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2 LOONEY AVE - BUILDING INSPECTION �i3- tU - GK -7oLfs $25CIL The Commonwealth of Massachusetts °t9 Board of Building Regulations and StandMEIVED SERvj�Es CITY OF Massachusetts State Building Co4%S%fiQc SALEM - ) Revised Mar 2011 Building Permit Application To Construct, Repair; Reu o de OZD�o}tshrj One- or Two-FamilyDwelli , CL This Section For Official Use Only t Building Permit Number: Date Applied: 5 IZ'2.1 14 Building Official(Print Name) Signatu a Date 1 ^ SECTION 1: SITE INFORMATION i 1.1 Property Address- 1.2 Assessors Map & Parcel Numbers l oi Lp,neAj Ave 1.1 a Is this an act ec et d street?yes d no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 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? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 O//��v��vner of Record: " 61 n-7 0 1�tA�b . f,Lt. JiIyt 7 Name(Pant) City,State,ZIP �voAey Av,= �V No.and Street Telep lone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) '4 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: Official Use Only Labor and Materials 1. Building $ t7 /"r' 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost' (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ dy Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ 7V ❑Paid in Full ❑Outstanding Balance Due: c � L�- �Zls J SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) y,.- ; r ' �rAu6�S l'0..DIS P een�- s�elumber xpiranonDate + Na CSL Hol er ) List CSL Type(see below) l/ and Street Type Description No. U Unrestricted(Buildings up to 35,000 cu:ft. tit J J(1 A AJ s R Restricted 1&2 FamilyDwelling + City/Town,State,ZIPS M Masonrys RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances -EhA I Insulation Telephone Email address D Demolition _ 5.22�Registered Home Improvement Contractor(HIC) p f b�1--A— CZ LAA (Ir gisfrkriNumber xpira? 11 HIC Company Name o HIC Registrant Name No.and Street Email address i. rn lcn rr.t�l o tNYO rtG�%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 .........•4 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 2EM � It4ul -) to act on my behalf,in all matters relative to work authorized by this building permit application. * Kta rt4j /Ib zo l Print Owner's Name(Electronic Signature) 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 information contained in this application is true and accurate to the best of my knowledge and understanding. / ,L Lo`Z `l l.17 Print wner's o Authorize Agen 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.eov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 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" t� Massachusetts -Department of Public Safety �✓ Board of Building Regulations and Standards Construction Super isur License: CS-084795 EVANGELOS LAPIS _ STONE ST REET MA 61922 1 R� ANVERS MA ff1923� Expiration Commissioner 05/13/2015 �T<s ��izv�uaeroarxlU o�'> //naa�smelG License or registration valid for individul use only ' Office of Consumer Affairs&Business Regulation . `IMPROVEMENT CONTRACTOR before the expiration date. It'found return to: OME 4egistratlon: 168672 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 xpiration: 3/2412015 Corporation Boston,MA 02116 EDA CONSTRUCTION INC. i ERIKA ERNSBERGER 27 WATER ST SUITE 116 WAKEFIELD, MA 01880 Undersecretary of val' fth,,tnature 'VO 1ti IS G The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston, MA 02114-2017 If www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Auolicant Information n Please Print Ledbiv Name(Business/Organization/Individual): Address: /&-b (.v ry M A _� {� LJ'tA� aZ` (•, City/State/Zip: fReyfend4 dA 6 14 IS7- Phone#: -79,6 Are you an employer?Check th appropriate box: Type of project(required): 1. [am a employer with 4. ❑ I am a general contractor and 1 employees(full and/or part-time).' have hired the sub-contractors 6. ❑ New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition workingfor me in an capacity. employees and have workers' y >� ty [No workers'comp. insurance comp. insurance.t 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I 1 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.Cg Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] .Any applicant that checks box NI must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContrsctors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that Is providing workers'compensation insurance for my employees. Below Is the policy and fob site information. Insurance Company Name: C100CA , s4 Policy#or Self-ins.Lie.#: c2 ht $ T"- (e Expiration Date: Job Site Address: t:v J&t:v a o,a/g—`Iler City/State/Zip&14.n 40 01 qt 20 Attach a copy of the workers'compe ads tion policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine, of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb certify under the pains and enallies ofperjury that the In ormation provided above is true and correct Si ature: Date t a < Phone#: Official use only. Do not write In this area,to be completed by city or town official City or Town: PermittLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: CITY OF SOU EN1, %LxsSACHUsETTS BuILDIING DEP.sRT\[&NT L• if 120 WASHINGTON STREET, 3�FLOOR TEL. (978) 745-9595 FAX(978) 740-9846 KI\tBERLEY DRISCOLL MAYOR THows ST.PtERRE DIRECTOR OF PUBLIC PROPERTY/BL'II.DING CMMSSIO.iER 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 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 111, S 150A. The debris will be transported by: C' - (name of ha r) The debris will be disposed of in (name of facility) _�/GPi1N.vP �YT (address of facility) signature of permit applicant date debrisatrd(x Details Page 1 of 1 he Ofit tag ,rebsite of ltie Executive O?ice of t utl:c Safety and Secu'ity(EOPSS) Masa^cv i-tome State Acende< ensee Details L. ulI ame: EVAr4GELOS LIAPIS Gender: r e: DANVERS MA 01923 ricense nt U 'led tales o: CS- 8 79 License Type: Construction Supervisor ession: Building Licenses Date of Last Renewal: 4/11/2013 e Date: Expiration Date: 5/13/2015 License Status: Active Today's Date: 3/11/2015 econdary License: Doing Business As: atus Chan e: o Prerequisite Information No Discipline Information ocumen um _- - ---- _ - Close Window ©2011 Commonwealth of Massachusetts Site Policies Contact Us http://elicense.chs.state.ma.us/Verification/Details.aspx?agency_id=1&license_id=273740& 3/11/2015 Commonwealth of Massachusetts L\ City of Salem I UIV �IIA4.11 Inspectional Services RE C E I PT 120 Washington St,3rd Floor Salem,MA 01970 Phone:(978)745-9595 x5641 Application For Building Permit (One- or Two- Family Dwelling) a �g `§ X re igmg In a. ie s T i li t,xt.Per'mitNo# „yTB=141874yr , 1` DateApplled �12/2/2014 v #f'�'�' iF T�7.�Ik .aa1 � .I+,.Fr�. & ,a... , ., -IS AM 1(s �1 i? '�.�'. �tl �1{ `114'Etas-'a` 1 o writ.,el p ,�anxA a:� All ,)` 7 b v �1- 1 y/, � 12/3/20141 is , ag '-a, I 2° Buidin VOfficial PnntName � 14 1 ', SI nature 4 r Date Issued s 1; 9 ( ) I aF. 9 .Rl a „ l tk �'.e vl is :` i .-, :1,�a,�,a,t. aN m._awc w, w,r;EFrv40 .I.. ° 1 SITE INFORMATION UZ _ �aa "i1kt af ,ars ;x 1.1 Property Address 1.2 Assessors Map & Parcel Number 2 LOONEY AVENUE 15-0393 1.3 Zoning Information 1.4 Property Dimensions R1 6000 Zoning District Proposed Use Lot Area Frontage(ft) 1.5 Buidling Setbacks (ft) Front Yard Side Yard Rear Yard Required Provided Required Provided Required Provided 15.00 0.00 10.00 0.00 30.00 0.00 1.6 Water Supply: 1.7 Flood Zone: Outside Flood 1.8 Sewage Disposal System Zone? Check if Public Zone: yes_ Municipal UI a j SECTION 2: PROPERTY OWNERSHIPS 1 rISWI . >,W kSECRI -,, . ;. 