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31 SETTLERS WAY - BUILDING INSPECTION
r IThe Commonwealth of Massachusetts Department of Public Safety UUU��' f` i \Lissarluurlls til.nc Ruildint;Cock(780 CMR) ' ' Building Permit Application for any Building other than a One-or Two-Family Dwelling (rhis Section Fur Official Use Only) Building Permit Nuntbec Date Applied: Building Official: SECT-ION I:LOCATION (Please indicate Block k and Lot N for locations for which a street address is not available) ---- No. end Street City /rown Zip Code Name of Buildint;(if applicable) SECTION 2: PROPOSED WORKS-_ _ Fdition of NIA State Code used If New Construction check here❑or check all that apply in the two rows below "— F\isling Building ❑ -Repair❑ 1-Alteration Addition ❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:_--- Are building plans and/or autslrurtion dtxuutents being supplied as part of this permit application? Yes ❑ No ❑--_--- Is an Independent Structural Engineering/&er Review reyu' •d?? Yes ❑ No ❑ Brief Descrip nt of Proposed K'urk:- lei id2lLe !i"i>'�i-4 SECTION 3:COMPLETE Tills SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here Ban Existing Building Investigation and Evaluation is enclosed (See 780 CNIR 34) O Existing Use Gruup(s): —_ Proposed Use Grou p(s):_ SECTION 4: BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)& Area Per Fluor(sq. ft.) "Total Area (sq. ft.)and Total Height(ft.) SECTION 5: USE GROUP(Check as a licable) A: Assembly A-1 ❑ A-2❑ Nightdub ❑ A-3 ❑ A-I ❑ A-i❑ B: Business ❑ F.: Educational ❑ F: Facto F-I ❑ F2❑ I If: High Hazard H-1 ❑ H-2❑ 1-1-3 ❑ 1-1-4❑ 1-1-5❑ 1: Institutional 1-1 ❑ 1-2❑ 1-3❑ 1-4❑ M: Mercantile❑ It: Residential R-113 R 2❑ R-3❑ R-T❑ S: Storage 5-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use SECTION 6:CONSTRUCTION TYPE (Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ II IA ❑ IIIB ❑ I IV ❑ VA ❑ VB ❑ s F:C"rION 7:SITE INFORMATION(refer to 780 CMIL 111.0 for details on each item) Water Supply: Ruud Zone information: Sewage Disposal: Trench Permit: Debris Removal: Public O Check if outside Hood Zone❑ 1 plicate uumiripal ❑ A Ircnch will not be - Lii rased Disposal Site❑ naluired ❑or trench or apecif% I'ricoh•❑ ur indrntity' Lane: ur on site sysh•m ❑ permit is me lased ❑ Railroad right-of-way: Ilaiards to.\ir Navigation: \1 ', I. .i• , , . . . ., i . .. . Not Applooble❑ Is tit nicto re within airport approach ,troa' Is their rev I, cony,Ichd' or C•msrnt h" Mudd ruclosrd ❑ 1 cs O or.No❑ )v.,❑ No ❑ SI:CI'ION 4:CON I ENT OF CFR I IFIC'A IT OF OCCUPANCY Fdition,d 6n1r: _. C sr Grou p(s): - . . 1\pr,a Comstroo nt: Urea pantI o,id por ll i.or [,ov, dw building contain en�prmklcr St stvnt': _ _ L;prc1,11 ';lipulationn: t , SE(:IION 9: PROPER IY OWN1:11 AU r I IORIZA'r ION ` i\i e,utd Addressof Property 0%%tier t Nance(Print) ---- --- No,and Street City/Town Zip Property Owner Contact Information: _ 5 Y - I'itle- relephone No. (business) Telephone No. (cell) - e-mail address If ails lic.tble, the property owner hereby authorizes !j A, Name Street Address City/Town State Zip to art on the property owner's behalf, in all matters relative to work authorized by this building permit a p plication. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) if building is loss than 35,I)tR)cu. ft.of enclosed s pacc arld or not under Construction Control then check here O and skip Section 10.1) 10.1 Registered Professional Responsible for Construction Control ` Name(Registrant) 'telephone No.- e-mail address Registration Number Street Address City/Town Stale Zip Discipline Expiration Date 10.2 General Contractor Cyotf1tpd/ny Name !� Nance of Person Responsible for Construction License No, and Type if Applicable 1a-7 -a. W4- a�u ai m Street Address City/Town S tte Zip lac 37� o� �P 0q t a� Tvle phone No. business Telephone No. cell a-mail,cldne - SECTION 11: t\i v i-k, t A111 Nt,a ru 0\ 1.N''•u1,'A. 1:Al 10,,•,Vl1 M.G.L.c. 152 9ZSC fi 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 a lication? Yes O No O SECTION 12•CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs: (Labor and Materials) Total Construction Cost(front Rent 6) =S__ I. Building S Building Permit Fee-Total Construction Cost x (Insert here 2. Electrical S appropriate municipal factor) -5 3, Plumbing, 5 4. :Mechanical (HVAC) 5 Note: Minimum fee 'S__(contact municipality) 3. Mechanical Other 5 Enclose check payable to e."total Ctps't S (contact numiripality) jj Itt t rite check Voinber here ----- """ SECTION 13:SIGNA I"URE OF BUILDING PER- IT A ICAN liv entering tin•name below, I hercbv ok-st t der tilt-pains anJ penalties of pe ury if at II of t e information contained in this epQp I atiot is tnx and acrtrrate to the • o tin ki Met gc dnd undersRmdin . I lease print utd si In naone I tile rolophone No. D tlo I titrrpa Address Clio, I\ran Stale Zip - ] Municipal Inspector to fill out this section upon application approval: A—,, i;lassuchusetts- Department of Public SMONana. ' Borard of Building Regulations and Stund; t(Is Construction Supervisor License License. CS 91942 MICHAEL L MERCURIO 127 OAK ST WAKEFIELD, MA 01880 Expiration: 1/412013 ('ummi..inncr Tr#: 9263 Office-�Gaiume1'f� ers&Bdiness ego eno License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: ,;d49839 Type: Office of Consumer Affairs and Business Regulation s Expiration 2113/2014 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 TM URIO CONSTRUCTION i;f MICHAEL MERCURIO ,i /////7 l 127 OAK STREET WAKEFIELD,MA 01880 Undersecretary Not valid without signature CCI'Y OF S,\LE.N1, Ati SSACH[;SE"ITS 1 1+ BUILDING DEPAW01E.\T 120 \V.%iHLNGTON STREET 3es FLOOK TEL (978) 135-9595 Rtr(978) 7•119M KI\IBERLEY DRISCOLL NL1Y0A THO\tAs ST.PTExaa DIQELTOaof PLOLIC PROPERTY/suMDTNG CO\L1IISSIONEl Workers' Cumpensailon Insurance ,\f Ultilit: l)uilders/Contracttirs/Electr)cians/Plumbers 4oplicant Information /D PI ase Print Le Ihly Villndlnatiite,.r�TUrdlnnali/ojnlndividual): Addresc /"Y / CityiStatc/Zip:�IeiN .1-k, Phone Al! Tin Rid 7a 7S Areynu an employer?Check the/appropriate boat Type of project(required): I. 1 am a employer with -__L J. 0 I am a general contractor and 1 6• Now,construction employees(ILII and/or part-time).* have hired the sulb-centrsctors 2.0 I um a sole proprietor or purtnur. listed on the attached shcuL t 7• modeling .hip and have no employees These subcontractors have g. ❑Demolition working ror me in any capacity. worker'comp,insurance. 9. 0 Building addition [No workers'.comp, insurance S. C] We are a corporation and its required.) officers have exercised their ME] Electrical repairs or additions 3.0 1 am a homeowner doing all work right of exemption per M I 11.0 Plumbing repairs or additions myself.[No workers'comp. C. 152, §1(4),and we have no 12.C] Roof repairs insurancorequired.) t empiuyees. (No worken' Cl Other cutup.insurance mquimJ.) '-.4,uy opplkaae del ehmks boa rl marl dao nil out tha scenes balaw alowina thdir wmkus'companudun puhlay inll)mudoa t Avnauwta�s who.uhodt this alrklavil indlcans ihey an doing all%wrk Ind then hiss outride cCmnetare mini tuttmle a raw anldavil indiaina on.suck<\mttxtun thsl Owk this box mual inachad an WalillurvJ.hal ehuwinV the noun of the aub.,unlea tan,and thole wnAtm'wrap.pullry lice a "li I om an ealpluyer that h provlJ/n orkaa'cumpenraNun Ltsurunce for my enplayeex Below it i 8f0furat an, the polAy and Jub site In.urmce Company Vamr. /�OeM feli.