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127 DERBY STREET - BUILDING JACKET f r^ate$ � :r f'?T� ... ♦rii.I�.'. '��. �� 127 DERBY .STREET r ,t e/ TO%7l//7�p��0Kevin Burke Secretary Ulf �� /�• 1� ��JJ�� Thomas G. niP.E. aJ' Commissioner -./�/ Gary Morma,P.E. Leval L.Patrick , OfI//r!L cN —7c Chairman Governor r�/�/L2¢ / c%/,(r_ _ _ /9O� Stanley eXYO-> GlI.CP, ,!life„ii /U Shuman,P.E. Timothy P.Murray Vice Chairman Lieutenant Governor6J� li, .�/� �fY7/7P7-3P00 .��fY7JPP1-175i/ Thomas St. Pierre 120 Washington St. 3rd Flr Wednesday,February 09,2011 Salem MA 01970 NOTICE OF HEARING Complainant: Louise Spohr 127 Derby Street,#3 Salem MA 01970 Registrant/Contracto Nathan Langford 17 Custom Street , Nashua NH 03062 Construction Supervisor: 100639 Subject Property Address: 127 Derby Street #3 Salem MA Complaint Number: 2010-345 Hearing Date and Time: 2/24/2011 10:00 AM Greetings: Pursuant to 780 CMR 110.R5 and/or 110.R6, a hearing will be held based upon the information contained in the above referenced complaint. Your attendance at the hearing is mandatory. The hearing will take place before a hearing officer at the office of the Department of Public Safety, One Ashburton Place, Boston, MA at the above noted date and time. Please report directly to the hearing room on the second floor overlooking the main lobby. (Go through the double doors after exiting the second floor elevator and take a left). The hearing will be held in order to determine whether administrative action should be taken against the Construction Supervisor's License. Violations of the law or regulations which are substantiated at the hearing could result in the imposition of a suspension, revocation,or reprimand of the registration and/or license, and the assessment of a fine. The complainant must be prepared to present evidence to support the allegations described in their complaint. The registrant/licensee has the right to be represented by an attorney at the hearing and may present written and oral testimony and any other relevant evidence to mitigate the claims made against them. Any party may present witnesses with relevant information in support of their case. The complete complaint file is available for review, upon reasonable notice and at a mutually convenient time, at the offices of the Department of Public Safety during.regular business hours. All requests for information or motions must be addressed to the following.address and shall be in writing with a copy provided to all parties: Department of Public Safety ATTN: Hearing Officer One Ashburton Place, Room 1301 Boston, MA 02108 Telephone calls relative to pending cases will only be returned in cases of emergency. Due to the great number of complaints being processed through the program, a hearing date will only be continued under extraordinary circumstances. Any motion to continue a date shall be made in writing at least ten (10)days prior to the hearing date. All parties must bring proper identification to the hearing. Construction Supervisor's Licensees must bring their license to the hearing. Thank you for your anticipated cooperation. Very truly yours, BOARD OF BUILDING REGULATIONS ANDSTANDARDS Advantage Home Inspection,Inc. 1 YoureWRoof covering application DONALD E. LOVERI NG Advantage Home Inspection Inc, 275 Grove Street Suite 2-400 Auburndale, IIIA 02466-2273 www.advantagehomeinspection.us el. (617) 928-1942 FAX (617) 698-3163 July 9, 2010 Ms. Karen M. Yourell = 127 Derby Street Salem, MA 01970 RE: Roof covering application at 127 Derby Street, Salern, MA 01970 Dear Ms. Yourell: You retained this firm to examine the condition of the two newly installed roof coverings. The first is the "Main house..'.".roof the second is a EPDM rubber. covering positioned under the third--floor units wood deck. This examination took place the morning of June 24, 2010. The application for roof coverings took place withnz the past 7 months. Almost immediately the roof.coverings were leaking. Photo #1 View from.the ground at the driveway Photo #2 View from right side of dwelling at ground level. Advantage Home Inspection,Inc. 2 Yourell/Roof covering application Photo #3 Rear of building at grade view. Photo #4 & 5 View from a ladder on the driveway side. The aluminum sheets are.tacked over the gutters. SEVENTH EDITJION� MASSACHUSETTS BUI,D)f�li G C®DIET_OR ONE- AND TW®-FAMMY DWELLINGS (780 CMR) 5903.3. General. Roof decks shall be covered with approved.roof coverings secured to the building or structure in accordance with the.provisions of this chapter. Roof assemblies shall be designed and installed in accordance with this code and the approved manufacturer's installation instructions such that the roof assembly shall serve to protect the building or structure. 5903.2 Flashing. Flashings shall be installed-M6 such a manner so as to prevent moisture entering the wall and roof through joints in copings, through moisture permeable materials, and at intersections with parapet walls and other penetrations through the roof plane. 5903.2.3. Locations. Floss"hings shall be installed at wall and roof intersections; wherever there is a change in roof slope or direction; and around roof openings. Where flashing is of metal, the metal shall be corrosion resistant with a thiclmess of not less than 0.019 inch (No. 26 galvanizedsheet). 5903.4 Rodf drainage. Unless roofs are sloped to drain over roof edges, roof drains 54all'be installed at each low point of the roof. Where required for roof drainage, scuppers shall be placed level with the roof surface in a wall or parapet. The scupper shall be located as determined by the roof slope and contributing roof area. 5903.4,3 Overflow drains and scuppers. Where roof drains are required, overflow drains having the same size as the roof drains shall be installed with the inlet flow line located 2 inches (51 mm) above the low point of the roof, or overflow scuppers having three times the size of the roof drains and having a minimum opening height of 4 inches (102 mm) shall be installed it Advantage Home Inspection,Inc. 3 Yourell/Roof coveting application the adjacent parapet walls with the inlet flow located 2 inches (51 mm) above the low point of the roof served. The installation and sizing of overflow drains, leaders and conductors shall comply with the Massachusetts State Plumbing (Code 248 CMR), Overflow drains shall discharge to an approved location and shall not be connected to roof drain lines. Photo #6 Unsealed face nailed flashing. Photo #7 Tar covered new sewer vents. Photo #8,9,10 - Tar covered chimneys with new aluminum flashing (incorrect) Photo #11,12,13, 14 Missing bituthane along the lakes. New plywood installed without a structural permit. Photo #15 Rear deck third floor Phot® #16 Unsecured drip edge Photo #17 Unsecured floor frame and railings. Advantage Home Inspection,Inc. 4 Youiell/Roof covering application Photo #18 Unsecured edges with partial bathroom caulk application. Photo #19 Unsecured threshold. Photo #20, 21,22 Bathroom caulking at unglued joints. Improperly secured siding post roof application. ®P>(1 ON: Based on our observations there was not evdn:eritry level workmanship exhibited in these new roof coverings or deck. All.-tbree require complete removal and proper/industry standard installation... Advantage Home Inspection,Inc. 5 Yourell/Roof covering application Cost- Wood deck: Demolition and disposal $700.00 Rebuilding with all PT stock $3200.00 Permits $60.00 Subtotal $3960..0® Ruubbeu• roof: Demolition and disposal $490.00` Correct replacement $13.00/sq. ft x approximately 120 sq. ft $1560.00 Permit $45.00 Subtotal: $2095.00 Main house roof- Strip and dispose of same $3000.00 Bituthane covering $680.00 New flashings $140.00 Provide and insfalfarchitectural shingles Approximately 22 sq. ft $6000.00 Permit $100.00 Subtotal. $9920,00 Advantage Home Inspection,Inc. 6 Yourell/Roof covering application Interior paint repairs. Labor 2 painters x 5 days @ $400.00 /man day $4000.00 California problem solving primer 4 gallons @ $50.00 each $200.00 Ceiling paint 2 gallons @ $45.00 each $90.00 Wall paint 2 gallons @ $45.00 each $90.00 Misc. supplies Rags, brushes, etc. $100.00 Subtotal: $4480.00 TOTAL: $207455.00 The Commonwealth of Massachusetts Town of Board of Budding Regulations and Standards to""W Massachuscus State Budding Code, 780 CMR. 7"edition Building Dept Budding Permit Apphcati o Construct. Repair. Renovate Or Demolish a fkg� One•or Tnu-fwnr/t Duelling This ection For OMcaal 7Onl Building Permit Number: Date pplied: °2 i 1 Signature: Budding ommnmoner/Inspeetao sold ga Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map 6 Parcel Numbers 7 y 5T mb I.I a Is this an ecce ted street:' M yea no �Nuif Parcel Number IJ Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq 11) Frontage(n) 1.5 Building Setbacks(Il) From Yard Side Yards Rear Yard EPublicO Provided Required Provided Required Provided pply:(M.G.I.c.40.154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zmw: _ Outside Flood Zim? Municipal O on site disposal system O Private O Cheek if wd3 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: 4 S eS7. 10^ Df/C4i 1 ST_ eOW✓;iotu f(Vm X077 O2i3 Name(Print) Address for Service: oC�GuN� 77 Ga —1901`7 Signature Telephone SECTION l: DESCRIPTION OF PROPOSED WORK'(check ad that Apply) New Cons It O Existing Building O Owner-Occupied O 1 Repaira(s) el Alterstion(s) 0 Addition O Demolition 0 Ace ssory Bldg.0 Number of Unit _ Other 0 Specify: Brief Description ofPropostd Work': ��PA 2 -7-A 1;L0 FlgoR W ., ,Oow T2in'1 �}vn SU22rJUN0/✓G 26'TTPo GUdPA SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and Materials I. Building f pv I. Building Permit Fee: f Indicate how fee is determined: O Standard City/Town Application Fee 2 Electrical f 0 Total Project Cost'(Item 6)x multiplier �x \ I Plumbing f 2. Other Fecs: f 4. Mechanical (HVAC) f List: - - s Mechanical iiire f Total All Fees. f Sup remon Check No. _Check Amount: Cash Amount:_ 6 Total Project Cost. f _�—o 0 0 Pad in Full 0 Outstanding Balance Due SECTIONS: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) e3-Zrf " -A, rIlw Lrcnc.4umbr Er frauonOitt N,yae utCSL-ZI ev Li.t CSL Type Jxv heluw) 00 . /7 aisn�m 51 Al 5uvAI, wi, Aurr7-d a3d6zOtsi&ntial oexr ton ned u to Jf.000 Cu. FI. ed 1e12 Famd Owelhn �igM1Yre Onl f�03 332—`78"6L Resident Raofin Covenn Telephone it Window and Sidor Solid Fuel Summit Appliance Insullaban D I Residential Demolition 33 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Registrant Name Registration Number Address Expiration Date Signal utt Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. ISL 1 2SC(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 AllWavitAttache& yes..........*,� No...........0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, 11(412yoQE GpI- , as Owner of the subject property hereby authorize O4✓ o A)- / ( to act on my behalf,in all matters relative to work authorized by this building permit application. nVUA` � d a— /9--i0 Signannofowner V Data SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION 1, 04�-Vt o Al- as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and behalf. AAv i`a m. 19,4-0 t, Print Name a-f-� h • �R'--e a-I�-/l7 Signature of Owner Authorized Agent Date Signed under the sins r' NOTES: I. 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 I HIC)Program),will sg have access to the arbitration program or guaranty, fund under M.G.L. c. I42A. 011ier important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110 R6 and 110 RS, respectively. 2. When substantial work is planned,provide the information below Total Moors area(Sq. FL) (including garage, finished basemenVanics.decks or porch) Gross living area(Sq. FL) Habitable room count .Number of fireplaces Number of bedrooms Number of bathrooms Number of half.baths Type notating system Number of deck.v porches Ty peofcoolmgsyvem Enclosed Open f Tout Project Syuare Footage"may he.uh,muted for 'Total Project Cost" "Number The Commonwealth of Massachusetts Department of Public Safety \lassachusdts State Budding Cude(780 LAIR)Seventh Edition City of Salem Permit A lication for an Buildin other than a I-or 2-Famil Dwellin (ThisSection Fur Official Use Only) Date Applied, Building Inspector: 4ChangeofU� 1: LOCATION (Please indicate Block M and Lot 0 for locations for which a street address is not ava' a ev 5T,12iveT s9zs,v/ C)ih'7c CRY /Town Zip Code Name of Building(if appli- e) SECTION 2:PROPOSED WORK If New Construction check here❑or check all that apply in the two rows below ❑ Repair Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) ❑ Change of Occupancy O Other ❑ Specify: Are building plans and/ur construction documents being supplied as part of this permit application? Yes ❑ No Is an Independent Structural Engineering Peer Review required? Yrs ❑ No fd-11 Brief Description of Proposed Work: `r2/ &.k/ r' 6C .9S 'iS'i72 /mow 'F. 0-1-9 Ale'UJ '12 COX Pe-V1✓CCQ i9vVQ Awe%/{'7-1— SECTION 3:COMPLETE THIS SECTTON IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE 1"USE OR OCCUPANCY Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) ❑ Existing Use Group(s): Proposed Use Group(s): Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: 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 AA ❑ A-2r ❑ A-2nc❑ A-3 ❑ A-4 13A-5 13B: Business ❑ E: Educational 13F: Facto F-1 ❑ F2 1-1H: Hi Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional 1-1 ❑ 1-2 ❑ 1-3❑ 1-4❑ M: Mercantile❑ _ R: Residential R-113 R-213R-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) JA IB ❑ IIA ❑ IIB ❑ 1 IIIA ❑ 11111 13 1 IV ❑ VA ❑ VB C3 SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Lai Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: lic ❑ C heck if out>ide Floud Zone❑ Indicate municipal ❑ A trench will not be Licensed Disposal Site le❑ or mdentifc Zone:_ or un site system ❑ required O or trench ur.pecif%:permit is enclosed ❑lroad right-of-way: Hazards to Air Navigation: \I:\ I h,1,,ri\( ,nnmi—wli Ho...•..\ \pp icable❑ 1,Strudwe,\1111111 airport aroach ara.' k their ie%lew annpleted' ment hr Rudd enclo,ed ❑ Yes❑ or No❑ Yes❑ \u ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY I-ditwn.d( odc: Lir Gruuplsl: I\ +col Construchun: l Occupant Load per 111111\ IAa•s lha•bwldlilg containa'n Sprinkler System.': Special Stipulations: SECTION 9: PROPERTY OWNER AUTHORIZATION s Name and Addressjol Property Owner Q/l/ 70 /feszc sr sA �/-T 1W Nu.and Stre Cit)•/Town Lip Name(I,rinU Property l)s\ner Contact Information; 76 7 Title Telephone No. (business) Telephone No. (cell) e-mailaddress If applicable, the property owner hereby authorizes Name Street Address Citv/Town Stale Zip to act on the propert\owner's behalf, in.ill matters relative to work authorized by this building permit a p plication. SECTION t0:CONSTRUCTION CONTROL(Please fill out Appendix 2) (II buildingis less than 15,p1U cu.ft of endued s pace and/ur not under Construction Control then check here O and ski Sediwp 10.1 Registered Professional Responsible for Construction Control Af,4-71d" lq-nrajF-O" jij- z33- 5-276 I" /"x637 Name(Rr pistrant) Telephone Nu. e-mail a��s Registration Number I-7 nim 5T ld/a-SNvA ZUUGI 6'-S Street Address City/Town State Zip. Discipline Expir tion Date 10.2 General Contractor Company Name: 40;0 rtvL Name of Person Res mlible for Construction License No. and Type if q licable , ilA 0-oSto I-S)Ke /tG' MGQl1)��rLW r>?i� OziOS� Street AddressCity/Town State Zip - - 1907 w"/ -G�- 140 7Dc✓l"wc ZY @ 6 0 60IW Telephone No.(business) Telephone No.(cell) e-mail address 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 issuance of the building permit. Is a signed Affidavit submitted with this application? Yes O No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs: (Labor Total Construction Cost(from Item 6)=$ �- f G 0 — and Materials) 1. Building $ S Q Building Permit Fee=Total Construction Cost x_(Insert here 2. Electrical $ appropriate municipal factor)_$ 3. Plumbing $ 4. Mechanical (HVAC) $ Note: Minimum fee=$ act xPuni ality) 5. Mechanical (Other) III $ Enclose check payable to 6.Total Cost I $ /0 0 (contact munici ality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT 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 o wledge and understanding. 