Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
1 HARROD ST - BUILDING INSPECTION
The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALENI Building Permit Ap icafto oConstruct, Repair, Renovate Or Demolish a Revised blm•2011 One-Vr Two-Family Dwelling This Section Fbr Official Use Only ' Building Permit Number: D to plied: 3 — Building Official(Print N;une).� v . - Si, re- LI Property Address: - SECTION L SITE I FOWNIATION i 4Azc r A sl_- 1.1 Assessors map&Parcel Numbers L I a Is this an accepted street?yes ✓ no_ Map Number T — 1 1.3 Zoning Information: 1.4 Property Dimensions: ,reel Number LuningLuning 0�— Proposed Use-- Lot Area(sq It) Frontage(R) LS Building Setbacks(ft) Front Yard Side Yards Provided Re Required Provided Rear Yard Required aired q Provided 1.6 Nater Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: Public❑ Private CIZone: 1.8 Sewage Disposal System: Outside Flood Zone? Check ifyes❑ Municipal ❑ On site disposal system ❑ 2.1 Owncrt of Record: SECTION2: PROPERTY OWNERSHIP' —1tGti4.P( cL 1 \ /LI/a (3 ctli7 me 1 not -S� 1-f(Y1 +ury State,ZIP Numtdstmt 33Z-(p.� fF'�,�-r,�,oQrt oye.IrK coo Telephone Emml Address SECTION 3: DESCRIPTION OF PROPOSED 1VORK3(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Brief Description of Proposed work': Other ❑ Specify: C SECTION a: ES 1 11 ED CONSTRUCr10N COSTS ( 2 > tn Item Estimated Costs: Labor and Materials Official Use Only I. Building S 3 i V I. Building Permit Fee:S Indicate how fee is determined: 2. ElectrirdS / 3O� ❑SfandardCity/TownApplicationFee 3. Plumbing S ❑Total Project Costa(Item 6)x multiplier x 2. Other Fees: S d. Mcchmiird (HVAC) S List: 5. %[echanic;d (Fire Su ression) 'S "rutal All Fces:S 6. Total Project Cost: S i 1 10 Check Na. —Check Amount l lJ ❑Paid in Full Cash Amount: ❑Outsemding Balance Due: SECTION 5: CONSTRUCTION SERVICES 10� 5.1 Construction Supervisor License(CSL) License Number Expiratioll Date dC�l� j Nmne of CSL Holder List CSL Type(see below)�— x .type Description No. aid StreetU Unrestricted Buildin s u to 35,000 cu. it CAC�x- 0 R Restricted 1&2 Famil Dwellin I ��•tfln CJ�CJI IA �i Mason Cityirowi� RC Rootin Covering WS Window and Sidin (xC SF Solid Fuel Burning Appliances C31 Insulation qQ— J�(\$(o Demolition Email address D Tele none a 3 5.2 Registered Home Improvement Contractor(Inc) II C R gF1(C R gr Exp, ution Date IIICCon :my ,pNamcorHt- RSegistrantName 15S,+, h/lA r�'0 /a Email address / No.mid Street Mfl v\Q`�J Fol$ t%g, W(u) _ .. Ci Town, tate,ZIP Tele hone SECTION 6:WORKERS'CONIPENSAT[ON.INSURANCEAFFlDAVIT(MIC.G.C. 152.¢ 25C(�); Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Isthe building permit. Signed Affidavit Attached? Yes ..........suanc No....... SECTION 7a:OWNER AUTHORIZATION.TO BE COMPLETED W HEN' OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUNG PERMIT` 1,as Owner of the subject property,hereby authorize \C t9 act on my behalf,in all matters relative to work authorized by this building permit appli ion, t Ct A Date PrinF O ner's Nmne(Electron,c S,gnnture) SECTION 7ti.OWNERI OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby,attest under the pains and penalties of perjury that all of the information contain dint is applicatio is tru and accu me to the best of my knowledge and understanding. D to Print Owner's or Aut,onzc r It an,c(' cctronic Sign'�O'I ES: 1. 