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27 HERBERT ST - BUILDING INSPECTION u j ------------ 7 --- I he C'ommonwe;l116 of blassachuseus o Board of Building Regulations and Standards ( I'1'1'OF �/' tr \lussachusetts Seuc Building Code. 7SB('AIR SALli.\I Building Permit Application TO Construct. Repair. Movatc r Demolish a One-or run-Pio)jrfr U,r.• in.p This Section For 011ie ul I I i Building Permit Number. Date A lied: AulJiny011h•iul(I'rinlN;une) Signu rc Bate SECTION I: SITE INFO ATIO I.I Property Address:2-7I.2 Assessurs Alap di Parcel Numbers t/�i�13'T�� S`r I.la Is this an acce bd street? a no blap Number I'urcel Nanthcr IJ Zoning Inforinatlont 1.4 Property Dimensions: Looms District Imposed D--.w Lal Mru(s III 4 Fmnluye(III 1.1 Building Setbacks(R) Front Y;ud Situ Yunls Near Yard Rryuircd Provided Reyuircd Provided RequiredI'roviJed 1.6 Witter Supply:(M.G.1.e.40. §54) 1.7 Flood Zone Informations I.l1 Sewage Disposal System: hiblie O Prlrjig O Zone: _ Outside Flood Zone? Cheek If vs0 Municipld O On sib Jispusul s)stem O SECTION 1. PROPERTY OWNERS.... 1.1 Ow_nef sofReeordt 7p, i wile(Print) ZA TS - elisu- /2 /`!- � �ILitdLS Nu.;mJ Stnel fe r hone AL-. NET P Elnail Addn:ss SECTION J: DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction O Esisttng Butldiny O Owner•Occupied ❑ RIll:tnls) ❑ Alterottonls) Addition ❑ De viol ❑ Accessory Bldg.O NuniberofUr Oil escriptton of Proposed Work': Other O .Spueity: G SECTION J: ESTIMATED CONSTRUCTION COSTS Ilan Estimated Costs: 11.a1\L,.erialsl Omclal Ust Only 1. Building �Me 00 1. Building Permit Fee: S • d0lndicate how fee is detennineJ: `. Iflectrical i OStanJard City:Tows Application Fee I I'hunhu,g S ❑Tutai Project Cosll 1 hen.6)1 multiplier _ Z. Other iii S J. \Iedl,wic.d ill\ \('1 j List: 1 �u res>iun: S rota 111 Fees: n 1"otul Project Cnsl i ( lied No. ( heck Ammmt: l'.ish \niounl: ❑ P.iid in Full 1301 . anJiny Flol,mee Due: • slI I ION 5: CONS I'RIICFION sl•;Rll'I('ES i,l Construction Supmn iiur L9icetu/e(C'S1•i I.,Ir,alnn H,ne - - N,uncull'Si. IInlJcr Inll'SI. I')pcl�eabclaol.-_._ 0���D_.. . pe imi riptiun /` , _ _ _�l�/_-zg --- - Q - 11 I-- No. .uIJ mrn�, htrcstncleJ I OwWi l n i liIt' lt,lllll) /AM .. —. li I1a,uicl.J IR?Tamil f)„ n elli lA _ 11 11esw1 Slue./it, He µ,wlin OlWin N'S %I uluSidin -- sF SuliaFuelIhlminyAppII-11 C y� �D� I 7 Iniulutiun 7 J� " �p /'h'�V — Dumalitiun n:ul aJJruss �f" U IV IV hums J$7 i.2 Rrgislcred Ilume Improvement Contractor(HI IIIC Itcgbtrauun Nunthcr I:.plrut unData f�R6SToN B✓h7Z l� im — IIICCon, > Nanteoy_struntNam� �5%a C� y/�/r9��dA 4Q iddress No. ;md5Vy11 )HI h� ae hone Ci frown,State ZIP WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C. 1l3. =3CM SECTION 6: th this application, Failure to provide Workers Con1pensatlon Insurance affidavit must be completed and submitted wi this affidavit will result in the denial of the Issuancrof the building permit, Sign edAffldavitAttached? Y Its..•.,••••• SECTION ')'a: OWNER AUTHORIZATION TO BE CO'iIPLETFD WHEN PUT OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERM I, as Owner ofb the f,In all property,hereby a work a this building permit application, to act on my behalf,in all matters relative to work authorized by 9 ZD /Z AMC Dte Print Uenar's Nwne EfCCIrnItIC$IgnalURti SECTION 7b:OWIVERt 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 o the best or my knowledge and understand. � Ihinl gencr's ur AulhonrcJ,\µnt s Nunse 11 I Mtn n1�\lyn Rural Norl st O%vtAn rot registered inbla,913he a hJprupermit to do lower o%vn Programin illnm er shave access loircsan tihe arbitration pn,gnm ur guar10 iyl fund nfomru un tin he Coestruclion Supery for Lic f nse c.in be found at 1 PWk Ill rogram Van`bml'found at \\'hen substantial,wrk is pl:u,ncd, prusiJe the inl'u'lill`ludiion nslova ro. tinishad bascntcnt attics,decks or por0lt g S� b rota) dour area 111.1. 11.1 . ----"— Habitable room count g area 1 iy. It I \,usher ul'bedrooms I (iroii lism .-.-. - N"111 Ill'Iircplacci ,. ... _ --- I), hall \lusher ,I tiath«wws - . - \luuhcr ol'Jecki parchci I'�pc Illheaung i),tem (teen I'nclo.cJ 1 ..I,d,ll I'r„Ica S,Illare Fool lea"111,1) he ,Ilh,I IIIIteJ 11Ir"I'JI,11 'hojeel C„lt'• 1 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-097288 RICHARD P WARD P.O.BOX 543 HAMILTON MA7019366 Expiration Commissioner 04/18/2014 Office- coir meI fairs ufinessv- t"1'egi�T.an`�on License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date:., found return to: Registration: .y157045 - Type: - .Office of Consumer Affairs and Business Regulation Expiration 8/30/2013 Private Corper<:tio. 10 Park Plaza-Suite 5170 F --� Boston,MA 02116 ESTON WARD GENERAL CONTRACTOR-, IIN L t � t R� HtiRD 258.MOULTON Slei T „-9,-TH H.A ILTON,MA,01982'y - t _ - y�. Undersecretary Not valid without signature. CITY OF SALEM, 2ANSSACHi SETTS y BUM-DING DFP PTNIENT 120 WASHNGTON STREET, 3}D FLOOR TEL (978) 745-9595 FAX 979 740-9846 KI\iBERLFY DRISCOLL T L~iiYOR. �IOsrAs ST.F�.QRa DIRECTOR OF PUBLIC PRO PERTY/SUIID[NG CO-,L1IISS ION ER Workers' Compensation insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers Applicant information Please Print Legibly Nault:(BusinessOrganizatiewindividual): • Pi_F'fS�dN Nrrr�p G rJ� ' Address: City/Statc/Zip: /71^ IwfLT,'fil MA Phonel/:_ -) 21 Are you an employer?Check the appropriate box: Type of project(requlred): 1.❑ 1 am a employer with 4. ❑ 1 am a general contractor and 1 employees(full and/or part-time).' have hired the sub-Lontractors 6. ❑New conswetion 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 S. [] Demolition workingfor me in any capacity. rkers'comp. insurance, Y9_ ❑ Building addition (No workers'comp. insurance 5. We are a corporation and iU required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 I.❑Plumbing repairs or additions myself. [so workers'comp. C. 152, §1(4),and we have no 12.❑ of repairs insurance required.)t employees.LNo workers' l3.[�Other t- l'ZI� � comp.insurance rcquin:d.J -Any applicant that ducks box xl most also till out the section below showing their worked compensation Policy inrurmation. 'I fi.cowrav who w1unit this affidavit indicating they am doing all work and then hire outside contmcror most sohmit a new amdavit indicating such. :Cammeton that check this boa most attached an additional sheet showing the noose of the sub�:orurwon and their worker vamp.policy infon scion. I am as employer that is providing workers'c'ompensadon insurance for my employees Below is the policy and jab.rite information. Insurance Company Name.,_.. Policy 4 or Self-ins.Lic.H: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration data). Failure to secure coverage as required under Section 25A of Y1GL c. 152 can lead to the imposition of criminal penalties of a tine up to S 1,500.00 and/or one-year imprisonment,as Weil as civil penalties in the Corm of a STOP WORK ORDER and a fine of up to 5250.W a day against the violator. Ile advised that a copy of this statement may lic forwarded to the Office of Investigutimts of the DIA for insurance coverage verification. I da h by cerrify un/dd eerr he pain earl penalties afperfary that the fnforntotlan provided above is rrue used carrerL .ill" : I Ire'. V —` - �✓ O✓LYr Data: ��•J �Z Of)iciul use undy. no not write in This area,ra be completed by city or town ofJiciaL I City or l"own: __ . Pcrmit/f.Iccnse Issuing Authority(circle one): I I. Board of Ifealth 2. Building Department J.Cilyffown Clerk 4. rieetrical Inspector 5. Plumbing Insspector 6.Of tier ..... ------ Contact I'crsmt: Phone 4: ] The CommoDwealth of ffassachusetts � - Department of Industrial Accidents = Office of Investigations s� 600 Washington Street Boston, Massachusetts 02111 Affidavit of Exemption for Certain Corporate Officers or Directors Thursday,August 23,2007 Pursuant to the provisions of MGL 152,Section] (4) as the amended by Ch. 169 of the Acts of 2002 your affidavit has been reviewed and the Office of Investigations has determined thefollowing: NOTE. It is your obligation to submit an approved affidavit to your insurance carrier in order to complete this process. The affidavit was approved O approvetl tlate 8/23/2007 _ Attached please find your approved affidavit The affidavit was rejected ❑ rejection date �� Your affidavit was rejected for the following reason(s): ❑ The affidavit was not signed by all Corporate Officers or Directors. We have enclosed another form please provide .all signatures required and resubmit. - ❑ The affidavit is not an original(THIS FORM CAN NOT BE REPRODUCED ONCE IT HAS BEEN SIGNED) ❑ Information provided does not match the Secretary of the Commonwealth Corporate records. ❑The affidavit you submitted-is.ar obsolete_form of t-he Depar-hnent. We have enclosed the appropriate form.Please complete and resubmit ❑ Corporation is not listed with the Secretary of the Commonwealth as a valid Massachusetts corporation. Other: - —_-�- Investigation/SWO ID# R. Preston Ward General Contractor, Inc. Affidavit lD# P. O. Box 543 134809 South Hamilton, MA 01936 FORM 153 The Commonwealth of Massachusetts se Only Department of Industrial Accidents ' r Office of Investigations-Dept. 153 4�/G ' 600 Washington Street—7th Floor,Boston,Massachusetts 02111 2 � ' .ti http://www.masa.gov/dia InvestJsB ID .-�_ �� c_ AFFIDAVIT OF EXEMPTION FOR CERTAIN CORPORA OFFICERS OR DIRECTORS :3Y Chapter 169 of the Acts of 2002 amended MG.L. c. 152, §1(4) by adding the following paragraph: "This chapter shall be elective for an officer or director of a corporation who owns at least 25 percent of the issued and outstanding stock of the corporation.Notwithstanding section 46,these provisions shall apply only if the corporate officer provides the commissioner of industrial accidents with a written waiver of his rights under this chapter. Said commissioner shall promulgate regulations to carry out the purpose of this paragraph. Violations of this paragraph shall subject the corporation to the penalties set __-- _-- forth in-section25C."- -- Pursuant to M.G.L. c. 152, §1(4)as amended,I/We the undersigned officers of: �PX4--5e6W1-4hy ed GE1cea4 43 ✓,yl ��o (Name ofCorponaon and Address) /M .r7/g3lo each holding at least 25%of the issued and outstanding stock in said corporation,do hereby invoke the right to be exempt from the provisions of M.G.L. c. 152, §25A and therefore are not required to carry a workers' compensation policy covering the undersigned corporate officer(s)or director(s). l/We the undersigned do also waive any and all rights to make claims for benefits as defined in M.G.L.c. 152 for any injuries that may be sustained while in the employ of the above-named corporation. Further, I/we the undersigned do understand that, should the above-named corporation hire or have in its employ any employee(s) in addition to the undersigned corporate officer(s)or director(s),said corporation is required to obtain workers' compensation coverage for the employee(s)as prescribed by M.G.L. c. 152, §25A. I/We the undersigned have read and understand the statements and obligations as delineated above and I/we have checked the appropriate box below my/our name(s) indicating my/our desire to be exempt or not to be exempt from the provisions of M.G.L. c. 152. Signed under the pains ad penalties of perjury: gnaNre Print Name&Title Date(mm/� VJ I wish to exercise my