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93 NORTH ST - BUILDING INSPECTION Cl WAWSIAWWIKNAW APMOV15D BY IM MPACnA MAR TO A` MW REM ORAWIM CITY OF SALEM Wed m�olle�la In P i ftwi logy DIMAd?� Yes No� 1a1 loostsm �t 43 far+l� S�fa¢t M AGWb LWWsd In ft OOIONI t one YM tta_ BIAMLDMIO PERAA<T APPUCAT M PM Pamlk to: (Ckola whi0h m apply) Rod. Rood. kWW f3kft COrtaUM D" Wwd, Pool PApawpApmm Olhar: NEW PLEAAE M L ONr L AGMLY&COMPLan L.Y TO AVOW DW AVE N PROOEs1fE� TO THE 1NSPECTDR OF MLD)N(W: hemby #go= for a parmk to build aomditto 1ha.lain Lp Ow ees Name AddMaa& Ph" 9 3 r or+H S+ Sal e.� (976 1 l y4- siBi Amhk@Ws Noma E I ) i o+ 5s6c�v.4eS kl-WAc-1s -,.1C. Addmu A Pla 41F leooia •d 0, f3el ggi a414 (617 ) 4F f-a 000 N @d=ia Nana 6"'0D AddrataAPhorn 3z.4 Swawpstett- (93( 1 59,� - 313J What IN to papm at k jdW LAW ofb~ KaSonrNJe�ee,r AadwMq.L9rhoarallytllllal-7 fV4 wa kddq owrrona to me Ado~ �l Etalallldatilt �I38�i,000.=° �Lllllra• � � ` � am Iapevwarat we. s Z;of APPIOW !�INlDE111NE PENALTY OF PNUURV DRECRp l OF WORK TrO M M ME C L ow p1¢�o. f�¢wo��,o y of rkMe ef-1,4 �A s cjc,4 rr2S. C rec-+ nC.. Si nq�e Skor4 S+eel s+d cl hf, ned 54rj,,4-,re. w4k bri&4 ✓enee( . A/e, Hfe /ro+eLr7'on Awd lH� l� S��ew/s Abe 4i/e ;,vpro✓GMc.4s /� II I T MNLP�To: (�rupv� Cons+rJf. on CO., 32L{ 'EsSe)e 54, SLuxµPSfu e^ V� s f+r�a d19o7 e 3 -SEMW JO OUBM #' V v 0 ..w�.L/tlJJ 03iwwo M� yy�a� t4gavo , E of Jw um N=V=I M AAA � , �� Zo Massachusetts Department of Environmental Protection Bureau of Waste Prevention . Air Quality ;l000toa5o BWP AQ 06 Decal Number Notification Prior to Construction or Demolition Important: rtffngout A. Applicability forms on the computer,use only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building, or to move your residential building with 20 or more units is regulated by the Department of Environmental Protection cursor-do not use the return (DEP), Bureau of Waste Prevention -Air Quality Control Regulations 310 CMR 7.09. Notification of key. Construction or Demolition operations is required under 310 CMR 7.09(2)ten (10)days prior to any work being performed. The following information is required pursuant to 310 CMR 7.09. a B. General Project Description 1. a. Is this facility fee exempt-city,town, district, municipal housing authority, owner-occupied Instructions residence of four units or less? [_-'Yes I�] No 1.All sections of b. Provide blanket decal number if applicable: ----- ---------------------------� this form must be Blanket Decal Number completed in order 2 Facilit Iformation: to comply with the Y n Department of THE SALVATION ARMY Environmeironmental �------- -----..------ Protection a.Name .. ._ _. __. _. . _._... . . . - ..--- __._. ._ ..---- — -- notification 193 NORTH STREET requirements of --. __-- --- __.. _...____.__.._-__.._---_—_-------_-- _.____...._-._...-'--._—_-_- 310 CMR 7.09 b Address _--, L01970 � e.Zio Code_—_____—._• 1(978)744.5181 f Telep—hone Number(area wde and extension) ��gE-mmail Address(optional) 11 18,240 -- — — — — --- — — h.Size of Facility in Square Feet i.Number of Floors j. Was the facility built prior to 1980? Z Yes rj No k. Describe the current or prior use of the facility: I. Is the facility a residential facility? i Yes j7,�, No ° m. If yes, how many units? -- -`- - - --- --------- — Number of Units ° 3. Facility Owner: a ITHE SALVATION ARMY o a.Name o i147 BERKELEY STREET b.Address BOON �MA 02116-5197 _--J tD11it /io_ws_—_---'--„---_,_,-,-----. d.State o (617)542-5420 J — —I I.Telephone Number(area code and extension g.E-mail Address O CAPTAIN KELLY Q h.Onsite Manager Name - ag06.doc•10/02 BWP AO 06•Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 1100010450 B,w/^ w Q 06 Decal Number Notification Prior to Construction or Demolition General Statement:If B. General Project Description cont. asbestos is found during a 4. General Contractor: Construction or Demolition ,GROOM CONSTRUCTION CO, INC operation,all responsible parties a.Name must comply with i324-ESSEX STREET 310 CMR 7.00, b.Address 7.09,Z15,and t Chapter 2;E of the !SWAMPSCOTT IMA ',01907 --- --..-----..__._---- General Laws of c. //rown - _ ____ _ _- ._ ., d.State —_----e.Zip the Commonwealth. !(t 781)592-3135 ,' I This would include, -----__.—___.