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13C GRISWOLD DR - BUILDING INSPECTION (2) PUBLIC PRQPERtTY DEPr1R'I11�IFa�TT �/AY'Ot 130NVAsFua�F1S11EiT• 'S�tl 01g, - 'IEi:9'67ii9S9S�FNC;97L7i0.9eN AFFII.YCA I'I®N F®R.,' ?,-RE RFENO�.�'I<'dON CdDN '�'R L Olt! DEMOLITION. bR CAANC3.E OF USE OR OCCCANCy„F..OR..A1�iY�E7�Q3'i"INC STRUZ"TUREORsBUILDINC. 14SITE INFOR, TION Locatlon Name c- 0.✓1 : C _ Pudding: — t'►oDeKYAdores!, -jS- C- �sw r: e -.. Propsrty'li iocaCed in a;'Cor eervatlort Arsa YM Hlstorlc DIiMd Y%N '2A OWNERSHIp;INFORMATION Z. Owmw:of Lane , Name: �er� WII C)1a70 Telephone:: S(_iO 7 05 1 3:0 COMPtETB.TH S SECTION FOR'WORK IN EXUMW BUILDING$ ONLY Addition Existing Renovation' 'Number of Stories Renovated> _ . rAppr,oximato-yearof. hange In:Uss NeNr xistin•Areaper floor(,dq Rennstrucdoww-renovation - , of existing 6u41ding New Bcief,De pticn.ot`Psed,,WAYnoV� `(= ( f�Gl Slll\+�C 11�v1S �� e,tit,)c Mail Permit to . oem t�'l . roS e . V,-7( ) Crry OF SALEM PUBLIC PROPEMY DEPARTMENT TM 0&7464M 6 IPA&9Ml+64w Consbvcdoa Ddbrb Obiwat AfiMavit ( "ow.22 daoom"sod mwvador waft id a000nfaaoe witb tha a6ctlt.dit6s a[dw St W Cody,7M C MI seedow 1113 0&"mod dwp mvbimM a llM a 14 s 54 _ a&�"be d gowd Ois a peop=l r Nwd craw drat-$ d.Wl d by M G dbywi Aait<gt>.d.flaed by 3(R3.e ttl.Stl0/1. ' 'I�e drJxia will be lowpoeta0 b9t iwd at The d4lxW will be disposed o(in: Iwo 1 �,,� ��` wl�raoe_ o2c?(40 (*Idomm of hs;uM Siva"afmmk ow >o, 1 esos CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT xawsusY t:atsooct. Ms M745.9595 a Fax:9W40.9me6 Workene Compensation Insurance Affidavit: Benders/ContractorsMeebiciena/Ptnmbers Applicant Information . ['_nncftruct"o y Specialties Plea,"]hint Legibly Name(stwimso ) .1 P.O. Box 53 ON Be Address: City/Swamp! Phone# 7 g� — (£ (e An •as employer?Check the appropriate best Type of prefect(regrdred); 1.p 1 am a employer with�_ <. Q I am a general contractor and I employees(tbil and/or part-time).• have hired the sub•eonttadoq 6. ❑Now caostntctim 2.❑ I am a sole proprietor or partner• listed on the attached sheet t 7. ❑1temodeling ship and have no employees These sub-oonnactca have S. ❑Demontims walling for we in any capacity. workers'comp.Insurance. 9, Q gip addItim [No workers'comp.tunuamm S. Q We are a corporation:and its required j ofters have exercised their 10•0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exanption.per MOL 11.Q Phunbing repairs or addldons myself[No workers'comp. a. 152.¢3(4),and we have no 12.Q pp Insurance required.]t employees,(No workers' 13. l�l �[1 comp.insmuce Sri•) Awwplia tWdm ttasetam.rs4owoWdwswtgmbdowremhq&irwatmfoS ad patloaao cybig rue.. .. Hmrowwo w3owbmk dda aaldwn tadtntlea dayaw ea+as as wadtaed em-tdw ana ddi emtraeesn mare side a een amdM*Acomadon ad leek&b box naw amched an addldmd.baw dawdea Abe a of dw nb.e�and tlwtr Wachs,MW !one an employer that 4.proaddlwr workers*eowpexradon firjorwat/aw. Gaarewe jor wy ewp/oyoa Blow/s 9ke po1&y axd/ob rbe insurance Company Name: 6 Policy M or ScW-h .Lis.M: Uy C-k'I gapbzdm Date: a 3 ©7 Job site Addceaa � ?i C Cley/StatarLip Attach a copy of the workers compensation Polley deelssadon pap(showing the Polley number and expiration