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(111C)Program),will'"Ithave access to the arbitration program tor guaranty ides on the Construction Supervisor Lirtant cense can be found or ation on the ata Prog,?m canvb ltfound at ?. When substantial work is plumed,provide the information iuinglgarige, finished bascment/attics,decks or porch) Total floor area(sq. RJ Habitable room count Gross living area(sq. It.) Number of bedrooms Number of fireplaces Number of half/baths Number of bathrooms Number of decks/porches TYpe of heating system Enclosed —Open Type of cooling system 3. "Total Project Square Footage"may be substituted for`"Total Project Cost" CITY OF Si1LE,\I, tiL-15S.1CH CSETI'S B12MDING DEPARTMENT 3 1r 120 \SU.iSHCNGTON STREET, 3aO FLOOR TM (978) 745-9595 F rax(978) 7.10-9846 KINfBERI.EY DRISCOLI- lYiYOA THON sST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING CO>LUISSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly 1 Name (BusintssOrganiralion,'Individual):_�� C�7� ( L w )n (- Address: n (-Address: 11 G�� aaa 3 31 City/Statel7.ip: A Phone N: Are ymu• employer?Check the appropriate box: Type of project(required): I.Srl am a employer with 4. ❑ I am a general contractor and 1 6. ❑Neiweonstruction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner. listed on the attached sheet.t 7• Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working lir me in any capacity. workers'comp. insurance. 9• ❑ Building addition INo workers' comp, insurance 5. ❑ We are a corporation mrd its required.] officers have exercised their 10.El Electrical repairs or additions ).❑ Iain a homeowner doing all work right of exemption per MGL I I.[] Plumbing repairs or additions myself. (No workers'comp. c. 152,41(4),and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' I3.❑ Other comp. insurancen:yuired;J •Any epplivant rut checks box el most six.611 out Clue section M:luwshowing their workers'compensation policy inll,rmatiun. 'I Lwrucuwtxn who suhmir this affidavit indicating they arc doing all worst and then hire outside contractors matt submit a new affidavit indicating such. :c.mtmctors that check this boa must attached an addaiwml sheet showing the nwne of the sub-contractors;and their workers'comp.policy infurmatian. 1 ran an eutpluyer that is providinAr workers'compeusadan insurunce for my employees. Below Is the policy undfob site information. I Insurance Company Name: \Ara k- Q Policy A or Scif-itis. Lie,da 0- V 5—k�DE—: � E xpiration Date:—kL "\ - lob Site Address: \ ` \ICII/Cy 1.\ S_� City/State/Zip: .7 ,4 � KAVA 00 q Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure cuvdmge as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a line up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. 13e advised that a copy of this statement may be furwarded to rhe Office of Investigations ol'the DIA for insurance coverage verification. - I do hereby cer i y under lite pains a erfurydrat the informurlon provided above �i.ss true andcorrect. S'�mtt �p Date: Phoned: —11p-0 O�•OK 0 4 ` Official use oily. Do oot write in this area,to be completed by city or town offiviaL CitynrTutvn: _.__.. . .