87 WASHINGTON ST - BUILDING INSPECTION (8) ` The Commonwealth of Massachusett
Department of Public Safety
Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or - wily D elling
(This Section For.Official Use-Only)w
Building Permit Number:`' D1te Applied Bwld ng Offtaal '''
SECTION 1:LOCATION (Please indicate Block 4 and Lot$for locations'foiwhicti'a'street address i not available)
81 14064NO:h1 SAaM I 010DO
No.and Street City/Town - Zip Code Name of Building(if applicable)
SECTION 2.PROPOSED WORK
Edition of MA State Code used_ If New Construction check here❑or check all that apply in the two rows below
Existing Building)) Repair❑ Alteration)1. I Addition❑ I Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ 1 Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes 16 No ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑
Brief Description of Proposed Work:
e r
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 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s): gS
.- SECTION.4:BUILDING HEIGHT AND AREA, .:f
Existing Proposed
No.of Floors/Stories(include basement levels)&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-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business E: Educational ❑
F: Factory F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑. H-4❑ H-5❑
1: Institutional 1-1 ❑ 1-2❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑
S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Checkers applicable)
IA 0 IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ 1 IV ❑ VA ❑ VB ❑
SECTIONS:SITE INFORMATION (refer to 780 CMR 111:0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
A trench will not be Licensed Disposal Site❑
Public 9 Check if outside Flood Zone❑ Indicate municipal'fii
Private❑ or indentify Zone: or on site system❑ required or trench or specif
permit is enclosed❑ � MR
Railroad right-of-way: Hazards to Air Navigation: NIA Historic Commission Review Pnr:ess:
Not Applicable A is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes ❑ or No IS I Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction: WO Occupant Load per Floor:
Does the building contain an Sprinkler System?: Special Stipulations:
SECTION 9:1 PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Gott ?IQD&
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable, the property owner hereby authorizes
Name Street Address City/Town State Zip
to act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CON STRUCTION,CONTROL(P[ease fill out Appendix
IF buildin is less than 35,000 cu.
.ft:of enclosed s ace.vid/or'not under,Constmetion Controltherrch'eck Here 0"and'sk Section 10.1
10:1 Re 'stered Professional-Reso onsible for Construction Control"' "
k)5 6uLLA 9 --m Pol
Name Re istrant T hone o e-mail a d ess Registration Number
wig` � Nc�m�JLS'f &i iokr � 6� ARC:
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor,
Nq i 1 Ayo%4 eg CowSTizU C[1 opt
Company Name
MXCA01e, SW-N.0 CS Sg2FM - CflkgsT. SUP. LICE.Ira"�
Name of Person Responsible for Construction License No. and Type if Applicable
13 ?k>A ST MAWkKST&C 1*
Street Address City/Town State Zip
Telephone No. business Telephone No. cell e-mail address
SECTION lI:4VORKEP'S'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c152 f25C 6
A bVorkers'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? YesX No ❑
SECTION'12:CONSTRUCTION COSTS AND PERMIT FEE "
Item Estimated Costs:(Labor OO�
• and Materials) Total Construction Cost(from Item 6)_$1. Building $ Building Permit Fee=Total Construction Cost x ,,'' (Insert her
2. Electrical $ appropriate municipal factor)_$ .C i�
3. Plumbing $
4. Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
6. Mechanical Other $ G�T•r b� t w
A ^ Enclose check payable to
(i-l/ o'Dmunicipality)
J cY3
.Total Cost $ (contact munici ality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT,'
By entering my name below,I hereby atte unde he ins and penalties of perjury that all of the information contained in this
application is true and accurate t t i k e and understanding.
SyMe.M>JTEOMWT 76(4& 4�ft 2 63
PMse�r;nt and sign name � Title AA
Telephone No. Date
Street Address City/Town State Zip S
Municipal Inspector to fill out this section upon application approval:
.. . - Name.. . . - Date
75 WASHINGTON STREET 530-13
GIS#: 514
COMMONWEALTH OF MASSACHUSETTS
Map::z 1351
Block: CITY OF SALEM
Lot:' _ 0199
Category: Interior Framing
Permit# 530-13 BUILDING PERMIT
Prog6et# 7S-2013-001758
Est. Cost: $6 2
Fee Charged: $6,205.00
Balance Due: $.00 PERMISSION IS HEREBY GRANTED TO:
Const.-
T Contractor: License: Expires:
Use Group:
Daniel Normand Construction Control- 103013
Lot Size(sq. ft.): 9848.0448 �Owner: GOLDBERG BROTHERS REAL EST LLC
Zoning: B5,
Polls Gained, '`Applicant: Daniel Normand
nits Lost: AT. 75 WASIHNGTON STREET
IDig Safe#: I
ISSUED ON. 20-Dec-2012 AMENDED ON: EypjpXS ON. 20-May-2013
TO PERFORM THE FOLLOWING WORK.
INTERIOR FRAMING AND ELEVATOR SHEFT jbh
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Electric Gas Plumbing Building
Underground: Underground: Underground: Excavation:
Service: Meter: Footings:
Rough: Rough: Rough: Foundation:
Final: Final: Final: Rough Frame:
Fireplace/Chimney:
D.P.W. Fire Health
Insulation:
Meter; Oil:
Final:
Homse# Smoke:
Water: Alarm: Assessor Treasury:
Sewer: Sprinklers: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS
RULES AND REGULATIONS.
Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
BUILDING IZEC-2013-001917 20-Dec-12 1047 $6,205,00
GcoTMS@ 2013 Des Lauriers Municipal Solutions,Inc.
Mr
CITY OF ScUZNt, 1fLisSACHUSETTS
t' BL'ILDC'G DEPAR"I'M&OJT
ti• :a f: 120 WASHNGTON STREET, 3" FLoat
TEL (978) 745-9595
KIJLLiF..RI EY DRISCOLL FA.r(978) 740-9846
;VLAYOR THo.%w ST.PIERRH
DteECTOtt OF PUBLIC PROPERTY/BCILDDVG CO\LItISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 730 CMR section 111.5
Debris, and the provisions of tb101. c 40, S 54;
Building Permit i# is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
l l 1, S ISOA.
The debris will be transported by:
(name of hauled
The debris will be disposed of in
NG-
(namc of facility)
(
addre
1ss
1offaoility)
S l W t'AA 01M
signature ofpeimit applicant
date
CITY OF &. LENI, N'LUSACHliSETTS
t BUILDING DEPARTSI&`iT
120 WASHLNGTON STREET, 3ta FLOOR
TFL (978)745-9595
F*a(978) 740-9846
KINfBERLEY DRISCOLL
MAYORTFIObtAS ST.PiERRB
DIRECTOR OF PUBLIC PROPERTY/BUII.DLNG COMMISSIONER
Workers' Cornpensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant information ` •' `1}�`' /� '^ �}—�1 ,PPle{ase Print Legibly
Name(0usiix�s oeganiratiavindividual): YV i t�t 1� �t E►1 — (mNS I ayc c 1 tit\
Address: 13 ELM ST _
City/Statc/zip: MA►,46kAESTEX� ML4hM: 9-9 FIL 9�10
Are you an employer?Check the appropriate box: 'type of project(required):
1.�I am a employer with 4. ❑ 1 am a general contractor and 1
employees(Nil and/or part-time).• have hired the sub-contractor 6. ❑New construction
2.0 lam a sole proprietor or partner. listed on the attached sheet,t 7. CkRemodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.Insurance. 9. 0 Building addition
(No workers'camp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work right of exemption per MGL 1 I.0 Plumbing repairs or additions
myself.(No workers'cutup. e. 152, §1(4),and we have no 12.0 Roof repairs
insurance required.]t employees.Wat workers'.
comp.insurance required.) l3.0.Odter
•Any applicarn th a chucks bast ill must atws nil out the sectim belowshowing their wotlim'mmpuudon policy infinmadon,
I hweowm"who submit this ulidavit indicating they am doing all work and then hln oVridecantmcton main submit a xxt afnd ivit indicting such.
:0,nimiots ihal chuck this box must aoaehedan additlonuishmt showing the name or the rub.:onmcwn and Chair worker'comp.policy infatmaeon.
l om an employer that Is providing ivorkerit'compensadon Insurance jar my employees. Below is du po/Icy end Job slue
injormadion, w w� ►t. ff�
Insurance Company Name: _4a.'l\T I aAPAi WshoQ T�ry DNS
Policy 4 or Self-ins`. Li1c. 0: \A/G 60 t (05Z 5,109 Expiration Date• .,/� .
