72 LORING AVE - BUILDING INSPECTION (8) The Commonwealth of Massachusetts
l', I Department of Public Safety
Massachusetts State Building Code(780 CMR)Seventh Him
City of Salem
BuildingPermit Application for an Buildin other than a i6 :1
(This Section For Official Use Only)
Building Permit Number: Date Applied: ® n' Building Inspr r:
SECTION 1: LOCATION (Please indicate Block M and Lot N for locations for which a street address is not available)
7 Lv lI�(cs AU,lu(lam i�/�i'�d OiaSiF'l Sf kl<
No.,and Street City /Town Zip Code Name of Building(ifapplicable)
SECTION 2:PROPOSED WORK
If New Construction check here❑or check all that apply in the two rows below
Existing Building❑ Repair❑ Alteration 19: Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ 1 Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ® No ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑
Brief Descr( tit) of Proposed Work: 00 L f� LV -0 R00 r � TU n 're-
GFL u =�
5 � �
D 90 NEW F44bffiP — �
1c.#4 IC "X"6 panes—*d*W 14&;2
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) ❑
Existing Use Gruup(s): Proposed Use Group(s): r
Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34:
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2r ❑ A-2nc❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business ❑ E: Educational ❑
F: Facto F-1 ❑ F2❑ 1 H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
r 1: Institutional 1-1 ❑ 1-2❑ 1-3❑ 14❑ 1 M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑
S: Storage S-1 ❑ S-2❑ U: Utility❑ 1 Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ HA ❑ 1180 IIIA ❑ IIIB ❑ IV ❑ 1 VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
Public ❑ Check if outside Flood Zone❑ Indicate municipal ❑ A trench will not be Licensed Disposaal tiite❑
I'rioate❑ or mdentifv Zone: - or on,ite my tem ❑ required❑or trench or,pecifv:
permit is enrlused ❑
Railroad right-of-way: Hazards to Air Navigation: \L\ I li,hm,t,-mmi-wn I(o,-iv,k I'n
a X"a Apphcably❑ I,tilniclure acithu,airport apprnach area' I,their reeieac completed.'
n l-Jn<rnt In Rudd ends.+cd ❑ t
i Ye,❑ or Nn❑ Yes❑ \o ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Ldltlun off C„de: Ule(Troup(,) rcpe of Con,trucuon: Occupant Load per Floor
I),w,the building contam,in Sprinkler}a,1em': Special Stipulations:
�)W A) Ocll,41-Cehl�—
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address it Property Owner
caiT—a lV 7�IJ� 7� 2c�1r./�L Adr. 4/9
Nome(Print) No.and Street Cih'/Town Zip
Properly 0%%ner Contact Information
l"„/�/['- (J����- 4�
am- T
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable, the property owner hereby authorizes
Name Street Address ` City/Town Stale Zip
to act on the pop pert%owner's behalf, in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
(If building is less than 350k)cu it.of endosad s pace and/or not tinder Cuastruction Control then check here O and skip Section 10.0
10.1 Registered Professional Responsible for Construction Control
�as6Pµ i '71601--c 20-,104- 2,51 /
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
5>v P14 T j"i wG& R P4a!`11?I/
C` , piny Name:
1
N
r lme gf.Per-son risible or.Construction;_x -, 1T •) License No. and Type if A pk'cable
T�Jgn/ t�j <i✓ l .S// / �1 Z°�
Street Address City/Town State Zip
Telephone No.(business) Telephone No.(cell) - e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(Q)
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes® No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_S. t271 07/
1. Building $ Building Permit Fee=Total Construction Cost x_(Insert here
2. Electrical $ appropriate municipal factor)=$
3. Plumbing $
4. Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5. Mechanical (Other) $ Enclose check payable to
b.Total Cost $ , rr7) (contact municipality)and write eck number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below, I hereby attest tinder 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.
