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37 LINDEN ST - BUILDING INSPECTION l ZG � The Commonwealth of Massachusetts °1� Board of Building Regulations and Standards CITY OF ( U Massachusetts State Building Code, 780 CMR SALEM \ Revised Mar 2011 - 71� Building Permit Application To Construct, Repair, Renovate Or Demolish a One or Two-Family Dwelling This Section For Official Use Only --- Building Permit Number: Date Applied: I C kA-r�f . n -ZH sV-I 5 /' Building Official(Print Name) Signanue Date - SECTION 1:SITE INFORMAT16N 1.1 Prope v Addr ss ��97 1.2 Assessors Map& Parcel Numbers l� �r- Lla Is this an accepted street?yes no Map Number Parcel Number - 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) 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: LS Sewage Disposal System: Public❑ Private❑ Zone: Outside Flood Zone?. Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSRIPr 24,Owper'of Record: `--- Sn /C� ,/, •�/l 4 ©r n-20 Name(Print) City,State,ZIP v Z 3 (s✓.i D �T No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory.Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work 2: SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: iU Labor and Materials)_ Official Use Only 1. Building $ 1. Building Permit Fee: $ 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:$ ! Project Cost: $ n Check No. Check Amount: Cash Amount: 6.Total Pro J '� I r p4� ❑Paid in Full ❑Outstanding Balance Due: �rA 857 2 z - �l �� r- SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 0,0 na (3 , CAn11X01) License Number Expiration DatJ Name of CSL Holder List CSL Type(see below)�, LLq a6\ M� � � No.and Street _ Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Mason ry � �n RC CoveringRoofing Window WS Window andndSiding SF Solid Fuel Burning Appliances '�-`-'-b"_ 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement(C/o�nttra�ctor(HIC) / Q / �2 � / ^ a `T IrfL-/ mb HIC RegUis rtaQtion Numbeer.J tO xpdir'F7on Datc C trip aNaq�e I RMeppstr Napte No.and Sir �W I lam. n „ /� Email address 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 79:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize C3e . to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) - Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,1 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. �z- 172 .2D g: Print Owner's or Authorized Agent's Name(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.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.f(.) (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" t i E y►'Qe�sc�-a I next step living l . Ire�adMm46 rmaee>'r1 I This agreement Is made and among 25Drj"Awaq B'lrer Rabat M.St.Pium Hoeg,MA02210 37 Da"Sl 8ateoi,MA 019704= Caalelrer �080002B39p Cea tad ID:20111109_WOItK ' BIbm1801B0M2B370 . . f. R2Lvapmkaemamb4l l it 0wIobrAOaakas0aaarneteadarmeWoa0.reOrae nrmaantbmeudsmwYh8rbmed paegp�,�pMAldladreampwllabWaakadsdemetlnp0mvarkbtlaN(MWo�_dloAnetpaporeYehaeY kY�efaaee: Oraft LOCO" 01140,00 elreAt m Aaag _�_�_ --_�2 _ MR tMreana ?4.... 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Ngd&VUft 26gity"Awaa.Pow-Bbft VA012110•(lWp674M• •wewJoe aaoa i Document Integrity Verified EchoFign Transaction Number:JNH2K37)C2M34XX next step luring This agreement Is made and"among NM Step uving Ue.CNSLI . 26DrydookAvmae5mfi m R.oban M.St:Pkae Baaem,MA02210 37 Undms St _ Balm,MA 01.9704520 CalwomIDs000010a390 CoatmetMs26111109 ABRAL Bb ms 800002Bigi70 - 1. DEKRMMOFWORKIDIE N&.vapedammauebbpedaanedbhb0pe0MmbaalanateedMepmaae,bapoleeaaielmaaEndbaoao�ioaaTlraeMmeM . 4MCoabaat b3rdnp ReelMhel�aNer�eoBM$bwoMbdMel lae9MaM�wNAMsbaoryonad hendn by rebrMioa . Daotlptlm Qa1mNIT L"fivon .Pa , n,AtaWlnatE$*MW-O2.SMg Parnwr ...._.......— 2 LRM OR awlTeal: $160.80 farum t'JMohr as kww" $teaa6 Nd*dmTm AtbrbtwMm $0.00 T" $0.00 1.CUBTORER elamOudth"how reeebed w haarriw6ft do put 12 mm0m.W W has gftL— . 2.TlrbdapaI sgsm p r andbrplahroantlwuM4allmi Wls lbmoaMWr 1 ofmiDprgNSLlXbaoikmb oee: PrMMd 1100011 Paae1AT Pepmd VV l2eNltlyda� oaMbbebWaka0�10110.RgiMpapMmlbnlbneDbewlNuWlaarbpkrMbyswbmereenlae repwtrdMwotbOhhdoditMap.aoPaMbnotbMaeeO WgbbWreldmab.ThbaMNne'kwjM WWm$Hkhdpol0bpldbytlu Cuaberr.Qk11c11tMaaatd.VlaAaed04barY�a�/ AdEaWRghrtb larlm MroflMTo_ �W pgMaM brOleMbdMaOEedwl$enaanpbtlmaltlrWM. 'a1 Oov 9,2011 " Deb N818 onf� TheNwr; Ina wanmNll Tema of MleAgmement ae msda nod cn boM Miles MthN pop N®dsrpudna2eapad<Armue•e�Bum•Boga�,MA�2+o•leeeleam2e• •vMw.nea�kdakcam �/Documem IMegnty Verified EchoSign Tmnwetlon Number.JNH2K37X2M34XX 11/10/00, TITU 17:04 FILM 617 393 2415 -; T: 16005 The Conwwnweolih of Massachusetts _':;:, ;: DepadnzentofAndushialAccfdents yi_ _: '! ' ;, _ "_y., ®�ceojlnpesGgntions• r3 t r 606 Washington Street `'� V'�^€€€'��''' Boston,MA 02111 yu' F:. - WW16:nraSS.g'OV/die . Workers' Cormgreasad(in ffnsumnee eAH"idavit. Builders/Contmetoes/lElceMcians/Plumbers tAuulicant YnSornratimn fl Please print LeAbly MaInc(Husiams/Organimtion/Individuai): )\�Q^.X �j,-�e I V nc ZY�f Address: City/State/Zip: &cJ o r� VA r, .' OZZ I 0 Phone#: GG) i o - Sf) J-9 Are you as employer?check¢he appropriate box: Type of project(regttired): I,�] D Tun a employer with__ / 4. I am a general contractor and 1 6. New construction employees(full and/or part-5me).° have hired rite sub-contractors 7. Remodeling 2.® 1 am a sole proprietor or partner- listed on the attached sheet 111 g ship and bare no employees These sub contractors have S. ❑Demolition E. for me in any rapacity. workers'comp.insurance. 9. ❑Building addition (Noworkers'oomp.insurance 5. ❑ We are a corporation and Its required) officers have exercised their 10.E Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL I I-O plumbing repairs or additions myself.[No workers'oomp. c. 152,§1(4),and we have no 12.0 Roof repairs 1 I insurdne Mqu6ed)t employees.[No workers' 11M Other Zr�5 jj comp.fasraantee required.) 'Any applieam That checks box#1 must also MI out die section bdow showing their workers'compensation policy information. r ldomawoms who submit this affidavit radiating they ate doing all work and Then hire ouiside contractors must submit a new affidavit krdier ing such. rCnnrwors gat rhaek,this box mug niched an addidimal sheet showing the name ofthe suh•amoelors and their workes amp.polity i tlemaim, !am an anployer that is providing workm,compewar0on inswnaneejor my errgrloyem Below is Oepegcy arrd joh tzie - infurmoaion Instu-mce Company Name: Policy#or Self-urs.l,ic. #_ -), I -) _-_- Expiration Date. -11/4/zo i Z Job She Address: City/StaWGp: Attach a copy of the®corkers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required ender Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a fore UP to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a file of up to S250.00 s day against the violator Be advised that a copy of this statemart maybe forwarded to the Office of Investigations of the DIA for inen�oce v e crifitah oa d do herebi,cry*under the , %end oPper/atry r'hat the lnt0brawdom provided above it true and corral 'Signante: Phone C F7.Md41ly. !So rant write In this area,fo he eoiarpieted by wiry or town oyJ7cfoi rity(Circle one)____ alth Z.Building drepartment 3.City/rowa Clerk 4.i; etrical Inspector 5.plumbing Inspector Contact 1Person- Phone Client#: 5042 NEXTSTEP ACORDr. CERTIFICATE OF LIABILITY INSURANCE 11129/Z0;;") PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION William Gallagher Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Insurance Brokers, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, 470 Atlantic Avenue Boston,MA 02210 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: One Beacon Insurance Company 21970 Next Step Living,Inc. INSURER B: A.I.M. Mutual Insurance Co. 33758 25 Drydock Avenue NSuR c: Riverport Insurance Company 36684 5th Floor NsuRER D: Hartford Fire Insurance Co. 19682 Boston, MA 02210-2600 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. NSR DD' POLICY EFFECTIVE POLICY EXPIRATION _TR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMDD DATEfMM/DDNYYYI LIMITS A GENERAL LIABILITY -- 792000560 11/11/2011 11/11/2012 EACH OCCURRENCE $100-0000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISESccurt nc $1 000 000 CLAIMS MADE ®OCCUR MED EXP(Any one person) $1 Q 000 PERSONAL B ADV INJURY $1000000 GENERAL AGGREGATE rs2,000,000GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO POLICY PRO LOC JECTA AUTOMOBILE LIABILITY 390001209 11/11/2011 11/11/2012 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) ALL OWNED AUTOSBODILY INJURY X SCHEDULED AUTOS (Per person) X HIREDAUTOS BODILY INJURY $ X NON-OWNED AUTOS (Peracciderd) PROPERTY DAMAGE $ (Per accident) GARAGE LIABIL11TY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY 792000561 11/11/2011 11111/2012 EACH OCCURRENCE $3000000 X I OCCUR CLAIMS MADE AGGREGATE s3,000,000 DEDUCTIBLE $ RETENTION $ Is B WORKERS COMPENSATION AND 71733288 11/1112011 11/1112012 X WC STATU- OTH- EMPLOYERS'LIABILITY C ANY PROPRIETOR/PARTNER/EXECUTIVE TBD106787 11/11/2011 11/1112012 E.L.EACH ACCIDENT s500,000 ,CQFICER/M€MBER EXCLUDED? Mandatory m H) LNJ E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under - SPECIALPROVISION$bel" E.L.DISEASE-POLICY LIMIT $500,000 OTHER D Property OBUUMHX5485 11/11/2011 11/11/2012 $212,594 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Evidence of Insurance DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE �_i"d ' ACORD 25(2009101)1 of 2 #S239491/M239489 © 7 8 -200 CORD CORPORATION. All rights reserved. IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance does not constitute a contract between the issuing insurer(s),authorized representative or producer,and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. CORD 25(2009/01) 2 of 2 #S239491/M239489 ------------ qv� i S--u Def Vi IL 3 022 GEORGES GARWOOD Bc)X 538/29 RODMAN RD W BROOKFIELD, MIA 01535 E 7116120"-3 Tr 15091 W HOME I M PROVEME.%'T CONTRACTOR Registratiop: ;136253 aYPc-: FxPifatj0n: 5i 2 6,12 0 12 lrd vicluai 6 E S. GA R GARWOCO 29 RODMAN RD. VV. B R 0 0 K F I LD A.0. 8