right of exemption or 0 I.wish NOT to exercise my right of exemption Signature - Print Name&Title Date(mm/dd/yyyy) 1 wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption N y - O �t Signature Print Name&Title . .Date(mm/dd/yyyy); I wish to exercise my right of exemption or I wish NOT to exercise my right of exemption „� m Signature _ Print Name&Title Date(mm/d8(yyyy) T I wish to exercise my right of exemption or Q I wish NOT to exercise my right of exemption -i ty Q O W Note:ALL ELIGIBLE CORPORATE OFFICERS MUST SIGN. THERE CAN BE NO MORE THAN 4SIGNATURE&IaarraWAR an back. Form 153-10-28-02 J CITY OF SAL.EM) MxsSACHUSETTS 8ciLDLNG DEPARa-.%L&Nr 120 WASHINGTON STREET, P FLOOR TEL (978) 745-9595 F.L.r(978) 740-9846 1< .,%IB RLEY MiSCOLL T b4,�Y0It �tO�f�►s ST.PtE.uts DIRECTOR OF PUBLIC PROPERTY/BCMONG CO-AIISSIONER Construction Debris Disposal Affidavit (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 tMGL 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 MGL c 111, S 150A. The debris will be transported by: f ieErl—dN 111AP,-b (name of hauler) The debris will be disposed of in 1/lL7 WASTE IS 6S A; L (name of facility) 2—y 1(--e VD�=L//V ,e A A 4ll4l3a (address of tacilny) �gZ signature of permit applicant da dabn;m�:dx i 1�4 •T A Iasi` -x.,ftja \�7Y1N6 W�t�. Salem Historical Commission 120 WASHINGTON STREET, SALEM, iMASSACHUSETTS 01970 (978)619-5685 FAX(978) 740-0404 CERTIFICATE OF APPROPRIATENESS It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving ❑ Reconstruction 'A Alteration ❑ Demolition ❑ Painting ❑ Signage ❑ - Other work as described below will be appropriate to the preservation of said Historic District, as per the requirements set forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: McIntire Address of Property: 22 Herbert Street Name of Record Owner: Nancy Corral Trust Description of Work Proposed: Replace existing sash lvith Kurd, solid wood simulated divided fl,�,ht, Nbc Over six windows On first and s'eG077[1 floor. Evterior nnlntins to be either I " or 7/8". Spacer between glass to be bronze. fill to be painted to match existing. "Installation to be dune In hvo phases—second floor to be clone in Fall, 2012 and,first,fluor to be completed no later than 8116113. This installation is to be cmnsiclered a pilot or test ease. Dated: August 20, 2019 SALEM LIh TORICAL C77111,111SSIOt % By: elz: /The homeowner has the option not to commence the work («mess it to resolving an outstanding violation). All work commenced must be completed within one year Calm this date unless otherwise indicated. HUS IS NOT 1A BUILDING PF_,RIVIIT. Please he sure to obtain the appropriate permits frail (lie Inspector of Buildings (or any other necessary permits or approvals) prior to commencing Work. R. Preston Ward, General Contractor, Inc. C.S.#97288 P.O.Box 543,Hamilton,Ma.01936 - Fully Insured Ell I7©®®a®13®0E3[3®®®®0M130000[3®®®000000®E Office; (978)468- 1164 .-_ - 8/17/2012 Fax; (978)468-3464 Nancy Corral 27 Herbert Street - Salem, MA 01970 Cell(312)919-4888 We are pleased to submit the following bid. Job Description: 27 Herbert Street Windows SERVICE PROJECT DESCRIPTION ALLOWANCES TOTAL 2nd FI.Windows Replacement of all 2nd floor window with ne Hurd insulated 6 over 6windows as previously approved on 8/15/12 Window material cost; 8/13/2012 10,161.11 Deposit request; 8/17/2012 6,000.00 Labor pending installation. - Payable to R. Preston Ward Total Due $6,000.00 Authorized Signatures; President DI (JPEG Im e, 1024 x 768 pixels)-Scaled(86%) https://mail-attachment.googieusercontentcomlattachment/u/O/?ui=2&ik.. ` I I of 1 8/15/2012 7:00 PM (JPEG Im e, 1024 x 768 pixels)-Scaled(86%) https://mail-attachment.googleusercontent.corWattachment/u/0/?ui=2&ik.. MIN K. ,! e -tom=--- - - I of 1 8/15/2012 7:01 PM