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6 LORING HILLS AVE - BUILDING INSPECTION (14) 2 61 i L4 y q Ob 5qs The Commonwealth of Massachusetts Board of Building Regulations and Standards SITY OF ALEM Massachusetts State Building Code,780 CMR Revised Mar 20/1 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: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 P perty Add re &lij 1.2 Assessors Map&Parcel Numbers L N this an accepted street?yes no Map Number Parce er . 1.3 oni Information: 1.4 Property Dimensions: Y 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 F:::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[] f �"SECTION 2: PROPERTY OWNERSHIP' 2 ,(� Re / ��g/ rl O/ ?F1// Name(Print) `��`� K/City,State,ZIP 6 U� W�� No.and Street Telephone Email Address �iYl SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed W rk2: � — Ve 7 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 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:.$ i' 4.Mechanical (HVAC) $ List: ... 5.Mechanical (Fire $ Suppression) Total All Fees: $ �� Uv Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 C struction Supervis License(CSL) /� lmilx7 tin� License Number L/ Expiration Dater Name of CSL Hg der D List CSL Type(see below) No.an treet Description O �7 U Unrestricted(Buildings up to 35,000 cu.k of Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 1 Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address Ci /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 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BU ING PE�RqMIT/^I I,as Owner of the subject property,hereby authorize �, �/V�C✓ to t on my behalf,in all matters relative to work authorized by this building p rmit application. Print Owner's Name(Electromc Signature) Date SECTION 7b:OWNERS OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest on r the pains and nal es of perjury that all of the information - con ed in this applicati is true and acc t the best ormy kn wledge and understanding. r. ✓�, Print Owner's or Authori d Agent's Name( e .Lot 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 wy .mass.eov/oca Information on the Construction Supervisor License can be found at www.masssov/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"maybe substituted for"Total Project Cost" I'mm VIP IFI'2 Fax:(866)631.4614 To;9i814696a4� @rcfa:L<al.Faf; +15787,459684 P'og¢'2 of? 101112013 7 11 CERTIFICATE OF LIABILITY INSURANCE DAic 1M1IMtODNYYT) 10/01/2013 THIS CERTIFICATE IS ISSUED AMA IV ELL O OF NEGATIVE ONLY AND:CONFERS NO.MU,mlS UPON:THE CERTIFICA'E HOLDER. THIS CERTI FICATE.DOES NOT AFFIRMATIVELY OR NEGATIVELY'AMEND, EXTEND OR ALTER THE COVERAGE:AFFORDED MY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S); AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate hDlder is an ADdTIONAL INSURED,ttre pohcy(ies)must be endorsed.. ff'SUBROGATION IS W.4IVE6,subject to Yhetennsand conditions of the policy,certain policies may require an endorsement. Astatement.on this Certificate does not confer rights to the Certificate holder in lieu Of such endom ment(s).. FR�UCER COMACr Phil Richard Insurance,Jnc: NAME 27 Garden Street .PHONE" __ _......