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5 SCHOOL ST UNIT 8 - BPA -15-1299 N411 -5z 6— The Commonwealth of Massachusetts Department ofPublic Safety Massachusetts State Building Code(780 CMR) i Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Budding Permit Number: Date Applied: _Budding Official: LO SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) 1 zj School S4- Un� 1- $ 12vw. N1 A b 197D No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK. Edition of MA State Code used_ If Ne Construction check here❑or check all that apply in the two rows below Existing Building❑ Repair❑ 1 Alteration I Addition❑ 1 Demolition O (Please fill out turd submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ 1 Other ❑ Specify: Are building plans and/or construction documents being supplied as pazLot this permit application? Yes ❑ No ❑ Is an Independent Structural Engineering Peer R 'r rrequired'l v ' Yes O �_ ❑ ✓+ Brief Description of Proposed Work: o. T, z n a _ 1 N n r„rri SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,AD&ION"OR CHANGE IN USE OR OCCUPANCY — Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ r� Existing Use Group(s): Proposed Use Group(s): N 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 A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-1❑ F2 13H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ 1: Institutional 1-1❑ 1-2❑ I-3❑ 14❑ M: Mercantile❑ 1 R: Residential R-113 R-2❑ R-3❑ R4❑ 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 ❑ IIA ❑ IIB ❑ IIIA ❑ [IIB ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CIvIR 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 13 or trench or specify: Private 13 'or indentify Zone: or on site system❑ permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: \M I IkL ric C,,nnni}sn � s n R-o-y v I ru„q : 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: ues the building contain as Sprinkler Systein?: Special Stipulations: tYl(� t lam♦:`() UL' r�7 SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Share. '43wer 5 ScktoIST OA $ S�t� tAn l� Gl x'70 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes bkr+- 3 o V bis'tavn f�- (fid C,1(1C 1 4 Name Street Address City/Town 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) . f budding is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here D and skip Section 10:x' 10.1 Registered Professional Responsible for Construction Control - - 2obo- -�- [,,_a, ae)le G �Dt '09fa -Q4ts4ogy , Na (Re istr n[ Teleph n No. -mail ai ress Registration Number `moo 1-dn ��h2 �(Und � DI�7Q -1-S-)7 Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor- - - - - - - - �>.ell� Comp Name K0. 6.er Nene of Person�F sponsible f 5�-Const ch a License o. and Type if Applicable 361 ( �01 � �. Street Addressa43 i /Town State Zip ��►�� Telephone No. business Telephone No. cell e-mail address SECTION 11:W0RKEh9'C0h-Il1FNSAI'RW INSURANCF AFF'IUAVi'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 result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes❑ No O SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) TotalConstruction Cost(from Item 6)_$ 1. Building $ y oo` Building Permit Fee=Total Construction Cost x—(Insert here 2. Electrical $ appropriate municipal factor)_$ 3. Plumbing $ d. Mechanical (HVAC) $ Note:Minhnum fee=$ (contact municipality) 5. Mechanical Other $ I Enclose check payable to 6.Total Cost $ I (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 true and accurate to the best of my knowledge and understanding. �v awl1 S `�U1 �,C# l/ 23 �0_ Please py�gt nsi ny�une ( I Title ��Telephone No. Date cS g iJDS�SY F(Z� tNq�IC. r e ' U( 77 g Street Address City/T wn State Zip I 1A Municipal Inspector to fill out this section upon application approval: tw—;'9 /Ay7 — �'l % L - Name Date a.. r OWNER AUTHORIZATION Job # A } TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FORA BUILDING PERMIT as owner of the subject property S Sd/�( g+- hereby authprize LaBelle Roofing to act on my behalf in all matters relative to work relating to this building permit application, and all permitted work Signatur� of Owner Date Home Address: (If different from Installation Address) City State Zip Project Information:I/We/Yoa("Pl rchasee,),the owners of the property located at the above installation address,offer to contract with LaBelle Roofing,Inc.to furnish,deliver and arrange for the installation of all materials as described on the attached Spec Sheet#: LaBelle Roofing,Inc.reserves the dight to cancel this contract if,upon re-inspection of the job,LaBelle Roofing,Inc.determines e that it cannot perform its obligations due to a structural problem with the home or because work required to complete the job was not included in the contract. DEPOSIT PAYMENT OPTIONS (Subject to fund verification and/or credit approval) CONTRACT.AMOUNT $ 1. Check,Cashiers Check or US Postal Service Money Order i (Made payable to LaBelle Roofing,Inc.) i *LESS DEPOSIT $ '� r ° !J Z. Credit Card' payment options-Circle One Below !��/� Visa - MasterCard Discove American Express BALANCE DUE Z3 LJIJ�, Acetlt.37�zPExp.Date: {� ON COMPLETION $ LJIJ� i s i Name as it appears on card: Indicate Payment Method For 'By my/our signature below,Uwe agree to allow LaBelle Roofing,Inc.to j BALANCE DUE ON COMPLETION: charge the above referenced credit card for the deposit indicated. Aolder's Signature Date Purchaser agrees that,immediatelyUP on satisfactory completion of the work,Purchaser will execute a Completion Certificate and pay any balance due.Purchaser also agrees wbe jointly and severally obligated and liable hereunder. Entire Atrreeroent:.This agreementd its attachments,including any financing agreement,contain the complete agreement between the parties and cannot be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it You are entitled to a completely tilled-in copy of the contract at the time you sign.Keep it to protect your rights.Do not sign any completion Certificate or agreement stating that you are satisfied with the entire project before this project is complete.Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract. You may cancel this transaction at any time prior to midnight of the third business day after the date of this contract See Notice of Cancellation for unadon of this right There w third thirdrd business day. ill be a service charge equal to 25%of the contract amount if the job is cancelled by Purchaser AFTER ' -°BY MY/OUR SIGNATURE'BELOW,T-/WS,AGREE TO BE BOUND BY THE TERMS OF TH fS CO—N--TR-'A-CT.-l[-WE-ACKNOWLEDGE RECEIPT OF A COPY OF THIS C D T O COMPLETED COPIES OFTHENOTICE OF CANCELLATION.DO NOT SIGN THIS CONTRACT IF THE A 'AN SPACES. SUBMITTED BY: Date_ s ousuliant ACCEPTED BY: 1 �ar Date `�Romwwuer� y Date Homeowner' NOTICE:ADDITIONAL TERMS,CONDITIONS AND WARRANTIES ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT. White-Office Yellow-Customer Pink-Sales Consultant -Mass ac usetts - Department of PON is SaMY' Bard of �€ a ing e. utati�zas anm Sian€�arrts �^ e uric Yi tacjeaurs t'f+,ir ' < License: CS-498666 RUIRERT A LABS T.E y 3f BOSTON POST-ferr Wayland MA OO78 t r u � AA- . i=xpi ration �.0 ,Cofnmissiv er 85/0912017 Y ✓1.y� t' 1�At$'1 gy �, g n HOME IMPROVEME+Y CCN 9 RA pOR p'egiatration: '154084 Type: 1 E;.piration: 2/5/2017 Private Corporatior' LABELLE P(DOPING, INC. 1 DC)S")ON POST' RD. 01778 1 UndeB'$eci-etary 1 i k µx t N r.1�r„+'1 A 6�;�',•_ tigt_N ,tr:+'�' " _n m"' �°� 't..$Ti1 y ,s OTY OF SALE4 MASSAMUSE TTS BUII DATG DEPARTMENT 120 WASIRNNGPONSTREET,3IDPr,OOR TIAL(978)745-9595 KH&ERLEYDRISOOLL, FAX(978)740-9846 MAYOR THOMM ST.PmM DIRECTOR OF PUBI.ICPROPERTYAUIIDING ODIvWSSIOMR Construction Debris Disposa/Affidavit (required for all demolition and renovation work) In accordance with the sixth edition on of the State Building Code, 780 CMR, Section 111.5 Debris, and the provisions of MGL c40, S 54; Building Permit# condition that the debris resulting from this work shalt be disposed of in aspropertyuwith the waste deposit facilitylicensed as defined by MGL c 111 S 150 A. The debris will be trap • u sported by. � k (name of hauler) The debris will be disposed of in (name of facility) (address of facility) Signature of applicant Date The Commonwealth ofAfassadhusetts -Department ofIndustriaiAccidents I Congress Street,Suite 100 Boston,MA 0211 4-2 01 7 www.massgov/dia- Workers' Compensation Insurance Affidavit:Builders/Contractors/Electridans/Plnmbers. TO BE FILED WITH THE PERMITTING ALMMOR=. ApplimlitInforrination Please Print Legibly Name(Business/Organizationdnndiividtualal),\ 1: Q I D Address: ��� +� '� S RcA `J City/state/Zip: 01 7?3 Phone#: J579 ' II Areyoa an employer?Check the appropriate box: Type of project r YP P 1 (required): L&f I am a employer with_employees(Hill a nd/orpartfime).Y 7. �New construction 2.Q I zm a sola proprietor orpartnership and have no employees working forme in 8. ❑Remodeling any capacity.[No workers'comp,insurance required] 3.Q I am a homeowner doing all vrork myself.(No M11='comp,mswance required]1 9• ❑Demolition 4.❑1 an. a homcovmer and will be hiring contractors to conduct all wait on my property. I will 10❑Building addition ensure that all ambactors either have workers'compensation insurance or aro sole 11.❑Electrical repairs or additions proprietors with no employecs. 12 EJ Plumbing repairs or additions SQ I am a general contractorand I have hived the suh-mno-eetnes tiered on the attached sheet. These subcontractors have employees and bane workers'camp,insurance-t 13.(. 1R,�O��Of airs 6.❑We are a corporation and its Officers;have exercised their right of exemption per 44GL c. 14.Mptb r 152,§1(4),and we have no employees.[No workers'c-am.insmaoce required] *Arty apo[icaotthat checf¢b-z�l tour.els-fill tinwwngwvcusmoron policy information. T Homeowners who submit this atndevit indicating they are doing all work and than him outside contractors must submit a new do—davit indicating such •`Contractors that check this hox must attached an additional sheetsbavring the man:of the sub-mnuacom and state whether or not those entities have employees. If the sub-mounha have e3ployeas,thei must provide the'v wodcers'comp.policy number. I am an emPLayer that is providingworkers'compensaCWR insurance for my empLayeec. Below is the policy"andiob she information r, ,.�,j Insurance Company Name: /I � ,,`4e C-+ T U`J' /,,�17(G: rtC L CO . Policy#or Self-ins.Lie. W S b V ` 6 0771 lftI "1 ' I c ,.q 7�" Expiration Job Site Address: )' ��f �� V� 4 City/Statalzip: ��yy\ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, MA is a criminal violation punishable by 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 Eric of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office Of Investigations of tate DIA for insvtance coverage verification. Ido hereby ander p . and p r erjury thm the information provided above is tree and correct Si atm-e: �� ? t G, Phone# -5 W �- �1 J V (O I' . FBojardof y. Do not write m this area,to be compLrted by city or town offrciat - PermiVLicense# . ity(circle one): - lth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PltnnbingInspector Contact Person: Phone#: aco CERTIFICATE OF LIABILITY INSURANCE 11.x/ 8/19/15 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: B the certificate holder is an ADDITIONAL INSURED,the policV(es) must be endorsed. U 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 holder in lieu of such endorsement(s). PROIwcER NAT Jennifer Goodfellow Chisholm Insurance Agency EHONE 508 358-6111 CIT .0: (508) 358-5324 PO Box 399 Ef L ADDRESS: Wayland, MA 01778 INSURE $ AFFORDING COVERAGE NAICS INSURER A:Western World Insurance INSURED INSURERa:Arbella Protection LaBelle Roofing, Inc. INSURERC:The Hartford Insurance Co. 304 Boston Post Road INsuReR D:Nautilus Insurance c/o CT Unde Wayland, MA 01778 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LM41TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR MOL SUBR PO(JCV EFF POLICY EXP LTR TYPE OF INSURANCE INSR INVID POUCY NUMBER MAXI/Y WA/OD/YYYY UMTS A GENEAALLIABILITY X NPP8236613 8/1/15 8/1/16 EACH OCCURRENCE $ 1 000 000 DAMAGE TO RENTED K COXWERCIALGENERALLVIBNTY PREMIS _ ce S 50,000 CIAIWB ADE ®OCCUR MED EXP(Arty orepermn) 5 5,000 PERSONAL&ADVINJURY S 1,000,000 GENERAL AGGREGATE S 2.000,000 GEN'LAGGREGATE LWTAPPLESPER PRODUCTS-OONP/OP AGG $ 1,000,000 FOLICV PCT7 LOC S H AUTOMOBILEUABIUTY 1020008624 8/31/15 8/31/16 CeNIBII EDSINGLELIMIT $ 1,000,000 ANYAUTO BODILY INJURY(Per parson) $ ALLOWNED x SCHEDULED BODILY INJURY(Per aciEent) S AUTOS AUTOS NONOWMA R NED PR S X HIRED AUTOS AUTOS erLd.. S D X UMBRELLA LIAR K OCCUR AN019894 8/1/15 8/1/16 EACH OCCURRENCE S 5,000,000 EXCESS LIAR CLAIMS-MADE AGGI GATE S 5,000,000 DED RETENTIONS S L. WORKERS COMPENSATION 6S60UB-0271N48-9-15 3/22/15 3/22/16 g WC STATU- oTH- AND EMPLOYERS'LIABILITY NJV PROPRIEIORIPARTNERIExECUINE Y/N EL.EACHACODEW S 100,000 OFFICEMEMBER EXCLLDED? NIA (Mandafory In NH) EL.DISEASE-EA ENIPWYEE $ 100,000 Ryas EescriE uMer DESCRIPTION aF OPERATIONS below EL.DISEASE-POLICYLWIT $ 500,000 OESCRIPTONOFOPERATIONS!LOCATIONS/VEHICLES (lltleeb ACORD101,AEEIUanal Rama Schell W,X=msnareffimgUretl) *The Workers' Com certificate will follow from The Hartford. The above is for info only.p. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISUNS. AUTHORIZED RER(ESEWATIVE Thomas B. Chisholm ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: Mike From: Kathleen Cyr<kathy@labelleroofing.com> Sent: Friday, November 13, 2015 11:17 AM To: Mike Subject: Fwd: Building permits H Mike, here the is Condo Association approval for the condos at 5 School St, Salem. Thank Kathy ----------Forwarded message ---------- From: Sharon Bonner<vaeirlinmass a,comcast.net> Date: Fri, Nov 13, 2015 at 10:58 AM Subject: Re: Building permits To: Kathleen Cyr<kathy@labelleroofinz com> Cc: Kathleen Dailey <kdaileyonel @verizon.net> To Whom it May Concern, As a trustee for Cogswell Condos, I give my approval for the issuance of a building permit for the installation of new skylights in four units of the condo building. Thank you very much. Sharon Bonner Trustee Cogswell Condos 5 School St Salem MA Sent from Sharon's iPad On Nov 13, 2015, at 10:29 AM, Kathleen Cyr<kathy@labelleroofing.com> wrote: Hi, Thanks for getting back to me so quickly! I just spoke to the Building Department again, and a typed signature from any Trustee is fine. Thank you. Kathy On Fri, Nov 13, 2015 at 10:14 AM, Sharon Bonner<vagirl inmass@comcast.net> wrote: Kathleen, Does the letter need a physical signature or can I write the letter and sign it with just my typed f name? Does it need more than one signature?We are a self managed building and all of us { getting the new skylights are trustees of the association. I'll be happy to do the letter, it will just t be a tad more complicated if a physical signature or more than one signature is required. Sharon Bonner y Cogswell Condos ESent from Sharon's iPad > On Nov 13, 2015, at 10:04 AM, Kathleen Cyr<kathy@labelleroofinp com>wrote: >Dear Sharon, ( > j > I just spoke to the Salem Building Department, and they said that when applying for I > building permits for condos, a letter from the Condo Association giving its approval for >the project is required. > > Would you please e-mail a copy of the letter from the Condo Association to me at your > earliest convenience. You could also fax me the letter at 978-443-7662.Please let me know if you have any questions. > > Thank you. > >Kathy Cyr >LaBelle Roofing 2 Mike From: Kathleen Cyr<kathy@labelleroofing.com> Sent: Friday, November 13, 2015 4:22 PM To: Mike Subject: LaBelleRoofing - MUKASA- Salem - 5 School Street- Unit 7 Attachments: 5 School St Unit 7 Salem Permit Services.pdf Hi Mike, Here is the information for Unit 7, 5 School St, Salem. There are a total of 4 units that will be getting skylights. I sent the info for Unit 5 this morning, and here is Unit 7. I am waiting on the Spec Sheets for the other 2 units. You can use the blanket authorization from the Trustee that I sent this morning for this permit application again. Thanks and have a good weekend. Kathy t