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1D HALSEY WAY - BUILDING INSPECTION (2) t BU DDqG DEPARTMENT 120 WASHD4 TON STREET. 3M FLOOR m� "I7j. (978) 745-9595 FAx(979) 740-9846 l`I_tgBERI-EY DRISCO L A�l'L Yof Tun.%Us ST. 1.ma DIREC<OR OF PUBLIC PROPEPTV/Psi:"LDL4G CO%f—WASSIOi Ei' Construction Debris DISPOS211 Affldav tr (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MG—I 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 MGf. c 111, S 150A. The debris will be transported by: 5 hoc+ 7t� (name of hauler) The debris will be disposed of in z (name of facility) (address of;acility) signature of permit a ant Jebtisal:due ;= CITY OF S.UEi , XL'tSSACHUSETTS BUILDII:G DEPARTMMNT ' - 120 WASHINGTON STREET,3w FLOOR TEL (979) 745-9595 F.qn(978) 740-9846 KIMBFRI Fy DRISCOLL MAYOR THObths ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BL'ILDCgG CON11MISSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricimns/1P9umbers Applicant information Please Print Le ibly VatTic(Busimss OrganimrioMndividual): Address: I q A C ��Y R b r� City/State/Zip: hone #: Are v n employer?Check the appropriate box: Type of project(required): I. I am a employer with 4:�' 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers' comp, insurance. 9. El Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions myself[No workers'comp- c. 152,§1(4),and we have no 12.❑Roof repairss�� insurance required.]t employees.[No workers' 13.0 Other LC� comp. insurance required.] ^Any applicar that checks box 91 most also till out the section below showing their workers'compensnuon policy information. t Ihnneowners who submit this affidavit indicating they are doing all work and then him outside contactors most submit a new affidavit indicding such :Canrro.:tum%hot check ibis box must attached an addiliwed sheet showing the name of the sub-r:antractors and their workers'camp,policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: e�✓«it`-'T!a ��i, - /�G��Js �'l Q Policy#or Self=ins. Lie.#:�_G / L41E Z �' Expiration Date: Job Site Address: l/_ ? s k&e--y ry Ciryistate/Zip:—!5�0/ef#i r / Attach a copy of the workers'compensation policy declaration e(showing the oilt7 number and expiration date).• Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investig ations of the DIA for insurance coverage verification. I rho hereby cerdfy r die pains and enahies of perjury that the iajurmation propided above is rime and correct 31 Si•nat ire. Dare: �.S % � /figgQ y�p� Phone#: �L'O " C1' LrU 3 Official use¢illy. Do not virile in this area,to be completed by city at town official City or Town: PermittLicense)l __ Issuing Authority,(circle one): _ 1.Board of health 2.Building Department 3.City/town Clerk 3.Electrical Inspector S. Plumbing Inspector 6.01ber Contact Person: ___ Phone#: The Commonwealth of Massachusetts I Board of Building Regulations and Standards CITY O Massachusetts State Building Code,780 CMR SALEM Revised Mar2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: I Date Applie . 0- 2, So 6 1 D �-1 3)3 B l uilding Official(Print Name) Signature Date 1 SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 1.1a Is this an accepted street?yes-100-1� no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq It) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 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 ifyes0 Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP[ 2.1 Ownert of Record: . /1 7a Name(Print) City,State,ZIP ZZ) /&/5 e Y. �•✓ GYP �G z-©7v� S.-AP,-z44'?'o tH�, No.and Street Telephone Email Address -_ SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other a Specify: Brief Description of Proposed nnWork2: /f e �' 7-i'-c 2 rPG�t e. Oc�7` lr•.,v SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1. Building $ `do 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Su ression) $ Total All Fees:$ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ L/ t9 Q ❑Paid in Full ❑Outstanding Balance Due: MN 1.:�'--'—D q h + SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) L-- ram,, OS9 Jt-�'� -' 4- �� -? .