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22 VALIANT WAY - BUILDING INSPECTION The Commonwealth of Massachusetts }y, Board of Building Regulations and Standards Iy( Massachusetts State Building Code, 730 CMR 0!! Building Permit Application To Construct, Repair, Renovate Or Demolish]a4 One-or Tsvo-Family Divelling This SectioaForof Icial Usg.Onl.. " ' Building Permit Number:, Date Ap )led, Building Official(Print Name) Signature.: Date SECTION I:SITE'INFORtV61T N. 1.1 Property r dress: 1.2 Assessors Map& Parcel Numbers 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: L4 Property Dimensions: Zoning District Proposed Use Lot Area(sq tt) Frontage(it) 1.5 Building Setbacto(It) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided ' 1.6 Water Supply: (M.O.L c.40,§54) 1.7 Flood Zone Information: 1.3 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check ifyes[] SECTION2. PROP.ERTV'OWNERSIIIP '. UOwn ertof ecord: -VialrJ t za , 1/eil,�v S� lam. 1Wa, Name(Print) City,State,ZIP 27 �f��:,t,.�- wn t 5a � .tW -781 G32 36;7 b t/p-izo rr No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF.PROPOSED WORK &heck all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg. ClNumber of Units_ Other ❑ Specify: Brief Description of Proposed (Yorks: 4 Pr tM a SECTION 4: ESTINLATED-CONSTRUCTION COSTS- (tern Estimated Costs: Labor and Materials Off[clal Use Only:.. l 1. Building S I I ©OQ L Building Permit Fee.S indicate how fee is determined: 2. GlectricalI �� ❑Standard.City/futynApplicationFee q'fotat Project Case(Item.6)x multiplier x 1. Plumbing Q� 2. Other Fear: S I ,Mechanical (11V List- i, Mcch.mic.il (Firerotal All Fees:.S Check No. Check Anwuut: ----Cash :\mount1'nr:11 I'1•11ject C ' L jy— -�C$'—� ' f ❑ I'.wl in Fall ❑thdstmnding Ilmlanca Uua: 1 � srcr[ON 5: CONs'I-RUCTION SERVICES 5.1 ConstruclionSupervisorLicertse(CSL) n � X License Number E.epirniun Da AJJ_ -- Name of CSL I[older G List CSL Type(see below) Description No. and Street \\ U Unrestricted Built Jin s u R to 35,000 cu. . ��r�,� �, Restricted u2 Family Dwelling Ciry/rown,State, ZIP bl 14asonr RC Roolin Covert[' %VS Window Ind Sitting SF Solid Fuel Burning elpplianees ( �391�1 51�J��isc I/eA ' I Insulation 1'ele hune Email address D Demolition 5.2 Registered Horne Improvement Contr^ac-toor(II[C) -� FIIC Registration Number Expiration Date v I Itc Company Name ur(IIC Registrant Nyne _ s �21 S! 1�c®t✓2F'Z" f t _ Email address No.and Street v6 7,51 (0 9 f col Ci /Town,State, ZIP Pale hone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L, c. 152. 9 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 ...........g No..,........❑ SECTION 7a: 01VNEEL AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Jas Owner of the subject property,hereby authorize my b in all matters relative to work authorized by this building permit application. `7 nt Owner's N me(Electronic Sigma ore) SECTION 7h: 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 ' this�a ty",'.atinn i cue and accurate to the best oknow ledge and understanding. / D� l'rii wner's or Autlwrized Agent's Name(Electronic Signan to) lud NOTES: I. :\n Owner who obtains a building permit to do hisiher own work,or an owner who hires an unregistered contractor (nut registered in the Home Improvement Contractor(HIC) Program),will no have access to the arbitration program or guaranty timd under M.G.L. c. I42A. Other important information on the H[C Program can be found at c www nrtss.¢uv%oca Intormulion on the Construction Supervisor Liecnse can be found at ttww mass.