462 LORING AVE - BUILDING INSPECTION (2) t i
Jr� � The Commonwealth of Massachusetts
} Board of Building Regulations and Standards CITY
',' !/ Massachusetts State Building Code, 780 CMR, 7'" edition OF SALEM
'I Revised Junuury
Building Permit Application To Construct, Repair, Renovate Or Demolish a I. 1008
One-or Two-FomilP Dwelling
This Section For Official Use Only
Building Permit Numb r: Date Applied: �i • 2� - / y
Signature: ^ ��'�'��, t L
Building Commissioner/Inspector of Buildings Date
SECTION 1:SITE INFORMATION
1.1 Property Address: S,/fiLRK� 1.2 Assessors Map& Parcel Numbers
'q6 L /ornz Ave-
l.la Is this an accepted street.o yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq(l) 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: 1.8 Sewage Disposal System:
Public❑ Private[3Zone: _ Outside Flood Zone?
Check if es❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP[
2.1 �pgwnerl of Reepprd: /�
f/+' AfA y/Of7l V�n��us �(oZ LlI-ln 0T`,G a/E'LtFI�`�l
N• IP t) Address for Service:
97� ?qy- 3F7e)
Sig6ature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied • Repairs(s) ❑ 1 Ahcration(s) ❑ I Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:,/ISVG O.
Brief Description of Proposed Work':
own
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I. Building s 1. Building Permit Fee:S Indicate how fee is determined:
2. Electrical $ ❑Standard City/Town Application Fee
- ❑Total Project Cost(Item 6)x multiplier x
3. Plumbing s 2. Other Fees: S ! //
4. Mechanical (BVAC) I $ List:
i
5. Mechanical (Fire s
Su ression - Total All Fees: S
Check No. Check Amount: Cash Amount:
6. Total Project Cost: 5 G"Do� 0 Paid in Full 0 Outstanding Balance Due:
r
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Number Expiration Date
Name of CSI: I folder List CSL Type(see below)
.r Description
Address U Unrestricted u to 35,000 Cu. Ft.
R Restricted 1&2 Famil Dwelling
Signature M Masonry Only _
RC Residential Routing Coverin
Telephone WS Residential Window and Sidin
SF Residential Solid Fuel Burring Appliance installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
I IIC Company Name or HIC Registrant Name Registration Number
Address Expiration Date
Signature Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. 4 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 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 as Owner of the subject property hereby
authorize to act on my behalf,in all matters
relative to work authorized by this building permit application.
signature of Owner Date
SECTION 7b: OWNERS OR AUTHORIZED AGENT DECLARATION
[-../' M-7' �l�SS t'/1f�ifJ-YTt.6Q( s Owner or Authorized Agent hereby declare
that the statements and informatiot or the foregoing application are true and accurate,to the best of my knowledge and
behalf.
Prim Name 6
Signature of(honer or Authorized Date
Si ned under the pains and penalties ofperjury)
NOTES:
I. 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 WJ have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 1 IO.R6 and 110.115. respectively.
2. When substantial work is planned,provide the information below:
Total floors 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 healing system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
Board of Buildim, Re!,ulations and Standards
Construction Supervisor Specialty License
License: CS SL 102293
Restricted to: IC
RICHARD LAMBY ,
3OCEAN AVENUE—
SALEM, MA 01970
Expiration: 5l3/2012
('innnissimu•.r Tr#: 102293
' e
f
I�
4
i
f ;�Bkarro uil mg egula ns and tan ar s
One Ashburton Place - Room 1301
o Boston. Massachusetts 02108
Home Improvement Contractor Registration
Registration: 111617
Type: Private Corporation
Expiration: 1/12/2011 Tr# 280650
MASS WEATHERIZATION, INC
RICHARD LAMBY
3 OCEAN AVE
SALEM, MA 01970 ---
Update Address and return card. Mark reason for change.
