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10 PORTER ST UNIT 2 - BUILDING INSPECTION Jan 28 11 03:09p 1 1 p 1 rr }' The Commonwealth of Massachusetts Department of Public Safety �� / A•„�y,-! %1asc1chu.ett.St.ue Building Code 1,80 C%TR)Seventh Edition City of Salem Building Permit Application for any Building other than a I-or 2-Family Dwelling - _— (Thu Section ftrc CNfiaat Use Univ) Uuddmg PermitNumber: Dare Applied: /-.28 -II Budding inspector. SECTION 1:LOCATION IPlease indicate Blacks and Lot 1 for locations for which a street address is not avii table) to aoyy, 6T va. rA S.,tIE/t l9R ,No.and Street City /Toacn Zip Code - - Name of Building(if applicable) SECTION 2:PROPOSED WORK If New Construction check here Our cheek,Ill that apply in the two rows below Existing Building Q Repair Q 1 Alteration p 1 Addition❑ Demolition JW(Please fill out and submit Appendix I) Change of Use ❑ Change of Occupancy ❑ 1 Other ❑ Specify: Are building plans andiur construction documents being supplied as part of this permit application? Yes ❑ No)K Is an Independent Structural Engineering Peer Review required? Yes ❑ No ¢� Brief Description of Proposed Work: f Re ✓& e�iRSec-^&wJ`T .9,04zl"r,4rt,t7r SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR .CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Evaluation is enclosed(See 78O CMR 3402.0) ❑ Existing Use Group(s): Proposed Use Group(s): r Existing Hazard Index 780CMR 34: Proposed Hazard Index 780 CMR 34: SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.uF Flours/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION S:USE GROUP(Check as Applicable) A. Assembly A-I ❑ A-2r ❑ A-Znc❑ A-3 ❑ A4❑ A-5❑ 1 B: Buainess ❑ E: Educational ❑ F: Facto F-1 Q F2❑ H: High Haurd H-I Q H-2❑ H-3 ❑ H-4❑ H-5❑ L• institutional 1-1 ❑ 1-2❑ d-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2 Cl R-3❑ R-4 O S: Storage SI Cl S-2 ❑ U: Utility O Special Use❑and prease describe below; Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applivablel IA ❑ IB ❑ IIA Q IIB Q IIIA ❑ IIIB ❑ 1 IV ❑ VA Q VB Cl SECTION 7:SITE INFORMATION(refer to 780 66 1111.0 for details on each item) }Yater Supply: Hand Zone Information: Sewage Disposal• Trench Permit: Debris Removal: I N.trench will not Ne L.cenaed Di.pvnal Sile❑ Public❑ I Check,f uul Ide FL,od Zuna•❑ lndicaie munic+pal❑ required ❑or trench I ..r�Fw.t'ofc: I'ncate❑ I ,mndcntdc Zuni: ur un•de>r.rem❑ 11 I r }'rrmll,.reel+sed❑ l Railroad right-of-war: Hazards to Air Navigation: %1 l I h.La,. t'.•nua.n-u.n 14".. \,n .\}`i'Iiial•Ee❑ L}truitu re..ah;n.urpnrt.rppn.acha ria.' Lrhert rea:e..cumpleleal' k .n'r ,n�a•m *lire it rndr.avl C 5 c�❑ nr Xu❑ ❑ %., ❑ SECTION 9:CONTENT Of CERTIFICA FE OF OCCUPANCY - — t i..'.dwn.d l , ,c ...__ Liata,nipr•i: r,pvkit l,imt«+i thin: _ rkcupant I�,aJ per Pfnur ___"_ ILn•� Iha•bu;l.hn4 r,u11.1v 5.111 Sr rank ler Iam': Spatial ;qu 1.11 It, `- Jan 28 11 03:09p 1 1 p.2 '% SECTION 9.. PROPERTY OWNER AUTHORIZATION .Name and Address ui Property Owner f a•r gem zee s Grp. 73c1/j�.,ea,.A? /f ol9v�l Nanietlarm0 No.and Street CktviTong Lip Pnt)aRv lh,ner Contact in[ omauon: AeAI ��'✓'N9 , hlL l��neR IP6R•I E EN 5 97g- _ Tide TelephoneNo.