Job Site Address: W �I� N ST City/Statd2ip. /tat
Attach a COPY Of the workers'compensation policy declaration page(showing the policy number and expiration bate).
Failure to sucuru coverage as required under Section 23A of MGL c. 152 can lead to the imposition of criminal penalties of a
line up to S 1,500.00 und/or one-year imprisonment,u well as civil penalties in the farm of o STOP WORK ORDER and a line
Of up to S250.00 a day against the violator. Ile advised that a copy of this statement may be forwarded to the Of ica of
Investigations of the DIA fur insurance coverage vcrilfeation
/do hereby cerd ter j1p;l1andploldds ujper/ury that rho iujornwrloe proviJrJ above is true uuJ corneC
Data' Z -6 � /3
Prune i•
ID//iciel use arty. Do nor write in this err,4 to be completed by city of town n//h•/aj
City Or'rown: ___ _ P*rmltlT.lccnse d __`
Issuing Aulltorily(circle one):
1. Ifuard of lleallh 2. Building Departinenl 3.Cilylfown Clerk J.Electrical inspector 5. Plumbing inspector
6.Other
Contact Person:__ . . ____ _. Phan*th
Unofficial Property Record Card http://salem.patriotproperties.com/RecordCard.asp
Unofficial Property Record Card - Salem, MA
General Property Data
Parcel ID 35-0199-0 Account Number 0
Prior Parcel ID --
Property Owner EIGHTY ONE WASHINGTON ST Property Location 75 WASHINGTON STREET
REAL ESTATE,LLC Property Use Office
Mailing Address 7 RANTOUL STREET SUITE 100B Most Recent Sale Date 21612009
Legal Reference 28302-461
City BEVERLY Grantor GOLDBERG BROTHERS REAL EST LLC,
Mailing State MA zip 01915 Sale Price 0
ParcelZoning B5 Land Area 0.226 acres
Current Property Assessment
Card 1 Value Building Value 1,656,500 Xtra Features Value 5,000 Land Value 209,600 Total Value 1,871,100
Building Description
Building Style Comm Block Foundation Type Concrete Flooring Type Carpet
#of Living Units 22 Frarne Type Steel Basement Floor NIA
1 of 3 2/6/2013 9:10 AM
Unofficial Property Record Card http://salem.patriotproperties.com/RecordCard.asp
Year Built 1882 Roof Structure Flat Heating Type Steam
Building Grade Very Good Roof Cover Tar+Gravel Heating Fuel Oil
Building Condition Avg-Good Siding Brick Air Conditioning 100%
Finished Area(SF)28560 Interior Walls Plaster #of Bend Garages 0
Number Rooms 0 #of Bedrooms 0 #of Full Baths 0
If of 314 Baths 0 #of 112 Baths 10 #of Other Fixtures 0
Legal Description
Narrative Description of Property
This property contains 0.226 acres of land mainly classified as Office with a(n)Cc rm Block style building,built about 1882,having Brick exterior and Tar+Gravel roof cover,with 22 unit(s),0
roorn(s),0 bedroom(s),0 bath(s),10 half bath(s).
Property Images
2 of 3 2/6/2013 9:10 AM
315 Washington Street • Gloucester, MA 01950 978.281-6071 • Fax: 978-283-9455 -officeElpoorc-co.com
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0
40 0 0
Integrated Design Services
February 19,2013
PROJECT:
Opus Restaurant
87 Washington Street
Salem, MA 01970
Proposed Openings In South (Alley) Exterior Wall:
The restaurant(Occupancy A-2)renovation 'Opus' at 87 Washington Street in Salem, MA is bordered by
an 8-foot wide alley on its south elevation. A new egress door, previously approved by the City SRA and
DRB, is proposed within the south exterior wall to discharge onto the alley. The door itself will have no
exterior hardware, and be operable from the interior only.
The exterior wall consists of load bearing (non-combustible) brick masonry and currently contains three
punched opening wood windows and a storefront type opening at the Washington Street corner of the
alley. The new egress door opening will be produced by modifying one of the existing punched opening
windows by removing the masonry, down from the window sill to grade. This will result in a slight
increase to the current'opening area'on this elevation.
The renovation is to include a fully automatic sprinkler system.
Openings in exterior walls have been reviewed and determined per IBC 705.8, Openings.
The maximum allowable area of openings permitted in an exterior wall in any story is determined per
Table 705.8.
The area of allowable openings is affected by 'Fire Separation Distance' (FSD) as defined in Section
702.1. FSD is the distance measured from the building face to one of the following:
1) The closest interior lot line.
2) To the centerline of a street, an alley or public way.
The Alley in reference is a private right-of-way that is owned by the City of Salem but is subject to the
rights of various abutting property owners to use the Alley, in accordance with an 1837 Easement
(documents 299, 32 and 357, 97 attached). The owners of the property at 87 Washington St. have an
easement over the Alley, which is referenced in their deed. Pursuant to this easement, the Owners, as
successors in title, have the right to occupy, cultivate, and/or pass over the Alley, and the owner of the
Alley(the City of Salem) is required to keep the Alley free from obstructions.
From the building face to center line of alley at 4 feet, the FSD = 3'to < 5'. 705.8, Openings allows 15
percent of exterior wall per story to be unprotected openings in a sprinklered building.
Maximum allowable opening area: Area of exterior wall story: 976 SF x .15 = 146.4 SF
Area of existing openings: +/- 133 SF;
Proposed increase to openings: 12 SF;
Total openings: +/- 145 SF
Total area of existing and proposed openings are less than maximum area allowed. Openings area is
compliant with 705.8 Openings.
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QUITCLAIM DEED
THE GOLDBERG BROTHERS REAL ESTATE, I,I.C, a Delaware limited liability company
registered to do business in Massachusetts, and having a usual place of business at 7
Rantoul Street, Beverly, Massachusetts, 01915; WILLIAM H. GOLDBERG, individually,
STEVEN J. GOLDBERG, individually; and ANDREW D. GOLDBERG, individually; all as
tenants In common, of 7 Rantoul Street, Beverly, Massachusetts,01915,
for nominal consideration paid, and in full consideration of One and 00f100 ($1.00)Dollar,
i
i grant all of their respective undivided interests to Eighty One Washington Street Real
Estate, LLC, a Delaware limited liability company registered to do business in
Massachusetts, and having a usual place of business at 7 Rantoul Street, Beverly,
Massachusetts, 01915,
with QUITCLAIM COVENANTS,
the land in Salem, Essex County, Massachusetts, with the brick building thereon, known
as the Kinsman Block, and all other buildings thereon, bounded and described as follows:
K
l Beginning at the Northwesterly comer on Washington Street at land now or late of Cate
Building Association, and thence running
EASTERLY by said land and by land formerly of Salem Lyceum, one hundred
fifty-two (152) feet to a stone bound established by an Indenture
dated June 21, 1862. recorded with Essex South District Registry of
Deeds, Book 638, Page 289, at land formerly of Chase heirs and
now or formerly of the Kinsman estate; thence running
SOUTHERLY on the same two(2)feet; thence running;
i
i
i
EASTERLY on the same sixteen (16)feet, ten (10) inches, to land now or late of
Chase;thence running;
SOUTHERLY on land of Chase heirs one hundred nineteen (119) feet, three (3)
inches, to land now or formerly of Newcomb and Gauss, formerly of
Pease;thence running
WESTERLY eighty-eight(88)feet, four(4)inches and
SOUTHERLY thirty-three (33) feet, four (4) inches by said last named land to land
of the City of Salem;thence running
WESTERLY, SOUTHERLY and WESTERLY again by said City land to Washington
1 Street;thence running
NORTHERLY on Washington Street, one hundred forty-three (143) feet, nine (9)
inches to the point of beginning.
Also a parcel of land adjoining the above land at its Northeasterly comer and extending
therefrom to Church Street, bounded as follows:
NORTHERLY by Church Street,sixteen(16)feet, three(3)inches;
EASTERLY by land now or late of Chase,fifty-seven (57)feet, four(4)Inches;
SOUTHERLY by the above-described land sixteen(16)feet, nine (9)Inches; and
WESTERLY by the above-described land and land formerly of Salem Lyceum
fifty-seven (57)feet, six (6) inches; excepting so much therefrom as
was taken by the City of Salem to widen Church Street.
Subject to agreements and provisions contained to and the rights conveyed to two
i Indentures—one between D.A. White and said City recorded with said Registry of Deeds,
Book 299, Page 32, and the other between said City and W.O. White, recorded with said
Registry of Deeds, Book 357, Page 97; the deed to said Pease and others dated May 3,
1882, recorded with said Registry of Deeds, Book 1082, Page 103, and another from
Kinsman to them recorded with said Registry of Deeds, Book 1082, Page 105.