Address Renewal [] Employment f-I Lost Card
DPS-CA1 O 40M-08/08-DBSLIFORMCA106212008
rax: nHl
K�iVf[U
ULK i IFICATE OF LIABILITY INSURANCE 0410612010
PRODUCER (508)393-7744 FAX (SOS)393-6983 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Eastern Insurance Group LLC - Cominercia7 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
155 8 Otis 5t ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO Box 1129
Northborough, NA 01532 INSURERS AFFORDING COVERAGE NAIL#
INSURED Mass Weat eriZdZlon Inc• WSURERA: Western World Insurance Cc,
3 Ocean Avenue INSURERS: Charter Oaks Fire ZS615
Salem, MA 01970 INSURERC: American International Group
INSI(RER D:
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.
INSRI'm D TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY uumnt4ION LIMITS
GENERAL LIABIUTY NPP11975171 05/28/2009 051,2812010 EACH OCCURRENCE $ 1,000,00 0
X TO
COMMERCIAL GENERAL LIABILITY DAMAGE5( RENTED $ 100,000
CLAIMS MADE O OCCVR MEO Ex (Any one pereen) $ 5,000
A PERSONAL$,AOV INJURY S 1,000,QO
GENERAL AGGREGATE S 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000 00
POLICY JEGr LOC
AUTOMOBILE LIABILITY BA469H7036 1010412009 1010412010 COMBINED SINGLE LIMIT $
ANY AUTO (E6 ecclaenp 1,000,00
ALL OWNED AUTOS BODILY INJURY $
JX
SCHEDVLED AUTOS (Per person)
HIREDAUTOS BODILY INJURY S
NON-0WNED AUTOS (Per apPdenl?
PROPERTY AGE $
1 Per aCddent)OOnt)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
ANY AUTO OTHERTHAN FAACC $
AUTO ONLY: AGG S
EXCESSIUMBRELLA LIABILITY EACHOCCURRENCE S
OCCUR CLAIMS MADE AGGREGATE $
S
DEDUC71BLE
8
RETENTION S -
WORKERS COMPENSATION AND WC0027088.53 0910312009 09/03/2010 X Wcs7g7uG o7H-
EMPLOYERS'LIABILFrY E.L.EACH ACCIDENT S 5OO'OOC
ANY PROPMETOR/PARTNER/EXECUTNE
OFFICE EXCLUDED? E.L.DISEASE-EA EMPLOYE $ SOD,OO
R/MEMBER
If yd6.deeaLe under E.L DISEASE-POLICY LIMIT S Soo 00
SPECIAL PROVISIONS pelow
OTHER
DESCRIP710N OF OPERATIONS/LOCATIONS 1 VEHICLES 1 EXCLUSI9N9 ADDED BY ENDORSEMENT I SPECIAL PROVISIONS nsured with
FI-Natfona7 Grid Residential WeatherTzation Rebate Program is an additional i
egards to General Liability where required by written contract.
4:1111 IE14OLDFI C NCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIE5 RE CANCELLED BEFORE THE
EFL'-National Grid Residential WeatherizaiTon EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVORTO MAIL
Rebate Program DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Attn: Rosemary St. George BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBUGATO N OR UABILDY
40 Washington Street
SI/7 to 2000 OF ANY KING UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES
Westboro, MA O1 S81 AUTHOR ZED REPRESENTATIVE I I ♦ate _ r� D
Francis Kittred a (EO)ISED `
ACORD 25(2001108) G)ACORD CORPORATION 1988
CITY OF S.U.E.`I, NLASSACHUSETTS
BL•IIDcga Dar.tim.tc iT
120 WASHGVGTON STIU11M. Y'FLOOR
TEL (978) 749.9599
F.ut(978) 74498"
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1"AYOIL Dincron or R I LIC pgor6ATr/K MDLVG CO.NWSSIO.%IFA
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City or ruwn: YermiHl.leemel__. __ ___
Iauing.Nrlhortly Icircte ww)!
I IluarJ ul tleallb 1. Auddlna pcpartmene I. City/rows Clerk I. Electrical Lllpeclor 1. Plumbing Invpeelor
6. Other
i l•.nlacl Perron: _ _ Phone 0: