22 PINGREE ST - BUILDING INSPECTION [q,5
• The Commonwealth of Massachusetts
TUUDepartment of Public Safety
Massac
husetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Two-Family Dwelling
1 (This Section For Official Use Only).
Building Permit Number: Date Applied: Building Official:
SECTION 1: LOCATION (Please indicate Block#and Lot#for locations for which a street address is not available)
D"2�� S-- Sok , mvc p1470
No.and Street City/Town Zip Code Name of Building(if applicable)
ILY.�1 SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here ❑ or check all that apply in the two rows below
Existing Building❑ Repair❑ 1 Alteration ❑ Addition ❑ Demolition ❑ (lease fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No
Is an Independent Structural Engineering Peer Review required? Yes ❑ No
Brief Description of Proposed Work: 0pc .v �- fentleer �SyH�-� RUL, r Qrtd S d l/nh�
\ tN 2K
, rr-
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,AL�pITION OR
CHANGE IN USE OR OCCUPANCY -p
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ 1
Existing Use Group(s): Proposed Use Group(s): _
SECTION 4:BUILDING HEIGHT AND AREA
Existing �,'Frop ''d
No.of Floors/Stories (include basement levels)& Area Per Floor(sq. ft.) rs'a
Total Area(sq. ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5 ❑ B: Business ❑ E: Educational ❑
F: Factor F-1 ❑ F2❑ 1 H: High Hazard H-1 ❑ H-2❑ H-3 ❑ FI-4❑ H-5❑
L Institutional I-1 ❑ I-2❑ 1-3❑ I-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-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)
IA ❑ IB ❑ HA ❑ IIB ❑ IIIA ❑ IIIB ❑ 1 IV ❑ VA ❑ VB ❑
SECTION 7: SITE INFORMATION (refer to 780 CMR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal:
Trench Permit: Debris Removal:
Public ❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site ❑
required ❑ or trench or specify:
Private❑ or indentify Zone: or onsite system❑ permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: MA 1_i_r.storic CbtmnlssRon_Review Prp_gs,:
Not Applicable ❑ Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes ❑ or No ❑ Yes ❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor:
Does the building contain an Sprinkler System?: Special Stipulations:
111clilluel-JR00-� AlUUj
SECTION 9: PROPERTY OWNER AUTHORIZATION 1
Name and Address of Property Owner 1
V 1C k4/ C1Jf� P�W Wee-e-A S1- G
Name(Print) No.an treet City/Town Zip
Property Owner Contact Information:
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable, the property owner hereb�authorizes
QOM lei (c VP-cs b Oox 6 L�6 �— O
Name Street Address City/To n State Zip
to act on the property owner's behalf, in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL (Please fill out Appendix 2)
(If building is less Ulan 35,000 cu. ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control
�1 � ( G jry �ifvl 7_Y_1 37- 75
CS- 0 ?
Name(Registrant) �J Telephone No. e-mail address Registration Numbef /G�
2G �tnr fc, ei — G 45 ec,sU cac Sv2er�5o
Street Address City/TZAvn State Zip Discipline Expirition Date
CSD
10.2 General Contractor
Company N
Name of Person Responsible for Construction License No. and Type if Applicable
Street Address t City/To—wn State Zip
/7j 1 Z33 _ 7511
Tele phone 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❑ No 0
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Estimated Costs:(Labor r/
Item and Materials) Total Construction Cost(from Item 6)_$ 16 t 09U
"l. Building $ Building Permit Fee=Total Construction Cost x (Insert here
2. Electrical $ appropriate municipal factor) _$
3. Plumbing $
4. Mechanical (HVAC) $ Note: Minimum fee=$ (contact municipality)
5. Mechanical (Other) $ Enclose check payable to
6.Total Cost $ Or/U (contact municipality)and write check number here
SECTION 13: SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this
application is truest accurate t�best of my kna vledge and understanding.
Please print and sign naM Title Telephone No. Date
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval: Iii- 'O 9 &
Name Date
_ The CommonwaO&ofMassprhuseM
Departrneftt ofl rdastrialAcc dents
I CongressS7ureet,Suite 100
Boston,M.4#2114-2017
www.mossgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/EleMclam/P)nmben.
TO BE FILED WITH TBE PERNDTTING AUTHORITY.
Anollemtlnformetlon Phase Print I.eEibly
Nam(Business/O>gamrstion/lndivlduel): _ ts"
Address:1 t1. �LD4 U�
City/State/Zip: Phone#: 7 Y
Are rat em
b e a box;
pkyerrC.. ppropotme. Type of project(required):-
. 1.71 m a employer w employees(full Ma/W W-t me).'
7. []New construction
2.Qlmawk{aopralmapartnaahipapd have no empb WOM. g famero
dty $; QR,�ode]mB
WWcs a .[bio sn M."dMp rosmame regtmedj .-
3.A l m a bomeo doing as woh myseN.fNo wodm*"rap.imma "qui,all � 9. O Demohtibis'
4.0 I sm waer
a bomeoand MH be hoing annnactma to count A l Volk on my poperyl wdl 10 0 Bul7dtng'edditidn.
emme that all contmaw eider have weakens'compeasmon romance a m sole 11.0 Electrical res or additions
»v"h°0eM*YV"' 11r]Phuxibi4'iepaus ornddili
S.OlmageoerN eonerLvaod lbave tified the aub•eootraaae tiered oat tlro aimed sheet 13.QRoofrepays_
7bese.atbwntigel have emp]oyasand bees we- '.cep.MUMOMs. . :
6.❑Wemammomtioa'aodiOoffi=hav cmcimddi*droofmcmpdmpwMQ.a 14.QOthec _
15Z1](4),and MhaYem employces.[NO Wo*M'6XW*suisace regahed.] '
.,A�'applicahe tlat abeeluboaMmust also Blood to aeat onbekwahow3og ebebwakels pohryrofampbon
t xomeowmswbo soTrm' it Pore et6derit iudialmg Poe)'are doing an woYlE®athmb'oe ailside t6�facHmmtsobmitamav affideva mdieetios aucL:
1Co mzmzs*a dwktius boimosl snicked kwadMional shoetsbowmg&a mme.af&eaub-crom6Cas end state*hc&ww no*me ensues have
enoploym If/hesob odaahave,employa4f Xmuttrovi64-wart-',eomp.pohcynm w- .. .
