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167 LAFAYETTE ST - BUILDING INSPECTION moo. 'Al The Commonwealth of Massachusetts i Board of Building Regulations and Standards CITY y ) Massachusetts State Building Code, 780 CMR, Ts edition OF SALE:M �yI Revised January Building Permit Application To Construct,Repair, Renovate Or Demolish a 1, .nnN One-or rivo-Family Dwelling This Section For Official Use Only Building Permit Nu eNr: Date Applied: Signature: Building CommissioncrMnspector of Buildings Date SECTION 1:SITE INFORMATION L I Property Address: 1.2 Assessors Map& Parcel Numbers 1(— '�half :i —1.la Is this an accepted street? no Map Number Parcel Number -. 1.3 Zoning Information: 1.4 Property Dimensions- Zoning District Proposed Use Lot Area(sq 11) Frontage(11) 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: Zone: _ Outside Flood Zone?Public❑ Private❑ Check if es❑ Municipal❑ On site disposal system ❑ SECTION2: PROPERTY OWNERSHIP' JJel qw, eve e LC.Z LAP-A N• r t) Address for Service: QI(6 -. 't �{ u � � �7 d tore Telephone S [ON ]ESCRIPTION OF PROPOSED WOR10(check all that apply) New Construction O ' ting Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ I Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other ❑ Specify: Brief Description of Proposed Work': ,V - Pet&tjlu4 2 fk Cs�T f / I�aLG✓ C/LLJfA7N /✓IUIGl��Ng ON ZL/ C'QiGua� ✓Allzr<r LU 2iN Sca'ty"'[Na fj�c4 JX»,cd /N h2i�h it�.rM v SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: OHiclal Use Only Labor and Materials I. Building S I. Building Permit Fee:S Indicate how fee is determined: �. Electrical S ❑Standard Cilyribwn Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (fIVAC) S List: 5. Mechanical (Fire s Su ression) Total All Fees:S 6.Total Project Cost: S ft Check No. Check Amount: Cash Amount: ❑Paid in Full ❑Outstanding Balance Due: ,� ve XA-'y G tee. /-ems SECTION S: CONSTRUCTION SERVICES 5.1 Lice ed Construction Supervisor(CSL) (.0 ic 8 C�F � � �� �-(O bs/„y�� (�UNNL��. I.ice'nse Number Expiration Date Name o-t'CCSSLL.I lolder List CSL Type(see below) U J S �r, / ( i/LC LL L-.V r✓'N .f.pe IJescri lino Address U llnrestricteJ u to J5,000 Cu.Ft. -�✓C � �� ' R Restricted I&2 Famil Dwelling Signal re '/ M M Onl �Z �-��/��/(6T RC Residential Roufin Covering Telephone / WS Residential Window and Sidin SF Residential Solid Fuel Bumin Appliance Installation D Residential Demolition S.2 Registered Home Improvement Contractor(HIC) 1D�2�/� 717 � /-)6m f .Lr�-fn I IIC Company Name or till- Registrant Name Registration Number /s Ts i �a2-�� 7— 3 --/G Address Expiration Date Signature 'felephune 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 ..........11ii( No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN O IS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT v I V �ZV @ as Owner of the subject property hereby authorize to act on my behalf,in all matters e to work a rze uild' unit application. �6 to of Ow Date CTIO 7b:OWNEW OR AUTHORIZED AGE T DECLARATION iv c as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. Print Name Signature of Owner or Authorized Agent Date (Signed under the pains and penalties of 'u NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (no(registered in the Home Improvement Contractor(HIC)Program),will Mof have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and I IO.RS,respectively. 