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51 LARCHMONT RD - BUILDING INSPECTION tA a 5-7 The Commonwealth of Massachusetts F O Board of Building Regulations and Standards CITY ITYSAL �j Massachusetts State Building Code, 730 CMR Revised Mar 2011 / Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For'Offteiat Use Only. Building Permit Number '. to Applied:' Building Official(Print Name) ..;:�Signature ;. - Date SECTION 1: SITE'INFORNIATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers S/ LQr`chmoni Rost 27 R s 1.la Is this an accepted street?yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Propert Dimensions: —£ I ssr ale )im,A, y7yT�/- sf, Zoning District Proposed Use Lot Area(sq ft) Frontage(it) 1.5 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water upply: (M.G.L c. 40,§54) 1.7 Flood Zone Information: 1.8 Sewage D/iipposal System: Public Private ❑ Zone: Outside Flood Zone? Municipal On site disposal system ❑ Check if yesftP' SECTION 2:, PROPERTY OWNERSH7P1 2.1 Ownert of Record: Gyry tLY�ne �rrei5` S4/eM , /r2✓9 O/970 Name— ( re City,State,ZIP Sl Le/chrt-7vn7' kzy�<l 7 qm,6,, yGhao,cor� No. and Street Telephone ' Email Add ess SECTION 3: DESCRIPTION OF PROPOSED:WORK'(check.all that apply) New Construction ❑ Existing Building Owner-Occupied Repairs(s) ❑ Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number ofUnits�_ Other Cl Specify: Brief Description of Proposed Work': H2moci e l fCh e 1717 d 171*/F bra f _ SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use 11 Only-_ Labor and Materials I. Building S t7�65 000 1. Building Permit.Fee S Indicate how fee is determined: 2. Electrical S ❑ Standard City/'town Application Fee 000 ❑Total Project Ccst',(Item 6)x multiplier x 3. Plumbing 3 y 000 a Other Fees: S 4, Mechanical (HVAC) s Li at: 5. Mechanical (Fire _Suppression) Total All, Fees: :S Check No. Check Amount: Cash Amount:. (. Total Project Cult S 3 6r600 ❑ Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) LSD �8at/b� 3 G ;.�p/y &7Vj'd 6enes14 _ LicenseNumber7 EspuauonDate Name of CSL flolder U p List CSL Type(see below) 'S 60'-m,��7 Type Description No. and Street uqh Vey-s-, ©�9�� U Unrestricted(Buildings u cu. ft.) R Restricted ISc2 Family Dwelling City/Gown, State " Ill M Masonr RC Roofing Covering 1VS Window and Siding SF Solid Fuel Burning Appliances y78-77y-S-,?O7 61/1397Y02a0l-tlal-�7 1 Insulation rcie hone Email address D Demolition 5.2 Registered Home Improvement Contractor(IIIC) —� 7J`3— 3 aDJ� Jlameslead_ HIC Registration Number Expiration Date 111C Co;?mpa n�ur1 any Name or 6 FIfC ReNameistrant Name by�j3C�7Y1V /'o� No. and Street Email address ,GL;7Ve/s'/off C>IV-3 9 7,P-775'-,520 7 City/Town, State, ZIP 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 1, as Owner of the subject property,hereby authorize 110M2S7ze4C1 Z�C to act on my behalf, in all matters relative to work authorized by this building permit application. Prin Owner s Name(Electronic Signature) Dat SECTION 7b: OWNER' 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 to the best of my knowledge and understanding. s ' W4, AAy0/.rIeile cr�� �i-l't"J L� �7 Uli/'j I�S� oZ0/3 Print Owner's'or r\uthorizo \�ent's N;une(Electronic Signature) Date NOTES: I. 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 Trot have access to the arbitration program or guaranty fund under iiM.G.L. c. 142A. Other important information on the MC Program can be found at www.mass.'