71 /�� EI✓ Uu�c"E u� �WdDEdZ �J7rff�5l/- � a d Please print anti .ign n, me Title Telephone No. Date Z 3,6FS77—'e titrcet ddress Cif\/Town State Zip Municipal Inspector to fill out this section upon application approval: Xame bate CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT , syn 120 WASHINGTON STREET,3RD FLOOR tg TEL. (978) 745-9595 FAx(978) 740-9846 KIMBERLEY DRISCOLL MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER May 24,2010 Ms.Shannon Engelhardt 127 Derby Street#1 Salem Ma. 01970 Dear Owner, The roofing work ,recently completed by Award Seal L.L.0 permit 3 498-10, has a number of problems identified during my recent inspection. #1 The roof has leaked since the time it was installed. #2 A third floor deck was constructed without a permit #3 The rubber roof beneath the third floor deck was not terminated correctly against the sidewall and under the door. #4 The flashing on the chimneys was not replaced and in one case,Aluminum flashing was slid under(.Galvanic reactions will occur) #5 The dripedge on the Main Roof does not cover the leading edge of the fascia in some spots and is an obvious location for leaking. #6 The new Fascia boards are attached at the framing members by one nail ,placed along the bottom edge ,and the nails are the gun variety non-galvanised. This improper nailing will allow the fascia to warp and move around combined with the rusting of the gun nails will lead to an early failure of the assembly. #7The flashing caps,or boots, around the plumbing vents are not installed properly and are open to water infiltration. #8 The dryer vent or bathroom exhaust on the East side is not installed properly and also appears to be source of water infiltration The State Building Code 789 C.M.R section 117.1 titled Workmanship- General states "All work shall be conducted,installed and completed in a workmanlike and acceptable manner so as to secure the results intended by 780 C.M.R" Additionally 780 C.M.R section 1503 —Weather Protection staes the following"Roof decks shall be covered with approved roof coverings secured to the building or structure in accordance with 780 C.M.R and the approved manufacture,s instructions such that the roof covering shall serve to protect the Building or structure" Section 1503.2 —Flashings states the following "Flashing shall be installed in such a manner so as to prevent moisture entering the wall and roof joints in coping,through moisture permeable CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT f� 120 WASHINGTON STREET,3RD FLOOR '�'O!rtna TEL. (978) 745-9595 FAX(978) 740-9846 KIMBERLEY DRISCOLL MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER May 24,2010 materials and at the intersections with parapet walls and other penetrations through the roof plane. These items constitute a violation of State Building Code and need to addressed as soon as possible. If you feel you are aggrieved by my interpretation of the Building Code, your Appeal is to the Board of Buildings, Regulations and Standards in Boston. Tho I. erre 7z' Building Commissioner/Director of Inspectional Services i CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT 120 WASHINGTON STREET,3" FLOOR TEL. (978) 745-9595 FAX(978) 740-9846 - KIMBERLEY DRISCOLL MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER May 24,2010 Ms.Shannon Engelhardt 127 Derby Street 41 Salem Ma. 01970 Dear Owner, The roofing work ,recently completed by Award Seal L.L.0 permit 3 498-10, has a number of problems identified during my recent inspection. #1 The roof has leaked since the time it was installed. #2 A third floor deck was constructed without a permit #3 The rubber roof beneath the third floor deck was not terminated correctly against the sidewall and under the door. #4 The flashing on the chimneys was not replaced and in one case,Aluminum flashing was slid under(Galvanic reactions will occur) #5 The dripedge on the Main Roof does not cover the leading edge of the fascia in some spots and is an obvious location for leaking. #6 The new Fascia boards are attached at the framing members by one nail ,placed along the bottom edge ,and the nails are the gun variety non-galvanised. This improper nailing will allow the fascia to warp and move around combined with the rusting of the gun nails will lead to an early failure of the assembly. #7The flashing caps,or boots, around the plumbing vents are not installed properly and are open to water infiltration. #8 The dryer vent or bathroom exhaust on the East side is not installed properly and also appears to be source of water infiltration The State Building Code 789 C.M.R section 117.1 titled Workmanship- General states "All work shall be conducted,installed and completed in a workmanlike and acceptable manner so as to secure the results intended by 780 C.M.R" Additionally 780 C.M.R section 1503 —Weather Protection staes the following"Roof decks shall be covered with approved roof coverings secured to the building or structure in accordance with 780 C.M.R and the approved manufacture,s instructions such that the roof covering shall serve to protect the Building or structure" Section 1503.2—Flashings states the following "Flashing shall be installed in such a manner so as to prevent moisture entering the wall and roof joints in coping,through moisture permeable CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT 3" 120 WASHINGTON STREET,3RD FLOOR �bm TEL. (978) 745-9595 FAX(978) 740-9846 KIMBERLEY DRISCOLL MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER i May 24,2010 materials and at the intersections with parapet walls and other penetrations through the roof plane. These items constitute a violation of State Building Code and need to addressed as soon as possible. If you feel you are aggrieved by my interpretation of the Building Code, your Appeal is to the Board of Buildings, Regulations and Standards in Boston. Thomas St.Pierre Building Commissioner/Director of Inspectional Services CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT ' 120 WASHINGTON STREET,3"°FLOOR TEL. (978) 745-9595 FAx(978) 740-9846 KIMBERLEY DRISCOLL MAYOR THOMAS STYIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER May 24,2010 Ms.Karen Yourell 127 Derby Street#2 Salem Ma. 01970 Dear Owner, The roofing work ,recently completed by Award Seal L.L.0 permit 3 498-10, has a number of problems identified during my recent inspection. #1 The roof has leaked since the time it was installed. #2 A third floor deck was constructed without a permit #3 The rubber roof beneath the third floor deck was not terminated correctly against the sidewall and under the door. #4 The flashing on the chimneys was not replaced and in one case,Aluminum flashing was slid under(.Galvanic reactions will occur) #5 The dripedge on the Main Roof does not cover the leading edge of the fascia in some spots and is an obvious location for leaking. #6 The new Fascia boards are attached at the framing members by one nail ,placed along the bottom edge ,and the nails are the gun variety non-galvanised. This improper nailing will allow the fascia to warp and move around combined with the rusting of the gun nails will lead to an early failure of the assembly. #7The flashing caps,or boots, around the plumbing vents are not installed properly and are open to water infiltration. #8 The dryer vent or bathroom exhaust on the East side is not installed properly and also appears to be source of water infiltration The State Building Code 789 C.M.R section 117.1 titled Workmanship- General states "All work shall be conducted,installed and completed in a workmanlike and acceptable manner so as to secure the results intended by 780 C.M.R" Additionally 780 C.M.R section 1503 —Weather Protection staes the following"Roof decks shall be covered with approved roof coverings secured to the building or structure in accordance with 780 C.M.R and the approved manufacture,s instructions such that the roof covering shall serve to protect the Building or structure" Section 1503.2 —Flashings states the following "Flashing shall be installed in such a manner so as to prevent moisture entering the wall and roof joints in coping,through moisture permeable CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT 120 WASHINGTON STREET,3""FLOOR TEL. (978) 745-9595 FAX(978) 740-9846 KIMBERLEY DRISCOLL MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER May 24,2010 materials and at the intersections with parapet walls and other penetrations through the roof plane. These items constitute a violation of State Building Code and need to addressed as soon as possible. If you feel you are aggrieved by my interpretation of the Building Code, your Appeal is to the Board of Buildings,Regulations and Standards in Boston. Thomas .Pierre Building Commissioner/Director of Inspectional Services ° CITY OF SALEM, MASSACHUSETTS o BUILDING DEPARTMENT 120 WASHINGTON STREET,3R°FLOOR TEL. (978) 745-9595 FAX(978) 740-9846 KIMBERLEY DRISCOLL MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER May 24,2010 Ms:Louise Spohr 127 Derby Street#3 Salem Ma. 01970 Dear Owner, The roofing work ,recently completed by Award Seal L.L.0 permit 3 498-10, has a number of problems identified during my recent inspection. #1 The roof has leaked since the time it was installed. #2 A third floor deck was constructed without a permit #3 The rubber roof beneath the third floor deck was not terminated correctly against the sidewall and under the door. #4 The flashing on the chimneys was not replaced and in one case,Aluminum flashing was slid under(.Galvanic reactions will occur) #5 The dripedge on the Main Roof does not cover the leading edge of the fascia in some spots and is an obvious location for leaking. #6 The new Fascia boards are attached at the framing members by one nail ,placed along the bottom edge ,and the nails are the gun variety non-galvanised. This improper nailing will allow the fascia to warp and move around combined with the rusting of the gun nails will lead to an early failure of the assembly. #7The flashing caps,or boots, around the plumbing vents are not installed properly and are open to water infiltration. 48 The dryer vent or bathroom exhaust on the East side is not installed properly and also appears to be source of water infiltration The State Building Code 789 C.M.R section 117.1 titled Workmanship- General states "All work shall be conducted,installed and completed in a workmanlike and acceptable manner so as to secure the results intended by 780 C.M.R" Additionally 780 C.M.R section 1503 —Weather Protection staes the following"Roof decks shall be covered with approved roof coverings secured to the building or structure in accordance with 780 C.M.R and the approved manufacture,s instructions such that the roof covering shall serve to protect the Building or structure" Section 1503.2 —Flashings states the following "Flashing shall be installed in such a manner so as to prevent moisture entering the wall and roof joints in coping,through moisture permeable ° CITY OF SALEM, MASSACHUSETTS l W� BUILDING DEPARTMENT 120 WASHINGTON STREET,3"°FLOOR TEL. (978) 745-9595 FAx(978) 740-9846 KIMBERLEY DRISCOLL MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER May 24,2010 materials and at the intersections with parapet walls and other penetrations through the roof plane. These items constitute-a violation of State Building Code and need to addressed as soon as possible. If you feel you are aggrieved by my interpretation of the Building Code, your Appeal is to the Board of Buildings, Regulations and Standards in Boston. Thomas . iene 4M Building Commissioner/Director of Inspectional Services ° CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT ti . 120 WASHINGTON STREET,3"°FLOOR TEL. (978) 745-9595 FAx(978) 740-9846 KIMBERLEY DRISCOLL MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER May 24,2010 Ms.Louise Spohr 127 Derby Street#3 Salem Ma. 01970 Dear Owner, The roofing work ,recently completed by Award Seal L.L.0 permit 3 498-10, has a number of problems identified during my recent inspection. #1 The roof has leaked since the time it was installed. 92 A third floor deck was constructed without a permit #3 The rubber roof beneath the third floor deck was not terminated correctly against the sidewall and under the door. #4 The flashing on the chimneys was not replaced and in one case,Aluminum flashing was slid under(.Galvanic reactions will occur) #5 The dripedge on the Main Roof does not cover the leading edge of the fascia in some spots and is an obvious location for leaking. #6 The new Fascia boards are attached.at the framing members by one nail ,placed along the bottom edge ,and the nails are the gun variety non-galvanised. This improper nailing will allow the fascia to warp and move around combined with the rusting of the gun nails will lead to an early failure of the assembly. #7The flashing caps,or boots, around the plumbing vents are not installed properly and are open to water infiltration. #8 The dryer vent or bathroom exhaust on the East side is not installed properly and also appears to be source of water infiltration The State Building Code 789 C.M.R section 117.1 titled Workmanship- General states "All work shall be conducted,installed and completed in a workmanlike and acceptable manner so as to secure the results intended by 780 C.M.R" Additionally 780 C.M.R section 1503 —Weather Protection staes the following"Roof decks shall be covered with approved roof coverings secured to the building or structure in accordance with 780 C.M.R and the approved manufacture,s instructions such that the roof covering shall serve to protect the Building or structure" Section 1503.2—Flashings states the following "Flashing shall be installed in such a manner so as to prevent moisture entering the wall and roof joints in coping,through moisture permeable ° CITY OF SALEM, MASSACHUSETTS x jqt BUILDING DEPARTMENT 120 WASHINGTON STREET,3"°FLOOR �+rus TEL. (978) 745-9595. FAX(978) 740-9846 KIMBERLEY DRISCOLL MAYOR THOMAS STTIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER May 24,2010 materials and at the intersections with parapet walls and other penetrations through the roof plane. These items constitute a violation of State Building Code and need to addressed as soon as possible. If you feel you are aggrieved by my interpretation of the Building Code, your Appeal is to the Board of Buildings, Regulations and Standards in Boston. Thomas StTierre �Lg,9a 1401� Buil in Comm issioner/Director of Inspectional Services CITY OF SALEM, MASSACHUSETTS BUILDING DEPARTMENT s 120 WASHINGTON STREET,3"D FLOOR TEL. (978) 745-9595 FAX(978) 740-9846 KINMERLEY DRISCOLL MAYOR THOMAS STTIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER May 24,2010 e � a Salem Historical Commission 120 WASHINGTON STREET, SALEM,MASSACHUSETTS 01970 (978)745-9595 EXT.311 FAX (978)740-0404 CERTIFICATE OF APPROPRIATENESS It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving ❑ Reconstruction Alteration ❑ Demolition ❑ Painting ❑ Signage ❑ Other work as described below will be appropriate to the preservation of said Historic District, as per the requirements set forth in the Historic District's Act(M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: Derby Address of Property: 137 Derhy Street Name of Record Owner: Robert Dana Description of Work Proposed: Replace asbestos shingles with wood clapboards. Replace missing around window. Repaint in existing colors. Dated: June 9, 2006 SALEM HI TORICAL C/O�MMISS10N By: TC C, j� `� / The homeowner has the option not to commence the work (unless it relates to resolving an outstanding violation). All work commenced must be completed within one year from this date unless otherwise indicated. THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessary permits or approvals) prior to commencing work. lSalem Historical Commission ONE SALEM GREEN, SALEM, MASSACHUSETTS 01970 (978) 745-9995 EXT 311 FAX (978)740-0404 NOTICE OF DENIAL OF APPLICATION FOR A CERTIFICATE OF APPROPRIATENLSS RE: 127 Derby Street On Wednesday, May 6, 1998, the Salem Historical Commission unanimously voted to dem an application for a Certificate of Appropriateness from Salvatore Minacapilli to remove the shutters at 127 Derby Street and to require that any shutters removed be reinstalled after completion of painting. I attest that this is an accurate record of the vote taken, not amended or modified in any wa% to this date. May 7, 1998 —_ Jane Auy Clerk o the Commission cc: Building Inspector City Clerk (fitp of &ale t, f am5ar uzatz 3publit Propertp Mrpartment Nuilbing Mepartment One Salem Oreen (978) 745-9595 (Ext. 380 Peter Strout Director of Public Property Inspector of Buildings Zoning Enforcement Officer March 2, 1999 77 Realty Trust Julie Tache Trustee RE: 127 Derby Street Unit 3 1. This letter is to verify that the rear deck is part of the rear egress and must be maintained as such. 2. The rear egress door should be replaced at the top of the rear stairs. 3. The double cylinder deadbolts need to be removed totally. 4Sincer Peter St ut Inspector of Buildings o CITY OF SALEM MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RD FLOOR a tA^ SALEM, MAO 1970 ' tonne TEL. (978)745-9595 EXT. 380 FAX (978) 740-9846 STANLEY J. USOVICZ, JR. MAYOR June 10, 2003 Eleanor Dubin Coldwell Banker 664 Humphrey Street Swampscott, Ma 01907 RE: 127 Derby Street To Whom it May Concern: The property located at 127 Derby Street is a legal non-conforming structure. Salem Zoning Ordinance Section 8-4 would require a structure that is destroyed by more than 50 % of its replacement cost or 50% of the floor area would require Zoning Board of Appeals approval before reconstruction. Any questions please contact me. Since ely, Thomas St. Pierre Zoning Enforcement Officer / --- I'lie C'o(nnutmce:dlh ul'biassachuscus �/ s �1r�iVi cgulatiuns and StandardS Cl I'1. OF 5,\Lli\I � \Mass; etts State Building Cude, 790 C'hIR Buildin ' nit \i ❑tion 'ro Construct. Repair, Rcnavat• r Deno is a Une-ur Tuv-k'amilr Du•ellitt•%r This Section For 011ricial Use Onl Building Permit Number: Date UuilJing Olticiai tl not Muncif Dale SECTION I: SITE INFORIIIATION L I Property Address: 1.2 Assessors Slap& Parcel Numbers 7 •1 a 6 Y S—r— I.la Is this an accepted street?ves no Map Number Purcel Number 1.3 Zoning Information: 1.4 Property Dimensions: /uning District Proposed Use Lot Area(eq 11) Frontage(ll) 1.5 Building Setbacks(R) Front Yard Side Yards Rear Yad Required Provided Required Provided Rryuircd Provided 1.6 Water Supply:(M.G.I.e.40,§54) 1.7 Flood Zone Information: 1.3 Sewage Disposal System: Nblie O Private❑ Zone: _ Outside Flood Zone? Municipal O On site dispusut s)stem O Check If es❑ SECTION2. PROPERTY OWNERSHIP' 2.1 Ownerl of Record: LC, U4 & .p S P () 6 a S tac., " M A D 1 9W2 Name(116111) City.Stale.ZIP I -L -7 Y' 5a$ sa-7X)It Nu.and Street relephune Fmuil Address SECTION J: DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction❑ Existing Buildin Owner•Occupie epairs(s Alteration(s) ❑ Addition O Demolition ❑ I Accessory Bldg. ❑ I Number of Units_ I Other ❑ .Specily: Brlcf[D�eTlptionofProposcd Work% ! e Cam'SC i �'7^ SECTION a: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only H.abor and Materials) I. Building S 7 Z I. Building Permit Fee: S Indicate how ree is determined: ❑Standard CiryTown Application Fee '. Iflcarical S ❑ i Total Project Cost (Itan 6)s multiplier ). I'lumhing S '. Other Fees: S_ 1. \ledtenieul tll\ ( 1 S List: — �1.6_ . . . iFiry �u .vessioitt romi .\II Fees: S_-'--___-- ChecA Vo. ( heck:\nnnnrt: l'.t�h \nunuu: o fetal Project Cost: S — O P.tid in Full 0 Outstanding 11.11.mce Due: �� roijk SEC I ION 5: ('ONSI'RIICTIONSF.RVI('FS 5.1 Cunstructiun Supen isur License(C'SI.1 / s'� . I ieenx Nunlher Pspuali+m DaW N.une ul l'SI. I Iuldcr I i.vll'SI. I'.Palssbcluol v -- — No. wJStreel 1)Pa I) smxriPtion ll I hrcitrided(DurWings 110 to 5,001)'o. II.) I&I Pamil Dortlin L il),Toon.Slane.Lit' \I %Iasoory I(C Rollin Cos Grin ..._. R'S Windoo',md Sidin SF Solid I°ucl Iluming %PPIiancc5 1 Insulation Talc hone I.mail address D Demolition 5.2 Registered Hunts Improvement �� Contractor IHIC) � D � ( ( ( T t( '0ZY IIIC Registration Numltur I?cpir`th1111 Dula I IIC company Noma or I IIC Registrunt Nunlu I:Inalll addled! City/Town.State ZIP 'relc hone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152.l 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this afildavit will result in the denial of the Issuance of the building permit. Signed AlPldavit Attached? Yes .......... O No ...........O SECTION 7s. OWNER AUTHORIZATION TO 8E 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. Print Dw wr's Nurvc(Electrunic Signature) Dute SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION 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. /- (:> I'r!nt Uoncr'f a \uthorire ,\gcn Naulc Ihaedrunic Signaulrc) Data NOTES: I. .\n Owncr whu obtains a building permit to do his her uwn work,ur an owner who hires an unregistered contractor tout registered in the Hume Inlpruvcnlent C'untractur(HIC) Program),will rrr+ have access to the arbitration program or guaranly fund under..\1G.L. c. I11.�. Othcr important information on the HIC Program can be found at . tl Information on the Construction Supervisor License can be found at ', \\'hen substantial twrk is planned, pros ide the inrurmatiun below: rota) Iloor area 1 iy. R.I . I including garage, finished basement attics,Jocks or Porch) Grass lie ing area I sq. lI.l ._... _ _,.. . ilobilabie roum count \unthcrol lireplaces .. ... ._. .. --- \umberolhcdroomi -. . \ttmherof'hathroums . . . _ _ \tunherofh;df hmhs . I\pe ofheanng i)aenl _ Ntunher of'Jccks, parches I\pe Icaalingi�<Ielll 17t10h 'ed Opall 1 I\dJI Pnljeet Stllf.11e I'Jnl.lyd" all) hC iuhiIlllllUl oaf"f+dol PrlijeCl (oil I 'r The Conamotnvealth of Massachusetts Department of Iitdustrial Accidents Office of Investigations d 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (t3usincss/Organiauion/tndividuaq: Len Gibely Contracting Company Address: 23R Winter Street City/State/Zip: Peabody, MA 01960 Phone.#: 978 531 -8234 r—Are you an employer? Check the appropriate box: Type of project (required): 1 1.® 1'am a employer er with 12 4. ❑ I am a general contractor 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. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.]- 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 1 LLI Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.) t c. 152, §1(4), and we have no employees. [No workers' 131-1 Other comp. insurance required.] 'Any applicant drat 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 anew affidavit indicating such. Tcont actors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have ei nployees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ani an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A. I .M. Mutual Insurance Company Policy li or Self-ins. Lic. #: 6010979012012 Expiration Date: 08/03/2013 Job Site Address: r?_ City/State/Zip: 0`?,A 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 1 do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature Phone#: -7 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 S. Plumbing Inspector 6. Other Contact Person: Phone#: JNN-24-2012 14:35 Sennott Insurance 9.78 88'7 2404 P.01 ...... ..�. - -• - - •- • -- - - - - - --- ---._. . .. _ _. - - -- -• - - - 1 01/24/2012 PRODUCER 978.857.4900 FAX 978.897.2404 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Edward F. Sennott Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 16 South Main $treat HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, P. 0. Box 457 Topsfield, MA 01983 _ INSURERS AFFORDING COVERAGE NAIC H INSURED Len Gibely Contracting Co. , Inc.* INSURERA Catlin Specialty Insurance 23R Winter Street INSURERS. '— -119038 -.._ __. . .....-Peabody, MA 01960 INSURER C' . INSURER D: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOICAYEU. NOTYVITHS"rANUING ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR 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'rERMB,EXCLUSIONS ANU cONUfrIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR NSA TYPE OF INDO kDO' P ICYEF RANCE - POLICY NUMBER FECTIVE FOUCTUPI RATION DATE MM/ODrYYYY DATE MMIDINYYY UANTS GENERAL LIABILITY 370030101S 01/29/2012 01/29/2013 EACH OCCURRENCE { 11000,00 X 000MMERCIAL GENERAL LIABILITY EB ERoawrrence t wp-'000 CLAIMS MADE EKOCCUR ME D EXP(PAY ana panpn) i S.OQ A PERSONAL B AUV INJURY $ I 000,OU GENERAL AGGREGATE { 2,000,000 GEWL AGGREGATE LIMIT APPLIES PER: aaUUCTS•COMPrpP AGO i 21000 Q0- POLICY PRO- •- - - — — - Jecr Loc AUTOMOBILE UAeIUIY COMBI --- ANY - (Ed a"INtlEaD191NGLE LIMIT 9 ALL OWNED AUTOS BODILY INJURY _--- B I X SCHEDULED AUTOS (Pci pal,pn) { X VIREO AUTOS BODILY INJURY X NON-0WNED AUTOS (Per F=IdM) { ---^^ PROPERTY ONAAGE 3 UARAUE LIABILITY AUTOONLY EAACCIOENT { AN'AUTO TH OER THAN EA ACC t AVYO ONLY. AGG S E%OESSIUMBRELLALIABWry EACH OCCURRENCE OCCUR uCWMSMAOE AGGREGATE —� t DEDUGTBLE �— I ANY WORKERSCOMPENSIATION ANY EMPLOYTORLUIBIUER YIN TOgY LIMITNy ER_ -_ - __ C OFFICOADIAEMB�E ICLUDEDT ECUTIVE[--I E.L.EACH ACCIDENT i _ IM"dalarF NI NMI u E.L 019EASE-EA EMPLOYEE3 U YYPP. it pRpdunder -- _ - OTHER PROVISIONS DFlow E.L.DISEASE-POLICY LIMIT { OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BT ENOORSEMENT I SPECIAL PROVISIONS VIOENCE OF 2012 RENEWAL COVERAGES. CERTIFICATE HOLDER CANCELLATION iJ SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE T'lle EAPIHATIONI DATE THEREOF,THE ISSUINO INSURER WALL ENDEAVOR TO MAIL 10 DAYS OR(I I LN NOTCe TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILJHE TO W SD$HALL IMPOSE NO OBLIGATION OR LMBILLTY OF ANY MIND UPON THE INSURER ITS FOEN TB OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Sennott Ins. Agency ACORD 25(2009101) m 1988.2009 ACORD CORPORATION. All rights reenrvad. The ACORD name and 1090 am m9istamd marks of ACOR13 �,: r� aJ L.i at ly�yl. CVLLira/ .\vrlOa 1. 1v >J / VJJ aJJ1.f:IP 1,I. + V- 1 CERTIFICATE OF LIABILITY INSURANCE DA07/24/?U12 ' THIS CERTIFICATE 13 ISSUED AS A XhTTER OF INFORNATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFSOATE NOLDLR. THIS CERTII'IG.TE DOES NOT AFTIRNATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER TNL COVERAGE AFFORDED BY THE VQLICILS BELOW. THIS CERTIFICATE OP INSURANCE D0E9,NOT cwsrITUTE A CONTRACT BETWEEN THE I33VING INSURER(S) , AUTHORIZED REFRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. I L.IAPORTANT: If the Dertificate holder is An ADDITIONAL IN9VRED, the polloy(iee) must be endoreed. If SUBROGATION IS WAIVED, s)BjeQt to the team. and conditions of the policy, certain policies may re"are an endorsement. A statmant on this certificate does not confer x1ghta to the certificate holder in lieu of euoh andolaaevent(A) . _ vxmucuR .."AOT Edward F Sennott Insurance x"a' vxoxe eax Agency Inc •-MIL 16 South Main Street Tops£ield, MA 01993- GVIIBVEP ION. IxmK01s1 N5'Ouol xc<w[NGr —___—.xtt n Len - .:en Gibely Contracting Company Inc — NwKN x: A.I.M. Mutual Insurance Co 37 d--I l PmKP o: 23 Winter Street Rear —'-_-- i Peabody, MA 01960-5961 INiVKn[ � _ Invinu'x r: COVERAGES CRRTIPICATE N@4HER: REVISION N ZR: �— I 'T1115 15 TO CERYI Y THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED MADE ABOVE FOR THE POLICY PERIOD DVDICATEG. NO7MIT113TANOING ANY REQDIRO@R, TLTYI OR CONDITION OF ANY CON RACT OR OTHER DOCNMOT WITH RESPECT TO NNICH THIS CERTIPICATC NAY BE I5SUED OR YJ.Y PBRI'A10 , THE INSURANCE AFFOVDIL BY THE POLICIES DESCRIBED HEREIN 14 4V ADT TO ALL THE TERNS, EMULV41ONS AND CONDITIONS Or SVCH VOLICIES. LIDIITS 9tL4.ti W.Y HAVE BEEN REDUCED BY PAID CLAIMS. POLICY RUBBER, POLICY Ell, POLICY EXP LM]TS TYPE OF INSURN,CE pVm/mn� UWw/rvnl GENERAL LIABILITY eAGx OccvMNti f --- - �i':MNdvFl,ti 431�::.L LI".p:lln pAM4r f0 R[xK0 , nep V.B FIT ❑ e Igor .o• u I aswML.c4n.osie I cnnr'. ::>rrsn lair^ vw.n u:Aa oIA.L i AUTOHOBILS LIABILITY c4roI XC0 a,N0.[ uw♦ ❑,.IY L. k P.N[, ❑n _ i:f.d�nl:ba Neeur IXa Oxr Ir•�voN s ❑^.'I I:IX..rI Aln)i OOpILT INJV•.Y IPR .cel0•ntl S �`12 x14 Y�JB (Me •ae14nt1 1 - i n:�N1.Rl 'a. ,1l ❑ f..:l'IF NACN VICVNKXCI S 0E:;—1 L-,� ❑ CN[YJ.WJ:C AG40.xCATC _ ?- I ❑4LIlI:A If L[ I - �I;[ xuiA Y f F— WORASRS CG�EN9ASION AND M'(PLO 9 LIABILITY avri LaasY CIB .`F!'I'R[I rIC3ARi:1035/ [.L, iACn Kem[xi e SOON 000 A rc¢r.rn"d¢ orrlcl-•. ZRI RXOI 6010 97 9012 012 L. owavv -eolac uNn' s BCD,VUV 08/03/2012 08/03/2013 .L. ortcud - u [IOLmi 1 500,007 CERTIVICATE HOLDER CANCELLATION Evidence Of Insurance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CMCELLN BEFORE 1'ill EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE. 'WWII TH',: POLICY PEOVISIONS. .V.xpxuf➢xl)venln lv[C.��'� _ LEN GIBELY CONTRACTING CO., INC. Page No. of / PP 23R Winter Street 23788 PROPOSA PEABODY, MASSACHUSETTS 01960 All home Improvement contractors and subcontract (978)531-8234 Fax(978)531-9304 engaged In home Improvement contracting, unit wwwAtur gibelyconlraeting.eoln specifically exempt from registration by Provisions Chapter 142A of the general laws,must be registe Submitted TO �Qr� I .� / with the Commonwealth of statusMassach should betm a to To:_✓ _SK.f.__- /_j1.1__ about registration and ment Contra t made at ---/�� Director,nAsh Home Improvement Contract n,MA One Ashburton Piece, Room 1301,Boston,MA 02' (617) 727-8598. Owners who secure their o construction related permits or deal with unregade contractors will be excluded from the Guaranty Ft O / Provision of MGL c.142A. Pq 7 NE BPi PP016TPATION NO. � r)WO —03 ) 1 MA.REG. 100811 �B NNAf/NY / 7 JOB LOCATION 41I� Wa mere bmll sp[lifts one ntl for wo to be petlormed matwhis w be used: Con traction ref tetl per its: WOnOC—a kcircumstancesOCIJ �' aCHEDUL C cto II n bap rk pr p M1 Cal ro tM10 third tley follow ng Ina started r9 0l this Agreement, p 'I'tl n o w t 9 /ratter w b q nv,mrt about (ealai.a rinq delay caused by c rcumstances Ceyv a Caneaclora n trot,Ina work w Ce comply oe by et.TM10 Owner a MawleU s a Ilu1 tn6 acneeullne tlal6e era eppro+imal6 end IM1aI sucM1 EBIaYa Nat are MI ewYJade by Ina wnlNctor¢Fell MI be con Itlarvtl as lions of tnia Pgmuni, WARRA laid contradict wavents Nat the work furnished hereunto,met be Imo Irom selects In material and warkmansM fora ^'j� �p�( p perin ol�2LLS.ylldvin9 completion and shall comp ins tequiremenla of NIs Agreement.In the ewnl any direct In wnrad enshlp or materiels,or damage caused by Me Conn...,,his eubcculdestan.employees or agents,Is t ilidne0u one year area completion 0 any tcb.Including claim up,the Conbatlor shall,at his own expense.kethwltn comedy,repair dimmi replace,or cause b be remedied,repaired,o,re; such coastal wsuch baled In materials or wmkmanship.The territorial w antheshall dervlve any miscarried pedormW in cranectwn with the agretebupon work. We Propose hereby to furnish material and labor—complete in accordance with above specifications,for the sum of: dollars($ Payment to be made as follows: M'4� j 0 z z-. %(s )upon aigning Contract: _ R.—of comronodow _. Ipmroe nupiatranl six is )Upon cvmPlelion of SaaolAWrasa %(a )Ch I compldion of q,yrsuw enw,v �%is )shaglaed of mrbwuhapon ompletion of work undo IM1Ia senses/. vmno yoveml IU r Not did No agreement for moms impmvamonl Contracting work email require adon w baman� payment(edvands disposed of mom than one third of tna test contract price or tp total amount of ell dep0¢Its Or payments which the wnlractor, must make,In advorMe, ea gww o ...w- to order and/or otherwilm eleven delivery of special order mounted.and ogalparem, n'cnewr nmoa, ow:iN.mwoaal ma _y ea wimerawmq It nvl accoyua wiinln Acceptance of Proposal I have read bath sides of this document and accept the prices,specifications and conditions stated.I underst that upon signing,this proposal becomes a binding contract.You are authorized to do the work as specified. Payment will be made as outlined into You,the Buyer,may cancel this transaction at any time prior to midnight of the third business day after t date of this transaction.Cancellation must be done in writing. /OQ) NOQ'f SIG T IS CONTRACT IF THERE ARE ANY BLANK SPACES. 1 scnowra ~ oma"�'.�1 I 1 2�bdmmada oma IMPORTANT INFORMATION ON BACK ti I Massachusetts - Department of Public Safety Board of Building Regulations and Standards 'it'll ti'tior Sri),I t 1"'I License: CS-094763 Is &BINS THOMAS K no 19 Cedar HULDriviR Danvers MA,-019 I It Expiration Commissioner 05114/20114 -%/' Y,, Office of Consumer Affairs& Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: I00811 Type: Office of Consumer Affairs and Business Regulation E0 Private Corporatior, 10 Park Plaza-Suite 5170 xpiration: G/23/2014 Boston,MA 02116 LEN GIBELY CONTRACTING CO., INC. Brian Dobbins - 23 R WINTER ST. PEABODY, MA 01960 Undersecretary Not ,1. vi,7� .C4 g Cowl '�cialuxe Salem Historical Commission 120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970 (978)619-5685 FAX(978)740-0404 CERTIFICATE OF NON-APPLICABILITY It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving 0 Reconstruction ❑ Alteration ❑ Demolition ❑ Painting ❑ Signage ❑ Other Work as described below does not involve an exterior architectural feature or involves a feature covered by the exemptions or limitations set forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: Derby Street - Address of Property: ,,127 herby Street a,=:f" t:} ._" ;.'..;UCG :;- ,{:blj., �riiJ�'of S C,. ...-R Name of Record Owner: Lou, Snohr Description of Work Proposed: Replace 3 skylights to replicate existing. No changes in color, material, design, location or outward appearance. Non-applicable due to being in kind maintenance/replacement. . Dated: October 4, 2012 SALEM HI MISSION By: tsb - tI - The homeowner has the option not to commence the work (unless it relates to resolving an outstanding violation).,_All:work commenced must be completed within one year from this date iinl-ess otherwise indicated. THIS IS NOT A BUILDING PERMIT.' Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessary permits or approvals) prior to commencing work. The Commonwealth of Massachusetts Board ul Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR, T"edition OF SALEM �. Revised Juwnnrry Building Permit Application To Con5ljVcl. Repair, Renovate Or Demolish a 1, lour One-or rw Fa#ri4y Dwelling This Se4ion Ifor Official Use QpIV Building Permit N bee/��_ Date pl' Signature: "r-a" Building Cummissioner pertor of Build' Date SECTI 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers I.la Is this an accepted street?yes /000� no s Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq 11) Frontage(11) 1.5 8ulIding Setbacks(R) 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❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system O Check if es❑ SECTION 2: PROPERTY OWNERSHIP' 2 Owner'of Record: Name(Print) Address for ServicT� Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(cbeck all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ AccessoryBldg.❑ Number of Units Other g r ❑ Sped c ! Brief Description of Proposed Work': ,.-r vc i ?)+r/ , 0/l2o S /LCNLGCiL 7- o� c; SECTION 0: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: OOlelal Use Only Labor and Materials I. Building S I. Building Permit Fee: S Indicate how tee is determined: ❑Standard City/Town Application Fee ?. Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 1. Plumbing S 2. Other Fees: S 4. Mechanical (IIVAC) S List: 5. Mechanical (Fire S Suppression) Total All Fees: S 6. Total Project Cost: S Check No. Check Amount: Cash Amount: 0 Paid in Full 0 Outstanding Balance Due: 1 SECTION 5: CONSTRUCTION SERVICES 5.11 Licensed Construction Supervisor(CSL) s�Z _V/AU! O dA�UOCG^ License Number iapiratiu Uale /N:�une of CSL•I IuWy.�y List CSL Type Isee below) 4y A2"� f IJescri ion \ U tinrestricieJ u to IS ON Cu.FI. R Restricted Id2 Fa-il Uwellin lignaturc M M Onl LJ7� 192-9' 711'7 RC 11ResiJemialRoolin C'overin I'.lephone WS RoiJmtial Window and Siding SF Residentia12 Solid Fuel Burning Appliance Installation D Reiidential Demolition 5.2 Regbtered Home Improvement Contractor(HIC) R'J ro '� ��Or Registration Number SIC Cump�n�Nayt^w 111�C'gegtstrant Nume / a /I'! " T �"/ S- vial A Rif � ' Q(26L01 �^ �!!� Expiration Date ,S Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.I.c. 152.1 23C(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 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 /Y/LF1\/ O as Owner of the subject property hereby authorize — to act on my behalf,in all matters rive " work a t orized y this building permit application. 3 id Si urc ofowner Date ION 7b:OWNERt OR AUTHORIZED AGENT DECLARATION 1 c,,,.:.. ,as Owner or Authorized Agent hereby declare that t e statements and information on the foregoing application are We and accurate,to the best of my knowledge and behalf. eF}(f'j(, Pri me 's 16 Signature of Owner or Authorized Agent e Si under the ains and hies of 'u NOTES: I. 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 ad have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 1 IO.RS, respectively. 1. 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 Number of decks/porches Type of cooling system Enclosed Open ). "Total Project Square Footage"maybe substituted for"Total Project Cost" VS OF SALEM V` PUBLIC PROPRERTY A?> �D DEPARTMENT a UIt;xI FY:)g Hk:,TA. \Ls)t to 12.WASHING I ON S"EleT • SAL F.M.MAss.wa It Sl.I ISO197.^, fl•.1.:978-745.9595 9 1'.t8:978-740-9846 Yorkers' Compensation Insurance Atfidavit: Builders/Contractors/Electricians/Plumbers n )licant Information ` Please Print Leeibly Name ,Business OrBanintinn In hvlduup:AIL 1 a �RVOI :Address: City,st.lrcizip:,cc tezO AA.#r o(`,�L,5 l'hune /:: Q2r 2!f3s Ar"you an",,),Oyer' Check the appropriate box: 'type of project(required): 1.❑ I :un a employer with_ 4. ❑ 1 am a general contractor and 1 6. ❑ new construction t to yces full and/or urt-tine).` have hired the sub-contractors p Y ( P 7. emoJeling 2 I :un a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8. �Demolirion working for me in any capacity. workers' comp. insurance. 9• ❑ Building addition Ko workers'comp. insurance [35. We are a corporation and its 10.❑ Electrical repairs or additions required] officers have exercised their 3.❑ I am a homeowner doing all work S exemption P right of per MGL 11.❑ plumbing repairs or additions Pon ' Inyself. [No workers' comp. C. 152, ¢1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] -Ally:5rplicuur that chucks box BI must also lilt out the scetimt below showing their wurkess cutup tmation pulicy intinnmtiur>_ ' I lumeowmrs whu submit this affidavit indicating they ate doing ell cork acid then hit"uutsida canr b aelon must Dumit a new al'rdavit indi W m g such. - ontm rs cnu shut check this box must atixhed on n addaivai she"1 showing the mote of the subcontractors and their workers'carp.polity mformntiun. C' i gut an eosptuyer that is pruviding workers'c•onrpen.cruion in.curnnee fa•my employees. Before is the pu/icy and job site informution. Insurance Company Name: --..._.. _. ----- Policy is or Scif-ins. Lic.il: —__.._ ... . . .-___ Expiration Date: Job Site Address: City/State/Zip: Attach it copy of the workers' compensation policy declaration page (showing the policy number and expiration date). hailurc to secure coverage as required under Section 25A of IGL c. 152 can lead to the imposition of criminal penalties of a Fine up to S1.500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine Of up to S250.00 a day against the violator. 13a advitic:d that a copy of this statement may be lurwarded to the Office o1 Invcsugaut nts ul'the DIA for imuracce coverage verification. l du hereby"unify under the p t is and penalises ujperjary that the information provided above is true and correct. t I'h,wc Ogiciul rue only. Da not write in this area.to be runtpleted by city or Town official. City or Mown: _ Permit/License k___.._. Issuing Authority (circle onc): 1. Board of Ilvalth t. Ituildinq I)cpartinent 3. Cityi fosut Clerk 4. Llectrical Inspector 5. Plumbing Inspector L. Other --- - Contact I'crsou: __ . ._. Phoned: Information and Instructions .10assachuseus General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual, partnership,association, corporation or other legal entity,.or any two or more of the Gxegoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual, partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, Q25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally. MGL chapter 152, s§'25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please rill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s) name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and duce the affidavit. The affidavit should be mined to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or"rown Offlelals Please he sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture 1 i.e. it dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. I lic Of I ice of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Deparunent's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE advised 5-26-05 Fax #617-727-7749 www.mass.gov/dia : > CITY OF SALEM � 'A PUBLIC PROPRERTY DEPAR"['MENT Construction Debris Disposal Aflidavit (requited Ii)r all demolition and renovation work) In accordance % ith the sixth edition of the State Building Code, 780 Ch1R section 1 1 1.5 Debtis, and the provisions of MGL c 40, S 54; Building Permit N is issued with the condition that the debris resulting from this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c 111. S 150A. The debris will be transported by: (name of hauler) 1'hc debris will be disposed of'in : (�ame ul laeility) Gig 6 Ri rti IuJdrres ul'13cllilyl l aguamre of prnnit apphcaut _-.L / I