•turdLt 2. When substantial work is planned,provide the information below: —(including garage, rinished basemendattics,decks or porch) Total floor (sq. ltJ tiro:; living mea(;y. tt.) _ Habitable moot count — Number of tiroplaccs _---------- Number of bedrooms —-----___-:- --_--_-- I'} . Nuut,er o(ha Nunthcrofbadrnuns Numbernfhacki"porih-e_. ._ paofha.16114iy,icin -_---- ._- .--_-- - ---- Fnclu.;cd Open \helllconlin,� ,y.tcnt _ -__ 1 "— I',,r.d Ptol,,a Oyu ua Foot r;a" 11, he ;nh,tind:,l G,r I..r.il l CI-I•Y OF S:U_EN15 NL1SSACHUSETTS BuiLouNG DEP.\RTNL&NT {.\�),` 120 WASHLVGTON STREET, 3w FLOOR '•' Ti EL (978) 145.9595 Fs-ic(978) 740-9844 !.:ImmB 4 IEY DRISCOLL L{YO THonks ST.PiFaRs DIRECTOR OF PULIC PROPERTY/iiivaz NG CO}Lti1ISStONER Workers' Compensation Insurance AtTidavit: Builders/Contractor.v/Electricians/Plumbers applicant lnformatinn \ Please Print Le�ih)y �l;llne (nutiiw+s�GrgantlaliulL lntlividual): :5K>• \ddress: t CilyiStatozip: !'hone IS —7&\ (,0-5c ( 00 :\re,vou an employer?Check the appropriat(f�L�er�,m 'rype of project(required): 1.❑ 1 am a employer with 4•A`am a general contractor and 1 6. I]Ncw construction employees(full and/or part-time).' have hind the wlrcomraclors 2.❑ I am a sole proprietor or partner.. listed on the attached shoot t 7. �Remadeling ,hip and have no employees Thesis sub-contractors have 4. C] Demolition working tier me in any capacity. workers'comp, insurance. 9, Building addition ]No workers comp. insurance 5. ❑ We are a corporation and its required.] officen have exercised their 10.❑ Electrical repairs or additions I J.❑ 1 am a homeowner doing all work right of exemption per MGL I I.[] Plumbing repuirs or additions myself. (No workers'camp. c. 152, 41(4),and we have no 12.❑ Roof re pmn insurance required.) t employees. [No warkers' 12.C] Other comp. insurance requircij _ •.guy oppli�anr dot cL•cska box rl mart alw fill out the secr:ua blow showing tn•it wmken'compenution policy in(umuion. ' lu.n.uwnite who mhmit thin aRlMvir indicating they_n doing all lwrk and then hire outride cuntmctda mml submit a new arT.davit indicting+uch $'.mtrxwn thel check ihir hose moat atmchud an.Wduiurul.he:a ahuwiny the and thelr workers'comp,policy inl'omutian. f um un employer that is providing fvorkers'compensation insurance for my employees Below Is the policy and job site informadan. p p�,,) (\ n1LIra11CC(_'m7ipany .lame: 1 t/a�e`�"(G� `�/ q �S• t� i'olicy 4 or Scif-ins. Lie. h: Z& 6 1 QO R Ex ` Q in . ptraon Date: __ ii --tnv ,,tAv ^-1 lub Site Address: 7 Z V!al 1 mar CityiState/Zipa ��Cle .� r V""� ©vi /D .Vlach a copy of the workers'compensation policy declarition pag (showing the policy number and eaplrulon data). ,.blurs to secure coverage as required under.Section 25A ot'MGL c. 152 can lead to the imposition of criminal penalties ofa ri�,e up to S1.500.00 and/or or.e-year imprisonment,as well as civil penalties in(he form'ofa STOP WORK ORDER and a I-,ne or 1:1)to 525i200 a Jay Ugainst the violator. Ile advixcd that a copy of this.ra tclnent may be forwurdcd to the 011icc of '.o e'llgaiiois of the nlA for insurance coo<rag vcrilwation• i dohycrfiyuder the r ad u/r' -rfPerjary/rat Me intfurmatlon provided above it(rue�urJ correct q U/)idol ate only. OJ oat i.rite if,drrs area, (J he completed by city or town gjjie'i j .'