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21 VALIANT WAY - BUILDING INSPECTION (2) The Commonwealth of Massachusetts --- -- U/ Department of Public Safety ±,' '� ::\lessarhusclls tilatc Building Cud('(780 C\IR) Building Permit Application for any Building other than a One-orTwo-Family Dwelling (This Section I'or Official Use ClnlV) Building Permit Number: Date Applied: _ Building Official: SECTION 1:LOCATION(Please indicate Block B and Lot N fur locations for which a street address is not available) No.and Street City /'Town Zip Code Nen1C of Building(if epplicaClbl.) SEC"PION 2:PROPOSED WORK lEdition of\IA Slur Code used If New ConstructionCheck here❑or check all that apply in the ttvo rnw:s below I:xisling Building❑ Repair❑ Alteration ❑ .Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ ChangeofOCCupanCV ❑ Other ❑ Specify:______ _ Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑ ----- Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑ Brief Description of Proposed Work:_ _ \�.•anj—�P�`IkS 1 �1k�t^—�cl G� L�J>os�+�+-r=��\�Rsi-�O_i✓C MrL�A nor ,--t"�--5,�/�O 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 3a) ❑ Existing Use Group(s): _ Proposed Use Group(s): SECHON 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)& Area Per Floor(sq. ft.) rot:d Area(.sit. ft.)and Total Height(ft.) SECr1ON 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-'_'❑ Nightclub ❑ A-1 ❑ A4 ❑ A-5❑ 1 B: Business ❑ G Educational ❑ F: Facto F-1 ❑ F2❑ H: fli h FlatarJ H-1 ❑ H-2❑ H-3 ❑ FI-a❑ 11-5❑ 1: Institutional I-1 ❑ 1-2❑ 1-3❑ 14❑ N1: Mercantile❑ R: Residential R-10 R 2❑ R-3❑ R-a❑ S: Storage S-I ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use SEC`FION 6:CONSTRUC'riON'IYPE(Check as applicable) IA ❑ III ❑ IIA ❑ 116 ❑ IIIA ❑ 111B0 IV ❑ 1 VACS VB ❑ SECI'ION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: flood Zone Information: Sewage Disposal: French Permit: Debris Removal: Public❑ Ch('Ck if outside Flood zone❑ Indicate nuutiCipal ❑ A trench will [lilt be Lic('nsed Disposal Site❑ I'm ale❑ Or indenlifv Zone: Or On site sV steto ❑ requinvl Cl Or tromIt or spec ik: ._ _. .. . prrmil is enclosed ❑ _ Railroad right-of-way: Ilaiards to Air:Navigation: ',I I !i:a„ , , , Not Applicable❑ Is StructunV within airport.ipproach irva? Is their r('v iow 1 onil+lal('d.' rr Cnnsriu to Budd enclosed ❑ )vs❑ or No❑ les❑ No ❑ SEC l ION N:CONTENT OF CER HFICA'IT OF OCCUPANCY Ediunu nl Cude, _ _. ._ L w Uroup(e): . . I\p('al Couslrw lion: lktupanl Lied prr l-Ior. Pov,the building inntain.ut 1�priukler Svstvnt.., }p('C ial�lipulolions: _ _ _ (_ SF( I ION 9: PROPER IN OWNER AU'HIOIIIZA"I ION Nanie,mJ Address of Properly O%%ner _._21 JAr\.mil �I' � J�a 1-- (V�e. _ D�R-10 N.uw(print) No.and Street City/Town Zip Properly O%umrrContact In for Inalloll: 930 fi -JfQ(�� 0015 title Telephone No.