0002 CARROLLTON STREET EXT - BUILDING JACKET Car/ O�l foh 5
UPC 10330
No.153L
HASTINGS. UN
/
���QO�i1 ��ad ��pDO� G��3nOQ��40�3a B�Qo
Professional Land Surveyors & Civil Engineers
ESSEX SURVEY SERVICE 1958 - 1986
OSBORN PALMER 1911 - 1970
BRADFORD & WEED 1885 - 1972
PIAT PLAN OF LAND
LOCATED IN
MASS.
i// Uf St
kR,Jh V
f /G
lei/�E L
� Gf`
LAI
i 9
s�i7
Ihereby certify to the
Building Inspector that I have
a examined the premises and the
SCALE: /- 40 buildings are located on the
DATE /)�/ Z/ / � ground as shown, and buildings
shown conformed to the dimensional
REFERENCE: Y�7 BK f Z pC Z) zoning laws of MA
when constructed
This Plan has been prepared for Building
permitting purposes only for the above party, T
and is not to be used for boundary measurements, C
land conveyancing or mortgage loan inspections or s MELLO
plot plans. V lo PLS 31317
4"�rsT
104 LOWELL STREET
PEABODY, MASS. 01960
(978) 531-8121
FAX: (978) 531-5920
F:i: /C. 0. COPY
il-- 'FIA/7-- OCCUPANCY
CITY OF SALEM Issued. Permit N '�yl
a 11. . fAa SALEM, MASSACHUSETTS 01970 City of Salem Building Dept
qtr,
DATE NOVEMBER 12 19 93 PERMIT NO. 80.14-1999
APPLICANT T0WN & COUNTRY HOMES ADDRESS 16 POURI3AN STREET 248
(NO.) (STREET). (OONTRS LICENSE)
CITY PEABODY STATE MA ZIPCODE 0196V..I TEL.NO. 978-535-1724
NEW BUILDING ONE FAMILY NUMBEROF 1
PERMIT TO (_) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT(LOCATION) 0010 CARROLL_TOtd STREE:::T ZONING
f#2 CARROLLTON_ STREET E%T! DISTRICT
(NO.) (STREET) �-
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION MAP 10 LOT 01 r'6 8LOCK SIZE 00098221 SG FT
BUILDING IS TO BE FT.WIDE BY FT.LONG BY FT.IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
mPE)
REMARKS: CONSTRUCT NEW SINGLE FAMILY DWELLING. PLANS SUBMITTED. P. S.
#2 CARROLLTON STREET E%T —
AREA OR 100 000 PERMIT 605. 00
VOLUME ESTIMATED COST FEE
(CUBICISOUARE FEET)
OWNER CARROLTON REALTY TRUST BUILDING DEPT.
ADDRESS BY P. S.
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY,ENCROACHMENTS
ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION,STREET OR ALLEY GRADES AS WELL
AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE
APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Remised,Nar 2011
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two; iily Dwelling
This S tion F r Official U Only
Building Permit No Date lied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
�J cAkQ 0-1 47'?f C4,22 Pr &X'
I.la Is this an accepted street?yeLW no Map Number Parcel Number
1.3 Zoning Information: I Property Dimensions:
9aa — 9a, 7
Zoning District Proposed Use Lot Area(sq it) Frontage(R)
1.5 Building Setbacks(ft)
Front Yard Side Yards 12ear Yard
Required11 Provided Required Provided Required Provided
isf Q7J 3o 1 ss�
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? Municipal ❑ On site disposal system ❑
Check if yes❑
SECTION2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
i<✓2TtTHE2ESA ",TTF/E2t S6le"-I I'1 0Ig7d
hne(Print) City.State,ZIP
� Cf+ gar L IaM sTeseT �t
No.mid Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied i. Repairs(s) ❑ T Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units OtherA specify: 06nk
Brief Description of Proposed Work'-:
c�cLsl 'J �y 0o2 hack CN R4PA 2
HcvvsF
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building $ 5/ a�� 00 1. Building Permit Fee:$ Indicate how fee is determined:
2. Electrical $
❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)s multiplier x
3. Plumbing S 2. Other Fees: $
4. Mechanical (HVAC) $ List: �� r
5. Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: S a ya�o 0 Paid in Full 11 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) 22n2 y
�//\/ License Number Espi anon ale
Nome- of CS�Holdcr
A/ List CS YP L Type(see below)
No.and Street P
Po �dx y � Type Description
d Unrestricted(Buildings u to 35.000 cu. it.)
