45 WEATHERLY DR - BUILDING INSPECTION a ,y
sgvgEU GEC
The Commonwealth OL"MNSsachusetts
Department of Public SafehL1 A 59
t lassachusetts State Building a�� Co)
Building Permit Application for any Building other than a One.or Two-Family Dwelling
(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)
_ G 6 f70 6 an Conk (r��
No.and Street City/Town Zip Code Nam of Budding(if applicable)
''SECTION 2-PROPOSED WORK
Edition of MA State Cale used_ If New Construction check here❑or check all that apply in the two rows below
Existing Building❑ Repair❑ I Alteration Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix I)
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? ,,1 Yes ❑ No M
Brief De!s0h n of Propo ed Work: �n�,� foil t�`f -
rQf-o t .J r ail 0.
a} /a.r nn i .-. .AJ .h• (uC�J \d���t - �C1t'l�-Z�S'1it
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) Q_✓'
Existing Use Group(s): I Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Fluor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-i❑ A-2❑ Nightclub ❑ A-3 ❑- A4❑ A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-I❑ F2❑ Fh Hi h Huard H-1❑ H-2❑ H-3 ❑ H4❑ H-5❑
1: Institutional I-l❑ 1-2❑ 1-3❑ 14❑ 1 M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑
S: Storage S-1❑ 5-2❑ 1 U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as a If life)
IA ❑ IB ❑ HA O 1111 ❑ IIIA ❑ ME ❑ IV ❑ VA ❑ VB O
SECTION 7.,SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Sup ly: Flood Zone Information: Sewage Disposal: Trench Permit. Debris Removal:
A trench will not be Licensed Disposal Site SK
Public Check if outside Flood Zone❑ Indicate municipal required❑or trench or specify:
Private❑ or indentify Zone: or on site system❑ permit is enclosed❑
Railroad right•of-w y: Hazards to Air Navigation: ti•�!!� t n ��„�,��,
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,in Sprinkler System?: ._ Special Stipulations: __—
f�l A�L.19D Z�ZL� 1 5
' � SE("1'IUN`k l'ItUi'PITIY(ItWF.RAUI_lU1RtYAl'IUN—___--J_,—.___._, _ i
Vawe and .1ddn•++ul Pntprrty Ora ner
No.and Street Lily/rows ZiV
'i Name(i rent) .
Property Owner Contactau
Inhmtuuiun:
� --- e•nutil addnhs
I"itle� Folephune No.(business) relcphune No. (colt)
it applicabiv,the proper`)'owner hereby authorises
i�sc>1• 2 ►►�- b\q
State
Name Street AL dn..' City/row•n Li P
j to act on the rat n•rt owners lxhalf,in,dl matters relative to work authurizal b•this buildin •nnifa irtStiun.
SECTION 1U.CUNsrttuCrION CONTROL(Please fill out Appendix 2)
If buikiho is Tess than 3i.lxv eu ft.of a ncktsart x,,ur and ur txn under Cumtmetion Contml then check here O and ski 5txtknt W.l
(iLl Re filtered Professional Res onsiblil far Construction Control
Tcle hone No. Registration Number
Mama(Registrant) p mail address K
Start Address City/Town State Zip Discipline Expiration Date
to3 General Contractor
!
Company Name rg, p�'�1$S
Nance of Person Responsible for Construction License No. and Type if Appikable
2!�3l�Mn�nrs—�vJ N•�.
Sheet ALICIMs City/Town State Zip
Sf.. tQ&fl'iV�f2AJ.ja
— +� e-maUaddress
rote+hone No. business Tele hono Nu. ceR
SECTION 11:to ;w'f v.\t It+r l,r a q:.\�s't .0 111 ;�'I I hLG.L a 1S2 75C 6
A Workers'Compensation htsurmce Affidavit from the MA Department of Industrial Accidents must be cmntpleteal and
submitted with this application. Failure to provide this affidavit wiUnsult in the denial of the ' uancc of the building permit.
Is a si nd Affidavit submitted with this a lication? Ya No O
SECTION li CONSTRULAWN COSTS AND PERrvlrr FEE
Estimated Costs:(Labor
Item .• ar,rh.,:..1s-;1_ rota)Construction Cost(from Item b)-S_
I. Buildin y - 1 ® v..._. Building PermitFrr'TotalConstructionCostx—(Invert here
Electrical S 2t�a � I appropriate municipal factor)2. S
A. Plumbing i 1- Nate: \lininnun ter"5__(contact municipality)
1. \lah.micul (FIVA S "�Od . .
i .Mcchaniwl Other) S p Fmiow ,h.rk payable to
t, rota)Cost 5 1 1 .c ;.ontact ntomci alih').utd writr:h..k numba•r here
- SECr1ON b:SIGNA LURE OF BUILDING PERMIT APPLICANT
+,fins at +enaltic's n er un•that all of the information Contained in this
Iry entering Illy more below.I hereby attest under the j F
application is true and accurate to rite best of my knoe Iedg n. ud
i I'Iea,v pant en.l'i),n rarer•
i �t.de /tp
••Ircrt .\.Ll n-s
2�� c1� wKS� M �►. o�
Municipal Inspector to Eill out this.cation upom application.tppnwal: I tety
\a to .
tA
i
i
CITY OF SALE.\I, N-WSACHUSETTS
BL•1LDLIG DEPARTIE.NT
3 ( l 120 WASHIINGTON STREET, 3'a FLOOR
TEL (978) 745-9595
Eix(978) 7404846
K.NIBERLF-Y DR)SCOLL
"iK,s1YOR THOA/AS ST.PtFxitl3
DIRECTOR OF PUBLIC PROPERTY/BCII-Drsr,CO\LURSSMNER
Workers'Compensation insurance AB)davit: Builders/Contractors/Electricians/Plumbers
iinlleant Information Please Print Leelbly
Nillnt:(Ilusirx,s0rganiratioltu'jlndividual):_,_„o��Jyg<1�L_��C�(��r� ��9(�.�k (,
Address: -
Cily/State/Zip: Phone
Are you un employer'Check the appropriate box: Type of project(required):
1.0 1 am a employer with 4, am a general contractor and
6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.0 I am a sole proprietor or partner. listed on the attached sheet.i 7• jtemodeling
.hip and have no employees Thee sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9. 0 Building addition
INo workers'comp.insurance 5. 0 We are a corporation and its 10.❑Electrical repairs or additions
required.) officers have exercised their
3.❑ I am a homeowner doing all work - right of exemption per MOL 11.0 Plumbing repairs or addition
myself.[No workers comp. c. 152, 41(4),and we have no 12.0 Roof repairs
insurance required.) t employees.[No workers' 13.0 Other
comp.insurance required,j
•Any applisma d%u ehnks bus rl attar also rill out the=siw below showing their wa coo'eompemad luon polity in nusdon.
'I hvneuwnts who submit this affidavit indicating dicy am doing all work and than hits outside commetas must submit a new rflldavil indicating web
:c,mtn tors that drsek this box must aeachol an additional sheet showing fhc namo ofncc sab4vitua tom and their workers'camp.policy intonation.
l one an earp/uyer that is providing tvorkert'conspensailon insurance for my employees: Below is the po/ley urrd job rice
information.
Insurance Company Name: �` Cn�/\trU +7`y�' '"�.,Q�,q- C-CI.
Policy d or self-ins.``Li��c.d: Q--JI — —'—c1' Enpiration Dals:
Job Site Address: "6� t- CA, �Y[\k �� 1�_City/State/Zip:
Attach a copy of the workers'compensation polity de Iaratloa page(showing the policy number and cap ration data). 7'
railurc w secure coverage as required under Suction 25A orMGL c. 152 can lead to the imposition ofcriminal penalties of a
fine up to 51,500.00 undlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line
of up to S230.00 a day against the violator. Ile advised t t a unity of This statemem may be rurwarded to file Office of
Inscstigmiuns ul'Ihe fIIA fur insurance vcmgc veri- ali -
/da hereby cerr/fy under the p mad eua/r s u njury rhal the/arjunuu/lan prurideJ ubuys is true and correct.
S-•n t re' j���j // ry7 lIQL Date: -7,/�7
7
4
OJJivial use mr/y. Du our rvrire in rhlr area,rube cuarplerrrr!by city of Iowa nJJ1sfal
City orTntvn: - -- Permlu'Llccnseq__...__. ..-_--. i
Issuing Authority (circle one):
1. Board of Ileallh 2. Building Department .i.ciiylruivo Clerk J. Electrical(uspector 5. Plumbing lospeetor I
6.Other
I �
ill
QTY OF SALEK MASSACHUSEM
BUIIAING DEPARTMENT
' 120 WASH NGTON STREET,3'm FLoaR
TEL. (978)745-9595
KMERLEYDRISCOLL FAX(978)740.9846
MAYOR THOMAS ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BUIIAING 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 c40, 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 deposit facility as defined by MGL c 111, S 150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in:
(name of facility)
(address of facility)
gnature of applicant
at
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE 02/03/20153/2015
PRODUCER (978) 922-0086 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Carmen-Kimball Insurance Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
4 Yr HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
48 Beckford Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO Box 73
Beverly MA 01915- INSURERS AFFORDING COVERAGE NAIC#
INSURED - INSURER A:Technology Insurance Cc
Sheldon Frisch Development Inc. INSURER a:Essex Insurance Cc
PO BOX 811 INSURER C:
218 Humprhey Street INSURER D:
Marblehead MA 01945— INSURER E'
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY
REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR DA
ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY
POLICY EXPIRATION L SI INSRD DATE MMIDDIYY)) LIMITS
B X GENERAL LIABILITY 3DK8834 04/15/2014 04/15/2015 EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAGE
SEa RENTED
$ 50,000
CLAIMS MADE FxI OCCUR / / / / MED EXP(Any oneperson) $ 5,000
PERSONALS ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2.00D,000
GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2,000,000
POLICY JECT LOC
AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT
ANY AUTO (Ea accident) $
ALL OWNED AUTOS / / / / BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIRED AUTOS / / / / BODILY INJURY
NON-OWNED AUTOS (Per accident) $
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO / / / / OTHER THAN EA ACC $
AUTO ONLY: AGO $
EXCESSIUMBRELIA LIABILITY / / / / EACH OCCURRENCE $
OCCUR CLAIMSMADE AGGREGATE $
DEDUCTIBLE / / / / $
RETENTION $ C g ❑❑ $
A WORKERS COMPENSATION AND WC990001B 03/31/2014 03/31/2015 X TORVrLA,T %T
EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNEPIEXECUTIVE E.L.EACH ACCIDENT $ 500,000
OFFICERIMEMBER EXCLUDED? / / / / E.L.DISEASE-EA EMPLOYEE$ 500,000
It yes,tlescribe under
SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 506,000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Job Site: 16 Holly St., Salem, MA
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
City of Salem FAILURE TO DO SO SHALL IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE
INSURER ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE '
Salem MA 01970- .r� ..- __. .�^'�^.�..•.... :r:
ACORD 25(2001/08) - 0 ACORD CORPORATION 1988
INS025(otospi; Page I of 2
.Verizon I MyVerizon 2.01 Verizon Message Center- Fwd: 45 Weatherly Drive, Salem M... Page 1 of 2
L�
Verizon Message Center
Thursday, Feb 5 at 10:12 PM
From: Howie Abrams<habrams@massmed.org>
To: Sheldon Frisch swfrisch@verizon.net
Cc: Israella Abrams
Subject: Fwd:45 Weatherly Drive, Salem MA-Howard Abrams
Here you go--
Let's try to pin down a start date soon
Howie
Sent from my iPhone
Begin forwarded message:
From: Cyndy Anselmo<cvndvC@ecpllc.net>
Date: February 5, 2015 at 10:05:40 PM EST
To: "tstpierrepsalem.com"<tstpierreasalem.com>
Subject:45 Weatherly Drive,Salem MA -Howard Abrams
Dear Tom,
Please be advised that Howard and Izzy Abrams have approval from the Weatherly Drive Condominium
Trust to install a new master bedroom bathroomin their unit.
If you have any questions, please call.
Hope you are having a great Winter!II
Cyndy
Cyndy Anselmo
East Coast Properties,LLC
Real Estate and Property Management
400 Highland Avenue Suite 1 I
Salem,MA 01970
P:978-741-2003
F:978-745-9684
cvndv0),ecpllc.net
https://mail.verizon.com/webmail/public/printjsp?wid=vz widget MailOpen 2&type=mail... 2/9/2015