I41"anemployertb4afisprovM&g>tovAM'C0mP0Wanonina>rrWcejormyem44yee& BalowisthepollryapdJabsire -
lnjorrriatlon.
Insurance Company Name: ^^P/� rt��C�p
Policy#or Self ms.Line.*'u, — Ur}�� J 150 �•'•� Eipuation Date: `•T J) /M�o I
-76
Job Site Addresa. rl`� AbQ:Cf S� City iP: 72(12 1 - 016
Attach a copy of the workers'com"pildsatlon policy declaration page(showing the policy number and eV,fraden date).
Fa>lure to am=coverage as'required under MGL c.152,f 25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year mvnso�t,as well as civil penalties in the from of STOP WORK ORDER and a.Rim df�to 5150.00 a
1 .day against the yjohltor.A copy ofthie statement may be forwarded to the Office ofluvestigstions of the DIA far insurance
coverage verification.
I do hereby epains dpq&pa ofperjWy that the information provided above is Brae and correct
Phone#• -
rC60011tt
dai use only. Do not write in this area,to be eo`aplefed by 4 or Town offle"
or Town: Permi(/ldcense#
ng Authority(circle one):
ard of Health 2.Building Department 3.City/1'own Clerk 4.Electrical Inspector S.Plumbing Inspector
her
act Person: Phone#:
J-
Information and Instructions
Massachusetts General Laws chapter 152 requires all emPtoYto provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every eery person in the service of another under any contract ofhire,
express or implied,oral or writtep"
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of in 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,§25C(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 commonweaMh for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §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 autboity."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to yea 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 date the affidavit. The affidavit should
be returned 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-insmedcompanies should enter their
self-insurance license number on the appropriate lime.
City or Town Officials
Please be 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 pramitnicense number which will be used as a reference number. In addition,an applicant
that mist 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 proofthat a valid affidavit is on file for future permits or licenses. A nese affidavit must be filed out each
year.where a home owner or citizen is obtaining a license or permit not related to any business or coaunercial venture
(i.e.a dqg license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number.
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-2017.
Tel. #617-7274900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
.Cc-�""""'6c••���. 'f nuus 'alf�s�^ tntlon�
Un Office of Consume* 8'Bodnw Rego
lesa,_.�., -=,-;HOME 1l8PROVENIENT CONTRACT
w Raglstratlon: 108292 ra0on
8JM14/20M18 PrivalsCoRm
.. Expiration
PERRY BROTHERS CONSTRUCTION,INC.
William Pam .
20 SEAVIEW LANE �-----
Fa NEWBURY,MA01951 Undersecretary
StIMUVIMi.MASS.GOYRIPS
OPS Licensing infonoation visa:
,Massachusekt, Department of Public SafeTY
Board of Building Regulations and Standards
License: CS-022831
Construction Supervisor
WILLIAM J PERRY
20 SEAYIEW LN r�
NEWBURYPORT MA,
"W
Expiration:_;
Commissioner 0810912017
e
rpvtirst
�e. CITY OF SAS ,I\i, L JASSACHliSE'ITS
DEPART>VLEIVT OF PI.ANIv'WG AND
'_ ✓nmen�" COQ.MU-CITY MrELOPAJENT
I;P.dktiRl_E-a'L1Rr5C!)uG
22v P,r.+stn.1;sftaa81RM a SALU1,Msssacitt7sc^;S oi97o
LrarC.:oa tD:rsar vu;-ATV.? •t7;[.E
IaaerroR :97"19-5685 f Fix 978-:40-o4o+r
HOUSIN=G REHABILITATION LOAN PROGRAM
REVISED BID FORINT FOR EMERCrENTCY REPAIRS
This bid form}vas revised on July 29,2016,after the contractor waikthroagb. By si,-wng this iormr the contractor
ailtnulrledges receipt of Addendum Ni. all costs-associated with the scope of workspecitied it the workwrite-up
dated July 2S,2016,and Addendum#1 dated July 29,2016,511211 be included on this bid form.
c
- Propeny: 22 PinxreeStreet Sulam Owner: Victor Dume
SerHwn }13rorkItems 1Price
i I.QJ Asphalt RoofRep(aeemtnt --
_I QcnetaltT)emohflon
i 1.2 __ -aci pU^
nitaPoRu Rubber oa ------.�
-- 13 - Chimney Po:ntlne and wnatcr Fleshm� 8 15 C ,
' IA ; Skylight -..
2.9 Re errlRe loci Rama id Cerltn —'
3.Q Electttcal Riparr$ —_ t
4.0 Plumbing Repairs
4J S;; ez Hpt.RCpwr $t,
t-- Buildms PmTmz
r TOTAL DID
Z,the und�rsigaed contractor,have iaspectid the above listed property and umdcrstand the extent and chancier of the ._
9EM77
completed as dtscrioed n18tt K.'ork 1Vri:e-Un dated 7uly 2i,?A16,and.Addendum 1?I dated Tuly 29;2014.
ludes tyery item idegt fled in the W ork Rrnte-Up and Addendum if1 by ibert5ptct vt nuuXbirs: Thr bid
in ed'ect for a minimum of thirty(30)business da}s af`tet tae bid opining.io fuznis0 all labor,ma#eaizs,.and egtipmtni aeiessary to accomplish alt work described in the Work avd Addendum#1 for ikes}�m of...e__ �r+'ysA v�. V'uw rgY:M:r� nollai�s(S�.f�4oX able to start the project oo ��_3 GJ(G
2016(estun ted date).