_ _ UniY7B °'t11 ^ EMAIL. Danvers,MA 01923 AooREss: INSURERSAFFORDINO COVERAGE NAICS �INsur�D TetlA.Robmson INsur,EaA Atbella-Protection_. 1^m g1360 dba Fences Plus- INSURERS 1S Delaware Ave. iNwReac _ Danvers,(MA01923 -._--I INBURERD: ;. INSURE0.'E MWRERF � _-- COVERAGES CERTIFICATE NUMBER - REVISION NUMBER , THIS IS CERfIFY THAT THE POLICIES OF INSURANCE'LISTED B-LOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NONYITHSTANDING ANY REQUIREMENT`TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT UmTH RESPECT.TO VlF-0CH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE.AFFORDED BY THE POLICIES DESCRIBED D HEREIN I5 SUBJECT TO A O THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH�POLICIES UMITSSHOWN MAYHAVE BEEN.REDUCED IT PA7DCLAIMS: INSR _. ADD SEER TR T'FE OF INSURANCE POLICY NLPoBER ' kOLICYEFF :P000YE%P. UNITS A GENERALC(ABUITY - 850004.4132 : 0812WX)13: 0829/2014 Eu;H accuR-rE:� 1,000 000 EDMNRCII IE GENERAL'LIABILITY' D4"nw,G TO ftEw D E a Ell Eel OOO 0.WMSrfADE ��DCOJR - - t MED w fAr c I s _ 5G00 MRSCNaLARV INURY 1000000 I; �a'EN—R-A A—c RECArE ¢ 2,000 C00 ' �N_AGDRECvAIC LIR110.TAPPLIES PER PR`($,LI T pp;p•pF AC•C, 2,000,000 POLICY 1 P .LOC AUTOMOBILE LIABILITY T m%i&hC SNGLCLIMI 1 Ea-ac a n ANY UTO CANES) 9DC{LYIJ,AJR Rn PeS ,) 15: ALTcs SCHCDULED 1, F,UTOS NON-OUMED 6GGLY IIVf,T2Y(Pcrmc.Cen15. HIREDA'uTOB - AUTOS Y DAMA(i`c '.'tPerac:ge� ( UMBRELLA GAB DER FACH OCCLIRRENC= y E%CESSLIAe f IMS-MADE I AGGREGATE ��$ CFD RETENTION$ " YNJRKER$COMPeNSATION ANDEMPLOYERS LIABILITY Y/N 'AC STI.IJ lT-I� ANY ROPPoETORNARTNERIE%ECU(IVE TORVIhI S ER __ GFICFR?AEMEEREAC_UOEO? ` NfA FL,EACH CCIDFv'r__ IM U rylnilH) , Rye dIFCON under I EL.CI9 E4 EM c PLCYCE .. f£G RIrT1�lN-0F OPERAT.IONStrelaw, E.L.OgEn:L-POLIDVL rvi T,. $ �— 1. -0ESCRIPTON OF�ERATIGye/LOCATOM1l9(VEHICLES,(Plmvp ACORD tOt;Atldtmny Reln;vkiS MtlWa'i lile�e.pace lsfequind) �; CERTIFICATEHOLDER'- - CANCELLATION ,. 1 , SHOULD ANY OF THE ABOVE'DESCRIBED POL CIES,BE CA14CELLED BEFORE ECP SEIVICOS i ` . THE 'EXPIRATION DATE THEREOF, NOTICE WILL BE: DELIVERED IN 400.HIghland Ave' ACCORDANCE WITH THE POLICY PROVISIONS. ,I Salem,MA - AUTHOAt2EDRfP sE AnV r P 7. ©1:9B8-2010ACORD:CORPORATION All rights reserved. ACORD.25(2010105). 'The ACORD name and logo are registered marks,of.ACORD. i c •Id PIROPERTY jam ° Cu') �} �(� iVIANAGEMENT . TEAS JS CuJAS J! �ara�° SECTIONPROPERTIE�, T,LG tihnoNnt,�soc.i.,�!oNorrltro�sb September 30,.2013 t City of Salem lR Building Department i.'. 120 Washington Street F.. Salem MA01970 Re: Unit A4,,6 Loring Hills Avenue;.Salem MA Dear Sirs: Attached is a copy Of the certificate of insurance from Ted Robinson,d/b/a fences Unitd who will be replacing the deck at A4,"6 Loring;Hills Avenue,Salem. The Board of Trustees has approved the replacement of this deck. If you need anything fyrther„please do not:.hesitate to call. Very truly yours,, EAST COAST PROPERT IES,LLC,Manager 3Y Cyndy,AAselmo t r r I S REAL ESTATE AND PROPERTY MANAGEMENT y 400 HIGHLAND AVENUE,.SUITE�11 email: EastCoastPro@aol.com Phone: {978) 741-2003 SALEM,MA 01970-1777 Fax: (978) 745.9664