t9 R Restricted 1&2 Family Dwelling
'Cityll'own,State, P ' M Mason
ry
RC Roo fing Covering
WS Window and Siding
9)8'G/O/-7o�G� b/riYPAnr7APNf _ SF Solid FuelBurning Appliances
- tp�jy/� 1 Insulation
`Felt hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) fyZ/-/O9'Z
1aAady19f HIC Registration Number �E/xp�ira<tion Date
HIC Company Name or HIC�egistmnt Name
P.O.
o. PDX yo�.r Joi/ni MivMA9r�I7rno, ,co,�
No. and Street
d/gc,/ t+ L r Email address
C s/Town, Stt;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
I,as Owner of the subject property,hereby authorize,,JoH" PANTA PAY
to act on my behalf, in all matters relative to work authorized by this building permit application.
HE2Esfl crlZ7fiPdPrAf��11 ( n �� I
Print Owner's Name(Electronic Sig ature�i-)- Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby ttest under the pains and penalties of perjury that all of the information
contained in this application is true a accur to[h st o m knowledge and understanding.
Print Owner's or Authorized Agent's a(Electronic Signature Date
NOTES:
1. 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 can be found at
www.massjgov.'oca Information on the Construction Supervisor License can be found at www.ntas.��ovkins
2. When substantial work is planned, provide the information below:
Total Floor 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"
LMLA0M S
�C(O�N�T�RLRLC'Tj1LN LGJ
SERVICES LLC
Full Service
Contracting
Mark Corriveau 5 .� �iyi9.1'li5 9
mco,riveau77@8mailcom Ll L� lam._•-1 L1..
DATE
ACORD CERTIFICATE OF LIABILITY INSURANCE 05/0M/D )
o5io9i20112o11
PRODUCER (978) 745-6464 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Rose Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
66 Loring Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. Box 958
Salem MA 01970- INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A:MERCHANTS INSURANCE GROUP
Mark r s Contracting LLC INSURER B:
5 Witchcraft Road INSURER C:
INSURER D.
Salem MA 01970- 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 ADD'L TYPE OF INSURANCE POLICY NUMBER PDALTEVMM DOME pDAITE MMIDDM'CY EXP N LIMITS
LTR INSRD
GENERAL LIABILITY BOPI048535 05/11/2010 05/11/2011 EACH OCCURRENCE 8 1000000
X COMMERCIAL GENERAL LIABILITY PREMISES Ea oocurrrence S 100000
CLAIMS MADE F—IOCCUR / / / / MED EXP(My oneperson) 50000
PERSONAL B ADV INJURY 8 1000000
GENERAL AGGREGATE 8 2000000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2000000
1-1
POLICY JECT LOC / / / / HOUND
AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT $
ANY AUTO (Ea amitlent)
ALL OWNED AUTOS / / / / BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIREDAUTOS / / / / BODILVINJURY 8
NON-OWNED AUTOS (Per accitlenQ
PROPERTY DAMAGE
(Per amdent) S
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
ANY AUTO / / / / OTHER THAN EA ACC
1 6
AUTO ONLY: AGO S
EXCESS/UMBRELLA LIABILITY / / / / EACH OCCURRENCE $
OCCUR F_ICLAIMS MADE AGGREGATE 8
S
DEDUCTIBLE / / / / $
RETENTION IS 8
WORKERS COMPENSATION AND / / / / TORV LIMITS ETR"
EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT S
OFFICEWMEMBER EXCLUDED? / / / / E.L.DISEASE-EA EMPLOYEES
If yes,describe antler E.L.DISEASE.POLICY LIMIT 8
SPECIAL PROVISIONS below
DESCRIPTION OF OPERATIONS/LOCAT IONSNEHICLEVEXCLUSIONS ADDED BY ENDORSEM ENTISPECIAL PROVISIONS
This policy will autonactically renew 5/11/2011 - 5/11/2012
CERTIFICATE HOLDER CANCELLATION
— SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
City Of Salem FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER ITS TS OR REPRESENTATIVES.
