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272 REAR JEFFERSON AVE - BUILDING INSPECTION C -OF`�ALE -C . �� PUBLIC PROPERTY DEPARTMENT KIMM ALEYDRISCOLL MAYOR 120 WASHINGTON STREET•SALX.y,MA.CSACJHLSh1-M 01970 TEL.978-745-9595 •FAx:97&740-9U6 APPLICATION FOR THE REPAIR. RENOVATION, CONSTRUCTION. DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION Location Name: a--1 "�- e erS0 Building: p(- Property Address: Property is located in a; Conservation Area Y/N Historic District Y/N 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land 2 V QI i C�J6h rf Name: Address: ;t qLd r?C�erTan f e S Sid eat /h4 019 (- Telephone: (( - SS%- G a`/ 3.0 COMPLETE THIS SECTION FOR WORK IN EXtS11 NG BUILDINGS ONLY A dition Existing t Ren ation Number of Stories Renovated Change in New Demolition Existing p Approximate year of Area per floor (sq Renovated construction or renovation of existing building New Rrief Description of P posed Work: V l Mail Permit to: F What is the current use of theBuilding? Material of Building? V' 4) If dwelling, how many units? ` Will the Building Conform to Law? Asbestos? !� D Architect's Name Address and Phone Mechanic's Name Ddh l Address and Phone 0 , Pro�ks �� ./2s Copy , /9O� Construction Supervisors License# HIC Registration# Estimated Cost of Project$ 5- 'Q`2 Permit Fee Calculation Permit Fee$ 90 D O Estimated Cost X$7/$1000 Residential Estimated Cost X$11/$1000 Commercial An Additional $5.00 is added as an Administrative charge. Make sure that all fields are properly and legibly written to avoid delays in processing. The undersigned does hereby apply for a Building Permit build to the abc ve stated specifications. Signed under penalty of perjury x !G Date N O 7 c j V� 7 br O p� �• D w O �+ W a C u y ✓,/ie Lr nrrumoizu�eal� o�✓�losusc�u9erxa Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ,L Registration: 140050 Board of Building Regulations and Standards One Ashburton Place Rm 1301 Expiration: 9/16/2007 Boston,Ma.02108 Type: Private Corporation BAY SHORE DEMOLITION JOHN WHARFF 22 BROOKS TERR SWAMPSCOTT, MA 01907 Administrator Mot valid without signature ,- - � � ✓le omniw !t Y BOARD OF BUILDING REGULATIONS tF License: CONSTRUCTION SUPERVISOR Number: CS 079800 a`k�' Birthdate: 09/25/1957 A>. Cons uc on-CS. Expires: 09/25/2007 Tr.no: 9239.0 Restricted: 00 < JOHN W WHARFF 22 BROOKS TERR G"..�... i SWAMPSCOTT, MA 01907 Commissioner � CITY OF SALEM PUBLIC PROPERTY DEPARTMENT iuso�at st oatsrbu. 120 WASMWCMW Snwxr 0 SALEU' "M'M 01970 WAVOt 'tom-976-74S-9S9S o FAW.975'740A8d6 Construction Debris Disposa l Affidavit �v��work) required for all demolition and In ucordance with the sixth edition of the State Building Code,780 CMR section L 11.5 Debris,and the provisio ns of MGL c 40.S s Building Permit p is issued with the condition that the debris resulting from this work shall be dispos ed of in a propeFly licensed waste disposal facility as defined by MGL c 111,S 1S0A. The debris will be transported by: ,-ja��-,�, (mms of bautar) The debris will be disposed of in: C�stx�c, (,tame of fwllity) (addte+s of ruiluy) Si a of permit applicant date .fehri,a�7.,4e CITY OF SALEM, MASSACHUSETTS < , PUBLIC PROPERTY DEPARTMENT a 120 WASHINGTON STREET, 3Ro FLOOR ^Why SALEM, MASSACHUSETTS 01970 TELEPHONE: 978-745-9595 EXT. 380 FAX: 978-740-9846 Thomas J. St.Pierre Director of Public Property Zoning Enforcement Officer Section 116.0 Demolition of Structures Structures over fifty (50) tears old must have approval of the Salem Historical Society UTILITY DISCONNECTIONS REQUIRED Authorized Agent Date of Disconnection Water: (see attached requirements) Electrical: (tj o� ( , 1,1, `� t3 •�b C9�8xa t ' Fire: Sewer: Dig Safe Number: 2 t l3 C� l Pest Control: &L A-,!