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81 WASHINGTON ST - BUILDING INSPECTION (2) l I / too — -EI'Irop- t Ir, PUBLIC PROPERTY DEPART'bIF.,'VT h J C �I>a,rusr oxul ou /—� MAraa 130 WASMNGTON]MT•S�LYJ1%(ASs.%Cl/156TR 01970 TEL 979-74i95"•FAx:97e.740.9g" APPLICATION FOR THE REPAIR. RENOVATION. CONSTRUCTION DEMOLITION, OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING STRUCTURE OR BUILDING 1.0 SITE INFORMATION Location Name: 60Loge06 PtO&T- 5' Building: Property Address: al 1n/04S0N(,7pN SrRcsT Property Is located in a;Conservation Area Y/N Historic District Y/N 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: 66Loj PQaPec 6s — Address: SI ti.14S141u6soN STeeeT SALEr. AA 01g78 Telephone: q,7 0 - q 1-1- o 80 3.0 COMPLETE THIS SECTION FOR WORK IN FYlaTwa BUILDINGS ONLY Addition Existing Renovation �/ Number of Stories Renovated Change in Use Now Demolition Existing Approximate year of Area per floor (sf) Renovated construction or renovation rDescniption ng New of Proposed Work: OE NEW QoOj $ti57rr. . Sc4� /;T7)4C 9Er� SGyPE Of 4�oCk Mail Permit to: //U 0 0 C What is the current use of the Building? Material of Building? If dwelling.how many units? Win the Building Conform to Law? Asbestos? Architect's Name Address and Phone Mechanic's Name (' II)"`^t'� Coe�a[an J JA,tiE< $Esr Address and Phone 101 U IC9 k Construction Supervisors License# CS 070 H9 HIC Registration# Estimated Cost of Project$ S0.000 Permit Fee Calculation Permit Fee$ 22i eu Estimated Cost X$7/$1000 Residential Estimated Cost X i11/$1000 Commercial An Additional $5.00 is added as an Administrable charge. Make sure that all fields are property and legibly written to avoid delays in processing. The undersigned does hereby apply for a Building Permit to build to the above stated specifications. Signed under penally of perjury Date ►-ZR-OS Z N O 0 w O 5 y `oW � CO �' •3 D� o - 4 CITY OF SALEM PUBLIC PROPRERTY o DEPARTMENT ,tvtarusr uaticssu Mvase 12CVA* Na.Mw9nzrraSAtsst.ILmzAan-.*.7't101975 fhi V6,745-95" a F.sx:9M740.9846 Workers' Compensation Insurance AfBdavitt BuilderWContracton/Electridans/Plumben applicant Information �1 q Please Print Legibly �laTClOuunssfOrsanintioatlm4v�l): L n.,7lrtiAeY laRPofAti.a , Address: 101 ge,aic ktLN �n Citylstamizip: LIW-j-t,cFo[o , #jA 01p2g Phone0: 978S- 2-?s-92s-y Art you an enspleyert Cheek the appropriate bow I.[T1 am a employer with�� ❑ 1 am a general contractor and 1 6. ❑ New conrtru¢tion of project(required). employees(ruff atuVur p ut-tinu).• have hired the sub-comnctors 2.❑ 1 am a sok proprietor or partner- listed on the attached sheet. t 7. ❑ Remodeling ship and have no employcroa These s aweauscom have s. ❑ Demolition working for me in any capacity. workers'comp,insurance. 9. Builds ng(too workers'comp. insurance 3. ❑ We am a corporation and its ❑ addition required) officers have oxerciaed their 10.❑Electrical repairs or additions ).❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.(too workers'comp. c. 152.f I(4),and we have no 12.0 Roof repairs insurance required.) t employees.LNO workers'. I3.0 Other comp insurance requirtxL) 'Any pp4cml ttr ehovi a boa el ataat also tie era elks rcum twine raowiaa thfr ewrhata'arapesati at pulwy ioruraWiaq '11uaa,wnwe who submit Mir affidavit indimmg dwr aka dm%as work am rite♦MR sands commcmrs a".ubmie a new amdtvit in licains uwh. :47 w rxun that chm(t the has mutt anaehal as addttiorW darer Jmwiry the name of ON sad#heir wurkera'cemy.policy miarmrba. l oar un employer that tx providing'workers'competttadoa lrtsaranee for my employees. Below it the poNsy and Job site infurwutlwa. Imurance Company Name: WILLt% of PCN.tyLvaNiA. _ Policy a or Selr-ins. Lie. N:i I W C1 217 C(a D I _ .. Expiration Date: 5- I-O$ Job Site Addreax: g 1A*yt,NjVN STfaCr Cuy/Statelzlp:_.SAt-&, t AvA 7 attach a copy of the workers'compensation policy dodaratloa page(showing the policy number and expiration date). Failure w wcure coverage as required under Section 25A of.