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18 OAK ST - BUILDING INSPECTION CITY-Or —— PUBLIC PROPERTY DEPARTMENT KImAIRAILEY DRISCOLL MAYOR 120 WASHINGTON b`rRE.Er•SAILEK MAcanrHUstz-a 01970 Ta;978-73S-9595 R F=97&740-9U6 APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION. DEMOLITION OR CHANGE-OF USE OR OCCUPANCY, FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION Location Name: iZ Building: Property Address: S f 57Ck�e� i N \A 0(� Property is located in a; conservation Area Y/N Historic District Y/N 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land _ [Telephone: ame: S�,�.L, Gtirrv,a, ddress: 0ak St. S�f>•>ti,l M� o 070 3.0 COMPLETE THIS SECTION FOR WORK IN EXISTtNr: BUILDINGS ONLY f. Addition °f Existing Z Renovation Number of Stories Renovated Change in Use New. Demolition Existing Approximate year of Area per floor (so Renovated construction or renovation I �5� New of existing building Brief Description of Proposed Work: �(a� C_^rr1, IAA 6�1w, a�d l pry a tfe4 C_1U_<0 CAL, felt ( atf � ---Mail Permit to: What is the current use of the Building? Material of Building? IA e,-)D6j If dwelling. how many units? Will the Building Conform to Law? Asbestos? Architect's Name Address and Phone ( ) Mechanic's Name Address and Phone Construction Supervisors License#CS 061-7 D 1 HIC Registration# 132—D� Estimated Cost. f Project$ °o `� Permit Fee Calculation Permit Fee$ Estimated Cost X$7/111000 Residential Estimated Cost X$11/$1000 Commercial An Additional $5.00 is added as an 1 Administrative charge. Make sure that all fields are properly and legibly written to avoid delays in processing. The undersigned does hereby apply for a Building Permit to build to the above sta specifications. Signed under penalty of perjury 06. 17 a a O uQ .+ O kXrY OF SAL.FM PUBLIC PROPERTY DEPARTMENT aVramk tavr stw�.a.sKn.xw�aaaanol+7e TILM74643O0 PAZgM74►" Consttucdion Debtrb DblWat ADWavlt (eequtrel 6 ari dtr WWos wA tweevt m w=O to=otdwe with the: adid=at&@ Stft ihtiidios Cody,7M CM seedm 111.5 pit,and&s peoAdaw of UM o A s 5% Bvilft lratttdt M is tatted with 60 aoAMM as the debt ttw aft be thk wont"be dtapoud oft a pt WN%O bm"d wum dtapead&d t1►Is dented W MM e 1li.315" TM/dcb&*rill b4 UMVDKad by: �a✓Lf.Li l� lntc�l Tha dcbde wjH be diapoaed o[in: Saul, rLta�w o!Ix�t4» F' dW CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT xmaaalav natscou MAvoa uoWAste4a pNsramasALme.MASSAGRJ5gM01970 TkL'97a.745.9595 a FAX 9M740.9N6 Workers' Compensation Insurance AiHdavit: Builders/CoutnctOrsMeebiditua/Plnmben Applicant Information /n1 Pie ee p.int Lt'Qibhr N8me(Buaiaesa/Orgaaiatioa/Individuai): Address: v' hOX 2 Z-S(o cityistatai p: We-jhl�yd, J,4 ,4 a AtK Phone tx. `l)Y 6�,9 Z OOOZ Are you am employer?Chock the appropriate boss i. I am a employer with 4. ❑ Y am a geaaal contractor and 1 a of Pro��(rsgmlred): employes(halt and/or part-time).• have hired the sub-contactors 6. ❑New ceoahuction 2. I am a sole prtoprietor or peruser. listed on the attachlane heet,t 7. ❑Remodeling ship and have no employees Those msb-eontracthave 8. ❑Demolition working for me in any capacity. workers'comp,insae. [No workers'comp insurance 5. ❑ Wa em a cmpmati 9. Building adder required) O icas have exerc 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing all work right of exemption pee 11.0 Plumbing repairs ar additiono myself.[No workers'comp. a 152.§1(4),and we ho insurance required)t employees.[No workers' 12.0 ROnfrepairs comp monsonoe requieed) 13.