11 CHURCH ST UNIT 318 - BUILDING INSPECTION r
The Commonwealth of Massachusetts Q
Board of Building Regulations and Standards t61b SEP .— �IyE1C�
7�>G W Massachusetts State Building Code,780 CMR Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
Q One-or Two-Family Dwelling
0 This Section For Official Use Only
® Building Permit Number: I Date pplied:
19 Building Official(Print Name) Signature are
SECTION 1:SITE INFORMATION
ILi Property Address: 1.2 Assessors Map&Parcel Numbers
C1..r.z1�
SA-
Lin
kLin Is this an accepted saw?yes ✓ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
IZoning 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
f
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 12' Private❑ Zone: _ Outside if Floeod Zage? Municipal O'�site disposal system C34
Check
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
C-L
Name ) City,State,ZIP
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK[(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) rr Alteration(s) ❑ I Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work':
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item Official Use Only
abor and Meurials
1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $ ❑Standard CitytTown Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
S ression Total All Fees:$
6.Total Project Cost: $ I,150 Check No. Check Amount: Cash Amount:_
❑Paid in Full O Outstanding Balance Due:
c0 % �
C 4d C._
SECTIONS: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) Qs- ltn;tl tf ►�
t•Ly -X Jt' License Number Expiration Date
Name of CSL Holder J
\6'Z- & ,��� �� List CSL Type(see below)
No.and Street TYPeption
U Unrestricted(Buildings up to 35.000 cu.ft.
R Restricted 1&2 Family Dwelling
Cityrrown,State,ZIP M Masonry
RC RoofmA Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
'art} t-- ire al.>r I Insulation
Telephone Email address D I Demolition
5.2 Registered Home Improvement Contractor(HIC) ,—rx t*%"O 1 m t
3tdkrs . Ta - HIC Registration Number Expiration Date
HIC Compnny Narn,s�or HI egistrant Name
V t`m} 14, C&/,-
No.and StreetEmail address
L'-I"
Ci /Town State ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.rs 152.§ 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 ..........W No...........13
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters
srelative to work authorized by this building permit application.
L �7`
Print Ownces Name(EkAmnic Signature) Date
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.
f' Print Owner's or AI
thorired Agent's Name(Electronic Signature) Daze
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 not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dos
2. When substantial work is planned,provide the information below:
Total floor 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 beating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
CITY OF S.UJ&%I, 1NLkss.ACHUSETTS
• BUILDING DEPART%1EINT
1.20 WASHINGTON STREET,3ro FLOOR
\ TEL (978)745-9595
FAX(978)740-9846
KIN(BERLEY DRISCOLL
MAYOR THOMAS ST.FtERRB
DIRECTOR OF PUBLIC PROPERTY/BUILDING CO%L%aSSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leajbiv
Name(Busineworganization/Individual):
Address:\.dr., FILL ir('_��. (*L
City/State/Zip: `m\ ; M Nwc Phone #: '��1-��b--1�t;
\re on an employer?Check the appropriate box: Type of project(required):
1.71 am a employer with A 4. 0 I am a general contractor and 1 6. 0 New construction
employees(full and/or part-time).* have hired the subcontractors
2.0 1 am a sole proprietor or partner- listed on the attached sheet.+ 7. ❑Remodeling
ship and have no employees These sub-contractors have S. 0 Demolition
working for me in any capacity, workers'comp.insurance. 9, 0 Building addition
[No workers'comp. insurance 5. 0 We are a corporation and its
required.] officers have exercised their 10.0 Electrical repairs or additions
3.0 1 am a homeowner doing all work right of exemption per MGC I I.0 Plumbing repairs or additions
myself.[No workers'comp. C. 152,§1(4),and we have no 12.0 Roof repairs
insurance required.)t employees. [No workers' 13.0 Oil=
comp. insurance required.l
•Any applicant the[checks boa M must also fill out the section below stowing their worker'comt,go d n policy infotmad,,
i l lorneowteaa who submit this affidavit indicating they are doing all work and thou hire outside eontmemr must submit a new affidavit indicating such
=Camrtwnos,that cheek this bur must anached an additional shat showing the am;of the soli-cantmctor and their workers'comp.policy infmrwtion.