(busman) Telephone No. (cell) a-mal address If applicable.the pnrperty owner hereby authonzes Name Street Address Cily/Town State Zip w act on the +m,ert%.n,rter'.behalf, m all matters relative to•Turk authunred by this bwldin• +erma a llf tttLm. SECTION I0:CONSTRUCTION CONTROL(Please fill out Appendix 2) (It buildtn g is Icss than 35.001.1111.it.of melt..d 11C1 and/ur n..t order CLmamction Contwi then cheek here Eland>kjp Seatiun 10.1) 10.1 Re 'stered Professional It"pansible for Construction Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor CENT tiv4L 1"A5� et) IN6 CumSL r e: 4yP E-S Name of Penn. Responsible for Construction U ase No,and Type if A plicable P. a Ir;nK J�i�s At 6.4 L Street Addr a77 City/Town Sate Zi 59$3 G U 6 des .3 _ 1c,zfz 61. Y es e✓roc &J; ; s,o —' Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS!CONDENSATION INSURANCE AFFIDAVIT IM.G.L.c.152§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will r 11 in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes O No O SECTION 12:CONSTRUCIION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cast(from item 6) _$ 1. 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) S. Mechanical [Ocher) $ Enclose check payable to 6.Total Cost $ cd ind 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 applicahun a trueond accurate to the best of my knowledge and understanding. I'lr.ty'}%ant and gn name Title re •+hone Xu. Ua:e til n•et lddre.+ iit:Tuwn fe t Municipal Inspector to fill out this section upon app�:kpprovab \a me I la to Jan 28 11 03:10p 1 1 p.3 UI/ZL/ A) II II :uo FAA DUB JUJ OI Id tASItNN 1N6 NUNIMBUNUUU VVI/VV[ A RLl 71NF 1IYYY) CERTIFICATE OF LIABILITY INSURANCE 1PAOne: s0P-fisl-TloO Paz: 5oe-653-e0B9 THIS CERTIFICATE IS ISSUER AS A MATTERATIONEastern Insurance Group LLC - Main ONLY 0.ND CONFERSNO RIGHTS UPON ICATE233 West Central Street HOLDER. THI8 CERTIFICATE DOES NOT AMD ORNatick NA 6:760 ALTER THE COVERAGE AFFORDED BY THE OW.INSURERS AFFORDING COVERAGE IReuRED 'NBURERA.'Tr era Insurance Co. Central 5E Contracting Corp P O Box 195 1995 'MSURER3 Northbor0 HA 01532 n+wlaRa •� IN6WFRD - INSURERE COVERAGES 'HE POLICIES OR INSURANCE LISTED 39LOW HAVE BEER ISECED TO THE INSURED NAMED ABOVE FOR THE FOLICE PERIOD INDICATED, OMITHSTANuMQ ANY REQUIREMENT, TERM OR CONDITION OP ANY CONTRACT OR OTHER DOcv WT WITH RESPECT TO WHICH THIS CERTIPIGTE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESOATBEO NERSIN [S 6LRJECT TO ALL THE rERMS, L%CLUSZONs AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CERINS. INRR PDLLYEEFEERVE POUCYURP"ro" POLICY NUMBlA Lents GEN PNAL LIAB"Y EAQI OCDDRRENCE E COMMERCIAL GENERAL IINRA,'TY SUM M ME I CIARU MADE OCCIm MEDEXP(Ap pp Pea S PEHSONLL A WV IMARV I -- GENGQA AGGREGATE 7 GENLAEORECWTE LDOI APPLIES PE0. . PRO. LOC DUCTS-COMPA3PAGG S POLILY AOTOWINLE LIABIUIY ANY AUTO WMSH&U SIN61F UNIT (EaaecbPle S ALL OWNDO AUTOS _.-. SCHGOACbMTOS BWRYDWHY I IAa perlROi HIRED AVM3 - BOOAYINAIRV NOMOYOf DAU10s IPor,PAONIn s F (PW seem Y OAraDE S N aeDaenq CARAO!Wenm AUTO ONLY.fA ACADEAR S ANY AUTO OTHERTAAN EA ACC S AUTOOAAY: AGO s EACE99IUMRRELU L4B14TY &Ac.OFGLRRENCE 3 OCCUR CIAIM51AAOf AOGREWTE s DEDUL-nsLe is s REreprwN S - FoiYRJs A � oEWUA8kYY YIN 1991)327-0-10 12/31/2D1012/31/2011 X ANYPERUMMOR MCLUDAME1fECVRYE^j ec�EACM ACCIDEM sloo O OFFICE M MNMI EKOLUOfD? a IMMIPEPR3 b rnl R EM A°TCARP wets EL D9FA6E•G !1 9PcuL PRp1M151 OTHER ELOMEASE POLIGYLINR E OEEDRITION OF OPERATNMe/LOCAIRINEIVlNRIf61 EALLVSWHR AODE➢BY EFODREEMlNTIePECUL FADWSIOnE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TRE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TILE 1m*IRATION DATE THEREOF, THE ISSUING ENSLAER ToWnWILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO The,Buil O£ Salem CERTIPICASS MOLDER NAMED TO THE LEFT, BUT FAILURE 1'C GO SO Building DepartmenC SMALL IMPOSE NO OBLIGATION OR LIABILITY OF WY KIND UPON 120 NaahlDgton Street THE INSURER. ITS AGENTS OR REPRESENTATIVES. Salem MA AUTAORQED REPRESEHTArFv .�� .& 7 r}RMA, ACORD 23(2008/01) 01888-20UBAC0RO CORPORATION. All rights reserved. The ACORD name and IOgo Bre reglstened marks al ACORD Jan 28 11 03:10p 1 1 p.4 Date: ,1/28/2011 Time: 11 ;22 AM To: 15083937059 AnaStasi Insurance Page: 1 "cam CERTIFICATE OF LIABILITY INSURANCE i128/2011, 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 A013MONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate hulde r In lieu otsuch endorsemenlisj. PROMDER CCWA ,Tess. ?OSkett NAME: Anastasi Insurance Agency, Inc. a"c�E,,: (500)248-1440 AA �:(SCBj 20B-La9J 4 Brookfield Rd EiaNL oD ss'J anfoskett@astasiinsurance.com A P.O. BOX 1261 CUSTQ 1 DOD 70222 FRDcicli I. Charlton MA 01500 INSURER(SI AFFOROING COVERAGE NAICf INSURED INSURERA:EIISPI Jers Mnttaal +NSURERS Travelers Ca:ll 6 Surety Il 19046 Central Mass Contracting Corp INsuaERc: P 0 Box 195 INsuRER v INSORERE: Northborough MA, 01532-0195 INSURETIF COVERAGES CERTIFICATE NUMBER:11-12 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEII MDICATED. NCNJiiHSTANDING ANY REOUIREM ENT,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, EXCLUSICNS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR ADM'YPE Of INSURANCE PCL LY EFF POLICY SMP OR N o FOLICYNUAIRER MIOOIYY NMIODIYYYY LIMITS GENERAL LIABILITY EA:]I OCCURRENCE f 1,000,000 X GGMIAERGPC GENERAL LWfi ,V PFEML�i avv�Jna S 300,000 A _ CLAINIS+AACE X❑DCCLIP. %2596512 /1/2011 /1/2012 AiEDEXP NSYww Parsanl i 5,000 PERsoll SAD'VINA;RY S 1,000,ODO GENERAL AGGREGATE Ii 2,000,000 G-101 AGGREGATE LIM1IIT APPLIES PER, PRODUCTS-CGMP,pP AGE -S 2,000,000 XPOLI"Y ��" LOC :$ AUTCAtOBLELIABILRY XMBNETI SNCL LSLF ANv alrD (EadmiiunJ S :,000.000 B PLL OvAl PUJC'S 190Pfi11 O/3/2D10 0/3/2011 e00LY NARY ECdui Dmsm) S (Per 9o:Nn1; 5 X H'cWLED AUTOS BZ NJLEtY PROPERTY Da.!AGE 'Y HIRED P.Ur05 (FerecOdfiP S X NON"ovmEowTos Ufti`i,A,rw fads:l at yin limn S iD0,000 S X UMBRELLA LPB 000UP EACR OClIrMENN2 S 1,OOD,000 E%CESSLIRB CIAMSMNR AGGREGATE ; 1,000,000 CEDUMIl A X RETENno1 S 10,000 62596512 1/1/2011 /1/2012 $ WORKERS COMPENSATION MMS LL_ OFH- PNDEMPLOVERS-LIABILITY Y+N ANY PROFRIFTIRIPAR,:,ERS aTINE EACH ACCICENT E1. OFFICER'MtNUME ILMIP ❑ NIA S 'Mendamni III EI IDISZ E-EREAPLOY S OF OESCR 0(!S. PiION OF OasvaelPERPTONS Eemw I{ EL DIBEASE-POIiCV LWtIi $ 4 DESCMPDON OF OPERATIONS I LCCATONS t WHICLES :AAaeh ACORD f01,Addlllonel Rema,Al S<eedPlq li mve".ft..,"W I dl CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Salcan ACCORDANCE WITH THEPOLICY PROVISIONS. Building Department 120 Washington Street AUrlCIRITED R@INSENrATINE Salem, 11A Paul Anastasi/ANAKGI ACORD 25(2009109) ©1998.20DS ACORD CORPORATION. All rights reserved. INS025L?0( } The ACORD name and logo are registered marks of ACORD Jan 28 1103:1 Op 1 1 p.5 1 � 4 'Z'\ Office of Consumer Affairs&Bnnsioess Regulation � License or registration valid for individul use only T ; - HOME IMPROVEMENT CONTRACTOR ! before the expiration date. If found return to: a Registration:. 104555 Type: Office of Consumer Affairs and Business Regulation Expiration 717 412 01 2 Private Corporation 10 Park plaza-Suite 5170 Boston,AIA 02116 CENTRAL MASS-,CONTRACTING CORP. - Scott Ayres 130 EAST MAIN Nonh6oroush,MA 01532 Undersecretary Not valid with si ature i NLassachusctis- Dcp:utment of Public Snfct� Board of Building Rc_ulatinn.;alld Standards Construction Supervisor License License: CS 65863 Restricted to: 00 SCOTT M AYRES 15 LAMPLIGHTER DR SHREWSBURY, MA 01545 Expiration: 5/30/2011 . t1nIV111»Inn.. Tr,: 16256 �. Restricted to: 00 00- Unrestricted lG-1 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is wase for revocation of this liceom Refer to: W W W.Mass.GovA3PS