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8 IRVING ST - BUILDING INSPECTION jn The Commonwealth of Massachusetts W Board of Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR, 7`h edition ALEM ReOF S January Building Permit Application To Construct Repair,Renovate Or Demolish a 1, 2008 One-or Two-F ily Dwelling This Se on For Official Use Only Building Permit N Z I Date Applied: 3 /7 Signature: Buildmg C issi n / nspector of Buildings Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers .8 �1NG b`1 srlt, J6 16- 0L8et- O L la Is this an accepted street?yes I/ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: I6-ft.».% ,,, ctY,,, 12 ono ' Zoning District Propose Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) r`c IA4.Men 1-- 1M 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 Q" Private❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: _ 'I jaM tt �nnt°n To..•(m.. J6�ur�� 1Z� rJJ.f01LE /��f, #-( JQfL Mk O2,ISI Name(Print) Address for Service: GLJ `ioS" 3368 Signatur Telephone SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building Owner-Occupied On' Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ 1 Number of Units Other ❑ Specify: Brief Description of Proposed Work': AEPL/ILE C1Cesfrnr(r WINOtl WS W�SGML -Sfj�_ R3 Spec. Vin y< Dour -/a E A+2uoN SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 3` 000.eo 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ [3 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 $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 3(°r o0o p°— ❑ Paid in Full ❑Outstanding Balance Due: 2 i GF�rfl cGG� CO ' > 3 2011-03-17 -18:28 -- — :aTeasdloa7 f'rom,�Jalaylor To:Melissa Pan„' n1 2011 03-17 130207(GMT) The C01112Lonweaith of lvf•'usachusetts Si Board or Building Rcgul;ll.iom and Sranitards CITY 4 t. i OF S:>LL: 1 Wt i,`:' +,1asaacllusett,State Building Duda.7S4 C vIR,7` cutnun Revired January Raildin Permit Application TOC:nnsl,mcl,Repair,Renovate 01Demo'1ch a �.271hs One-or Two-cannily T.iveffing This Srnliou Fa-Ofrcinl Uw,Only .. _ Hnil(I;n„Permit htm;bu: Dote Applied: 8igratura: _ Building Cntntnisdonef inspector ofTsuilciiap Date ...__. ........... ...... ..... ---_-... SECTION t:81'rk INFORMATION l.J 1'nYna:rtv Adds•<r:„ 1,2 Assessors binu ak Parcr.INutnbers ,SR ... ... 1,lit UJr,,isollacc(ptcdatrmtyyea ✓ nu__..-.:._....-fit„I.uv:nb::r Can:el'h'.'umbe,—_—.._.. �,. e• "•�w 3 'fa 1.3 /�111nP LJful'l'Ja t luperty ilirnen.cieuy: 1019P •"...^_.—_.__—.—.._ 1.4.!. L-- in zorlili ili_In'Ad__ro osc t7,c Lot Arta(:q.11) 7_[wtm_e I,ft) l5 Su.ta,tt ucfl :lcla+fft) rcPlawrrdrf--�"rpw±1n�rr:'vn _ .,._..,.) . ioa. foo, I Sidt Ya d R•ir Ya,d 2.yrir.d p""law, --•— Regvit-J I A_u+'idW karyl u! Provided JI 1.6 WWcr Supply:W.O.T.c.40,§54) 1-7 Flood Zone Information: LA smage DlepnsnlSystem, i ,de)�lucd Z,,00 Ribii::lY PricN�cQ --_ J ?vL:oa:y.!'hi flu ave Jivpomdayxlem ❑ SDJC'1'[ON 2: PROPERTYOWNFRSIIIPI 2.i Uvracr'^f 12ecnr(1: _'_f:4•+5 '�`-'M1!,rau T.I;, �tb r r.