. City or Tuwn:_ i'crmiul.iccnre# f miiagl Awhorily (circle one): I. I;uard of 11"llh 2. I3uildim-4 I)c11J rl uteW I. ( ity%Ibrnn C'lork 4. F.lectricd ln�pcctor 5. Plumbing Inkpector 5. Other (.onl.ld Ferran: - . .k Information and Imstructiom, \la,saClID5etls General Laws chapter 152 requires all employers to provide workers' compensation for their employees. PUr9n11111 to this.statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual, partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." NIGL chapter 152, §25C(6)also states that"every state or local licensing agency shaU withhold the Issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any .applicant who has not produced acceptable evidence of compliance with the Insurance coverage required." Additionally. NiGL chapter 152, §25C(7)states"Neither the commonwealth not any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s) name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should he returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Scif-insured companies should ehtcr their self-insurance license number on the appropriate line: - City or Town Officials _ - - - Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In,addition,an applicant that most submit multiple permiNlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on Cite for future permits or licenses. A new affidavit must be tilled out each vicar. Where a hume.owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum(caves etc.)said person is NOT required to complete this affidavit.... he of;--"of Investigations would like to thank you in advance for your cooperation and should you have.any questions, please do not hesitate to give us a call. fhe Department's address, telephone and fax number: - The Commonwealth of ivfassachusetts Department of Industrial Accidents Of11ce of favesdgations 6CO Washington Street Boston, NLN 02111 Tel. .# 617-727-49CO ext 406 or 1-877-MASSAFE Fax # 617-727-7749 www.mass.govldia CITY OF S4UZNfj 3,WSwijusFTTS l� 130 1'V.1iH6VGTOV$TRUST, 3'a Ft oo, ILL (973) 145-9595 XIMMU-EY ORISCOLL F+x(973) 7.10-9344 , ` L�voR '1110 usr.PtERM ❑MECTOR OF PLOL1C PROFEQTY/Bl MnLNG coxallssi0AJEA Construction Debris Disposal Afttdavit (required for all dcmalitiun and renuvation work) In accordance with the sixth edition of ilia State Building Code, 730 C&f section I I l.g Debris, and the provisions of NIGL c 40, S 54; Building shall be permit tl this u is issued with the condition that the debris resulting from l 11, S I JOA. disposed aein a properly licensed waste disposal raeility as defined by rtilGL a The debris will be transported by, (namaufhaulur) 'f he debris will be disposed ot'irt (name of taalit%) ;rSnanar olpermit•i I'•.tnt up r� I 06/28/2UIS PRI 1U:J4 FAX grid 9" 232tl Carmen xinvI ins Urance wjUUir UUZ DATE(MMIDDM ) ACORD CERTIFICATE OF LIABILITY INSURANCE 06/28/2013 PRODUCER (978) 922-0086 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Carmen-Kimball Insurance Agency, Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 48 Beckford Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 73 Beverly MA 01915- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA Technology Insurance CO Sheldon Frisch Development Inc. wsURERB.Essex Insurance CO PO Box 811 INSURER Cr 218 Humprhey Street INsuRER D: Marblehead MA 01945- 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 DD'L N POLICY EFFECTE POLICY E%PIRATON LTRI SRD TYPE OFINSURANCE POLICY NUMBER GATE(MM/DDIA LIMITS'Y) DATE(MMIDOttY) B R GENERAL LIABILITY 3DK8834 04/15/2013 04/15/2014 EACH OCCURRENCE Is 1,000,000 x COMMERCIAL GENERAL LIABILITY PREMISES Eaoccurrence $ 50,000 CLAIMSMADE YOCCUR / / / / MED EXP(Airy one person) $ 5,000 PERSONAL&ADV INJURY IS 1,000,000 GENERAL AGGREGATE $ 2,600,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUC SF-,COMPIOP AGG $ 2,000,000 POLICY JRO LOD AUTOMOSILELIABILITY / / ./ / COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS / / / / BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS / / / / BODILY INJURY $ (Peraccident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per ecaldent) 4GARXGELABIUTY AUTO ONLY EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ E%CESSIUMSRELLA LIABILITY / / / / EACH OCCURRENCE $ OCCUR CLAIMSMADE AGGREGATE $ DEDUCTIBLE RETENTION $ _ $ A WORKERS COMPENSATION AND W9900018 03/31/2013 03/31/2014 X TORY UMIis OER EMPLOYERS'LIABILRY 500,000 ANY PROPRIETORIPARTNER/EXECUTIVE E L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDEW / / / / E.L.DISEASE-EAEMPLDYEE$ 500,000 II yes,describe under 500,000 SPECIAL PROVISIONSbelpw E.L.DISEASE-POLICY LIMIT $ OTHER / / DESCRIPTION OF OPERAMONSAUCCATIONSIVEHICLBMXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER HALL ENDEAVOR TO MAIL 10 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 INSURER MSAGENTS OR REPRESENTATIVES. AUTHORUED REPRESENTATIVE AI Salem MA 01970- ACORD 25(2001108) ®ACORD CORPORATION 1988 INS025(0108)06 Pege 1 of 2 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-051135 DM"w '- Po SOX S11 NtarbkhoaA MA 81 Expiration Commissioner OW14=14 p which Unrestr'�*an3 cub Of y�(Usc�')of Ooutalu �nrjoqed space - of a ourreM edition the ofa tk s 1ice�. Failure tostate p.���is cause for revo�O t;ov(� PS Uonsins��acon visit v .Mass. Office of Consumer Affairs and Business Regulation _ 10 Park Plaza - Suite 5170 '0- '`f Boston, Massachusetts 02116 Home Improvement Contractor Registration Reqistration: 104546 Type: Private Corporation Expiration: 7/14/2014 Tr# 226592 SHELDON FRISCH DEVELOPMENT INC. -- ---- - -- - Sheldon Frisch _-____._.— P.G. BOX 311 Marblehead, MA 01945 Update Address and return card.Mark reason for change. Address —7 Renewal - Emplovment Lost Card ( """"""'"'�"°% ��""'"r°''"`�� License or registration valid for individul use ontp Officc of consumer Affairs&Business Regulation before the expiration date. If found return to: -o .[{OME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation - 'tegistration: 104546 Type: f;. 10 Park Plaza-Suite 5170 piration: 7/14/2014 Private Corporation Boston,MA 02116 SHELDON PRISCH DEVELOPMENT INC. Sheldon Frisch 216 HUMPHREY STREET ,� •% _______ _ _ .-_— Marblehead; MA 01945 Undersecretary Not valid without signature Norman Bogosian PO Box 4523 Property Manager Salem, MA 01970 Office (978) 745-2225 Fax(978) 745-2251 E-Mail: NormBogosian@Comcast. July 1, 2013 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#22 Ben & Barbara Yellin 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#22 as part of the kitchen renovation to Ben and Barbara Yellin'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#22 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 NormBogosian(a Comcast.net Very truly yours, A/Wor 480tffi4or Property Manager Village at Vinnin Square Condominium Trust cc: Trustees-Village at Vinnin Square Condominium Trust Bogosian and Company LLC(Property Management Co.) ILC188TF3�84 r30rr 2411 4 rollouts for 21 inch deep cabinet - _ _ o ao d � N N of a toN w N Z� W O O O M O M i CO x P 0) w 00 o cn CV) I .P CO of g (h o I � o - U_ (n M v CF of CA) CV) m coo W m .-n' All dimensions size designations �'1 '°}f^! This is an original design and must Designed: 1 0126/20 1 1 given are subject to verification on tecsNotomes not be released or copied unless Printed: 1/26/2012 job site and adjustment to fit job applicable fee has been paid or job *c ------conditions. - - -.-. _ . __. -_ "----orderplaced. Sheldon-I 0=26swam _ -- __-_--- _- - _ Legend Drawing#: 1