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B-19-772 - 0025 1/2 BARR STREET - Building Permit The Commonwealth of Massachusetts Board of Building Regulations and Standart31 CITY OF Ulf Massachusetts State Building Code, 780 CMR fit••'Reviseedd Mar 2011 Building Permit Application To Construct,Repair,Reno Rtei&12(RnoAh ' One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: Building OfficiaT(Print gDate SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 25'l2 Garr Sfi. L l a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zonipg Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water'Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public Private❑ Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: mnL,JR MA L-)19I O Name(Print) City,State,ZIP 2512- T)arr l-loyi- 543- 1499 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORIO(check all that apply) New Construction❑ Existing Building d Owner-Occupied 9 Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Workz: 91_yhodek kttAell SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ - 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee r— a 2.Electrical $ 3 /6 C/ C30 ❑Total Project Cost (Item 6).x multiplier x 3.Plumbing $ 2-1 5D,b 2. Other Fees:'$ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Su ressic)n Total All Fees: $ . Check No. Check Amount: Cash Amount: 6.Total Pro ject Cost: $ 5 1h, DD 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS- Ul 1315 Zo BI 18,o f A)l t,,( j License Number Expiration Date Name of CSL Holder List CSL Type(see below) LL i I Kt o onafe, 1L r . No.and Street Type Description C�hYS •M A ��Z3 U Unrestricted(Buildings u to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding 1- SF Solid Fuel Burning Appliances ��'11�'I" �3 by lei n Q `��fU1c��b •L0m I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 6pp h Q�h C,Ln-�er �nc. ID�>oII -��gl�a Zr).s YA en i HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name �12_ HA-ckAen L5t . �JYiCQn Q bYdwns ICb•eom N. and Street Email address eibnwns Mk u1gZ.3 `1'li�-'1�4 3333 City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.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 Atfidavit Attached? Yes.......... 69' No...........❑ 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 relative to work authorized by this building permit application. Print Owner's Name(Electronic 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. Print Owner's or Authorized A ent's Vame(Electronic Signature) OF Date 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.mqK.&ov/oca Information on the Construction Supervisor License can be found at www.mass. og v/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross livii,ig area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" ,t Commonwealth of Massachusetts t f- Division of Professional Licensure ` Board of Building Regulations and Standards Constrgc-bbn'Siiperrisor CS-073375 Expires: 09/03/2020 BRIAN F MURPHY _ 11 KENMORE=DR � DANVERS MA 91923 Commissioner J�.c iCe�izniairrr ra�lli t f< !(ci.::ncir%:e%!: Office of Consumer Affairs a Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Corporation Reaistratibn Exakajign 103611 07/08/2020 BROWNS KITCHEN&BATH CENTER INC BRIAN F.MURPHY 72 HOLTEN ST. " it DANVERS,MA 01923 • Undersecretary COMMONW ET EALTH OF MASSACHUSTS ;.:BOARD`OF PLUMBERS AND GASFITTERS. ISSUES.THE FOLLOWNG LICENSE fNASTER PLUMBER ;F BRIAN F MURPHY 11 KENMOREDR DANVERS' MA`016214:126::" Su Vl-. 9326 05)01/2020.: 446847 AC�® DATE(MM1DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE F3/12/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the'certificate holder is an ADDITIONAL INSURED,the policy(ies)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 holder In lieu of such endorsement(s). PRODUCER NAME: Commercial Lines Harris-Murtagh Insurance Agency,Inc. PHONN E (978)532-2844 AIC.No)- 80 Prospect Street E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC'# Peabody MA 01960 INSURER A:Western World Insurance Co INSURED INSURER e:Associated Employers Ins Co Brown's Kitchen and Bath Center Inc ;i INSURER C 72 Holten St INSURERD: INSURER E: Danvers MA 01923 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1852927330 REVISION NUMBER: THIS IS TO CERTIFY THAT POLICIES 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE:ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCEINSD WVD POLICY NUMBER MM/DDNYYY MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MARE X❑OCCUR DAMAGERE 100,000 PREMISES Ea occurrence $ NPP1516408 3/3/2019 3/3/2020 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATELII,AITAPPUESPER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- a Jf.CT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIREDAUTOS AUTOS Pare dent $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CUUMS MADE AGGREGATE $ DED I I RETENTION S $ WORKERS COMPENSA'nON PE OTH- AND EMPLOYERS'LIABILITY YIN X STATUTE ER ANY PROPRIETOR/PARINER/EXECUTIVE E.C.EACH ACCIDENT $ 500,000 B OFFICER/MEMBEREXCLUDED? ElNIA (Mandatory In NH) WCC-500-5010092-2019A 6/1/2019 6/1/2020 E.L.DISEASE-EA EMPLOYEE $ 500,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Salem THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 121 Washine{ton St ACCORDANCE WITH THE POLICY PROVISIONS. Salem, MA 01970 AUTHORIZED REPRESENTATIVE J S Scholnick/MPB ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 po14o1) AC(:?RV® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD"YYY) 03/07/2019 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 6ertificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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 holder in lieu of such endorsement(s). PRODUCER CONTACT Commercial Lines NAME: Harris-Murtagh Insurance Agency,lnc. A/CNfV Ext: (978)532-2844 A/C No: 80 Prospect Street E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Peabody MA 01960 INSURERA: Falls Lake National Ins Co INSURED INSURER B: Republic Franklin Ins CO 12475 BF Murphy Plumbing and Heating Inc. INSURER C: Associated Employers Ins Co 72 Holten St INSURER D INSURER E: Danvers MA 01923 INSURER F COVERAGES CERTIFICATE NUMBER: CL1811728123 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRPOLICY LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD EFF MM DD E P LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 1001000 MED EXP(Any one person) $ 5,000 A SKP120147412 03/03/2019 03/03/2020 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 I ON POLICY RO PRODUCTS $❑P JECT ❑LOD 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ g OWNED SCHEDULED 4904328 11/06/2018 11/06/2019 BODILY INJURY(Per accident) $ AUTOS ONLY Ix AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED I I RETENTION$ $ WORKERS COMPENSATION /� SPER TATUTE ERH AND EMPLOYERS'LIABILITY C ANY PROPRIETOR/PART NER/EXECUTIVE YIN❑ NIA WCC-500-5010092-2019A 06/01/2019 06/01/2020 E.L.EACHACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Sak:m ACCORDANCE WITH THE POLICY PROVISIONS. 44 Lafayette Street AUTHORIZED REPRESENTATIVE Salem MA 01970 �,( ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston;Mass. 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant lInformation Please Print Legibly Name(Business/OrganizationAndividual): IC ftl(db!t floyh6rn. -1Lc�t► nL - CztiunS KA:6yl &r,Yh (�ytt;cInc_ 1 Address. _12- 64DO1 r, _<�J . City/State/.Zip: �GhVers . M1,\ 131GZ3 Phone#: CJ-1k- 11Lf-3333 Are you a'n employer?Check the appropriate box: Type of project(required): 1. 9 I am an employer with 3 4. ❑ I am a general contractor and I 6.❑New construction employees(full and/or part time).* have hired the sub-contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ? Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers'[No workers'comp.insurance comp.insurance.$ 9. ❑Building addition required] 5.0 We are a corporation and its 10. ❑Electrical repairs or additions 3. 10 I am a homeowner doing all work officers have exercised their myself [No workers'comp. right of exemption perm MGL 11. ❑Plumbing repairs or additions insurance required]t c. 152,§ 1(4),and we have no 12.❑Roof repairs employees.[no workers' 13. ❑Other comp.insurance required.] *Any applicant that checks bog#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContactors that check this box must attach an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.Below is the policy and job site information. Insurance Company Name: Ih.Su ra Policy#or Self-ins.Lic.#: �t_ -Sup-Si�lL�9Z - �Ol�A Expiration Date:Jung. 14 ZD20 Job Site Address: 251/L Barr C,+ City/State/Zip:Clem . All Ar 61kl0 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration(date). Failure to secure coverage as required under Section 25a of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. 1 do herby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: ®' -� Date: Print Name: fi n P- Cnuy-pI%u Phone#: r11Sc--IlcF- 3�33 Official use only Do not write in this area to be completed by city or town official City or Town: Permit/license#: Issuing Auth6rity(circle one): 1.Board of Hpath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#• . _--.... . --.-- --- . 151 '-12"-I"---------36"---------k--18"---;j_---30"-------- =_-----------55"'_.