6 LORING HILLS AVE - BUILDING INSPECTION (5) co"- aAl, - �
The Commonwealth of Massachusetts
OF
Board of Building Regulations and Standards CITY� M
Revised Mar/ Massachusetts State Building Code, 780 CMR SdMar
„ 2011
1IJ� 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 lied: -
1
ilding Official(Pri Name) gnatu ,ate
t
SECTION 1: SITE 1NFORMATI
.01
1.1 Pr pe %ddresst�/�� � 1.2 Assessors Ma & Parcel Numbers
I.Ia Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq III Frontage( I)
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'
Name(Pn t) City,State,ZIP
�D ��//��r�o3
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Atteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work': J
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor a d Materials
1. Building $ C7QCl , 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑ ySiandard City/Town Application Fee
otal Project Cost (Item 6)x multiplier,-5 pllCJ x
3.Plumbing $ 2. Other Fees:
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
�y// Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ GV U ❑Paid in Full ❑ Outstanding Balance Due:
��� 701" .'o��
SECTION 5: CONSTRUCTION SERVICES
5.1 onstruction u ervisor License( SL) /- n-2/ .
7A, License NumberExpiration Date
Name of CSL Holder
List CSL Type(see below)
No.an"reet gn 4n /I Type Description
///p�k y /j/ / V R Unrestricted2 Family
(Buildings u el ing cu.ft.
�"� (� /� R Restricted l&2 Famil Dwelling
City oT/ wn,StAte,ZIP _ M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I 1 Insulation
Telephone Email address D Demolition
5.2 Rpgisteree(1 Hom /I�nproovement Con ractor(HIC) 13IR51
/�(�lO/ /
2 / �"��� 74 HIC Registration Number Expiration Dale
HIC Com y N e or HIC ant Name l
My 2
No.and t �.,. Email address
.Lip r7c
City/Town,State,ZIP p e hone
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 R BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf, in all afters relative to work authorized by this building permit application.
P. Owner's Name(EI ctronic Signature) Date
SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below hereby attest under the pains and penalties of perjury that all of the information
Xrmter's
n this applica 'on i true and accurate to the best of my knowledge and understanding./m
or Author' Agents 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.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos
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"
i CITY OF SALEM, AxsSACHUSETTS
BUILDING DEPART',ff_NT
Tr.p 130 WASHINGTON STREET, 3-FLOOR
TE1_ (978) 745-9595
F.;x(978) 740-9846
D j1-BFRi EY RY RISCOLL
MAYOR T•HObIAS ST-PIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDLNIG CONNISSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
A r alicant Information Please Print Lepjbl
Na1T1C(Businesssorganiza' Nlnd''iiviidual): �H"lt.C�// k(l ���
Address: Z I IU,�
city/State/Zip: �/��0� _ G/ Phone #:
Are you an employer?Check the appropriate box: - 'rype of project(required):
1.❑ I am a employer with 4, ❑ I am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2'PA am a sole proprietor or partner- listed on the attached sheet.: ?• ❑ Remodeling
ship and have no employees These sub-contractors have g. ❑ Demolition
working for me in any capacity. workers'comp. insurance. 9• ❑Building addition
(No workers'comp. insurance S. ❑ We are a corporation and its
officers have exercised their I0.❑ Electrical repairs or additions
required.) of
3.❑ 1 ran a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions
myself. (No workers'comp. C. 152, 41(4),and we have no 12.0 Roof repairs
insurance required.)i employees. [No workers' 13 ❑ Other
comp. insurance required.]
•Any applic:w out chocks box HI must also fill out the section below Showing their workns'compensation policy information
!I Lnnenwnen who submit this affidavit indicating they arc doing all work and then hire outside contractors most submit anew affidavit indicating such.
:Gmtrxwn,hoi check this boa most attached an additional sheet showing the name of the tub�comnctors and their wurken'comp.policy information.
lam (/l/
un employer that is providlrrg workers't ompTM
nsurance jar my employees: Below/s the paltry and jah site / �•� 17
CnwranceCompany Name: l -/ f'Tc--� f /
crou
Policy 4 or Scif--ins. Lic, tl: Expiration Date:
Job Site Address: (/,—/-1-mle ( e �U�17
'7 KG Cit /State/Zi
,leach a copy of the workers' compensation policy declaration page(showing the policy number and expiration slate).
Failure to secure coverage as required under Section25A of MGL c. 152 can lead to the imposition of criminal penalties of a
tine up to S 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$230.00 a day against the violator. 13e advised that a copy of this statement may be forwarded to the Of flee of
Investigations ol•the DIA for insurance coverage verification.
l da hereby c ertJ under the i m+d pen-u7h�/les ojperjary that the inJurmu!!o»provided aboveri�s true and correct.
Sicniuure• ` 1117e, Date:
Phone 3• �2��--0 `C�' ✓�
Official use anly. Do not write in Mix area,to be cou+pleted by city or town officiul
City or Town: PermitlLfcense
Issuing Authority(circle one):
1. Board of Ilcahh 2.Building Department 3.City/rown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6,Other !_ --_--__-
Contact Person: ..._______,__ Phone#:
From:East Coast Properties LLC 978 745 9684 11 /19/2012 11 :41 #337 P.001 /001
PROPERTY
MANAGEMENT
A /� ST CO /� ST TJO SECTION
JLed-]1 J! d�e11 PROPERTIES, LLC NnTioNnl ASSOCIATION OFaenLloes �
FAX TO: CITY OF SALEM
BUILDING DEPARTMENT /Ja/�J Id y4�
RE: UNIT H2, 6 LORING HILLS AVENUE, SALEM MA
DATE: NOVEMER 16,2012
FROM: EAST COAST PROPERTIES, LLC, MANAGER
LORING HILLS CONDOMINIUM UNIT#I TRUST
The Board of Trustees of Loring Hills Condominium Unit#1 Trust has approved the removal and
replacement of the rear deck at Unit H2,6 Loring Hills Avenue, Salem, MA.
J.'
East Coast Properties, L !C, Manager
REAL ESTATE AND PROPERTY MANAGEMENT
400 HIGHLAND AVENUE,SUITE 11 email: EastCoastPro®aol.com Phone: (978) 741-2003
SALEM,MA 01970-1777 Fax: (978) 745-9684
b