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10 PRINCE ST - BUILDING INSPECTION The Commonwealth of t• N assachusetts -- "Department_of Public Safety ICU Massachusetts State 6uililing Code(780 CNIR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use OnI ) Building Permit Number: Date Applied: Building Official.- SECTION 1: LOCATION(Please indicate Block N and Lot N for locations for which a street addre is not av ' e No.and Street /' wn S•R,IQM Zip Code Name of Building(if applicable) SECTION 2•PROPOSED WORK 4 Edition of NIA State Code used_ If New Construction check here❑or check all that apply in the two rows below Existing Building❑ Repair❑- .Alteration ❑ Addition❑ Demolition Cl (Please fill out and submit Appendix 1) __- Change of Use ❑ Change of Ocau pancy ❑ Other ❑ Specify: (iv Are building plans and/or construction dOCllillents being supplied as part of this permit npplicii on? Yes ❑ No ❑ Is an Independent StructuraLEngineerin r Peer Review required? 'f� "� Yes ❑ No ❑ qn f Description of Proposed Work- I O LK15MI N� VLCX/7 QN(X 1�5T]Q 1� F� black I�PD vn Q)& '14� ,. SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CNIR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed Nn.of Floors/Stories(include basement levels)8r Area Per Floor(sq.ft.) 3 Total Area(sq. ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as a Iicable) A: Assnrnbly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business Cl E: Educational ❑ F: Facto F-1 ❑ F2❑ FL• Flt h Flazard H-1❑ H-2❑ H-,3 ❑ H-4❑ H-5❑ 1: Institutional [-1 ❑ 1-2❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-1❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 13 IB ❑ IIA ❑ fill ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ - VO ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate municipal Cl A trench will not be Licensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ required❑or trench or specify: i permit is enclosed❑ Railroad right-of-way: Flazards to Air Navigation: al:\I lit n �'nmm i si n 1 •cicr, ai I r xrs: Nut Applicable❑ Is Structure within rport approach area? Is Iheir review co mpleted? or Consent to Build enclosed❑ Yes Cl or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICA'CE OF OCCUPANCY _ Edition of Code: Use Gruup(s): "Type of Construction:. Occupant Load per Floor: Does the building;contain on Sprinkler System?:" Special Stipulatfous:_ r SECTION 9: PIiOPER'rY OWNER r1U"rIIORIZA'rION Name and Address nof Property Owner Name(Print) No.and Street U City/Yowl Zip Property Owner Contact Information: 'title Telephone No.(business) 'telephone No. (cell) e-mail address If applicable, the property owner hereby authorizes Name Street Address City/Town State Zip to act on the roper roperty owner's behalf, in all matters relative to work authorized by this building ermit a lication. SECTION 10:CONSTRUCTION CONTROL(please fill out Appendix 2) If buildin•is less than 35,000 cu.ft.of enclosed s ace and or not under Construction Control then check here O and ski Section 10.1 10.1 Registered Professional Responsible for Construction Control - �o�sllh�S�vu(Ilan �e ?e 8ag3 Lw-gC t(ilcnfe� rt� I2.►`7y8' /� ✓J `�.x1- fTel••��1\{!o'ne �/ o e-luaid— I ad/�d/Ir/eess � {��(� Registration Number ` 1. [ •I rIQ \ j � - SStt-rl/eet Address City/Town State 'Lip Discipline Expiration Date 10.2 General Contractor Con any Name Name of Person Responsible for Construction License No. and Type if Applicable Street Address City/Town 1 StIt_e Zip 3�,� _ ��I _3�9- pig_; I GQ�6(�l I I IQ/; ^ "U. CC 4-1 `rele hone No. business Telephone No. cell e-mail address SECTION 11:lvt?Il FIt15'COkIPIIVti,1l10N INSUI::\NCP_:\I'PIUi\Vll M.G.L.c.152.§ 25C6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yes❑ No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estiuulted Costs: (Labor Item and Materials) Total Construction Cos[(from Item 6)-'S_ s� I. Building $ Building Permit Fee-Total Construction Cost s_(Insert here 2. Electrical $ appropriate municipal factor)-$ 3. Plumbing 'S uuutici alit Note: blininuun fee�'S (contact N• Y) .1. Mechanical (1-IVAC) S 5. \lechanical Other S Enclose check payable to 6.Total Cost S •AQr (contact municipality)and write check number here SECFIOl4 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of illy knowledge and understanding, r,r Please print and.sign name "title telephone No. Date Street Ad res Ca /rPw�l , S(I e Zip ' / %lunicipal Inspector to fill out this section upon application approval: t3� Noute Bate I 976 r �, �,� � tftate��ous.