I agree to begin the work within seven(7)calendar days o:tilt Notice to Procmd`and compleri the work within i6irty
(60)ca{pndar days. I agree to fully a a .Tee all tabor and materials for one 7
/> O YeariMm thop:-oject completion date.
-�_-13-vs L'tn..+T -25�- '2.33 -•?Sl/
Comp1, r .e — RhoNumber
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amroof Autl e�ri2e epresentatilc Data
22 Pingree Street Page
Revised Bid Form
�(;0%QI Pgy9
CITY OF SALEM, MASSACHUSETTS
DEPARTMENT OF PLANNING AND
hrt " t.ec n :q2 'f
:.�,�• „�. �,. �;,• COMMUNITY DEVELOPMENT
,cJrorrei';d°
KIMBERLEY DRISCOLL 120 WASHINGTON STREET ♦ SALEM,MASSACHUSETTS 01970
MAYOR TELE:978-619-5685 ♦ FAX:978-740-0404
THOMAS M.DANIEL,AICP
DIRECTOR
SALEM HOUSING REHABILITATION LOAN PROGRAM
NOTICE TO PROCEED
Date: September 1, 2016
Case# : 16-01E, 22 Pingree Street, Salem, MA 01970
Contractor: Perry Brothers Construction, Inc.
Dear Bill:
You are hereby given authorization to proceed with renovations to 22 Pingree Street, in
Salem, MA in accordance with the agreement dated July 25, 2016, Addendum to Work Write-
Up #1 dated July 29 2016 and Addendum to Work Write-Up #2 dated August 25, 2016. As
stated in the aforementioned agreement, work is to commence within ;wK% (/f) days and be
completed on or before Ri„1S (#) days subsequent to the date of this proceed order.
KV
helma Naomi Fran
Housing Coordinator
This program does not discriminate on the basis ofrace, color, national origin, gender, age, religion,familial
status, sexual orientation or disability. This program is funded through the United States Department of Housing
and Urban Development(HUD), utilizing HOME and Community Block Grant Funds (CDBG).
•r
potIlTg4
CITY OF SALEM, MASSACIUSETTS
q z '�' DEPARTMENT OF PLANNING AND
COMMUNITY DEVELOPMENT
�?�;GdMINF IIa�P�
KEVIBERLEY DRISCOLL
MAYOR 120 WASHINGTON STREET ♦ SALEM,MASSACHUSETTS 01970
THOMAS M.DANIEL,AICP TELE:978-619-5685 ♦ FAX:978-740-0404
DIRECTOR
HOUSING REHABILITATION LOAN PROGRAM
OWNER - CONTRACTOR
AGREEMENT FOR REHABILITATION
This AGREEMENT, made this 1st day September, 2016 by and between Perry Brothers Construction,
Inc., (hereinafter referred to as the CONTRACTOR), having a business address of P. O. Box 646,
NewbuDTort, MA 01950 and Victor A. Dume having an address of 22 Pingree Street, Salem, MA
01970 hereinafter referred to as the OWNER.
WITNESS THAT:
WHEREAS, the OWNER intends to rehabilitate his/her property located at 14 Beacon Street in Salem,
Massachusetts, now therefore, the CONTRACTOR and OWNER, for the consideration herein stated,
mutually agree as follows:
1. BID AND PROPOSAL
1.0 This AGREEMENT shall consist of the bid and proposal; the general conditions included herein,
drawings (if any) and approved work write-up/specifications.
1.1 All work described and listed in the work write-up/specifications dated July 25, 2016,
Addendum to Work Write-Up #1 dated July 29, 2016, and Addendum to Work Write-Up #2
dated August 25, 2016, (attached) shall be performed by the CONTRACTOR for a sum not to
exceed Eighteen Thousand and 00/100 dollars ($18.000.00).
1.2 Exceeding of the above stated amount shall be grounds for the termination of this AGREEMENT
by the OWNER if the CONTRACTOR did not receive prior written approval from both the OWNER
and the City of Salem's Department of Planning and Community Development (heretofore
called the CITY). Said written approval shall be in the form of an amendment.
1.3 If the AGREEMENT amount is exceeded without the approval stated heretofore (1.2), the
CONTRACTOR would bear all additional costs of the materials purchased and work performed.
Page 1 of 8
1.4 If the AGREEMENT amount is exceeded with the knowledge and prior approval of the OWNER,
in collaboration with the CONTRACTOR and without the prior consent of the CITY, then the cost
of said improvements would be born solely by the OWNER.
2. TERM OF AGREEMENT
2.0 The CONTRACTOR shall commence the work to be performed within 30 (thirty) consecutive
days of the Notice to Proceed issued by the CITY.
2.1 Said work shall be completed within 60 (sixty) consecutive days.
2.2 The CONTRACTOR shall provide the OWNER with at least three days notice that work will
commence.
2.3 The commencement date may be changed, if agreed upon by both the OWNER and
CONTRACTOR. The OWNER must notify the CITY in writing of the change in commencement
date.
2.4 Delays caused by, but not limited to, such events as poor weather conditions, illness or
unforeseeable construction problems may, at the option of the OWNER and CITY, constitute
legitimate reason for delays in the start or continuance of work. In such event, the
CONTRACTOR shall notify the OWNER or the CITY of any delay and the reason. The OWNER and
CITY reserve the right to reject said reason and demand continuance of work.
2.5 Failure to continue work if reason for delay is rejected, pursuant to 2.4, shall be grounds for
termination of this AGREEMENT by the OWNER.
2.6 Delays that are deemed legitimate will not be charged to the term of this AGREEMENT and will
be considered an automatic extension of the AGREEMENT.
3. USES AND DISBURSEMENT OF FUNDS
3.0 Project funds will be used only for those activities deemed eligible under Community
Development Block Grant (CDBG) Regulations, pursuant to 24 CFR § 570.201 — Eligible
activities and/or HOME Program,pursuant to 24 CFR § 92.205.
3.1 The CONTRACTOR may make application for payment only on those items in the approved work
write-ups or amendments thereto and satisfactorily completed. Satisfactory completion is
determined by the CITY. Payments will be made only upon work approval by the CITY.
3.2 The CONTRACTOR'S application for payment shall include an itemized list of the work
completed and copies of receipts and/or paid invoices for materials. The CITY will reject
payment requests that are not itemized and/or incomplete.
3.3 In order for payments to be disbursed, proper city building code inspections, heating and
plumbing and/or electrical permits must be pulled before the start of work and proper signoffs
received for work that is complete.
Page 2 of 8
3.4 Work performed under this AGREEMENT shall be payable within thirty(30) days after the work
is satisfactorily completed, approved by the OWNER and the CITY, whose inspection and
approval of such work is required, and a complete, itemized invoice is submitted.
3.5 Payment by the CITY shall not exceed the percentage of work completed nor the amount of
assistance committed by the CITY and/or the OWNER.
3.6 The OWNER and the CONTRACTOR acknowledge that, work not included in the Work Write-up,
performed at the homeowner's request is not covered by this contract. This includes not only
additional work items but also upgrades in materials and the quality of installation (i.e. ceramic
tile instead of linoleum, hardwood floors instead of carpeting, etc.). The quality of product and
installation is the sole responsibility of the OWNER and the CONTRACTOR.
4. FINAL, PAYMENT
4.0 The CONTRACTOR is allowed to make up to 5 (five) progress payment requests, unless there is a
prior AGREEMENT to allow more payments. Final payment shall be requested only upon
completion of all work in the approved Work Write-Up and amendments thereto.
4.1 Final payment shall be made only upon receipt of a Certificate of Final Inspection from the
Housing Rehabilitation Specialist and the following documents from the CONTRACTOR:
• Contractor's Final Invoice,
• Release of Liens and Warranty,
• Subcontractor List, and
• Building Permit.
4.2 Once final work is approved by the Housing Programs Inspector, all proper permits have been
pulled and required inspections have been completed and signed off by the City of Salem's
Building Department, the OWNER and the CONTRACTOR acknowledge that if the owner refuses
to sign Certificate of Final Inspection and/or co-sign check, the City may proceed to issue final
payment to the contractor and the project will be considered complete.
5. RESPONSIBILITIES OF THE OWNER
5.0 The OWNER agrees to comply with the conditions of this section. The CITY reserves the right
to withhold payments if the OWNER fails to comply with the section.
5.1 The OWNER shall be current in payments to the CITY of real estate taxes, user fees and other
obligations. Failure to be current in payments or to have made agreement to pay delinquent
accounts shall be grounds for termination of the project and withdrawal of funds by the CITY,
or suspension of the project.
5.2 The OWNER shall permit the CONTRACTOR to use, at no cost, existing bathroom facilities and
utilities such as electric power, lights, water and telephone only for the purposes of this j
AGREEMENT. Failure of the OWNER to cooperate in this way shall be grounds to suspend or
terminate the project.
IG
Paee 3 of 8
5.3 The OWNER will facilitate work by removal of rugs, coverings and furniture as necessary and
when possible.
5.4 The OWNER will, when possible, cooperate with the CONTRACTOR in keeping the project
interior and or/exterior clean and free of debris, in compliance with the State Sanitary Code,
Article H.
5.5 Any unreasonable action by the OWNER, as defined by the CITY, to hinder the CONTRACTOR
from proceeding with work, or any action by the OWNER to deny the CONTRACTOR access to
the project site, shall be grounds for suspension or termination of the project by the CITY and
subsequent withdrawal of public funds committed to the project.
5.6 In the event that the OWNER takes legal action against the CONTRACTOR and, thereby, delays
the project for more than sixty(60) days, then the CITY reserves the right to suspend the project
temporarily and apply project funds elsewhere. Said funds may be restored upon completion of
legal action.
6. RESPONSIBILITIES OF CONTRACTOR/PERFORMANCE OF CONTRACT WORK
6.0 The CONTRACTOR agrees to comply with the conditions of this section. The CITY reserves the
right to withhold project payments, suspend or terminate the project if the CONTRACTOR fails to
comply with the section. Failure by the CONTRACTOR to comply with this section may also be
grounds for the CITY to deny the CONTRACTOR or any SUBCONTRACTOR participation in the
CITY's housing programs for up to three (3) years.
6.1 The CONTRACTOR shall maintain records of this project for at least three (3) years after its
completion and shall provide access to the CITY, upon request, to inspect all records related to
the project, including,but not limited to bids, drawings, vouchers, payrolls and purchase orders.
6.2 The CONTRACTOR shall comply with all applicable building, health and fire codes in the
conduct of this project and must obtain all necessary required permits for work. Cost of
permits may be included in the CONTRACTOR's bid. Conies of permits must be submitted to the
CITY before commencement of work. Copies of signed-off permits must be submitted to the
CITY before final payment will be released.
6.3 The CONTRACTOR acknowledges that all lead based paint abatement/deleading will be
conducted in accordance with the both the federal and state lead based paint regulations_All
contractors conducting lead based paint abatement/deleading must be licensed by the
Commonwealth of Massachusetts, Department of Labor and Workforce Development, Division
of Occupational Safety.
6.4 The CONTRACTOR shall indemnify and save harmless the OWNER from liability for any
personal injury or damage to the property in the performance of work unless there is a reason to
believe there is OWNER negligence.
