required under Section 25A of mt c I h canlead to the imposition ofcriminal penalties of a
tint up to S1,500.00 and/or one-year imprisonmenq as welt as civil pcnaltdes in the fotm:of a STOP.WORK ORDER and a fine
of up to$250.00 a day against the violator: Be advised.that a copy of this.ptatemearmaybe forwarded to fhb Office of
Invesligaliona of the DIA for insurance covcraga ycritiutmn. + -
/do hereby term under the puli+s used penulder of p&jury r/err[die rnjainrutlar provlr%rd ubavr is rin erne d correct
Siennmre: Da[a-
L
oily. Oo not rvrUe!n this arru,}o bB cun+pleled by city or lowra o)lc&4
wn' Pcrmit/Llccnse#
hority(circle one):
health 2.Building Department 3.City/town Clerk 4.Electrical Inspector 5. Plumbing Inspector
rson: _ _ Phone#•
A15S:lCHUSETTS
BUILONG DEP.%,tvnW.Nr
i_'0 C/-UHOIGTC, JTitEET, 3 O Rao,*C7.r i TFL (978) 735-9595
vt� ,ry
I<lJt0E2L 8Y DR ISCOLL F-Ut(978) 7.10-9344
,b GlY01 ,f}i0MU ST.nERRB
DI2ECTOrt OF Pt:OLic pRoPERTY/Bt:UML-1G CMWISSIO,V ER
Construction Debris Disposal Affidavit
(required for all demolition :utd renovation work)
In accordance with the,sixth edition of Ilia State Building Coda, 730 C11,fR section l 11.5
Dcbris, and the provisions of tMOL e 40, S 54;
Building Permit N is issued with the condition that the debris resulting from
this work shall ba disposed of n Properly licensed waste disposal raoility as defined by ,LfGL a
l l 1, S lSOA.
The debris will be transported by:
(name of haulur)
The Dcbris will be disposed of in
(name of raeility)
(address of raeility)
,iynanue ofparmit applicant
Luc
C U/eQ tpononeaeenieall�o�C�/Clt/��/rc��mal/J
f Office of Consumer Affairs&Busthcss Regulation
G1 _I OME IMPROVEMENT CONTRACTOR
egistratlon: 174863 Type'
xpuatlon 3/22— 15
-7 Individual -
JAMES MEALEY
F
JAMES MEALi
3v, t f
320 HILL DALE AVE
MIDDLETON,MA 01949 Undersecretary
t
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supcn'isor '-. .'
License: CS-066660
JAMES J MEALE)t -
32 HILLDALE AVE - s
MID MI
A A 01
954� 11 Expiration
n1/�917/11 F
Terms:
F .P-esie +r •' ¢h,`_ 33%down upon agreement
�µr r
33%due after frame is up
7 Date..., Balance due upon completion
9�A-4AA-SO02 ............ .
31 Asbury Ave.Hamilton,MA 01982
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¢ nn 1 r Designer. ................ ............. ... .. .. ............
�J f OMz VC-esp"Jj l� [ Installe .. . ........... . .. .......... ...... ............ .
L1 I Owner... .... ..... . . ........ ...... ..:.............
FILE NO.: 180755
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1 +T.l STORY DWELL'-ING mu 4
0
LOT-12 LOT-14
f
Lr l\l�•I
F L Y N N S T R E E T
py-0 OF MASS
=y�F 9s THERE WERE NO LOT
o G CORNERS FOUND.
JOHN S RECOMMENDATION IS TO
o LA U RETANI -�i PERFORM AN INSTRUMENT
A 34311 " SURVEY TO VERIFY LOCATION
" AS SHOWN.
S9 MORTGAGE LENDER
UJRq
Lam- �of USE ONLY
plotplans.com
L
'zQ DLS LALIRIERS
+
101 CONSITNTTON BLVD. 3417E D
FRANKLIN. MA 02038 ".,.. ..,
(BOD)287-8800 FAX.:(508)528-4011
�•a'-sue,..
_ MORTGAGE INSPECTION PLAN THERE ARE NO DEEDED EASEMENTS IN
THE ABOVE REFERENCED DEED OR
'ADDRESS::.3 FLYNN STREET. SALEM, IAA o- -..". . "..'" . ENCROACHMENTS�WITH RESPECT T0.
EXCEPT AS STATED ON THE DEED OF
LENDER:WELLS. FARGO BANK. N.A. RECORD SHOWN. '
T ATTORNEY: SOTIRI SOUGARIS. ATTORNEY AT LAW
3; THE LOCATION OF THE DWELLING AS
M OWNER:JOSEPH GRENIER R DALE ANKETELL TRUSTEES SHOWN HEREON EITHER WAS IN
APPLICANT: KAITUN E. LEBLANC & PETER M. COBB COMPUANCE WITH THE LOCAL ZONING
DATE: 11 24Z2009 SCALE: 1*=20' COUNTY:ESSEX BY—LAWS IN EFFECT WHEN
CONSTRUCTED (WITH RESPECT TO
UNREGISTERED LAND STRUCTURAL SETBACK REQUIREMENTS
ONLY), OR IS EXEMPT FROM VIOLATION
FLOOD HAZARD INFO:. DEED BOOK:28332 PAGE:412 ENFORCEMENT ACTION UNDER MASS. G.L.
ZONE: C DATED: B S 1985 PLAN BOOK:91 PAGE:71 LOT(S): 13
COMMUNITY PANEL: 250102 00050 PLAN NUMBER: OF
THE LOCATION OF THE DWELLING SHOWN REGISTERED LAND CERTIFICATE OF TITLE:
DOES NOT FALL WITHIN A SPECIAL REGISTRATION BOOK: PAGE: ASSESSORS MAP:
FLOOD HAZARD ZONE, EXCEPT AS MAY
BE INDICATED. PLAN NUMBER: LOT(S): BLOCK: LOT:
GENERAL NOTES: (1) THE DECLARATIONS MADE ABOVE ARE ON THE BASIS OF MY KNOWLEDGE, INFORMATION, AND BELIEF AS THE RESULT OF A MORTGAGE INSPECTION TAPE
SURVEY, NOT THE RESULT OF AN INSTRUMENT SURVEY MADE TO THE NORMAL STANDARD OF CARE OF REGISTERED LAND SURVEYORS PRACTICING IN MASSACHUSETTS. (2)
DECLARATIONS ARE MADE TO THE ABOVE NAMED CLIENT ONLY AS OF THIS DATE. (3) THIS PLAN WAS NOT MADE FOR RECORDING PURPOSES, FOR USE IN PREPARING DEED
DESCRIPTIONS OR FOR CONSTRUCTION. (4) VERIFICATIONS JOF PROPERTY LINE DIMENSIONS, BUILDING OFFSETS, FENCES, OR LOT CONFIGURATION MAY BE ACCOMPUSHED BY AN
ACCURATE INSTRUMENT SURVEY. (5) NO RESPONSIBILITY IS ASSUMED HEREIN TO THE LAND OWNER OR OCCUPANT.
GwP lgh1 C 2008.Dee L ri 4 Av .. me