1 LOONEY AVE - BUILDING INSPECTION � -����d-�"�9��
,
�
���' � -„ _ ___ _ .
� I'ht Coinmumrrahh uf��las�orliusclts C'I'1'1't)F
IluarJ ol'13uilding Rrgulatiuns;inJ 51anJ;�rJs
j �;�� ��t;issarhusrtts Statc �uilding Cud�. 730 CbIR �,�LI:�I
� 'ti�,.. ltrri.���il.I h�r_'ll/!
I3uilJing P�rmii ��pplicalion 'fo Canstruct. Repair. Rznuvatc Or Demulish u
n���•-,,, r��,,.f��,��,n ���,-rr;,�.e
!his Srctiun For Otliciul Ust Onl
UuilJing Permit Nwnbcr. Uate ApplieJ:
_�,��c� �,t,�z,�..see,� �' 1
1)uilJin�OIRci�l�Prinl Nwne) tiiµ�io Uaic
SECTION I:SITE IIV ORAIATION
_ I.I ProTerr�Jreer. I,2,1��ee�un�Hap S Purcel Numben
I.I a Is Ihie an acc Itd siref el? te no ��+�P N������� 1'urcel NwnMr
" I.J 2onlnQ Infonnrtlan: !.i Properly Dlmenelon�:
. Loniny Diatrict 1'mpusuJ Uvo � Lot Amu 1%y 111 Pnmiagu(Il)
1.3 BuIIJIn�Setb�clu(11)
Frunt Y;vd SiJc Ynnl� H��Y;�,
Rryuired I'ruvidud Reyuircd 1'ruvided Hryuind PNYIJlII
1.6\Vwter Supply;�M.G.I.c.aU,§3�1 1.7 Flood lone InPorm�dons 1.!S�w�a�Dl�po�d Sys�em:
1 � Zona: Uu�iJe Flaod'Lune1 Muniei d� Qn�ila Ji� 9YI Y aum O
14iblic O Pri�o�e O — Chack iY ce0 P � �
SECTION2: PROPERTYOWNERSHIP�
l.l O1�wner�of Recordt//�g'C
-ZLL'/n U�b� 5� �l�e���
• N, no Prial) /1 C'iqt ma� 7
/�ii�l✓!!�i �^Gr•'`-� ��_���G7�J -� �
�nJ��n�� . I'.lephuna h:muil Addnsf
SECTION): DESCRIPTION OF PROPOSED WORK�(check oll thal oppiy)
Naw Construction� H.ristiny Building❑ Owner•Occupicd O Repain��) O Altera�lon�f) ,�ddiliun O
Demuliiion O Accesfory BIdg.O NumberofUnib Other � 3p.ciry:
, Orief Detc�iptian of Praposad Work': � �
� —
SECTIO�V �; ESTI,�I.�TED CONSTRVCTION COSTS
������ Estimaitd Costs: p(pclul Ufe Onl
I l.ahor wid .\I;nrrial�� Y
I. Ouilding S Ud I. Buildiny Permit Fee: S Indicate huw f'ee i�JeirnnineJ:
� =. lilvcuical S O Standard Ciry�Tu��n Applicatian Fee
' ❑Tutal Projt�t Cosl�I ltem 6)r muliiplier _.__x
� J I'hnnhing 5 '. Ulher Feas: S
� l. \k.h,ini..d ill\� \('1 5 LisC.- ----- .
5 \Ic.h.mic,d i f nc ---•---. . _ . . _
� Cu�uC�iiUnl S fot,ll \IIfCCS: S —'-- --- '-- _' .. _
ChrcA Vu ChaA:lmaunC l',i�h �\inuwil:
n Tulni I'rnject C�i.�C i .. _— _._.._..
��� ❑P,iiJ in Full O UwsrmJing Hal.uic¢ Due:
�,
I��. � v �LGI�"�l�`�Jt/'
SEC'T'IONS: CONSI'RIIC'riON.NERVICF.S
5.1 Construction Su pen icor License((SL)
----
I Icenx unlher f sI anion D;ne
_
S,un• �I'l'SI. loiter ......---- I Ist01. 1')fig heehaluw).- _
I pe
N.. m InclIt 141mstricmd I IIIIIIJ 's 1,' 1) ll,llllq cu. It1
R Re,lricted IR?Pamil Dwellin
Chi rI,nc.7111 %1 \anon
RC Kmoin Coscrin
� µ'ti Window.uld.Sidin
6/1 LIf`" .SF Solid Fuel Ruming Appiiunces
huulution
Pale amt Email address U Demolition
5,2 Registered Homejpprovem III Contractor(HIC) -�/< 7
IIIC ICegulratiun Number lisp' Wien I e },
III a ) Name or TIC I •gastrum Na
N � 1 Trott :moil udJ ss �'I/
Cityrrown. State I Pale hone
SECTION 61 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.1.e. I52. 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...........O
SECTION 7s:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize
g
behalf,in all matter,relativeto work auth razed by this buRdingpermit a plication�NWlle(Eltt•Iruilic$ignatureI Date
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 int mation
r. jndin th' .p licatio 's tr nd accurate to file best or my knowledge and understand'
r'iorAwhurin gent' ;unullilectrunic.\ign;llurul o1e
NOTES:
wner who obtains a building permit to do his.her own work,uran owner who hires an unregistered contractor
gistered in the Hunte hnprovtmeotContmour(HIC) Program),will nu have access to thearbitration
m ur guaranty fund under M.G.L.c. 11?.A. Other important information on the HIC Program can be lilund at
n�a" ��� ,', I Inrornlatiun un the Construction Supervisor License can be round at t,tt,s nIA,; s 'Ip,
substantial work is pivmed.pruside the information below•.arca(sq. 111 . __—_,._Iinaludinggnage, finished bascnlcntattics,decksorporchl
Grosi liking area l sy. ll.1 ,__.. Ilabimlilt rounl count
\umber of fireplaces _ Vunther tit hedruums
\unlhcr of halltnwnts Number of'Imil'halhs
I')Ilk:ofheaung i)smnl \unlhernl'tccks porches
9elo,ed Open
I1 he Uelll
1 "loial 'row Isqulre I'ool�ltte 1ila.1 he,I1h,1111110lilt"rolal Project Co,C '
CITY OF S.VzN(, AkSS.ICH(:SETTS
JLtLOLNG OEf. MLST
I'0 WASHLNGTON STXMM, JA FtOOIt
rM (978) 745.9595
KIJIG91:ALfiY DRLSCOLL FAX(973) 7149844
N(AYO)t Mo.W f ST.PMW
OIABLTCA Of PLBLlC PROPEATY/KaDLYG C0wassimex
Ca'astruction Debris Disposal Affidavit
(required rot aU demolition and renovation work)
In accordance with the sixth edition orthe State Building Code, 780 OUR section I 1 I.1
IJebris, and the provisions of MOL a 40, S 54;
Building Permit b is issued with the condition that the debris resulting morn
I If. S I JOA.
INS work shall be disposed of in s properly licensed waste disposal facility as dcilncd by,b1OL c
,
The debris will be transported by:
(n4meufha v)
The debris will be disposed of in
(nome of facd!
I�Jdna orr�ciL�y)
t
yn�Nro of permit rpphc mf
�__��
CI-1-Y OF SiVLEM, NWSACHUSETTS
t l3L'lt-Dl.\G DFPAwr.%LE\T
! ;)
120 WASHINGTON STREET, 3'a FLOUR
TEL 978 715-9595
Eta(979) 710-98.16
t,-j.
%10ERLF-Y DRISCOLL li-iontisST.PIEas
%VLs,YOZ
DIRECTOR OF PL'9LIC PROPERTY/81I'tt )ING COJLtiIISSIONER
Workers' Cmnpensation Insurance ,Vlid•avit: Builder/Contractury/Electrici•ans/Plumbers
ite llleant Inrorniatine Pleagarint Levibl
Nairic IDaSII a .41)l�aNl.IIIJ L lNl1Y1d1111I• �G�'
Address:
CilyiStatclZip:Z7;remE /J/11. Phone
Are you An employer?Check the appropriate bolt 'rype of project(required):
I. I am a cm to cr with 4. Q lam a general contractor and I
D Y S. QNow construction
employees(NII and/or part-time).• have hired the sub contnetors
2.Q I am a sole proprietor or purifier- listed on the attached Acct.t 7,P Remodeling
.hip And have no employees These sub-conrnctors have R. Q Demolition
working for me in any capacity. workers'comp.insurance, 9• Q Building addition
(No workers'.comp.insurance S. Q We are a corporation and its
reyuired.j officers have dxerciscd their 10.Q Electrical repairs or additions
),Q 1 am a homeowner doing all work right of exemption per MGL I I.Q Plumbing repuin or additions
myself.(No workers'sump. C. 152,rJ 1(4),and we have no 12.Q Roof repairs
insurancereyuired.j t ampluyecs.INo Workers,
sump. insurance required.) 13,C]Other
•.ling applham nw ch�cxa bat I I mwr alvu M1II uul Ihs fuatiw buWw chewing Ihair waken'campanudun pueey mnlrmmioa
'I Lvnvuwtays who,uhnsil this anrdavir Indlealne they are doing all wort and has hire uu4i4s contractor tutor mhmir arm atyldavie indradng wd4
:c,.rirxtur Ihot chcdt this box must attwh d an asbnnuwl.h,w1 showing the nwno of the rubaunimtone and Ihair warbar'comp.pulley intemu ion.
