3 LAURENT RD - BUILDING INSPECTION �2- aq
The Commonwealth of Massachusetts
Board of Building Regulations and Standards Town of
�y Massachusetts State Building Code, 780 CMR, 71"edition Wilbraham
Building Dept
Building Permit Application To Construct, Repair, Renovate Or Demolish a 4I3-596-2800
(, One- or Two-Family Dwelling Ext 118
This Section For Official Use Only
M Building Permit Num r: Date Applied: 11 s 'a 2. CP
y p ' Signature:
�✓ BuildihgCommissioner/Inspectorof Buildings Date
SECTION 1: SITE INFORMATION
I.1 Property Address: 1.2 Assessors Map& Parcel Numbers
�3 1.-�rrn n-t , _U_&1 '3 _ -
l.la Is this an accepted street'?yes—el— no Map Number Parcel Number '
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq @) Frontage(R)
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:
Public® Private❑ Zone: _ Outside Flood Zone? a Munici
Check if yes❑ P IOn site disposal system ❑
I SECTION 2: PROPERTY OWNERSH,,IP'11
2.1 �n e lsl)or�l! -e r W t
r Qf t
Name Print) Address for Service:
Signature' Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) 'EL Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief D scription of Proposed Work2 ��_ 6, Q QI"t
k ho r 1
IVC
SECTION 4: ESTIMATED CON RUCTION COSTS
Item Estimated Costs: Official Use Only
1 Labor and Materials
I. Building $ 6 1. Building Permit Fee: $_71 _Indicate how fee is determined:
2. Electrical $
❑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:$
y`� Check No. _Check Amount: 1 Cash Amount:
6.Total Project Cost: $ ����, paid in Full ❑Outstanding Balance Due:
L
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) 7:!K 9 7
U License Number Expiration Date
Na -Molder e of l A,� List CSL Type(see below) U
Type Description
Ad ress U Unrestricted(up to 35,000 Cu. Ft.)
R Restricted 1&2 FamilyDwelling
Siygnatur 7 M Mason 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 Registraticn 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
1 as Owner of the subject property hereby
authorize to act on my behalf, in all matters
relativz:to wort:authorized by this ba]ding permit application.
Signature of Owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
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
beha!f.
Print Name
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties of er'u
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 not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 1 I O.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"may be substituted for"Total Project Cost"
s \
CITY OF SALEM
PUBLIC PROPRERTY
-.� DEPARTMENT
D
,,\ILL:M'I N )K I (t o l
�I\ss to l2C W,\\tll.\(il0NS I31-L I • SAI I`\3,M.\iS.\l.I It it'I I\0197^�
1'c1: 978-745-9593 • 1:\x 978-741'-7846
Workers' Compensation Insurance affidavit: Builders/Contractors/Electricians/Plumbers
J3 3licant Information, > /� �/',�J /� Please Print LeCihly
Name 1,LF/'}r"9� (mot" jeena �
Address: -7l7 05CAoo 1� /��7 p
Ciry,Statc:7ip SQ�Qiy/� ✓� 4 D/9�o fhunei': % / 0 — ��
Are%you an employer? Check the appropriate box: 'ry pe or project (required):
I.❑ I :un a employer with_ 4. ❑ I om a g
s eneral contractor and 1 6. ❑ new construction
employees(full andur port- nit).• have hired the .uh-contractors
listed on the attached sheet. t _
2.K I j ut a sole proprietor or partner- ❑ Remodeling
S. ❑ Demolition
ship:utd have no employees These sub-contractors have,
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
No workers' cum 5. ❑ We arc a corporation and its
l P insurance officers have exercised their 10.29 Electrical repairs or additions
I required.] 1 I. Plumbing repairs or additions
3.❑ 1 am n homeowner cluing all work right of exemption per MGL ❑ b P�
myself. LKo workers' comp. C. 152, j 1(4).and we have no 12.❑ Ruuf repairs
insurance required.l r employees. LKo\vorkers' 13.❑ Other
comp. insurance required.]
-Any.�ppbcanl(bot cliccks box ill must also till out the se000n Inluw showing their wurkui cumpenruiva pull y iolinmuliuo.
' I lomcuwnen wh uanoil this affidavit indicating ill.)am doing all work and dtcn tra
hire outside cutscton must.uhmil a new alfdavit indicting.ncA.
o
-(',mtrxwn(hut dwck this box most anachcd an additional stu-el showing the name of this sub-comracwrs and then wurken'comp.policy mformanun.
loin an employer that is providing workers'colnpen.vation insurance for my employees. Below is the policy and job.Nile
infuriation. ('
Itnurancc Company ^ -_ Chr(L//"'aj(.Cf2"
Policy a or Sclf-irks. Liic. r: CL� 7�5,((d���J/...fib. - -- EA piruuun Dater L/-n Li'
Job Site Address: �J 41?cq-� /. 1%Y_-- City;Slutcizlp:1 L�f�ryl C)/P7�
Attach a copy of the workers' compensation policy declaration page (showing; the policy number and expiration date).
pailw'e to secure coverage as required under Section 25A of>IGL c. 152 can lead to the imposition of criminal penalties of a
nine kip to SI.500.00 and/or one-year imprisonincnt, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of❑p to 5250.00 it Jay ❑gainsl file violator. De advised that a copy of this stalcment may be forwarded to the Office of
lucc>I r,e auto ul the DIA for insurancc cascragc \criticaGun.
