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1 GOOD HOPE LN - BUILDING INSPECTION < � CTTY OF SALEM i PUBLIC PROPRERTY ' D�,�t�rtT �.�o.�«,. �/% o� �aroa uo v,�,+oe,s�.ar.s�,��rrsa,s�o 'I1i 9'!►7�S%9S�FA7a 97F7�9tK Wo�icers' Compea�at[o�Imnnace A(Qdavi� gai�deyConene 4ontlrant Ieform�tb� Name� � -t;' / r� �� Addi+ess: �- � lJ> city/s - /7/I_OC,L ,�Zt� - �ld�l� �a �wne�:-_ 7�l - 3�9 - -2. _�� An yoa ao ovplsyv?Cbe1t W ay�n►pef�a oen l.❑ 1 as a amploy��rit6 �. Q I m a�en1 eoetiaetor md 1 ������n9��� r1' a�PbY�(lhll�ndlor pns.dm��,� l�w hieed�wb� 6. IVi�r cm�uetiaa 2.I�J I am�wh peopeiaoor ar p�emeo- liued an eh�am�ehed�esf.t 7. �� shi�aed h�w no empbyear 'l3�w wbomaaemn hsvr S. �1iya,s rrorlda� !ar m�it my eap�etey. wra�ka�'eomp� [���eomR inaunnp 3. � W�an a aaepoudon aed ier 9' ��Oi�ddhim �4�1 o81ee�haw a�nd�ed t�eit 10.��ebial iep�io ar�ddWae� 3.� I am s Lomeow�o�dotnj ail wait +��lt otaa�amPtios Pa M(S. 11.Q ph�f�a+ddtdo� my«!t(Na woeiras�eomp, a Is;�1(41 aoa w.baw no ����� ��1� �P�U'�w�adcew• 13.�Oth�r . �tiayol4+rdra.a�6aanmorr..ma.�Y..abDro�r,rl��r�„b,�' � � Fo�ro�'�Orr�ivtAY�Al�vlti�tl�iM/pdai�d�ad�/A�ilwar�WaaY�ed�ss •M�� �Ca��1 e��ek�YY b�sor re�ol�/��ddYlaed�r�I�iy er d6� �i tl wisaa�mes d�l�ir�alee'ea�F P�ry�s ��dl�t b��+���������� Belaw b Wonik>oRlJo1 iiN ' � �---F--f2�_ In�u�ne.Comp�ay Name:- � � � GZ�A,s�l 77�17 ai ,a S Policy N a 9ei!ins.Lia N: f')7 1 J �-1� F.�pintion Dw: �'�- O`> — )� lob Site Ad�ae ' C��s�� - AtheY a eo�ot tY woAun'eospewtlo�potlry duLeaqe�Y�p(+��ti�PoUef��sb�r ud aOlrsNo�d�q} Failun ro xeun eovawP+�r�u�uoda Seedos 23A otM(3L,a 132 can!nd eo�impodeiaa�eraaioat peaaitla�ofa tiae up ro 51,300.00 aod/cr one- ar' r'a oa Y imprtwnmeo��weq u civil penalues in�farm of a STOP WORJC ORpEA aad s ffn� (vati f230.00 a day apinrt�violsoor. B��dvixd tLtt s copy of thL mtameoc rosY b�foew�rded to t6�Ofllp of �oaa o[tLe DU for inwne�eoven���, I se be►�y earraab p�/�y /��ya o1�1�,u1r u4 tu/oree�dow p�Ovld�/abor�1�anre conres �� � a ^ � � 2 OfJldaf+Ari owl)t Qr�wt w�lii/w utb arn�,m bi eoa'i�bl�bl w�ow�oQlelal CIq or Tows: P�����r ruWe�,�,ueor�h�etrr4 oa��: 1. Boud o(Halt� 2, BuUdte�Department 3.ClryRow�perk 4,E]KMeal Inspeeror S.PlumAtn�Iwpeetor 6�Other Coatut Persor Psoae M: Information ann ins�ru.:�l�uJ � ., y�y�Chuxas Gena�1 Laws ed�i S2 ce4ains all emPloy�s�P��`x°rlcas•eomP�O°faecnauad�� , ����as"...avaeY Pmso°�ths sa�viea of ano�uoda anY �a�lied�aal ac v�i�� ` • , auoeiadm.��°�a�a ��ry•01IIY tvw ac mo� u deAneA d"at iodividu�l•P�°i�P' �ot a deceased��a�� rhs�'�i�9►�m.'�� a�oei�ido�a ���� ���� r�eiwr ar ausse�o!m iod�.����ahs raidea�+�.ar�0°�"�°�eh� owoot ot�d�s����m ds m�i�.�a���meY d�+ll�tbOO'� dw�� a bn.idini��6�0 sh�it mt boauu ol ad amPbYme� m b�a ampbYs•� a os ths O� �q w leal Mn���������� MC�.ch�P�131.1�(� b�� �or t�a��O b eM a�wallf fir aq ce�awd ot�tluaw�r P�r�lt �w�t wP�w w4�tY f�wraw errmP�4�Irei''�1 — ���t wM W Mt Qr��„���onwedlL aor anY��P�a�bdivido� �y�b!(�:aba�ot 132.425C(7� . evideap ot eomPlia°°° - - ����w�p�pmmd m th�eao�aedni aw6oritY•• _ _ �P�d �y�ca�th�bous th�t�PP�Y ro ya�r at�d°°m4 d Ptew Sil°ut td����ddro�(��PhOO� Pnm�ah�p�(LL���`'°�0f t6m t6� ��[.iabi]itY����odtms�' . waaop. Itm LLC or LLt doa haw membaes a����advia�d t6rt th�a�ldav6t msY 6�w6m�a�d o���OP� � �hoaW AW b�.,ur a.ip..a aaa 15..md.vl6 'Ib aAidavk d �fas����°n�.�r tht psm$a Hce�is beint rc4m�d.°°t t�� b�mw�m�eitY as aows th�t �PP�O° �y�a�{yon atr�ed t°°bt�m�wrorkan ��. 36ao1A Y'��v����liwd below. Selfriowed eamp��°O��. ���y.P��Ibt Dep�� �eit-inauaoa N�w�as� Cfty ar?�� ��d s�u ty�botoom Plw.b.uue�6.c du s8id.vie u comvlaa.ua vrioted kv'blr. ?h.D�p�� ance ron m�i�aPP�O`� ot the a&Idsvit faY�m 9ll out in th�aveat t6e OSiee ot iavewiatiod yymba�whic6 wiU b�ured a�s retarmet wmber. Ia additioo.m�PV�°'� Pt���fO�m�� lieadaos m s�Y��Y�T�����ou�aHidavit in�� �hat mu�t n���P��� PolieY infae°ud°°(if ne�Y)+�� �Sia Addea�" a madccd bY��t°w°ms�Vp"'d°d to� � wvrnl'A wPY o[dr a8idavit�has bem oRleiallY� a��� A uew aF',drvu mut b�8lled ou►aeh th�t a valid aAldwi��oo db foc Hwn Peemib �a eommacia���°� '���� owms a eidms u obtainini�I�e�+�°°P��uat eeluad to anY yar.WhaM s Lo�o� u Ntr[required eo e�P�t6ir afdd�va. (i.e. s dcL 1ie°oa°�P°�ro bueo lesva ero.)iaid pasaa� ' and sNauld You hsve anY 4�O°�' T!u O�ottnve�cWbm wonbd lilu to thank ya�in advaas fot Your woPe�°° please do mt haina ro�w u�s atl. 'Tiye Dep��s��"��aod 6u wmbar T�COmIDcnwalth otMs�achuseas p�p�mne�t°t�1 A�d�ats Otlia o�lsvadpidoes 60o w��sa�e so�oa�uaatt� 'Tel. #617-729-4900 ext 406 a 1-87f-MASSAFB Fuc�{617-717-7749 ��;ua s-zbos warar.m�ss.8ov/dia � � EI'I'�OF�XLE� — -- ��� � PUBLIC PROPERTY _, \' DEPr1R'I11dF.►�iT �_ Sl� —�jZ ��.�o.�,. W..roa �3ow..vur�crcw5�sr. • . . �1I�J4�L��IAOil:sh'1l3 01970 , '113:9?LTii9S9S�FNC 97/-7�0.96k � APPLICATION FOR'THE REPAIR RENOVATION. CONSTRUCTION. DEMOLITION. OR CAANGE OF USE OR OCCUPANCy, FOR ANY EXIS'PLYG STRUCTURE OR BUILDING . 1.0 SITE INFORIMATION � �� � � Lacatbn Nams: ,L uildiny. /SG D _ _ _ --- p�ertyAddresr.— - -- -- ----------- - ---- -- / G�b �P� LA�v� property is beated in a; Conae�vatlon Aroa YM Hlatoric Olstrid YM 4.0 OWNERSHIP INFORMATiON 4.1 Owna►of Land � N�: ,� � , C'�is;n�� ,�ea �,ei s Addreas: j GaoD ldbPE �'vE � �'lfGEm /�/�- C��`�7l� Telephone: g7B- 75�5; �g'SFG, 3.0 COMPLETE THIS SECTION FOR WORK IN FYigT�us BUILDING9 ONLY Addition Exiating � RenovaGon Number of Storfes Renovated Change in Use t/ N� DemoliUon Existing � Approximate year ot � I�gB Area per floor (s� Renovated construction or renovation o(existing buiiding N� 9aef Description oi Proposed Work: �{-Di.7 G� LA-UNl7A-�c',+, �v��l 77> �u/6��wG o� C A-.