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21C MARION RD - BUILDING INSPECTION What is the current use opF�th�e-BO ding? Material• Building? `^'p0 .ifdwellino. how many units? of — Asbestos? - - - Wtlt the Buiidinq Conform to.LaW? Architect's Name Address.,and PhoneSi j Mechanic s,Name, U'Vl vT 0 ? 1 Z 6 Address-and•Ptrona b Constructlon Supervisors license#.eo S Z HIC=Registration# EstimatedCost of Project S ¢� Permit Fes:Cakxilatbn Benoit Fee — - Estimated Cost X�3W000'f;esidentlal+ - - - ----- --- — — - Estlmsted= ost')E'.Sf�1000;` -----... An Additional S5.Gailwadded4wAri Adminiatrat(ye ch'argq. Make sure=that all fields are properly and legiblywritten,to avoid'delays-I0;pr0cessifig: The undersigned does hereby appy-for:a�Building Penmlttdbuild•to the above stated. specifications. Signe6under:penalty oUpedury VNK N CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT MAYOR lW W.W@1GTONSIIFET a SALLH.MAXActatseM01970 . Tin:WI.745.9595 a FAx 978.7449a46 Workers' Compensation Insurance APIIdavit: Bnilde WContmtorsMecbidsns/ptambers AnnHeant Information Cnnetruction Specialties Please Pent UAW Name(tAoleeaU -P.O. Box 53 VIA; 09180 Address: City/Statemp: Phone# c�( — f tc L i A"ps an employed the appropriate boss h pe o f J�( ): 1. I am a employer with 4 I am a Zen"contractor and 1 employees(flrll snd/ar parl-time).• have hired the subtontractoaI[, . ❑New construction 2,[31 am a sole proprietor,or parmso- Used on the attached sheet.l . ❑Remodeltas ship and have no employees These U&COnnaooas have . ❑Demolition working for rot in a�capacity. woritus'comp insurance. , a addition (No workers'comp.ummnee S. ❑ We Am a corporation and its required.] 0Ricen have exacised their .[]Electrical repairs or additions 3.[31 sm a homeowner doing all work risk of exemptionper MOL 11.13 Plumbing repairs or additions myuZ(No worker'comp, a. 152.j 1(4),and we have no 12.[3 Roof inwranea regahea.]t employees.(No workers'c 13.0 (ale, l CL �PR lntunn¢e requit a l ;Any APVbaat drat dweb tan e1.teat den tm net the toedoa tdow dwiniq etdrw yothsy otko'eomp000doa Han.nweo.�m weeu ultadkkvk tsdieaaes dwy a ds ie doing go W and .t�i.-aade.eem.eoote matey kh rCoeatMN Md chook this trot=no athebd on addidma sbR ahaa'tas roe noun of tb snbetetruam and dirk wo.brt'rom06 k nmdm 1 a er Niat bprovldlwj worrkkeers'eowpexwdow Grsaraweejorary exnployesa Blow 4 rbepa/try awQJoi r/re Insurance Company Name: , • Policy#or SW-ins,Lis#_—WC15 �!7��C� �p F� f/�n � Expiration Job Site Address: O? C V / Q f,-- n r� City/State/Zip l�thi mfrt ©(Q Attach a copy of the workara'oompeasadon policy declaration pap(showing the Olky number and expiration date). Failure to sum coverage as regtired under Section 23A of MOL a. 152 can lead to the imposition of erimioal penalties ofa fine up to 51300.00 anNar one-year imprisonment,at woo as civil penalties in the form ofa STOP WORK ORDER and a Rae of up to$250.00 a day against the violaer. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance wverap verifkuioo. l do herdby ee�r(a�t Ae pew M%/ P awd jPe1/nsJ'rkas d e infonxadow provldrd a�l and eorrea signature, D-7 FBosirrrdo' se only. Dd Add write is dtL ores,to be complrtrd br ciq w toww d,Q7elaf ows: PermWlJeense# uthority(circle one): I. Health L Building Department 3.Cityfrows Clerk 4.Electrical Inspector S.Plumbing Inspector Contact Person: Phone#: i pgrd of BgBGing Ragyl�{jona and,Stsdiladilst. Gonstr'ucti'gn Supgr�isorl,icense' ligese CS.. 53897 3Jr2hdgte 5/2/i982 Expiration 51212Q09 Tr# '12955 ReStSiraion; 00` TIMOTHYJ F{NN 8 VALOORA L)RlP0,60X`53 2780 � — STONEk{AM,.;MA 0 Gommisaiorier ' e ---- Clw OF S�1LEM - - -- ' PUBLIC PWPEERW i DEPAETIIOM Move INVArOiarorUNW O MA&MwA&WSCRIM Consimdom Debris Dbposd Affidsvu (rs"irr I*A domalmos and rsasvadas waft Ia aeeardaaos wide ms S o asdas DoOdl Co 7S0 CUR asedas 1IIJ Debdel ad dwpmvtdaM 3dl3 t3vnol ftwa 0 is tarots Mm dw"addas mat ms ddwk nwdds0 Boat Arts ward* 0 be dtapowd arts s pvpsb'end woo dtapoad hdifgt as daanad by l/ts.s I?A debris wig bs tran*oMd bys The debris wilt be diapaasd of in: �d ur.awr etperasK�pyUaas , N 0'•.,-09-2007 04 : 33 PM SU R 1)AN 978 499 8789 P 2 PROPOSAL CONSTRUCTION SPECIALTIES UNLTD., INC. P.O. BOX 53 STONEHAM, MA 02180 Phone (781) 6654410 Fax (781) 665-4411 LE N N X BROAN-NUTONE HffARTH PRODUCTS A NORTEK COMPANY �ec �n Li--Q_a7 `101 �i �fLv'ibcl lG..�( ' DtQ1a S 4,- qil p.V�i� tM n or �ck rnas t 6 vlCl�^� �ccv7 I v�D�1 U 2Fvt J rem C �''�"�"'�� ,��''�a�c�e-•� . �e�t�.�S ce°r ccGQ�r`�tb�101 � 'C,�1�C.r e propose hereby to furnish material and labor- complete in accordance with the above s ecifications for the stun of iAS ABOVE Payment to be made as follows: For special orders a 50% deposit is required. F QI central vacuum and intercom installation, half is due upon rough-in and half is due upon completion. For all other work, payment is due upon job completion. Authorized Signature N TE : All plumbing hook-ups, carpentry work & building permits are the responsibility of the job site general contractor or homeowner. Pr}ces are effective for up to 3 months from date of proposal. A ceptance of Proposal 7M Ptm..tp.01e .ed dw.w�,"/WMury wE w h-'*y.'WPW Y.u..utloNsatl t."d.—ak r"-BW P�t WW a owd.m e WAW nbow. Si ature Date: f accepted please sign and return. �F ox D �15 (L V eens� �a �� ro�0•a � \t T\ PUBUC P]tt3FER'I'Y uAvuY 13ovti urwicwaItsuI i 't�497d-7iS-9591��i17C9 ��hM(6; Apt C dkTION FQI liTHE REA REN'=Yh'l l� . C( N�'TY2 y ION, DEMOLY'TI( 1 � OI�'C yGE (�FFi�SE �SRC�PANCiI.. 'Oit .ET�'t'lly ; . � LtC�JRE':OR$tJILDYI�IG` 1:,p:SITE INFORMATION 1:csallonNams --- _ — r\ ----- t�roP«b b;located:ln a, Eo etCon Area YM Htstaric Ctstrlc!Y1N _ ._ Z Q'O whims F;<IFYNIcdR ON 3.1 Owner of Land Name: pit r Address: i C GLgr%V p8dd.NsscAptionlof IIAPCETE T 's SECTld?4 FOR"W1:1RtC(N J .S�IAIG�t71 D1 1Ca F1�Y t n EzTstirT� tion Number of Storid's Rebovated` e.in Use Ale1N ttan ting Exis imaWyearof Afea"per`floor�(o, Renow teq ction or renovation is building Neir " scriptian of Frepased IUork: REM C.D �� -- Mail Permit"to: `^C2cMo n _ 0 2t j (