Plea a se print nd sign name Title Telephone No. )ale
Street :lddress Cih/Town tat Zip 2 /�
Municipal Inspector to fill out this section upon application approval: / t/
mr I). to
CITY OF S.U-E.`I, jNYLkss x I-IL:SETTS
SUaMLNG DEPARTSIE�JT
120 W.ismLNGTON STREET, r FLOOR
T'E L (978) 74S-9595
F.%X(978) 740.9846
Kj, ED Y RISCOLL
MAYOR DR THOMAS ST.PM2IItIS
DIRECTOR Of PLeLIC PROPERTY/RLRDLVG CONOUSSIONER
Workers' Compensation Insurance Affidavit: guilders/ContractorslElectriclrnsJ Plum bars
►nolleant information Please PrintLeniblr
Valne(eusidsr,rurylntrarionln,kvtduai): 74,54ez4 T file 6 e-
IIOPCNf2Y
Address: i f C 15 C4fl l✓ 6916;
City/StawZip: .Stj�/�i�l?�C.y7�i>'IH IYJjr7 Phonex: -211 ;5�
Are you as employer!Check the appropriate boa: Type of project(rtqukcQ.,
l. I am a employer with 1 4. ❑ 1 am a ipment contractor and 1 6 ❑New constructionemployee(full and/or pan-time).• have hired the wbb corw"tws
2.❑ I am a solo proprietor or parmer- listed on the attached short: 7• ❑Remodeling
,hip and have no employee Than sub-contraetate have e. ❑Demolition
working rot me in any capacity. worker'comp.insumnoa 9. ❑Building addition
1No warkm'comp insurance - S. ❑ We ar a corporation and is 10.❑Electrical repair or additions
rtquired.) ofters have exercised the*
J.❑ 1 am a homeowner doing all work right of exemption per MOL 11.❑Plumbing repair or additions
myself.[Na workers'comp. c. 152,91(4).and we have no 12.0 Roof repair
insurance required)► employees.LNo workers' 13.[]Other
comp insurance required.1
-Any appuna ihr dhocka bet el aww alws nu tall the smlwt below Shordq their wmkaa'comic,'"puliey irddtnnneu
t I Itw leclep a who atbade this■Mdrvk indicating they an doing sit work and thus him Otte`eordnwma ffma V Mob a tat amd"il irwicNing OWL
(',wtrsVra slut dMek this box mud atfaabd m rldilimsd J"rhowiry the mmea ddu rA4eaaeama ed that wmom -refer,policy iwrtmwarts.
/ate an earpleyer that lr provi0/trR wooers'rosrpenedea/nsuruwn jo►My siwployW% SNmr b/Ae Palley swal/ai slur
� injornrwiaa
Insurance Company Name: l: Rf41V(riff =Z7 .119N
Policy Y or Self-ins.
�Liie.p: 1�� 7 Q.� �� Z Expiration Date. h /o l
Iub Sife Address: /� 40 f(l l�6- l� :5_ City/State/Zip: �fJ/.�/Y/r /S A. IJ*7//
,%track a copy of the workers'compensation policy declaration pap(Showing tke policy number sad tiplrsdoo hate),
Failure to secura coverage as required under Section 25A of MGL c. 152 can lad to the imposition orcriminal penalties ore
erne up to 51,500.00 and/or one-year imprisonment,as well as civil penalties is the am of a STOP WORK ORDER and a fine
Of up to S250.00 a day against the violator. lie advi,dxl that a copy u/this statement may be forwarded to the ODtce of
Invc,ngaiiuns or he nIA for insurance coverage verincatioe.
/do here tarn milder thus pain and penalties of era/a that tlla injoraxodon providi�u ve is true and i arreea
I)ut
Pin a =�99- o7 '1
OflIcial oat anly. Do raw write in this area,to f1ty,
iry or town o/ffriat
City or rusen: _ it/I,lcense 1
-- -- - -- -
i
I,suinr Aulhorily (circle one):
I. tluard of Ileallh 2. Rudding Departmcal k 4. Electrical Inspector 5. Plumbing Inspector
6.Ilthtr _
l.-tttlacl Person: _ Phone c
�S CITY OF SALEM
• PUBLIC PROPRERTY
a Y' DEPARTMENT
Td;: Mlhl '141M O1I
\f`.t"N I!Q�11.1i111.\L;JV�1*$LVT*S.\I I'%I- \L\ii.\l III it 11�:1'1
1'FI:V3.74 9i'1S 1'.\X:978•140-')946
Construction Debris Disposal Affidavit
(required lur 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 t1 _ _ is issued with the condition that the dcbris 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:
Iname of hauler)
The debris will be disposed of in
n�sAV��
(name of racillty)
taJdress ul'lacility)
iigl ature of permit applicant
date
kin n.l( :,K
AYORD . CERTIFICATE OF UABIL I ! INSURANCE 10/23/2007 mm
meNlctnTKS C43MRCATE IS ISSUED AS A MATTER OF INFORRIATION
Richard Bertolino Jr Iusrr®aoe Jigency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1200 Salem SC 47.2i H� THIS CETaIFICA'M DOES NOT ANEND, EXTEND OR
ALTER THE C WAGE AFFORDED BY THE POLICIES BELCW
:yrmfxeld, MA 0194D
IN IRE SAFFORDOIGCOVERAGE, NAIC0
ru+aes i INsur�JR.a Arbella MttLual _
Joseph McCall Carpentry wsxmMe Cr to state/A36---__ ---
55 Eastman Ave Na QArbella lasuraace
3wampSCOtt MAsa 01907 },OAtsaa i
COVERAGES
THE POLICIES OF ISUAAtCE LISTED BROW HAVE BTfN ISSUED TO THE INSURED NAMED ABOVE FOR TtE POLICY PMOO INDICATED. NOTWITHSTANDING
ANY REOUWE3.IENT. TERM OR COMMON O� ANY GONTPACT OR OTHER DOGL3AElTT WIMN RESPECT TO WHICH THIS CERTIRCATE WIT BE ISSUED OR
MAY PERTAIN. THE IM UMIE AFVCRDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TD.AIL THE'TERMS ENCWSIOHS AND CONDMONS OF SUCH
POLICIES AGSREGATF LASTS SHOWN t&AYHAV'-?EEN REDUCED BY PAD CLANS.
LTR'mWo TMPE�MWINC£ raucrwaeee rourr I:�:, GONci_ U�} ^—.
A LU.eeRr �9500O2E746 OS/13/2CO9 IOs/13/2010 +i s1_000,600
x +«MN96wLt�E�uBr�@Vir ;_wB3.eBENrD—) ial,ou oro _
j EXTE
cLaNSM �,m-a `ov. s1,000
i NALa�wI+AaY $1,000,000
aMNB»L>J:sPEwTE s2,000,000
9ENLs6aFECnTEtaareTM^.FSM+}A: IPmoxls-�uTnaPm }1,000,000
Ci 43005400002 0151/13/2009 08/13/2030 coPe��a+slEumT {}
IPs.mesq
rX Al«MT4DPUIOS {
}100,000
i { i nwEa,rtMtra i I s�wa '.}300,0000
�'_ Nm10T»aaPUTa F--
�- �Tw M100,000
i
i oMMwMMu361rr � � jrvJ:O aAr-EAAtKru+r _ } _
+ I oMteMTwH
j i I i A11I00Rr: PG3 }
aMeX531Pr8RitA Lt}MPY � I LEAd1oDrJAd&]P.f i}
i Prlemv+ s I 1 M
H t}osRsocxmaMa,rtmNum 1 WO 869 03 62 10/20/2009 110/20I2010 I i TOPYt2¢fa i Bt { _!
wtxmas•Laatm' �E�+.,�-�et� }{00,000
at RAOUMatt Vadt sop,opp
�Tw,esriae.ex i�gEP�E-pwrrruwi s 100,000
�.saruLnacr�xPrsra.+F
i
i
{ j
o�xmmw aYrner.}TIMo IInL}MIa�M3tlLtlH!FSCW9aV9�IXJ®s.•Oe�a,946}LPfK1Yama
Separate Cart Has bean ordered fo= holder from WAas WOrkerm Comp Batimv Bureau
CERTFICATE HOLDER CANCELLATION
Dr Alan D9_amoed mms AIY eT nE Asvr ac, mmu; wMctis Is w�JA 9BFOAE THE M:vewTm
417 Atlantic Awe w,E Tom• asoa p01 ' Rw+. emPeuTax To NPA_MMY9 vMBld
Harblahoad Maas 01945 Aons To TIM oa m aaLsa aN® w T+a c>-sT. BUM Tn}.VAe m oa sa mwt
wens NP amlmw w m UAtArtY aP ANY 'ov mua TIE ImPaTI m A.Bv'o ort
m3+avelrrTNta
i Pax to 781-596-3713 ArMNa®rt nM
I Richard BartolLm
ACORD I CMD CORPORATION 1980
1 'd BILOTEGGLS MC OuT101.Jag P,JzyuTti d1E :E0 BD 9Z 3a0
Joseph T. McCall
Carpenter & Builder
400� 65 Eastman Avenue Swampscott, MA 01907
�� Mass. Builders Lic. No. 051018
Home Improvement Contractor's Reg. #103478
Tel. No. 781599-7591 Fax No. 781596-3713
EASTERN BANK MARCH 8, 2010
72 LORING AVENUE
SALEM,MA. 01970
TEL. 1-978-740-6372
ESTIMATE
FRAME NEW ROOF USING 2"X 12"KILN-DRIED STOCK INSTALLED 16" ON
CENTER.
FASTEN TO MASONRY WALLS USING 6" WEDGE BOLTS, INSTALLED 16"ON
CENTER.
FASTEN TO WOOD WALLS USING 6"TIMBERLOK BOLTS, INSTALLED 16" ON
CENTER.
SHEATH ROOF WITH 3/4"TONGUE AND GROOVE PLYWOOD.
BUILD A KNEE WALL ON END USING 2"X 4"FRAMING, INSTALLED 16"ON
CENTER.
SHEATH WITH 1/2" CDX PLYWOOD.
WRAP WITH TYPAR.
INSTALL 1"X 8"FASCIA.
INSTALL 1/2"X 6"PRIMED CLAPBOARDS.
TOTAL LABOR AND MATERIALS---------------------------------------------$7,000.00
DC
FASTr'� ulll"H 2 ^X6 " r�EDv 6o("rs
3
WA(,,L IM
!6 "o. G.
„
sa�r,#To#
ef�p FDAkD3
Y � I
S13E�rH �JiT� Ilya Td G PZ-YWo0D
UJOd D u/H� on/ T-HIS S)DG-
�� c15106-
- y
i
r
IW-
VIr..F