18 WEBB ST - BUILDING INSPECTION ETry OF;�r�LE1G -
"' PUBLIC PROPERTY
DEPARTMENT
gma3FJLLE!DRISCOLL
MAYOR 12D WASHING"STREU•SALLK MASSACRM--I M 01970
TEL-978-745-959S♦FAx:978-740.9646
APPLICATION FOR THE REPAIR, RENOVATION, CONSTRUCTION,
DEMOLITION OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
Location Name: t,tf �j7 Building:
Property Address:
property is Located in a: Conservation Area Y/N Historic District Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: 34 IZSRz %77s�%
Address: 1 L/ �j ,
Telephone: G/7- 4 i75y J7J
3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
Addition Existing Z
Renovation Number of Stories Renovated —
Change in Use New —
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of
}Proposed Work:: /Vj�rr 771V ��6jNt�xna
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Mail Permit to: 6011 dLU W_
What is the current use of the Building7 C / ��V✓4aAOI,4�e owv s
Material of Building7 "OfV P If dwelling. how many units?
Will the Building Conform to Law7 is Asbestos7 Ale
Architect's Name
Address and Phone A � � / ��� D S
Mechanic's Name
Address and Phone Z
Construction Supervisors License# /1GW HIC Registration#
Estimated Cost of P ojeect�S _� � Permit Fee Calculation
Permit Fee$ f 1 J Estimated Cost X$7/$1000 Residential
Estimated Cost X$11/$1000 Commercial
An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build to the a e 'led
specifications. Signed under penalty of perjury X
Date C
` of
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Crry OF SAmm
' PUBLIC PROPERTY
DEPARTMENT
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From:Georgia Raneri At:LJM Insurance Agency FaxID: To: 1 B Weh6 Street Realty Trust Date:11/302006 04:24 PM Page:2 of 2
ACORD CERTIFICATE OF LIABILITY INSURANCE BUILD 3 DA 11/300/6
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
LJM Insurance Agency, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
327 Union Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Framingham MA 01702
Phone:508-872-0662 Fax:508-879-5299 INSURERS AFFORDING COVERAGE NAIL#
INSURED INSURER A. Penn-America Insurance Co.
INSURER R
Builder Services Associates, L INSURER c.
755 Hemenway Street INSURER D.
Marlborough MA 01752
INSURER EE.
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REDUREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO 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,
LTR NSRE TYPE OF INSURANCE POUCYNUMBER DAZE(MMBDNY) DATE(MMIDDIYY) LIMITS
GENERAL LUI9NTY EACH OCCURRENCE $1000000
A X COMMERCIAL GENERAL LIABILITY PAC-6574709 05/23/06 05/23/07 PREMISESEawcurance) $S0000
CUJMSMADEFXJ OCCUR MEOEXP(Ad,..pelsm) $5000
PERSONAL A ADV INJURY $ 1000000
_ GENERALAOCREGATE 3 2000000
GEN'L ADOREOAM LIMIT APPLIES PER: PRODUCTS-COMP/OP ACID It 2000000
POLICY JEST r7 LOC
AUTOMOBILE UARIUTY
COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED gtrtOS (Par person)
HIREDAUTOS
BODILY INJURY $
NON OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per eccMed)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTIER.RIAN EAACC $
AUTO ONLY: AGE $
EXCESSAUMBRE"LIABILITY EACH OCCURRENCE $
OCCUR CIAIMSMADE AGGREDATE $
$
DEDUCTIBLE $
RETENTION $ It
WORKERS COMPENSATION AND TORV LIMITS ER
EMPLOYERS'UABIUTY
ANY PROPIVETORIPARMEIVEXECUTIVE
E.L.EACH ACCIDENT $
RNEMBMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $
If Yes
yes,A PR under
SPECIALL PROVISIONS FabN E.L.DISEASE-POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
16W83BS SHOULD ANY OF THE ABOVE DESCRIBED POUCHES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAR 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FNLURE TO DO 80 SHALL
18 Webb Street Realty Trust IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
19 Webb Street
Salem MA 01970 REPRESENTATIVES.
AUTHORUE REBE
ACORD 25(2001/08) ACORD CORPORATION 1988
i
6chna5 5tmctr,ral �nglneerinq LLC Phone 978.465.6436
Daniel L. Gelinas, P.E. Fax Line 1: 978.465.5160
579A North End Blvd.