1 r6,w.a ,G: a'I• tb.al.,Cr.e...art. ,.,,SECTION , n, Owner of Record CHERELLI KAREN 2 LOONEY AVE SALEM MA 01970 Name Address (617) 633-0721 Phone Email — w ��3 � nsm,1 0, $ SECTION 33DESCRIPTION OF PROPOSED WORK�,t r p4a Permit For: Roofing Brief Description of Proposed Work: REMOVE & REROOF AL 1,: ;. , ,tSECTION 4: ESTIMATED CONSTRUCTION COSTS/PERMIT FEES ,If � Total Project Cost: $2,590.00 Payment Date Amount Paid Check No Total Permit Fee: $25.00 12/3/2014 $25.00 7045 Total Permit Fee Paid: $25.00 `"� "F" >nraw�ntxi-�+a� -^q'";kF rm4wp- RTrme �n n1 G"a , K, THIS IS N�TG Q►�PFRMIT . Wt Ut, Commonwealth of Massachusetts )1 r G City of Salem Inspectional Services 120 Washington St,3rd Floor Salem,MA 01970 Phone:(978)745-9595 x5641 RECEIPT7. Total Area (sq. ft.) 0.00 Type of Heating System Number of half/baths Gross Living Area (sq. ft.) 0.00 Type of Cooling System Number of decks/porches Number of Fireplaces Room Count Enclosed/Open Number of Bathrooms 0 Number of Bedrooms 0 U. � ` G. THISmISmNOT 4' P.ERMITR'i 9d Commonwealth of Massachusetts City of SalemI UU, Inspectional Services �,-»a:mc•... «xw+wam ° 120 Washington St,3rd Floor Salem,MA 01970 Phone:(978)745-9595 x5641 RECEIPTS Building Type: Single Family Existing Proposed No. of Floors/Stories(include basement levels&Area Per Floor(sq.ft.) 0 0 Total Area (sq.ft.)and Total Height(ft.) 0.00 0.00 0.00 0.00 �' fr 3t Ig 7' n.:rv� €' 9 a �� v '! rr-Yexlrs w ap , I� y limN r , p*SECTION 5CONSTRUCTION SERVICES M r ' j kfijfij � €� 5.12 Registered Home Improved Contractor (HIC) EVANGELUS LIAPIS 26 WATER ST License Number: 138595 Name Address (617) 908-6146 WAKEFIELD, MA 01880 License Type: HIC Phone City/State/Zip License Expiration: 8/8/2015 Email x , um "SECTION 6 WORKERS COMPENSATION INSURANCE AFFIDAVIT y l IC y v 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 On File? True �' +1- ,I � 3 '� YtSECTtON 7a:OWNER AUTHORIZATION;TO BE COMPLETED WHEN��� ��: p�a . �. _ ,,.y4 ��z, .,OWNER'S�AGENTORCONTRACTOR'APPLIES'FORBUILDING 1, as Owner of the subject property hereby authorize EVANGELUS LAPIS to act on my behalf, in all matters relative to work authorized by this building permit application. CHERELLI KAREN 12/2/2014 Print Owner's Name(Electronic Signature) Date Submitted SECTION 7bijOWNER OR AUTHORIZED AG ENT;DECLARATION " ` r�(� a �� _ fi:xi4 .. 4.§Mai..� _IE y aev.76� By entering my name below, I 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. CHERELLI KAREN 12/2/2014 Print Owner's Or Authorized Agent's Name(Electronic Signature) q Date Submitted 0NOTES ,ysx .. �gg�a `a' x „, :.. `a't �t w. -s, $€ p� ftw1i_ iFit '3_`{.} dh`ZZIU " 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 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/dps When substantial work is planned, provide the information below: ''IS#.NOTI.' PERMIT SearchResults Page 1 of 1 • -i he Oti iol Lb"e6si!e OPme Ex�cuGv e O`ice of PobllC Saraty and SEGUp'IJ(EOPSS) Mass L?a:Home Ste±e fioeneios Search Results • Select the licensee name below for more information. (If your search produced more than one page, you may select page numbers at the bottom of this screen.) • Select the Search for a Person or Search for a Facility button to perform a new search. • Select the Preview File button to view a sample of the fields included in a file you can download. • Select the Download File button to download a text file of your search results at no charge. • Select Public Information Re uesq t Form for a form to order a data file. L Search for a Person L�Search for a Facility j Preview Fill I Download Films Name License Number License Type License Status Address ' LIAPIS EVANGELOS CS-084795 lConstruction Supervisor jActive DANVERS MA 01923 1 ©2011 Commonwealth of Massachusetts Site Policies Contact Us http://elicense.chs.state.ma.usNerification/SearchResults.aspx 3/11/2015