Excepting from the above-described premises that portion thereof conveyed to the Salem
Redevelopment Authority and described in a deed dated December 10, 1969 and
recorded with said Registry in Book 5655, Page 602. With the benefit, however, of the
permanent easement reserved by the grantors and described In said deed recorded in
Book 5655, Page 602.
And subject to the easement in gross (known as Fagade easement) described in a deed
of Easement to the Salem Redevelopment Authority dated October 1, 1976, and
recorded with said Registry, Book 6286, Page 433. This conveyance is also made
subject to all existing leases in the granted premises.
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zft62t38 Pi=433
THIS DEED OF EASEMENT, made this ',- day of . . 1975, .
between jAAMES KAILAS and PETER RALLAS, both of Peabody, Essex
County, MaSSaChU6etta, and WILLIAM RALLAS, of Salem, said County i
of Essex, herein called the Grantors and the SALEM REDEVELOPMENT
AUTHORITY, a public body, politic and corporate, duly organized
and existing pursuant to the provisions of the Housing and Urban
Renewal Law of the Commonwealth of Massachusetts, appearing in
Massachusetts General Laws, Ter, Ed., Chapter 121Br and having
its principal place of business in Salem, Essex County, Massachu-
setts, herein called the Authority.
WHEREAS, the Authority in pursuance of its powers and
objectives as set out in said Rousing and Urban Renewal Law and .
every other power thereunto enabling, determined that the area
I
known and referred to as Heritage Plaza-East Urban Renewal Area,
within the City of Salem, which includes the premises hereinafter
described constituted a substandard area as defined in Chapter
121B and further determined that an Other, Renewal Project ought
i' to be undertaken in said City; and
WHEREAS, the Authority has prepared an Urban Renewal
Plan as defined in Section 1 of said Chapter 1212 for the said III
project area entitled, ."Heritage Plaza-Sast Urban Renewal Project
No. Mass. R-95"; and
WHEREAS, following due notices, the City Council for
the City of Salem held public hearings regarding said plan and
said plan was duly approved by the Mayor and the City Council of
the City of Salem, complete copies of which are on file at the
offices of the Authority and the Salem City Clerk; and
WHEREAS, the Authority has entered into a Loan and Grant
Contract with the United States of America under Title I of the
i` BK6288 PG434
-z-
Housing Act of 1949, as amended, providing for federal financial
assistance in connection with the carrying out of said Urban
F
Renewal Project in accordance with the said Urban Renewal Plan;
and
WHEREAS, the said Urban Renewal Project was undertaken
i
and the said Urban Renewal Plan was adopted for, among other
things, the preservation and restoration of historic and archi- i
I�
tectural values associated with structures and areas within the
Project Area; and
WHEREAS, the said Urban Renewal Plan contains standards
for exterior appearance to be imposed on all structures designated
for historic and/or architectural preservation requiring, among
j
other things, the acquisition and/or retention of facade easements '
over individual properties by the Authority as a stimulus to pre- i
servation activities; and
WHEREAS, the Grantors are the owners and holders of record
JJi of fee simple title to certain real property located in the Urban
f Renewal Project Area and situated on Washington Street and Salem
i
Green, in said Salem, on which there is situated a structure of
architectural significance and historic value, said premises being
more particularly described in Schedule A annexed hereto and made
a part hereof.
NOW, THEREPORE, in recognition of theforegoing and in
consideration of the premises, mutual promises, obligations, cove-
nants and restrictions hereinafter defined, the parties hereto
agree as follows:
1, The Grantors do hereby grant and convey to the
Authority an easement in gross (known as a facade easement) over
PH6288 PG435
-3
rear of the
the exterior appearance of the/structure situated on the herein-
before described premises visible .f.rom the public way, known as '
Salem Green. The tacade easement herein granted shall entitle j
I
'the Authority to enter upon the Owner`s premises .for the purpose 33
of furnishing and installing upon or in connection with the fffl
exterior of the structure all additions, improvements, alterations)
repairs, and services in accordance with the construction plan li
for the rehabilitation, restoration and preservation of the -
..,...exterior.appearance of said structure, which plan is on file in
the office of the Building Inspector of the City of Salem and the
office of the Authority. Upon completion of the rehabilitation
and restoration work by the Authority, the Grantors covenant and
agree that the exterior appearance of said structure shall be.
maintained and preserved in its completed state.. The facade ease-
ment herein granted shall further permit the Authority and its
representatives, agents and/or employees access to and entitle thei
Authority and its representatives, agents and/or employees to
i enter the property thereafter whenever and to the extent necessary)
; for the purpose only of inspection and enforcement of the covenants
and the terms of the easement granted herein which the Authority j
is hereby entitled to enforce in any court of competent juriadic-
tion_ In the event of any default or failure, thereafter, on the '
part of the Grantors to so maintain and preserve the exterior
appearance of such structure, whether in whole or in part, whether
by omission or departure from the standard and specifications
hereirbefore designated, the Authority shall have the right, power
and authority at its election, after refusal or neglect by the
Grantors to correct such default or failure following a ninety (SO)
day notice so to do by the Authority, to exercise the Grantors'
ri
BX6288 PG436
4
unfulfilled obligations hereunder including the right to remedy
any and all defective performance on the Grantors' part and to
charge the cost thereof to the Grantors.
2. The Authority covenants and agrees to furnish and
install upon or in connection with the exterior of the structure,
is at no cost to the Grantors, all additions, improvements, alters-
' tions, repairs and services in accordance with the said construe-
is
� tion plan in order to achieve the rehabilitation, restoration and
preservation of the exterior archi(rectural character of said
structure up to a maximum of Fourteen Thousand Four Hundred Twenty
. 1$14,420.00) Dollars. The work which the Authority is required
:. i:o perform shall be fully completed within six (6) months from the
L
date of commencement of construction.
The Authority shall assume all risk of and shall save
harmless, defend and indemnify the Grantors against all acts,
claims, demands, liabilities, and damages which may in any manner
be imposed on or incurred by the Grantors as a consequence of, or
i
, arising cut of, any act, default or omission on the part of the
Authority, or any of its officers, employees, or agents, in connec-
tion with the condition or use of the Grantors' premises by the
Authority as a result of the work caused to be done by the Autho-
rity to achieve the rehabilitation of the exterior of the said
structure.
3. In the event that the cost of said rehabilitation
and restoration work shall exceed Fourteen Thousand Four Hundred
Twenty ($14,420.00) Dollars, the Grantors covenant and agree to
pay to the contractor, chosen by the Authority, to perform said
work, any additional sums over and above the said Fourteen Thousand
Four Hundred Twenty ($14,420.00) Dollars including all necessary
N 6288 tG437
change orders that may come about in the process of the work to
be done, in accordance with contract documents to be prepared by
the Authority, provided such change orders shall be agreed upon
i
by the Grantors and the Authority. The Grantors agree to execute
such documents as shall be reasonably required by the Authority
to effect and complete such work. I
4. Structural changes, alterations, additions, or improve-
I
menta over the exterior appearance of the structure visible from
the public way, known as Salem Green, as would not in the opinion
of the Authority fundamentally alter its character or its setting
. may be made thereto by the Grantors, provided that the prior
written approval of the Authority to such change, alteration or
improvements shall have been obtained. The Authority shall act
upon a written request by the Grantors for such approval within
thirty (30) days of its receipt and shall give notice of any dis-
approval to the Grantors in writing with reasons. If a request
for approval is not disapproved by the Authority within thirty
(30) days, it shall be deemed approved. In case of disapproval
i
lithe Grantors may within thirty (30) days after notice of disapproval
is request a review of the disapproval by a person of competence and
experience in such matters, designated by the Salem Historical
Commission or its chairman or acting chairman. The finding of
this .review shall be made in writing within sixty (601 days after
the request, and shall be binding on the Grantors and the Authority.
The cost, if any, of such review shall be shared equally by the
Grantors and the Authority.
5. in case of damage by fire or other casualty so serious
as to cause reconstruction to be reasonably adjudged to be imprac-
tioai, this easement, together with all covenants, obligations,
I
BK6288 °6438
-6-
and restrictions herein recited shall terminate and otherwise shah
I
remain in effect without limit to time.
