54 LAWRENCE ST - BUILDING INSPECTION What is the current use of the uilding?
Material of Building? W U If dwelling.how many units? 3
Will the Building Conform to Law? yes Asbestos? Nam_
grchited's Name
n (y
Address and Phone ( )
Mechanic's Name I 1
c, M��
Address and Phone � � n a,
Construction Supervisors License# p`f$ 4 HIC Registration# I 6
Estimated Cost Of Psr�ojed S a a (7 Permit Fee Calculation
Permit Fee$ '� Estimated Cost X$71$1000 Residential
— - --- - -- -- Estimated CostX S71/f1000 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 to build to the above stated
specifications. Signed under penalty of perjury X ° v
Date �
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CITY OF SALEM
07*ziPUBLIC PROPRERTY
DEPARTMENT
Kl\I I{I'K I.EY L,ftISCIi11.
M-%i og 120 WASI NGTON STREET ♦ SA1.1:M, MASiACI tL.SL 1-1 SO 197C
Trt:978-71i-9i95 +C.ax:978-74G9846
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 111.5
Debris, and the provisions ofMGL c 40, S 54;
Building Permit # _-.____ 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:
(narneWf ha�)
I'hnc ,debris will be disposed of in
VvQlU �12 wov
oiamduf facility)
l' Idress of f�il`lyj I
siL"uature of pmIlit applicant
n:
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
xnat=.arrt,t Wt6catl.
MAYM
t20 WASIGI%- M Smaet a SAtFY,MASSAanUM 01970
Tat::9711-745A595 a FAX 9W40,9ee6
Workers' Compensalioa Insurance AtIIdavit: BnildeyContrutersMeetrkianypbmben
Applicant Information
Pi�� �,Q"_ "� Pleases Prt..e r .atwe..
Names p n ): 1LllC�n UU�+ie� d �G ` flyl5 ri/Cf'tnY1
Address: Ile 2
CityiSfatG0P: 1� (4 )'b' OOI t S Phone#. gSZ H R 6 (till
A
Zon u ampbyer?Check the appropriate bout
1. I am a employer with 3 _ 4. ❑ 1 am a postal contractor and I Type of Pmjea( '
employes(Ad,and/or past-time).• have hind the suyeoutraepaa 6. ❑ ew construction
2.❑ lam a sole proprietor or partner. listed on the aaached sheet t 7. Remodeling
ship and have no ampktyees These have 8. ❑DemoUtion working for we in any capacity. workers'comp ;nnnanes
[No worker' comp insurance 5. ❑ We an a corporation and its 9. ❑Building addition
required.] officer have GXamised their 10•❑Electrical repair or additions
3.❑ 1 am a homeownsr doing all work right of exemption par MOL I I ZI Plumbing npaira or additions myself.(No workers'comp, a 152.41(41 and we have no
insurance ]t employees.(No worker' 12.[3Roof repairs
_ coon*innuance required.] 13.0Other
t I now
Hmuowam wbe submit&k chah box a&eldryn ho fia out dw aadon below d ooring ddr wmkne'Smpmmdaa pow
rCeewaataen tires cbeak ddo boa now resold r 'S wok ad to ate oandde coomwon am red rah a ow al�vy(e iai Sri
dwolug dla man Oten$ beoseectaw and*Ak waken•camp inns?idanmatlea.
/see oar iesptoya that b prov/dhtt worheri'compmsedam btsuraeca or
1efOMQllala f my eleptOyelr. BQ/OI/Is
the p0Ha7 and
fad JJdr
insurance Company N.
Policy N err Self-ins.Lie.N
Expiration Date
lob Site Addrera:
City/Statea4.
------
Attach a copy of the worker'compensation poticy deehuuba page(sho the
Failure m seeun coven wing Pulley number said expiration date}
fine up to S 1,500.00 and/ ardor Section 2SA of MGL c 152 can lead m the imposition of criminal penalties of a
Y imprisonment,as well at civil penalties is tie fool of a STOP WORK ORDER and a fins
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the OtEca of
Investigations of the DIA for insurance coverage verificadon
/do hereby eerai/y ands uFa pales and ealtla o/perjury that rho leJormadoe provided ablm it true and corral
EMSENEW
PhoneDa
$ 5sL 16
0*W use only Do not write IN this are;to be eomp/eted by city of tows ogelo[
City or Town; Permlutleems N
Irsuing Authority(circle one):
1. Board of Health 2.Building Department 3.Clly(rowa Clerk 4. Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person:
Phone N
'� :r,�e �am, rr/�ib o�✓�amaafr
Board of Building Regulations and Standard
HOME IMPROVEMENT CONTRACTOR ,
I kt
Registratla 106095
?Ea pi�atfon /22/2008
4�"� 'Typo-.:1' svidual..
p. - BRIAN G.BOCHE VY
Brian Soches
y( 19 Rena Road
4-g Beverly,MA 01915. - _ Deputy AdmlaBtntor 4;:
r R.
��re.eomrirrrcyuae¢/(/ a�✓�taaeac�is t
BOARD OF BUILDING REGULATIONS+
" . . license:. CONSTRUCTION SUPERVISOR - s!
Number:"CS�\ 045576
I Birthdatei 0/23/1459
- Expires: 10/23/20 7-1 Tr.no: 5052.0
I • Fa 3� 8:�1
Restricted;
�J BRIAN G' BOCHES-,'
8 19REZZARD yY
BEVERLY, MA 01915`�- %" �
' .
Commissioner "
�ir'�.`.w>x°f "�„b Sur P`b:umq�9+fy.,.'•y..,�
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f
4i19)::007 9:42 AM FROM: Fa: Gerald T. 1(1.r Fl Iasarance dc=m y, Ina. TOi 1-978-740-9c4d FACE: CO2 OF 002
Gerald T. McCarthy Insurance Agency, Inc.
P.O.Box 839-92 North Street,Salem,MA 01970
978-744-6433-Fax 978-744-3575
April 19, 2007
Building Inspector
City of Salem
City Hall
Salem,MA 01970
Re: Brian Boehes-Coastline Construction-Polk 6KIJB260Y479206
Dear Sir:
By law,certificates for workm compensation insurance must be issued by the assigned insurance
carrier; therefore,we have faxed a request to the above mentioned company to issue a worker's
compensation certificate of insurance which they will mail directly to you. In the meantime,please
be advised by us that this coverage is,in fact,presently active for the period of 3!14!07-08 with St.
PautTravelens Insurance company
I hope you will find everything in older;and if you have any questions,please feel free to call.
Sincerely,
Deborah Toumas
dt
r
EITY-OFglTLE� _--
PUBLIC PROPERTY
DEPAR'I'�IF.�IT
KIMBERLEY ORMCOU
MAYM 120 WwaNGww h MEEr•SALLK mA.,sACHLSLj-M 01970
147:978-745-959S•Fex:976.740.98"
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY FOR ANY VaSTIN
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: > L.,T ce ( Building:
--- — Property Address.--— — -- ----
Properly is located in a;Conservation Area Y( Historic District
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address: sgir�ti�
Telephone: g 2 V0 9773
3.0 COMPLETE THIS SECTION FOR WORK IN FY1sTING BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use Now
Demolition Existing
Approximate year of �D s ? Area per floor (sf) Renovated
construction or renovation
of existing building 4 New 'I
Brief Description of Proposed Work: ]�x y IM_() Ck 15�I l�S �jaTn tin S 6Y I
1� �hd{- 3Cd OM5 l r (. cj ujk JCWV dry r-GC i � BPS �-
A
Mail Permit to: