6 GREENWAY RD - BUILDING INSPECTION e
One or Two-Family Dwellin.,
The Commonwealth of Massachusetts
Ulf Board of Building Regulations and Standards
Massachusetts State Building Code 780 CMR, 78'Eddton 0
Application to construct,alter, renovate,repair or demolish
ylV1a1 Ph[s Sectio tcial 3se. a nl
Building Permit Number: Date of ton:
Signature:
Bud it Com issioner/Lo as ctor pale
S+D �IAN SIC) ItVFORVIAPTON
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
to Gite�,Nay TC<�
L la Is this an accepted street? Yes_❑ No ❑ Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(feet)
Front Yard Side Yard
Rear Yard
Required Provided Required Provided Required Provided
1.0 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: Outside Flood Zone?
Check if yes ❑ Municipal❑ On site disposal system ❑
1.9 ZBA Special Permit 1.10 Old &Historic Commission 1.11 Conservation Commission
Date filed N/A❑ Date filed N/A❑ Number 40- N/A❑
... .. a. la,'•'
2.1 Ow t er of Recor :� �' •
N e(Prink) Address for Service
7yr^ /-76 /
a ure of Ow er 1 'telephone
f +
New Construction❑ Exist ng Building❑ Owner-Occupied ❑ Repatrs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Description of Proposed Work: /3r</L� 7(/�yr/ �'��„�� c/�Tlq/��'
SGTTON 4: EST1lVTA1 EI1 Ct)N5ZAlTCTTbN COSTS $iJ� I�ItspITEj ` o,
Item Estimated Costs
(labor and materials) This Section For Official Use Only
1. Building $ e
Building;$10/$1000
2. Electrical $ Building+Plumbing: $12/$1000 Building+Electrical:$13/$1000
Building+Electrical+Plumbing combined:$15/$1000
3. Plumbing $ Qc
4. Mechanical (HVAC) $ Total project cost(labor and materials)$ `7�lG
5. Fire Suppression $ Fee multiplier from above$ /$1000
6. Total Project Cost $ /-/fla Permit Fee$—S3 Receipt Number
� C
SE.CTTON,S CONSTRUCTION SERVICES.
5.1 Construction Supervisor License(CSL)
License l0-�173 3 Expiration Date
Name of CSL T Description
�p v r-it .,9d tJ r- !ti/fz.Cd'LE➢/En9 AeW D/y'V� U Unrestricted(u to 35,000 Cu.Ft.)
Address R Restricted L&2 Family Dwelling
M Mason ,Only
Sigri re RC Residential Roofing Covering
WS Residential Window and Siding
73 , S Telephone SF Residential Solid Fuel Burning Appliance
D Residential Demolition
5.2 Home Improvement Contractor Registration (HIC)
Registration Expiration Date
HIC C ompaiay Name or HIC Registrant Nay
Address
Signature _
-7OI' 6Yl— WSJ S
Telephone
7r r i
�,y u �
Worker's Compensation Insurance affidav'('i st be completed and submitted with this application.
Failure to provide an insurance affidavi ay result in the denial of a building permit.
Signed affidavit attached? Yes No ❑
TQNa` (�1 �3AIHOI ?kIi(31OrELC7 IrRIZLb�IK11 a x ,4
m i �1 xt lti
s.,�xt ed .ss ymxt;s
as Owner of the subject property, hereby authorize
to act on my behalf in all matters relevant to work
aut rized y is i g pe it application.
Sig e o wrierL Date
3� Ji xft .,r7n ' d'p �S a ' FM + rt
c TO 7t➢ ,+2 lYE 13{l l7TIO ILETI,AG,bNT4M AI l PN
."
as Owner or Authorized Agent,hereby declare that
the stateme the foregoing application re true and accurate, to the best of my knowledge and belief,
ure of Owner or Autho gent Date
(Signed under the pains and penalties ury)
NOTES r
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 110.R6 and 110.R5.
