1 GOOD CIR - BUILDING INSPECTION �� � �
`�� .
\`�� ' ,� The Commonwealth of Masslchusetts
1� �. ° Board of Buildiug Regufatious and Standards
SALEN[
I
. tate Buildin Code 7S0 CNIR
�� : �Iassachusetts S g > Revised Nlar 20!l
�
�
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
- This Section For Of£cial Use Only
Building Yermit Number. ' Date Apphed`; .
. . � . Date.��
Buildm Offi
cial Pnnt Name . �Si namre � . .
B .
B �. ) . . . . .. .
i
, SECTION 1: SITE [NFORNIAT[ON -
, ddre •� V � ��r
I.1 Property A ss. 1.2 Assessors Map & Parcel l umbe s
_i,��,3c1. ( na�lr.c�-l�, stLe N. M� o - o3sz- v
1.t a [s this an accepted street?yes_ no_ N�ap N�wnber Parcel Number
13 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Fmntage(ft)
1.5 Building Setbacics (ft)
� Fron[Yard Side Yards Reaz Yard �
Required Provided Required Provided Required Provided �
1.6 Watgr Su I : M.G.L c.4q 54 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
PP Y ( § )
/ Zone: Outside Flood Zone?
Public m�� Private❑ Check if yes� Municipal �On site disposal system ❑
' , , SECTION2: PROPERTYOWNERSHIP'. .
2.1 Owner'of Record:
Sal: ni. ���a.n �.I�p/t� U.L �edv�v . Ml�r 015�5
Narnz(Print) f City,Sta�te,ZIP
�00 ��.�Jvi" ��.a.T (4��)�oa-'n.suy S�f� a��'o��o �w�CoMoan�CS. �6N.
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF.PROPO5ED WORK=(check ali that apply)
New Construction Existing Building ❑ Owner-Oceupied ❑ Repairs(s) ❑ Alteration(s) O Addition ❑
Demolition ❑ Accessory Bldg. ❑ NumberofUnits Other ❑ Specify:
BriefDescriptionofProposedWork2: Np .� 1�'or.p
SECTIOY 4: ESTI�L4TED CONSTRUCTION COSTS - '
Estimated Costs:
Irem Official Use Only�, ,
Labor and �(aterials
1. Buifding $ l Building Permit:Fee $ ' tndic5te H4w fee is determined:
�. Efectrical � ❑ Standard City/Covin Application Fee
❑Total Pro�ect Cost'',(Item,6)x multiplier' x '
3. Plumbin� S ?. Other Fees $
l. �techanicaf (EN:\C) S List ."
5. �dezh:mical (Fire $
Siippression) Cotal All Fees: $
— Cfteck No. Check e\mount: Cash .-�momtt:
(. 'Cut:�l Project Cost: S , .
�� S U J (7 ❑ f 1n1 in P'ulf ❑ Outstaitding 13:il:�itcc Due ____
— --- ---�----- ------- — -
� ,
srcT►o�v s: co�srauc r�ov sEavicF�s
5,1 Conshvctiun Supervisur License (CSL) S � a0`3
�-b �-`�--
�O ��S �_T�� _ License Number E.rpirltion D:�[e
N�me oFCSL h[ulJcr �
G � List CSL Type(sae below)
S� �� "�� ' `�`�/ �� Type . � � - Description �
Nu. and Street �
_� ��vl� C`� �ry ( 55 U Unrestricted 6uildin�su Io3i,000cu. ft.)
R 2estricted 13e2 Fs�mil Dwailin
City/Town, Statz, L[P �I \�lusonr
RC 2uo[ino Covcrin
. � WS Window and Sidin
SP SoliA Fual Hurning Appliances
.-� ��-U � [ Insulation
� cle hone Email uddress U Demolition
5.2 Registered Home [mprovement Contractor(HIC)
Fl[C Registration Number Expiratiun Dare
FI IC Company Nnmz or 1[IC 2agistmn[Name
No. and Street � Email�dArcss
Ci /Town, St�te, ZIP Tele hone
SECTIO�V 6: WORKERS' CObIPENSA'C[ON INSURANCE AFFIDAVIT (M.G.L, c. L52. § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
diis affidavit will result in the denial of the [ssuance of the building permit.