—_______. but would not be f.Telephone Number(area code and extension) _—___.____q.E-mail Address(optionaD _______________ limited to,filing an ITIM COSTIN asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threat of release of a C. General Construction or Demolition Description hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. ,GROOM CONSTRUCTION CO., IONC. a.Name - -"---"--" 1324 ESSEX STREET b.Address SWAMP$COTT MA i L01907 i - c.Cirilrown -. d.State------------- e.Zip Code — --' (781) 592-3135 — --__ _— —._— ---_ L Telephone Number(area code and extension) _ `�E-mail Address o tionaii�_ ITIM COSTIN ,h.On-site Manager Name - 2. On-Site Supervisor: !GARY THOMAS rin_Rifa S,narvicnr Name 3. Is the entire facility to be demolished? Fv] Yes ❑ No N 0 4. Describe the area(s)to be demolished: o !EXISTING 1 STORY MASONRY BUILDING AND A N, ITWO STOR 0 0 5. If this is a construction project, describe the building(s)or addition(s)to be constructed: !NEW 1 STORY WOOD AND STEEL FRAMED STRUCTURE i 0 i o O Q ag06.doc•10/02 BWP AO 06•Page 2 of 3 J. Massachusetts Department of Environmental Protection j Bureau of Waste Prevention • Air Quality [100010450 - - - B W P AQ 06 Decal Number Notification Prior to Construction or Demolition C. General Construction or Demolition Description (cont.) 6. a. If this is a demolition project,were the structure(s)surveyed for the presence of asbestos containing material (ACM)? ✓' Yes No If yes, who conducted the survey? IGZA GEOENVIRONMENTAL, INC _ jL.Survevor Name - - - -- A106189 -___ patio-------- i c. Division of O ccupational Safety certification Number Numbb er . 7. Construction or Demolition: i10128/2)04 — _—j 08/01/2005 a.Start Date(mmlddlyyyy) b.End Date(mmlddlyy-w) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: 71 seeding ❑ paving b. If other, please specify: 9 wetting [j shrouding _ _I covering _j other 9. For Emergency Demolition Operations, who is the DEP official who evaluated the emergency? NA a.Name of DEP Official --------- i -- _._-papa-__`----- b.Title _ I 1 c.Date(mrn/dd/yyW)of Authorization d.DEP Waiver Number---___-__._.—___.____._.-_.—___— " I certify that I have examined the TIM co o above and that to the best of my a.Print Name o knowledge it is true and complete. ITIM COSTIN The signature below subjects the bb.Authorized `----- -I N signer to the general statutes PROJECT MANAGER o regarding a false and misleading o. Position/rMe statement(s). (GROOM CONSTRUCTION CO. INC.o — d.Representing i1i 0/19/2004 — — --- `D e.Date(mm/dd/yyyy) 0 d Q atlKdoc•10/02 l3WP AD 06•Page 3 of 3 Y /o=First Organization/ou=First Administrative Group/cn=Recipients/cn=tim From: eDEP-Confirmation@state.ma.us Sent: Tuesday, October 19,2004 8:16 AM Subject: Email confirmation from eDEP Transaction 20395 Thank you for using eDEP Online Filing from the Massachusetts Department of Environmental Protection. Your transaction is complete and has been submitted to MA DEP. This email is your receipt for the eDEP Online Filing transaction described below. Please review it and keep a copy for your records. Please do NOT reply to this message, this email address will not receive messages. For assistance with eDEP Online Filing, please email the DEP Help Desk at DEP.HELP@state.ma.us or call 617-556-1100. MA DEP is interested in how we can serve you better. To help us make improvements to eDEP, please take a minute to complete our eDEP Online Filing Survey at http: //www.state.ma.us/dep/edep/edepsurv.htm. To contact MA DEP Programs, please see http://www.state.ma.us/dep/contact.htm. DEP Transaction ID: 20395 Date and Time Submitted: 10/19/2004 8: 15:16 AM Form Name: BWP - Demolition Form for AQ-06 Payment Information DEP code: 4029 Date: 10/19/2004 8:14 :47 AM Amount ($) : 85 Payment Detail: Timothy P Costin --Card -- 0346 Contractor Contractor Number Name Address Supervisor Project Monitor Lab 1 eDEP - Payment Confirmation Page 1 of 1 Mass.: masagovhome • onlineservimz • siateagendes SEA1tfNYASS�QY, dep home calendar - new additions search site map d my profile Payment Confirmation my . homepage current. Transaction ID : 20395 submittal Payment Date : 10/19/2004 8:14:33 AM online forms $85.00 has een charged to Credit Card ************0346 data Transaction Information converter tool DEP Payment Code#4029 instructions Payment Confirmation #3399 contacts Please note that payments received after 3:30 pm will not be posted until the next business day. feedback survey a' exit eDEP dep home • calendar• new additions* search - site map • privacy policy contact eDEP Version 3.3.6.0 httnc•//mien rlen mnec anv/RezhirtPrl/wahnnaac/PavmPntCnnfirmntinn acnx 10/19/2004 A ENERGY CONSERVATION MANDATORY CHECKLIST FOR NEW CONSTRUCTION g, (OTHER THAN LOW-RISE RESIDENTIAL)780 CMR, 130].8.1 1� "� - Owner/Agent Name: $AUVAFTtOtJ q-f�.