When substantial work is planned,provide the following information:
Total floors area(Sq. Ft.) (including garage, finished basement/attics,decks or porch)
Gross living area(Sq, Ft.) Number enclosed of decks/porches
Habitable room count Number open of decks/porches
Number of bedrooms Number of fireplaces
Number of bathrooms Type of heating system
Number of half/baths Type of cooling system
NOV-14-11 11:39AM FROM-E.A STEVENS CO 1781-397-7672 T-104 P-001/002 F-360
,4 C CERTIFICATE OF LIABILITY INSURANCE 11/14/2011
THIS CERTIFICATE IS
DOES NOTUA FIARNiATIVE YS A EOR NEGATIVELY AMENDAY[ON ,EXTEND OR AND ALTER NO FTHET OVERAGE A FORDEDS UPON THE ABY THE POUCTE HOLDER. HES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. to
IMPORTANT: If the Certificate holder Is an AODfT10NAL INSBI Wre•the an Endolrsement, A statement o tit S Certificate does not conferghts Subject he
the terms and conditions of the Policy,Certain polities may q
certificate holder In IieU of such endorsemen sl• CONTACT Steva Gill
.NAME: -- FAx
PRODUCER PHONE (781)322_a324 �IAM.No)•(TSS)39T•T67R
EA St.evekns COMPany. Inc- .. G o,c,,,—
elm L
AD RE331 agile®eaetaveas iae•cODt_--
389 MAIn St. PRODUCER p0006773
P. O. Box 188 aT^
INSURERS I AFFORDDiG COVERAGE NMCN
Malden MA 0214E —
INSURER A,TRAVELBRS CASIVALTX AND SORETY 19046
INSURED
INSURER IS -
ADAM DSXEY DBA PRECISION REMODELING INSURERS:
30 SEWALL S1` INSURERo_
MARBLEHEAD MA 0194S INSURERF:
COVERAGES CERTIFICATE NUMBER:ll-12 Master REVISION NUMBER:
THIS IS 1`0 CERTIFY TI1AT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TD THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
CERT1FlCATE MAY BESSSUEO OR MAY PERTAI THIS
N, THE INSURANCE AFFORDED BY THE PPOOLICIES DESCRI EDCT OR OTHER OHEREN S SUBJECT TO ALLTHEWITH RESPECT TO 1 TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN R EDUCED UCY a SY PAD c ELAIMS, urns
INSR TYPE OF INSURANCE POLICYNUMMER MMIOD MMIDD 1,000,000
LTR EACH OCCURRENCE S
GENERAL LIASIUCY �7•T0 R�l7TE0 300,000
P E IM SES(EP vc=vrc $
X COMMERCIALGENERALLIABILIY /22/2011 /22/2012 MEOEXP(ADYPnA^OMWA) S 51000
A CLAIMS-MADE ®OCCUR 680971BP704
PERSONALS ADV INJURY S 1,00U,000
--. GENERAL AGGREGATE S 2,000,000
--- - PRODUCTS-OOMPIOPAW S Z,GOO,OOD
GEN'L AGGREGATE UNIT APPLIES PER: S
X POLICY PRo- LOG COMBINED SINGLE UNIT S
AUTOMOMILE LWMILITY (Ea Bcclb M
ANY AUTO BODILY IWURY(P@PMavII) S
ALL EO AUTOS aDOILY INJURY(Pv xdtlwrt) S
SCHEDULED AUTOS PROPERTY DAMAGE S
(PeYa¢iJ9nU -.-
HIREDAUTOS $ -,
NOWOW GD AUTOS S
EACN OCCURRENCE $
UMBRELLA LIA11 OCCUR
EXCESS LIA6 CLAIMS-MEAGGREGATE __ S^
S
DEDUCTDILE y.