2. When substantial work is planned,provide the information below: 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"maybe substituted for"Total Project Cost" ,A CITY OF SALEM PUBLIC PROPRERTY T' DEPARTMENT 1'.11; N111 "141r"1 \I .1.'14 1's k[T 0 SA I%I,fit.\+UI III J 1 rn:9:1-7454P)9 .1:.%N:711-M%')S* Construction Debris Disposal Afridavit (required lur all demolition and renovation work) In accordance with the sixth edition of the State Building Cade, 780 CMR section 111.5 Debris,and the provisions of MGL c 40,S 54; Building Permit N is issued with the condition that the debris resulting from this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c t 11. S 150A. The debris will be transported by: p notrte of hauler) The debris will be disposed of in T-�s �rrvsti mz���.fti� (Ila"of aialty — CGI�li1'��2Cl2� S� I.YN�✓ I:IJJree�of f u i lily) +gtnature of permit applicant date 1clo..di s� R CITY OF S.U.&A INWSACH SEM avariLVG DErmastENT 120 W.jiHINGTON STurr, )as FLOOR T EL (978)745-9595 F.ut(9711) 7449&W Kl�®g(�Y DIUSCOLL MAYOR TW&W ST.PM"x 01M.CrOROI1111.eLICPWPERTY/KI DLVGCOSQQSSIO\F1 Wurken' Compensation InsuranceARldavlt: Builders/Contractors/Eleetricionslplumben annllcant Informallon Please print Legibly %lallle ltlurtreevaOryrstrMietaltrdsvtdualY 662h /-d/IJN'K/ AJtlrcsr. /S �lo� Ci2Gh City/StatelZ it L-7/n-"nJ Phone* ou se empkyw'Cbeek the appropriate boss Type ar Y►elect(rpW►M: I I am a emphsyw with r 4. 0 1 are s Inroad cmasreor Mail S ❑Now conscructiw Wunployse(li ll and/or pan-rims)." have hit"the stsdettrwwu ns 2.0 1 am a loin proprietor tw parutea listed an the attached sheet: y. 0 Remodeling +hip and have no employee These su►contresmrs have e. 0 Ikmolition .vorkln for me in as c workers'comp inwsaoa g Y >PesM'• 9. 13 Building addition INn wmkea'comp insurance S. 0 We are a corpora"and in rtquirsd.) odk e haw/tmrelsed their 10.0 Mocarical repsin or additions ).0 1 am a homaawow doing all work ritltt of t:semprioa per MOL 11.0 Plumbing repairs or addWom myself.(No workcm comp c- I3Z 11(4)L tad we haw to 12.0 Roof repair insurance required.)► employees.LNs waken' I l.❑ comp inwnncs tegttired., Other- Any appaea/the checks boa at NWrn 9"tall test the eetua below areiq thi eertw't>otgrWsim talky inaems" 't I.wwuwnm else salmd d1Y adkb"indicates they an dtrip 811110011 i tad tie NO Writ . alter PA"a new attltlrrk uNirniq nod► T..nnaw.AM cbwk yak bra wtr a"W had as aditiww Anne r..6y the snee of ft a awaserenw rd their earbwa•camp poky iaaaaWase. J um an dwp/ayer lkdW h p wrld ft workers'corpmusdas Jwsarewre fw q SMWSydda Bdiew/s/AY ponhp sr/m sib Worms" In%urancoCompany Vame: i=r/:ISiZS- Policy 4 or Self-its.Lie.N: __7 ETO/3 a e7Z 3//U&.,L111-Z Expiration Datr. �— C) Job Sire Adthesa: IL I- City/Stan/Zip: dz . ,%crack a copy of the wanton'compsoatlos pe0ry dorlsrathes pap(showlig tbs policy sambo,and sti lrWoa date)6 Failure to%"am coverage a required under Seciloo 25A of MOL c. 152 can lead to the imposition of criminal penalties era nine up to S 1,500.00 andlo,one-year imprisonmerK as well as civil penalties is the farm of o STOP WORK ORDER and a flat or up to 52io.00 a day apainsf the violator. ife adlfi+ol that a copy u(this statemcm may be rurwarded to the Office of Invauaatiuns ul'ihe MA far insurance coverage v.rifi atiota J Je hereby certiffyy�un/MAW Ike pains onel peneh/es al pdr/aq Am rAd injormaNw p ovi/nd�abbove is It" end cwreA � Jr.nureC 6iT_��-'�w"�t�T-" 'C��L'�2✓"�� IJuNt 7�(X(s'�' f�� O/fJcie!use an/y. De not wren in this vrr%to be c ernp/rW 6y ciq or tort„/fh•;aL I City or ruwn: YcrmiNl.Ieened e I Issuing Aurhuray(tircte unel: I. Iluard ut lleallb 1. Rusidlau Deparimcal 1. Cilytrowa Clerk 1. Electrical Impactor S. Plumbing Inspector 6. Ihhte - l .ntact Person: _ Phone e• tztt„fber��xtrre�>rcr �a��,!