6.5 Unless otherwise approved, the CONTRACTOR shall carry full and complete Workmen's
Compensation hisurance for all employees who require coverage under the law.
Paee 4 of 8
6.6 Prior to the start of the project, the CONTRACTOR shall provide the CITY with evidence of
liability insurance for not less than $300,000 for bodily injury and $100,000 for property
damage, unless otherwise approved.
6.7 The CONTRACTOR shall keep the project premises clean and free of work debris and remove all
such debris upon completion of work. Materials and equipment that have legally been removed
and replaced as part of the work shall belong to the CONTRACTOR.
6.8 The CONTRACTOR shall not assign this AGREEMENT or any portion of it without written consent
of the OWNER and the CITY.
6.9 Abandonment of project work by the CONTRACTOR for more than ten (10) consecutive days
without the Written or verbal consent of the OWNER and the CITY, shall be deemed a breach of
contract and is grounds for termination of this AGREEMENT by the OWNER and the CITY. In the
event of such termination, the CONTRACTOR shall be liable to the OWNER or to the CITY any
costs beyond the amount of this AGREEMENT, which are incurred for completion of this project.
6.10 If the CONTRACTOR'S right to proceed is terminated, the OWNER and/or the CITY may take
possession of or utilize any materials, tools, equipment, or plants on the site as may be
necessary to complete the project.
6.11 The work specified herein must be completed by the CONTRACTOR within the terms of the
AGREEMENT, including extensions. The OWNER and/or the CITY reserves the right to take legal
action to recover any payments previously made to the CONTRACTOR.
6.12 During the performance of this contract and during the term of this AGREEMENT, the
CONTRACTOR agrees to the following conditions. The CONTRACTOR shall
6.12.1 Not discriminate against any person seeking his/her employment or any employee
because of race, color, national origin, gender, age, religion, familial status, sexual
orientation or disability. Such action includes, but is not limited to, employment,
upgrading, demotion, transfer, recruitment, advertising, layoff, termination, rates of pay
or other compensation, and selection for training, including apprenticeship.
6.12.2 post hereinafter, in a conspicuous place, available to employees and applicants for jobs,
notices provided by the CITY setting forth this non-discrimination clause.
6.12.3 include all provisions in this section to be placed in any agreement s/he has with
subcontractors working on the project.
6.13 The CONTRACTOR and any subcontractor is prohibited from inducing by any means, any
persons employed in the construction, completion or repair of public work, to give up any part
of the compensation to which s/he is otherwise entitled. The CONTRACTOR shall fully comply
with this section, pursuant to 18 USC 874, the Copeland "Anti-Kickback" Act, as
supplemented in 29 CFR § 3. The CONTRACTOR shall cause to be inserted in any contracts and
subcontracts related to this project such"Anti-Kickback"regulations,
6.14 The CONTRACTOR agrees to abide by Lead Based Paint Poisoning Prevention Act, which
prohibits the use of lead-based paint in residential structures constructed or rehabilitated with
federal assistance in any form.
i
Page 5 of 8
7. MISCELLANEOUS
7.0 No member of or delegate to the Congress of the United States and no resident commissioner
shall be admitted to any share or part of this AGREEMENT or derive any benefit from the same,
provided that the foregoing sanction is not construed to this contract and is made with
cooperation for its general benefit.
7.1 No Officer, employee or member of the governing body of the CITY or the Department of
Planning and Community Development, who exercises or functions or has responsibilities in
connection with this project, shall have any private interest, direct or indirect, in the
AGREEMENT or in proceeds of this loan or grant.
S. AMENDMENTS AND CHANGE ORDERS
8.0 This AGREEMENT, executed under the regulations of the U.S. Department of Housing and
Urban Development and the general laws of the Commonwealth of Massachusetts, may be
modified or amended only by a written instrument executed by the OWNER and CONTRACTOR,
with the consent of the CITY.
8.0.1 Change Orders shall only be executed for unforeseen conditions that require
modifications in the work. The written Change Order shall itemize the change(s) in the
scope of work and any change(s) in the amount of the AGREEMENT.
8.2 The OWNER and the CITY reserve the right to withhold payment for any work performed, which
is not authorized by either this AGREEMENT or amendments thereto.
9. WORK GUARANTEES AND PROTECTIONS
9.0 The CONTRACTOR, in consideration of the final payment s/he received under this AGREEMENT,
hereby releases the OWNER and the CITY from any and all claims arising from or by virtue of
this AGREEMENT.
9.1 The CONTRACTOR, by execution of this AGREEMENT, hereby provides the OWNER with a
Release of Lien and Warranty, which guarantees all work under this contract for a period
of one (1) calendar year from the date when said work is completed or terminated. This
includes work terminated before all work specified under this AGREEMENT is completed.
10. RIGHT OF RESCISSION
10.0 The OWNER and the CONTRACTOR, hereby understands that, under the general laws of the
Commonwealth of Massachusetts, the OWNER may cancel this AGREEMENT if it has been
consummated by a party thereto at a place other than the address of the seller (CONTRACTOR),
which may be his/her main office or branch thereof, provided the seller (CONTRACTOR) is
Paee 6 of 8
notified in writing at his/her main office or branch by ordinary mail posted, by telegram sent or
by delivery, not later than midnight of the third business day following this AGREEMENT.
11. INDEMNIFICATION
11.0 The OWNER and the CONTRACTOR shall save harmless the CITY against claims for injuries to
persons on the premises of the project or damage to project-related property.
11.1 The OWNER and the CONTRACTOR are required to reimburse the CITY in the event such claim is
successfully prosecuted by an injured third party and damages recovered against the CITY.
11.2 The OWNER and the CONTRACTOR shall be required to carry all necessary and required
insurances for the work to be provided under this AGREEMENT and for coverage of loss or
damage on any premises affected by this AGREEMENT. This shall include, but not be limited to,
insurances and certifications for contractors, subcontractors and vendors.