• 35..r4'3Pitel A uE 76t_, um _ L S.EMON 3:DESCRIPTION(AT %Rf YOSE;D WORK=(eiaeck nil rtmt SOON) New CC F.M(Mction❑ � ' r:istin Bttildin Onvcr•Occu:iad i2e tuss(nl Fif Ahcrauon!n!; R 1 Wf1 p . ) Q I AddLdon ❑ Denxoli4on ,7 (Accessory 13ldg.❑ N',ne'.n'.t pf!l::il+ Otho; ❑ Fpsi.`r Eric;'Dascripnou:+1'Prnpuacd�Gotk': - . ,.------- ----..,._ .9.Ze Pcr}�Lt �. cr'i,l_ Win.rDn us :.^I:ON•L_s're.. ., A-.t.�AH----..............--- --- SECTMN A•FSTIMATEn CON'STHUCTION COSTS he, p Shur and Mausiah;) e)fliccrl Use only . 1.iltnlc:t^ $ 3 6 004� 1. 9U!14*r Fennit Fee:$__„ Tudicatohow tee is deterrtunod fJ 3=tcard f'iiv Ann AphliudonF.:c 2.Eleco e:al .3 -- _,.___' 2 JAtzr C',•; : �'osc'l!u'n16?a nnlltiolirr e � 4.M& ,ch.:oivai .....-- _5 S Totali':ilC'tc•>: ;_--- _ . _._.... p6t .—_ .... ... 1 - I Chcek No. (]ler:k Aututrzw Cash Arinrmt.• .. a LJ Pei. Fill! l7:.l;rtstvt •.......— -- 6,'Caraal"roicet('ush. IS 3G�ono ¢- 0 !n di,zglstalul7ceUue:—._ i `2611-03:7M 18-:28 — 1978as61na7 IrnmPa ls�xflor To:MeilsSa Pa!lr (A., 2U1 I U:I-1'r [4.:U2:di Ira'✓iT) SECTIONS: CONCT.RUCrI'lt)NSER.VIt:GS _ 1U Lit cuRd Crinstructiun Supervisor•1C817) r 7 c¢nta,Krn,bcr Lspi mn n I11Ie t o`er( [[1� \ 11 11 '' ` i_istCSLT;'lx{aee!;ux.+•: __ _ "-1":� (_ _......__..— fL�7�Z�:.. CA! - - j,- " -I limrx:;i�icd Ic:+io ij(illll 1:u.1'fi (`Cj(W I-J'tT 1 .__.kt 6.n 1.22.id n[ I n.1n4'-nCtwk — T I�nr : \lS F'2'id ,t 111innow.:n Sidwk SF I hid , 515o id Pttcl Hurnmg,lppltatuc 1.1=:nliation Il irvidewa5117A.a.�Ii IP. _... 5.1 Lie:;>d+::a d H4,ntr.11 rmelneol CnatrIk"01'(HI(:) 1. r 4cNa1 trN 1(JC'l:ii vans Itlab,::nr N lr,kclp4rm,t n.E Re-is``'faeri:m,Nllinher :11rrnu ' 'I'le,nnao J s„_,"1'1f)lti<:\YOfllCEItS'COMI''FNR ATION iNS1RANC'I:Abl%It)A4't?'(M:4i.L.t.152.§ ESC(t�) Wor�erz i'nnylensation Insurance eidoit,uust be compl,tra and subuliuod v,+In llrs anplication. Failure to pmvide the ol'tuluvi(,+ill rc.hult in the denial of'dit Issuance cfthe 1AIdding penn�t. S]TCd.:A M32lvit A„tlnriLd'? Yes..........uy, 'To ..........❑ i -SEC:'1'L"+^'-":,:O'A'NS''K AUTHORIZAS'f0�1'I'p Iii•:rOh1YLLr'l'lEll WHEN -...— ..._.. -- --..— OWNIKI N:SGI((vT OR CONTRACTOR APTUPS FOP&UIL:JINC PRRr1Tl' 1 c-_4Fy-rem aa.M t.o(L _....... - asC)tmer o±fsla.;uujcct property herehy authorisa .... .' .. .-_. _ „�:u(:,n my behalf,in ail mattus i raa! ;c-b;.%!,n_4 auihurr:,cd by this building pennit rpplicai,ou cj Si;ry,;u:p?n(r,v.ne^ isle _ SFQTi0N7b:0WNFRIOP.wU'G'ria:liIZEP?AGFNTiIyTt;a„;:R.GTIOM ta Agenlhern.ydeclare dun tl:c• t:de:'=ur' `n•ti i;li1ru18tion on flit f lrtrr�r...