1 ran un employer that Is providing worken'rumparradun huurunce for my employees. Below is du policy und/ub We
infurmutien.
tneunulce C0111pany Nmne: B- G S
Policy 4 or Self-ins. Lie.N: ��JJ � ��__ Expiration Date:
Job Site Address; 1—ll4,jnQ; •- eco • � Cilyistattizip: S
.roach A espy of the workers' compensation pulley declarallon page(showing the policy number and eapirstloe data),
Falluro to wcurc coverage as required under.Section 25A ol'NIGL c. I52 can laid to the imposition orcriminal penalties of a
tine up to S1,500.00 ondfur one-year hriprisnnmenk JS well as civil penalties in the form offs STOP WORK ORDER and a line
Of up to SMA0 3,14y against the violator. Ile advkcd that a copy of this,tahlntcrit may br iurwarded to ilia Ofricu of
Lt vevti gJl iuml oft lit:DIA IOr in.iunnea covcrago vcri ticatiun.
/do frerrby certify wider rhe paint ud penal of erf drat flit iufurnrudar provided above 'v/t'rue It td vorrrrt
Official rue wily. Oa nal write its dtiv arra, ta.5e cumpleled by 61yal,lawn"IJA f
City or 1'uwn:.V__. ._ I'crmiril.Iccnse 9_--. —
Iauie-,%tjiIwrily (circla one):
I. noanl of IleAllh !. Iluildimg Dep.lrmtum I,('i lyillmn Clerk 1. hleetrlc al InylcOor i, Phimhinl; lutpectur
G
i
INVOICE
Inv #: 139407
MOYNIHAN BEVERLY LUMBER Ord #: 132151
PO BOX 509 MHA
82 RIVER ST RE 99 Route: CITY
BEVERLY, MA 01915 Page: 1 of 1
Phone: (978) 927-0032 MOYNIHAN LUMBER order: 04/19/12
Fax: (978) 927-8201 Sched: 04/19/12
Invcd: 04/19/12
Printed
To: JOL200 Ship To: 0001 Date: 04/19/12
Time: 01:40 PM
JOLY, MARK R. JOLY/GENERAL ACCT.
38 COOLIDGE RD ASHLEY
DANVERS MA 01923 MA
FOB: DM Entd By: DT45 Via: CUSTOMER PICK UP Contact:
Inv By: DT45 Phone: (978) 762-3539
I, Type: WHSE In: 09 / Out: 56 Terms: 2% DISC/NET Your Order:
I
Customer Instructions
I A: MARK JOLY
Net
Line # Item Number Quantity Description Net Price Extended
001 3448WFW 1.00 PC PCS 3/4X48 WINDOW FLASHING
WHITE
002 162198 1.00 EA PHENOSEAL ADHESIVE WHITE
102-W 10 OZ. 00005
003 18SSH 1.00 BO 1 LB 8D STAINLESS STEEL SHAKE Tt �,
NAILS S13A250SN7-1 � � n r
004 8465PVC 1.00 EA ROYAL 1-3/4116' BAND MLDG
SOLD AS 16' PIECE ONLY MM7901
�r J
f
l
n
-Return Policy. All returns must be accompanied by an invoice. Returns must be made within 30 days of receipt of gootls. There
will be no return on special ordered or assembled goods. All returns are subject to a handling charge and must be in saleable condition.
-TERMS:2/10 net 25. Finance emerge atter30 days on unpaid balance. 1.5%per month or 18%annual percentage rate.
*Customer Acceptance Policy I have verified quantity,description and condition of goods to be acceptable. I understand I nave 48 hours
to report any concealed shortages or damages to Moynihan Lumber by phone or in writing.
ACCEPTED BY. 6M
,(