!am as employer that fs providing workers'compensation fnsuronce for my employees. Below is the policy and Jab do
hrjormmion.
Insurance Company Name: 1 t�-L- l3-t'OIiP 9
Policy#or Seif-ins.Lic.#:-4n`koZVY'a— ��41,14 9— t r Expiration Date J1 119l1 lib
Job Site Address: 1ta yt ti.JA .311City/Smote/Zip:I�tn
Anach a copy of the workers'compensation policy declaration page(showing the policy number and expiralon date).
Failure to secure coverage as required under Section 25A of MGL o. 152 can lead to the imposition of criminal penalties of a
fine up to 51.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 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.
!do hereby cerlljy uad pains and isinahtles jperJary that the injormallon provided above is true and correct
U,naturs �`> �`� Date-
Phone
OffleAd use only. Do not write in this area,to be completed by city or(own oflkhrl
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other,
Contact Person: Phone#:
NOTICE N NOTICE
TO w a TO
EMPLOYEES a e` EMPLOYEES
O'9M SV6
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
1 Congress Street, Suite 100, Boston, Massachusetts 02114 — 2017
617-727-4900 — http://www.state.ma.us/dia
As required by Massachusetts General Law, Chapter 152, Sections 21,22&30, this will give you notice that
I (we) have provided for payment to our inured employees under the above mentioned chapter by
insuring with:
ACE GROUP
NAME OF INSURANCE COMPANY
P .O. BOX 1450
MIDDLEBORO MA 02344-1450
ADDRESS OF INSURANCE COMPANY
(6S62UB-8D82249-9-15) 11 -19-15 TO 11 -19-16
POLICY NUMBER EFFECTIVE DATES
COLUMBIA INS AGCY INC 31 CENTRAL SQUARE
LYNN MA 01901
NAME OF INSURANCE AGENT ADDRESS PHONE#
PRECISION PROPERTY BROKERS INC 62 EAST PARK AVE
LYNN
MA 01902
EMPLOYER ADDRESS
EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE
MEDICAL TREATMENT
^� The above named insurer is required in cases of personal injuries arising out of and in the course of
employment to furnish adequate and reasonable hospital and medical services in accordance with the
provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the
injured employee. The employee may select his or her own physician. The reasonable cost of the services
provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably
connected to the work related injury. In cases requiring hospital attention, employees are hereby notified
that the insurer has arranged for such attention at the
NAME OF HOSPITAL ADDRESS
o,,,B, W20PIGIG TO BE POSTED BY EMPLOYER
The Essex Condominium
Telephone: 978-532-4800 1 Fax:978-532-6023
Crowninshield Management Corp.
18 Crowninshield Street
Peabody,MA o196o
Jeffrey Pierce
Unit 318, The Essex Condominium
11 Church St.
Salem, MA 01970
Dear Mr. Pierce,
The Essex Trustees have reviewed your request to replace the windows of your unit with
Harvey model 10000,& 11000 materials. The Trustees have given their consent for you to
proceed with your replacement, but with the following qualifications:
The Trustees are not in a position to assess the engineering details of your request nor can they be
assured that the final product will be in accord with the plans. Thus you the Owner retain the
responsibility for ensuring that the finished work does not"affect the appearance or structure of
the Condominium, or the integrity of its systems",that"all materials used and Work performed
shall comply with all OSHA, other federal, state, county,and municipal laws,rules, ordinances,
codes and regulations," and that the work is carried out by the contractor in the manner specified
by the Essex Condo Documents* (vis a vis hours, removal of refuse, noise,etc.).
Regarding replacement windows, please be aware that:
o Windows must be of a quality equal or greater to the original windows;
o Installation shall be done by a reputable contractor with a good work record and
references, and as required by State Building Code,the contractor must obtain a
building permit from the City of Salem. This ensures that the contractor is properly
licensed and insured;
o The appearance from the outside must be identical to that of the original windows,
specifically as to color(white), number and spacing of mullions(grids), and location
of mullions/grids on the outside of the outer pane(not between the panes);
o Screens must cover only the bottom half of the windows to match those throughout
the rest of the building;
o Flashing must be to Massachusetts code standards
Please contact the Management Company if you have additional questions.