•,r.p: lira;:.ei arr n.la God ; uraic,G.)the Sett of my lmowlcdgc and hcir;If: Sit9?:,nlrrc,:•Fi'l„i,cr^ra.,on,riztldAgent Date rise yrus nnt!kcnsltirsxia:y) IVQ'0'i?4: 1. An"wnei who: ,t:ins a building pennit to CIO 1110.11C:r ie:a work,r,>G an uwncrvlu+bins an ulv islered cimtracror (na '.tg;n!crcd h]du Home Imprm•cu:cut Cun(td;dn- (t lit":aro.r:ni Fj;n''I'+gl1:ivc rc::as u,the arbiva[ion c;r va or•»nrn:,t±�lived under M.G.L.c. 1 a^-q.GLhe�iryrrtar.r.i]`imnaricn cn thr ll if, PrOtr,,m anti C:+n,.:n;ctir:n Smpe�aisur Licensing(LSLj can Lc liver d;n�A(f C�IR I:e�uYvions 1 ifl.i+6 mId 110.LLti,ttspedivcly. w'h uLlstamirl vorl(is pl unted,provide the iufcnt;rt .: t,e;r,w: "'-1z A; 'I'otzl It-ate s:a!•IG. Pi I .__., "„lmcludigg eare,;t,fini,ilcl bitvcntcatt'athcs,decks or porch) din!o ii ;,;.•:�:r.! -.+I. P• ) l i,:hitattfr ttA,P.]"oµnt Nwnhcr:tS' umiler of hcdre:ntns Nulxber. .:r"n:!a',y 'a; Number of hall;irlt'aY 7.rr?of:.:raTir.. ,.:feu ....__... sh•m�er Or Cc.k:;'(.orch!l T)q:c Eneloved ,optal ---- 3 ":'c':4 rroit t(Fiq:ere.Fouth(:d'limy hr nvhsl.utdcd ae" 'orvl Pmirct(..':.1st SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) License Number Expiration Date Name of CSL-Holder List CSL Type(see below) Address Type Description /Y U Unrestricted(up to 35,000 Cu.Ft. R Restricted l&2 Family Dwelling Signature M Masonry Only RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Registrant Name Registration Number Address Expiration Date Signature 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 -Tar ce 3 p l rho 'aq"R as Owner of the subject property hereby authorize to act on my behalf, in all matters relati .e-W,�ork authorized by this building permit application. 3/ 16I It Si at of wrier Date LIZ l 9 SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION I, / i,�il -- ,as Owner or Authorized Agent hereby declare that the state tt7 ty. and information on the foregoing application are true and accurate,to the best of my knowledge and behalf Cjames 1�aun�t`�a�,l n P nt Name 3 � 16 �I1 SignatureiJ^wuer or Authorized Agent Date (Signed under the pains and penalties ofperjury) NOTES: 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(HIC)Program),will not have access to the arbitration - program or guaranty fund under M.G.L.a 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,respectively. 2. When substantial work is planned,provide the information below: N / 6- Total floors 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"may be substituted for"Total Project Cost" • 09/24/2010 13:33 5087992768 DALONZO SAMPSON INSU PAGE 01 A-- CERTIFICATE OF LIABILITY INSURANCE o9/24" PRODUCER (508) 790-3998 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Elaine D`AlonEO Sampson Insuz ca A441nGlr ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 490 Shrewsbury HOLDER, THIS CERTIFICATE DOES NOT AMEND, EATEND OR r7f Street ALTER THIS COVERAGE AFFORDED BY THE POLICIES BELOW. Piccadilly Pub Plaza Worcester MA 01604- �INSURERS AFFtlRDING COVERAGE NAIL 9 INBURec Final Di>Tsneion BuildingG Const'ruc . . ..