Signed Affidavit Attached? Yes ..........� No ........... ❑
SECT[ON 7a: OWNER AUTHORIZATIOIV TO BE C0IVIPLETED WHEN
OWNER'S AGENT OR CONTRACTORe�PPLIES FOR BUILDING PERNIIT
[, �s Owner of the subjzct property, hereby authorize
to act on my behalF, in all matters relative to work authorized by this building permit application.
Print Owner's Vamt(Elzctronic Signature) Date
SECT[OY 7b: OWNER` OR AUTHORIZED:\GEY'C DECLAR.ATIOY
By entering my name below, 1 hereby attest under the pains and penalties of perjury that all oE the information
contained in this application is true and accuratz ro the best of my knowledge and underst�nding.
PfI11I OW11tf�S Jf ALIII1Ufl'l.tti:��'CIl[�5 NflI11C(Gitcu'unic Signaturt) n�«e
NOTES:
I. An Owner who obtains a building permit to do his/her o�vn work, or an owner who hires an unregistzred mntractor
(nut rcgistered in the Homa Improvement Contractor(H[C) Program),will nnt have access to the arbitration
program or guaranty fimd uniler DLG.L. c. ld2A. Other important infurmation on the H[C Proonm cnn be found at
«ww.in;us.��oe:%uca Information on the Construction Supervisor License can be found at���co-.mass.co�dL
3. Nhen substanti;d work is planned, provida tlie information bzlow:
Total tloor�rea(sq. ft.) _(inclu�ing garage, tinishzd basemend:�ttics, decks ur porch)
Gross livim�nrca(sq. ft.l _ Flabit�ble room count
Numberuffirrplaccs_ --- Numbzrufbcdrooms - -----
Number uf b,lthrooms Number af h;ilbb:�th� _
— --- —
Tvpe ot he;uing systcm ------------ �umber of dxks! purdus
I'1�pe uf cooling sy�tem— --- Eudosed--- -----Opcn- —
J. (btal P���j�ctlyu;�rc I notag� inny besub;titutcd for-'lor�l PrujactCust'� ---------------- ---
, „
---------
------
I
,�°" Crr�r oF 5:u..E�,t, 1�L-�ss.�cHLSE�rrs
BL¢nivc Dersx�nc$.�r
� � � �j� l3O CUd5H4�IGTON STREET, 3tD F100R
'�� 1'FL (978) 1�5-9595
� F.��c(979) 140-98�f6
��{pFRt FY DRISCOLL
�fAYOR 'I�tonus Sr.FtExas
DISiECTOtt OF PL'BLIC PROPERTY/BCILDL�IG COJL�II5SIONER
�Vorkers' Cumpensation Insurance Afl'idavit: Duilders/Contractor9/Electrician�/Plumber�
A�nilicant in(ormatlon ' + Plca4e Print Leeiblv
V;1tl1C(Uuei�xSyUr�,7nirafiaNlndividual): Sa�Q.n r1C)1�4 Ul 1 o/.S L(��
Addre�s: �� ��.�D� -sRcst,�
Ciry/Statc/Zip:�.�.oi���Ik Ul� l5 Phone M: ��11 �� �1a 2,- o1S`�`�
Are you rn employer?Cheek the appropdate boxt 'Typ�oP projcet(requ(red):
L 0 f am a cmployer wit6 �• � ���g��l contractor and 1 6. �New connwction
cmployea(tLll aallor paR-cime)J have himd�he xulxa�tracmn
2.� 1 am a sola pmpdctor ur punra:r• lisrod on ihe auached.rhect t �� ❑2emadeling
.rhip anJ have no cmployees Thaa subcontracton havo 8. ❑Demolition