Good luck with your project.
Signed: �o/Lr �u�ir Date: May 26, 2016
As managing agent for The Essex Condominium
*Exhibit C of the Certificate as to the Rules and Regulations, Book 23224, Pg. 241, South Essex
Registry of Deeds and Sections 5.2 and 5.15 of the Declaration of Trust, Book 101169, Pg. 84.
Both are available in the black bound copies of the Essex Condo Documents available from the
front office.
Vns CerAff irs&-mow( J�ac%nJet�3i
.C",T
Office of Consumer Affairs&Busi ess Regulation
OME IMPROVEMEfST CONTRACTOR
Registration .:_EMEA0 Type:
Expiration t175/b17 Corporation
PRECISION PROPERTY_BtROK�ERS rINC.
BRET BENNETT � �'
62 EAST PARK AVE
LYNN, MA 01902 �'= :_"�-'`
Undersecretary
I Missacnuaatts Dapsrunant of Public Sat
��Sl.�ard Of$uiidinV Rgpula2iptts aad Stary�Cla( 5 „..
t J4;
` !* LPr;ense;69-IM74
Construction Supervisor.
BJiBT 1 iBENNETT: � '4
63#WMLL JIVE
LYNN MA OfBO},
' x
t i
tk*
`�.�n CA._:. Expifid
Commfsspaner t IO+i a,
GENERAL CONTRACT FOR SERVICES
This Contract for Services is made effective as of August 18,2016, by and between Jeffrey
Pierce of 11 Church Street,Unit 318, Salem, Massachusetts 01970,and Precision Property
Brokers, Inc. of 62 East Park Ave,Lynn, Massachusetts 01902.
1.DESCRIPTION OF SERVICES. Beginning on August 18, 2016,Precision Property
Brokers,Inc. will provide to Jeffrey Pierce the services described in the attached Exhibit
(collectively, the "Services").
2.PAYMENT. Payment shall be made to Precision Property Brokers,Inc.,Lynn, Massachusetts
01902, in the amount of$1,150.00 upon completion of the services described in this Contract.
Jeffrey Pierce shall pay all costs of collection,including without limitation,reasonable attorney
fees. In addition to any other right or remedy provided by law, if Jeffrey Pierce fails to pay for
the Services when due Precision Pro Brokers Inc. has the option to treat such failure to a
Property � P pay
as a material breach of this Contract,and may cancel this Contract and/or seek legal remedies.
3.TERM. This Contract will terminate automatically upon completion by Precision Property
Brokers,Inc. of the Services required by this Contract.
4.CONFIDENTIALITY.Precision Property Brokers, Inc., and its employees,agents, or
representatives will not at any time or in any manner,either directly or indirectly, use for the
personal benefit of Precision Property Brokers, Inc., or divulge,disclose, or communicate in any
manner, any information that is proprietary to Jeffrey Pierce. Precision Property Brokers, Inc.
and its employees,agents, and representatives will protect such information and treat it as strictly
confidential. This provision will continue to be effective after the termination of this Contract.
Any oral or written waiver by Jeffrey Pierce of these confidentiality obligations which allows
Precision Property Brokers, Inc.to disclose Jeffrey Pierce's confidential information to a third
party will be limited to a single occurrence tied to the specific information disclosed to the
specific third party,and the confidentiality clause will continue to be in effect for all other
occurrences.
Upon termination of this Contract, Precision Property Brokers, Inc. will return to Jeffrey Pierce
all records,notes,documentation and other items that were used, created,or controlled by
Precision Property Brokers,Inc. during the term of this Contract.
5.DEFAULT. The occurrence of any of the following shall constitute a material default under
this Contract:
a. The failure to make a required payment when due.
b. The insolvency or bankruptcy of either party.
C. The subjection of any of either party's property to any levy, seizure,general assignment
for the benefit of creditors, application or sale for or by any creditor or government agency.
d. The failure to make available or deliver the Services in the time and manner provided for
in this Contract.
6. REMEDIES.In addition to any and all other rights a party may have available according to
law, if a party defaults by failing to substantially perform any provision,term or condition of this
Contract(including without limitation the failure to make a monetary payment when due), the
other party may terminate the Contract by providing written notice to the defaulting party. This
notice shall describe with sufficient detail the nature of the default. The party receiving such
notice shall have 60 days from the effective date of such notice to cure the default(s). Unless
waived in writing by a party providing notice,the failure to cure the default(s)within such time
period shall result in the automatic termination of this Contract.
7.FORCE MAJEURE. If performance of this Contract or any obligation under this Contract is
prevented, restricted,or interfered with by causes beyond either party's reasonable control
("Force Majeure"),and if the party unable to carry out its obligations gives the other party
prompt written notice of such event,then the obligations of the party invoking this provision
shall be suspended to the extent necessary by such event. The term Force Majeure shall include,
without limitation,acts of God, fire,explosion, vandalism, storm or other similar occurrence,
orders or acts of military or civil authority,or by national emergencies, insurrections, riots, or
wars,or strikes,lock-outs, work stoppages,or other labor disputes, or supplier failures. The
excused party shall use reasonable efforts under the circumstances to avoid or remove such
causes of non-performance and shall proceed to perform with reasonable dispatch whenever such
causes are removed or ceased.An act or omission shall be deemed within the reasonable control
of a party if committed,omitted,or caused by such party,or its employees, officers, agents, or
affiliates.
S.DISPUTE RESOLUTION.The parties will attempt to resolve any dispute out of or relating
to this Agreement through friendly negotiations amongst the parties. If the matter is not resolved
by negotiation, the parties will resolve the dispute using the below Alternative Dispute
Resolution(ADR)procedure.
Any controversies or disputes arising out of or relating to this Agreement will be submitted to
mediation in accordance with any statutory rules of mediation. If mediation does not successfully
resolve the dispute,the parties may proceed to seek an alternative form of resolution in
accordance with any other rights and remedies afforded to them by law.
9. ENTIRE AGREEMENT.This Contract contains the entire agreement of the parties, and
there are no other promises or conditions in any other agreement whether oral or written
concerning the subject matter of this Contract. This Contract supersedes any prior written or oral
agreements between the parties.
10. SEVERABILITY.If any provision of this Contract will be held to be invalid or
unenforceable for any reason,the remaining provisions will continue to be valid and enforceable.
If a court finds that any provision of this Contract is invalid or unenforceable,but that by limiting
such provision it would become valid and enforceable,then such provision will be deemed to be
written, construed,and enforced as so limited.
11.AMENDMENT.This Contract may be modified or amended in writing by mutual
agreement between the parties, if the writing is signed by the party obligated under the
amendment.
12. GOVERNING LAW.This Contract shall be construed in accordance with the laws of the
State of Massachusetts.
13.NOTICE.Any notice or communication required or permitted under this Contract shall be
sufficiently given if delivered in person or by certified mail,return receipt requested,to the
address set forth in the opening paragraph or to such other address as one party may have
famished to the other in writing.
14. WAIVER OF CONTRACTUAL RIGHT. The failure of either party to enforce any
provision of this Contract shall not be construed as a waiver or limitation of that party's right to
subsequently enforce and compel strict compliance with every provision of this Contract.
15. ATTORNEY'S FEES TO PREVAILING PARTY. In any action arising hereunder or any
seperate action pertaining to the validity of this Agreement,the prevailing party shall be awarded
reasonable attorney's fees and costs,both in the trial court and on appeal.
16. CONSTRUCTION AND INTERPRETATION.The rule requiring construction or
interpretation against the drafter is waived. The document shall be deemed as if it were drafted
by both parties in a mutual effort.
IN WITNESS WHEREOF,the parties hereto have caused this Agreement to be executed by their
duly authorized representatives as of the date first above written. Jeffrey Pierce, and Bret I.
Bennett,Jr. for Precision Property Brokers,Inc.,effective as of the date first above written.
Service Recipient:
X By: `
Je tart
Service Provider:
Precision Property
Brokers,Inc.
By: / 1 �
IX -, Bret I.Bennett,Jr.
�t