__._.. .,._..._.. .._.. ... .. . . ... , NBUR6R A.SAFETY INST)BAITCE 455 Walnut at ... . .,. . ...._...,. . ..... .. I wsulO:Rc. RIsuRERD: shremebury MA 01545- PINUME T E: COVERAGES THE POLICIAS OF INSURANCE LISTED BELOW HAVE BEEN I0SUIDT0 THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOICATRD,NOTWRHSTAN DING ANY REQUIREMENT,TERM OR CONDITION OF 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 15 SUBJECT TO ALL THE TERMS,EXCLUSIONSAND CONDITIONS OFSUCH POLICIES.AGGREGATE UMIT3 SHOWN MAY HAVE BEEN REDUOED EY PAID CLAIMS. _ ?NBA — _______.._... POLICY HUNGER PDLJCY EFFECTNEDATM FOLX."J EXPMNOM) LIMITS GEN9#AL WMII IIY / / J / 'EACH COMrMERCML GENERAL.LWILTA '�R6MPEEAAL.,Am.�l S ...... OIA%A%—c r OCCUR / If / / MED E%T IP^Y wreaalmN # . . .. .., .. I If I PERSONALAAOV INJURY__ # . J / / / oeNeRALADDREDATE f^_f . GENL AGGREGATE LMO APPLIES PER I / / / J PRODUCTS-COMPA]PAGG S POLICY I I PRo- LOC AUTOMOBILE LABILITY 5204493 09/24/2010 09/24/2011 COMBINED SINGLE UNIT a 100,000 ..,li AXY AUTO J J / J (ER stmro) A ALL OWNED AUTOS l J J J BODILY INJURY . ''6 300,500 X SCHEDULED AUTOS / / / / !(Pa perm) . .HIRED AUTOS / / / / OODILr INJURY ODO X• HE NON-GUO AUTOS J / / J ?Per eFPdwFI S 100, / / J 1PR PEERTY idenIDLMAOE 'S GARAGE LIABILITY I / / / .M T ONLY-EAACCIDENT :S . . ANY AUTO / / / / OTHER nIAN EAACC,s . . AGG'S GC ESSNMBRELLAI.IABLITY J J .._.� J I !EACH OCCURRENCE .... S. OCCUR (CLAMS MADE J J J J AG OREGATE E .. . / / J / ... .. . .. is .. DWUCTISLE / J J / _._.._..._....._..,... ... .Lt .. RETENTION - a f WORREISCOaPEISATION vM: TA . AND IMPLmERs.ua.JrY YIN ANY PR0PRIETOAA'ARTNERI6XEQJ1n ❑ / J J I EL.EACHACOIblN! �PPIGERMEMOCR EXCLUDED? NNI / J / / 11L_DISEASE.EA EMPLOYE�I ... SPECIAL PROM310NS F.L.OLSEIISE-PDYCr LIMB 9 OTHER JJ r / DESCRMIIUN OF OPERATIONSILOC ANONSIY ICLE81 EXCLUSIONS AWED 13YBIDORSEMENTISPEO1 ALFROARNIONS tq -G c@ePAMIEs, we AND ANY AlOI AiL SWaIDIJWI29 ANa MMW AS ADDITICML INBORIOD A9 =41PECT = AVHF13BILN CERTIFICATE HOLDER CANCELLATION ( ) � ( ) BHOYMOANYOFTMC A90YE pE1oR�DPPIYhEe BECANCE44RD SEroNETIIE ENPRIANDN • DATE TNEIEOF,THE 193"INSURER WILL ENDEAVOR To MAIL 10 DAYS WRITTEN NOnCF TO THEwR1FICATE HOLDER NAMED 10 THE LEFT,BUT FNLVRE TO DO BO SHALL I.O%%S COMPANIES INC_ R#POSE 1009UGATHDN OR UA9L ANY KIND UPON THE DJWRHL,ITS AOENTB OR ATTN: IS INSURANCE MP . PO BOX 1111 A ePRPEENTA N WIIRESBORO NC 7,8686- i ACORD 25(2009101) S)1968- R COR TION. All Nghts reserved, INS025120 M1 Tho ACORD now and logo are regleter9d marks ACORD 2 d IWLL 60-£0-LLOZ 05/19/2010 00: 19 02840 P.002/002 d...ate.