(.'� Phone: a+ Owner/Agent Address: [At-j R 3 S� City/State/Zip: ProjectNamc: S (.V>•4JlON Al2µY HSH02f �� S Site Address: _q3 t_iz"H STQf 6T City/Town S40 k MA Applicant's Name:. Signature: Applicants Pheoe: Date of Application: 1.Envelope Compliance Option(check ONE) ❑ Trade-Off (1304.5)-Attach software Compliance Report(COMchxk-U) ❑Appendi:J(1361.2-For buildings up to 1o,00o sf only)-Attach Appendix I compliance documentation ❑Systems Analysis(1309)-Attach Registered Architect's or Engineer's tepart ❑ Prescriptive(13042)-Complete this section,and attaeb copy of applicable Table(13042.1 through 13A2.12) �/ Zona i4a Climate Zonm(from Table 1303.1) ❑ Zone 12a L7 Lone 13a a. Gross above-glade wall area _ —x1'ft b. Total window&glass door,area . _ 2�s1•fL e 9 Table 4 utilized: c. Glazing/o(100 x b-m) 11.RVAC(check ONE) ❑ Simple stems&Equipment(13052) R Complex Systems&Equipment(1305.3) . S ❑Systems Analysis(1309)-Attach.Registered Architect's or Engineer's report. / III.Lighting(check ONE)' R Buildiag Area Method(1308.6.2.1) `Attach Compliance Documentation(COMchoek-EZ or other) ❑Space-by-Space Method(1308.6.22) 1 ❑Systems Analysis(1309)-Attach Registered Architects or Eugincds report i1V.Approval&Acceptance Construction Documents(1301.8.4.1) Attach a narrative report describing the HVAC,Lighting,and Electric Distribution systems,including: 1.Design Intent 2.Basis of Design Y r r 3.Sequence of operation I systems interaction 4.Docription of the systems(capacities,etc.) > ; Q .. 5.Testing requirements/criteria acceptance Q; 6.Requirement for submittal of operation manuals and mairrtenancc manuals 7.Requirement for submittal of record drawings and control documents Z 'd ZSSS68VL 19 30SSV 110I-1-13 W08d WVLS'6 VOZ-9Z-01 This Side For Use by Building Deparitnent Only Official's Name: i itie: I.Plans Review Date Application Received: ❑ Complete Narrative Report Received(1301.8.4.1) ❑ Design and Specification Documents prepared by legally recognized professional(1301.8.43) Application is: Approved ❑ Date: Signature: Denied ❑ Date: Reason(s)for Denial: (provide additional details as needed on separate sheet) H. Acceptance(1301.8.4.4) ❑ Successful system tests witnessed by Building Official,OR ❑satisfactory test report received(check one) ❑ Certfficatidn by Registered Professional(per 780 CMR 116.2)that systems arc installed in accordance with construction documents ❑ Confirmation by owner(or their authorized representative)that they have received record drawings, reviewed for reasonable accuracy ❑ Confirmation by owner(or their authorized reproscatative)that they have received reports,controls documentation,operations manual(s),maintenance manual(s),and other documents specified in 1301.8.4.1 Building Official's Signature: £ 'd ZS9S62VL l9 30SSV 110I-1-13 W02i--J WV9S'6 VaZ-9Z-01 ZADE ZADE COMPANY. INC. Munom nu•d%atic. Ph.l l., I'.G. Consulting Engineers Mcvltn S. 6nvuu n. CE. 140 Ile;fcli tit., Roston,MA 02111 Nimaffer MW tehitzMIt',NLSc..1'.E. Email: zudeco0laol.com - RIC:(lit:)47.1- ,4n COMCHECK MECHANICAL SYSTEMS NARRATIVE FOR: THE SALVATION ARMY, NORTH SHORE CORPS 98 NORTH STREET, SALEM, MA 1-Description of Design Intent of the design is to provide heating and cooling systems layout for new offices and gymnasium for Salvation Army. HVAC systems shall be gas fired rooftop units, gas fired hot water boiler and split system HVAC units. Hot or cold air is distributed to each space via ductwork. The building is approximately 16,500 square feet. There will be two gas fired rooftop units, five split systems and one gas fired hot water boiler with fin tube radiators, conditioning the building. 2-Description of basis for Design Design for the building is based on ASHRAE standard for calculation methods. We are using Climate Zone 13a per 780 CMR 1303.0, Table 1303.1. 3- Rooftop units shall be high efficiency type, EER rating 11.0, which meets the Table 1305.3.3a requirement. 4- CMR 780 Code compliances: Article 1305.2.3: This article does not apply since we do not have equipment listed in the Tables 1305.3.3a,b and d. Article 1305.2.4.1: Programmable thermostat shall be provided to control the HVAC units. Article 1305.2.4.2: No humidity control is provided with this system. Article 1305.2.6: Minimum outside air is provided to the space from rooftop unit as per mechanical code listed in Appendix A. Article 1305.2.6,1: The cooling system over 65,000 Btu/Hr capacity are provided with econoizer. Article 1305.2.7: 100% outside air economizer is specified with the rooftop unit. Article 1305.2.8: All supply, return and outside air ductwork shall be lined with 1" thick fiberglass insulation or insulated with 1" thick fiberglass insulation on outside. Article 1305.2.9: N/A Fed MEvtuT f Simultaneous heating and cooling is not provided. g_ w KOYMEN Article 1305.3.4.7: N/A A r 30554 '9C.GIs C Article 1305.3.13: Kitchen grease hood is less than 5,000 cfm. Hood exhtstfb all comply with NFPA-96. Mevlut S. Koymen P.E. V 'd 7SSS68VL19 OOSSV 110I_n3 WOaJ WV9S:6 V0Z-9Z-0t Envelope Compliance Report Massachusetts Commercial Code COMcheck-EZ Software Version 2.2 Release la Section 1: Project Information Project Information: Salvation Army, - - North Shore Corps 93 North St,Salem,MA Owner/Agent Information: ZADE CO. INC. 140 BEACH ST. BOSTON,MA 02111 Document Author Information: CT Notes: Glazed door included in window section. Section 2: General information Building Location: Salem,Massachusetts Climate Zone: 13a Heating Degree Days(base 65 degrees F): 5641 Cooling Degree Days(base 65 degrees F): 678 Building Use Method of Compliance: Activity Type Method Activity Tvae(sl Floor Area Athletics Court Sports Area 1680 Common Space Types Conference/Meeting/Multipurpose 4215 Common Space Types Corridor/Transition 2400 Common Space Types Food Preparation 326 Common Space Types Electricalllvtechanical 1275 Common Space Types Office-Enclosed 1015 Common Space Types Restrown 895 Common Space Types Stairway 635 Common Space Types Active Storage 1850 Religious Fellowship Hall 2170 Project Description(check one): —New Construction _Addition Alteration Unconditioned Shelf(File Affidavit) Section 3: Requirements Checklist Air Leakage,Component Certffication,and Vapor Retarder Requirements Inspection Approved Initial Date (Y/N) All joints and penetrations are caulked,gasketed, weather-stripped, or otherwise sealed Windows,doors,and skylights certified as meeting leakage requirements Component R-values&U-factors labeled as certified Vapor retarder installed S 'd ZSSS6817L19 OOSSV ilOI-1-13 NOaJ WV6S°6 VOF-9Z—aL Climate-Specific Requirements Gross Cavity Cont. Proposed Budget Component Name/Description Area R-Value R-ValueU-Factor U-Factor Skylight L Metal Frame with Thermal Break,Double Pane with Low-E Clear,shgc 1.00(b) 81 --- --- 0.600 0.060 Roof 2:Metal Roof with Thermal Blocks 2300 0.0 30.0 0.032 0.060 Exterior Wall l: Solid Concrete or Masonry>8" Furring Metal 7195 0.0 19.0 0,047 0.091 Window 1:Metal Frame with Thermal Break,Double Pane Clear,shgc 1.00(b) 43 --- --- 0.600 0.603 Window 2: Metal Frame with Thennal Break,Triple Pane with Low-E Clear,shgc 1.00(b) 836 --- --- 0.320 0.603 Window 3: Metal Frame with Thermal Break,Single Pane Clear,shgc I M(b) 342 --- --- 1.100(b) 0.603 Door 1: Solid 86 --- --- 0.400 0.143 Basement Wall 1: Solid Concrete or Masonry>8" Furring Metal,Wall H19.0,Depth B.G.9.0 3852 0.0 13.0 0.066 0.115 Slab 1:Heated Below-Grade(c) 0 --- 5.0 --- --- (a)Budget U-factors are used for software baseline calculations ONLY,and are not code requirements. (b)Claimed performance does not exceed defaults in Tables 1301.9.3.1.No manufacturer certification required. (c)Certain building use types require continuous under-slab insulation(see Massachusetts Code Section 1304.2.7 and 1304.2.8). Envelope PASSES: Design 18%better than code Section 4: Compliance Statement The proposed envelope design represented in this document is consistent with the building plans, specifications and other calculations submitted with this permit application. The proposed envelope system has been designed to meet the Massachusetts Commercial Code requirements in COMcheck-EZ Version 2.2 Release la. Oct-. 25 ,tioo¢. Principal Envelope Designer-Name Signature Date MEVLUT �� S. M . $ KOYMEN 4 p #30554�p g'O. GIST62' FSS/ON1,l.EaG 9 "d zSSS69VL L9 OOSSV 110I1-13 W02i3 WV00'0 L V0Z-9Z-0l Permit Number Lighting Compliance Certificate Checked By/Date Massachusetts Commercial Code CO\4check-EZSoftware Version 3.0 Relcase I Data filename: Untitled.eck Section 1: Project Information Project Name: The Salvation Army North Shore Corps 93 North Street Salem,MA Designer/Contractor: Mahendra Patel Document Author: Mahendm Patel Section 2: General Information Building Use Description by: Whole Building Type Project Type: New Construction Building Tyne Floor Area Convention Center - 16500 Section 3: Requirements Checklist Bldg. J Dept. J Use J ( ) J Hrterior Lighting 1. Total actual watts must be less than or equal to total allowed watts J Allowed Watts Actual Watts Complies(YIN) 23100 22402 YES J Exterior Lighting [ ] 2. Type(s)of exterior li ting sources: J _Fluorescent Y Metal Halide _High-Pr. Sodium J Exceptions Specialized signal,directional,and marker lighting;lighting highlighting exterior features of J historic buildings;advertising signage;safety or security lighting;low-voltage landscape lighting. J J Controls,Switching,and Wiring [ ] 3. Master switch at entry to hotel/motel guest room. ( ] J 4. Minimum of two switches,dimmer,or occupancy sensor in each space. J Exceptions: J Only one luminaire in space; J Security lighting,24 hour lighting; J The area is a corridor,storage,restroom,retail sales area or lobby. A 'd 5'SSS68pL l9 OOSSV 110I-1-19 "Od-d WV00°0 l P0Z-9Z-0 t Lighting Application Worksheet Massachusetts Commercial Code COMcheck-EZ Software Version 3.0 Release 1 Section 1: Allowed Lighting Power Calculation A B C D Total Floor Allowed Allowed Area Watts Watts Huildine Tvoe (ft2) (watts/ft2) (B x C) Convention Center 16500 1.4 23100 Total Allowed Watts= 23100 Section 2: Actual Lighting Power Calculation A B C D E F Fixture Fixture Description/ Lamps/ #of Fixture ID Lamp Description/Wattage Per I.amn/Ballast Fixture Fixtures Watt, fD x E) 1 96"T8 ES 60W/Electronic 2 15 105 1575 2 48"T8 32W/Electronic 4 26 124 3224 3 24"T8U 32W/Electronic 2 61 62 3782 4 36"T8 25W/Electronic - 4 6 93 558 5 48"T8 32W/Electronic 2 33 65 2145 6 48"T8 32W/Electronic 1 44 32 1408 7 Triple 4-pin 26W/Electronic 1 ion 29 2900 8 - Metal Halide 100W/Magnetic 1 2 130 260 9 Metal Halide 25OW/Magnetic 1 10 295 2950 10 Incandescent100W 1 36 10o 3600 Total Actual Watts= 22402 Section 3: Compliance Calculation If the Total Allowed Wata minus the Total Actual Waits is greater than or equal to zero, the building complies. Total Allowed Watts= 23100 Total Actual Watts= 22402 Project Compliance= 698 Lighting PASSES: Design 3%better than code 8 d. ZSSS68VL19 DOSSV 110I-n3 WO zl WV[0:0t vaZ-9Z—Bl [ ] 5. Photocell/astronomical time switch on exterior lights. Exceptions: Areas requiring lighting during daylight hours [ ] 6. Tandem wired one-lamp and three-lamp ballasted luminaires. Exceptions Electronic high-frequency ballasted luminaires not on same switch Section 4: Compliance Statement The proposed lighting design represented in this document is consistent with the building plans,specifications and other calculations submitted with this permit application. The proposed lighting system has been designed to meet the Massachusetts Commercial Code requirements in COM check-EZ Version 3.0 Release I and to comply with the mandatory requirements in the Requirements Checklist. Principal Lighting esigner-Name Signature Uafc _ 6 'd 7-5S868VL[9 OOSSV 110I1-13 NOd3 WVIO'0[ VOZ-9Z-a[ rusuc rRvruRTT 0"ARTMaN T ea0 V"HINGTON s M9W aaDFLOM dALm wA of oho TEL WG)749-MOB OR.ib FAX (WM 740 N 4s STANLEY A Aft pVm= Jrr. MAYOR DISPOM OF I)EM AFFIDAVIT In awmdanoe wft me povWQW of MM c 40,SKI aclmowledpa mat m a coOftm of Hmlft Fesmit/ .aD deb&muWag ftm•me omse<ud m adi ft pvawd by this BuQft Pmait du!!be&pond of m a properly llamsed soa"aab dbPmd AmId ►.a.datloed by)SM a 11%8110& The debdswdlibe&ponda[� 6t.l v'5 Wcsfe 4cyc/;�� Lacahoa ofFac�y a[Peamit Dae. OULM PRIM'CLEMLy) mom: dame GfPdbok Appllemt -- Coo a� l�n�es�r✓G�o.