Salisbury, MA 01952-1738 email danlgelinas@adelphia.net
October 25, 2006
Tracy Cronin, General Contractor Fax 978.536.0013
114 Treble Cove Road Phone 2880
Billerica,MA cell 617.293.1611
RE: 18 Webb St., Salem, MA
Dear Mr. Cronin:
You have requested Gelinas Structural Engineering LLC (GSE)provide structural observations regarding
your proposed beam/column/footing strengthening at 18 Webb St. As such we have limited our
observations to this issue. Our recommendations are as follows:
1. We suggest an insect specialist inspect the basement, sills,posts, beams, floor etc. to determine if
there is any live insect activity,and address appropriately if need be
2. Site observations and follow up office review indicates we agree with your proposed strengthening
program and details, reference drawing SG-1 attached,that is:
Provide 10"thick minimum x 20"wide continuous footing
Provide 2x4 @ 16" o.c.knee wall:
Use P.T. sill plate
Provide ''/z"diameter anchor bolts or expansion bolts 4 feet on center
Provide diagonal 2x4 brace at 45 degrees on side of stud,minimum two per wall section
Use double 2x4 top plate or 4x6 top plate
Provide Simpson clip 32"o.c.,securing top plate to beam
3. Footing/knee wall locations to be field determined as required per site conditions, generally in the
area of our site walk thru.
4. If a beam needs to be shored and a footing can not be placed, field discretion is required. A
potential beam strengthening detail is enclosed as drawing SG-2
Please call with any questions.
,A OF 444.9s
�O DANIEL L. Gu,
GELINAIR
Very Truly Yours, STRUCTURAL y
No.33994 e
SlONAL
Davie L. Ge inas,P. .
D Letter Oct 25 with sketch Tracy Cronin.doc
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GELINAS STRUCTURAL ENGINEERING LLCGNEETW.
579A North End Blvd. er L�.J DATE 10,-0-4,b(�
Salisbury, MA 01952-1738 ' 'T—
Phone:978.465.6436(Fax 5160)
e-mail:danlgelinas@adelphia.net g '0
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GELINAS STRUCTURAL ENGINEERING LLC S EETN�L_
579A North End Blvd. er—�!f�>`� t< CS' 11TE-IC:"
Salisbury, MA 01952-1738
Phone:978.466.6436(Fax 5160)
e-mail:danlgelinas®adelphia.net JOB1,4eac
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CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
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MAYM tM W.merreMN Sorter•svA►t.MAssACM[rsgTlx01970
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Workers' Compensation Insurance Affidavit: Sanders/Contractor&Mectr(eLnstplambers
Applictut Information
Name(BusineWOrgan ntiodfcdividu i):
Address: 8�
City/State/Zip: m�x1 /i4r' /nq ff Phone
Are yes as employart Cheek the appropriate boss
1. ?am a employer with 4. 0 1 am a general contractor and I7&P4cja6-&ljnS
(required):
employees(NU and/or part-time).• have hired the sub con"ctorstruction
2.0 1 am a sole proprietor at partner- listed on the attached&beat, t gship and have no employees These wb�conaactars have nworking for me in any capacity. workers'comp,insurance. ddition
[No workers'comp,insurance S. 0'we ue a cap�ion and its
required.] officers have exercised thaw 10.0 Electrical repairs or addalone
3.❑ 1 am a homeowner doing all work right of a xenpt!=per MOL I I.[]Plumbing repairs or addition
Myself.[No workers'comp. u. 152,11(4).and we have no 12.(]Roof repairs insursnce required]t employes[No workers'
comp.insurance reQuired) 13.0 Other
*AoY WVllant thou chocks lee 01000118110 all out the seetiao blow shoving ehdr wets•
Hamousn m who suhob risks alOdsric hedhaeng they m doing an wont and the him aesnide anetsso Pout sacks nswa nAldsvY
indicating each,
tCanwoatwe that check this box com anechad an■ddidonel slop Amming rho gong of the sub.aaanocem am thdr0004Lpolicsinformodoo.
lam as earPloyer that b provldbas workers'compaasados Insur"Ce for try employees Be/aw is Nis pocky and job slaw
Wormadlom
Insurance Company Name:
Policy eY M Self ins Lie,M Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the worken'compensation Polley decLratlos papa(show
ing the PoNCY number and expiration dgta)v
Failure to secure coverage as requited under Section 25A of MGL C. 152 can lead to the imposition of criminal penalties of s
fine up to$1.500.00 and/or one-year imprisonment,as wen as civil penalties in tha form eta STOP WORK ORDER and a tine
of up to S250.00 a day against the violams. Be advised that A copy of this statement may be forwarded to the Office of
investigations of the DU for'murance coverage verification.