. wur&ing fur mn ip;uiy capaciry. worken'comp.(nsurnnce. 9, �Duilding addition
(No worked'comp. insurance 5. Q We are a corparntion ond iq
reyuireJ.J offlcers have execcised�helt �0.�ElecMica!repairs or addieio��
3.� 1 am a homcuwner doing all work ribht of exemption per MGL 1 I.Q Plumbing repuirs or udditions
myxlP.[Naworkcrs'cump, c. 152,jl(4),nndwehaveno �2,� [��FRpaicy
inwtanca rryuircd)t cmployees.(No wadcen' U.Q Olha
cumµ inxurnnce rcquimd.J
•Any uppll.:un ilwt rhwkt baa JI must airu 611 aW iha sn�iuo bclowihowiny ihe(r wmkan'compnudun pu8ry inl'wmaUo4
�II.Hnauwn��whu�ulm�il tAia aflfdavit indtcaling ihry aro�lainy oll work.lnd Ihm hlm uultidacantlacMn m4t1 au6mil a new all(Jtvil indtcalin¢yuch
�Conimcan�hal ch�sk ihi�6a[m�nt atxh�m�Witiuwl xhml ehuainp iho nomc of I�e yubcomhcloif and thcir woAten'mmp.yul(ry infomm�ion.
/um an eu�pluye�that b provldln,�ivorkan'compa�sadon luruirrnn jor my emp(uyerr. Beluw 6 du pa/ley und Job s!q
irrjormullon. �
insur�nc¢Company Nmne: �� ( � �
Pulicy N ur Srif-i�m.Lic. N: �,( r�,Or7, O�7 I�i Qi�i Ezpimtion Data: I( O(� I '
lubSi�eAJJresa: �� �.�a. �7(7� l �rC�.2 CirylStatr/Zip:_So.�Q=n� �� V��17�
.lttach a copy u(tde worken'compematlon pulicy dectarottan pag�(�howing tha potley numbar and axpintlau dato�
Failuro to securo coveruge�r requircd ueder Scetion ZJA aC tifGL c. I 52 can lead to the impoaition of criminal penaltias of a
tine up to S I,SOO.UO unJ/ar one•year imprisonmcnr,u well as civil Qun�INe�iu�he Cocm uf o 5TOP WORK ORDER anJ u tine
��f up eo 5?30.00 a Jay ug�ins�rha viulamr. Ile advixed ihat a copy uf ihis vtuement may Ix forwarded to�he Office oF
Invcsiigaiiuin uf die nL1 for insuronca a�vcr�ga verilicaliun.
/du lrrrrby crnljy m�Jer rhu puln:uud penu/der uJpr�/ury t/mt�/re LrfurmuNon proviJrJ ubuvr ia lrua urtJ co�rrct
; ,. , ,�. ����J� al� I � 3
r �, ,�• � .. 5�i
O/Jirru!use wdy. Du iial rvrilt in Ihb urru�m dt cuu�p/elad by dry ui towe n/flclu!
City or'fuwn: __.,_._ Prrm(t/I.leenee q
(ssuing.\ullwrily(drela unc): --------�—�-'—
I. BUUf1I U�II09III1 E. IIIIIIIIIII� UC�1:1f1111L'llI .).CIIY/�q1Vp C�C7R J. Glectric�l tnspector 5. PIum6(nK In.�pector
8.nllll•f
Cunlact Pcrson: . _ Phana 1t;
� ._. - -- - - -- ` - - - - � - - �- -- . . _ . _. . .. _
� . _ . . . - - - -
acoRo CERTIFICATE OF LIABILITY INSURANCE DATE (MM DD nYY,
1.
02/01/2013
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(les) 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 endomement(s).
PRODUCER Phone' (978)7446433 Faa: (978)744-3575 CONTACT Deb TOUrnas
.NAME_-______- _—___—_..__..___._ ._—.