%iGL c. 152 can lead to the imposition of criminal penalties of a ring up to S1.500.00 and/or one-year imprinm,ncnt,as well as civil pcnalties in the form of STOP WORK ORDER and a fine of up to i250.00 it day 4gainst the violator. Ile advised that a copy of this siatcau:nt moy be forwarded io the 011ice of lil\':pII�aimna of the DIA ror iav,rrarce covcrro ge vcrificatiun. !da hereby renify1 the pains and penuliks of perjury Aar the infaraailon provided ubova is true and correct Ki:n:uura `�"2' Date / 24 oB q78- - 2'7.f- 92.f q L11,1ffkhdmxr&m4t Do aor write is this area,to b<eaapleredby dryor town off&•%L rown: Permit/I.lcense e\Wpurity (circle one):of Ilvalth 2. Building Dcpartnunt 1. CivrowaClerk J. Electrical Inspector S. Plumbing Inspector Person: _ Phone p: o - 97P-722 OPva C - 07k - 1123 - &,711L! , Information and Instructions Slassachusetts General Laws chapter 132 squires all employ Provid thee wurkeKe Of�`compensation anytheir CWIQYCM contract of him. Pumuaemt to this statues,an soybyer is defined as'...every person evress or implied,oral or written' An rsiyfeyor is defiled as as iwi uld-terp pasted inc anociaMis'corporation or other W&entity.tar any two ar mat Of the foregoing engaged in•joist estetprtn.and 100ft t6a legal representatives of a deceased employer.or the usociation or other legal entity,employing employees' However the receiver sec truest of no individual.partnership.Association who residue tbemin,at the occupant of the owner or it dweltieg bouse havi a trot s persons tons to do aparbeesls work on such dwelling house dwellit�house of another who employs persons m do no because f vmb outplcdm or robe tit tamed to be an employes.• or on the grounds or buildlnS appurtenant tbeteso shall teat because of web mtploytitaat �iGt chapter 132. i123C(6)also states that..overt'state or local lkessht axouey shine withbeY tbs Isstssnce or a operate a business or to construct buildings In the eemmonwesW for any renewal of•e boa m ptrudiroduc [K applknnt wise base set pcedtsud s><eeptalahe wideaee Of ees•ptlasee with tbt Itasurasce coverage regtdrN." Additionally.MGL chapter 133,d2SC(7)states'Neitlter the commonwealth sec any of is political wi dive ns dull moat tarn lay contract far the performance of public work until acceptable evidence of compliance with the insurance requirements of ibis chapter have bees presented to the contracting audtority.' Appliran" Please fill out the workers' compensation afidavit completely,by checking the boxes that apply to your situation and,if necessary.supply,sub-c tsc�s)nartte(1).ad�pa(u)and P °ranber(s)along with their certifica s)of �than the ies L or Limited Liability Partnerships(LLP)with no employ insurance. Limited Liability Companies(L C) insurance. If an LLC or LLP does have member or panties.am not required t carry workers'eompensatias employees,a policy is required. Be advised dint this affidavit may be submitted to the Department of industrial Accidents for confirmation of insurance coverage. Abe be sure to sign and date the afftdavp. The affidavit should be returned to the city or town that the application far the permit or license is being requcmd, not the Department of Industrial Aceideou. Should you have any questions regarding the law or if you are required to obtain a workers' compeuation policy.please call the 12epartmeW at the number listed below. Self-insured companies should enter their self-insursnce license number on that appropriate lam• City or Town Off Gish 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. I'leasc be sure to till in the purmiglicense number which will be used as a reference number. In addition,an applicant that must submit multiple permitilicense 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 file for future permits or licensee. Anew affidavit must be tilled out each year. Whet a home owner or cidncn is obtaining a license or permit rot related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. 1'ha Orrice of lnvestiZauuns would like to thank you in advance for your cooperation and should you have any questions, lease do not hesi care to give us a The Department's address. telephone and fax number. Thin Commonwealth of Massachusetts Department of Tadustaial Accidents Omer of Ir verdentleeo 600 WashillISM Street Boston, MA 02111 Tel. 4 617-7274900 ext 406 or 1-877-MASSAFE Fax A 617-727-7749 �teviocd 3-26-05 www.mass.gov/dies CITY OF SALDA PUBLIC PROPRERTY DEPARTMENT fL���a t+1'ttl.�a N::anf itiT�fAl.ti>/�vltt�r.a 11t:.91 r- Construcdos Debris Dlsposst Affidavit (mquimd for all deswlidam and s onovatiem wart) to aaon{soee with tiw sittdm eadm otthe Stus&-;Wlns Codsb 7SO CNIS sactioa 111.11 Debris.and the peovisiau of. CL a dq 9 Sk 13wid1%pamb 0 _ is lammed with the aoo Um that the dabrie mmWns gas ,his wort shell be disposed of in a properly licamad waste dispoepl &cility as dented by MOO a Lt1.S15" rho debris will be transported by. !r L }�gt�l:ti Wnsx Ina�M al hand) fhe&--bris will bo disposed of in EL �-19QvEti �n�AcTt WESrr.Cu, (name ur faad�ty) •.a. tw:.ii,:ali.0.H�iJ:J.7r I, 1-24-03 — w - 11/15/2007 ' 16:49 9789220833 GOLDBERG PROPERTIES PAGE 02 NUV-Uu-�Uur rHl II ;31 AM kNTIPM FAX N0, 1 508 435 0110 P. 09 8/2007 Pagel oft CENTEM • a Job Number: Itaference Number. Name: -tes ma± Na=: Goldberg Proaerties Address: A. Address; $1 Wosbineton Street City: ✓ City: Salem Zip: 01970 State: a lip-, State: Ma. p: Contact 4zftelth Phone: '97g1922-080 Phone: bs'D Building(sysectiou(s): Maln Roof • 9.590 sq.ft. Per proposal Dated 71ll/2007Ceat!MArk Auto Proposal 136213 ArNt,r as follows: Purchase price; S49 447 _ Warranty to be issued in the name of: purchase": I. �� Cantimark Sales Rep: David Piero 2. t it Office Location #1 g0 - Cholmstord,Ma. Warranty Length Yrs: 20 years Phone: (978)275-9259 Payment Terms: 1/3 down . net 30 days Initial 401mowicdgement of Payrnnat Terms: Bank Name: rl �, r� e L untN; 0 13eV o Address: Contact Phone: a._ City; Trade R areeeer: Phone: L Trade Reference: —OO Address: City: State: P 2.Tradc Reference: IrhOnE �fa�fq—a Address: State: �Ziip 3.Tzade Rcfereaee: — �— Ph` 'a' 5 4 �d f Address: p, 7 City- tlt nt-? State: Zip By my signam below,J certify that I have authority to bind the purchaser and have had the opportunity to rMow the tame of this Agreement including those set forth on the second page. Oa behalf of the ptachaw, I uaderatand and accept said tm= aad agree to bound thereby:and acknowledge that a satnplo copy of the warranty has been provided for my review. I also auth ' the please of credit information to Centimark Corp0121Jon. vCr�N �im.nBER4 ,, owed accepted m Purchaser Printed Name sad tlo Dare tlti Ci U V $ABJECT TO THE TERM AND CONDrrtONS OR SECOND AC <l ., .. Construction Specification ► ► ► ► Goldberg Properties 81 Washinton Street Salem, MA 01970 Specifications For CentiMark EPDM Fully Adhered System Sections included: Entire Roof Project Preparation: Perform a pre job meeting to determine jobsite logistics and safety requirements. Furnish proposed construction schedule, if needed. Safety Related Furnish and install proper safety equipment in accordance with Centimark's written safety program. Furnish and install warning lines to identified areas associated with ground related roofing activities. Store roofing materials in accordance with good roofing practices. Material placement will be to distribute weight loads throughout the entire roof area. Surface Preparation: Remove and dispose of existing loose gravel/rock ballast by means of industrial roof vacuum or mechanical sweeper. Prepare blisters,ridges, and other field imperfections as required for the proper application of the new roof system. Remove areas identified as wet down to the structural deck and fill void with rigid insulation to level at a cost of $2.25per square foot. In the area of removal, the deck will be inspected and if it is not capable of providing a acceptable substrate for the installation of the new roof it will be replaced at a unit cost of $5.25 per square foot. Areas of removal will be approved by an Owner's representative. Insulation Attachment. Furnish and install a layer of 1/2" High Density Wood Fiberboard insulation, (R-Value = 1.3). This layer of insulation will be mechanically attached to the prepared substrate utilizing FM Global (FM) approved 3" plates and fasteners. Furnish and install a new nailer along the outside perimeter as needed. System Application: Furnish a CentiMark 60 mil, non-reinforced, EPDM roofing membrane. Position the EPDM membrane over the newly prepared substrate and allow the membrane sufficient time to "relax" prior to installation. Fully adhere EPDM membrane to the prepared surface. The seam shall overlap by no less than 4" and be treated with an application of primer wash and sealed with a 4" butyl-based seam tape. CentiMark Confidential HVAC Curbed Penetrations and other Air Handling Unit Details Famish and install a 6" wide laminated reinforcement perimeter strip at the base of the curb. Fully adhere the EPDM membrane up the curb using a bonding adhesive. All comers will then be completed with uncured EPDM rubber flashing. Pipes Less Than 6" In Diameter Furnish and install new prefabricated rubber pipe boot secured at the top with a stainless steel screw type clamp fully adhered to the field sheet. Stacks Greater Than 6" In Diameter Furnish and install 60 mil EPDM uncured flashing. Miscellaneous Projections Famish and install 60 mil EPDM uncured flashing at roof projections. Furnish and install sealants to detail projections as needed. Encapsulate the raised monitor(approx. 10' x 10') with 60 mil fully adhered EPDM and make part of the entire new roofing system. Sheet Metal Accessories: Famish and install new 16 oz. red copper gravel stop along perimeter edges. Fumish and install a 16 oz. red copper drip edge into the existing copper gutter. Along the front parapet coping, cut the existing copper wall panels approximately F - 0" up from the base of the roof. Install 16 oz. red copper counterflashing up and under the copper wall panels and properly counterllasb to the new roof membrane. In the location of the existing wood covered roof opening....remove and install a new Bilco 2' x 3' spring loaded roof hatch per manufacturers' specifications. Standard Operating Procedures: Employee Professionalism All work shall be performed in a safe,professional manner in compliance with Centimark policy. Permits CentiMark does not typically supply the necessary permits for the project. Permits During permitting, the town of Salem may require the services of a certified professional. Any fees related to obtaining permit approval are not included in CentiMark's proposal. If the permit is purchased separately from the roof contract, CentiMark can submit all required documentation to secure the permit on the owner's behalf. CentiMark Roofing will provide for all necessary police details and street/sidewalk permits for loading and downloading during the roofing project. Nigbtly Tie-In's Depending on new roof system being installed, temporary water cut-offs are to be constructed at the end of each working day to protect the newly installed roof system and building interior. CentiMark Confidential f - - Clean Up All work premises will be cleaned daily during the construction process and at the completion of the project. Job Acceptance and Punch List Conduct a post job walk through for final sign-off of our job completion form. Warranty Upon purchase of the roofing system, you become entitled to receive the benefits of single source