-----___. L��'1'' I I I; T4 l --1 N B1J5R RANGE1.30} j : i � - w �r -�- -COCO CO CO cO M G o Ref in closet V� N M IN M N f m B33 B33 IZ Cv�rl�cc��cj � y i All dimensions-siz esi natio J3rawhs kitchen _Bath This is an original design and must Designed: 5/7/2019 given are subject to verification on 72 Holten St not be released or copied unless Printed: 5/23/2019 job site and adjustment to fit job Danvers, MA. 01923 applicable fee has been paid or job �L1 conditions. 978-774-3333 order placed. � �y�j['� KS 7--,TC -J C A _. I 72 Holten Street * Danvers, M4 01923 Telephone(978) 774-3333 *'Fax(978) 774-8709 Home Improvement License#103611 * Mass. Builders License#073375 CC)NTRACT' This contract,dated below,for materials and/or labor to be supplied by Browns Kitchen&.Bath Center (Hereinafter,referred to as the contractor),at the sole request and order of: NAME:Natalie Mahady PHONE: 1-617-543-2498 DATE:May 24,2019 ADDRESS:25%Barr St.. Salem,MA 01970 (Hereinafter referred to as the owner or buyer)to be supplied/performed at premises set forth above,subject to all of the terms and conditions set forth on both sides of the Agreement,as follows: Browns Kitchen&Bath Center is pleased to furnish you with a quotation on your Kitchen remodeling.. For the purpose of this quote, we have used Kemper Cabinets. These will be supplied and installed according to Our design and drawing. Door styles, hardware, wood species and stain color to be decided. Carpentry: To remove the wall as far as possible, remove frame around closet and plaster where needed. We will frame for and install a door by stairs Flooring:None at this time. Plastering: Where needed Plumbing: We will disconnect and reconnect appliances We will supply and install an undermount stainless steel sink and pull-out faucet(chrome) We will connect owner supplied disposal and dishwasher All work to be connected to existing plumbing.Any modifications to accept draws.or other items will be an extra.If any upgrades are needed a quote will be provided. Ventilation:None Heating:None Electric: Will be quoted Counters:For this quote Mid priced granite with no backsplash has been quoted (Some granite colors are higher in price). The walls between the upper and base cabinets will have Owner Supplied Browns installed tile. Appliances: We will re-connect appliances. We will hang microwave **All hardware(knobs andpu/ls)must be picked out at time of signing contract or within a week of signing.If there is a delay in ordering hardware and it is not at the job when cabinets are being installed there will be an additional charge for the carpenters to come back. "Counters.are priced i3er•our measurements..si_e chances will affect price Marble like Glass and large tile are an added cost or installation Tile backsplashes are priced Lor installation ofa Plain straight backsplaslt Intricate patterns are an additional cost for installation. Nothing other than stated above is included in this quote.No paint orpaper.AM sales tax is include&All work is fully insure&Any debris created by Browns will be disposed of by Browns.Local Permit gees not included Owner supplied material is the sole responsibility of the owner,Any defects or problems will be billed at an hourly rate. Door Style: AGREED PRICE:$21,516.00 Handle/pull: Floor: 113 DEPOSIT: 760 0 C) Counter: BALANCE: SEE PAYMENT SCHEDULE: It is und�.rstood and agreed that this contract will be completed on or before the day of .2019. The owner represents Mid warrants that he is owner of aforesaid premises and that he/she has read this agreement,set forth on both sides. IT IS EXPRESSLY AGREED THAT NO STATEMENT,ARRANGEMENT OR UNDERSTANDING,ORAL OR WRITTEN; EXRESSED OR.IMPLIED NOT CONTAINED HEREIN WILL BE RECOGNIZED AND THIS CONTRACT CONSTITUTES THE ENTIRE AGREEMENT. It is further agreed that this contract is not subject to cancellation except by written consent of both parties. Do not sign this contract if there are any blank spaces SALESPERSON: ACCEPTED: ACCEPTED BY: X� X --�� (SUBJECT TO ALL CONDITIONS ON THE REVERSE SIDE) CITY OF S{, ALEM, MA,SSACHC15ETTS `BUILDING DEPARTMENT 120 WASH[NGTON STREET,3R0 FLOOR ItL(978)745-9595 KA1BERLEYDRISOOLL FAX(978)740-9846 MAYOR THOMM STJPMRRE DIRECTOR OF PUBLIC PROPERTY/BUILDING ODAWSSIONER Construction Debris Disposal Affidavit (required for all demolition & renovation work In accordance with the sixth edition of the State Building Code, 780 CMR,Section 111.5 Debris, and the provisions of MGL c40,S54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licenses waste deposit facility as defined by MGL c 111,S150A. - The deb is will be transported by: dtv) s /Z r`3 fv �J (name of hauler) The debris will be disposed of in: (name of facility) ' (address of facility) r *9ture of applicant (today's date)