6. The Authority in its discretion may erect a single
marker or sign not exceeding two feet by two feet, which states the
name of the Authority and advises that the Authority owns the ease
�! ment granted herein. I
7. The covenants agreed to and the restrictions imposed
as aforesaid, shall not only be binding upon the Grantors but also.
other successors to them in interest and shall continue as a servi-
tude running with the land in perpetuity with the above described
;. premises and shall survive any termination of the Authority's ,exis-
jj tence. All rights reserved herein to the Authority may be exercised,
modified, or released by its successors or assigns or by its de-
` signee duly authorized in a deed or appointment executed by its
Chairman. This facade easement shall not be assigned to any person
or entity other than the City of Salem without the prior written
consent of the Grantor.
I' 114 WITNESS WHEREOF, the said James Kallas, Peter Kallas
Land William Kallas hereunto set their ha ds and seals, this r =
II day of 1976. r
r
' f�I- IYI�t'"J�TG/zf Fes, 1-
JAM��s
f _
ACCEPTED: `. . . -C. °� -• .:c c..= .
SALEM REDEVELOPb7ENT AUTHORITY PETER KALLA '
/• � _�L�-t•L•CLC..LL1 Jli:.YSCcL�
WILLIAM X.�.L lAS S�
COj,1r,ONf-7EALTH OF MASSACHUSETTS
Essex, ss. �_' 7 1976
Then personally appeared the above-named James Kallas,
Peter Kallas and William Kallas, and acknowledged the foregoing
instrument to be their free act and deed, before me,
, 1 i
1
I
k6288 Pr439
i
"SCHEDULE A"
A certain parcel of land, with the buildings thereon, situated
on Washington Street, bounded and described as follows:
WESTERLY by Washington Street, one hundred thirty-six
and 1/100 (136.81) feet; '
NORTHERLY by land now or formerly of the Heritage
Cooperative Bank, eighty-one (81) feet;
EASTERLY by land now or formerly of the Salem
Redevelopment Authority, commonly known
as the Salem Green, one hundred forty and
31/1DO (190.317 feet;
SOUTHERLY by other land now or formerly of Salem
Redevelopment Authority, eighty-one and
86/100 (81.86) feet.
Being a portion of the premises conveyed to us by deed of Howard
W. Cole, et al, Trustees by deed dated November 1, 1965, recorded
{ with Essex South District Registry of Deeds, Book 5315, Page 44,
,
I
ss�.;.: ... . rtrcoxrls,.�(��iif >�rb�:.. _._,^l,/_.._ /�•�, �.;:e�r,; rr'7
K676
SEE Prig liq/��
DEDICATION AND RELEASE OF STREETS AND WAYS
WHEREAS, the Salem Redevelopment Authority, a public
t body, politic and corporate, duly organized and existing pursuant
to the provisions of The Housing and Urban Renewal Law of the
Commonwealth of Massachusetts, (appearing in Massachusetts
'rGeneral Laws, (Ter. Ed.) Chapter 121B; and having its principal
place of business in Salem, Essex County, Massachusetts, in pur-
suance of its powera as set out in said Housing and Urban Renewal
Law and every other power thereunto enabling, determined on
December 2, 1966, that the area known and referred to as Heritage
Plaza-East Urban Renewal Area, within the City of Salem, which
; includes the area or areas hereinafter described, constituted a
substandard area as was defined in Section 26J of Chapter 121,'
(now repealed) , and further determined that an urban renewal
project for -said Heritage Plaza-East Urban Renewal Project Area
ought to be undertaken in said city; and _
WHEREAS, the Salem Redevelopment Authority has prepared
: an Urban Renewal Plan, as defined in Section L of said Chapter
12LB, for the said project area entitled, "Heritage Plaza-East
Urban Renewal Area Project No. Mass. R-95"; and
I WHEREAS, following due notice, the City Council for the
: City of Salem held public hearings on December 28 s 29, 1966,
regarding said Plan and said Plan was approved by the Mayor and
r: the City Council of the City of Salem on February 23, 1967,
complete copies of which Plans are on file at the offices of the
Salem Redevelopment Authority and of the Salem City Clerk, and
which Plan subsequently amended, which amended Plan was approved
LIK6304 PG677
_2_
by the Mayor and the City Council of the City of Salem on March
23, 1972, complete copies of which Plans are on file at the
offices of the Salem Redevelopment Authority and of the Salem
City Clerk, and
WHEREAS, the Planning Board of the City of Salem by
acpropriate votes taken on December is, 1966, and on March 16,
1972, found the said Plan to be based on a local survey and to 1
conform to a comprehensive plan for the locality as a whole and
1
the Department of Community Affairs of the CUmmonwealth of
Massachusetts has concurred in such findings as required under
Section 48 of said Chapter 121E approved said plan; and
WHEREAS, on April 3, 1968, the Salem Redevelopment
Authority entered into a Loan and Grant Contract with the United
States of America under Title I of the Housing Act of 1949, as
amended, providing for Federal Financial assistance in connection
with the carrying out of said Urban Renewal project in accordance
with the said Urban Renewal Plan; and
WHEREAS, the City of Salem and the Salem Redevelopment
Authority have entered into a "Cooperation Agreement" dated
February 27, 1967, providing for, among other things, acquisition
of certain parcels of land owned by the City, and the vacating,
discontinuance and relocation of certain public ways in .connection.;
with the completion of said Plan; and - -
i
WHEREAS, the Salem Redevelopment Authority determined
that the taking in fee simple by eminent domain of certain areas
was necessary and reasonably required to carry out the purposes .
Of the Housing and Urban Renewal Law and said Urban Renewal
Plan; and
i
i
i
j
..BK6304 P6678
-3-
WHEREAS, the Salem Redevelopment Authority, acting under
the Provisions of the Housing and Urban Renewal Law, and, of
`. Sections 46 & 47 of Massachusetts General Laws (Ter. Ed.) Chapter
121B, and all other authority thereunto enabling, and pursuant
i to the applicable
PP provisions of General Laws, Chapter 79, and of
r !� any and epery other power to it granted or implied, ordered
�! takings by eminent domain for the Purposes hereinbefore set forth,
certain areas located in the City of Salem including all parcels
of land therein, together with any and all easements and rights
appurtenant thereto, including the trees, buildings, and other
structures standing upon or affixed thereto, and including the
fee to the center of any and all public streets, highways and
f: Public ways; which takings are recorded with Essex South District
Registry of Deeds, in Book 566a, Page 220; Book 5713, Page 239;
Book 5H55, Page 231; Book 5858, Page 551, Book 5874, Page 104;
Hook 5927, Page 447; Bock 5945, Page 612; Book 6057, Page 618 and
Book 6205, Page 413; and
WHEREAS, the Salem Redevelopment Authority has developed
Pedestrian and vehicular circulation networks and supporting
services and facilities and has Provided certain public improve-
ments within the said areas.
NOW, THEREFORE, the Salem Redevelopment Authority,
�i acting by and through its Chairman, Robert B. Bowman, hereto duly
authorized, in consideration of the sum of One Dollar ($1.001 and
Other good and valuable consideration hereby dedicates, transfers
and conveys and releases all of its right, title and interest to
G the City of Salem, the areas bounded and described in Exhibit A
i�
i
G��
C m�ss�N4 wr�'�r�
JOHNSON ENGINEERING AND DESIGN, INC.
5 Elm Street, Suite 14, Danvers, MA 01923
E-mail: eiohnsonengineering.biz
Telephone (978) 646-9001 Facsimile (978) 646-9002
ELECTRICAL CONSTRUCTION CONTROL AFFIDAVIT
(Design Only)
In accordance with the Massachusetts Building Code, 8t' Edition, Chapter 1, Section 1.07.6.2.1,
I,Eric D. Johnson being a registered professional engineer, Massachusetts License No. 32641,
hereby certify that I have supervised the preparation of the electrical design plans, computations,
and specifications for the Opus Restaurant, 87 Washington Street, Salem, MA 01970 and that,to
the best of my knowledge, such design plans, computations, materials, and specifications
conform to the provisions of the Massachusetts State Building Code, all acceptable engineering
practices, and all applicable laws and ordinances for the proposed use and occupancy.
PROJECT NUMBER: JE-2026
,PROJECT TITLE: Opus Restaurant
PROJECT LOCATION: 87 Washington Street, Salem, MA 01970
NAME OF BUILDING:
NATURE OF PROJECT: Level 2 Renovation/Alternation
Engineer's Stamp Original Signa a Date
pMORA
q>... .... .
'comm. F '•.FG���
�yGGT. 10,20-Fai9::4 L
Subscribed and sworn to me this �� day of Rl rG 2013.
r N .PU.... �`
�C -, I D, 2oi9
Notary Stamp NOTARY PUBLIC My Commission Expires:
• cod+�olrt„r CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
�' co 120 WASHINGTON STREET, 3RO FLOOR
+� o SALEM. MASSACHUSETTS 01 970
9` TELEPHONE: 978-745-9595 EXT. 380
rrtEDo� FAX: 978-740-9846
KIMBERLEY DRISCOLL -
MAYOR
�1 CONSTRUCTION CONTROL AFFIDAVIT
Project Number- 3- -9Voa(,0 t_ Date:
Project Title- QYJ US5��t [AGI�'!T
Project Location: 8? WaZi Ii -zl -e-� Cde h 1 4 MA t7 Jrl '70
Name of Building:
Scope of Project: Le u e- 1 oZ 72 n U VoAio l
IN ACCORDANCE WITH SECTION 116.0 OF THE MASSACHUSETTS STATE BUIDING CODE, i
ErM6 -0- j-6h/1SU/) MASS. REGISTRATION NO.3a 6.y 1 BEING A REGISTERED
PROFESSIONAL ENGINEER HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY
SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS, AND
SPECIFICATIONS CONCERNING:
Civil Architectural Structural Mechanical
Electrical Fire Protection Other(specify)
FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE, SUCH
PLANS, COMPUTATIONS, AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE
MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES AND
ALL APPLICABLE LAWS FOR THE PROPOSED PROJECT.
I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES
AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO
DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS
APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING
AS SPECIFIED IN SECTION 116.2.2.
1. Review of shop drawings, samples and other submittals of the contractor as required by the construction
contract documents as submitted for building permit, and approval for conformance to the design concept-
2. Review and approval of the quality control procedures for W code required control materials-
3. Special architectural or engineering professional inspection of critical construction components requiring
controlled materials or construction specified in the accepted engineering practice standards listed in
"Appendix 1.
PUf.S$U"tT„ TKO SECTION 116.4, 1 SHALL SUBMIT PERIODICALLY, A PROGRESS REPORT
TFf �I7e8REJ;H PERTINENT COMMENTS TO THE BUILDING I P CEI )FACTORY
R. UPON COMPLETION
°OFF: t E�V,QRK; SHALL SUBMIT A FINAL REPORT AS T T COMPLETION
�tD u6t �2Ij,SS F THE PROJECT FOR OCCUPANCY.
g lure Co
Sl3fC I `Aj3SWORN TO BEFORE ME THIS d DAY O 2004
•.MO E?��P�-a`` .
My commission Expires: ,.--1
Notaryr�ubfic��
W 82839 15 5 1fi.35.56 12-28-2012 212
/ c,1.olt1
CITY OF SAL.EM, MASSACtiUSETTS
PUBLIC PROPERTY DEPARTMENT
120 W'AoNINGTCN.STREET 3r70 �7LOOR
CA!_E10. MASSAC HUSE-1'T501970
7Et_EPHONE 978-745-9595 ExT. 380
`'pE.;7y`i8 FA x: 978.740-9846
KIMBERLEY DRISCOLL
MAYOR
CONSTRUCTION CONTROL AFFIDAVIT �J
Prcjeci Numbers Data:, f I a,
Project Till
Project Location: 77 M R t P1 VY6 -- — — --
Name of Building_)
Scope of Project: l�Y n b�icx
IN :ACC RDANCE WITH SECTION 116.0 OF THE MASSACHUSETTS STATE BUIDING CODE, i
ASS. REGISTRATION NO,•�q_',Z�7, EING A REGISTERED
PROFESSIONA ENGINEER k�QEBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY
SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS, AND
SPECIFICATIONS CONCERNING:
Civil Architectural __ Slructural_ Mechanical_�
Electrical Fire Protection Other(specify)
FOR THE'ABOVE'NAMED PROJECTAND THAT,TO_THE BEST CRMY KNOWLEDGE, SUCH
PLANS, COMPUTATIONS,AND SPECIFICATIONS MEET THE'APPLICAI3LE`PRdVISiONS"OF THE
MASSACHUSETTS STATE BUILDINGCODE, ALL ACCEPTABLE..ENGINEERING PRACTICES AND
ALL APPLICABLE LAWS FOR•THE PROPOSED PROJECT.
I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES
AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR,AND PERIODIC BASIS TO '
DETERMINE THAT THE WORK IS PROCEEDING IN ACCOROANCE'WITH THE DOCUMENTS
APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING
AS SPECIFIED IN SECTION 116.2-2. l
1 Review of shop drawings, samples and other submitta s of the contractor as required by the`ccnsfruction •
contract documents as submitted for budding permit, and approval for conformance to the design concspt.
2 Review and approval of the quality control procedures for all code required control materials.,.
3. Special architectural or engineering`professional`inspection of critical construction components requiring
controlled materials orconstnuct'an specified In the accepted engineering practice standards listed in
Appendix 1.1 ;.:,.., .. .. -r"
PURSUANT TO `SECT,I,ON 115.4, 1 SHALL SUBMIT PER ODICALLY, A PROGRESS REPORT
TOGETHER WITH PERTINENT COMMENTS TO THE BUILDI !NSPECTOR. UPON C MPLETiON
OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO, HE SATI GORY ri N
AND READINESS OF THE PROJECT FOR OCCUPANCY
SU43S Po A`D SVJ t T FORE 'Ig are
Mt HiS DAY C
N My co n rlsslon E. olre5
Joanne G.Cerasoll
Notary Public + ... _. .
Commonwealth Of Massachusetts _
My Commission Expires
July 7,2017
t31'�ofi rd�o CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970
TELEPHONE: 978-745-9595 EXT. 380
rve oo� FAX 9 78-740-9846
KIMBERLEY DRISCOLL
MAYOR
CONSTRUCTION CONTROL AFFIDAVIT
Project Number. Date: 1/2/2013
Project Title: Opus Restaurant
Project Location: 87 Washington Street, Salem, MA 01970
Name of Building:
Scope of Project: Level 2 Renovation /Alteration
IN ACCORDANCE WITH SECTION 116.0 OF THE MASSACHUSETTS STATE BUIDING CODE, I
&LZ- dW c i' HI MASS. REGISTRATION NO. yZ 707P BEING A REGISTERED
PROFESSIONAL ENGINEER HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY
SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS, AND
SPECIFICATIONS CONCERNING:
(��vu+Lar.vG.
Civil Architectural Structural Mechanical XX y
Electrical Fire Protection Other(specify)
FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE, SUCH
PLANS, COMPUTATIONS, AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE
MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES AND
ALL APPLICABLE LAWS FOR THE PROPOSED PROJECT.
I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES
AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO
DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS
APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING
AS SPECIFIED IN SECTION 116.2.2.
1. Review of shop drawings, samples and other submittals of the contractor as required by the construction
contract documents as submitted for building permit, and approval for conformance to the design concept.
2. Review and approval of the quality control procedures for all code required control materials.
3. Special architectural or engineering professional inspection of critical construction components requiring
controlled materials or construction specked in the accepted engineering practice standards listed in
Appendix I.
PURSUANT TO SECTION 116.4, 1 SHALL SUBMIT PERIODICALLY, A PROGRESS REPORT
TOGETHER WITH PERTINENT COMMENTS TO THE BUILDING INSPECTO . UPON COMPLETION
OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE / RY COMPLETION
AND READINESS OF THE PROJECT FOR OCCUPANCY.
Signature
SUBS IB D SWORN TO BEFORE ME THIS 2 DAY OF 015
T My commission Expires:
Notary Public "V
.r
f .
ZY
Deval L.Patrick
Governor - �/ � yp�n�+�+O ThomaCommissioner
P E
Timothy P.Murray (1�1�P'9l.Pi !/✓7�y /Ly !/O(/
Lieutenant Governor Thomas P.Hopkins
Director
Mary Elizabeth Heffernan /
Secretary
TO: Local Building Inspector Docket Number v 12 266
Local Disability Commission
Independent Living Center
FROM: ARCHITECTURAL ACCESS BOARD
RE: Opus Restaurant
87 Washington Street
Salem
Date: 11/6/2012
Enclosed please find the following material regarding theabove location:
_Application for VarianceDecision of the Board
Notice of Hearing _Correspondence
Letter-of Meeting
The purpose of this memo is to advise you of action taken or to be taken by
this Board. If you have any information which may assist the Board in reaching
a decision in this case, you may call this office or you may submit comments in
writing.
d
Deval L.Patrick
Governor _ /i7L/ Q�� ryp�QQ_ Thomacommissioner
t P.E.
Timothy P.Murray �J(�1L�P""�lLPiq yy yy/pGyy I/r/
Lieutenant Govemor xv ellp,1/-Q665 - Thomas P.Hopkins
Director
Mary Elizabeth Herroman -
secretary �'� 4';9�-Z- �' Docket Number V 12 266
NOTICE OF ACTION
RE; Opus Restaurant, 87 Washington Street Salem
1. A request for a variance was filed with the Board by Mark McDonough (Applicant) on October 12,2012
The applicant has requested variances from the following sections of the 06 Rules and Regulations of the Board:
Section: Description:
28-12.1 Petitioner seeks a variance to allow the installation of a vertical wheelchair lift to serve the first floor and lower
level of a proposes restaurant. The petitioner does not meet any of the"By Right'allwances of 521 CMR
Section 28.12.1 a thru e. The vertical wheelchair lift will meet the requirerments of 521 CMR Section 28.12.2
2. The application was heard by the Board as an incoming case on Friday, November 2, 2012
3. After reviewing all materials submitted to the Board, the Board.voted as follows:
GRANT: the variance to Section 28,1.2.1 as proposed for the reason that impracticability (see definitions of
impracticability in Section 5 of 521 CMR) has been proven in this case and on the condition that the vertical wheelchair
lift is permited and inspected by the Commowealths Elevator Division, and a copy of the inspection certificate is
provided to the Board upon completion of the work.
PLEASE NOTE All documentation(written and visual) verifying that the conditions of the variance
have been met must be submitted to the AAB Office as soon as the required work is completed.
Any person aggrieved by the above decision may request an adjudicatory hearing before the Board within 30 days of
receipt of this decision by filing the attached request for an adjudicatory hearing. if after 30 days, a request for an
adjudicatory hearing is not received, the above decision becomes a final decision and the appeal process is through
Superior Court.
Date: November6, 2012
cc: . Local Disability Commission Chairperson
Local Building Inspector ARCHITECTURAL ACCESS BOARD
Independent Living Center
,J
The Commonwealth of Massachusetts
Department of Public Safety Docket Number
Architectural Access Board
One Ashburton Place, Room 1310
(Office Use Only)
Boston Massachusetts 02108-1618
Phone: 617-727-0660
Fax: 617-727-0665
www.mass.gov/dps
REQUEST FOR ADJUDICATORY HEARING
RE:
Name and address of building as appearing on application for variance
I, do hereby request that the Architectural Access Board
conduct an informal Adjudicatory Hearing in accordance with the provisions of 801 CNIR Rule 1.02 et.
seq. as I am aggrieved by the decision of the Board with respect to Section(s)
of the Rules and Regulations of the Architectural Access Board, 521 CAR.
I understand that I may request such a hearing within thirty (30) days of receipt of the Notice of Action.
Date:
Signature
PLEASE PRINT:
Name
Address
City/Town State Zip Code
E-mail
Telephone
PLEASE NOTE:
This form must be received by the Board within thirty (30) days after receipt of the Notice of Action.
Rev, 01/10
INCLIN0cnMwAwv or 1
„___..__At.- ---- INV.DA W.W=
�FD1a lID w m t r
NECSERENITEE
14it �VU' MANAGEMENT CORP,
-r�77 87 WASHINGTON ST,
SALEM, MA 01970
[[Ef:ll=
S4�--------—Z L-Im
2
VERTICAL LIFT
0 WATMOl aNP
TMR w
�TY
mm
rmw w H�m
��mwu�MIUTM
�m AT �im W,
15 m-�m
T�rj?
BMATTEN
.-C N
VL0774
MUNOTOR
01— TIC..Ba,SV.BY GC.
-FIELD LOCATE TO MEET 5✓.OP nano we Hn
'I I.A.C. / NCC ANpm
1 N LOCAL CODES, SERENITEE
ENCLOSURE BY OTHERS I� i°�R MANAGEMENT CORP,
143' 1331u _ 87 WASHINGTON ST.
-�- SALEM, MA 01970
x5 a vENDLL
BEER
PLATFORM
INTERLOCK
FONIPMSH! SNAP T1rD BYE
INTERLOCK ygI• LOBE 3 � /
ChF 38I-D.54•W //36, HBE CORPORpiION
-FULL NEYO OTHENOERS
OSUflC p p
DBMS BY OiNERS I—
z[B:°� sl=EcxF-x c.a rxoHs
_ __ _
�T pq•cnR '_ K Lam
�61,ua 2 LANOINO
VERTICAL LIFT
UPPER SHAFT PLAN
CPO 36'Dx54'Vx42'X cowls,3
CAPACITY 750 LBS,AT 10 FAIL
FINISH,BEIGE
0 ALL DOORS MOST BE INTERLOCKED
AR KEYS WITCH OPERATION
12'-0 1/2' IOB' UP O WTD FOLD RAP
LOVER TRAINEE O STA IIO NARY RAMP
XEI T O LANDING GATE M/]NICHE OCK
O ELATING GATE WITH INTERLOCK
®EMERGENCY ALARM
O ®EMERGENCY STOP
0 NLATFL LOWERING
KEY STOP ALARM PLATFORM
SAFETY MELXAHISM
0 LIN TOOT REVERSE
0 LIMB SWITCHES
REDROPS
0 ENCLOSURE BY IN BY INCOA
CAR CORP R N 0 ENCLOSURE BY INWA
THE PLATFORM)
D DN O SAFELY STOP DIAPHRAGM
THE PLATFORM)
421.
NOTICE !11 ELECTRICAL CONTRACT GR-SINGLE
INSTALL 110N.SINGLE PHASE
EDAMP MAI SLIME
L°VFR 1 H.P MOTOR 120r.SINGLE PHASE
60 CYCLE
T 20 AMP MAIN LINE NSC
"-FLOOR 6'MIN,30000ps1 CONCRETE C
FLOOR t0 HAVE SMOOTH TROYEL o
Q �q•--------;• FINISH FREE OF HOLLOWS OR BUMPS. J
SURFACE TO BE LEVEL AND FLAT TO
41TXIN SI/B'IN ANY
DIRECTION RCM IC CAR CONTROL INCOA JOB A 12-427-BR
L BOATED At EACH LANDING DRAWING BYE B.BRAiTEN
SECTION 1r1N A-A DATE,10/13/2012
.]L1J REVISED 10/23/2012
REVISED
DRAWING IDENTIFICATION MUMH ER
VL0774
F
OEM os CcarpcsraCGor�
LIFT INSTALLATION AGREEMENT
DATE: October 5, 2012
PURCHASER: Tim Curtis
Poore & Co
PROJECT: 87 Washington Street
Salem, MA
BBE Corporation (referred to herein as BBE) proposes to furnish and install one VL-120 2-stop vertical
platform lift manufactured by Inclinator Company of America at the above-referenced project.
All work shall be performed in accordance with the latest revised edition of the United States of America
Standard Safety Code for Elevators, Escalators, and Dumbwaiters,the National Electrical Code, and/or
524 CM (MA Code).
The specifications are as follows:
1. Model VL-120 Indoor Vertical Platform Lift—unenclosed
2. Manufacturer: Inclinator Company of America
3. Load: 750 LBS
4. Travel speed: 10 FPM
5. Lift platform: 36"x 54" clear
6. Platform configuration: enter exit same side
7. Drive system: screw
8. Total travel distance: 106 5/8 "(120" maximum)
9. SS main with emergency platform lighting
10. AC/DC Emergency battery operation
11. Lower landing fire-rated door
12. Upper landing fire-rated door
13. Interlocks for upper and lower doors
14. Manual lowering wrench
15. Telephone jack on platform
16. Color: beige powder coated
17. DRAWINGS: Shop drawings are included, lead time is approximately 5 days.
SCHEDULE: Estimated lead time is 4-6 weeks for the elevator equipment and 4 days for installation.
These are estimates only. Actual schedule is subject to Inclinator's/BBE's lead time at the time of
fabrication and installation.
BBE Corporation,27 Congress Street-Suite 205-5, P.O. Box 925,Salem, MA 01970
978-594-1197-Office 978-594-1024-Fax www.bbeeievator.com
South Shore Office-68 Hancock Street, Braintree, MA 02184
INSTALLATION: The equipment will be delivered directly to the project site. Purchaser will provide a
staging area to store equipment. If off-site storage is necessary purchaser will pay the storage fees.
Structural support landing preparation, working phone line, and power supply to the unit is the
responsibility of the Purchaser. It is the responsibility of the Purchaser to insure that the building site,
structures and materials they supply are code compliant. BBE will obtain the necessary permit to install
the lift and will arrange to have the lift inspected and a certificate issued.
PERMITS,TAXES, LICENSES: All applicable sales taxes, installation permit and license fees are included.
LIMITED WARRANTY: Standard warranty coverage of parts and equipment is provided Inclinator
beginning on the date BBE purchases the equipment on Purchaser's behalf. Inclinator warranties that
the product will be free of defects in material and workmanship under normal use and regular
maintenance.
PAYMENT/TERMS: BBE will furnish and install the equipment pursuant to the following terms:
Cost : $28,735.00
Terms: 50% deposit payable upon order; 50% payable upon completion of work and issuance of
Certificate by Commonwealth of MA Dept. of Public Safety.
PURCHASER ACCEPTANCE:
Authorized Signature Authorized Signature— BBE Corporation
Name &Title Name &Title
Date Date
.Deval L.Patrick 41dA. e/dd6d4""-" "--- 1921 IM'
Governor �/ ll",p-een? ThomaCommissioner
P.E.
Timothy P.Murray 'A Thomas
Vsry gpLy 00
LieutenantGovemor Thomas P.Hopkins
Director
Mary Elizabeth Heffernan
Secretary Gfl'P'!3-L!s''llllldG'p
TO: Local Building Inspector Docket Number V 12 266
Local Disability Commission
Independent Living Center
FROM: ARCHITECTURAL ACCESS BOARD
RE: opus Restaurant
87 Washington Street
Salem
Date: 11/6/2012
Enclosed please find the following material regarding the-above location:
_Application for Variance 4Decision of the Board
Notice of Hearing _Correspondence
Letter-of Meeting
The purpose of this memo is to advise you of action taken or to be taken by
this Board. If you have any information which may assist the Board in reaching
a decision in this case, you may call this office or you may submit comments in
writing.
Deval L.Patrick ei� etttl t%G7O��6�CJ
Govemor �f y ®y �+ Thomas G.Gatzunis,P.E.
c/ I xx m -m-e"i Commissioner
Timothy P.Murray y yp, q
Lieutenant Govemor �%pq' rl��j-/bwj-OO�� Thomas P.Hopkins
Director
Mary Mizabeth Heffeman
secretary Lf1GrfLrh9JZCllld / Docket Number V 1.2 266
NOTICE OF ACTION
RE: Opus Restaurant, 87 Washington Street Salem
1. A request for a variance was filed with the Board by Mark McDonough (Applicant) on October 12, 2012
from the following sections of the 06 Rules and Regulations
of the Board:
The applicant has requested variances m g
Section: Description:
28.12.1 Petitioner seeks a variance to allow the installation of a vertical wheelchair lift to serve the first floor and lower
level of a proposes restaurant. The petitioner does not meet any of the"By Right"allwances of 521 CMR
Section 28.12.1 a thru e. The vertical wheelchair lift will meet the requirerments of 521 CMR Section 28.12.2
2. The application was heard by the Board as an incoming case on Friday, November 2,2012
3. After reviewing all materials submitted to the Board,the Board.voted as follows:
GRANT: the variance to Section 28.12.1 as proposed for the reason that impracticability(see definitions of
impracticability in Section 5 of 521 CMR) has been proven in this case and on the condition that the vertical wheelchair
lift is permited and inspected by the Commowealths Elevator Division, and a copy of the inspection certificate is
provided to the Board upon completion of the work.
PLEASE NOTE:All documentation(written and visuaa verifying that the conditions of the variance
have been met must be submitted to the AAB Office as soon as the required work is completed.
Any person aggrieved by the above decision may request an adjudicatory hearing before the Board within 30 days of
receipt of this decision by filing the attached request for an adjudicatory hearing. If after 30 days, a request for an
adjudicatory hearing is not received, the above decision becomes a final decision and the appeal process is through
Superior Court.
Date: November 6, 2012
cc: . Local Disability Commission Chairperson
Local Building Inspector ARCHITECTURAL ACCESS BOARD
Independent Living Center
The Commonwealth of Massachusetts
Department of Public Safety Docket Number
Architectural Access Board
One Ashburton Place, Room 1310 (Office Use Oniy)
Boston Massachusetts 021084618
Phone: 617-727-0660
Fax: 617-727-0665
www-mass.gov/dps
REQUEST FOR ADJUDICATORY HEARING
RE:
Name and address of building as appearing on application for variance
I, do hereby request that the Architectural Access Board
conduct an informal Adjudicatory Hearing in accordance with the provisions of 801 CMR Rule 1.02 et.
seq. as I am aggrieved by the decision of the Board with respect to Section(s)
of the Rules and Regulations of the Architectural Access Board, 521 CMR.
I understand that I may request such a hearing within thirty (30) days of receipt of the Notice of Action.
Date:
Signature
PLEASE PRINT:
Name
Address
City/Town State Zip Code
E-mail
Telephone
PLEASE NOTE:
This form must be received by the Board within thirty (30) days after receipt of the Notice of Action.
Rev, 01110
faw�acnre mesei swov aw.vxtia wn
SERENITEE
ssrmaat v mms Y i�Y - - rmER MANAGEMENT CORP,
87 WASHINGTON ST.
t—�- - c SALEM, MA 01970
mi vvuuai
PLd4TI ,
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,I.. VL0774
AMERICA
M�M�DRe.PA
INAR.Drs,SW BY L.C.
-FIELD LOCATE i0 MEET .MOP navy we MATTI
T�ruc. / N.EO AND/OR LOCAL CODES. SERENITEE
—ENCLOSIIRE DV OiXERS I , for MANAGEMENT CORP.
�—�-III 133"H
__ 87 WASHINGTON ST.
- SALEM, MA 01970
ALL
MA WEND
DOOR
DR PLATFORM
603E 3 %{ 1 ED P xrx wvl�rO are
ERLDCK 3B3' /% BDE CORPORATION
1 C R 38I'O"A W
UL"-LL XEIGHT ENCLOSURE I
1 /DOOR
DONS BY OTHERS I
l—=2-R'[:- SPECIPSCHTIONS
---541CRR —k L-12D
LANDING
VERTICAL LIFT
UPPER - SHAFT PLAN
CAR 36'Dn54'Vr42•X CDDE(SI 3
CAPACITY 750 LBS.AT 10 FPA.
FINISH.BEIGE
®ALL INCOME MUST BE INTERLOCKED
O ®KETSVITCH OPERATION
O AUTO FOLD RAMP
12'-B I/2' RAVEL
0 pP O STAY ID NARY RAMP
iGMER TRA EL O EAH DING GATE WE` IN TERLDCK
HEI{HT O PLATFORM GATE WITH INTERLOCK
®EMERGENCY ALARM
O ®EMERGENCY STOP
®MANUAL LOWERING
NEY STOP gLARN PLATFORMSAFETY MECHANISM
INS
O INSTANT
REVERSE
- DOVN o FLIMITNCL SWITCHES
CHOL GOENCLOSURE By RS BY INCGA
CAR CEDON O SAFETY ST By
INCOA
MWNTCD ON O SAFETY STOP DIAPHRAGM
THE PLAifGRMI
NOTICE TO ELECTRICAL CDYIRAC iDR.
INSTALL IIOr,SINGLE PHASE
DISCGNNE Ci SWITCH
I N.P.MOTOR 12D..SINGLE PHASE
LOWER
LOOR [4?0
60 CYCLE
20 AHP MIN LIRE FUSE
FLOOR 6'MIN JOOOp9 CONCRETE
FLON iO Ma GE A SMOOTH R11111
BLAP NrY FINIBM FREE N HOLLOWS OR BUMPS.
SURFACE TII BE LEVEL AND ILA. ID
WITHIN SI/B'IN ANY DIRECIIDN. RE!'fAT CAR CpMftNG DMEGARAWL JOB X 12-ATTEM
LOCATED AT EACH LANDING DRAWING BY,B.pRAiiEN
SECTION A—A E REVS OVIBIOME
@ 10/23/2p12
R I
EVSE@-
DRAWING IDENTIFICATION NUANCE
VL0774
LIFT INSTALLATION AGREEMENT
DATE: October 5, 2012
PURCHASER: Tim Curtis
Poore & Co
PROJECT: 87 Washington Street
Salem, MA
BBE Corporation (referred to herein as BBE) proposes to furnish and install one VL-120 2-stop vertical
platform lift manufactured by Inclinator Company of America at the above-referenced project.
All work shall be performed in accordance with the latest revised edition of the United States of America
Standard Safety Code for Elevators, Escalators, and Dumbwaiters,the National Electrical Code, and/or
S24 CMR (MA Code).