� 40. Firm Name.if miry► 3aY Essex S•�, cSi✓Q„q sca" yw�/ o7 Add(ew.Chy a ft" The shove ataM r qmm mat debris ftm me demolition.rmmadM r&&or oma dt mfm of bml&g of Mw me be disposed in a pmpedy-hceosed solid-era agwd 5cmty sa dewed by M(X c)Q Sl5GA,and the bm7ding pam&or licanaes see to indicate the locodw of the&mky. CotAinvAu/e/i{iA 4 111a"AClL MI& 600 w..L.06 SI..j ism" CUMO &do% V..e1.ai 02111 C....ean. worken' Cmnpensodon lawman AffMwk .1, Grooms Cprmslro� ftc , GO, TaC, . . whh-0 pekdpal plan of bu+eians an 3,24 Else Sk* o Sw DNA Or o7 do hersby'cF* under tfaa palm and I of peepge d mig N� Ia on ampleyer phi ++psis' compensation covsrals for nw sinPliv rew working w . At aJia 1asvrunce_ bir"A 009/. lAswonea Company Pao) qr Numbw I an a "is prop km and haw .e ens working fir an In aq opedq. () I am a sek proprlemr, general camranCier or homeownsr (drds tale) and how Mrod the contractors listed blew who hew the following workers' melon 1 6dess Comrseter Insurands Compaeq/p N Conusum, Insistence Compaq►/*o N Coaasaer Inswance Company/poft Namisr () I am s homeowner performing all the work thyself. •I wassru ee am J fM►e/ab amwom.e of lw►ars" ■ am Ones A Wru*j a 9/elf WA tI fa..ra.e..deism me M Mom a MeM fe..rsry a/Hewn.fefr fffium SfA f1 r'It:l I f S fal 4N w er:Incite of sdrfiml aeaai�.eflf.e•R sf s sae r A.Ff 1.lOttOO MWOF afa tew we w omm a„s s dd eaeia Yl an Imw e(. STOP WORK ORDER .oe f hu N f IOOAO s a/WkN oL Signed this . day of b c.4 Mbar :icer,�eeiFe ittee 6utl inf DepaArkent i.icensinf Ecart seleamens Office =eslth Depsmrnent Yc : _ ace apr eye 775 �.y �Gas�e� i 10/08/2004 08: 19 781383GO35 EASTERN INSURANCE PAGE 02/03 ACO D CERTIFICATE OF LIABILITY INSURANCE OATS(MMIDONYYY) 10/08/2004 PROr CER (800)333-7234 FAX (508)655-$$53 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION EASTERN INSURANCE GROUP LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 WEST CENTRAL STREET HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NATICK, MA 0176o INSURERS AFFORDING COVERAGE NAIC p INSURED Groom Construction Co., Inc. INSURERA; Acadia Insurance Company 324 Essex Street INSURER B; Swampscott, MA 01907 LINSURER C: INsuRER D: INSURER B COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TI-IS POLICY PERIOD INDICATED, NOTWITHSTANDIN ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,TIRE 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, INSR DO' TYPE OF IN POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY CPA00969SI 03/10/2004 03/10/2005 EACH OCCURRENCE S 1.000 000 X COMMERCIAI.GENERAL LIABILITY DAMAGE TO RENTED S SD OOO [ , CLAIMS MADE X�OCCUR MED E%P(Any ane person) $ 15,00 A PERSONAL&ACV INJURY S 1 000,000 GENERAL AGGREGATE S 2,D00,000 CENT•AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGG S PRD. 2 OOO 00 POLICY X JECT I.CC AUTOMOBILE LIABILITY MAA18793982 03/10/2004 03/10/2005 COMBINED SINGLE LIMIT ANYAUTO (Esaccldenq $ 1 0001000 ALL OWNED AUTOS BODILY INJURY S A X SCHEDOLEO AUTOS (Per pCNnnl X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident( S X $500. DEDUCTIBLE PROPERTY DAMAGE I COMP./COLL. (Pdrar.Fldent) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC $ AUTO ONLY; AGG $ EXCESSAIMBRELLA LIABILITY CUA0096953 03/10/2004 03/10/2005 EACH OCCURRENCE S 10 000100Q X OCCUR CLAINIS MADE AGGREGATE .S 1Q 000,QQQ A S DEDUCTIBLE $ X RETENTION S 10,DD S WORKERS COMPENSATION AND W[A0096955 03/10/2004 03/10/2005 X WC sraru- OTH• EMPLOY EMPLOYER$'LIABILITY A ANY PROPRIETORIPAP.TNERIEXECUTIVF E.L.EACH ACCIDENT $ 11000,000 OFFIGCRIMEMBER EXCLUDED" If ee.de.edbe under E.L.DISEASE I EA EMPLOYS F $ 11000 QQQ SPECIAL PROVISIONS beICw E.L,DISEASE-POLICY LIMIT S 1 000-000 A LEASkO/RENTED CPA0696951 03/10/2004 03/IO/ZOOS $SD,000. LIMIT DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS C619 HOLDES CANCULATIOIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILLENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. CITY OF SALEM AUTHORIZED REPRESENTATIVE Rosemar Fulham/PMA ACORD 25(2001108) ©ACORD CORPORATION 1988 10/08/2004 06: 19 7813836035 EASTERN INSURANCE PAGE 01/03 OEastern Insurance CONSTRUCTION DEPARTMENT 233 West Central Street Natick, MA 01760-3796 Date: 10/08/04 #of pages (including cover): 3 From.: Ted.Matthews To: TIM COSTIN Assistant Vice President Phone#: Phone#: 800-333-7234 ext. 1213 Fax 4: 781-593-1480 Fax 4: 508-655-8853 Action to be taken: ❑ URGENT ❑ Please call upon receipt X As Requested ❑ For your review and comments ❑ As Discussed ❑ For your information Proof of Insurance for Salvation Army.Tob Please call me if you leave any questions. Thank you. cMoonmem. cn.wnlnFklnnunximlomw Inmmnm my wnex-ec.n,clm.nm Tftransmission is illegible or incomplete;contact the sender immediately. t ' of '43, tt1Pm, ttSsttc�uPtts Public Vrnpertg Department Nuilaing Department Wnr *alem 6rcrn 508-745-9595 Fxt. 300 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer Section 116.0 DEMOLITION OF STRUCTURES Structures over fifty (50) years old must have approval of the SALEM HISTORICAL COMMISSION UTILITY DISCONNECTIONS REQUIRED Authorized Agent Date of Disconnection WATER: ✓ ELECTRICAL: GAS: SEWER: DIG SAFE NUMBER: .2 00 r o97o2 PEST CONTROL: +d PE y� Cy�i RCL ***DOCUMENTATION OF ALL THE ABOVE MUST BE ATTACHED BEFORE*** ** PERMIT CAN BE ISSUED ** Fee for Demolition: $5.00 for application plus $2.00. per 100 square ft. gross area, minimum $15.00 Massachusetts Electric A NatlomW arid Company Michael I Byrne supervisor of Support Services October 22,2004 Groom Construction Co. 324 Essex Street Swampscott,MA 01907 Re: Removal of electrical service for demolition. Dear Mr, Costin: This letter is to confirm that the electrical service and meter(s) was removed from 93-95 North Street, Salem,MA on Thursday, October 21,2004. If you have any questions or need further , assistance, please feel free to contact me at 78 1-388-5342. Sincerely, Michael I.Byrne Supervisor of Support Services MIB/cmc 170 Modford Street Malden,MA 02148 781.388-5342 N 3CVd ONI=NI91,13 T4ZS32£TBL £T:TT t,0aZ/ZZ/0T l UCEN$E OR PERMIT BOND KNOW ALL MEN BY THESE PRESENTS, THAT WE Groom Construction Co. ,Inc. , 324 Essex Street, Swampscott, MA 01907 as Principal, and International Fidelity Insurance Company as Surety, and having its prirKipal office in the Rockland, MA as Surety, are held firmly bound unto City of Salem, MA hereinafter called the Obligee in the penal sum of One Thousand w--------------------------- Dollars($1,000 �• Lawful money of the United States of America to be paid to the said Obligee,for which payment well and Wy to be made we bind ourselves, our heirs,eXecutors,- adrif"Strators and assigns,jointly and severally,firmly by these presents. SIGNED WITH OUR HANDS AND SEALED WITH OUR SEALS this 20th dayof October 2=- 2004 WHEREAS a license or permit has been granted by the Obligee's to the above bounden Principal auUnorizing him to Street Permit Bond NOW,THEREFORE,THE CONDITION OF THIS OBLIGATION IS SUCH, that If the Principal shall faltlMly observe the provisions of the laws, ordinanoes, and resoluUons, governing the issuance of this license or permit , thenlhis obligation Mall be hull and void,otherwise to remain in full force and effect This bond shall become effective the_ 20th day Of October A • 2004 The Surety may cancel this bond at any time by filing with the Obligee 30 days notice of its desire to be relieved of liability. The Surety shall not be discharged from any liability already accrued under this bond,or which shall accrue hereunder before the a)Viratiortof.the 30 days period. Groom Construction Co. ,Inc. Principal BY: International Fidelity Insurance Company Surety BY: - Christine B. Dean, Attorney-intact Tel(rrxi)624a2oo POWER OF ATTORNEY INTERNATIONAL FIDELITY INSURANCE COMPANY HOME OMM ONE NHWARK CENTER.20M FLOOR HHWARK,NEW JERSEY 07102-5207 FORBID BONDIMERMONSERMAFFIDAVITS liliOW AILMENBYTHESEPRFSFNOS TWDaUNAT10HALMELITYROMANCE00MPMY, aompaa6ou«pdredRode46i lswt of the Shoe of Now Jetsey,and bavag its Pdwi of offix io 6t My of Hmark.Now Juscy.don baeby codsfode am appal CHRISTINE S. DEAN, ADM W. DESAHCTIS, BRYAN F. am, L. ROBERT DESANCTIS, GREGORY D. JOWA, ,TAMS iT. AXON, KICHARL F. CARNEY, WILDER PARKS, JR., MICRAEL T. GILBERT Woburn, HA. its tmeambyfdays { auoasm,sealanddeWatoramanitsbebaHasa¢egams0�oods�odaodrcattaaFya�s.,eaoaactsafiodeamig� oma wrki+tys o6GLYYotJ iu ite ewae s➢ at w"ere«aaq be Epp ,xgtmcd« yy hw a 1TONAL F7D8<ltY .fie thtecvtion of wch d israo em paooe of th Pttse ms, sMl tie as1 die oil . ATotY a?fi0p red IWPV,a GII N-W aud:POWM as if me ame had been doh aloculod and adaowledfed by ks ngduV dotted*mom at Its . . '1tiisYowaofAdm Lezcarbd,am�pmsamtaaodbranmoeipofActideMCIAa3ofdwB�-Laws�d000�d6J6oB Dhaaea of IN1EdJiA FBlH21Y OOIdPANY n a meeGog ta0od and held on �th day ofFdx�atT,197a. lureddedccc low V PresNat,Bwwft"Vm?taideet,.SeaaagaArian,cSaaetuy.dial bave power andaotboft c0 el� w�iap 0nfaa�m°4neof And. OwspanysmLch ie Sed of drc OomplaJ�ttao.bonds col amtr&m6 . (n7bawave.atanJtiAmmeana�n�rwek�at�odmney-infiactaodaevotey6mea°�Cttatpµrea. dbddwe29mdaf�oCApcl9ofW owG ioSka ante ottbeBardaDnecmaofaaidCooQagPaboPa?d u imxmt Mm-daefae lr aigowres of mach offom and fie oat of 4o company aq be ai5xed a any sock of atoomey« cwft a daeto by tatxlimle,and w aaeh of «t>adr betting aacb 5a®0e atgmsma«faot®Se oal ahau be vaBd ud boa�e �'a°d sq. . pbood«wa erz MAnUbve to b tit fuaimIIe domes and fine gat ahaB be vaIId and bmd'm f pro°be my in Td«e'w tapocta coy is aftdw& INTEnWONYWai .RMHATfOHALIMELMVMANCE00MPANYbascwmdthb* mmtabe' aitoed Sod kstaapauexdaboalfizedbyksaommimdoffioee.#hStst day dito$t,AD.IM. DnMUTWHALUm TYJNS11 Ak=m r y Us04 h . Comely ofEmx JFRSy1f y � O caeyofyaat avco�m.aid dle Lek 4e 6ack4esea AA rr�and S eho crenated me O a me ta�aeaf I wmedd b acid company. Is 66 Capocaa Seal of aid ComPlay;dat de nail Capoarie Seal am bit Ogo;mc were ddy affixed by otda of Me Bond of Dkeolon of MARgG IN 1EnWONY VMRBOF.I bave berevao gamy bud,[Cued any Offi"SaL �Qr at the City of Ncwnk.New Jmv it day and year first wcksea. 0 NOTARY PUBLIC A NOTARY PUB11C OF NEW IMM CERTOC.ATIOH My Caomisdon yapim Nov.21,2005 1,memda*W officer of 1NIFR1IATIONAL FlDEUrY DMANCE COMPANY do hereby cu*du I Lave composed the foagohg ooq of de Powet of Attmaey and&M&vk,and de copy of the Sec(m of be Bylaws of aid Compaq as Set ford in aid Power of Atsorxy,with de ORMWJS ON IN THE HOME OFFICE OF SAID COMPANY.and that de tame are coma ttansaipts dueof am of de wh*of de no odgimts,and that de aid Power of Adomey has not been revoked and U row in ful face and effect /1 INTESTSIONYWHERSOF.Ihavehennas set ag him this 26�hdayof 0�771�� 02BDy Asstsont Secretary • CITY OF SALEM • ROUTING SLIP - IJ CHECKED DEPARTMENTS REQUIRE SIGNATURES BEFORE BUILDING PERMIT WILL BE ISSUED. LOCATION: 95 IVOF'-* % ST S&W4. -ion Arwiyl DATE: APPLICANT: Groom Gons�r.+CA;an GO . ASSESSORS OFFICE r @ 93 WASHNGTON ST. FRANK KUL] DATE: 1a — I O l l Q CITY CLERK(if involving a new street) @93 WASHINGTON ST. DEBBIE BURKINSHAW a DATE: 0 LBRUCE LIC SERVICES( ngineering Dept.) WASHINGTON ST,4T THIBODEAU P T DATE:TER DEPT WASHINGTONST 4TR FL.cw rrennc� DATE: 6 S� d CROSS CONNECT SU BOB DESCHENE @120 WASHINGTON ST,30.° FL. DATE: PLANNING @120 WASHINGTON ST.,3R0 FL.. hff�£ DATE: v O� CONSERVATION COMMSSION (PI nn ept.) @120 WASHINGTON ST.,3RD FL. 6� D9N-2ErrAw DATE: i0 i3 �PiAa)Z fJiofwtl!k1 - d ELECTRICAL @ 48 LAFAYETTE STREET,2ND FL. AR r JOHN GIARDI DATE:za/z�vp/z�. ❑ FIRE PREVE CTIOI"� @29 FORT AVE AREA) CAPT.HUDSON DATE: HEALTH @120 WASHINGTON ST.,4TH FL. JOANNE SCOTT DATE: BUILDING DEPT @ 120 WASHINGTON ST.,3A0 FL �7� TOM ST.PIERRE �C �w� DATE: D 0 r ***SUBMIT WITH PERMIT APPLICATION WHEN COMPLETED*** 't �t: M CITY OF SALEM • ROUTING SLIP • J CHECKED DEPARTMENTS REQUIRE SIGNATURES BEFORE BUILDING PERMIT WILL BE ISSUED. LOCATION: 93 Nor4.6 54: SpAvoJio , Arm3 DATE: APPLICANT: Groom Gon&fr4c- rion Go , ASSESSORS OFFICE @ 93 WASHINGTON ST. FRANK KULIK C-e�t� DATE: CITY CLERK(if involving a new street) @93 WASHINGTON ST. DEBBIE BURKINSHAW .6 �� DATE: LU ''Z 5-aj5�� PUBLIC SERVICES(Engineering Dept.) @120 WASHINGTON ST,4-FL. BRUCE THIBODEAU DATE: WATER DEPT. @120 WASHINGTON ST,4TH FL. . HELEN JIADOSZ DATE: d CROSS CONNECT SUP'R BOB DESCHENE {�/ @120 WASHINGTON ST,310 FL. DATE: /6 PLANNING PLA PLANNINGGTON ST.,30.p FL... DATE: L s GGIy V/ tFk c.H. CONSERVATION COMMISSION (PI nnin ptJ @120 WASHINGTON ST.,3RO FL. I36N-eERAI-0 DATE: t-G4a)� jAo^h11no ELECTRICAL @ 48 LAFAYETTE STREET,2ND FL. FAR i JOHN GIARDI �_ F'/�' DATE: 7 G J FIRE PREVENTIO / 29 FORT AVE I LOWS AREA). / CAPT.HUDSON �'LL u � DATE: L' i I�� D" HEALTH @120 WASHINGTON ST.,4TN F/tj JOANNE SCOTT DATE: 1b- /b' D y ❑ BUILDING DEPT @ 120'KASHINGTON'ST.._Rc FL. TOM ST. PIERRE DATE: 'T'Siiis?�1IT 'J�`iTH °ER1.1i7.