/do hereby eerdA atrder pe aides of peyary that the laformadoa provided abaft Is ffigr and tarred
r/ f
O,07eld use 041A Do not wolfs IN tbtr area,10 be eomPleW by City or Iowa ofJ1elaL
City or Town: Permlt/License N
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.Cityl!'own Clerk 4.Electrical
6.Other Inspector S.Plumbing Inspector
Contact Person
Phone p•
Information and Instructions
Chapter 152 requires all employees to provide worlkers'compensation for their employes.
Massachusens General Laws chap a in the service of another under any Cottact of�' r
Pursuaar to this Swaim an employee is defined as"...every perso
express or implied.oral or written."
assoeiuio4 won m other legal cnnw'or any two or more
An
r,KP/eyp is defined as-an individual,parmeship. va of a deceased employer-or the
of the foregoing engaged in a joint enterpriseo and including this legal mpresentan liowevts the
association or other legal entity,employing employ
receiver at trustee of m individua4 Pam• aid who resides therein.or the occupant of the
owner of a dwelling house having not mera thm three sparonents ceoson cc repair welt on Such dwelling haw
dwelling haw of imoditeror budding
who ee ploYa f��maintenance no because of s�employment be deemed to be an tmploYe-"
or on the gFotmda or building appurtenant
MGL chapter 152.125g6)also stela that"every style err b'd 2c"SlSit agency shaft wltbbold tM Wnanee or renswat of•ticeuw or permit to operate a business or to eeesu'eet bididleig s In tba commenweallh for aq
acceptable evtdew et cemptlaw wkh the insuratua coverage required
appUeaat w MGL ehapeerpr 113�25C('1)spa"Neither the commonwealtb not any of i<a pnuacsl
Additiona subdivisions
lly.
ct for the perftenswe of public work until acceptable evidence of compliance
with ths insurance
enter of this abaPtar and to the contracting authority'
req
Appoeants the boxes that apply to Your sdusnon and'it
Plesaa fill out the wodms'compensation affidavit by c umber with their cetiBeatKs)of
neceSMY,Supply�,�p�(s)name(s),addresKes)and phone numbar(s)along with no employees other than the
Limited Liability Companies(LLC)or Limited Liability Pumeshtps(LLih have
insurance.members or paimers,late not required to carry workers'Compensation umtrrsnee. If m LLC or LLP does
empbyeee,a policy is required Be advised
that this affidavit may be Submitted to the Department
of Indiatrill
su Abe be to sign and date the afsdavlt The affidavit
should
Accidents for confirmation of insurance eoverags for the permit or lieeme is being requested,not the Department
Of
the
be returned to the city or town that applicationdie lie a if you are required to obtain a workers'
ent,
Industrial Accid should you have any questions regarding
at the number listed below. self-insured Cotnpsnies Should c EMEMMEM
ute that
compensation Policy-i?leese cad&0 artment line-
Self-insurance Hoatee nimtbm on the
City or Tows OMdad
Please be sure that the affidavit is complete and printed legibly. The Departmeat has provided a space he 3PPUCSOL
the bottom
to contact you
of the affidavit for you to fill out a 0nha w6ich will used as sa mffice Of Investigations feonee numbers regarding
4 applicant
Please be sure m fill in the permi hestiotu in any given year,need only submit one affidavit indicating Currant
that must Submit mdtiPIG permit�enseund�Job site Address"the applicant should write"all locations in�AdtY or
policy bformation(if tureasa*Y) or marked by the city or town may be provided to the
town)."A copy of the affidavit has been officially Stamped or licenses. A new af"-&vu mast be filled out each
applicant as proof that a valid'sffidavit is on file fan fbtttre peanuts as related to any business err commeaial venture
year. %Ilan a home owner or Citizen is obtaining i license s permit
y to bairn leaves etc.)said Perron is NOT required to complete this affidavit.
(i.e. a dog license or Permit
ns would like to thank you in advance for your Cooperation and Should You have any gneuiona.
The Office of Investigatio
ns
please do not hesitate to give us a call.
The Department's address.telephone TM Wealth of MaSSachttm"
Depntment of I AuMd Accidents
Office of Iavadpttoos
600 Washington Sheet
Boson,MA 02111
Tel. #617-727-4900 Od 406 of "77-MASSAFE
Fax N 617-727-7749
Revised 5-26-05 wwwa aSa pv dia