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65 WEATHERLY DR - BUILDING INSPECTION (2) The Commonwealth of Massachusetts 4 Department of Public Safety Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two- m' Dwell' g (This SecttotrFor,OfficialUseOnly), ,,,, ,,;; �„, ,.` ' Budding PermitNomber.' ''- iDateApplied __'�, n _ 'BuildmgOffictal SECTION 1:.LOCATION(Please.indicate Block.#and Lot#for locations for which a street,address is not ' iu No.and Street hty/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED Edition of NIA State Code used_ If New Construction check here❑or check all that apply in the two rows below Existing Building❑ Repair❑ Alteration. Addition❑ I Demolition ❑ (Please fill out and submit Appendix 1) Change a I 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 IX Brief Description of Proposed Work• J C-O_ AyOoti �� t1 Ar SECTION 3:COMPLETE THIS SECTIOMIF EXISTING BUILDING UNDERGOING RENOVATION;ADDITION,OR. CHANGE IN USEOR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA.: Existing Proposed No.of Floors/Stories(include basement levels)8r Area Per Floor(sq.ft.) Total Area(sq. ft.)and Total Height(ft.) SECTION 5i USE GROUP(Checkas.applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ F B: Business ❑ E,Educational ❑ F: Facto F-1 ❑ F2❑ H: High 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❑ Us-Utility❑ Special Use❑and please describe below: Special Use: SECTION 6i CONSTRUCTION-TYPE(Checkers applicable) [A ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)' Trench Permit: Debris Removal: Water Sup�p(/ Flood Zone Information: Sewage Disposal: Licensed Dis osal Site❑ Public IB' Check if outside Flood Zone Indicate municipal A trench will not be Private❑ or indentify Zone: or on site system❑ required❑or trench or specify: L Z permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: NIA Historic Commission Rovicw flr(X]VSS: 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 AUT}iORIZATION N,'a1me and Address of Property Owner .. .. . - 114. xspi G r P�C2 (D J5- � t!u-�, C�_ n 1 Q 70 Name(Print) No.and Street City/Town Zip Property Owner Contact Inform n: Title Telephone No.(business) Telephone No. (cell) e-mail address If ap'plic-able`, the property owner hereby authorizes S V�^� �IyS�Q/� Z�V K Jn'1�WG, �� •�+(�O�A� l'w �� T, 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 CONSTRUCTION CONTROL(Please frll out Appendix 2) ', ' If buildin is less than 35,000 cu.fti of endosed's ace and/or not under Construc6oii Control then check here O'arid ski Sectton 10.1 ' 101 Registered Professional Res onsible for Construction Contiol"I t.�.-�� t �34 ivai �fdfi�1�+,� Butz", Nam 1rC3 �e(Re istrant) Telephone No. e-mail ad s Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor, Company" Name oSt 13 S— Name of Person Responsible for ,C.o7�tstruction License No. and Type if Applicable q `/ z I o l�cl�1t rGu / /VJA�I 4.�4 M4 �z Street Address City/Town State Zi ? _jam va 7L-38f (�327 ScJfi2is�FF �6'iJen z dll/ Telephone No. business Telephone No. cell e-mail address " SECTION-11:WORKERS'.00'NQ ENSATIONINSURANCE 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 i vane of the building permit. Is a signed Affidavit submitted with this application? Yes ff No ❑ )SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE;' Item Estimated Costs: (Labor and Materials) Total Construction Cost(from Item 6)_$ 1. Building $ 0 f> Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ - 50 appropriate municipal factor)_$ 3. Plumbing $ 0D 4. Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5. Mechanical Other $ Enclose check payable to 6.Total Cost $ (j (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT.,,', ' By entering my name below,I hereby attest under the pains a d penalties of perjury that all of the information contained in this application is true and accurate to the best of my k aed understanding. 5�...1� .� .�r.svk 74 -(3- 10o' Pleadr�nt and ig�t�� Tit ,�y{.�. Telephone No. Date Street Address City/Town State Zip Municipal Inspector to fill out this section upon application.approval: Name Date CITY OF SiU Emil IN'L1SSACHliSETTS BUILDING DEPARTNtEDiT 3 1 ram' 130%V.1SHLNGTON STREET, 3'a FLOOR TEL (978) 745-9595 FAIL(973) 740-9844 - KIMBFRt RY DRISCOLL T MAYOR �{ODtAS ST.IstERR13 DIRECTOR OF PUBLIC PROPERTY/BUILDLNG COSLMISSIONER Workers' Coinpensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers altiilicant information Please Print Legibly N:trig(Busitxs!60rgtniratiaNlndividual): a ��w J Address: 2-4 6 140,71 ow:el : • City/State/Zip: /Yh A N e Phone M: —78/ (D 3 9 A9 D J Are you an employer?Cheek the appropriate best Type of project(requlred): I.D i am a employer with 4. 1 am a general contractor and 1 employees(full and/or part-time).* have hired the subcontractors 6. ❑New construction 2.0 I am a sole proprietor or partner. listed on the attached sheet t 7. Remodeling ship and have no employees These subcontractors have V. ❑Demolition working fur me in any capacity. workers'comp. insurance. 9. 0 Building addition [No workers*comp.insurance 5. 0 We are a corporation and its require].] officers have exercised their t0.0 Electrical repairs or additions 3.0 1 am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions myself.[No workers'comp. e. 152,$1(4),and we have no 12.0 Roof repairs insurance required.]t employees.[No workers' 13.0 Other camp.insurance required.) •Any applicant that ch6ckox a b rl must also fill uut the seaim below showing their workers'tsmpenamiun poh y inrormatfon 'I f,"vowmxs who su0mlt this aMovie indicating they am doing all work and then him vutridt ronimctm meet nihmit a new af0davil indicadna such. :Omiractun that chak this box meet attached an addiduwt Amt showing the name of the sabtontnetom and their workm'ramp.pot icy intom+adon. l um an employer that is providing workers'compensadon Insurance for my employees', Below is the policy and Jab she iuformadan. I / � Co.nsurance Company Name: ' CC Policy U or Self-ins. Lis N: I N�6y�� L7 Expiration Data:�.3 lob Site Address: ��i/`) �1. City/Statr/2ip: 4. N Attach a copy of the workers'compensattan pallcy declaration page(showing the policy number and expiration data). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a (inc up to S 1,500.00 und/or one-year imprisonment,as well as civil penuldes in the form of a STOP WORK ORDER and a fine of up to S230.00 a duy against the violator. Ile advised that a copy of this statement may,be rurwardcd to the Office of Invesligwitins of the DIA fur insurance coverage veciticaliur l do hereby certify under that pains td enult of p ury t/rat the infurarudon provided ubuve is true and correct � G Data: �J r a 7• � 3 / / U� t (Wiciul use way. Oo nor write in t/ds area;robe cantpleted by rity ur town )IJleluL City ar'ruwn: __,___ Parmtt/LlcenseAl Nsuintl Aulhority(drelo one): ---_— L Gourd of health Z. Building Department .i.City/rown Clerk 4, rteetrlcal inspector S. Plumbing Inspector 6.other Contact Person: -__ __._ _ Phone It: I . � CITY OF SAL.EM3 -L-kSSACHUSETTS BuaDL\G DEPARTStEYT 120 W-ASHNGTON STREET 3", FLOOR TEL (978) 745-9595 F.LX(978) 740-9846 KI�tBE.RLEY DRISCOLL AWOR THO.%w ST.PtERRs DLRECTOR OF PI:aLIC PR0PERTY/9C1LDDjG C0\B115SI0NER 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 MOL c 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: 2 (name of hauler) The debris will be disposed of in ' (scoff/atcillty) - (address of facility) signature of permit applican0-4 date dam.. i f d•k ACORD CERTIFICATE OF LIABILITY INSURANCE 0 B/20/20 T //2013) 013 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 9 y. 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 Co Sheldon Frisch Development Inc. INSURERB:Essex Insurance Co PO BOX 811 INSUflER C: 218 Humprhey Street w"REfl 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 ADVL POLICY EFFECTIVE POLICY EXPIRATION LTR INSRO TYPE OF INSURANCE POLICY NUMBER DATE(MM/OD/YY) DATE(MN IYY) LIMITS B X GENERAL LIABILITY 3DK8834 04/15/2013 04/15/2014 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES TO aEoccurrence) $ 50,000 CLAIMS MADE FRI OCCUR / / / / MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JECOT LOG 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 $ ANYAUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY / / / / EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE / / / / $ RETENTION $ p $ A WORKERS COMPENSATION AND WC990001B. 03/31/2013 03/31/2014 X TORVLAMTs ER EMPLOYERS'LIABILITY ANY PROPRIETOR.PARTNERIEXECUTIVE i EACH ACCIDENT $ 500,000 OFFIGER/MEMBER EXCLUDED? / / / / E.L.DISEASE-EA EMPLOYEE$ 500,000 If yes,tlesctllae under 500,000 SPECIAL PROVISIONS belae E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCAnONSMEHICLEVEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Job Site: 65 Weatherly Dr, 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 OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE III= � Salem MA 01970- ACORD 25(2001/08) 0 ACORD CORPORATION 1988 INS025(0108).06 Page 1 of 2 CORD CERTIFICATE OF LIABILITY INSURANCE DATE 20/2I A 08/20/2013 013 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 y. 