AU HORIZED EP
f1p,JWNTATIVE
ACORD 25(2001108) m C RPO ION 1988
INS025(D1DB).fx' Page 1 of 2
CITY OF 5ALEM
•11. PUBLIC PROPRERTY
a}
DEPARTMENT
,Nil:; n:PY:IMIM:uI l
\I,1tst
1?�WA%HJ.%t:lU\51xEL•T a $1tb.M, Md5,r.r1.111 si.1 Iv,)1')7:
)78•FI3-`)395 a 1:%x. 9711•74C-9346
1Vorkers' Compensation Insurance untiovit:. Builders/Cuntracturs/Electricians/Plumbers
lunlicant Inrorination Please Print Leeihly
Name Illuuiw.f/l)rganlralinrvinlal�v^auun: -(YI IT' k N rVC)c
ddresis:1c; lJ�i�G' KKK fl� V-1 Q
City,Srarc %ip Sd�YL N\ y-v-, G1 9 7 C/
i'hune it: I—lvf 7 —799—/7S9
Are rou an employer?Check the appropriate box: 'Type of project(required):
1.0 1 am j employer with _ d. 0 1 am a general contractor and
employees(full and/ur part-time).• have hire)the sub-cuntracturs //' New construction
2.X 1 till a sole proprietor or partner- listed on the attached sheet. : 7• ❑ Remodeling
,hip and have no mnpluycGli These sub-contractors have S. 0 Demolition
working for me in any capacity. workers'camp. insurance.
--_. 2_O..DuiWiag-nlJitiurt ----- -
— ----- - - I�`�workers'comp. insurance —
S.-[]-a arc a amparntien;mJ its -- --
required.) of iccrs have cxelciscJ their MCI Electrical repairs or additions
3.0 Iran a homeowner doing all work right of exemption per bf I 11.0 Plumbing repairs or additions
myself. [No workers'comp, c. 152,j 10),and we hlrvc no 12.❑Rtwl'nprirs
insurunco required.) t cmpWyccs. IN worked'
comp, insurancerequircJ.J 13.af Other DEGbc
nn1.glphemd Thal checks boa In muA_:aw 101 oul the wm,on Wow dwwinx ihvir wukus'cumpe"wdiwr pokey inrurmmiun.
I lu,neuwmn w110.Wm,it this affidavit indiutina Only jle joins ell work and then hit onside"umwma moat.alma a new AIITdavil indi,aainx vteA.Q1,nl,acuwv that check this bon,most anwhcd an additional..hen.Auwine the name W thin mbKentraclors and then wagon'tmmp.paiey intbmtaliva.
/ran an employer dear lr praeldheg workers'rumpemadon hlrurattco jot illy etnp/oyerr. Br/uw Is the pu/fay and/ub.rite
iu/annerinn.
In.urance C'unlpany Vmne:
Policy p ur Sclr•ins. Lic.it: Expiration Date:
Job Site Address; C'ityl State/Zip:
.\track it clipy of Ibe workers'cumpensailon policy deelaratlun page(showing the policy number and expiration date).
Failure w sears coverage as required under Scctiun 251%ul'XIGL c. 152 can lead to the imposition of criminal penalties of a
tine up 1-1-it.500.00 antl/ur one-year impristmmcnr,4.4 well Js civil penalties in the!'arm of a STOP WORK ORDER and a fine
of up to i250.00 a Jay.lgoiml file violator. Ile advised that a copy urthis.1Jtcatent may be Iurwarded to the 011ice ul
Ill\'�MIgJIVllls ul file OI.\ for insurnce coverage lcrilicauun.