responsibility through CentiMark's comprehensive written warranty. This warranty protects your roof against defects in materials or workmanship. If your roof leaks at any time during the warranty period, we will provide complete warranty service. Quote Name Section Name - Length 81 Washington Street- Retrofit Entire Roof Twenty CentiMark Corporation disclaims any and all responsibility for pre-existing conditions including, but not limited to: structural damage or deficiencies, clogged drains, mold growth, excessive standing water, removal of hazardous material or other hidden deficiencies such as; damaged or leaking skylights, HVAC units/conduits, electrical or gas lines. This proposal does not cover, and in no case shall CentiMark be liable for, the removal of, or damage to, HVAC units/conduits, gas lines, water lines, electric lines, or conduits, whether located above, below, or in the roof system, lightning protection systems, landscaping, communication cable, communication devices, or other devices, including recalibration of satellites. It is the building owner's financial obligation to provide corrective measures. Recommended Accessory Options to Consider: Optional System: CentiMark Roofing has included an Option to "leave the gravel on the roof inplace" and install the included Scope of Work providing a 15 Year Total System Warranty. $45,488 CentiMark Confidential oard of Building�Begulations and Standards ii Construction Supervisor License . License: CS 80749 I , Birthdate '5/24/1976 rExplration 5/24/2009 Tr# 1086 Reetriction: `00 I = JAMES"EBEST 4.SIMONDS FARM RD BILLERICA,MA 01.862 Commissioner TE ACOR9. CERTIFICATE OF LIABILITY INSURANCE page 1 of 2 05/01/2007 PRODUCER 412-586-1400 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Willis of Pennsylvania, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 444 Liberty Ave ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Four Gateway Center suite 505 INSURERS AFFORDING COVERAGE NAIC# Pittsburgh, PA 15222 INSURED Centimark Corporation INSURERA: Arch Insurance Company 11150-001 12 Grandview Circle INSURERB: American Guarantee E Liability Insurance 26247-001 Canonsburg, PA 15317 INSURER C: INSURER D: 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. IITR N R TYPEOFINSURANCE POLICYNUMBER PDATEYMMFEOI")TIVE POLICY MMPIDDM) LIMITS A GENERAL LIABILITY 11PKG2125701 5/l/2007 5/l/2008 EACHOCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES E,ce.urence $ 100,000 CLAIMS MADE FX7 OCCUR MED EXP(Any one person) $ $ 000 PERSONALS ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 _7 EAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 4,000,000 POLICY X JE PRO LOC A AUTOMOBILE LIABILITY MA 11CAB2125901 5/l/2007 5/1/2008 COMBINED SINGLE LIMIT S 2,000,000 A X ANYAUTO IIPKG2125701 5/l/2007 5/l/2008 (Es accident) ALL O WNED AUTOS BODILY INJURY SCHEOULEDAUTOS (Pere rson) $ HIREDAUTOS BODILY INJURY $ NON-OWNEDAUTOS (Per accident) PROPERTY DAMAGE $ (Peracddent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHERTHAN EAACC $ AUTO ONLY: AGG $ H EXCESS LIABILITY AUC930387905 5/l/2007 5/l/2008 EACH OCCURRENCE $ 5,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 51000,000 DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION AND (ADS) IIWC12125601 5/l/2007 5/1/2008 X ToRVLMITS DER EMPLOYERS'LIABILITY ANY PROPRIETOWPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICEWMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 11000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 11000,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Workers' Compensation Policy #11WCI2125601 (ADS = All Other States except OH, WA, WV, ND Wy which are insured through state funds) . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Evidence of Coverage REPRESENTATIVES. AUTHORIZED REPRESENTAE ACORD 25(2001/08) Coll:1969186 Tpl:624710 Cert:8905466 ©ACORD CORPORATION 1988