RETENTION S WC�YTATUU- CTH-
WORKERSCOMPENSATION
AND EMPLOYERS'LIABILITY YJN EL EACH ACCIDENT S
ANY MOPMETORTARTNE"XECUTNE❑ E-Fit EMPLOYE S
N/A
OFFICERIMEMBER EXCLUDED? E.L.DISEAS -
(MPI w"In NH)
IIyBS,poacM1bO Meef E.L DISEASE-P ICY LIMIT S
DESCRIPTION OF D ERATION 6 navo
DESCRIPTION OF OPERATIONS I LOCATIONS I VEMCLES (Amdl ACORO 107,AGdNenal RAma,LII Scnadu)a,R man appcR la repWlva)
CERTIFICATE HOLDER CANCELLATION
(97 8)745-4638 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Salem
Building Inepecter AUTHORI2EO REPRESE
93 Waahingt,on Street
Salem, MA 01970
Tho>aaa r Care
ACORD 25(2009109) ID 1988-2009 ACORD CORPO TION. All rights res(Irved-
INS025 t=009) The ACORD name and logo are registered marks of ACORD
MOV-14-11 11:39AM FROM-E.A STEVENS CO 1761-397-7672 T-104 P.002/002 F-350
-L kLjgnxrax \ -+
9j 7Li J Lq 65
'6 07/11/2911
ACORD. CERTIFICATE OF INABILITY INSURANCE _
THISCERTIFICATE 141BS AFFVM TNELY OR NECA71VVFL AN�,� END OR AEN THWECO ERA(;F EMS),AUT ORr&D PRESERVATIVE
cERDFICATE DTME or IffolWATION ONLY AND cONFl AFFORDED WV THE pOUCES BELOW.
OES NOT AFFITdA
THIS CERTIFICATE OP 00W RANCE DOER NOT CONSTTTUTE
OR PRODUCER AND THE CE3MCATE HOLDER.
DTPORTANT.WtMcmEO leol4 idwi.m ADDflIONALKSUAE� Wts At ontl �
6 dgu"M tAP WrMWni DelONt$Wtho
W't and CAroOian d do PADCY.SAdlin peOdw RIAY TOMB
.,lij hHtlPT in WualcYON endAreemRM(A). CONTACT
PRODUCER NAME: FAX
PHONE FAX
(AIL,N%Ed): (Ar,Ne):
E�srevexs co me
EDAIL
389 MAIN ST ADDPESS:
PRODUCER
CGSTOMERID A NAIL 0
MAELILIY.MA(ZT4E DTSURER(S)AFFORDING COVERAGE
22LML INSURER A: TRAVEL=S7NTIEMN'Y CCNID:ANY '
INSEIRED INSURER B:
INSURER C:
t)DZ9Y ADA14DBAI?nC35I0NR9MOr&MWG INSURERD:
INSURER E:
30 SE%ALL ST INSURER R
MARBLE 7E.0,MA 02945 REYISION NUMBER:
COVERAGES CERTIFICATEN=ER:
11te 1D TO CBTRFYTFIA TdED
CMe* WAWOAM HCH�� _
ANTRfQUpaBU OR EENNDON ERIODUCICATM
Of YCW"OT OR ONSUFROCTUOaAfLT TRCpRWEEY o`EDMNB OF RUai POUCIEO
NyTyUHOTWOMiOR �By-me POUCE6 DHP180 HEAEN
OR MAY PENTA THONA1UNC .
Uwe SHOWN MAYIUVE EEFM REDUCED OY PAIOCLAWS, PODCY EfF GATE POIICY QPOATE
ADDLAU�L Uwe
MR TYPEOFv;uURANOE AOUCVNUMOER WOO.YYYY p1MOPIYYYY)
MR wYO EACH CCGVR{EEAR:E $
I.TR
OFTaERAl L1AtALITY
COMMERCIAL GENERAL LIABILITY DAMAGETOREM® $
PREI4LGPS(Ea OCCNTBrMD)
CUUMSMADE OCCUR. MEDEXP(Anydm P=&M) S
PERSONAL A$ADV INIURY S
GENERALABOREOAYE $
GENL AGGREGATE L9AR APPLlESPER; PRODUCTS-COMP:OP ADS $
POLICY PROJECT LOC OOMBPlEO SINGLE $
AUTOMOBILE LIABILITY UMR(E2 acmon9
ANYAUM BODILYMJURY S
ALL OWNED AUTOS (Per psr l S
SCHEDULE AUTOS BODILY INJURY
Perec-mCTd)
HMO AUTOSPROPERV DAMAGE $
NON-OWNED AUTO$ (Pxv�den0
EACHOCCURRENCE $
UMBRELLA LIAR OCCUR AGGREGATE 5.
EXCESS LIAR CLAIMS MADE S
DEIIUCTIELE
RETENTION 3 WCST).MCRYUAIDS OTI"
WORKERS COMPENSATION AND Ue yg2PIRD lI RV3I2011 OM:Al2OI2 E.L.EACH ACCIDENT S _ 100,000
EMPLOYERM LIABILITY Yln el.DISEASE EA EMPLOYEE $ 100400
ANY� E.L.DL4EASE•POLICY L¢u1T $ 300,000
OM41SM CUJDEDT
1dodoe,y Ih IA I
ay,960 0E
Ut&5y.WP IIUN Ci tW131A11CNb AOIOw
DESCRIPTION OF OPERA710NA/LOCA'BONS'YEHIDLE&'RES'TRIC110HS)3PECUlLlY0AT5
'11ASREF`CO ANY PRIOR tlWl QVIYISSUYDTU'17LlItY3TTLHl'Al'I:HVLDYIL.U'll!L'11PU\VVIUEEILT VVW L'VYBMA(H.
TVEWOMMN COto`1S+ AMONPOLILYDOEENOTRtOVMECOYIILAGEFORMMYADAM-
CornI ATE HOLDER CANCELLATION
My OF SATF.M SHGULOANYGF'THEADOMB DEHCW���uDE EO POLICIES DDELNEAED IN ACCORDANCE
THE EXPIRATION DAYETHEOWP,
93 WASUNGIION ST V ATH THE POLICY PRONTSION&
AUTHORISED REPRESFIITATIVE
SATM M.A. OlrO C�TRr sI CtRrk
1986.2009 ACORD CORPORATION_ All rights reSETYed.
ACORD 23(200S1)R)
e
Contractor Agreement
This Agreement is of 3 day of November 2011 by and between john Lunt Here after called the contactor,
and precision remodeling between after called the Owner
WITNESSSETH that the Contractor and the Owner for the conditions name agree as follows
Scope of Work
The Contractor shall furnish all material and perform of the work on the property at 6 Greenway Rd
Salem ma 01970
Work Performed:
Build new front stairs
Contract Price
The Owner shall pay the Contractor for material and labor under the sum of$4310.00
Progress Payments
Payments of contract Price shall be made as follows
Half down and remainder upon compilation
Signed.- day day of 20 /
Owner / Contract %f
CITY OF S.V-F—%1, Akss.wHuSETTS
9LILDLVC DEP.IRTLLN-r
120 W.ISHLVGTON STU". }ao FLOOR
TM (978) 745-9595
K13COFRYEY OXWOLL FAX(978) 740-49
MAYOR 7}10.+W ST.FtEtRs
DIRWTOE OP PLBLIC PR0PERTY/8t:M0LNG C0\01ISSI0NER
I
Construction Debris Disposai Aftldavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code. 780 CMR section I I I.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 p
111, S I SOA. roperly licensed waste disposal facility as defined by MGL c
The debris will be transported by:
04me of hauler)
The debris will be disposed of in :
(name of facility) K f9`X�tiCN
(�ddrcef of fxduy)
eiyn�rure ofpermrt�pphunf�
Lta