/,o hereby rertijy ender the p,linr and Pedimh/ex u/perjury that t/rt/n/urrnullon prvviJrd u u.•t it out real eorrer4
I'I,n: •:r
U//lciu!nvv on/y. Od nor n•r/tt in d�ir urea,to he ruorpleled by airy ur town a//ir1oL
i
Cirrur 'fnwn: Permit/fAct se0,
bruinµ.\W hurity(circle one);
I. IAIurJ of Ilealth 2. Ihlildin; Ilcpartnleul I.Cilyi futon Clerk J. Electrical Inspector 5. Plumbing Inspector
6. Ulher
I
information
and Instructions
.\I:us.lchu;ens Ueneral Laws chapter I i2 requires all employers to provide workers' compensation for their employees.
contract of hire,
I'ur>u:aht to this aatule,an rmp e luW is defined as"...every pcl:son in the service of another under any
rspre»or implied,oral or written."
An !,npluyer Is delincd as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the l0reguing engaged In a Joint enterprise,and including the legal representatives of a-deceased empluy'cf, ur the
lelClVef or lfa&lee Jt .ut individual, palmenhip,assoclation 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
,Iwe fling lauuse of another who employs persons to do maintenance,cunsuuction or repair work on such Dwelling house
Jr on the grounds or building appurtenant thereto shall not because of such employment be deemed to be art employer."
state or local licensing agency shag withhold the Issuance or
NII,L chapter 152. p25C(6) also states that"every
ness or to construct buildings In the commonwealth for any
renewal of a license or permit to operate a busi
applicant wlso has not produced acceptable evidence of compliance with the Insurance coverage required."
itJditionully, %IGL chaptcr 152, a25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance ul'public work until acceptable evidence ofcunrpliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
- - compensation affidavit completelYhonanumber(s)a by checking the loxes that apply to Your ertg with their certificateU of On and,if
phase-rtll-Jut-the-workers'_
necessary, supply sub-contractors) name(&), addrcss(es)sad p
insurance. Limited Liability Companies(LLQ or Limcompensation
- - -
ited iabsatioa insurance.(L an)with
or era Does s other than the
members or partners, are not required to carry P
employees,a policy is required. Be advised that this affidavit may be submitted to the Department Of Industrial
\ccidents for confirmation of insurance coverage- Also be sure to sign and date the of idavit, Tim affidavit should
be rettlmed to the city or town that the application for the permit or license is being requested. not the Department of
law of if you arc required to
Industrial Accidents. Should cyou have all the Department at the number liy questions regarding sted below. Self-insured companiestt a workers'
should enter their
cmnpensatiun policy,p P
self-insurance license number on the aPPrO riatc line.
City or'fown officials
please he sure that the affidavit is complete:and printed legibly. The Department has provided u space at the bottom
an
of the affidavit for you to till not in the event the Office of Investigations has to contact you regarding the applicant.
(if the affidavit
sure to fill in the p rmit/licmue nwnlxr which will be used as a reference number. In addition,an applicant
that must submit multiple pennio'license applications in any given year,need only submit one affidavit indicating current
policy information t if necessary) and under"Job Site Address"the applicant should write"all locations in (city of
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided t the
applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled nutt each
year. Where is home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. it dug license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
I h r>tticc of, Investigations would like to thank you in advance fur your cooperation and should you have:any questions,
pleahe do not hesitate to give us a call.
The Ueperunem's address, tcicphune and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
OQIce of Isvesdgadons
600 Washington Street
Boston, MA 02111
Tel. p 617-727-4900 ext 406 or 1-877-MASSAFE
Fax N 617-727-7749
It.-.l>cd J-24-05 www.mass.gov/dia
CITY OF SIU.&M, NSSACHUSETTS
• BLLLDLNG DEPiR-MENT
t 120 WASHNGTON STREET, 3 °FLOOR
TM (978)745-9S95
FAX(978) 740-9846
KIN
C3ERJEY DRISCOLL
1AYOR THouas ST.PmRn
DIRECTOR OF PUBLIC PROPERTY/BUII.DLNG COMMISSIONER
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 l l 1.5
Debris, and the provisions of MGL 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
l 11, S 150A.
The debris will be transported by:
rn�C'kS Cc3rt7✓Y�c'T�,ry �
(name of hauler)
The debris will be disposed of in
Y C-�r-7 CA v%
sww w, scd`Tr flVE
--
(name of facility) u.
(address of facility)
signature permit app ant
date
dcbnvlf J,M:
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