�otharS(A/C �� S�/G(Gtir� ;AuY appiteam ad Cloth bare 01 mart dm tm as tba sonic.bdmr dmwbq mdr wmbets tcaau.t um 00 obaek We box�attached m adMom �k and lobs aaMda GOMPMUmtkm Policy a umv�dtvtt baatlpa md• tbawb*tba mma of dm sub400mmam sad dadr woi6n'aOF PWW7 Infi matlaa ass OR nwpAoyt►that 6provAdhq workers caapensodow twfarasaalow, lwtumme for my eAaployeea Bckw Is A#policy owdlob tits Insurance Company Name:1Y h�fn 7 core h i h o we A ut2[nc¢ C Policy N or Self-ins.Lie.N Expiation Date o _- Job site Address: city/stte/z;p: ��+L �,tQ p�9 Attach a copy of the workers'cent nsatlom '—'—^L` - Pe policy declaration page(abowing the policy number and explragom dabs Failure to secure covemge as required under Section 25A of MGL a 152 can lead to the fine up w S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form off&STOP WORX ORDER and a Jim of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Ot13co of Investigations of the DIA for insurance coveags verification. I do hereby cerdo undep and pena/des of prrJ th w provided P above Is awe and comsd FEW se only, Do not write In thb area,to be completed by city or towns oQlc/al own: Permit/License N uthority(circle one): f Health 2.Building Department 3.Cltyfrowe Clerk 4. Electrical Inspector S.Plumbing Inspector erson: Phone N: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. pursuant to this statismk an eaiAVIS is deffOed as"...every person in the service of another under any conuad of hire, ' or implied.oral or wrings." ecorporeem mine � l entity.or any two or An earptbye►is defined es"an individual.partnership. alb represmtsnva deceased employer,or the of the foregoing esgailed is a joint enterprise.and inchtdmi to employees However the of an individual•parteership.sesactsaon or other legal math, a fhb occupant w the receiver or trustee house having mt more than three Verunena and who resides owner of a dwelling mainicisancO,motion as repair wodc on such dwelling hats dwelling how of another who UVIDYa persons o shall��mae of such employment be domed m be an empinyW." or on the grounds or building appurtenant cmh an" or MGL chapter esue or pe �o'�that a hod stateevery Of b nst set uildings In the�wealth tar so b openb•busitua b " remwal of a lasso or P acceptable evideaee of eompMaaee with the inanranu coverage rM°�' SW applkaat wYo has tabs produced152,$25CC>)states"Neither the commonwealdt nor any of its political subdivisions Additionally,MGL chapter Spey work until acceptable evidence of eomplisnu with the insurance recut into any contract for the have bib prence to the contracting ausbonry" requirements of this chapter have bi:m presented , App§umt@ the boxes that apply to your situation and.if Please fill out the wodws' compensation affidavit eomptetely,by checking with their catiticate(a)of yuy.conusctor(a)name(s),addreas(es)and phone namba(s)along with no employees other than the necessary, or Limited Liability ParmerahfW ti.LP) insurance. Limited Liability Companies d to carry o�as' O° , if an LLC or LLP does have members nr i are not advised that this affidavit may be submitted to the Department of Industrial employees,s policy is�ot'unat a ado coverap Abe M sue b sip and dab the sfildavit. The affidavit should Accidents for confirmation or license is being requested,not the Department Of be returned to the city or town that the application for the permit the law or if you are required to obtain a workers' Industrial Accidents. Should you have any que listed l below. Self-in r' companies should�� compensation Policy.Pub the Depart at the number a into lino. self iaarrenee Beene number on the ZPFM City or Town OtfldaJs ace at the botbm fete and printed legibly. The Department has provided a space Please be sure that the affidavit is comp ons has to contact you regarding the applicant.. of the affidavit for you b fill out l the seem the Office of investigations be used as Please be sure m fill in the perntit/lietmaersumber which will be used es a reference Wombat. In addition,an applicant that must submit multiple permtt/itcense aPP�hOOe in any given year,need only submit one affidavit indicating current 1 information(it WLCestafY)and under"Job Site Addrese"the applicant should writs"all locations in _—to the °i policy or marked by the city or town may be provided b the town)."A copy of the affidavit that bat been officially stamped or licenaea A new afudrvir moat be filled out each applicant as Proof that a valid affidavit is on file for fixture permits V6edue year.Where a bane oa>mt err citizen is obtaining a license or permit not related to any business or commerc (i.e. a dog license es perms to burn leaves etc.)said pawn it NOT required to complete this affidsvit you in advance for your cooperation and should You have any questions. The Office of investiptiotu would like to thank please do nor hesitate to give us a call. ,the Department's address,telephone and fax ntmrber: 'dye COMMwesith of Massachusetts De UMient of IntfilsUW Accident offla of[avesdpdong 600 WLAMOM SftTd Boston,MA 02111 TeL #617-727-4900 W 406 of "77-MASSAFE Fax Al 617-727-7749 Revised 5-26-05 wwwmags pv/dia LJEPARTMENT OF PLANNING AND W a COMMUNITY DEVELOPMENT S20 WASHINGTON STREET 0 SALEM, MgSSgCNUSETTS 01970 TEL: 978-745-9595 FAX: 978-740 p4pq KIM DRISCOLL, MAYOR LYNN GOONIN DUNCAN, AICP DIRECTOR HOUSING RF.i/gg/LjrA77ON LOAN PROGRAM WORK WRITE-UP PROPERTY INFORMATION: Homeowner (s): Sarah German 16 Oak St Date: Septeml 2006 S<! Prepared by: Cliff Ageloff (978) 542:1981 Case #: Housing & Construction Consultant 1. LICENSE: The contractor must have in his possession currently valid licensing as required by CMR 780 e l for all applicable construction trades including hazardous mat rias removal and clean-up. 2. INSURANCE: Contractor must show proof of adequate liability insurance and workmen's compensation coverage be.provided. 3. PERMITS: The contractor must obtain all required building required permits must be submitted to the Housing Progrm rmits prior to starting work. Copies of the _4, CODE REQUIREMENTS: All workmanship must CORfpm1 to_the Pr Massachusetts Building Code and local codes and must be of acceptable quality, as determined by the Housing Programs Inspector, eptabo r 9 am's guidelines, all applicable Contractors are res onsibie for verification Of field conditions measurements and uantitie Submission of a hid is k h five evidence that contractor has evaluated all site conditions which ertain to the work herein. Permits and Permit Fees to ao be includeaf in alf bids. WORK SPECIFICATIONS for EMERGEGY REPAIRS 11 ASBESTOS REMOVAL and HEPA VACUUM CLEAN UP A Approx 180 I_F of pipe Insulation In basement— remove all; contractor to verify remove all material including asbestos attached to any heating equipment currently in use or located on the premises. quantity and B. Note Heating Alternative— pipe removal may be required for C. Obtain all permits a re s required for compliance placement of distribution r e with IOn asbestos removal. p hFcderai system. a6. , State and lo cal requiremen ts for E rle UUF ILI aclVS II lust uc ua.oewos vp .. .. .._......_....--•-•• -- ----- _ 2. The contractor must provide Community Development with a copy of testing by an independent inspector 3. . The contractor must submit the shipping manifest to the Community Development Office. 4. Firm performing asbestos removal shall have been successfully engaged in such work for not less than five years. 5. Principals and workers of engaged removal company shall be familiar with all applicable publications and regulations and conduct themselves in manner reflecting knowledge of prescribed asbestos removal methods. 6. All applicable regulation shall apply for the proper removal and disposal of asbestos. 7. Nothing in this specffication shall constitute the methods or means of performing asbestos removal. S. Applicable regulations enforced by other agencies shall guide the work associated with asbestos removal. 9. Use only OSHA-certified asbestos removal workers to perform all set-up, removal and breakdown of job site. 10.The contractor's bid shall include all costs for post-removal air quality testing, hauling and disposal of asbestos. 11.The contractor shall assure that all free asbestos resulting from the removal work be confined to the immediate work area. REQUIRED DOCUMENTATION a) Insurance Certificate for asbestos abatement b) License: Massachusetts asbestos abatement c) Air Quality Testing: Documents and reports certifying results of air quality testing d) Manifest and Dump Site: Documents of disposal certifying compliance with state and local codes, including D.O.T. transport manifest and dumpsite receipt. e) Permits: Any and all certification required by all applicable jurisdictions for the proper removal and disposal of asbestos and related materials. NOTIFICATIONS: a) U.S Environmental Protection Agency b) Massachusetts Department of Environmental Protection, Division of Air and Hazardous Materials, Woburn c) Massachusetts Department of Labor and Industries, Asbestos control unit, Boston, MA 2. Main carrying beam and associated structural repairs including masonry 1. Shore and brace structure to stabilize 2. Allow up to 20 running feet of sill replacement in base bid 3. Allow up to 20 C of foundation-repairs as needed to implement work - 4. Allow an additional 100 CF of repairs to original masonry supports throughout the foundation. Replace brick, stone and mortar where deteriorated and tie in to existing structure 5. Provide footings and foundation as needed to support building. Excavate as needed to provide footings to meet all MSBC requirements. 6. Remove and dispose all remaining sections of the main carrying beam 7. Remove and dispose all deteriorated sections of adjacent framing members, up to 120 LF of framing in addition to the main beam 8. Remove as needed all plumbing, electrical and mechanical components'associated with the structural repairs;and.reinstall same to restore all services-upon completion of the structural work. Permits for all PEM work shall be posted on site. 9. Accommodate as needed all existing electrical system components associate with the work herein. Reinstall all wiring and terminal components as needed at completion of work. .10. Remove existing beam and adjacent frame sections and provide up to 7 new footings.and support columns in basement area, provide and install new doubled 2 x 10 beam with %2" ply spacer, glued and nailed per code requirements. Set new beam on new columns set into new footings, mid-span and oeroendicuz ar to io€ste. ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID N DATE(MM/DD/YYYY) EAGLE 11 09 06 PRooucea THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Charles F. -Murphy, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEN D OR 14 Storrs Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Braintree MA 02184 Phone: 781-380-0599 Fax:781-380-0686 9;94N FFORDING COVERAGE NAICIN INSURED merican Home Aaeuranee co. 19380merican Int'1 Specialty LineaEagle Abatement Services, Inc. afet Insurance Cc an 0007737 Box Car BoulevardTewksbury MA 01876 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER 0 DATE MM/DD/YY DATE MM/DD/YV LIMITS GENERAL LIABILIIATY EACH OCCURRENCE $ 1,000,000 B X COMMERCL GENERAL LIABILITY BINDER/PROP6190644 11/06/06 11/06/07 PREMISES(Ea occurence) $ 100,00 CLAIMS MADE aOCCUR MED EXP(Any one Person) $ 25000 X MOLD - PERSONAL 8 ADV INJURY $ 1,000,QQQ X Proff claims made GENERALAGGREGATE $ 1,000,QQQ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,QQQ,QQQ POLICY PRO-ECT 17 LOC - Ben. 1000000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT C ANY AUTO 1607661 12/07/05 12/07/06 (Ea accident) $ 1,000,000 ALL OWNED AUTOS SCHEDULED AUTOS BODILY(Per person) - $ (Per person) X HIRED AUTOS X NONAWNED AUTOS BODILY INJURY $ - (Per accident) PROPERTY DAMAGE $ (Peraccident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT g ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ FRETENTION $ESSIUMBRELLA-LIABILITY EACH OCCURRENCE $ OCCUR, -. EJ CLAIMS MADE AGGREGATEDEDUCTIBLE $ _ $ WORKERS COMPENSATION AND X TORV LIMIT ER EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE WC8959999 10/08/06 10/08/07 E.L.EACHACCIOENT $ 100000 OFFICER/MEMBER EXCLUDED? H yas,describe under EL DISEASE-EAEMPLOYE $ 100000 SPECIAL PROVISIONS below OTHER E.L.DISEASE-POLICY LIMIT Is500000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Job #A6097: 18 Oak St. , Salem, MA CERTIFICATE HOLDER CANCELLATION CITYSAL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOR E THE EXPIRATION City of Salem DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Dept of Planning & Community Development NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 120 Washington St. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Salem MA 01970 REPRESENTATIVES. AUTHO E REP SE TATIV \ ^( Il a ACORD 25 (2001/08) �/)f ©ACORD CORPORATION 1