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 CO Sheldon Frisch Development Inc. INSURERB: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 ADD'L POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE"MWDDIYY) DATE(MMIDDNY) B X GENERALLIABILITY 3DK8834 04/15/2013 04/15/2014 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISESE.ocaErrDence $ 50,000 CLAIMS MADE Fx_1 OCCUR / / / / MED UP(Any one person) $ 5,000 PERSONAL B ADV INJURY IS 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN-L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2,000,000 POLICY PRO- JECT LOG AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS / / / / BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS / / / / BODILY INJURY (Peraccvdent) $ NON-OWNED AUTOS PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGO $ EXCESSIUMBRELLA LIABILITY / / / / EACH OCCURRENCE 1$ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE / / / / $ RETENTION $ yy�� gg $ A WORKERS COMPENSATION AND WC990001B 03/31/2013 03/31/2014 X TC LIMITS OER EMPLOYERS'LIABILITY ANY PROPRIETONPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMSER EXCLUDED? / / / / E.L.DISEASE-EA EMPLOYEE$ 500,000 It yes,describe under 500,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONVLOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Job Site: 65 Weatherly Dr., 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 Weatherly Drive Condo Trust FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 70 Weatherly Drive INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Salem MA 01970- ACORD 25(2001/08) — ®ACORD CORPORATION 1988 INS025(olospit Page 1 of Verizon I MyVerizon 2.0 1 Verizon Message Center- Re: Grace Residence - 65 Weatherly... Page 1 of 2 Verizon Message Center Monday,Aug 19 at 10:06 PM From: EastCoastPro@aol.com To: swfrisch@verizon.net Subject: Re: Grace Residence-65 Weatherly Drive Hi Sheldon I will need a revised insurance certificate naming Weatherly Drive Condominium Trust as a certificate holder. I did speak with Denise Grace today and she told me that you are going to be remodeling her bathroom and will be installing a new tub, vanity and new flooring. That work is okay by the Board of Trustees but I do need the insurance certificate naming the Trust. Cyndy In a message dated 8/19/2013 2:19:24 P.M. Eastern Daylight Time, swfrisch@verizon.net writes: Hi Cyndy, Attached is my Certificate of Insurance together with copies of my Home Improvement Contractor's License and Construction Supervisor's License in order to commence work to remodel Denise Grace's bathroom at 65 Weatherly Drive. Sheldon W. Frisch SHELDON W. FRISCH DEVELOPMENT, INC. 218 Humphrey Street Marblehead, MA 01945 Office: (781)639-1001 Fax: (781)639-2320 Cell: (781) 389-6327 www.frischconstruction.com East Coast Properties, LLC 400 Highland Avenue, Ste I Salem MA 01970 Tel 978-741-2003 Fax 978-745-9684 EastCoastProCq'aol.com www.EastCoastPi-oLLC.com https://rnail.verizon.com/webmail/public/print.jsp?wid=vz widget_MailOpen_7&type=ma... 8/20/2013 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 " Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 104546 Type: Private Corporation Expiration: 7/14/2014 Tr# 226592 SHELDON FRISCH DEVELOPMENT INC. Sheldon Frisch -- P.C. BOX 811 — _ __...-_ -.__ . ....._ Marblehead, MA 01945 Update Address and return card.dark reason for change. Address -I Renewal Emplovment _- Lost Card il"d""'1"'«111`9^ License or registration valid for individul use only Office of Consumer Affairs&Business Regulation _ tOME IMPROVEMENT CONTRACTOR before the expiration date. If d Buoundsiness retuness t0: OMEra PR 1MENT Type: Office of Consumer Affairs and Business Revelation 10 Park Plaza-Suite 5170 :Expiration: 7/14/2014 Private Corporaticn Boston,MA 03116 SHELDON FRISCH DEVELOPMENT INC. Sheldon Frisch 2i8 HUMPHREY STREET -- Marblehead.MA 01945 undersecretary Not valid without signature Massachusetts-Departrnent of Public Safety Board of Building Regulations and Standards Consn ucRoa Sapery sor License:fS451135 SHE[AON W POBOX8l1 AAMA� . Expiration Convnissimw 07MAIM M4 �__�.�t of anS (999, of Uores°'� 35 OOU COW M�ttwsetts a af tne gent editi9n a eAs liter's?. State khK Cade ism M�.GMIV"S �pp5liteKir'Bearmow Verizon MyVerizon 2.0 1 Verizon Message Center - Re: Grace Residence - 65 Weatherly... Page 2 of 2 I Ih S ' e_er�M,c_Iz I 1 rJ u � � 3 2 o Z 9 M I Z https:Hmail.verizon.com/webmail/public/print.jsp?wid=vz widget-MailOpen-7&type=ma... 8/20/2013