__ PermitAlcensek Issuing Aulhurity(circle one): - 1. Board of health t. Ruildinq Departuteut .i.City/rows Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person Phone ft:_ I - rye CITY OF Sm�Emll NLUSACHUSETTS t ©t:1LDL,;G DEPARTM&NT 130 WASHNGTON STREET, 310 FLOOR "F TEL (978) 745-9595 Kl\LBF_RL EY DRISCOLL F.kx(978) 740-9845 ,tiL-XYOR Ti-imLis ST.PtE.RRa DIRECTOR OF PUBLIC PROPERTY/BUILDLNG COMMISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 730 CMR section l 11.5 Debris, ;utd the provisions of MGL c 40, S 54; Building Permit J# 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 11 1, S 150A. The debris will be transported by: (nama ofhauler) The debris will be disposed of in (narnc of faedity) 0_ a J3 Iv.0.lN - (address of facility) i -,A s re ofpermit applicant date Rightfax C2-2 1/23/2014 4 : 54 : 44 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATErMM/DDnvvn TWLS.GERTIFICATE 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 C KATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: M J FOSTER INS SVCS INC PHONE FAX 163 MAIN STREET (A/C,No,EXU): (AIC,No): E-MAIL NORTH ANDOVER,MA 0105 ADDRESS: 75rK I NSU RE R(S)AFFORDING COVERAGE NAIC9 INSURED INSURER A: ACE AMERICAN INSURANCE COMPANY MIS CONSTRUCTION INC INSURER B: INSURER C: INSURER D: 177 MAIN ST INSURER E: LYNN,MA 01940 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INSUREDANDING MYRECIIREMENT,TEFVAORCCNDITICNOFANYCONTRACTOROT7ERDOGMENTWRHRES�ECTTOV*ICHIMSCEFrnFrATEMAYBEISSJEDORMAYPERTAM THEINSUWJJCE AFFORDED BYTHE POLICES DESCRIBED HEREIN IS SUBJECT TOALLTHETERr,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMrs sio.N M y wi:BEEN REDUCED By PAIDCLAIMS INSR ADD SUB POUCYFFFDATE PCLUCYEXPDATE LTR TIDE OF INSURANCE L R POLICY NUMBER (MoTDDUYYYY) (MADDIYYYY) LIMITS GENERAL LABILITY EACH OCCURRENCE COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE ❑OCCUR. PREMISES(Ea occurrence) MED EXP(Anyone person) $ GEN'L AGGREGATE LIMIT APPLIES PER. PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ POLICY ❑PROJECT❑LOC PRODUCTS-COMP/OPAGG $ AUTOMOBILE UABIUTY COMBINEDSINGLE $ ANY AUTO LIMIT(Ea accident) ALLOWNEDAUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED ADI OS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB LJ CLAWS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND WCSTATUrORY OTHER EMPLOYER'S LIABILITY YM UB-56592539-13 09/052013 03105'2014 X UMrrS ANY PROPERITORPARINEWEXECUTIVEy WA E L EACH ACCIDENT OFRCEWMBNBER EXCLUDED? ❑ $ 100,000 (Mandatory In Mf) E.L.DISEASE-EA EMPLOYEE $ 100,000 It yes,describe urda DESCRPICN OF OPERATIONS bdm EL.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS(LOCATIONS/VERCLESIRESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION ---"---`--mm mmm CITY OF SALEM SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED 120 WASHINGTON STREET BEFORE THE EXPIRATION DATE THEREOF,NOTICE NLL�6E DELIV ED IN ACCORDANCE WITH THE POLICY PROVI$WD SALEM,MA 01970 rK- AUTHORIZED REPRESENTATIVE ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988.2010 ACORD CORPR nghts rem �ed. -- 1/22/2014 2:45 FM FROM: Fax M.J. Foster Insurance Secvicee, Inc. TO: 918-140-9846 PAGE: 002 OF 002 MJS.CO-1 OP ID[RA DATE(MMIDDfYW11 CERTIFICATE OF LIABILITY'INSURANCE 0V2212014 THISCERTIFICATEIS 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-INSURERS), AUTHORIZED . .REPRESENTATIVE OR.PRODUCER,AND THE.CERTIFICATE HOLDER. IMPORTANT: Jf the certificate-holder is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to. the terms and conditions ot.the.pollcy, Certain policies may require an endorsement. A statement on this certificate(does not confer rights to the certificate holder in(leu of such:endorsement(s). PRODUCER Phone.976-666-2266 CONTACTNAME, . . . . North sten Ins murranee Se Agency PHONE Ppz MA. Foster insurance Services Fe%'976-666.6410'pe NoEkIL__y1 . L: yy___y—__ _ ____ a _ _ _____—. ———— 163 Main St. ADDRESSNorth Andover, MA 01845 Michael Lescord INSURER(S)AFFOROING COVERAGE NAIC# WsuRERn:TRAVELERSINSURANCE CO INSURED MJS COn6tfUC110h,'1DC. INSURERS ACE:AMERICAN,INSURANCE COMPANY 177 Main Street INSURER Lynnfield,MA 01940 .INSURER C: INSURER D':. NSURERE: INSURER'F- COVERAGES CERTIFICATE NUMBER`.. 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 IOF 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 ALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN,REDUCED BY PAID CLAIMS" LTfl�TYPE OF INSURANCE POUCYNUMSER MMSO� -MEFF -PMJDO :. . LIMITS .GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X GDMMEPCIAL GENERAL LIABILITY 68078561510 07/0912013 .07/09/2014D n TUT.EFC.I _ PREMISES(Eaecprrsroe) 1 300.006 CLMNSWADE 1:X1�OCCIO ..MED EXP IAnv one Fasorl I$ 5,000 . . . . . . . PERBONALeADy:iNLUev _ s 1,006,00 _____ GEUERn�nGGk�eATF ,q _ . . 2,000,00. GEN'L ALIREIGATE LINIIT APPLIES PER .:PRODUCTS-COMPOP AGG $ 2,000,00 X.1 POLICY^PRC :LOC AUTOMOBILE LIABILITY C(`M NE[151NGCE LIMIT 1,OOD,OO- :(Eeaccden:) $-_.. A gNYALTO . , . 68076561510 07109/2017 .07/0912014 BODILY IN'ORY(Pehor,e"I Is ALL OWNED BJHEgULED NJ1'OS ,'LTGS- :BODILY INJURY(Per.ealyl'entl $ NON OWNED. PR TMY DkAIAGE X iila�D euros X MOS. Per _0 t $ _ _ UMBRELLA HAD "COCUR .:EACH OCCURRENCE $ EXCESS LIAR CIAIM9-MADE- '-AGGREGATE t DED I I RETENPION $ WORKERS COMPENSATION. N�Suws E AND EMPLOYERS LIABILITY VIN X rJFY LIMIrS: ER B ANY PRgPRETORPAP"NEPEXECUHVE WC ASSIGNED RISK 09105/2013 0910512014 'EL EAC ACCDE_NT 4 10000 OFFICERBIENIBEREXCLUDEDI NIA _ (Mandatory n NHI - TO BE ISSUED BY CARRIER :EL DIScA£-EA EMFLO`!EE $ 100000 (yySCRIPnONCrl j21111( "DESCRIPOFORERAHUFIS AaINw j I'EL.DISEASE'-P0LICY LIMIT $ 'SDDiDDD -DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES U t,h`AC0RD 101,Addlttonel'Remark¢Sche9ule;If more space I.T,W ed) CERTIFICATEHOLDER :CANCELLATION SHOULD,ANY OF THE ABOVE DESCRIBED.POLICIES.BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICEWILL BE DELIVERED IN CITY OF SALEM ACCORDANCE WITH THE POLICY PROVISIONS. 120'WASHINGTON STREET SALEM,MA 01970 AUTHORIZED REPRESENTATIVE ©19.88-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name.and logo are registered marks of ACORD f, i 1 Massadfitrsetts •Department of Public Safety ' . 3 Board of 8widing Regulations and,Stanc,�afds p - 'Constjucffun Stipcnnsor ,. License- cS-106470 { I MICHAEL SEUL - 177 MAIN STREET kluv Lynnfield D1A 01940 % "'`' ,�nro`� Expiratioal 0311912016 Commissioner y K t \ Office o(coneume;. airs "Bu3`roeegu a rt'ou'" < �¢s M HOME.IMPROVEMENT CONTRACTOR Type q s Registration y173428 Corporation ° ?� j Expiration 1013!71014 P { r e •M' ONSTRUCTIOfN 06 M §MICHAEL SELIG i� � Jle' 17'7 MAIN ST LYNNFIELD,MA 02940 -� ., Undersecretary