C� v� Salem Historical Commission 120 WASHINGTON STREET, SALEM, MASSACHUSETTS-01970 (978) 745-9595 EXT 311 FAX (978) 740-0404 CERTIFICATE OF NON-APPLICABILITY It is hereby certified that the Salem Historical Commission has determined that the proposed: 0 Construction ❑ Moving Reconstruction ❑ Alteration Demolition ❑ Painting ❑ Signage ❑ Other Work as described below does not involve an exterior architectural feature or involves a feature covered by the exemptions or limitations set forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: Derby Street Address of Property: 127 Derby Street Name of Record Owner: Karen Yourell Description of Work Proposed: Repair/replace damaged fascia boards and shingles along fascia and gutters. Temporary removal of gutters permitted to accommodate repairs. No changes in color, material, design, location or outward appearance. Non-applicable due to being in kind maintenance/replacement. Dated: September 9, 2010 S E O COMMISSION By: The homeowner has the option not to commence the work (unless it relates to resolving an outstanding violation). All work commenced must be completed within one year from this date unless otherwise indicated. THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessary permits or approvals) prior to commencing work. 1 5 . 0 g Salem Historical Commission 120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970 (978) 745-9595 EXT 311 FAX(978)740-0404 CERTIFICATE OF NON-APPLICABILITY It is hereby certified that the Salem Historical Commission has determined that the proposed: 0 Construction ❑ Moving Reconstruction ❑ Alteration Demolition ❑ Painting ❑ Signage ❑ Other Work as described below does not involve an exterior architectural feature or involves a feature covered by the exemptions or limitations set forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: Derby Street Address of Property: 127 Derby Street Name of Record Owner: Karen Yourell Description of Work Proposed: Repair/replace damaged fascia boards and shingles along fascia and gutters. Temporary removal of gutters permitted to accommodate repairs. No changes in color, material, design, location or outward appearance. Non-applicable due to being in kind maintenance/replacement. Dated: September 9, 2010 S E O COMMISSION By: The homeowner has the option not to commence the work (unless it relates to resolving an outstanding violation). All work commenced must be completed within one year from this date unless otherwise indicated. THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessary permits or approvals) prior to commencing work. }lassachusetts- Department of Public Safct? Board of Buildin, Re,ulatiunsand Standards Construction Supervisor License License: CS 62502 Restricted to: 1 G , DAVID S SAVOIE f 169 EASTERN AVE ESSEX, MA 01929 Expiration: 9/19/2011 t .n..... nrr Tr#: 9307 0ftice onkuO1m'e� -IF iness"�g`ulefiori"- iNOME IMPROVEMENT CONTRACTOR rRegistration: -116360 Expiration: 6/6/2012 Type: Individual _ DXVID S SAVOIE DAVID SAVOIE . 64 MARTIN ST - - ESSEX, MA 01929 4 �T Undersecretary 09/13/2010 13 :40 FAX 978 281 0473 CARROLL STEELE INSURANCE U 001/001 AC Q® 1 OATE(MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 9/13/2A'0 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(lee) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and Conditions of the policy,Certain policies may require an endorsemant. A statement on this Certificate does not confer rights to the certificate holder in lieu of such endorsemen s . PRODUCER NAME: Shirley Bilva Carroll A. Steele InauratlCO Agency, In0 PHONyP,Exn: (97B)283-5100 ApC No:(978)201.0473 32 Pleasant St. vPRESS:a a ilva®eks teele.com P.O. Box 1347 FROeUCEq CU A00032D6 _ QIPNF.R ID P. Gloucester _ MA 01931 INSURERS AFFORDING COVERAGE NAILfl INSURED INSURERA-Colony Insurance CO _ David S Savoie - INSURER B:Libert LEutual IEeurance Co - 169 Eastern Avenue wSURERC: INSURER p; _ ]EssexMA 01929 INSURER E ` INBURERF- COVERAGES CERTIFICATE NUMBER:CL10 913 013 95 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REOUIREMENT, 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .wR AD R TYPE OF INSURANCE A POLICY EFF POLICY EXP POLICY NUMBER MMIDD/Yl'YY y LIMITS GENERAL LABILITY EACH OCCURRENCE § 1,000,000 X COMMERCIAL GENERAL LIABILITY DANgEE PREMISES(Ed wcurranol 100,000 A CLAIMS•MADF, Fx] OCCUR L3728084 0/23/2009 0/23/2010 MED E%P An m.e arson d 5,000 PERSONAL AAOV INJURY Is 1,000,0130 --- GENERAL AGGREGATE § 11000,000 GEN'L AGGREGATE UMITA P-UES PER PRODUCTS-COMP/OP AEG d 11000,000 X POLICY PRO- ---- LOC d -- _ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT § ANY AUTO (Ea..Mere) ALL OWNED AUTOS BODILY INJURY(Per paoan) § `- BODILY INJURY(ParedcdonO S SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE § (Per eemdanl) NON-OWNEDAUTOS § UMBRELLAUAB OCCUR EACH OCCURRENCE § E%CESS LIAR CLAIMSMgpE AGGREGATE _ § DEDUCTIBLE d RETENTION a S - B WORKERS COMPENSATION WC STATU- OTH. AND EMPLOYERSP LIABILITY YIN ANY PERIMEMTORrPARTNER/E%ECUTIVE EL EACH ACCIDEM d 10O,,000 OFFICER/MEMBER E%CLUDE09 NIA (Mandaory In NH) C2-318.325897-030 1/2/2009 2/7/2010 EL D16EASE-En EMPLOYE s 100,000 rc vas.aear+IDa antler DESCRIPTION OF OPERATIONS tvlow EL DISEASE-POLICY LIMB 599,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 191.AdBlUonal Ramarke SCMDU18,If mere apeca V and Wroa) CERTIFICATE HOLDER CANCELLATION (978) 740-9 B46 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION PATE THEREOF, NOTICE WILL BE DELIVERED IN City of Salem ACCORDANCE WITH THE POLICY PROVISIONS, Attn: Salem Building Dept. 10 Congress St. AUTHORIZED REPRESENTATIVE Salem, MA wI 1� ACORD 25(2009/09) �r (P1988.2009 A RD CORPORATION. All rights reserved. INS025(20DDoR) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Board of Building Regulations and Standards Town of k' Massachusetts State Building Code, 780 CMR, Vh edition Building Dept Building Permit Application To Construct, Repair, Renovate Or Demolish a *WIO 6 NM One- or Tao-Faintly Duelling �L This Section For Official Use Only Building Permit Numb Date Applied: /A Signature: zge Building Commissioner/1 pector of Buildings Date SECTION I: SITE INFORMATION 1.1 Property Addrew, 1.2 Assessors Map& Parcel Numbers 1.1 a Is 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(It) 1.5 Building Setbacks(ft) 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❑ Zone: _ Outside Flood Zone?Check ifyes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Xt o Name(Print) Address for Service: Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': / A/!�-c SECTION 4.-E-STIMATED CONSTRUCTION COSTS r2E]ectrical m Estimated Costs: Official Use Only Labor and Materials Building g 1. Building Permit Fee: S Indicate how fee is determined: g ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: S 4. Mechanical (HVAC) S List: 5. Mechanical (Fire $ Suppression) Total All Fees: S Check No. Check Amount: Cash Amount: 6. Total Project Cost: S ❑Paid in Full ❑Outstanding Balance Due: �35 SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) se/ 1, 7c� y ', , ykl-�. -e { Lo 0,,�,t License NumberExpiration Date Name of Cg-;Idelr—Y List CSL Type(see below) `J Description Address e•G, n/R U Unrestricted(up to 35.000 Cu. Ft.) �y�✓��'� Y' V R Restricted 1&2 Family Dwelling Signature M Masonry Only RC Residential Roofing Covering Telephone WS Residential Window and Sidin SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) f 3 ) q 38 Sz� h-0 HIC Company Name or HIC Registrant Name Registration Number Address Expiration 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........... ❑ SECTION 7a: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 CTIO 7 : OWNER' OR AUTHORIZED AGENT DECLARATION 1 , as Owner or Authorized Agent hereby declare that the statements an i formation on the foregoing application are true and accurate,to the best of my knowledge and behalf. Print Name Signature of Owner or Authorized Agent Date (Signed under the 2ains and penalties of perjury NOTES: I. 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 not 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 I O.R6 and 110.115, 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 Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage" may be substituted for"Total Project Cost" �, qO ��a�,eow