(business) Telephone No. (cull) c-mail address If applicable, the property owner hereby lLn B)UriVCj -5 yg- � S Name Street Address City/Town State Zip to art on the property owner's behalf, in all matters relative to work aulhoriaed by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,0011 cu.ft.of enclosed s wce and 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 o. c-mail address Registration Number / Z* t ,oti r T• t"MbIv� -7 l Street Address � City/Town State Zip Discipline Espiri tion ate 10.2 General Contractor Company Name 4�� w. � c �s��. -l1 3S Name of Person Responsible for Construction License No. and Type if Applicable Street Address City/Town State Zip 1_ �� Dal ? °� fa3Z7 ;Jro2lsGh�Y ✓e%Zo�cl, Tole,hone No. business Telephone No. cell a-mail address SECTION 11:isiIrar.r.:rrW,ylrr.N>yIONIv:,ljI,'AmT.trfu,n<'ll M.G.L.c.152.1 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' uance of the building permit. Is a signed Affidavit submitted with this a lication? Yes No ❑ SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE Itam Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=S_ I. Building S Building Permit Fee-Total Construction Cost x_(Insert here 2. Electrical I $ O ©tom appropriate municipal factor) =S 3. plumbing, $ O D 4. .%lechanic,d (11VAC) 15 Note: \lininnmt fee=S__(contact ntttnicipality) 5. \Icchanical Olhcr) S Fndosc duck payable to n.Total Gut S &ve (contact municipality)and write check number Isere SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT liy t'ntering my name below, I hereby attest Wider tilt'pains and penallics of perjury that all of the inforimition contained in this application is true and accurate to the best of ill kill,%%Icdge and understanding. �_ � --- - - -- — � ----- -?/V(639 too . PI+ wr pri at . • / ai r i = a - Hwy 5� __ J)AArk .. itrust Address `/ O' t✓ Cityi 11 nvn Slate Zip Municipal Inspector to fill out this section upon application approval: - � Name Bale CITY OF S.1. ZNf, ,. kss,ICHUSETTS 8l.MDLNG OEP.1AT-%ZNr 120 U7.ksj4LYGTON STREET, j'O FtOOR Tit- (978) 745-9595 K)1®ERUY ORLSCOLL FAX(973) 740-9846 .tifAYOit 1340stu ST.PtBAu DIRECTOR OP PCBLic PROPERTY/HCMnC.Jr COSQ1ISSfOVEII Construction Debris Disposal Affidavit (required for all demolition and renovation work) !n accordance with the sixth edition of the State Building Code, 780 CINR GL c 40, Oebris, and the provisions of M S 54; section I I I.S Building Permit It this work p is issued with the condition that the debris resulting from shell be dis oscd of in a properly licensed wrote disposal facility as defined b b I l I. S ISOA. y� 1GL c The debris will be trunsportcd by: I (n.une ut hauler) l The debris will be disposed orin : Ai4-&t (,ddre�f of raahty) +yn mreorperm,t , —' GPhunt CIT`lOFS.vr . M) NL1SS.ICHUSETTS yy t 1 UL'ilDING DEP.{RT-,LF-NT +'),'�x rl,• 120 WASHINGTON STREET 3'a FLOOR ',`✓ TFL (978) 745-9595 FAL<(973) 740-98-16 KJMBERLEY DRlSCOLL %L1YOa4 THONUS ST.P}HRRE DIRECTOR OF PL 9LIC PROPERTY/HLQDRIG CO.NNISSIONER Workers' Compensation Insurance At7idavit: Builders/Contractorv/Electricians!Plumbers Allltlicant Information Please Print Legibly Mine Individual): 011 iiddreti5:_ �r CityrStatc/Zip: �AIa/Li� 1^ -� PhoneH: -791 6, fdd/ Are you in employer?Check the appropriat box: Type of project(required): 1.❑ 1 am a employer with 4. I am a general contractor and 1 ,. .niployees(full and/or part-time).• have hired the suit-contractors 6' tvew construction - 2.❑ 1 am a sole pro prictar or partner. listed on the attached sheet,t ?• Remodeling .hip and have no employees These sub-contractors have g. Demolition working for me in any capacity. workers' comp.insurance. , ). Building addition INo workers:comp. insurance 5. ❑ We are a corporation and its required.) officers have exercised their 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL I L❑ Plumbing repairs or additions myself.