Loading...
30 WARREN ST - BUILDING INSPECTION (3) may, t7rd y --- I he Commonwealth ul'�1;usarhuuus is a Board of 1uilding Regulations and Standards C-1'IT OF Massachusetts State Building Code. 79B(AIR SAL1:,%1 Building Permit t%i licalian To Construct. Repair, Renovate Or Demo ' a IObm-or Tun-Piunilr D,rellilr•V this Section For 017icial Use Only Building Permit Number: -- Date A plied: Ifl'ilJinyUllieiala� tiiynulurc � _- Dale SECTION 1:SITE INFO IATION I.I Properly ddress: 1.2 Assessors Hp di Parcel Parcel Numbers D �41T/e-r 5' 1.la Is this an acce led street?yes no Map Number Purcal Number 1.3 Zoning Information: 1.4 Property Olmenslons: Loniny District I'mpused Ilea Lot Area(sq II) Fronlage(11) 1.5 Building Setbacks(it) Front Yard Side Yams Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.I.c.40.§Sa) 1.7 Flood Zone Informatlon: I.tl SewaEe Dlaposal System: Public❑ Private❑ zone: ._ Outside Flood Zc Check ifaC Municipal O Gn site disposal s)stein ❑ SECTION2. PROPERTY OWNERSHIP' 2.1 nets of Reeordt © 'r f 4^L4 ��.7 Cbordo• 30 4.r.�_ �r / N;line 11'ron) C u),Slate.LIP �. No.and S(rcel Felephuno hmuil Address SECTION!: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ F Owner-Occupied ❑ Repairs(!) ❑ Aheratlonls) Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ .Specify: Brief Veiiplion of Proposed \Vork': SECTION a: ESTIMATED CONSTRUCTION COSTS Hems Estimated Costs: (Labur and.%laterials) O133clal Use Only 1. Building S I. Building Permil Fee: S Indicate how fee is determined: 2. lAcclrical s ❑Standard CitytTossn Application Fee 1. I'hnnhiny s ❑Total Project Costs(Ilene 6)x mulliplier - '. Ocher Fees: S- J. M"11.1sical ill\ %('1 S List: \Iech.u(ic.11 (Fire n Total Project CIUt; s ('hcek No, _( heck:\nnnun: . _. ... . l'.uh \mmml: 3ai ❑Paid in Full ❑UulstauJing 13.II,mce Due: � � SECTION 5: ('ONS I'RliCTION SFRVICF-S ION I ON I RI N r k—pir-a�1111 if.1 V c"0' or License(011) .5,1 unit rue I ion Sullen is ist 01. 1"%Iw(14c lie kin 4—� ;3 uo i., Sircet it tdIllm", 11 , '-1,..LIL R iikwokd .... si-fle.ZIP KC Rodin Co,erin SF solid Fuel Burning Appliances -7V I InSulaLiOn 7 D Donolilitin .4.2 Registered Ilonle Improvement Contractor(IIIQ - 44 e' itegibiration Nuink1 1:%piralikill Will 411 .—clompin) Mont:or 111%. neal-4-116 Nanw No.and S City Own,state ZIP Tmle hone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C. 162.1 ISCM) Workers Compensation Insurance affidavit must be com leted and submitted with this application. Failure to provide this atYidavit will result in the denial of the Issuance We,building permit. Signed Affidavit Attached? Yes .......... No...........E3 SECTION Jun in; OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I owner of the subject property,hereby authorize authorize by this building permit application. to ct behalf,in all matte�relat' �to work tit Print Owler 5 Nwne(Eleclninic........... DECLARATION -- SEC ON 711s:OWNEWOR AUTHORIZED AGENT By entering my name below, I hereby attest under the pains and penalties or perjury that all of the information contained in this application is true and accurate to the best or knowledge and understanding. Dale I-Hin owwr*i or.litaboriMAge"I 4-Manw l.ctrunlc sign nun) Norm I. \n Owner\ollu Obtains a building permit to do his.her u%vn work,or an owner who hires an unregistered contractor In1provellientCuntractur(HIC) Program),will LU) have access to the arbitration (nut registered in the Hume v prog�ani or guarant) 1-ulld under M.G.L.C. 141.%. other important information on the HIC Program an be Aiund at N befoundat I lorbrination on the Construction Supervisor License can e ilit�)rinatiun below: lien itt"s antial%kork is planned,131— including garage, 111nislwd bascirient allies.decks or rordii rota) floor area('+ 111 Habitable rou'll cOU'll Groiili%ing area lsq. 11.1 N11,11ber kit bedrooms Number ol hall,limlli Numh%:rofd%:,;kSr porches I pc i1eill 01'eli pe oI'k:ooIl11q iteill proico squarc Ft III,,) 1,c ik1h,tituwd 11or 'I*o[al 11roicO rat CITY01 S,UIElfq NL1SSACHUSETTS 1f BLILDING DEP.kitnLENT 'i 't�`lt• ') / 120 %Y//.\SIiLNGTOV STREET, 3'a FLOOR T EL (978) M-9595 Full:(979) 1449844 1<1�I13EaU_EY DRISCOLL T L{YO Z }IOSL\3 ST.P1E.QR8 DIRECTORGF Pl:9LIC PROPERTY/0CILDMIG CONNISSIONER Workers' Cumpensatlon (nsurunce AlVdavit: [3uilders/Cuntructurv/Electrici•rnyPlumbers + f tlleant Information n l aye Print Le?ibi .V;Irfla Ilimiix.uUrgamrafiun,lnd;vidual): lGal✓� �je d/ ^ S� • S Addfu'Y4: 2/ CiryrStatc/Zip: jAlovp e/ 9?d Phund m! ! 77— Are you an employer!Cheek the appropriate bait Type of prn)ect(required): 1.❑ 1 tun a employerwith ;. ❑ 1 am a genurul cuntraetor and 1 6, Now,construction mnployeea(Ittll and/or past-time).• have hired the sub•canlncus 2.D I am a sole proprietor or puttnur. listed on the attachcd.nheet t fl 7• ❑ Remodeling fl .hip;and have no employees These subcontractor have g. ❑ Demolition working forme in Any capacity. worker'camp.insurance. 9, Building addition INo workers'comp, insurance 5. ❑ We are a corporarian and its required.( officer have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of eaempliun per MGL I I.❑Plumbing repairs or uddidons myself.(No workers'sump, c. 152,41(4),and we have no 12.0 Roof repairs insurance requited.)t cmpluyees. [Noworkers, I),QOlher cutup. insurance required.) nay appll.:ud tlW ehwto but of muse a1w On Jul ihv weliw allow Allowing their.oaken'eampanudun putruy in4mnullon. I h.nouwnwv who Yahnlit this amdavie indlcalna ihcy in,doing it ware and than hit*outside Contneton,mime'Omit a raw JaMavil;ndiaing 4"1L :C"mnrtun that th.h this It"must mxhod sn IdatilluaW.hose.huwing the numo at tha'?.unlnaWn sna(hall uIlAvn'rump.policy Infwmatlon. /um on elupluyer that it pruvl Ong workers'rumpenrorlun Luurunee/ar my rmpluyerx Below 6 da polity and Jub site in�unnudnn. I n.ur:ufce(:ontpany Nmnat O�`'+��ller/ Policy 4 ur Sel6ins. Licc. f/.JM:7 /n /q 1Z/ 7 ExpirWion Date: tub Sifa.\ddruss: 7 a, /ram, cityislute/Tip: SJr/•y /4 �., ���1 b .\Itacb a copy of the workers' compensation policy dcclarallon page(showing the pulley number and aspinnon data). F.tiluru to wcuru cuveraga as required under.Seetion MA jl',,MGL c. 132 can lead to the imposition of criminal penalties of a sine up to i 1,500,00 und/ur mu-year impri:mnmcnt ds well is civil penalties in the farm of a STOP WORK ORDER and a tine ar up to Sn-i0.110 s day r;ainst die viulamr. Ile advl.;ed that a copy of this.ralement may W turwurded to the 01,1%o of lorrrtigstiuns oldie OI.\ 11rr iosurvlce toVcragc vcritic.iliun. /du/rrrrby sassily tillJrr rah r ail Lit 1, souls ury rho'the in/uramtlun pro vlJrd e no abuuve iii Trud eafrret I7 ::,.•.. t ,/" �L �����V _. pp .ta: ti_ /.tl/it i�/me ntly, D..,rut i.rirr in I/air unb ro 5r Lunlplvrdd 5y Lily ur tans,rJJit'iuL Ciry or town: _. ._. i'crmibf.lcertne 9 I. IiU'd nl ul Ilrahh 2. ILuhlln� I7rp.trhneut I, ('itytTnnn Cferk 1, I•:feetric.tl 1!iytuc lnr i. 1'Iomh;n•„ Inrpechrr G. Other C.mt.t.t Penns: Thane h CITY OE S-V-&Nf, AISS.ICHUSETTS OLLM04G Clar.immNT 1 '0 WASHLNGTON Srurr, ve FtOOII Kj3j3FRLBY OUXOLL FAX(973) IW&W .MAYOR Momu ST PMU4 OIRFLToit ail n auc PROPIRTY/9t:mDC4G COSOIISsto,V Ex Construction Debris Disposal Atfidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 730 CMR section 11 I.S Oebris, and the provisions of MGL o 40. S 54; Building Permit a is issued with the condition that the debris resulting from (his work.$)all be disposed of­­inserly licensed waste disposal facility as defined by NIGL c 111. S I JOA. The debris will be transported by: (mane of hauler) rho debriswill be disposed of in : 71 (name of falcfllay) (rddrefaor'fr,fh�y) � yn� We ufrermfl ipphcanf !Aft To: Page 1 of 2 2012-08-03 12:30:34(GMT) Lauranzano Insurance Agency From:Larry Lauranzano ATE ACORD CERTIFICATE OF LIABILITY INSURANCE OD7/19/2012 07/1 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 e.Travelers Guimaraes Construction INSURER C'. 