�� ***DOCUMENTATION OF ALL THE ABOVE MUST BE ATTACHED BEFORE PERMIT CAN BE ISSUED*** Fee for Demolition: $5.00 for application plus$2.00 per 100 square ft.gross area,minimum$15.00 ^ ` QITIJ Lit l°T.t, :.� cT.�SciLi?LT3PII .+Vr ir: Decart-unt Pub-dart:rs �acu ;. (3reanm •t n'r[ SFPR E29C In accordance with provisions of General Laws of the Commonwealth of Massachusetts and the Salem Fire Code, the following regulation governing the demolition of structures within the City of Salem shall be followed. This regulation is made in the interest of fire prevention, to prevent conditions which are or may become dangerous as a fire hazard, or are otherwise in violation of law. 1. Before a structure can be demolished, the Salem Fire Department Shall conduct a preliminary demolition inspection , to ascertain any conditions which may require a fire watch or other preventive measures, to be taken before , during and/or after said demolition process. 2. A permit to demolish or remove a building or structure shall not be issued until said inspection has. been conducted, and a report of requirements necessary for prevention of fire and life safety hazards shall be obtained by the applicant for the permit. 3. The requirements outlined in the report shall become a part of the restrictions portion of the demolition permit issued by the Building Inspector, for compliance with the Code. 4 . The inspection report shall include, but not necessarily be restricted to the following: A. welding and cutting permit required. B. Fire watch to be maintained by a professional off-duty firefighter, with such equipment as determined by the head of the Fire Department. Per Order:V_Approved by: { '� , Lieut. David J ggi Salem Fire Mar al James F. Brennan, Chief Salem Fire Department (8/76) , _ _ �.� r c Z � 1xM1.'♦ etiq/ -iM '�� l - t � -. r{24:}��yw.','j Y'•-^-r'a'-v7T'fi►J-�� a:-.. '..0 �.. Ya �• .3 k,3::+W '� i ca' `i 6 �G�..R r'A'r.,a.rm:�:... 7- M., Y�.1• �r1+1 n1ic�- .ter. ,.w m 760 CMR: STATE BUILDING CODE COMMISSION 5' SECTION 115.0 CONDITIONS OF PERMIT - ,.. t shall be a a 115.1 Compliance with andeshallhnoiebe construed as authorityy proceed with the of the provisions of this ? to violate, cancel or set aside by modification or legally •i L code, except as specifically granted variation in accordance with Section 126.0. 115.2 Compliance with permit: All work shall conform to the I 1 _ tlwtion and Plana for which the Permit I I. stamped or endorsed apPa roved amendments thereto. has been issued and any approved 115.3 Change in site plan A lot or site shall not be changed, :• increased or diminished in area from thatu less a revised on the (plan site pin. as specified In Section 113.6, affidavit of showing such changes accompanied by the necessary I • I �, w ----� owner or applicant shall have been filed and approved. -� A revised site plan will not be required it the Exception: reason of an official street opening, - .t,7: chnga is caused by _ public improvement' or other improvement' I I. „•�y• street widening b�- t. ?• y,� SECTION 116.0 DEMOLITION OF STRUCTURES , F 116.1 Service connections: Before a building or structure can '. b or struC- e demolished or removed, the owner or agent shaII notify all utilities having service connections w mthilare and other connec- t'��y; tee, sur2t water. electric. g or structure rat,,, bons. A permit to demolish or remove a'building :;�r+•�••...� she not be issued until a release is obtained from the utilities. ' stating that the as;as; meters and egulators have I service connections and abeen re- ant equipment, ti... jugged in a safe manner. moved or sealed and P 0g 116.2 Lot regulation: When a building or structure has been demolished or removed and a building operation has not been ed, the vacant lot shall be filled with non- t .Zc•` with adjacent d r T•;y projected or grates organic fill. graded 11 maintained free from the accumulation r _ grades. The lot shall be maintai or ned which of rubbisht and he Ufa Q health tether P hazardous provisions ssh°S be endanger _ CM to prevent the accumulation of water or damage m any foundations on the premises f the adjoining beproperty; erected yin ��d- tj�� � necessary retaining walls and fmwI rovisions of Article 13. ante with the p SECTION 117.0 MOVED STRUCTURES I� 1171 General: Buildings and structures moved into or within the jurisdiction shall comply "^tit the provisions of this code. 39 I!I 9/1/80 •r- CITY OF SALEM, MASSACHUSETTS DEPARTMENT OF PUBLIC SERVICES 120 WASHINGTON STREET, 4TH FLOOR SALEM, MASSACHUSETTS 01970 BRUCE D. THIBODEAU, P.E. DIRECTOR OF PUBLIC SERVICES/CITY ENGINEER TEL: 978-745-9595 EXT. 321 FAX: 978-745-0349 WATER & SEWER In accordance with provisions of General Laws of the Commonwealth of Massachusetts and the Salem Water and Sewer Department,the following regulations governing the demolition of structures within the City of Salem shall be followed. This regulation is made in the interest of protecting the water and sewer infrastructure at each domestic & commercial hookup location within the City of Salem as well as to prevent conditions, which may cause danger to public safety, cause water to be lost or loss of city or personal property due to water or sewer loss. 1. Prior to demolition of property, a licensed plumber shall ascertain where all water and sewer lines are located on said property. The plumber shall make a determination of use of such water and sewer lines, not limited to, domestic use, irrigation, fire suppression, or septic systems. After all water and sewer lines have been located,the plumber shall make a written report with diagrams of utility locations found to the Director of Public Services. A request to the Department of Public Services shall be made to terminate water services at the street after such notice of locations have been made but not before item#2 is completed. 2. Prior to demolition a licensed drain-layer, licensed by the City of Salem, shall cut and cap the water and sewer lines at the city main. In the event that water or sewer will immediately be used after demolition for construction purposes, a set of certified plans and drawings by a registered professional engineer must be provided to the Dir. Of Public Services/City Engineer reviewed and approved prior to the obtaining a demolition permit. 3. A demolition permit shall not be issued until items 1 & 2 have been completed and the Department of Public Services has conducted an inspection and signed off on the water and sewer portion of the Building Department prerequisite Utility Disconnections Required form. Approved by: 4r.ce-ff. hi ea Dir. Of Public Services/City Engineer 11105 STREET OPENING PERMIT Citp of balem, OTaoubuattg Mepartlueut of Pu blic gperbicee; 120 Vas tbiugtuu btreet, Qb flour 978-745-9595 (Ext. 321 .DATE OF ISSUANCE: 9/13/2006 701 i � Permission is hereby granted to: dfd^� f k'• � "�"k Michael Mangini 21 Highland Avenue Swampscott MA 01907 PH 781.592.5700 FAX 781.59,:.5717 To break up the surface of the: STREET: YES SIDWALK.• YES AT. 272 Rear Jefferson Avenue Ward: 3 Utilities: Water/Sewer For th a reason of: Abandonment and d:molition of existing unsafe structure/utilities You are,subject to the provisions of the ordinances 4the City of Salem,Chapter 26,Article LV and City of Salem Department of Pi,blic Services manual. CONDITIONS 1. Permit expires 6 months from date of issue. 2. Street surfaces shall be restored using infra-red heater method 3. Sidewalk areas shall be restored immediately as follows: a.) concrete-cement in complete blocks b.) bituminous-concrete shall be saw cut along edges of excavation c.) brick shall be restored to its oriiginal condition 4. Cali DPW Garage @978 744 3302 to inspect prior to backfill(48 hrs. prior) ADDITIONAL COMMENTS OR CONDITIONS: Trench backfill,compaction and roadway pavement patch to be as outlined in DTE documentation and approved by the Water Foreman of Public Services tel.No.978.744.3302. Work date to be approved by Water Foreman. The contractor may be directed by the City at any time to suspend work and repair the roadway surface due to impending inclement winter weather conditions. ;�acro !/` City EnginBE s�j ATE IMWOON�'Y' Q CERTIFICATE OF LIABILITY INSURANCE D09/13/2006 PRODUCER (781)599-2200 FAX (781)581-3940 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION Farquhar & Black ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 85 Exchange Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTENDOR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 101 •-- Lynn, NA 01901-1475 INSURERS AFFORDING COVERAGE NAIC# INSURED Bay Shore Demolition, Inc. IISUPERA'. Scottsdale P.O. Box 556 IaSURERB Safety Insurance 39454 Swampscott, NA 01923 I''GuRERc-. Granite State Insurance Co. I URER O. wgsu R=R E: — ----� COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHST— A� ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TD WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF St POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR OY POLICYEFFECT'VE POLICYEXPIRATION PIPE OF INSURANCE POLICY NUMBER LIMITS j GENERAL LIABILITY �— CLS1167539 10/18/2005 10/19/2006 E-CH OOOORRENO-- b 1 000 000 !CMMEROIA-3ENERA-:✓BILITT DANAC'_TO R'_NTEG — r--I iia:-- r i5 iQQ QQQ aaMS MADE A OccuR MEC E?P(L 'ene ParaPn) Is 5,000 A XI Broad Form CGGLL1 PERSONcL&ACV rta.URY ; b _,000 000 II--I• 3-NERFLAGGRET'i ; b 2,000,05 Q 'GEN'L AOGREunTE LIMITnPPLIES DER: P5DDUO-S- OMPC-AOC b 21000 QQQ PO �� ,KOT AUTOMOBILE LIABILm 3141276 05/01/2006 05/01/2007 'OMEINED SINGw'-IM:T b ANY AUTO (Ea amlunt) 500 00 , ,4-D'MNC-DAUTOS BOCILYIN.URY B X SCHI (Per perscm S -- HIRF.O ALTOS (Per derl)IN b I IWCN-ONMEC AIFD_< � (Per aCatl-nQ ( - PROPERTY DAMA3E Peramaanz) li A I GARAGE LIABILITY ALTD JNL•-EA i>ACCENT II E ANv AUTO °'rEoTh.,N En�cc & CC. ' b EXCESSIUMBRELLA LIABILITY EACH OCCURRE"ICE $ OCCUR CLAIMIS MADE ACCRE3kTE b CEC'UC-IBLE b RETENTION 3 b ACRKERS COMPENSATION AND 11CS735976 01/22/2006 01/22/2007 1 �A sTATU- c-H EMPLOYERS'LIABILITY TOR`LIMITS ERT_ C q y P'RQPR ETORPARTNERP,ECUTIVE E I.EACH ACCI GENT b $QO QQQ DFFICERMEMSER EXCLUDED? E.L.O SEASE-EAEMPL"YEE b §QQ QQQ fy g,ce; IGP V1der SF ECIALPROJISIONSeelm E.L OSEASE-POLICY LIMIT . 4 500 QQ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS re: 272R Jefferson Avenue Salem, MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE. city of Salem EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Building Department 10 DAYS%wirrEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Thomas ST Pierre BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGAnoN OR LIABILITY City Hall OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Salem, MA 01970 AUTHORIZED REPRESENTATIVE Ate` Christopher Kennedy/CPK ACORD 26(2001/08) FAX: (978)740-9846 OACORD CORPORATION 198E II IMPORTANT If the certificate holder is an ADDITIONAL INSURED.. the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s) If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement of this certificate does not confer rights t0 the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract beh-;een the issuing insurer;s), authorized representative or producer, and the certifi•c,ate holder, nor does ii affirmatively or negatively amend, extend or alter the coverage afforded by the policies lister thereon. i I AGORA 25(2001108)