� �/,}.efl�E. Gf// L G � X ��v�� fl- �:ur9 LL /9G�2oS5 G�/�6�'� /�/�P•eo�c /2 FT ��oitr /'��A.e GUff�. f�DD R �ff�S6 � L'c.m6ivT_ lU�GL i� Sfl�E f�E/6i�i �S �'f�,� � CXis7'iivb f�`�/6/�T T� Ti`fE ,j�ooe ;EA!TiQ/�iiiG:E F�o�rr 6R����, 'TI•L�tS ev /G L` /3.E ,n� 1�LA�v� wlr.� ��,S�inEwT FL�.e„� %1/IATf� OFlIJf}6L ,8c � •i ------- Mail Permit to: ------ -- What is the curtent use ot the 8uiiding? 4 � , I M�����ib�gT �`�yc/�,��1� N dwelling.how many units? — Asbestos? � WiU ths Building Conform W LawT I pJcti�tect's Nams Address and Phons � � I Mechanic's Nams I Address and Phons ,� Coastruction Suparvisors ucense� a�7.�3 G� HIC Re9istratbn# /�� Estimated Coat.ot Projed i /� Psrtnit Fe�Calwlatfon Permit Fes i — EsUn+ated Cost X S7Ii1000 Reaidential - - - - ----- ---- - -- -- ------ Estlmated Cost X f 11151000 Commerclal— - M Additional 55.00 is added as an AdminiatraUve charSs. Make sure that all flelds aro ProVerIY and legibly written to avoid delaya in processing. The unders�9ned doea hereby appy�a Buildiny Pertnit to build W the above stated speciflcaUons. Signed under penalty of perJury Date � � �I . ...,: vl e N � � � � � G � � � o � � � ` � a � v F �. , o �7 y 3 � •�� � ' � � . a � - � � .��— --- -.._. _ . . _ __ __. — x � a�— E _ _ � - - ✓� ���� ���r� ✓1ie �ammonu�r.a��i a�✓�far:;ac�ivaetla � ftoard of Building Regulxtions nnd Standards BOARD OF BUILDING REGULATIONS HOME IMPROVEMENT COh1TRACTOR ,,,, License: CONSTRUCTION SUPERVISOR i,r; '"� � � - Registretion:, 143739 �, Number: CS 077336 Expiration: 7/27/Z008 � U . ry -�= Birthdate: 04/18/1975 Type: Ltd Liability Corporation � Expires: 04/18/2008 Tr. no: 22904 '���� � CANTILLON CARPENTRY LLC. Restricted: 00 THOMAS CANTILLON THOMAS P CANTILLON 20 DIANE RD ����` 20 DIANNE ROAD � � MEDFORD, MA 02155 MEDFORD, MA 02155 /� � Dcputy .4dministr�tor r�_ Commissioner-c�� - � G1TY OF SAI.EM :' PUBLIC PR+OPF.A'TY i DEPAa�r �� �.,�. ����.�.Y...�,��+,. �.r.r.s.w....,s+n».+w Coasdrucdoa Dee�4s Df�tat AAWsvit (�uirr a,r�Il e�aoltdoa.o�e.nov.doa�ad� : . 1s aaonboo�wid���6nf tlidos ddw S�Bui{�a�Cod�7'0 C��eeda�111.! p�i��e/dr p�ovt�W�a��7L s�S 3/1 BuiWiei hndl M b ho�i wtd�ooadllla��t�d�Ms ewL6y Sas �arat�Ill��otit a po��►UoiesM vrN df�oat AdBq a�Ad�b�rl�t3.� 1 t t.!1lOiA. ' 'I�dehrla�ri11 b�ti'�atOoMd b�R „ � y'r�� , ff2�.��'/s' (dw d�rM! T}w deMs wip b�dia�d ot In: �//d�h<<S /1� r' lsam�o[I�oi1tM fa�Wnrs a/heiltM u alp�aaul�pOlit� � � �` —a '^ � . . / 6it1 � 'shn.rT.�Ls , _,.� � �.�..� ` _ ___ _ ___. _ __._____ . I � r_____T�T_T'__ . . . .. . � � � - T-T-T---__'i . . . . . �. r-----r-r i i i . i i n--�------� i I �--�- -, I WATER I------------------ I �—�--� I I ; �-----�—� r� --I I . 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