12. LEFT BLANK INTENTIONALLY
13. NOTICE TO PROCEED
13.0 The execution of this AGREEMENT constitutes notice to the CONTRACTOR to proceed with work
specified herein, or attached hereto, no sooner than three (3) business days following the date
of signing of this AGREEMENT.
IN WITNESS THEREOF, the CONTRACTOR and the OWNER (s) have entered into this AGREEMENT as of
the date first written above.
FOR THE CONTRACTOR: FOR THE OWNER:
By: VL�2l" By: Ilict6){ D U/tfe
William J. Perry, Co ntr or Vi for A. Dume, Owner
Auth� ignatory (Print Name) Victor A. Dume, Signature
9 / //o
William J. vy, Agnature Date
Date
WITNESS:
By: Thelma Naomi Francisco
Authorized Representative of the ��,//b
Cit of Salem, Massac setts
ti
Date
Signature
Paee 7 of 8
i
ATTACHMENTS:
1. Work Write-Up
2. Contractor's Bid Form
I
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Page 8 of 8 I
,�CONU(T9 .
` 4 CITY OF SALEM, MASSACHUSETTS
DEPARTMENT OF PLANNING AND
� COMMUNITY DEVELOPMENT
KIMBERLEY DRISCOLL 120 WASHINGTON STREET ♦ SALEM,MASSACHUSETTS 01970
MAYOR TELE:978-619-5685 • FAX:978-740-0404
LYNN GOONIN DUNCAN,AICP
DIRECTOR
HOUSING REHABILITATION LOAN PROGRAM
ADDENDUM #2 TO WORK WRITE-UP FOR
EMERGENCY REPAIRS
PROPERTY INFORMATION:
Homeowner: Victor Dume Date: August 25, 2016
tj.I ly Meky Dume
Property: 22 Pingree Street Phone #: 781-346-2215
Prepared by: Kevin Nestor, Housing Rehab Specialist Case #:
The Work Write-Up for 22 Pingree Street dated July 25, 2016, is changed as follows:
1. Section 2.1 (Apartment #3 Repair Ceiling), Section 2.2 (Apartment#2 Replace Ceiling),
and Section 3.1 (Electrical Repairs) shall be deleted from the work write-up and are not
included in this contract. These items shall also be deleted from the contractor's bid
form dated 8/11/16. The total cost of the contract shall be $18,000. This is the sum of
Sections 1.1, 1.2, 1.3, 1.4, 4.1 and the building permit.
Addendum #2 Pagel August 25, 2016
���CO N4ITq
> CITY OF SALEM, MASSACHUSETTS
DEPARTMENT OF PLANNING AND
COMMUNITY DEVELOPMENT
KIMBERLEY DRISCOLL 120 WASHINGTON STREET ♦ SALEM,MASSACHUSETTS 01970
MAYOR TELE:978-619-5685 ♦ FAX:978-740-0404
LYNN GOONIN DUNCAN,AICP
DIRECTOR
HOUSING REHABILITATION LOAN PROGRAM
ADDENDUM #1 TO WORK WRITE-UP FOR
EMERGENCY REPAIRS
PROPERTY INFORMATION:
Homeowner: Victor Dume Date: July 29, 2016
Vicky Dume
Property: 22 Pingree Street Phone #: 781-346-2215
Prepared by: Kevin Nestor, Housing Rehab Specialist Case #:
Section 1.2 in the Work Write-Up for 22 Pingree Street dated July 25, 2016, is changed as
follows:
1. Please acknowledge receipt of this addendum by using the revised bid form. A copy is
attached.
2. Section 1.2 of the work write-up required all roofs at 22 Pingree Street to be replaced with
asphalt shingle roofs. The roofs over the enclosed porch (front left side of the building)
and the rear porch shall be replaced with rubber roofs. The roofs over the main building
and the small front porch shall be replaced with asphalt shingles. See the attached sketch
for clarification of each roof and the specified replacement materials. All roofs shall be
replaced with asphalt shingles or rubber membranes upon completion of the contract.
All new rubber roofs shall comply with the following minimum requirements: supply and install
Y4 inch composite insulation, new sheet flashing where the roofs abut the siding, and new
rubber membrane roofs (Firestone or approved equal). The work shall include all required
adhesives, fasteners, flashing and drip edges. The drip edges shall overhang the existing
gutters. The rubber roofs shall include a one year warranty for labor and materials. The
contractor shall assign the manufacturer's 10 year warranty to the owner. All work shall be
performed according to the manufacturer's specifications.
Comply with all remaining requirements of Section 1.2 regarding removal, disposal,
underlayments, flashing, asphalt shingles, etc.
Addendum #1 Pagel July 29, 2016
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CITY OF SALEM MASSACHUSETTS
pa DEPARTMENT OF PLANNING AND
COMMUNITY DEVELOPMENT
KIMBERLEY DRISCOLL 120 WASHINGTON STREET ♦ SALEM,MASSACHUSETTS 01970
MAYOR TELE:978-619-5685 ♦ FAX:978-740-0404
LYNN GOONIN DUNCAN,AICP
DIRECTOR
HOUSING REHABILITATION LOAN PROGRAM
WORK WRITE-UP FOR EMERGENCY REPAIRS
PROPERTY INFORMATION:
Homeowner: Victor Dume Date: July 25, 2016
Vicky Dume
Property: 22 Pingree Street Phone #: 781-346-2215
Prepared by: Kevin Nestor, Housing Rehab Specialist Case #:
1. LICENSE: The contractor must meet all local and State licensing requirements and be duly licensed.
2. INSURANCE: Contractor must show proof of adequate liability insurance and workmen's compensation
insurance.
3. PERMITS: The contractor must obtain and pay for all required building permits prior to starting work.
Copies of the required permits must be submitted to the Housing Program.
