BPA 12-747 PICKMAN CONDOS ROOF 4 BLDGS The Commonwealth of Massachusetts CITY OF
gkkkVVWWW0.ttY Board of Building Regulations and Standards
\ Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
n�y This Section For Official Use Only
r 1f Building Permit Number: I Date Applied:
Za /
Building Official(Print Name) Signature / Date
SECTION 1:SITE INFORMATION
1.1 Prgpgrtyy e�d-dress: 1.2 Assessors Map&Parcel Numbers
' /j—v�r ; ' 1.
L la Is this an accepted street?yes_ no Map Number _ Parcel Number
1.3 Zoning Information: 1.4L Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(it)
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'
2. "qr f Record: '/ `�
K ®1-g-kimv►�. )JrrI'6J311t Ahh CJ
ame(Print) ity,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration( Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Ritter ❑ Specify:
Brief Description of Proposed Work : 4
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials Official Use Only
1.Building $ pQ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (INAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
6.Total Project Cost: $ �� 90Q — Check No. Check Amount: Cash Amount:
0 Paid in Full 0 Outstanding Balance Due:
r.
t y
SECTIONS: CONSTRUCTION SERVICES
W
Coq ction Supe sor License(CSL) PS
07�f L-r— I ?
t /V �{ G,)• License Number(/ ' Ex tion ate L�
Name of CSL Holder
List CSL Type(see below)
No) et Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.
R Restricted 1&2 Family Dwelling
Ci /To ,State,ZIP M Masonry
�V 2�/ 5UV RC WindoRoofinw
Covering
Siding
I SF Solid Fuel Burning Appliances
N
t C4 I I Insulation
Telephone Email address D Demolition
5.2 Registered Ho �e IIm�prov meat C tractor(HI 3�/ a � �i 2
CIT HI tion N CumOber p ration Date
HI Companyy Nitrite HIC gistrant e I
N�11�trc4 /� !t- 1 1t1T�1 ( U»S�TU�t/di1 a AD
}�p)la /� f 7CX/
//Yk.�IS� `�(��' [alb-S ty� Email address
Ci /Town,State,ZIP ' t �A Telephone
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 FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
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 andaccurate to the best of my knowledge and understanding.
kr Alwyn Y)Q 1,0 1
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
I. 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. oe v/oca Information on the Construction Supervisor License can be found at www-mass.gov/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"
-�e �ommo�uaeaf c�✓ �aeluueC�a
Office of Consumer Affairs & Business Regulation
HOME IMPROVEMENT CONTRACTOR
= Registration 123356 Type;
Expiration: 2/4/2013 Private Corporatio
WJ CONSTRUCTION CORP - _.
i
WILLIAM MANGIASI
407 REAR MYSTIC AVE UNIT.36A 4 _
MEDFORD, MA 02155 �—
Undersecretary
75985
WILLIAMA MANGIASI
13 GIBSON CIRCLE
MEDFORD, MA 02155 _
Expiration: 7/17/2013
( ,�nnni+ri mer T=— 18165
9
OP ID:CH
CERTIFICATE OF LIABILITY INSURANCE owTe(mmroomrr)
05/23/11
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
SELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PROD,IICER,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 Toms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
ccrtiflcaw holder in lieu of such endorsement B.
PnocucER 976-975-1300 NAOME:NTACT
Seyreve 6 Han In3ur.Asuoc.lnc PHONE FAX
309 North Main St. 978.975-7596 As
Andover, MA 01810 ft*
L. ,i,rence J.Hall AO RES3:
PRODUCERCUSTUME
WJNCO-1 _
_ INSURINUSI AFFORDING COVERAGE NAIC9
UIsoRED WJN Construction Corp INSURER A:Arbella Protection Ins. Co. 41360
Thor Construction INSURER 8:
407 Rear Mystic Ave #36A --'
INSURER c
Medford,IYJ.4 02155
INSURER D
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POUCIES 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.
INOK TPEOFINSURANCE DOL B POLICY
LI >�F POD YEXP
LTN T NUMBER mM OM
UMllTS
GENERAL LIABILITY EACH OCCURRENCE_ S 1,000,00
A X COMMERCIAL GENERAL LIABILITY 8500036963 05/21111 05/21/12 E-TOERENTED
� PR MISES Ea acwrrenm I 300,00
CIAtMS-hv10E LA OCCUR MED EXP A I ono pnrsan S 5,Op
PERSONALSADVINJURY $ 1,000,00
GENERAL AGGREGATE S 2,000,00
GE AGGREGATE LIMIT APPLIES PER PROOUCTS.COMPIOPAGG S 2,000,00
POLICY PRO- LOC S
AUTOMOBILE LIABILITY COMBINED SINGLE LIMB S
(EaaPOW.I)
ANY AUTO BODILY INJURY(Pa,panOnl S 100,00
ALL UWNED AUTOS BODILY INJURY(Per ac aanl) S 300,00
A X SCHEOULEDAUTOS 68794400003 07/18110 07118/11 PROPERTY DAMAGE
1 HIRED AUTOS (Pere 6 1) $ no'cli
NON-OWNED AUTOS $
S
UMBRELLA LWB OCCUR EACH OCCURRENCE S
EXCESS ILIAD CLAIMS-MADE AGGREGATE S
DEDUCTIBLE S
REI ENTION 3 $
WORKERS CON.OhNSATION WCSTATU- OTH-
AND EMFLOYM(3a UABIUTY _LDP
A ANY PROPRETMR)PARTNERIEXECUnVE YiN El CFFEER,MEMBER EXCLUDED? N/A 810389 01f01111 01/01/12 E.L.EACH ACCIDENT s 500,00
(MYYa,damY in NN) EL DISEASE-FA EMPLOYEE S 50O.o0
GESCRIPTION OF OPERATIONS balrnr EL DISEASE-POLICY LIMIT S 500,00
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Adach ACORD 101,AddlilOaal NamaNra SOMdule,If moo a,Nu lc MuToB) �
l
CERTIFICATE HOLDER CANCELLATION
WACONS
V. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
WJN Construction Corp THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
dba Thor Construction ACCORDANCE WITH THE POLICY PROVISIONS.
L 407 Rear Mystic Ave ti36A
Medford,ly(A 02155 AUTHOMED REPRESENTAT
Lawrence J.HaI
J
1988.2009 ACORD C -RATION. A its reserved.
ACORD 25(200S/09) The ACORD name and logo ate registered marks of ACORD
I
MAR-27-2012 20:23 FROM: TO: 19787409846 P.2/2
American Properties Team, Inc.
TO: Salem Building Inspector
FROM: Jennifer Pappas, Property Manager
RE: Roof Replacement --- 50 & 52 Pickman Road;
2 & 4 Arnold Drive; 4 & 5 Nimitz Way; 4 Spruance Way
DATE: February 29, 2012
Please be advised that the Board of Trustees for Pickman Park have
approved a roof replacement project at the above referenced buildings. This
work will be completed by Thor :Roofing & Construction,
Should you have any questions or require additional information, please feel
free to call me directly at (781) 569-2675.
BOO WEST CUMMINOS PARK•SUITE8080- WOBURN -MA •01801.781-932.9220 FA%781-9354289