[No workers'Gump. c. 152, g 1(4),and we have no 12.0-Roof repairs insurance required.) t employees. [No workers' l},Q Other cump,insurance required.] >wy applicant dw checks boa At most also rill out the scaioo below showing chair workers'compensation policy mlumtation. 'I hrmcauncta%he.ohmit this amdnvii indicating they am doing all wilt and than hire""side cantmctam mint,,hmit a new at-ndA,,t indicting ,"h. - :r'„m nwtun that chuck this box mua attached an,ldliniorad.heel showing the rl of the tubeanlraclom and their waken'comp.policy infama,ioe. I um an employer that is providing workers'c•ontpensatlon iesurance for my employers. Below!x dte policy undi site information.. / ln.I,lfatle'e'Company Name: J6 V^4 -sf,i- n)A-i-ralp.. i'olicy t!or Scif-ins. Lie, o:: I Oi ( s; 1 ©V-Z Ip� I EI Plration Date:_. /� h ✓��/I Z lob Site Address:21 V��v��/t' CA-4lAl .� .+(sV r ' [:ityiStute/Zip: .l ttac6 a copy of the workers'compensation policy declaration page(showing the polfey number and expiry lon date). F.tilure to secure cuvenge as required under Section 25A of S(GL c. 152 can lead to the imposition of criminal penalties of a tine up to 51,500.00 and/or one-year imprisnnment,as well as civil penalties in the form of a STOP.WORK ORDER and a line 'If tip to 5250.(lo a day ago111st file violator. Ile advised that a copy tit this raleme'nt tray bc:forwarded to the Otlice of nvcstigatiorl.ai the DIA for insurance coverage vcrilicatiun. I du hereby certify under dnr pu' joad u 'er of perjury that the iuforrttudon provided ubu'v_e is true uud correc4 _'••nlr r sr Date L/��Z Oi jiciul nee mdy. Do not vire in drys:area, to be cumpliered by city ut town ujjieiut ,I.City or 7utvo:- Pcrmiul.lccnse i — ksuijig Aiiihurily (circle one): I. 13oord of Ifealth 2. Iludilim, Departnleol I. lily/fawn Clerk 1. Electrical Intp.cf,tr i. I'lumbinw I:npeelor 6. Other (.uulacf I'c nun: Phone.k t� - - Office of Consumer Affairs and Susmess Regulation 10 Park Plaza - Suite d 170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 104546 Type: Private Corporation Expiration: 7/14/2012 Tr# 700456 SHELDON FRISCH DEVELOPMENT INC. Sheldon Frisch -- -- -- - P.O. BOX 811 - — -- -- - - Marblehead. MA 01945 ------- --- --- - Update Address and return card. Mark reason for change. Address f- Renewal 1--� Employment =,I Lost Card !Or lt,iL^ Office`o' onsG{n�r Ali &�B�isSne"sS1u��i4` License or registration valid for individul use only _ HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: i Registration: 104546 Type: Office of Consumer Affairs and Business Regulation __ Expiration: 7/14/2012 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 SHCLDON FRISCH DEVELOPMENT INC. Sheldon Frisch 218 HUMPHREY STREET Marblehead, MA 01945 �— ----- Undersccretan' Not valid without signature ' 11a..ac lnncii� - Je;)a;tmenl4 Public Board of Bt ildm Rc,-uiatioll' and i[am :lrf]N Construction, Suoervisor License License: �-5 51135 SHELDON W FRISCH PO BOX 811 MARBLEHEAD, MA 01945 !' =;oiratio.n 7/1412012 29944 12:11 FAX 97S 922 2328 CARMEN KIMBALL INS '�Dti1 ACII CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDOIPIYY) 