4. CODE REQUIREMENTS: All workmanship must conform to the Program's guidelines, all applicable
Massachusetts Building Codes and local codes and must be of acceptable quality, as determined by the
Housing Program's Inspector.
5. WORK AREAS: The owner must completely remove all furniture, stored items and other obstructions in the
work areas identified herein. Items must be moved to a non-work area and covered by the owner or
relocated to temporary storage as needed. Neither the Program nor the Contractor is responsible for
owners' items improperly relocated during construction. Work can not proceed unless work areas can be
freely accessed by the contractor(s) on a regular basis during the term of the contract. Failure to provide
regular and unfettered access to work areas may be cause for contract termination.
Contractors are responsible for verification of field conditions, measurements and quantities.
Submission of a bid is presumptive evidence that contractor has evaluated all site conditions which
pertain to the work herein. Permits and Permit Fees to be included in all bids.
22 Pingree Street Page 1 July 25, 2016
WORK SPECIFICATIONS FOR`REPAIRS _.
Section 1.0 Asphalt Roof Replacements .
1.1 General / Demolition
The scope of work includes replacement of the asphalt roofs on the main
building, dormers, and the front and rear porches. The scope of work also
includes replacement of the skylight on the right side of the building. It does not
include replacement of the gutters and downspouts. Any damage to the gutters
and downspouts during the roof replacement process shall be repaired to the
satisfaction of the owner. Clean the gutters upon completion of the work (remove
and properly dispose of all new and existing materials from the gutters).
Remove all asphalt shingles, drip edges, flashing, underlayments, and the
skylight. All roofing materials shall be removed down to the sheathing.
A dumpster must be on-site prior to demolition. Properly dispose of all debris.
All work shall be performed in compliance with applicable codes and shall be
subject to the approval of the City of Salem Inspectional Services Department
(ISD). The contractor must submit a building permit signed by the Salem ISD
before the final payment will be approved.
1.2 Asphalt Roofs
Remove and properly dispose of all defective sheathing. Replace all defective
sheathing with new rough spruce boards or exterior grade plywood the same
dimensions and the existing. All new and existing sheathing shall be properly
secured to the framing. Allow for 200 square feet of new sheathing in the base bid.
Supply and install new ridge vents according to the manufacturer's specifications.
Supply and install 8 inch aluminum drip edges along all exterior walls and at the
edges of all gables, rakes, etc. The-drip edges shall properly overhang the
existing gutters.
Cover the perimeter of all roof areas with a double row of 36 inch ice & water
shield (Grace or approved equal). The minimum width of the ice &water shield
shall be 72 inches. The ice & water shield shall also be installed in all valleys,
around the skylight, and at all other penetrations. Cover all remaining areas with
30 lbs. felt paper. Install new step flashing at the chimney. Install metal or
rubber fitted flashing at all other penetrations.
Install new flashing in all areas where the roof abuts the vertical building
sidewalls (the siding). The flashing at the sidewalls may be reused if it is sound
and in good condition. The junction between the rear porch roof and the window
casings shall be properly flashed and caulked so it is weathertight. This area will
be identified by the Salem Rehab Specialist at the contractor walkthrough.
Cover the entire roof with 240 lbs. 30-year, three tab asphalt shingles (CertainTeed,
GAF, or Owens-Corning). Hurricane nail the shingles (double nail the shingles
above the two middle cut-outs). Substitute roof shingles shall not be accepted.
The color shall be black or charcoal grey. Verify the color with the owner.
22 Pingree Street Page 2 July 25, 2016
Section 1.Oh• Asphalt Roof Replacertient (continued)`A
1.3 Chimney Pointing and Counter Flashing
Repoint the chimney above the roofline. Remove and replace all loose mortar.
Remove the loose bricks at the top of the chimney and reinstall them in new
mortar so they are secure.
Replacement of the step flashing was specified in Section 1.2. Remove and
replace the counter flashing. Supply and install new counter flashing embedded
at least one inch into the chimney. The new counter flashing shall overlap the
step flashing a minimum of three inches.
1.4 Skylight
Remove and properly dispose of the skylight on the right side of the building.
Supply and install a new operable skylight manufactured by Velux. The skylight
shall be Energy Star rated for northern climates, and have Low-E thermopane
glass and an interior screen. The skylight must have a U-Factor of 0.50 or less.
Install the skylight in full compliance with the manufacturer's specifications. Install
Velux EDL step flashing and all other flashing required by the manufacturer.
Patch all interior areas after the new skylight is installed. The interior walls
abutting the skylight include wood trim and ceramic tiles. Supply and install new
interior stops and trim. Install new materials to fill all holes, voids and missing
sections. All areas with gaps greater than '/z inch between the new and old work
shall be repaired. Prime and paint all new interior casings/trim upon completion.
End of Section 1.0 —Asphalt Roof Replacement
22 Pingree Street Page 3 July 25, 2016
Secticm 2.0 Repair/Replace Damaged Ceilings. ext
2.1 Apartment #3 (Repair Ceiling)
Repair the water damaged ceiling in the left bedroom in Apartment#3.
Remove all damaged plaster. Patch the ceiling with blueboard similar in
dimension to the existing plaster. Tape the seams between the new and old
work. Apply plaster for a smooth finish.
Prepare the entire ceiling for repainting by removing all loose paint, patching all
holes and cracks with joint compound, and sanding all materials. Apply a
primer/sealer to all water stains (Kilz or approved equal). Prime (one coat) and
paint (one coat) the entire ceiling using Benjamin Moore interior primer and
paint. The color shall be white.
2.2 Apartment #2 (Replace Ceiling)
Remove and properly dispose of the suspended ceiling, crown moldings, and the
drywall ceiling above the suspended ceiling in the enclosed porch in Apartment#2.