GERALD T MCCARTHY INSURANCE AGENCY, INC PHONE (978)744 6433 _ IF^X (978)744-357535
92 NORTH ST .INC.NOIEN);__._.__ _ _.__ LNC.Nm._—_---__ _
E AIL
debbiet@gtmccarthy.com
P O BOX 839 ngOREaess:._. _....___ _.__._..___..-
SALEM MA 01970 PRODUCER 537
INSURER(S) AFFORDING CO_VERAGEINSURED
__________ NAICp _
HOLLORAN DEVELOPMENT LLC INSURERA :Acadia Insurance Company
HOLL
C/O JEFFREY HOLLORAN INSURER B
41 FAIRMOUNT STREET INSURER
SALEM MA 01970
INSURER D',
INSURERE
INSURER
COVERAGES CERTIFICATE NUMBER: 22728 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 SUrH MITS SHOWN MAY HAVP R r UCED BY PAID Q1 AIMS
INBR AOD�L- SUER POLICY NUMBER LIMITS
TYPE OF INSURANCE WPOWu0C0Y EFF IIdA lROvIYllXYYL
GENERAL LIABILITY L -----
r
RRENCE $
COMMERCIAL GENERAL LIABILITY ENTED
yone __ $CLAIMS-MADE �OCCUR ny Ona parson) $ADV INJURY $GREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-
- PRO- —I COMP/OP AGO $
_—
POLICY II LOC ---- —---�-�----
LJECL.. S
AUTOMOBILE LIABILITY ____._-______._--_.____.
�COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
BODILY INJURY(Per person) $
ALL OWNED AUTOS BODILY INJURY(Per acddent)
SCHEDULEDAUTOS $
PROPERTY DAMAGE
HIRED AUTOS (Per occident) $
NON-OWNED AUTOS $
IS
UMBRELLA LIAR OCCUR
EACH OCCURRENCE $
EXCE88 UAB CLAIMS-MADE AGGREGATE
DEDUCTIBLE $
RETENTION $ If
A WORKERS COMPENSATION Wt72O2000IBBB 11/OB/12 11/O5/13 7WC8TATL 0_R --AND EMPLOYERS' LNBNTY YIN iQ1;L'LIMDS_1-1 _ R I$
_ _0
ANY PROPRIETORNABTNERIE%ECUTNE E.L.EACH ACCIDENT $ 100,000
OFRCERIMEMSER EXCLUDED? NrA
(Man4atoNlnl0l) E.L.DISEASE-EA EMPLOYEE $ 100,000
If rm,ee nw Amer - $
DESCRIPTION OF OPERATIONS Lel. E.L.DISEASE.POLICY LIMIT $ SQO�OQQ
- ------------1----I-----1 ---- -- i-- ----
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach t.0ACORD 101,Atltlitional Remarks Schedule,if more space to required)
CERTIFICATE HOLDER CANCELLATION
CITY OF SALEM - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
93 WASHINGTON STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
SALEM,MA 01970 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTNORRED REPRESENTATIVE_-_----
Attention:AL;UKU 25(2009109) (S)19118-2009 ACURD CORPORA HUN. All
rights reserve .
The ACORD name and logo are registered marks of ACORD
The
Efie 1-d-
Hoffi&--
To Salem Building Inspectors:
Holloran Company has secured me as their HERS rater for building on Nurse Way and
surounclings as of 1/1/2013.
I am currently processing the Projected HERS scores for these homes.
Thank you,
Ian Rex
u-1 A
Dominic Pezzulo
Fwd:Holloran Companies
' January 31, 2013, 11:47 AM
Jeff Holloran
Sent from my iPhone
Begin forwarded message:
t
i
Ian Rex
i Energy Efficiency Analyst & HERS Rater
978-578-1782
11 Broadway, # 3, Beverly, MA 01915
i
The
t
i .