0l/26/2oi< i?RODUCER .978) 922-0086 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Karmen-Kimball Insurance Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE j HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 48 BQckford Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PC Box 73 Beverly MA 01915- INSURERS AFFORDING COVERAGE NAIC At !I$"UR2 INSURER A A1EGI Can International G I !Sheldon Fri Bch Development Inc. INSURER E: ! P G pox 9ii INSURER C: �218 '4amprhey Street INSURER D: i IDL=rblehead M'j 01945- INSURER E: j COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTVMTHSTAND!NG ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MP.Y PERTAIN; I THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_ ..3GREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. D TYPE OF POLICY EFFECTIVE POLICY EUPIRATION <'!NSRD PCUCY NUMBER DAYE(NMIDDPII'I DATEIMLIIDOIYY) LIMITS !. GEN:,21L UA91LIT7 EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY DAMAGE TOR curDD 6 P I CLAIMS MADE OCCUR / / / / MEDEXPA one Pinson 5 I / / / / PERSONAL&.ADV INJURY 5 i GENERALAGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER I—I 1�I PRODUCTS�COMFIOF AGG IE E POLICY JECDT LOG 1 AUTOMOBILE LIAeILItt COMBINE SINGLE LIMIT f I ANY AUTO (Ea accidan0 S ALL ORNED AUTOS / / / / BODILY INJURY I I SCHEDULED AUTOS (Par Percnj & HIRED AUTOS BODILY INJURY '7 NON-OWNEDAUTO$ (Por acucen!) 5 PROPERTYDAMAGE (Per PvcidenQ { GARAGE LABILITY - AUTO ONLY-EA ACCIDENT 3 ANY AUTO / / / / OTHERTHAN E4 ACC 5 AUTO ONLY, A t " ! EXCESSIOMRRELLA LIA i EACH O FiEIVB 5 CLAMS MADE AGGREGATE j QECUC7IBLE i I RPTENTION 6 _ ' WORKERS COMPENSATION AND 007417907 03/31/2011 03/31/2012 $ T ' L'11.�IWS ��- EMPLOYERT UA31UTY ANYFROPRIETORPARTNERI 9QUTIV6 E.I.EACH ACCIDENT S 100,D00 ! OFFICERfMEIdBER EXCLUDE? / / / / E.L.DISEASE-EA EMPLOYEE5 500,000 ! !;pee,dn=cbe odd, SPECIAL PROVISIONS balm, E.L.DI&EASE.POLICYLIMIT S -100,000 ` I=TH_R / / ESCBIPTON OP OPERAT!ON N VEWICLES(EICW$IONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS I I I I ! CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE A30VC DESCNI3W POLICIES EE CANCELLED BEFORE TE'E 9 EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TC MAIL 10 DAYS WRITTEN NOTICE TO TWE CERTIFICATE HOLDER NAMED TO THE:EFT,'SO- :City OP Salem FAIWRE TO 00 SO SHALL IMPOSE NO 0eDGAT10N OR UADILITY OF ANY KIND UPON THE 511.11dlltg Yri9peCtOY INSURER.ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE .I Salem 'M? 01970- d i .ACORD 23(2001106) ACORD CORPORATION ISSB SN.—j025(p1D01,C6 f-c6 t Ci 2 AC-QBD CERTIFICAM DF LIABILITY INSURANCE THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFER6 NO R10HTa UPON THE CERTIFCATE 9 NDM Consulting Croup, n HOLDGR. THIS CERTIFICATE DOES NOT AMC, EXTEND OR 1 0 George Street ALTER THE CO RAGE AFFORDED BY THE POLIO R i BELOW. Wavland, MA 01778 INSURERS AFFORDNGCOVERAOE NaOo aw ww�a spen ec a ns C YrwPane: ,Sheldon Frisch Develo a t, ZnC, ruea�o 1 218 Humphrey Street wnnaAO Mar1D1 head, MA 01945 E: COVE GES TrdE POLICIES QFINBUP.VICEU>3TEDBELOW 189U�70 THE*=REO NAMED AWM FORTHE POLICY PERIOD INDICAI6D.WC SEH8TANDIHi: lry ANY REQUIREMENT.TCRM OR CONOITION OF RACT OR OT M DOCUMENT WI REBPECr TO WHICH TN18 CERTIFICATE MAY SE 19W E�ck� MAY PSRTAM,THE INSURANCE