dab), Failure to secure coverage as revired under Section 25A ofMGL a. 152'con lead to the imposition oterimiaal penalties of a fine up to 31500.00 aad/ar one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a Rne of up to$250.00 a day against the violator. Be advised that i copy otthis statement may be forwarded to the Oflioe of Investigations of the DIA for insurance coverage verification, /do hereby caetb under she paw/and psnalNss ojperJary she?tiv lnJorssteafow proadd eye Is nme and correct Signature � T � Da w . Yet Phone M: — S ` Y41-0 OJJlclaf an on/Ju. Do not write/w tAris area,to be coatp/eredby c/a,Or/own of W 4 City or Town: PermlNldeease/ Issuing Authority(ehets one): L Board of Health L Building Department 3.CRY/rown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone M: j. 00,-35,000 cf enclosed space it (MGL CA 12-S.60L) 1A-Masonry only 1 t G I&2 Family Homes Failure to possessa current edition of the -{ IvIassachuse8s State Building Code -is cause for revocation of this license. j r k DIG-S'SAFE CALL CENTER: (888)344-7233� - 92. eon BOAR ems` 1' D OF 96�REGGL?/ATA. ,.license CONSTRUCTION SUPERk§Dl ' Number. CS 05SBQ7 :: Birthdate t 5j02(�196�. �� F _ Exp re `Q�'J/0212007 Reskricte"'�d TIMOTHY J FINN f 8\'/ALDORA DR/PO elan STONEHADI, N1A 021'b0 t Commisslo� r PROPOSAL CONSTRUCTION SPECIALTIES UNLTD., INC. P.O. BOX 53 STONEHAM, MA 02180 Phone (781) 665-4410 Fax (781) 665-4411 L E N N OX BROAN-NUTONE HEARTH PRODUCTS Gam( A NORTEK COMPANY « c S ��Grsvool� -aa -07 S4.Ie vI)ew L-e�nox $V.r^3f� �c Ploce l ��,m �ey �yswt nose6_ ferry), 1 n t � A c4a � II p ri C—e- CtA n'h'nSen b,,n i nSi ClR t A S C2 � NO& We propose hereby to furnish material and labor - complete in accordance with the above specifications for the sum o£ AS ABOVE Payment to be made as follows: For special orders a 50% deposit is required. For central vacuum and intercom installation, half is due upon rough-in and half is due upon completion. For all other work, ayment is due upon job completion. Authorized Signature NOTE : All plumbing hook-ups, carpentry work & building permits are the responsibility of the job site general contractor or homeowner. Prices are effective for up to 3 months from date of proposal. Acceptance of Pr o The above price;spexi5wti.. v ere eat;sfadory erM are bar a Pt oo ere autboflz to do the work as sp ed, payment be made d oo,l ood above. Signature Date: If pted pleasygn and return. �a�5 2� �Q What ls`ftVurrent uss of tha8wtdirig7 Un l7 Q O N•d"l ling.how manyvn�ts? .. Matwtal-af°Buildiny4 �-- Asbestbs't WiM'.ths Building;Can�^.tO`lcaw't puchitecGsName _ . :., Address an&PhoM Meohani s Nart+e Addms aril>Ptk", Construction supeivisomucess*n �S®�' (� MIC^Regfstatkut.�i Esb=ted:Gost of'Prolect s. aa7�•®0 Pennit'Fse Calwistbn Estimated X Cost s7/s1000'ResldentW Permit Fee's _ _. _ _. _- .___, __ estimated.eoatXsslrsl000Eomn+ereial------ An Addhionahis.00-Is,^addod as an -- Adrtiinistrative ct+ery , Make sure that al4.flekla ars properly and taytbiy-written to avold�delaya lh-proeesaing. Ths undersigned "does°hereby apply for.a Buliding Pertrtit=to-bbuild to:=thSs abo^vs^stated' speciticatlons. 'Slgned under pen'' cf penury Date (AD l CDC o CL y L a