>ov/oca Information on the Construction Supervisor License can be found'at www.Inass.,ao�'rd 2. When substantial work is planned, provide the information below: Total floor area(sq. ft.) (inchtding 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 halUbaths — Tvpe of heating system ---- Number of decks/porches--_-- -- I'ypeofcoolin" System_--—_-- -- Enclosed -----()Pell -- ..i " total Project Squurc Footage" may be sub_hthitcd tm _Total Project Cult" ___-- i CITY OF S:UE. I, INL�SSACHUSETTS BULLING DEPARTMENT 120 WASHINGTON STRfiET, 3iD FLOOR TEL (978) 745-9595 FAX(978) 7�SQ-98�t6 KIMBERT RY DRISCOLL MAYOR Tlimus ST.Pium DIRECTOROFPCBLICPROPERTY/Bu .DLNGCOSLMISSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information j� Please Print Legibly NiiinetBmiivs&Organiratiorulndividual): 110177es�eQ r Address: 6 �70r1r14✓1 rld4C� City/State/Zip: A/ilVe's /7 019o223 Phone#: 9 78'^ 77;/,5�7,07 Are you an employer?Check the appropriate box: Type of project(required): L❑ I am a employer with 4. 1 am a general contractor and l yxployees(till and/or part-time).• have hired the sub-contractors 6. ❑Now construction 2.W ate a sole proprietor or partner- listed on the attached sheet t 7. ('Remodeling ship and have no employees These sub-contractors have V. ❑Demolition working for me in any capacity. workers'camp.insurance. 9. 0 Building addition [No workers'comp,insurance S. ❑ We are a corporation and its required,) officers have exercised their to.[]Electrical repairs or additions 3.❑ 1 ate a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.[1 Roof repairs insurance required.]t employees.[No workers' 13,0 Other comp.insurance requircd.J •Any applicam that ehwkt box el must ahu all out the suctim bdowshowing their wwkms'cempan odua policy inrumtatice, '1 htmuou,m" he submit this affidavit indicating they am doing all work and then him aalii40 contnctara main submit a new amd evil indicting such :Cunnxtom that cheep this box mttat attached an additluml sheet showing the cane of the tuttwomradan and their workers'camp.policy infotmndon. l one an employer that lr providing workers'catnpensadan Insurance far my employees Below Is the policy and Jab site informurion. Insurance Company Name: Policy 4 ur Scif-its. Lic. 0: Expiration Date: / Job Site Address: S1 20i-M1296172' Kid CitylState/Zip:.-- Ca r��o�97U 'kitach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one-year imprisonmm as well as civil penalties in the form of a STOP WORK ORDER and aline of up to S'_50A0 a duy against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigwivav of the DIA for insurance covcraga verification. Ida hereby er i y�utder the pules and penultlessuoJf perjury that the infurnrurlan provided above is true uud correct. iianantre: 1'7� ��/�;/"/' I3uta• —Tel;,o4rk 1 a2o/3 Phone,l: U/Jiclu!use only. Du nuf wtite in t/dr urea4 to be completed by city at,town n/pelut City or Town: PcrmltR.ketae q _ Issuing Authority(circle one): 1. Bourd of Health 2. Building Departinunl 3.Cityffown Clerk 4. Electrical inspector 5. Plumbing inspector 6.Othcr Contact Person:. ..... __._ ._ Phoned: oi CITY OF SAL.EM, UxsSACHUSETTS BUILDL\G DEPARTMENT l30 VU.I SHINGTON STREET, 3" FLOOR TT EL (978) 745-9595 F.,x(978) 740-9846 KI.NIgFRr FY DRISCOLL A+LNYOR T1-osw ST.PtERRE DIRECTOR OF PUBLIC PROPERTY/11U'1LDNG COSaIISSIONER 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 11 1.5 Debris, and the provisions of MGL c 40, S 54; Building Permit A 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 t 11, S 150A. The debris will be transported by: 17N)16✓I 417d Soli l "s> -Z;71-. (name of hauler) The debris will be disposed of in 1,1 1 'ej Wef,51e 1-7-417J{el' S12;7,o17 --- (name of facility) fineil �S4 fe4v0Q1y (address of facility) signature of permit applicant aabrc: u,i.