AFFORDED SY ICES D"wISED HEREIN O SUSJECTTOALL THE TERMS.EXCLUSIONS AND COPAITION6 OF SUCH ?OLICIES.AGGREQATE LIMITS SHOWN MAY HA REDDCEpBYPADCIAS'S. rwdrMe LaRra 'I.5 I CaNFlMLLMPI0T1' EACMOG'Ct1aRENOI i I ' - cerleRaneexereALUAsILOr CB 1 341 1 4/1 5/1 1 4/1 5/1 2 ! I mow a uNawoeocw , PExaONaaAwa1141RY i I , j ' , ;— oixaAALAaalrwre��C� ] I PRaOucTa•couPmFAoO �b opin.wwawTE�rrAAFLIaaoEA; I PaIxy LOC t 1 AV 0110"SUAW- Y 1 ] AWAUTO ALLOWNSDAUTOa Domy 'MY S 6CxibULODAVtOB HMUO At1T0a _ I� i I xCN.ovmenAurva _ - , i Dl" b CAIUCauAMLNY .. AUTOOM.Y-aAACCDENT ! I. GACC i. AIrl AVFO O 0KT. AM 7 s i VCpafLY LULLAWL" aACHOGOVIweNCC 6 IS t O=M D CWMaIYOB A gIIiI Te j Awwm[M T10N b ! i WgCO;Aa CplYdlaATgN AND {11YLCY[Aa'i1MalTY .. EA.FAONAOI'!.DRR t I OPT�CWYEMMA IXCIUI ECUTNE E.4daaFAG-GIMFciOYEE b .I :QTw: ICY LMRDFCFaaATp1Y(LCwMNalrpaCLNI AppeaerelW0Rvn1V16PtWALMt9vMC" I 7 CG TD1CA HOLD R �' 110H ' NIOULCNlYdMAaCYCasGRIYDMMIOIaaaECANtILl.baafdlETFat EXMUAnCx..� . Bare TIIeROF,nt MaVINe MAIM YAK YalaflYOR w wA 3 m".xxrnx I em City of Sal Salem, MA it lra'nuTCTxacatrncATaxaaRNAworoTHaLeFr.wrFAruaaTooveoixALL a ae xo G 888 0010W.PQ4 col+M UACM"a Atn iewo OM nu anlwelt.Pi Ian+*a of. M I aanwaMlrAYNe ACORD 26(2081/0E) m CORD CORPORATION 1988 I IUO'�j MIN D£U OSM'02 S`d 't=TT ,Tp:',;g7L T/: Norman Bogosian PO Box 4523 Property Manager Salem,MA 01970 Office (978) 745-2225 Fax(978) 745-2251 E-Mail: NormBogosian@Comcast.net January 30,2012 Sheldon W. Frisch SHELDON W.FRISCH DEVELOPMENT,INC. 218 Humphrey Street Marblehead,MA 01945 RE: Installation of a 6 inch kitchen vent through outside wall of Unit#21 Alan & Barbara Sidman Dear Mr.Frisch I am in receipt of both your insurance certificate and your description of the location and size of the proposed kitchen vent you wish to make through the outside wall of unit#21 as part of the kitchen renovation to Alan and Barbara Sidman's unit. Pursuant to my conversations with members of the Board of Trustees,there is no objection for you to create the proposed kitchen vent, providing 1. Your installation of a 6 inch vent meets or exceeds the existing building codes in Salem,MA 2.Your company's certificate of insurance already received will continue to be in effect during your proposed kitchen renovation to unit#21 3. Your company works between the hours of 8 am and 5 pm,Mon through Friday 4.Your company cleans up all debris at the end of each day If you should have any questions please call the office at(978)745-2225 or Email at NormBoposian@Comeast.net Very truly yours, 4/mxQ4 6Opoa;w Property Manager Village at Vinnin Square Condominium Trust cc: Trustees- Village at Vinnin Square Condominium Trust Bogosian and Company LLC(Property Management Co.) ----- I - ---i-. VLC188TF384 �-30"- F n � 24"- i 4 rolloutb for 21 inrh deep Cabinet I � I a N N N o to N 0 3 N W Wo P = l = � i O O M M , cal - w W O C Y 1 JCD m w (n . CO 71 (A) p N N i All danensions sire designations '°'t0 � Tb is is an original design and must De nod-u§O/26—I I given are subject to verification n rNi, net bo released or copied unless 'in[ed: 1/26/2012 job site and adjustment to fit job applicable fee has been paid or job conditions, order placed, it i — — Sheldon-10 26swam Legend Drawing N: I � a o Q 4 ®® [] 'VD tu �� 0 e C 1]