21 Balcomb Street w2URER D. Salem MA 01970- IN'UP ERE. 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 AODT POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPEOFINSURANCE POLICYNUMBER DATE (MMIDDNY) DATE(MMIDDIW) LIMITS A GENERALLIABILITY PAC6978224 03/09/2012 03/09/2013 EACHOCCURRENCE s 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAG-PREMISE TO aotturD nce 5 300,000 CLAIMS MADE F�ilI OCCUR / / / / MEDEXP Anyone person) 5 5,000 PERSONAL&ADV INJURY 5 1,000,000 GENERAL AGGREGATE s 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMPIOP AGG a 2,000,000 X ROLIcv PEc°'i LOc / / / / DOWND AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT ANY AUTO (Ea accident 5 ALL OWNED AUTOS / / / / BODILY INJURY SCHEDULED AUTOS (Pel person) $ HIRED AUTOS / / / / BODILY INJURY LOU OWNED ALTOS (Peraccidenq 5 PROPERTY DAMAGE GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ANYAUTO / / / / OTHER THAN EA ACT $ 0 AUTO ONLY. AGO $ EXCESSIUMBRELLA LIABILITY / / / / EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ 5 DEDUCTIBLE RETENTION 8 5 B WORKERS COMPENSATION AND 7PJUB-5059P86 02/26/2012 02/26/2013 g I wCBTATU- OTH EMPLOYERS'LIABILITY TORV LIMITS ER ANY PROPRIETORIPARTNER/EXECUTIVE EL EACH ACCIDENT a 100,000 y OFFICEPRAEMSER EXCLUDED? / / / / EL.DISEASE-EA EMPLOYEE $ 100,000 u ves,eescr)e Linder SPECIAL PROVISIONS below E.L.DISEASE POLICYLIMIT 5 500,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION ( ) - (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 Salen FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE One Salem Green INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Salem MA 01970- - ACORD 25(2001/08) ©ACORD CORPORATION 1988 fk-INS025(Ding)05 ELECTRONIC LASER FORMS,INC.-(800)327-0545 Page 1 of 2 To: Page 2 of 2 2012-08-03 12:30:34(GMT) Lauranzano Insurance Agency From:Larry Lauranzano IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001/08) „-INS025(rf,m C5 Page 2 of 2 II 0 _o I R� I Massachusetts- Department of Public Safety Board of Building Re;,ndations and Standards �33111 Construction Supervisor License Licenser CS 91942 MICHAEL L MERCURIO - p 127 OAK ST WAKEFIELD, MA01880 Expiration: 1;4/2013 f'unnuiesiuncr Trft: 9263 �COmceo� ness egu at`rto a License or registration valid for individul use only — HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration ,,�149839 Type: Office of Consumer Affairs and Business Regulation .• Expiration 2/13/2014 DBA 10 Park Plaza-Suite 5170 Y M URIO CONSTRU } Boston,MA 02116 CTION- v I MICHAEL MERC(. _ 127 OAK STREET , WAKEFIELD,MA01880 � ^' — = °� Undersecretary iNot valid without signature 0 C p 0 GUIMARAES CONSTRUCTION 21 BALCOMB STREET SALEM MA 01970 FONE: 978-836-7279 To: Conservatory Condominium QUOTE: 01 30 Warren St unit 4 DATE: July 10, 2012 ; Salem MA 01970 E 978-979-8262 Quantity Description Rate' Amount Bathroom: $ Demolition of entire bathroom Reframe entire bathroom Remove, toilet, sink and vanity Installation of Toilet, sink and vanity Installation of subway tile (64" high in tub area soap " holder) Demolition of Ceiling, Insulation, blue board and plaster of ceiling Installation of Ceiling exhaust fan/light ... ! Demolition of floor Installation of octagon tile sheets New light, vanity and medicine cabinet Installation of new shower valve Paint of walls and ceiling Reglaze tub Total Price includes, labor, plumber,trash removal and material Quote valid for 30 days. Quotation prepared by: Rodrigo Guimaraes Si nature of Rodrigo 50% due up front. GUIMARAES CONSTRUCTION 50% due at the last day of job. 21 BALCOMB STREET To accept this quotation, sign here and return: SALEM MA 01970 Complete Name of person signing this quote: FONE: 978-836-7279 Date:0 O r