<vy,� aa.ao uuc rur,rA rc FIAE 02/83 o o& CERTIFICATE OF LIABILITY INSURANCE nsnarzoTo FRCeucoN TNIa6ERTMA -Ao6mrnoOF man mAT= 814ohlGne Irlsurama ONLY AND CONFERS NO RIGHTS UPON TTal ONLTIFIOAra $7 Harvard SiraiA Suitt 213 OATS DOES VWAGE ro W Wareaster,MA 01800 NSWRERS AFFOROVA QMmRAGE NAIL r aNa�O INI9AERA: AtlantleCfwapyllrcwanueCeNmeny final Dllnensiotl eUlldhlq 8 COrtstruetion Comm Aeaaalara[Mpk�an I uuranea ampany 455 WalrU Street aNDKAC, Shrew ".MA 0150 aNMRO; _ COW THE POLICI63 OF INSURANCE ILIUM me-OWHAvE 0SE N AS&UED TO THE INILIARD NAMED APMW FOR THE 61"ICY PERIQO INa11CAre0.NOTWTITWANONG ANY R6auIRt=WNT.TERM OR OONCITNONOF ANY 00 TOR OTHER DOCUMEII'I'WRM Rr`�ECT TO MMI�NrNM CgITIPIWTa MAYeS t33UEC 011 MAY PERTAIN,THE INSURANCE AFFaRpaO 9Y THE FOIUCI�SrO NEREM 18 IULMCTTG AL4 THE TERMS,EXCLUSIMNS AND CONOTnCNS Of SUCH POLIGE6.AaeREOATS LIMBS 910MM MAY RAYS KEN REDUCED aY PAIC mAFA3. TWRVWIURANM Pm-mmNNafa af20"MCM lACXOO f �.Oaa.A00 OAsaAR{CNL6ENERAL LMaILIM f 50,0oa A CIAMe NAME [ OafAIR Lo026348 SM972010 SH 02011 NdEO iNw(any r APy Mn f $,CPO �— aADV Y r tA00,AAA ; Eft AdGK!9TeLWAPPMP t Oe OAT'E f a,0A0AOO FOIkY rlx*mTr7 Lae PNOWGI3'CONN�OP AOa s 7,o00,0Aa AlrraNNaPIFF UAle11Y AHYAWN cw=MNNiE UNIT e ALL OWNED AUTO$ e0411011 COwTus VILP.YI.INAM e NIIRW Aum aO NONCWNEDAUTOa r SddaA R RM PAa[Nglt a '. aAfl11L�LMAILRY ANYAIRD Ap7UNTEORdTRL�YN.pgAWOp(N' 3 AUf00M,Y; FA ACC i � Tr 9ACN OCCURRlNCE E 0mmm O aIAAN MADE AGM=ATE a . OBOUCnPLe ' Tom f f AM BLW WCC6005745o12oto 871a1201D 8715=11 Ft.WHAIi-c r a 10D,900 �il�.`vk� ,yyv alNewE-rAenLors f tDa,vaO . EL OIeEAe!•FW,1Cyu = BAA.OAA laaa'1 C.anN 00%INa V4 any and ae otoldtaXaa aro mflai as moaminal I^eWse vAlh nlfpae!to Ganarai Llahiely. Ce iL N0{,OER CANCELLAl10N LawsCamputies Ina.fMWIDYNYpTNRAaOWepCllNfeP4apEa9EWCELRE11esoNICTIrcIZRRATf711 A".IS InSmTenq a►reTMPA .TNENseRplNa�aergkoroELvaRmNAa 13 aA.y wmm RD, Bcw 1111 aCTeEm1NI iElfieNfTE NO{i6LNAa3aYOTRELa•f,svrFlaws mDOie ylau N,WIINembor0,NC2aW INPa9fNNGOMAWTIOPallWAr "or ANYIOIOLyaNTxeamRERRfAskNNYaaa aEs Tryaa AOrNOAaT:p A91espNrAlrye AODIN� Tpq) ' , 81ACORP RF'ORATIOIe TEN ' 6/£ d 'I£:LI, 60-£0-LLOE r CD w 0 10 V W W n: L.w ROBERTA PALMER 455 WALNUT ST SHREWSBURY, MA01545 1405 10 O CU � N a o lee 0 Office of Consumer Affairs and usmess Regulation 10 Park Plaza- Suite 5170 Boston,Massac setts 02116 Home Improvement C for Registration _ Repistration: 143756 y _ TYpe: Private Corpo allon EXPIret101t: 712912012 - Trp 2W050 FINAL DIMENSION BUILDING+ l l ROBERT PALMERI 1 _455 WALNUT ST. - SHREWSBURY, MA 01545 Up>lale Address and rofurn card.71ark reason fur change. DrscAt a sWKN-maiars [I Address F.1 Renewal [] 1S®ployment © Lost Card Offee sf Cooromer�Aifaia g�gfjpesr ge gu ire Limnse or rxgis[rgtloa valid for indiridnF use only ROME IMPROVEMENT CONTRACTOR Won the eapiration dale. If ound retina to: R0QI9katiotrr`,M437W Type OlRee ofCoasumer Affa@n and Business Regnlalion Expiration: 3fll�Ot2 PrWfe Ca oration 10 park Plan-suite 5170 Bosta= -' TFIDIMENMDT•Ts _t- QJJgTRUCTION n.MA 02716 f-'. ROBERT PAiNfE{`, 455 WALNUT SHREWSBURY, Is .-- - Uadersecntary M Not valid without signature w a A N OP 7 O o f+] o O , o CD N