/ado herehy cerlifr under the pains and penallics of perjury that the infannalton provided above is(rue used correct.
Isar• _-22—D
Official use only. Do lint write in this area, to he completed by city or town officiut.
Pcrinit/License 0
City or Tn\rn: ---- -- - ..
Issuing .fluthuriiv (circle one):
I. Board ur Ilc(Ith 2. Ifuildit, Deparuncut .1. City:'fotsa Clerk 4. Electrical Inspector ;, Plumbing; Inspector
6. 01 her ...
Contact t'cnun: -_ __ Phone it:
Information and Instructions
.Iassachusetts General Laws chapter 152 requires all einplo)ers to provide workers' compensation for their employees.
Pursu:uit to t'nis statute, an empft tee is defincd as "...every person in the service of another under any contract of hire,
cypress or implied, oral or wimen.
An employer is defined as-an individual, partnership, association, corporation or tither legal entity, or any two or more
,,i the l0reeoing engaged in a joint enterprise, and including the legal representatives Of a deceased employer,or the
recei%cr or trustee ul an individual, partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because Of such employment be deemed to be an employer."
.%IGL chapter 152. §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required:'
additionally. NIGL chapter 152, a25C(7) states"Neither the commonwealth nor any of its political subdivisions shall
anter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority,"
Applicants -
Please Fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es)and phone number(s) along with their certiftcatc(s)of
insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The aff idavit should
he returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or'rown Officials
Please he Sure that the affidavit is complete and printed legibly. The Department has provided a Space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regardingthe applicant.
111:ass be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary) and under"Job Site Address"the applicant should write "all locations in Icity or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file fur future permits or licenses. A new affidavit must be tilled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. it dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
the of icc of luvestigations rvuuld like to fliank you in advance fur your cooperation and should you have any questions,
please du not hesitate to give us a call
The Ucparnnent'S address, telephone and fax number
The Commonwealth of Massachusetts _.
Department of Industrial Accidents
Office of lovestigadons
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax # 617-727-7749
5-�0-us
www.mass.gov/dia
CITY OF SALEM
Y a t
a PUBLIC PROPRERTY
DEPAK"I''�IENT
,..
Construction Debris Disposal Affidavit
(required for all demolition :utd renOVallult work)
In accordance t%ith the sixth edition of the State Building Code, 780 CNIR section I 1 1.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit rt dis is issued with the condition that the debris resulting front
this work shall be posed of in a properly licensed waste disposal facility as defined by MGL c
l l 1, S 150A.
The debris will be transported by:
y aer V1 CF—
I lie debris will be disposed of in
(name ul laeihty
(address ut facility)
• uture of permit .applicant
L
Page 1 of 2
Andrew Oliver
From: Andrew Oliver[aoliver@transatlanticcapital.com]
Sent: Wednesday, November 19, 2008 9:40 AM
To: 'ajoliver47' �)
Subject: FW: Laurent Road - Changing doors to meet code ,. �� (U "
-----Original Message----- I v I
From: Thomas Stpierre [mailto:TStpierre@Salem.com]
Sent: Thursday, November 06, 2008 5:18 PM
To: Andrew Oliver
Subject: RE: Laurent Road - Changing doors to meet code
Yes, the notice will suffice. Tom
Andrew O' er [mailto:aoliv trans n ' capital.mm]
nt: Thursd vembe� 8 10:10 AM
To. s Stpierre
Subject: Laurent Road - Changing doors to meet code
Tom—we are having a little difficulty in tracking down Trustees to sign the letter authorizing us to go ahead and
upgrade the doors.
Does this email from the management company, giving direction to the Trustees, suffice?
Regards
Andrew
-----Original Message-----
From: Lesley Management, Inc. [mailto:lesleymanagement@comcast.net]
Sent: Monday, November 03, 2008 1:30 PM
To: Andrew Oliver
Cc: Jason3349@comcast.net; Jason Marshall; d.c.lepard@juno.com; Christine Sullivan
Subject: Re: Changing doors to meet code
1
Andrew,
I have no idea what you are referring to. CHANGE YOUR DOORS! Neither management nor the Trustees are
standing in your way, or saying, or doing anything that is preventing your from updating your unit doors{bringing
them up to code while maintaining the integrity of the building}. I have copied the Laurent Road Board of
Trustees on this email, so as there to be no confusion. If you feel the necessity to write a letter of which you want
the board to sign off on, please do so. I know your time is valuable as is ours and I'm sure you would want to
have this project completed.
Regards,
Kim
Original Message ----
I From: Andrew Oliver
11/19/2008