Remove the light fixture and store for reinstallation. Comply with the following
minimum requirements.
A. Supply and install new strapping for the new ceiling. If necessary, patch
all defective framing with new materials. All holes (voids) shall be repaired
to assure a smooth transition from old surfaces to new. Shim all surfaces
as necessary to assure smooth, flat and sound finish materials.
B. Supply and install Owens-Corning R-38 fiberglass insulation to the
opening framing cavities above the ceiling. Supply and install "fireblock"
insulation if required by the Massachusetts Building Code.
C. Supply and install a new ceiling using 5/8 inch gypsum wallboard. Tape,
seal, and sand all seams and screw heads so the entire ceiling is ready for
paint. Supply and install new crown moldings at all four walls. Crown
moldings may be 1 x 3 flat pine stock with butt joints.
D. Prime all new materials (one coat) and paint (one coat) in their entirety
using Benjamin Moore interior primer and paint. The color shall be white.
Reinstall the existing light fixture so it is working properly.
End of Section 2.0—Repair/Replace Damaged Ceilings
22 Pingree Street Page 4 July 25, 2016
Section 3.0Electri6al Repap€s
3.1 Electrical Repairs
Complete the following electrical repairs:
A. Two circuit breakers were removed from the electric panel for Apartment#1
(in the basement). Supply and install blanks or cover plates to conceal the
open wiring.
B. There are two uncovered junction boxes in Apartment#3. The junction
boxes are located in the eave that is accessible in the right front corner of
the kitchen. Supply and install junction box covers to conceal the open
wiring.
C. The light fixture in the rear bedroom in Apartment#3 does not work.
Supply, install, and replace the light with a new ceiling mounted fixture
with an energy efficient bulb. Allow $40 for the material cost of the new
light. The light fixture shall be operated by the existing wall switch.
End of Section 3.0— Electrical Repairs
22 Pingree Street Page 5 July 25, 2016
'bil
-Section 4.0 �. Plum ing
4.1 Sewer Pipe Repairs
The building has cast iron and PVC drain/waste/vent pipes that are connected to
the municipal sewer system. Two old sewer pipes in the right front corner of the
basement are open (they are not capped or sealed). Raw sewerage from the
municipal sewer system back-ups into the basement.
Supply and install plugs to cap the sewer pipes. Threaded plugs are preferred.
Compression plugs will be accepted. Rubber caps shall not be accepted.
End of Section 4.0 — Plumbing Repairs
22 Pingree Street Page 6 July 25, 2016
eowrre�n
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CITY OF S-UETTNI, ASSACH SMTS
s� as
's DEEPART VIEN T OF PI ANNING ANTS
Aeq¢YrNeW ... COZuIltisU?QITY DM�£S.OPMENT
ILO NV*AP NGTON STREET } SALUd Mas&l(T-HUSL'!TS 07.970
I.i. CrJo�af,DUNCJcx,.ATC? TEE:gy8 6x9-5665 + TAX:978-740-0404
DITMCfpR
HouSINGR 3HABILITATION LOAN PROGRAM
REVISED BID TORMT FOR EMERGENCY REPAIR$
This bid form was revised on duly 29;2616,after the contractor vs alkthi ough. 183,signing this form;the eoutractor
acko usvled.gas receipt of Addeuitutu#1. :ail ceststassociatedtvith the scone of stork specified is the ii ork write-up.
dated Me 25,2016;and Addendum#1 dated July 1-9,2016,shall be included on this bid form. -
Property; 22 Pingree Street,Sulam 0w.ner, Victor Dunce sl y
Section. Workitems Price; €
--�AsphaltRoofReptacement
General/Dctwliton.
1.2 Ashalt andRubberlteofs
-- p
C 1.3 Chin.'aey Pointing a rid Counter Flesfiwg $ . '6-0-0
i 2.0 Re az/B 1—Damaged Ceiling 'i
ro
tea
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3.0 - Electrical Repairs
4 0IPIunrbing'Repaua
4.1., I Sarver Pipe Repair $
Building Eennit
TOTAL 13M IY 000.... '11^
1,the undersismed cuntractor;have inspected the above listed property and understand the extent and character of tlac•
work to be completed as de$crlbed in.he Worx`Vrite-Up dated July 25,2016;and Addendum#1 dated July 29,2016. j
Thr bid idcludcs every item identified irithe Work Waste-Vp acd 2.ddendum 41,by Lo respective numbers.. 'alt bid
Aid'[remain in effect fora minimum of thirty(30)business days after tae bid opening.
1
`Lproposc to fiuuisb all labor,material's,and equipment necessary to accomplish all work described in the 1Vork
Wine Cp-and hdvenduut'#1 geuo
Twok r9ve £
Dollars($�'r flo-'r
1 1
1:wwitd.be able to start the project,on s-o_!G. 2016(estunnac 3.date).
Is t�ee ro bagta_the svorkwithin seven(7),calmdw days o tL Nonce to Proacedand complete the work with .hart,, --
(60)cal ndar days. I agree Sa fully g id antes.all labor and materials for one(1)year from f Sr c prosect conipiet.oa date.
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.Comb S' em Phone Number. - F
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22 Pngrce5areut Page'7 Revised Bid Form
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Construction Debris Disposa/Affidavit
(required forall demolition and.renovation work)
In accordance with the sbA edition of the State Building Code, 780 CMR,Sem 111.5 Debris,
and the pmviskms of MGL coo,S 54; Building Permit 8 is Issued with the
condition that the debris resulting from this work shag be disposed of In a properly licensed
4
waste deposit facility as defined by MGL c 111,S 151.
The debris will be transported by:
✓Ze /)C) b, Sc 1
(name of hauler)
The debris will be disposed of in:
geld c� SPAS
(name of facility)
S cnr Sb Git. �
(address o facility) �—
Signature of apolicant
Date
r.
�r: