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22 SUMMIT AVE - BUILDING INSPECTION (2) I ;►, The Commonwealth of Massachusetts Department of Public Safety (� ^�..�..•y \IaSSalh USVI1s Slate Building Code(780 C%1R)Seventh Edition Q1111 City of Salem Buildin Permit Application for an Buildingother than a 1- or2-Famil Dwellin (This Section For Official Use Onlv) Building Permit Number: Date Applied: Building Inspector- SECTION 1: LOCATION (Please indicate Block# and Lot# for locations for which a street address is not available) 22 Ste . 7C .No. and Street. City /T00%n Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK If New Construction check here❑or check all that apply in the two rows below v Existing Building 19 Repair Pk I Alteration ❑ Addition ❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ - Change of Occupancy ❑ Other ❑ Specify: Are building plans and/ur construction documents being supplied as part of this permit application? Yes ❑ No ❑ [San Independent Structural Engineering Peer^Re'vinew rep oared? nn Yes ❑ No ❑ Brief Description of Proposed Work: IS r ice` ,/Lns�j s],a tU� ©�-- i 316 4— SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCC UPANCY Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) ❑ ' Existing Use Group(s): Proposed Use Group(s): r Existing-Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basemenElev]ells)&Area Per Floor(sq. ft.) Total Area (sq. ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2r ❑ A-2nc❑ A-3 ❑ A-4❑ A-5❑ I B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: Hi h Hazard H-1 ❑ H-2❑ H-Mbelow: 5❑ 1: Institutional 1-1 ❑ I-2❑ 1-3❑ I-4❑ M: Mercantile❑ - R: Residential R-1 ❑ S: Storage S-1 ❑ S-2 ❑ U: Utility❑ Special Use❑and pleSpecial Use: SECTION 6:CONSTRUCTION TYPE (Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ HIS0 IV ❑5ECHON 7:SITE INFORMATION (referto780CMR 111.0 for details on Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public❑ Check it Outside Flood Zone❑ Indicate municipal ❑ A trench will not be Licensed Disposal Site ❑. 1'11vate❑ ur indentily Zone: or ion site S%Stem ❑ required ❑or trench Or,pecifv: permit iM encLaSed ❑ Railroad right-of-wav: Hazards to Air.Navigation: MA I IiSlai�( .nn n,i��im Rrvirm I'ri ,o..: Not :\pplicA,le ❑ I.Struilure%cuhin airport appruarh area.' IS their 1e%ieac cOna ,I bled'. � r ('u runt to Build rnclO.ed ❑ Yes ❑ nr..NO❑ 1'rn ❑ SECTION 8:CONTENT OF CF.R"i1FICATE OF OCCUPANCY IAn•s thcbiI&PI;ronl.aua,an . prinkler Sasem', F `fpCal Stipulations Clcaipdnt Load per PlOOr. Iidnim nl C dr L.e CnnipaM 1. fa 'c ul t ti > Special Stipulations: SECTION 9: PROPERTY OWNER AUTHORIZATION dame end Address of Property Owner I . Name(Print) Nu.and Street City/Town - Zip Property Owner Contact Information: Title Telephone:No. (business) Telephone No. (cell) e-mail address If applicable, the property.owner herebv authorizes Name Street Address Citv/Town Stale Zip to act on the property km tier's behalf, in all matters relative to work authorized by this building permit a > ,lied tion. SECTION 10:CONSTRUCTION CONTROL (Please fill out Appendix 2) (If buildin•is lees than 35,000 eu ft of enclosed s dace and/or not under Construction Control then check here O and skip Section Ill.l) 10.1 Registered Professional Res onsible for Construction Control Name(Registrant) Telephone.No. e-mail address Registration Number Street Address Citv/Town State Zip Discipline Expiration Date 10.2 General Contractor ompany Name CS (� ,2 FL � O 7 N �oI Person Responsible fur Construction A R License o. and Type if Applicable© �4�f•. tre t Address City/Town Slate Zip Oil Telephone No.(business) Telephone No. (cell) - e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 2506)) 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 Estimated Costs: (Labor Item and Materials) Total Construction Cost(from Item 6) _$ 1. Building $ CAW Building Permit Fee=Total Construction Cost x_(Insert here 2. Electrical $ appropriate municipal factor)=$ )' .GJ*) 3. Plumbing $ Note: Minimum fee=$ (contact municipality) 4. Mechanical (HVAC) $ 5. Mechanical (Other) $ Enclose check payable to 6.Total Cost $ QjZ1 C,%D (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below, I herebv attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the of my knowledge and understanding. Please print�.and sign name Title Telephone \ :. Dale r12 i��G r+rra� c�,+�M-r.� n,.,.� �ltu.a,'fei•� 0 /9 1 Ktrret Address C ih"%Town S to p 1unicipal Inspector to till out this section upon application approval: G�1 v -. 'amr I ate CITY OF SALEM � i PUBLIC PROPRERTY DEPARTMENT :tea SI 1,nit 120 W.\il IISI::'ON 51'N@ET 0 5.\I 1'\t,Nt.Ni.\l ffl:')78-7{ 9595 • 1:.\Y:978.740-9846 Construction Debris Disposal Affidavit (required fur all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit ft.- . - is issued with the condition that the debris resulting from this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: C(Z)Q n;,(i ra C ONc:.2.v c Tbr� rJ� (name of hauler) The debris will be disposed of in (name ul acl rty) laddrcssuffacdtty) signature of penntt dpplicant date ACORD CERTIFICATE OF LIABILITY INSURANCE zi26%200 PRODUCER (978)532-5445 FAX: (978)532-2217 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION S.K. McCarthy Insurance Agency, . Inc. _ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 10 Centennial Drive - - ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. West Entrance - - Peabody MA 01960 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Peerless Ins Co Corporal Construction inc. - - INSURERB:Guard Insurance 46 Shepard Street INSURER C: INSURER D: Marblehead MA 01945 INSURER E:FRAGES - THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAYPERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. G ATE N MAY HAVE BEEN REDUCED BY PAIDLA INSR ADD-L POLICY EFFECTIVE POLICY EXPIRATION LIMITS TYPE OF INSURANCE POLICY NUMBER DATE MMIDD DATE MMI1mIYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 R COMMERCIAL GENERAL LIABILITY PRE ISES a nen $ A 7 CLAIMS MADE %OCCUR PKGTBD 3/1/2009 3/1/2010 MED EXP(My One rson $ 15,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: JCTS_COMPIOP ArG $ 2,000,000 R POLICY JEC LOC PO AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ (Ea am)m) ANYAUTO ALL OWNED AUTOS BODILY INJURY $ (Per Person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per acd en0 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHERTHAN EA ACC S 0 AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION S $ WC STATU- OTH- $ WORKERS COMPENSATION AND - LI EMPLOYERS'LIABILITY SOD,OOO ANY PROPRIETOPJPARTNER/ ECUTIVE E.L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? COWC913962 3/3/2009 3/3/2010 E.L DISEASE-EA EMPLOYEE$ 500,000 I(yes,tlesvibe under E.L.DISEASE-POLICY LIMIT S S00,000 SPECIAL PROVISION low OTHER DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECKI.PROVISIONS _ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Salem EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR- TO MAIL Attn; Building Department 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT One Salem Green FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Salem, MA 01970 INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE - n John McCarthy/LG4 CITY OF SsU EN1, NLUSACHUSEM BUILDING DEPARTNW.NT 120 WASHINGTON STREET, 3w FLOOR TEL (978) 745-959S FAX(978) 740-9&M KI,lgRRt FY DRISCOLL -K MAYOR ilo&LU ST.PMM DIRECTOR OF PLBLIC PROPERTY/BL'QDLNG CO.%DQSSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers arillcant Information Please Print Legibly Name (ousimvOrtantraiiomindsvtdu:d): CuR(�oRAl, Address: 21 VA, a—,/ City/State/Zip: M+1AALcAJc.A I N\A Phone Al: l— C S 2— OC- 79- Are:yon.aa employer'Check the appropriate box: Type of protect(required): •I. I am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New construction �• employees(full andlor part-time).• have hired the sub-contractors 2.❑ I am a sate proprietor or partner- listed on the attached sheet : 7. Remodeling .hip and have no employees These subcontractota have a. Demolitioin' working for me in any capacity. workers'comp.insuntrim 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] otlRcers have exercised their 10.0 Electrical repairs or additions J.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.(No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. (No workers' 13.❑Other comp, insurance requirted.l •Any applicant that checha Itro at Maas also fill sot Ihs nctim below a6ewimg their voids'CU wmayial pulley MilarnLlon. '11, n uwtama who submN this affidavit indicting they are doing all work and then him outside enerrnetms nma submit a new amdsvil indicating nett. 1C.,rumw ran than chuck this bets mum anachad an addilismd aware showing dw note of the su►smunnuon and their wmama'comp,policy infmnauaa, l ant an employer that b providing workers'compensadon lnsarotrcefor my earpltayeee. Barlow Is the potty and Job alp information. ��jy Insurance Company Name: R •I , rs Ccn x-i}4 me ks Policy N ur Self-its. Lie. N: C O \AiC' 91J 6 Expiration Date: C)3 0.3 I a r �y�'V�` ���— City/StatNZip:,�b sire Address: 5Ne,%.. MA a .mach 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 fine up to 51.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Ik advistd that a copy of this slatcment may be forwarded to the Ofr:ce of Invcaugasiuna ul'the DIA for insurance coverage verification. - l do hereby cerr' under tea pains,and penaldrr of perJury that tee Information?provided above is trgQe and carrect Win•r t r Data: � 7 Phone ,i: 9— O rial ate only. Do not tvrire in this area,to be.utorptried by city or rows of leiaL City or Tuwn: _. PcrmiUl.IccnseN _. hsuiog Aulhority (circle une)t I I. Ituard of Ilealth 2. AuildinL Department J. C'ilyfrown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.01her Contact Person. _ _ __. Phone N' CORPORAL CONSTRUCTION INC. 22 HIGHLAND TERRACE MARBLEHEAD,MA 01945 DATE C✓I9/2009 BILL TO SUNSW PLACE CONDO ASSOCLATION 22 SUMMIT AVE SALEMNA 01970 PROJECT decks. WORK GATE TABOR HOURS RATE LABOR&MATERIALS AMOUNT O.t)0 Corpotd Coltshuetim Into has made The fdbw•iog 0.00 chi to the two deck proposals issued on 03I02009 and 03182W9 r floarde�pmject0d9balpr0posaid 6�� 0 9. 7irefatlow6tgdumotshave made Ike reamw of die iasta0ation of roof deck pad3labar'DjUmaudals. '1tx changaof to Cedarfrom PVC. Tbeaddition afan 10k12'mofdcrJ- Pressure wl0 be installed an the flat. Tared be' ofthesleepem . All 009 to be Meted per dated (031 18,936.00 Changes to the Smut Parch deck proposal dated 1$936.00 03182009. The dtaogein mU rammials to Cedar 6om PVC. The wooden eohrmm will not be replaced and will main as is. All older work to beeomptetod per the prnpaaai dated 03182009 All Cadarpmduetswill be pre primed prior to l0abdIA & Final paint by auothetnot htduded in the i pnm COMMA Construction Ire.has aim adjusted their labor rants In order m ammV to maim the pmjear more affafdable for the customer. - W&APPItECfATE YOURBUSIIJWSIII Total The above estimate does not include danages rbquested by the tragmm er or unto acm difficuhies in comple ingthe project ! iv � CORPORAL CONSTRUMON INC. 22 HIGHLAND TERRACE MARBLEHEAD,MA 0I945 DATE 3/10f1009 BILL TO SUMMfPPLACE CONDO ASSOCIATION 22 SUMMITAVE SALSKMA 01970 PROJECT 3rd fir roof deck replacement MVORK DATE LABOR HOURS RAYS LABOR&MATERIALS AMOUNT 7.400.00 Corporal Construction lam doer propose to provide the 7.400 00 labor,materials,sub coubaciers,permit and disposal face needed to replace the third floor roof deck. The wooden roof deck and railing system will be removed I,, ..tu< and wi pll be disposed of mpaiy. The damaged side waft shhWm will be removed and will l..ri t'U' be disposed ofWapedy. z . \ The exposed side wag arse will be covered with Grace Ice and Water sbield. • The old rubber roofand recovery board will be removed. Press am:treated 4x4 pasts will be installed new the framing ofWeAVE New recovery board and rubber roofing will be Insalled. The rubber roof will be wrapped up the side wells at least twelve inches_ _ 3x3 roofdeck pads will be instalfed over the rubber roofiag 76e tsanovcd side wall shingles will be replaced Weather Best PVC railings will be installed to a.height of 42 inches. All construction and demolition debris will be removed from the site and will be disposed of properly_ .. Tha job site will be left in a broom clean cooditimt. THE ABOVE IS AN ESTIMATE ONLY. THE EXTENT OF THE DAMAGE UNDER THE DECK AND RUBBER ROOFING 15 UNKNOWN AT THIS TIME, THE DAMAGE WILL BE DEI'ERM[NED AFTER THE DECK AND RUBBER ROOF HAS BEEN REMOVED AN ADJUSTED EST24ATE WILL BE PROVIDED IF THE DAMAGE IS MORE EXTENSIVE- rEAPPR�TE YOURBUSINESS111 Total s7.4ao.ao The above cstimam does not include changes requested by the customer or uaforse difficulties in completing the proiecL - /O 09 CORPORAL CONSTRUCTION INC. 22 FUGHLAND TERRACE MARBLEHEAD,MA 01945 DATE 3ligIZOD9 BILL TO SUMMIT PLACE CONDO ASSOCIATION 22 SUMMIT AVE SALEM,MA 01970 PROJECT _. Front porch rehab. WORK DATE LABOR HOURS RATE LABOR&MATEMALS AMOUNT Corporal Construction btu does propose to provide the WWWAM labor,materials,disposal,and permit fees needed to complete the following wort to the first Boor froat porch ... of the above address The old railing system and decking will be removed and will be disposed of property. The$wing under the porch will be inspacted and secured as needed. Grace ice and water shield will be installed on top ofall • of the floorjoists and rim joists. Three beams can be installed to split the existing spans of joists to include con crem footings to code. The stair treads and rise boards will be removed as well as the ruajoist fnseia board and trim. The wooden columns nand to be replaced with round fiberglass rnlumos,cape an d bases. r A four inch wide square edged composite decking will be screwed down over the Haar joists on the deck surface and staG heads. All rise boards and fascia demos will be installed using PVC trim. A PVC railing systm will be installed to a height of 36 inches offofthte finished deck The wiling system will consist of a top rail,a bottom rail and square balusters. The stag case will aiso have PVC rails insmilc& PVC lattice wont will be installed to cease in the area under the stair case. .- All construction and danol idan debris will be removed from the site and will be disposed of properly. WE APPRECIATE YOUR BUSINESSII! Total The above estimate does not include changes requested by the custom"or onto difficulties in compering the project- d o Page 1 %p ( e /-o 6)