„: ,a Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supervisor ' License:CS-082402 i . DAVID P GEPIE9T el- 127 STANDLEY ST BEVERLY 10A 01915 Expiration Commissioner - 03mW2014 Oficc�ovsvmerirs&-Bvessegv aho � T HOME IMPROVEMENT CONTRACTOR ReglsLation: y154755 Type-, Expira8on: 4ASM13 Partnership EAD ENT_ERPRISES LLC'•, WILLIAM LOWD JR E =i - 4 6 GORMAN RD. - DANVERS,MA 01923_- < Undersecretary ---1444 1 HOMES-8 OP ID:DF ,a►`oRa CERTIFICATE OF LIABILITY INSURANCE °°11=12"'"' THIS CERTIFICATE 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 INSURETR(St AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the polley(les)must be endorsed. N SUBROGATION IS WAIVED,subject to the tars and conditions of the policy,certain policies may require an endorsement A statement an this certificate does not Corrter rights to the ceril0eate holder In Ham of such andorsem s PRODUCER - Phone: Appleby&Wyman Ins MEngtallAh�onGmup•NE F NAEE:ax: -866-253.0293 ra:EE6n=-4776 PO Box 2027 ;servicecenterMaiMFoup.corin Kama,NH 03431 AgMtM Appleby&Wyman ire Agency WSUREIMAIFFORDINGOOVERAGE NMCP NBILa31A:MGM Insurance Company 14788 INSURED Homestead Enterprises LLC wsu iE RB:Main Street America Assurance 29939 6 Gorman Rd INSURERc: Danvers,MA 01923�1516 INSDIBND: NSURERE: e SIARERFI COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CCNDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCR13ED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN P AY14AVE BEEN REDUCED BY PAID CLAIMS. tw TYPE OR N�atANCE POLICY NUMBER Lame BB6ULLUBOITY EACH OC RENCE E 1,0o0, B X commEiaALGENENA1LuADuTY MPP9537L 04/09442 04I M3 PREMISES . S 500, CLAIMS-MADE FX1 OCCUR MEDEMP(Any mepsrs ) $ 10,00( PERSONAL&ADV NA1RY E 1.000,01001 GENERAL AGGREGATE E 2,000, GEWL AGGREGATE UNIT APR.IESPER: PRODUCTS-COMPOPAGG E ZOOS. xi PoucY n P Loc $ R0A=W8A"W0uAEaM WdNd GA NIP9537L 1o/02M2 10102M3 BODILYNaw(Pwpw ) E 100,00( ALL OWNED X SCHEDULEDN.0 GOWLYRY(PK8"I t) S 300,iM— AUTOS A(ROS RED HIREDAUTOS AUTOS Pet ectldeN $ 100,00( S UMBRELALMB OCCUR EACH OCCURRENCE E EXCESS tAe CLaIMSMADE AGGREGATE E DED RE78Nr10Ns s ' WORNBe COMPINSAnaN A D AND EMPLOYERW LIABILITY OANY fFiC07� A4T�HtDUDED! RA YIN❑ NIA EL EACH ACCIDENT E prNMdgrylo o E.L DISEASE-EA EMPLOYEE S Nyes�desm-beundw DESCRIPTION OF OPERATIONS Mwt E.L.DISPASE-POLICY LIMIT S DE9TA nMNOFOPHNATIONSILOCATIONSIVEHCLES (aaeeAACORDIOI,AdReanalRW=MItdaada,warm spawnreq&64 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE OESCRM POLICIES BE CANCELLED BEFORE - THE IDIPIRATION DATE THEREOF, NOTICE WILL BE DMNMW M ACCORDANCE WITH THE POLICY PROWSENB AUrHORIZEDREPRESENrATNE ®1988,2010 ACORD CORPORATION. All rights reserved. ACORD 25(2D10f05) The ACORD name and logo are registered marks of ACORD 139'" 3n 24-1 12" 311IT --43" 24" " 9 0" 294 n 63n p 4 36' " 31zn ' 2 1n 4 2$" 11 WN 2W243� -2424 593It Chco = N I N � A ^m o" al 1p _ Z N Q OC93 fL � 37" 29„ N a 1 p 0J A o _ i- 0 0 1 m w N co f T (P AP T coW W N = x CX A t W tl mI+ CC(D W j V IW 1 "17 All dimensions-siw dexigmtions e)�1 �O j�f This is an original design and must Designed: 1229/2 given are subject to verification on TECHNOLOGIES(P� not be released or copied unless Printed: 1/11/2013 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. 