The specifications are as follows:
1. Model VL-120 Indoor Vertical Platform Lift—unenclosed
2. Manufacturer: Inclinator Company of America
3. Load: 750 LBS
4. Travel speed: 10 FPM
5. Lift platform: 36"x 54" clear
6. Platform configuration: enter exit same side
7. Drive system: screw
8. Total travel distance: 106 5/8 " (120" maximum)
9. SS main with emergency platform lighting
10. AC/DC Emergency battery operation
11. Lower landing fire-rated door
12. Upper landing fire-rated door
13. Interlocks for upper and lower doors
14. Manual lowering wrench
15. Telephone jack on platform
16. Color: beige powder coated
17. DRAWINGS: Shop drawings are included, lead time is approximately 5 days.
SCHEDULE: Estimated lead time is 4-6 weeks for the elevator equipment and 4 days for installation.
These are estimates only. Actual schedule is subject to Inclinator's/KBE's lead time at the time of
fabrication and installation.
BBE Corporation, 27 Congress Street-Suite 205-5,P.O. Box 925,Salem, MA 01970
978.594-1197-Office 978-594-1024-Fax www.bbeelevator.com
South Shore Office-68 Hancock Street, Braintree, MA 02184
INSTALLATION: The equipment will be delivered directly to the project site. Purchaser will provide a
staging area to store equipment. If off-site storage is necessary purchaser will pay the storage fees.
Structural support landing preparation, working phone line, and power supply to the unit is the
responsibility of the Purchaser. It is the responsibility of the Purchaser to insure that the building site,
structures and materials they supply are code compliant. BBE will obtain the necessary permit to install
the lift and will arrange to have the lift inspected and a certificate issued.
PERMITS,TAXES, LICENSES: All applicable sales taxes, installation permit and license fees are included.
LIMITED WARRANTY: Standard warranty coverage of parts and equipment is provided Inclinator
beginning on the date BBE purchases the equipment on Purchaser's behalf. Inclinator warranties that
the product will be free of defects in material and workmanship under normal use and regular
maintenance.
PAYMENT/TERMS: BBE will furnish and install the equipment pursuant to the following terms:
Cost : $28,735.00
Terms: SO% deposit payable upon order; 50% payable upon completion of work and issuance of
Certificate by Commonwealth of MA Dept. of Public Safety.
PURCHASER ACCEPTANCE:
Authorized Signature Authorized Signature— BBE Corporation
Name &Title Name&Title
Date Date
INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes[3 No❑
If you have checked Yes,indicate the type of coverage by checking the appropriate box below:
A liability insurance policy ® Other type of indemnity n Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this boxUL I hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and
accurate to the best of my knowledge and that all sheet metal work and Installations performed under the permit Issued for this application will be
in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Duct inspection required prior to insulation installation: YES NO
Progress Inspections
Date Comments
Final Inspection
Date Comments
Type of License:
By 0 Master
Title
❑Master-Restricted
City?own
❑Journeyperson Signature of Licensee
Permit#
❑Jo u rn eyperson-Restricted
Fee$ License Number: 2 0 3 5
❑ Check at www.mass.gov/dpi
Inspector Signature of Permit Approval
CITY OF &U� EM, 2UNSSACHUSETTS
BL'II.DING DEPnn ENT
\ 120 WASHINGTON STREET,3"FLOOR
TEL (978) 745-9595
FAX(978)740-9846
KLNfBERLEY DRISCOLL
1NMAYOR THoltus ST.PIHRRI3
DIRECTOR OF PUBLIC PROPERTY/BUILDLNIG CO%tNiMIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Vame(ousinessDrganizatiorolndividual): i..7t.rt d 4
Address: SG
City/State/Zip: .�Ou^,O -c L ei4O Q/f3 Phone t/: 97B-3sb 4 40o all' Q�8 _ ram£4 s
Are you an employer?Check the appropriate box: Type of project(required):
I. 1 am a emplo cr with 20 4. [] 1 am a general contractor and 1 6. ❑New construction
employees�ll%nd/or part-time).• have hired the sub-contactors
2.Q 1 am a sole proprietor or partner- listed on the attached sheet.t 7• (A.Remodeling
ship and have no employees These sub-contractors have S. Q Demolition
working for me in any capacity. workers'comp.insurance. g, Q Building addition
(No workers'comp. insurance 5. Q We are a corporation and its
required.) officers have exercised their 10.Q Electrical repairs or additions
3.Q I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself.[No workers'comp. c. 152,§I(4),and we have no 12.Q Roof repairs
insurance required.)t employees.[No workers' 13.❑Other Ig S r in�L
comp. insurance required.1
'Any applirant awl cltttits box ql must also fill out the section below showiagthen wwkpa'compensation he mformadon.
'I tnmeownm whn submit this affidavit indicating they are doing ell work and then hire outside contractors most submit a new affidavit indicting such.
:Contrwton that cheek this box must attached an additional chat showing the name of the mbt tm uxg and their workers'comp,policy information.
1 um an employer that is praviding workers'compensation insurance for my employees. Below Is the polley and Job site
information.
Insurance Company dame: -J'Q/9dC leis_
Policy k or Self-ins.Lie.#:. o?S6 S F3 Expiration Date:_
Job Site Address: .. M City/State/2ip• .Sar(e. 011014-
Attach 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 S 1,500.00 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigatioms of rite MA for insurance coverage verification.
i do hereby Gerd nder the pains and penalties of perjury that the hitforaration provided above is true and correct.
i
n r ve p�4 Date 7 /iV / J
Phone#: //�— 3 SG 9 T o y V., 99'8 n e, r a-1 ?r
Official use only. Do trot write in this area,to be courpleted by city ar town official
City or Town' Permit/!-feense#
Issuing Authority(circicone):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other..._,
Contact Person: Phone#:
-"—..N OP ID: MH
,4`�Ro CERTIFICATE OF LIABILITY INSURANCE DAT05/23/12
OS/23/12
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. 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 endorsements .
PRODUCER 781-914-1000 CONTACT
TGA Cross Insurance,Inc. NAME:
401 Edgewater Place,Suite 220 aICONrio Ent: FAXNo:
Wakefield,MA 01880 E-MAIL
Chris Hawthorne ADDRESS:
PRODUCER MORRI-2
CUSTOMER,,,
INSURERS AFFORDING COVERAGE NAIC9
INSURED Morris Heating 8 AC,LL . INC.
Tim Morris INSURER A:Travelers Indemnity Company 25658
8 Scotts Way INSURER B:
Essex,MA 01929 INSURER C:
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NSRAMI gun LTR TYPE OF INSURANCE POLICY NUMBER MM0DY/YYYY MMLODY/YNYY LIMITS
GENERAL LIABILITY MBen. $
RRENCE $ 1,000,00
A rX COMMERCIAL GENERAL LIABILITY 6801582MO48 04/01/12 04101113 Eaccou,rence $ 300,00
CLAIMS-MADE OCCUR y one person) $ 5,00
ADV INJURY $ 1,000,00
GREGATE $ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER: -COMP/OP AGG $ 2,000,000
Poucv PRO- LOC $ 1,000,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
A ANY AUTO BA-1584MO78-12-SEL 04/01/12 04/01113 (Ea accident)
ALL OWNED AUTOS BODILY INJ URY(Per punier) $
X SCHEDULED AUTOS BODILY INJURY(Per acadent) $PROPE
X HIRED AUTOS (PeraW ent)TY GE $
(Per acadent)
X NON-OWNEDAUTOS $
UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,00
EXCESS LIAB CLAIMSMADE 2,000,D00
A CUP-9234Y245-12-42 04/01/12 04/01113 AGGREGATE $
DEDUCTIBLE
X RETENTION $ 10000 Is
WORKERS COMPENSATION WC STATU- OTH-
AND EMPLOYERS'LIABILITY V LI IT
A ANY PROPRIETOWPARTNER/EXECUTIVE Y/- UB7617X217 04/01/12 04/01113 E.L.EACH ACCIDENT $ 500,00
OFFICEIRMEMBER EXCLUDED? NIA
(Mandatory In NH) E.L.DISEASE EA EMPLOYE $ 500,00
IfyyeUsSr0peunder
IJESCRIPTIONOFOPERATIONSeem EL.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required)
CERTIFICATE HOLDER CANCELLATION
PROOF-2
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
PROOF OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
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C 1988.2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD
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ISSUES THE ABOVE LICENSE TO:
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8 SCDTTS WAY
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LICENSE •. EXPIRATION DATE SERIAL NO.
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