-A- Policy 4 or Sclr-ius. Lie. tf: o �r C /C a N 0 Expiration Date' Job Site address:31 JL'lveloer, Cilyistute✓2ip: ��1�srr j7C� 1r7e .\each a copy ur the,.orken' compdnsatlae pulley declaration page(showing the policy number and eaplitatlon data). Failure to securu coverage as required undue.Section 2JA of VIOL c. 152 can lead to the imposition of criminal penalties of i tire up to SI,500.00 undlur one-year impri.mnment,as well as civil pcnallids in the Corm of a STOP WORK ORDER and a line of uqt to SM.00 a Jay against the violamr. Ile advi.acd that a copy of this aulvment may be furwirdcd to the Oliicd of Invr,ti g.atiuns,ti die DIA lbr insurance coverngc verilicaliun. /du hereby certify ruluier 111e puLu oil penulllrr of yerjury'but I/1e infurutalluil pravideJ above�i 'ru uuJ correct. t Data: 01liri4i rue✓aJy. lLa not n•rile ht'h[r area, to be cunlyleted by rily ur town nJJlriui City or l'utvn:_ _ PermitiLlccnte i I„uing,\ulhurily (circle uac): —._. - ....._ . I. Iloard nl'Ilcalth '. Iluildln., Mlij,tou•ot 1. ('ityillnut Clerk 1. 1{lectrlcal Lt,pccrnr i. 1'Inmhin;; Intpdcmr G. t)t1wr L u�t Lt�t i'C stu n: ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNYYY) 04/02/2012 PRODUCER (978) 927-8420 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Lauranzano Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE a' HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 107 Dodge Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Beverly MA 01915- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:P8nn America Insurance CO Rodrigo Guimaraes INSURERS: Guimaraes Construction INSURER C: 21 Balcomb Street INSURER D: Salem MA 01970- INSURER E: 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. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER PDATE YMM/DD/YY EFFECTIE PDATE(MM/DD/YY)N LIMITS TR INSRD A X GENERAL LIABILITY PAC6905437 03/09/2012 03/09/2013 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea RENTED $ 100,000 CLAIMS MADE OCCUR / / / / MED EXP(Any onepension) $ 5,000 PERSONAL&ADV INJURY $ 1,000.000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY JECOT LOG AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED AUTOS / / / / BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS / / / / BODILY INJURY (Per accident) $ NON-OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / / / / OTHERTHAN EA ACC $ AUTO ONLY: AGO $ EXCESS/UMBRELLA LIABILITY' / / / / EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE / / / / $ RETENTION $ $ WORKERS COMPENSATION AND / / / / roar LIAMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT ANY PROPRIETORIPARTNERECUTIVE/EX $ OFFICER/MEMBER EXCLUDED? / / / / E.L.DISEASE-EA EMPLOYEE$ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT Is OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLIE EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION (978) 745-9595 5641 (978) 740-9846 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT City of Salem FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Public Properties Department INSURER ITS AGENTS OR REPRESENTATIVES. 120 Washington Street AUTHORIZED REPRESENTATIVE Salem MA 01970- A(ACORD 25(2001/08) ©ACORD CORPORATION 1988 p6.rw INS025(0108)OS ELECTRONIC LASER FORMS,INC.-(800)327-0545 Page 1 of 2 GUIMARAES CONSTRUCTION 21 BALCOMB STREET SALEM MA 01970 FONE: 978-836-7279 QUOTE T0: Patricia M Bates QUOTE: 01 iF I iyay.. 31 Settlers Way DATE: April 4, 2012 Salem MA 01970 978-857-5031 Quantity Description Rate Amount 25 Sq Ft Installation of Bathroom tiles $ Demolition of old Bathroom Installation of pocket door and 6 panel/paint Demolition of kitchen floor 270 Sq Ft Installation of Kitchen Floor 70 Sq Ft Installation of tiles on entry way 90 Ft Installation of baseboard molding lx5 pine#1 Installation of kitchen hardwood floor(Bruce brand) Repair Ceiling Paint Kitchen and Bathroom �lmJ Price includes, labor, trash removal, material and permit Total Quote valid for 30 days. Quotation prepared by: Rodrigo Guimaraes Sii?nature of Rodrigo kz'4rz eg� GUIMARAES CONSTRUCTION 50% due up front, the other 50% due at the last day of job. 21 BALCOMB STREET To accept this quotation, sign here and return: SALEM MA 01970 FONE: 978-836-7279 Complete Name of person signing this quote: Date: O 01 y / _ To:+1-9787409846 Page 1 of 2 2012-04-05 13:25:04(GMT) Lauranzano Insurance Agency From:Larry Lauranzano DATE ACORD,M CERTIFICATE OF LIABILITY INSURANCE 04/05/2012) PRODUCER (978) 927-8420 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Lauranzano Insurance Agency HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 107 Dodge Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Beverly MA 01915- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A'.Penn America Insurance Co Rodrigo Guimaraes INSURER B.Travelers Guimaraes Construction I INSURER C. 21 Balcomb Street INSURER D'. Salem MA 01970- INSURERS 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. INSR AOD'L TYPE OFINSURANCE POLICYNUMBER DATEY(MMIDOTNY) P DATE(MMIDOIM)N LIMITS TR NSRD IVE A X GENERALLIABILm PAC6905437 03/09/2012 03/09/2013 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISEGE S TO RENTED occurrrence $ 100,000 CLAIMS MADE ®OCCUR / / / / MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPIOP ASS $ 2,000,000 7X POLICY iEc°T Loc AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT $ ANY AUTO IEa accldenq ALL OWNED AUTOS / / / / BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS / / / / BODILY INJURY NON OWNEDALTOS (Pernaoden0 PROPERTYDAMAGE (PeraccldenU R GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY / / / / EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE / / / / $ RETENTION $ CS $ B WORKERS COMPENSATION AND 4549P245 02/28/2012 02/28/2013 X I TORYLIITS ER EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE EL.EACH ACCIDENT $ 100,000 y OFFICERIMEMBER EXCLUDED? / / / / EL.DISEASE-EA EMPLOYEE$ 100,000 Ryes describeunder SPECIAL PROVISIONS below EL DISEASE-POLICYLIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION (978) 745-9595 5641 (978) 740-9846 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT City of Salem FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Public Properties Department INSURER ITS AGENTS OR REPRESENTATIVES. 120 Washington Street AUTHORIZED REPRESENTATIVE Salem MA D197D- A�ACORD 25(2001/08) ©ACORD CORPORATION 1988 ft.,-INS025(Dlo :5 ELECTRONIC LASER FORMS,INC.-(800)32]-0545 Page Ioi'_ COLLINS COVE CONDOMINIUM ASSOCIATION 37 Settlers Way, Salem, MA 01970-5269 Don & Pat Bates April 14, 2012 31 Settlers Way Salem, MA 01970 Dear Don and Pat, The Collins Cove Board of Trustees is in receipt of your plans and specifications to renovate your kitchen and half bath on the first floor of your unit. As you know, section 18 of our Master Deed, addresses the modification of any unit, Zts language reads that the work must be done in a good workmanlike manner pursuant to building codes and pursuant to plans and specifications which have been submitted to and approved by the Condominium Trustees. You are required to obtain the appropriate building permits from the City of Salem and post them prominently at your unit. We also expect that you will inform your contractor to be considerate of your neighbors. Your plans look good and with the understanding that the appropriate building permits are obtained, the Trustees approve the project and wish you well with it. Sincerely yours, �frQy- ,� . Jeff W. Conley President Collins Cove Condo Assoc.