1824 82;" 302" 45" 24"— 403," 0 a" 101 e" r 2W3021 N 3W4539 DW2439-1 2W3021 a L) F " 30-GAS-RANGE2 2g33RT SSSW36-L v M All dimensions-size designations A/1 �O j' This is an original design and must Designed: 12292 given an subject to verification on TECHNNOLOG(es G� not be released or copied unless Printed: 1/112013 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. 139 4" 3a r 24" 12" 31 2" 3" 24" 9 „ 0' 29;,, RW(312424) M DW2439-L 1239 2W2439 123901 L RBEP.7593' 30R-REF 25W 393415 -R v SSSW36-L co 36" 31 2" ",, 24' "---J--28"- a 4 All dimensions�dw designations 7r1�O gjfJ, This is an original design and must Designed: 12292 given are subject to verification on TECHNOLOGIES(/� not be released or copied unless Printed: 1/112013 job site and adjustment to fit job applicable fee has been paid or job conditions order placed. 172 t � I 1" 4" 411" 5" 0" 5" 113G" 4,e" tc I! 2W2439 W1539- 2SKXXW3039 153 -R39 of V J932SW33303RBDFB24 24.DISHW 09-R 2B(303412) 2B(303412) 330 `a 24' 4""' 416" 0' 0"- 4 is All dimensions Diu designations 7/1�O''J This is an original design and most Designed: 12/29/2 given are subject to verification on .tc"soLoaes�r� not be released or copied uolexx Printed: 1/1 112013 job site and adj uxtment ro fit job applicable fee has been paid or job conditions. order placed. 60" 121' — --3611�12" CIO cn / N 36" tN r v I � o \C Z TOILET-1 U 6011 All dimensions size designations A!1 7/'1 This is an original design and must Designed: 1/102013 given are subject to verification on iLecxVxoLLOWES not be released or copied unless Printed: 1/112013 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. Gary.Lynne Barrett.Bathroom JAR Drawing#: 1 No Scale. Unofficial Property Record Card Page 1 of 2 Unofficial Property Record Card - Salem, MA General Property Data Parcel ID 27-0525-0 Account Number 0 Prior Parcel ID 61 — Property Owner BARRETT GARY M Property Location 51 LARCHMONT ROAD BARRETT LYNNE F Property Use One Family Most Recent Sale Mailing Address 51 LARCHMONT RD Date 7/17/2003 Legal Reference 21283439 City SALEM Grantor MURPHY DAVID F, Mailing State MA ZIP 01970 Sale Price 351,000 ParcelZoning R1 Land Area 0.109 acres Current Property Assessment Building Xtra Card 1 205 400 Features 0 Land Value 143,100 Total Value 348,500 Value Value Value Building Description Foundation Building Style Colonial Type Concrete Flooring Type Hardwood #of Living Units 1 Frame Type Wood Basement Floor Softwood Year Bulk 1950 Roof Structure Gable Heating Type Forced H/W Building Grade Good (-) Roof Cover Asphalt Shgl Heating Fuel Oil Building Condition Average Siding Aluminum Air Conditioning 0% Finished Area (SF)2421.6 Interior Walls Plaster #of Bsmt Garages 0 Number Rooms 8 #of Bedrooms 5 #of Full Baths 1 #of 3/4 Baths 0 #of 1/2 Baths 1 #of Other Fixtures 0 Legal Description Narrative Description of Property This property contains 0.109 acres of land mainly classed as One Family with a(n) Colonial style building, bulk about 1950 , having Aluminum exterior and Asphalt Shgl roof cover,with 1 unit(s),8 room (s), 5 bedroom(s), 1 bath(s), 1 half bath(s). Pro a Images http://salem.patriotproper6es.com/RecordCard.asp 1/14/2013 Unofficial Property Record Card Page 2 of 2 J =�= INA. , Disclaimer:This information is believed,to be correct but is subject to change and is not warranteed. hup://salem.patriotproperties.com/RecordCard.asp 1/14/2013