�4' /� Y. je �7 e y License Number Expiration Date Name of CSL Holder r /r R�b List CSL Type(see below) tJp No.and Street Tye Description Unrestricted(Buildings u2 to 35,000 cu.ft) Restricted 1&2 Family Dwelling Ct own,State,ZIP M Mason ry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) /��r7T' E /7foG z on "11✓ n Date /�—� ' l�+Y;n i�' HIC Registration Number Expiration Date HIC Company Name or HIC Regysaant Name f�i�!/y'Y /C GC Nor�nd�S/t/feet d'6 y'�G 17Ya'• �j ` �D Emil address "'"'' sCG:3�'' City/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 BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize - °G"�— L��of s to act on my behalf,in all matters relative to work authorized by this building permit app cation. 3 -157 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER' OR AUTHORIZED AGENT 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 Agent's Name(Elec[runic Signature) Date NOTES: I. 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 can be found at wxyw.mass.eov/oca Information on the Construction Supervisor License can be found at wsvtv.mass.eovidos 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage, finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system - Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost" ` - American Properties Team, Inc. .• �® [,1AL'D . iSl'ECTiONAL S€R1C1E: o , 201b MAR 20 A ct. 0�1 10 TO: lXHalsey Way FROM: Jennifer Pappas, Property Manager RE: Deck Replacement DATE: March 23, 2016 Please be advised that the Board of Trustees for Pickman Park has approved the replacement of the deck at the above referenced unit. This approval is contingent upon it matching the existing deck (composite materials can be used) and following the Engineering Alliance Deck Specifications. The Board will not allow any design alterations. We also require that permits be pulled in advance (regardless of what your contractor may tell you), and then a copy of the fmal approved permit once completed must be sent to APT for the unit file as well. You will need to bring a copy of this letter to the Salem Building Department in order to receive, your permit. Should you have any questions or require additional information,please feel free to call the APT Service Team at(781)932-9229. cc: Unit File 500 WEST CUMMINGS PARK-SUITE 6050- WOBURN -MA .01801.781-932-9229 •FAX 781-935-4289 Emery Constructions LLC Estimate # 19 Kelley Road Date Estimate Salem Ma, 01970 2/9/2016 E1s-z18 978-880-2638 Christine Pollock 1 D Halsey Way Salem,Ma.01970 Description Cost Total As requested,we have prepared an estimate for the replacement of the rear deck. Remove and dispose of the existing deck. Frame new pressure treated deck frame with 2 x 8 framing material. All stringers&4 x 4's to be pressure treated as well. All decking to be 5/4"x 6 pressure treated decking. All rails to be pressure treated balusters and 2 x 4's. All hangers and fasteners to be to code. Permits will be obtained. Painting and staining by others. All existing footings to be re-used. Total Stock&Labor 4,200.00 4,200.00 Total $4,200.00 Brett Emery From: Christine Pollock <silkey24680@gmail.com> Sent: Saturday, March 26, 2016 10:04 AM To: Brett Emery Subject: Replace deck 1 D Halsey Way Brett, Please replace my whole entire deck as we spoke about earlier at my address I Halsey Way unit 39D Salem MA. Please replace my whole'deck,with pressure treated wood at the price of 4200.00 Thank you! Christine Pollock 1D Halsey Way Unit 39D Salem MA (Pickman Park) t ,I PCONSTRUCTION, LLC Commercial • Residential Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-c593" BRETTSEMERY= 19 KBLLY RD SALEM MA 019�f P' 'r�` n-nz�• J�-�- G- Expiration commissioner - 09/2512016 TTS 'R VER SSWCENSE 531450790 09-?52013 09-25-,i9 Ar ars -air sir D rrol hI � Iry a EMERY BRErrs 19 KELLY RD - a• , sALEM,MA- :197(M314 s - J/rc r(nnriuOrrrccrr/�l c/�" V-� i,-,�t*HOME Officofcoas:me Affairs&BusinessRgultionLicense or registration valid for individul useonly IMPROVEMENT CONTRACTORbefore the expiration date. If found return to: �;Registradon: 176626 Type: Office of Consumer Affairs and Business R Expiration:. 9/102017 DBA 10 Park Plaza-Suite 5170 Regulation _ EMERY CONSTRUCTION - Boston,MA 02116 EMERY 19 KEL - __./��e""" 19 KELLEY RD SALEM,MA 01970 �{�-�-_�" �— Undersecretary Not valid with: gnature