r
Y
.':,, 01 - ,-„"'; i.,_ , _ ..r i ;SS . at,�rP .,,,. _.,,�.+ � : ;:1L � .) ' � - i 1 ,_. 2U 1i 1-[i3 � i_�l'•.;:
Y:)�-!Wilt ,'1 if YroL eiVo I_.I'd (. 11,1;'lr
.�r�:� � i i ; 73! w„• ,3,� —i.l �.:O} _ ,. ..� -�t,ir .1 rs�4_ : �;� :xr 1 P Ire _ f :`f;�^,r.i)i
Rem/Cost Namepermits
�� �
city water and sewer hook up fee $ 1,135..0000 pull permits based on 145k=$1595. $11 per$1000+$5--1600
250
arohitechtec $ 1,000.00
engineering $ 2,000.00
windows $ 4,368.00
utility water and sewer
final grade rough loam
perimiter and basement stone
excavation,backfill,rough grade
excavate for foundation
tree clearing and stump removal
foundation _ $ 8,500.00
foundation coating $ 400.00
concreate floor $ 2,500.00
framing labor $ 9,000.00 8k usher
framing lumber $ 16,000.00
decks $ 1,500.00
trash removal $ 1,000.00
hvac $ 8,675.00
plumbing $ 9,175.00
Pump sewer $ 3,500.00
bath vanitys and tops $ 1,00000 _
water heater $ 650.00
fire place $ 1,400.00
fire place mantel $ 500.00
electrical $ 10,370.00
insulation $ 4,000.00
sheetrock $ 9,149.00
kitchen cabinets $ 2,500.00
finish floors $ 6,400.00 hard wood carpet vinyl
light fixtures $ 50000
trim and stock $ 3,000.00 doors trim stain parts
finish carpentry $ 3,000.00 install all doors,trim,kitchen and bath cabinets and vanitys and microwaves stairs
painting $ 2,400.00
appliances $ 2,500-00
leaning $ 400.00
jiffy john $ 200.00
mailboxs $ 10000
siding labor $ 3,500.00
siding $ 3,200.00 3200 labor tucci
roof $ 3,700.00 18.5 square
garage doors $ 2,000.00
countertop $ 2,300.00
landscape $ 3.000.00
drive way
mise labor $ 3: �:�
contingences $ 4,728.00
$ 145,000.00
Subtotal Subtotal
Real Estate Taxes
Light/Electric
insurance
Total
- o
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N -4 P
N 7rr
i
dow,d of Building RLtiula�Y.imiNUMWA
E ms` Construction. Supervisor License
- License: CSL 76746
My
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P84 SOUTH ST FLOOR.; 1.. F p
* MEDFORD ' MA021
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Lklll 55
Y.l W
5/1412013
r 14491
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- CITY OF S.U.ENf, i�I��SS.�CHL'SETTS
1 BUILDLNG DEPARn ENT
130 W.tSNLNGTON STREET, 3° FLOOR
TEL (978) 745-9595
KIJiBERLEY DRISCOLL FAX(978) 740-9846
AAYOX THOMAS ST.PIERRI3
DIRECTOR OF PUBLIC PROPERTY/13UMDLNG 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 1 l 1.5
Debris, and the provisions of MGL c 40, 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 disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
nam
( c of ha er)
'['he debris will be disposed of in
(name of facility)
(address of thcility)
signature of per it applica
�+ q I 13
date
Icbnvr l,'',Lw
CITY OF SALEM
ROUTING SLIP
New Construction V
Certificate of Occupancy ,�f y
LOCATION /-Of Z; L;;/t'✓/,ft; v ATE t+ —
ASSESSORS DATE
93 Washington t.
CITY CLERK DATE ' J1
93 Washington S
PUBLIC SERVICESDATE
120 Washington St.
WATER VU DATE
120 Washington St.
CROSS CONNECTION DATE
5 Jefferson Ave
PLANNING-
`�' DATE Z I
120 Washington ll
CONSERVATION ATE d'
120 Washington St.
ELECTRICAL DATE
48 Lafayette St.
FIRE PREVENTION DATE
29 Fort Avenue
HEALTH L- z �` "J- DATE i 7–LI
120 Washington
BUILDING INSPECTOR DATE
120 Washington St.