�� a!at�a� ---- - HOME IMPROVEMENT CONTRACTO':', Registration: 102844 Expiration: 7/3/2010 TO 0 Type: DBA C(2NNOR HOME IMPROVEMENT Rcbert Connor 15 Joel Cir ��y�.S.a^�-�'•" -_ Lynn. MA 01904 %dm i n istrs tur �l assathuset ts- Department of Public S:rfet� - Board of Buildim, Rc_ulatiunx and Standerd> Construction Supervisor License License: CS 68989 • Restricted to: 00 ROBERT P"GONNOR 15 JOEL CIRCLE S+y%ry LYNN, MA 01904 Expiration; 8/30/2010 ( . nuni.+i,nn•r Tr: 2155 --- HOME IMPROVEMENT CONTRACTOi— Registration: 102844 Expiration: 7/3/2010 Tr4 0 Type: D3A CQNNOR I10ME IMPROVEMENT Robert Connor 15 Joel Cir Lynn. MA 01904 -Will i iiistratnr Massachusetts- Department of Public Safety Beard of Buildin—, Rc_ulatiuns and St:mdard> 1 Construction Supervisor License License: CS 68989 _< ,,,,,, Restricted to: 00Xj ` 1 ROBERT P'CONNOR 15 JOEL CIRCLE LYNN, MA 01904 Expiration; 8/30/2010 ( .nnn. Tr--: 2155 i RECEIVED 09/16/2009 20:55 17815817164 BOB CONNOR Date: 9/17/2009 Time: 8:48 AM To: Connor, Bob ® 9,781-581-7164 Page: 002 ACORQM CERTIFICATE OF LIABILITY INSURANCE DATE OS/ 6/226/2 09 009 PRODUCER 781.233.9050 FAX 781.231.8151 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Tarpey Insurance Group Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 347 Central St HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Saugus, MA 01906-0304 INSURERS AFFORDING COVERAGE NAIC# INSURED Robert P Connor INSURERA. Travelers Indemnity Co of Conn 25682 15 Joel Circle INSURER B. Phoenix Insurance Co 25623 Lynn, MA 01904 INSURER Travelers Insurance Co 36161 INSURER D INSURER E' COVERAGES 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 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 IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D'L POLICYEFFECTIVE POUCYEXPIRXLON LTR NS TYPE OF INSURANCE POLICYNUMSER DATE MIDO DATE MIDO LIMITS GENERAL LIABILITY I660204N8287TILOS 05/13/2009 05/13/2010 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ee occurrence $ 100,000 CLAIMS MADE �OCCUR MED EXP(Any one person) $ 5,D0C A PERSONAL 8 ADV INJURY $ 1,000,00C GENERAL AGGREGATE $ 2,000,000 GEN II LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $ 2,000,00 POLICY JPRP,CT LOC AUTOMOBILE LIABILITY BA-204N8287-09-SEL 05/13/2009 05/13/2010 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,00 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ B HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per acciden) GARAGEUABILRY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHER ALTO O HAN EA ACC $ AUTO ONLY. AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCURCLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ WORMERS COMPENSATION 7PJUB0431N88309 04/28/2009 04/28/2010 X TORY LIMITS ER AND EMPLOYERTUABILtry YIN C MY OFFICEOPRIETER F'cQUDEDXEiCU VE E.L.EACH ACCIDENT $ 500,00 (M dg.n,in NH) YES E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes describe under SPECIAL PROVISIONS bar. El DISEASE POLICYLIMIT $ SOO,OO OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT)SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY MIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZ5D REPRESENTATIVE To Be Furnsished Upon Request Stephen Tare , CPCU CIC,VP ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. 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