�,' �osta� ✓�as�zu� s, 02>33 " . on Francis Galvin ... : Tetary of the - - mtnonwealrh June 13,2012 TO WHOM IT MAY CONCERN: I hereby certify that according to the records of this office, JOE SQUILLANTE,INCORPORATED is a domestic corporation organized on April 19,2000,under-the General Laws of the r y— Commonwealth of Massachusetts- I further certify that there are no proceedings presently pending under the Massachusetts General Laws Chapter 156D section 14.21 for said corporation's dissolution; that articles of dissolution have not been filed by said corporation;that, said corporation has filed all annual reports, and paid all fees with respect to sudfi reports, and so far as appears of record said existence and is in good standing with this office. corporation has legalNs . . � .,., In testimony of which, .- I have hereunto affixed the Great Seal of the Commomvealdi on the date first above written. f the Commonwealth d By:TAA Sege onw Y �Y o s W wLIL) a mass t G-Ov �Pl 1 �:iassac>t;. :-s spar m. . OF Patlic sa's-'V. .. _ 3ca€d 1: --uAdma Reclul trans and standards . Q.ncer!La3rsn Sttpen�isor - - -JOSEPH D SQUILLANTE -, - - 13 DOANE RI) - MEDFORD MA 02155 - - - 02/20/2014 O)Tce of/onme� 'e¢ � ..�✓lt. uac(equ. q '` _ n HOME IMPROVEMENTatn; i°ess egu hon CONTRACTOR , Registration 121708 ` giEx tration 7/8/2013 Type' J�!a P - - Private corporatioi O ILLANTE INCORPORATED JOSEPH SQUILLANTE _ 13 DOANE - MEDFORD,MA 021: a Undersecretary - IOE SQUILLANTE,INC. ESTIMATE 20 DelCanmine Street#103 Wakefield,MA 01880 Date:, Proposal/f' Phone ft 781-246-6293 6/26/2013 249 Fax.ft 781-245-2360 Name/Address-' Project> SANDFCOOK to PRINCE STREET - 23'BROADWAY - SAL.EM,MA-01970 - . BEVERLY,MA-01915" - - - P.O.No. , Terms . PRINCE.613 Description_. - :� � '' Total 1.REMOVE ALL ROOFING FROM ENTIRE RAT ROOF. _ i..-_ .. -..• 16,590.00 L INSPECT ALL SHEATHING.AND REPLACE AS NEEDED.UP TO 3 SHEETS AT NO COST. 3.INSTALL 3-INC14ES OF PRESSURE TREATED WOOD NAILER AROUND ENTIREPERIMETER. - 4.APPLY 6 MIL.VAPOR BARRIER: - 5:.FASTEN 3 INCHES OF POLY iSO. - .6.APPLY.060 FULLY ADHERED CARLISL.E RUBBER TO ENTIRE DECK.- -:-7.FLASH ALL PENETRATIONS ACCORDING TO CARUSLE SPECIFICATIONS OR EQUAL OR BETTER THAN. 8.FABRICATE.AND INSTALL 040 BRONZE ALUMINUM METALTO ENTIRE PERIMETER WITH HOOK STRIP:, - ..9.REMOVE ALL DEBRIS. 16.OBTAIN ALL NECESSARY MUNICIPAL PERMITS. `11.PROTECT ALL EXTERIOR OF PROPERTY INCLUDING ANY SURROUNDING LANDSCAPING. '12. [10i.YEAR WARRANTY ON ALL WORKMANSHIP. - *-Quote pricing valid for 45 days. -* All special-order materials are non-refundablep. - - - please do not hesitate to contact us with any questions or concerns. s Total 516,500.00.. - We at lne$quiNante,inc.appreciate.your patronage _ Respectfully sub ed b Ice Sampan SigoatureJDate „�_4_/V/LytCustomer Signature/pate: •A`� ® CERTIFICATE OF LIABILITY INSURANCE 0;1y2D,3 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY 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 holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME. STRATEGIC RESOURCE GROUP PHONE I FAX 27 WATER ST STE 107 A/C No Eid: A/C No E-MAIL WAKEFIELD,MA 01880 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A THE TRAVELERS INDEMNITY COMPANY OF AMERI INSURED INSURER B JOE SQUILLANTE INC INSURER C- 2b DELCARMINE STREET SUITE 103 WAKEFIELD,MA 01880 INSURER D: INSURER E: _ INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLIO NEvFvFv, POLICY EXP DMRS LTR INSR WVD ( IYYYY) MMIDD GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGETORE.EMED $ CLAIMS-MADE OCCUR PREMISES ny o e person) �I MED EXP(Anyone person) $ PERSONAL$ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY 'jF& 7 LOG $ AUTOMOBILE LIABILrrY MBIED SINGLE LIMIT $ a aces an ANY AUTO BODILY INJURY(Per Person) $ ALL OWNED SCHEDULED $ AUTOS AUTOS BOp[D�ILYqINJURV(Pat accident) HIRED AUTOS AUTOS UMBRELLA Peta¢IdT AMAGE $ UMBRELLA LIMB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DELI I RETENTION$ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y M I TORY LIMBS ER ANY PROPRIETORPARTNER/EXECUTIVE[fl EL EACH ACCIDENT $1,000,000 OFFICERMIEMBER EXCLUDED? Y 6HUB 06-21-2013 06-21-2014 (Mandatory in NH) 6BO65983 E.L.DISEASE-EA EMPLOYEE $1,000,000 d yes,describe under DESCRIPTION OF OPERATIONS below EL pISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,AcidNloeal Remarks Schedule,R more space is required) Oakridge Condos CERTIFICATE HOLDER CANCELLATION Alpine Management SHOULD ANY 'OF THE ABOVE DESCRIBED POLICIES BE Attn:Chris Boyle-Oakridge Condos CANCELLED BEFORE THE EXPIRATION DATE THEREOF, 12A Damon Hill Square NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE Concord,MA 01742 POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE W—� V " .— /05 The ACORD name and logo are r ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010 g registered marks of ACORD �! CITY OF Sm.&m, LItLA SSACHUSETTS " BUIIDLNG DEPAR-nL NT 3 t t 120 WASHINGTON STREET, 3w FLOOR TEL (978)745-9595 F.+e(978) 740-9846 KI.\BFRI EY DRISCOLL THobtAsST.PIERRH MAYOR DIRECTOR OF PUBLIC PROPERTY/HI:II.DL`IG C01L\IiSSIONER Workers' Compensation Insurance Affidavit: Builders/Contractorq/Electricians/Plumbert Applicant Information Please Print Legibly Nance(Busiiis-&Organizationtindividual): llry�C v�r��. 4 ��e —I—tl✓�' Address: a�U Q2�Cl�tcffJV1( KW U I luI't e ru City/Statc/Zip: (),','Vt' rr iI GQ M OWE (-) Phone#: the you an employer?Check the appropriate box: Type of project(required).- I I am a employer with 4. 0 I am a general contractor and i 6. ❑New construction employees(full and/or part-time)." have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet t 7. ❑Remodeling ship and have no employees These sub-contractors have V. 0 Demolition working, for me in any capacity. workers'comp:insurance: 9, 0 Building addition [No workers'comp.insurance 5.'0 We area corporation and its. required,) officers have exercised their I0.0 Elechi " repairs or additions 3.❑ 1 cam a homeowner doing all work right of exemption per MGL 11.0 P bing repairs or additions myself.(No workers'comp. c. 152,§1(4),and we have no 12. Roof repairs insurance required.)t employees.[No workers" 1J.❑Other comp,insurance required.), Any appilum thus chucks boat 01 must ata s rill uu/thv scclim bdowshowinp their werkars'mmpenwien policy infunnstlom t I r,"cownurs who submit this affidavit indicating they am doing all work and thaa hit*ohfside commeton muss submit a now amdavil indicating such lCommclwa that chink this box must anachad an addiaunul+have showing the nnme of that subeentracton and their wurkon'eemp.pulley tnfatnadon. I cam an enrplayer that/r provldlrtg workers'compensation lirrurance for my emplayeex Below/s the policy and Job site injururatiam � Insurance Company Name: I—y IaV IeAS Policy q or Seif-its.Lic.#: (V H U p (0 r�ocPS-t Y Expiration Date:_ 01 1- ao)11 Job Site Address: V9 ,jet I'l/.UCe / St. City/State/zip.. qaj elf-) {M IiZ attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a line up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the fort of a STOP WORK ORDER and a tine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations ufthe DIA for insurance coverage verification, l do hereby certify finder the inns oud penalties of perfury that the hifurmullon provided above it true and correct. �' Dare: 3v 13 n `Z I- so kaq3 Official user wdy. Do not write in this arro,to be completed by city err town afjlcial City nr Town: Permit/I.lcensev _ Issuing Authority(circlo one): I. Buurd of health 2. Building Depurinwilt J.Cityffown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Odtcr Ph one It. [ _ t ;�• CITY 0 •�LE.,�r[, ,.��LiSS:ICHUSETI'S QL MM;0EP.IRTSL&Nr 1'0 W"JumT0 �{ , `LrQOZ TIRL (979) 7'I.3-9595 -!Q.%fOEftLoY OMSCOLL FLN(979) 7•W9344 ' \� L1YOR TFfOSLl9ST.PlE.�ItB DIAECTO:tOFFULICPROPERTY/8j:UnM3COJL\(tS�fO,YER Construction Debris Disposal Aff1davit (required eor all demolition and n(nuvation work) (n accordanco with the sixth edition of the State Building Coda, 730 CLbtR section Ocbris, uid the provisiuns of tb(CL c 40, S 54; ©wilding Pershall be is issued with the condition that the debrfs resulting from this wud<shell be disposed of in a properly licensed waste disposal fauility as daBned by tYg e o l 11, S ISOA. 1'ha debris will be transported by: f)UVIY►to TA Ud C (nuna ut'hauler) 'i'lte debris will bo dispa+ad of in : (nanta ur ncitit%) it i'I nime, ppliamt