22-24 WEATHERLY DR - BUILDING INSPECTIONP
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The Commonwealth of Massachusetts
Department of Public Safety
Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building o ther than a One-or Two-Family Dwelling
C\j (This Section For Official Use Only) -
Building Permit Number: Date Applied: Building Official:
_.. . . -..
SECTION 1:LOCATION(Please indicate Block#and Lot:#for locations for which a street address is not available) '
No.ar@
Street City/ own Zip Code Name of Buil ng(if applicable)
Edition of MA State Code used If NSECTION
w CConstruction check here
c PROPOSED W
\.— re❑or check all that apply in the two rows below
Existing Building Repair Alteration ❑ 1 Addition❑ 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 ❑ No ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No C
B ' f Description of Proposed Work: ® -
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SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,AD TIO� `.
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Ci
Existing Use Group(s): ot Proposed Use Groul:
SECTION 4:BUILDING HEIGHT AND AREA `
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-20 Nightclub ❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business ❑ E: Educational ❑
F: Facto F-1 ❑ F2❑ H: Hi Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional I-1❑ I-2❑ I-3❑ I-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(Check as applicable) ,
IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑
Private❑ or indentify Zone: or on site system❑ required❑or trench or specify:
permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Prexess:
Not Applicable❑ Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes ❑ or No❑ Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor:
Does the building contain an Sprinkler System?: Special Stipulations:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Prope Owner
Dr,
Name(Print) —r6'U94- No.and Street City/Town Zip
Property Owner Contact Information:
-1V/ - 003
T' e Telephone No. (business) Telephone No. (cell) e-mail address
I p lica e,the property owner hereby authorizes
�
Name Str6k Address City/Town State Zip
to act on the property owners behalf,in all matters relative to aA,authorized by this building permit application.
.SECTION 10.CONSTRUCTION CONTROL(Please fill out Appendix 2), x;
If din,is less than 35,.0 cu.ft.of enclosed space and/or not under Construction Control then check t. rm and'ski Section-10.1 ,
10.1 Registered Professional Responsible for Construction Control_
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General-Contractor r' '. 'x 'u
T
Company Name
aa,A-"rtt � 4 r
Name of Person Respons'bl�for Cons action License No. and Type if Applicable
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Street A O ress City/Town State Zip
_ telephone No.(business) Telephone No. cell a-Mail acOress
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L-.c.152.:§ 25C 6
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the f uance of the building permit.
Is a signed Affidavit submitted with this application? Yes No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT-FEE .: '" 'j
Item Estimated Costs: (Labor
and Materials) Total Construction Cost(from Item 6)
1.Building $ Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)_$
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical Other $
Enclose check payable to
6.Total Cost $ �� �'�,q0, dD (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APFLICANTiw,,
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this
application is true and accurate to the best of my knowledge and understanding.
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Please print and sign name Titie Telephone No. Date
as - p `P CJ�H of o 4U
Street Aqfdress City/Town State Zip
Municipal Inspector to fill out this section upon application approval
QN The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): KTM Properties, LLC
Address: 25 Spaulding Rd - Suite 17-2
City/state/zip: Fremont, NH 03044 Phone #: 603-895-0400
Are you an employer? Check the appropriate box:
Type of project(required):
1.0 I am a employer with 25 4. ❑ 1 am a general contactor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have g. ❑Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.l 9. Building addition
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I LEJ Plumbing repairs or additions
myself No workers' comp. right of exemption per MGL
Y [ P 12.❑ Roof repairs
insurance required.] 1 c. 152, §1(4), and we have no 13.❑ Other
employees. [No workers'
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
=Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is thepo/icy and jab site
information.
Insurance Company Name:
Union Insurance Company
Policy#or Self-ins.Lic.#: WCA51 5231 6-1 0 Expiration Date: 6/16/2015
Job Site Address:
Weatherly Drive Building 22-24 Salem, MA
City/State/Zip:
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$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
Investigations of the DIA for insurance coverage verification.
I do hereb ert/if�y�under thepAains an enalties ofperjury that the information provided above is true and correct.
Si¢natureCJ /L���f1J, Date: 9/18/2014
Phone#: 603-895-0400
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority (circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
CITY OF U.&\12 i�I-
SkSSACHUSE=
BUILDING DEPART%MNT
• 130 WASHINGTON STREET, 3'o FLOOR
TEL. (978) 745-9595
FAX(978) 740-9846
KLNiBERLEY DRISCOLL
MAYOR TlioNw ST.PmRRRs
DIRECTOR OF PUBLIC PROPERTY/BUUMNG COMMISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL e 40, S 54;
Building Permit# 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
111, S 150A.
The debris will be transported by:
�22iAf- g /a,�
(name of hauler)
The debris will be disposed of in
(name of facility)
(address of facility)
signaturAp/itZapplicant —
date
debrisaITakw
- C'/' �,`( uveatos tt;wd�rf<=f4xi%an�"�u,efli
nnsumerhffairs&Cusmess ttcgulntian License or registration valid for individnt use only
' before the expiration daie. If found.return
of G g
V&JME IMPROVEMENT CONTRACTOR office of Consumer Affairs anti I3usiooss Re
ulation
2ogistratian 1Gdit38 TYPO f0 Fark Pl.Gaa-Suite SS70
Expiratjtin '872512016_ Supplement Gard Boston,MA-02116
f. KTM;PROPERTIESrA LO„ ;
CHARLES MiNASALLI ,
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f REMONT,NH 03044 Vndersecre airy
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Appendix 2
Construction Documents are required for structures that must comply with 780 CMR 107. The
checklist below is a compilation of the documents that may be required for this. The applicant
shall fill out the checklist and provide the contact information of the registered professionals
responsible for the documents. This appendix is to be submitted with the building permit
application.
Checklist for Construction Documents*
Mark"x"where applicable
No. Item Submitted Incomplete Not Required
1 Architectural
2 Foundation
3 Structural
4 Fire Suppression
5 Fire Alarm(may require repeaters)
6 HVAC
7 Electrical
8 Plumbing include local connections
9 Gas Natural,Propane,Medical or other
10 Surveyed Site Plan(Utilities,Wetland,etc.
11 Specifications
12 Structural Peer Review
13 Structural Tests&Inspections Program
14 Fire Protection Narrative Report
15 Existing Building Survey/Investi ation
16 Energy Conservation Report
17 Architectural Access Review 521 CMR
18 Workers Compensation Insurance
19 Hazardous Material Mitigation Documentation
20 Other(Specify)
21 Other(Specify)
22 Other(Specify)
*Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work
so identified must not be commenced until this application has been amended and the proposed construction document amendment
has been approved by the authority having jurisdiction.Work started prior to approval may be subjected to triple the original permit
fee.
Registered Professional Contact Information
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address
Registration Number
Discipline Expiration Date
Street Address City/Town State Zip
sy The Commonwealth of Massachusetts
f, Department of Public Safety
Massachusetts State Building Code (780 CMR)
Building Permit Application to Construct, Repair, Renovate or Demolish any
Building other than a One-or Two-Family Dwelling
Code and Other Requirements for Building Permits
The Department of Public Safety has issued these building permit application forms so that municipalities
across the state can move toward use of a single permit form and consistent permit application process.
The MA State Building Code specifies the requirements of building permits and the applicant is advised to
review and be familiar with these requirements in order to avoid some of the common permit application
problems. Likewise the applicant should be aware that some municipalities require that the owner confirm,
even prior to acceptance of the building permit application, that no outstanding property taxes, water fees,
etc. exist.
Filing Instructions
1.Please contact the city or town where the work will be done to ensure that the city or town will accept
this application form and if any additional information is required, and obtain the correct mailing
address. After doing so, print the application, fill in completely and then submit to the local city or
town where the work will be done.
2.All applications shall be considered complete and will be reviewed if construction documents,
specifications, fee, and other materials that may be required as indicated in the Building Permit
Application are included with the application.
3.Please include a check for the Building Permit fee. The fee may be calculated using the information to
be supplied in section 12 of the Building Permit Application. The check is to be made payable to the
local cityr town w o o here the work will be done.
1
pc oc t�c uS.g aL
August 5, 2014
Weatherly Drive Condominium Trust
C/O East Coast Properties
400 Highland Avenue Suite 11
Salem, MA 01970
Re: Rubber Roof Proposal—22-24 Weatherly Drive
Dear Cyndy,
As per your request and our site visit, we are pleased to provide you with a proposal for rubber roof
replacement at the address reference above.
Scope of Work:
24 Weatherly Drive- Lower Left Wing Roof
• Remove& Dispose existing rubber roof system to roof deck
• Remove& Dispose of White Metal Drip Edges
• Supply& Install tapered insulation and mechanically attach to roof deck
• Supply& Install Carlisle .060 EPDM Fully Adhered Rubber roof
• Supply& Install Membrane flashings at all existing penetrations
• Remove existing wood trim at the base of the rising walls and install new membrane flashings
• Reinstall wood trim at base of rising walls
• Supply& Install new .032 White aluminum drip edge metal
• 20 Year warranty
Price:$5,200.00
22&24 Weatherly Drive-Upper Roofs
• Remove& Salvage PVC Railings
• Remove & Dispose existing rubber roof system to roof deck
• Remove & Dispose of White Metal Drip Edges
• Supply& Install 1" insulation and mechanically attach to roof deck
• Supply& Install Carlisle .060 Fully Adhered EPDM Rubber roof
• Supply& Install Membrane flashings at all existing penetrations and railing posts
• Reinstall PVC Railings
• Supply& Install new .032 White aluminum drip edge metal
• 20 Year warranty
KTM Properties, LLC
25 Spaulding Road, Suite 17-2, Fremont NH 03044
Tel: 603-895-0400 Fax: 603-895-0445
2
Price:$21,545.00 Each
If you have any questions, please feel free to contact me at 603-895-0400.
Sincerely,
C
VI440(
CharlesJ. Minasalli
President
KTM Properties, LLC
25 Spaulding Road, Suite 17-2, Fremont NH 03044
Tel: 603-895-0400 Fax: 603-895-0445
Marcia Kirkpatrick
From: Cyndy Anselmo <cyndy@ecpllc.net>
Sent: Thursday, October 30, 2014 3:32 PM
To: Marcia Kirkpatrick
Subject: 22 - 24 Weatherly Drive, Salem MA 01970
Hi Marie
This letter will confirm that we are replacing the rubber roofing at 22 Weatherly and 24 Weatherly Drive, Salem
MA. The property is located in the Weatherly Drive Condominium Trust, which is a property that I manage.
If you need anything further, please do not hesitate to call.
Cyndy
Cyndy Anselmo
East Coast Properties, LLC
Real Estate and Property Management
400 Highland Avenue Suite 11
Salem, MA 01970
P: 978-741-2003
F: 978-745-9684
cyndy cr eepllc.net
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