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6 B NIMITZ WAY B-10-152 - BP APP ' v The Commonwealth of Massachusetts Board of Building Regulations and Standards Town of .Massachusetts State Building Code, 780 CMR, 7'"edition Building Dept Building Permit Application To Construct, Repair, Renovate Or Demolish a * One-or Tiro-Fumih'Dwelling � This S tion For Official Use Only Building Permit Number A Date Applied: Signature: Building Commissions for of Buildings Dates —� IV SECTION 1:SITE INFORMATION f1J.Property,Address: 1.2 Assessors Map dt Parcel Numbers s this an accepted street?yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(fl) 1.5 Building Setbacks(fl) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private O Zone: _ Outside Flood Zone? Municipal O On site disposal system ❑ Check if es❑ SECTION 2: PROPERTY OWNERSHIP' co1 wner'of Reco g�,.)AA &fkf;� 6Q tij M I j2 (n/W Name(Print) Address for Service: Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction O Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) W Alteration(s) ❑ I Addition ❑ Demolition ❑ Accessory Bldg. ❑ 1 Number of Units Other ❑ Specify: Brief.D scription of F(o sed Work': e. I/V Q �l / 611�e�1E' SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only WCost: abor and Materials L Buildi $ r pp Q 1. Building Permit Fee: S Indicate how fee is determined:❑Standad City,Town Application Fee 1. Electri ❑Total Project Cost'(Item 6)x multiplier x 3, Plumb2. Other Fees: S4. .MechaList:5. MechaSu ressiTotal All Fees: S Check No. Check Amount: Cash Amount: 6. Total r Q� O ❑ Paid in Full 0 Outstanding Balance Due: G ` SECTIONS: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) 901 /) Q, iz l `-QgjJ f ,30 L&cnse Number Expiration Date N of Cfl. Heider r'11 List CSL Type(sec below) o e N orGJeL)CQ5 T Description A •s U Unrestricted lup toJ3,000 Cu. FIJ R Restricted 1&2 FamilyDwelling atureok qA/ N ,Mason Only y1n �C� RC Rcsidcnnoi Routing m Cover Telephone WS Rcsidenual Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2C Re isle'0 Home I rove meoLC�ontractor(HIC) a1 S� <-i3 /VC GCt , _1� HIC Comp4a Na c or kith tram ! MA O Registration Number 0' 4� a Gaga--J,4 b I y��� Expiation Date Signature Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 25C(6)) Workers Compensation Insurance affidavit 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. Signed Affidavit Attached? Yes .......... ❑ No........... O SECTION 7s: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date j, SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION i, , 1 15 ,as Owner or Authorized Agent hereby declare that the statements and info)wAtion on the foregoing application are true and accurate,to the best of my knowledge and behalf. ignature of Owner or Authetized Agent Date (Signed under thepains and lienalties of perjury) NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will nWi have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and I IO.RS, respectively. 2. When substantial work is planned, provide the information below: Total floors area(Sq. Ft.) (including garage, finished basement/attics,decks or porch) Gross living area(Sq. Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system \lumber of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for 'Total Project Cost" 08/24/2009 21:30 9782818072 BABSON ELWELL DAVIS PAGE 01/01 ACORDN CERTIFICATE OF LIABILITY INSURANCE DATE(MM DD YYYY) 08/24/2009 PRODUCER 978.283.1561 FAX 973.281.9072 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION BABSON-ELWELL & DAVIS - ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 44 Blackburn Center ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Gloucester, MA 01931-0441 Laurie RGbey . INSURERS AFFORDING COVERAGE NAIC if INSURED C F Carpentry, Inc, INSURER A: Travelers 50 Fernald St INsuRERe Travelers Insurance 25658 Gloucester, MA 01930 WSVRERC Liberty Mutual y1NSURER D; 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THETERMS,EXCLUSIONSAND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN�R SR TYPE OF INSURANCE POLICYNUMBER DATE MMIUOO/YYIY DATE MM/GD/TYYY LIMITS LTR INSR GENERALLNIBILITY I6800903MSS7COF09 03/01/2009 03/01/2010 EACHOCCURRENCE _ $ 1,000 000 X COMMERCIAL GENERALLIABILRY PREMISES F,eaccwfence_ E 500,000 CLAIMS MADE Fi-IOCCUR MED EXP(Any one Pelson) i_ _ _5,000 A PERSONAL S ACV INJURY $ _1,000,000 GENERAL AGGREGATE E 2,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS•COMPIOP AGG $ 2,000,000 POLICY FRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMB S ANY AVTO (Ee eccidenl) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) S HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per mcienrn) ....... PROPERTY DAMAGE, T IPer MIdenq GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHERTHAN EA ACC $ AUTO ONLY: qGG $ EXCESS I UMBRELLA LIABILITY XSFCUP3241TSBZIND09 06/15/2009 03/01/2010 EACH OCCURRENCE S 2,000,000 X OCCUR CUUMSMAOE AGGREGATE S 8 S DEDUCTIBLE S RETENTION S E I WORKERS COMPENSATION YIN (MY PROP In NH) LIABILITY Y /22/2010 EL DISEASE ACCIDENT .......]OTH- AND .,ER......_._ ... IMITS AFFICEW EMBRRIPARTNDED? CUTIVCEACHACCIDENT E 500.000 OFFICEory In NH) EXCLUDED? O EASE-EA EMPLOYEE $ 500,00 AS 09[f f _._..__._..__..._.. . . --- IAL PROVVr ISIONS below E.L.DISEASE-PODGY LIMIT i 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS"DEB BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NO C OWE ERTIFICATEHOLOER OTO THELEFT,BUTFAIWRE TODD SO SHALL IM All N OR UARILnY FAN HINO UPON THE INSURER ITS AGENTS OR City of Salem E ESENT IVES. Building Inspector UT REPRES nVE Salem, MA 01970 ACORD 25(2009/0i) FAX: 978,740.9846 ©1 98 2009 C D COP RA71 N. All rights reserved. The ACORD name and logo are registered Markfi of ACO ' CITY OF SALEM : Iwo PUBLIC: PROPRERTY Is DEPARTMENT Construction Debris Disposal .allidwtit (rcyuired awall demolition and rcnu\ation wulk) In accordance \\Ilh the sixth edition of the State Building Code, 7S0 CAIR section I I 1 5 Debris, and the provisions ut'*vIGL a 40. S 54; Building Permit It is issued with the condition that the debris resulting front this work shall he disposed of in a properly licensed waste disposal facility as detimed by MGL c I11. S 150A. The debris will be transported by: L2I I name olh r) I he debris will be disposed ot'in G�j�UceS��2 11'D 1 numrat lau „v) - ,.nldre.. „r lhiluvl •�endlwc • I p:,uur .i p Lint ����/og -� CITY OF S.1 -&Nf9 AkSSACHUSETTS Bu=LNG DEPARTMEINT 120 WASHINGTON STREET; Yo FZOOR°.. - TEL (978) 74S-959S FAx(978) 740-994 KIMBE•l EY DRISCOLL HAYOI! THobtAs ST.PmItRt DIRECTOR OF PL BLIC PROPERTY19t:MDLYG COSOUSSIONER Workers' Compensation Insurance AMdavit: Builders/Contractors/Electricians/Plumbers lnnllcant Informatloo Please Print Legibly r Naine (Business,OrgaruranonlnJsv'duall: � V AOdfCsa: o �e�_ Phone city/staldzip�nt►cc3S MA \re you as employer!Cbee he appropriate box: Type of project(required): I I am a employee with� d. ❑ 1 am a general contractor and t b. ❑New construction employees(full and/or pan-time).• have hired the sub-contmcmrs 2.❑ I atn a sole proprietor ar partner- listed on the attached sheeL : 7. Remodeling :hip and have no employees These sub-contractors have V. Demolition workingfor me in an capacity. a aci workers'comp.inwnnce Y P ry• 9. ❑ Building addition We are a corporation[No worker'comp. insurance S• ❑ rPo and its olytcen have exercised their I0.0 Electrical repair w additions required.] J.❑ 1 am a homeowner doing all work right of exemption per MGL 1 I.❑Plumbing repair or additions myself [\o workers'camp. c. 152•�1(4)•and we have no 12.❑ Roof repairs insurance required.) t employees. LNo workers' •�11 J � 11.❑Other.camp. insurancetequired.J •AnY apphcant nun chase bon t t muq aW no aer thr fa "m below showisa their Waken'canyansati•m pulicy infurma on. t I I•s'wuwsus Who submit chis afl chrris indicating they we doing all work and then hilt outride emtmnsan maw submit s new arndsvir indicating"k, <r,,I amn Ihm'hock this ban mud anaehod an*19 i'iord Jwd showing the name of tta alk-etWmc mt ud'half+mbar'sun/.polity infmmauaa. /gar an employer than 6Provid/ni f worAaa 2'canrOentarbn fnaannee for nq emP/ayaaa Qr/uw/s the pol47 MAdM 1110 informwion. Insuranct Company Name: Pal icy a or self-ins. Lie.p: Expiration Date: Job Site Address: City/state/zip: ,\ttach a copy or 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 is the form of a STOP WORK ORDER and a flan of up to S250.00 a day against the violator. tie advised that a copy urthis statement may be forwarded to the Office of Invcaugationo of the DIA for insurance coverage verincaliun. III /dd hereby •t i y nder rho psi and p u/Nis of perjury that the beformadotr providtd show it true and carrtcL oat : ay 01rhial use only. Do ,or write in this area, to be:urnpletd by city or town„/Halal City or ruwn: _ . _ eermit/I.1cente M_ hsuing Authunly (circle tine): I. Ituard or Ileulih 2. Hwlding Department 5. City/rown Clerk a. Electrical lmpccior 5. Plumbing Inspector 6. thher C�,nlacl Person: Phone q: American Properties Team, Inc. —. .^ � r. . 7jt'..,: _ r-.is •, ' ':'r: ...._ C f=.: a - .. •...f._ 1 dLf 1. n :S E __ 1 TO: ` 6B Minitz Way Robert K..Butler IV, FROM: Jennifer Pappas,Propel ty Manager . RE: Window Replacement DATE:" June 9,2009 * *s*#*s**ssssss*s*s*s***ss*ssss*s*ss*s**s*s*s*s***ss*sssssssssss;s***** Please be advised that the Board of Trustees for Pickman Park has approved replacement windows for the above referenced unit. This approval is contingent upon them matching the existing windows and that they fit in the existing opening. They must be the same in appearance from the exterior. The Board will not allow windows with grids,crank outs,etc. We also require that permits be pulled in advance(regardless of what your contractor may tell you),and then a copy of the final approved permit once completed must be sent to APT for the unit file as well. We also recommend that owners obtain a certificate of insurance from the licensed contractor. You will need to bring a copy of this letter to the Salem Building Department in order to receive your permit. Should you have any questions or require additional information,plebe feel free to call me directly at(781)932-9229. cc:- Unit File 500 WEST CUMMINGS PARK•SURE 6050. WOBURN •MA •01801-781-932-9229 -FAX 781-935-4289