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B-19-1291 - 0002 BOARDMAN STREET - Building Permitr The Commonwealth of Massachusetts ;> t t tf. Board of Building Regulations and Standards Massachusetts State Building Code, 780 CMR SALEM � Resed�tLf���011 Building Permit Application To Construct,Repair,Renovate Or D'aMalit uj One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Applied: I Building Official(Print Name) Signature Date Q SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 2- &arA,�, a. L l a Is this an accepted street?yes ✓ no Map Number Parcel Number 1.3. Zoning 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: Public 9f Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: d6kn r^ilufrctO 3a-kLw.. LAA 61a7D Name(Print) City,State,ZIP .2 &,af irnVn LS-1• i -'Ikl- 632- 8k28 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply) New Construction❑ Existing Building Od Owner-Occupied d Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units I Other ❑ Specify: Brief Description of Proposed Work2: ren'ba& 2k)A cam- bAnwm SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 121-1 Sr bD 1. Building Permit Fee: $ Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ -43r- ❑Total Project Costa(Item 6)x multiplier .x 3.Plumbing $ 56W.pD 2. Other Fees: $ 4.Mechanical (HVAC) $ -G- List: 5.Mechanical (Fire Suppression) $ -Jg�' Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ '$�2 S ,DD 13 paid in Full 0 Outstanding Balance Due: r SECTION 5: CONSTRUCTION SERVICES. 5.1 Construction Supervisor License(CSL) LS"t13375 913�m License Number Expiration Date Name of CSL Holder �f :Na(A List CSL Type(see below) LL SNo.and Street td Type Description I l � rye�r U Unrestricted(Buildings u to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry any s. ON b 1°I L3 RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 919 IN-3333 I Insulation Telephone li t Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) n �a3>o►� ,I�1� 66-w ns YA ,6n a Ce nie►- the• HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 72- t4D kern 3-� . ►�sdu brc nsk��,can ,1�o,and Street Tr Email address L?Irwers. MA 6192.3 G`iSs-"�1tk- 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 Affidavit Attached? Yes .......... No...........❑ .SECTION 71: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Brffuns L-W c MiN to act on my behalf,in all matters relative to work authorized by this building permit application. fA15[19 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 tth rized Agent's Name(Electionic Signature) 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.mass. og v/oca Information on the Construction Supervisor License can be found at www.mass.goy/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 living 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" 72 Holten Street,Danvers,MA 01923 Telephone(978) 774-3333 * Fax(978) 774-8709 Home Improvement License#103611 * Mass.Builders License#073375 ON , RACT 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:John Murray PHONE: 1-781-632-8828 DATE:Oct 17,2019 ADDRESS:.2 Boardman 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: —-- - _— -_- --:Brown's-Ichen--and-Bata-Center=is-.happy-to-fur-nish-you-with-a=quote-on your Bathroom project. Carpentry:We will remove wall to studs.. The outside walls will be insulated.The wall will have new blue-board and plaster. We will repair bedroom ceiling;install new blueboard'and plaster The shower walls will have waterproof backer board and Owner Supplied,Brown's installed tile. We will supply and install an Acrylic or Swanstone base. We will build a%2 wall at end of shower No door and window trim included in this quote Above the pedestal will be a medicine cabinet or mirror Z-00 ce.; Flooring:The floor will be prepared for Owner Supplied,Browns installed tile. ' -ter- - Plumbing: We will disconnect all fixtures. We will supply and install a Symmons shower valve.Model S-4701(chrome).We will use owners hand-held and a shower head We will supply and install a Kohler K-2362 Cimarron Pedestal sink(white) We will install Owner Supplied faucet We will keep existing toilet All work to be connected to existing plumbing.Any modifications to accept draws or other items will be extra.If any upgrades are needed a quotg will be provided. Shower Door: Will be quoted(Please note that shower doors take 2-4 weeks after template) Heating:None Ventilation: Fan light(supplied by other)vented to outside - �— -Electrical:Will-be-quoted:---. -- Windows:Bathroom window may need to be replaced.This is not included in price at this time. ram Door Style AGREED PRICE: $19,475.00 (�3 ti 1 Handle/Pulls Floor 1l3 DEPOSIT: _d9e BALANCE: SEE PAYMENT SCHEDULE It is understood and agreed that this contract will be completed on or before the 217 day of 2019. The owner represents and 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: ;-v ACCEPTED BY: X X' r ` lCTTR.TF. T Tn AT.T.irn1%T11rT1FnNC nN TUT IDIWXrV'DQT cTni.N .. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Mass. 021.11 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual) MLAtr6�!, flu n,btiY , ]-►Gn-[ttti, Inc, -lrn,�n5 K,C�, L t Address: _12 6AokA&r City/State/Zip: DLh\JeXS . M ZI Phone#: G-1lk- Are you an employer?Check the appropriate box: Type of project(required): 1. EV 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' 9. ❑Building addition [No workers'comp.insurance comp.insurance.I required] 5.0 We are a corporation and its 10. ❑Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. 0 Plumbing repairs or additions myself [No workers'comp. right of exemption perm MGL 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 box#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. $Contactors 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. //��� .. 4 c Insurance Company Name: t_.mocI ca.A Flyntgh;e rs IiLsJ. rd ne-2- L. Policy#or Self-ins.Lic.#: LLY-C -Sw— S� okIoGZ - aolo:A Expiration Date:c Ung, 14 zCI?' 0 Job Site Address: Z L)c�CirAn-1,) C.7T . City/State/Zip:c r. io m. "A 61111D 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 andpenalties of perjury that the information provided above is true and correct Signature:t ��� 1.c "� Date: Print Name: _Brucan P. Jl)L U n W Phone Official use only Do not write in this area to be completed by city or town official City or Town: Permit/license#: Issuing Authority(circle one): 1.Board of Heath 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#• ACO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 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 certificate 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 CON Commercial Lines NAME: Harris-Murtagh Insurance Agency,Inc. AHC No Ext, (978)532-2844 FAX A/C No 80 Prospect Streeth-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 8 Peabody MA 01960 INSURER A: Falls Lake National Ins Co INSURED INSURER B: p Re ublic Franklin Ins Co 12475 BF Murphy Plumbing and Heating Inc. INSURER C: Associated Employers ins Co 72 HDlten 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD MMIDD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000 CLAIMS-MADE 7xOCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A SKP120147412 03/03/2019 03/03/2020 PERSONAL&ADV INJURY $ 1.000,000 GEMLAGGREGATE UMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JECOT- LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT g Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B OWNED ;U SCHEDULED 4904328 11/06/2018 11/06/2019 BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Pere ddenl UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE Of ERH AND EMPLOYERS'LIABILITY YIN -• ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 C OFFICERIMEMBEREXCLUDED? NIA WCC-500-5010092-2019A 06/01/2019 06/01/2020 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below EA_DISEASE-POLICY LIMIT $ 500-000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 Salem ACCORDANCE WITH THE POLICY PROVISIONS. 44 Lafayette Street AUTHORIZED REPRESENTATIVE Salem MA 01970 � A 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACC® CERTIFICATE OF LIABILITY INSURANCE °ATE`MM'°°"YY"' 3/12/2019 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 UUNTACT C NAME: ommercial Lines Harris-Murtagh Insurance Agency,Inc. PHONE (978)532-2844 nrAX Noc 80 Prospect Street EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAlt# Peabody MA 01960 INSURER A:Wes tern World Insurance Cc INSURED INSURER B:Associated Employers Ins CO Browns Kitchen and Bath Center Inc INSURERC: 72 Holten St INSURERD: INSURER E: Danvers MA 01923 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1852927330 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DDM'YY MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 NPPlSI6408 3/3/2019 3/3/2020 MED EXP(Any one person) $ 5,000 PERSONAL BADVINJURY $ 1,000,000 GEN'LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO ❑LOC 2,000,000 JECT PRODUCTS $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPER DAMAGE HIREDAUTOS AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED i I RETENTION$ $ WORKERS COMPENSATION TH• AND EMPLOYERS'LIABILITY Y/N X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑ NIA A B (Mandatory In NH) WCC-500-5010092-2019A 6/1/2019 6/1/2020 E.L.DISEASE-EA EMPLOYEE 1$ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 i DESCRIPTION OF OPERATIONS I LOCATIONS I 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 Washington St ACCORDANCE WITH THE POLICY PROVISIONS. Salem, MA 01970 AUTHORIZED REPRESENTATIVE J S SChO1nick/MPB ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 pow)) Commonwealth of Massachusetts �t Division of Professional Licensure Board of Building Regulations and Standards Constrat,:&obh`S'upervisor CS-073375 Ecpires: 09/03/2020 BRIAN F MURPHY. •: 11 KENMORE•DR r $u DANVERS MA 01923 Commissioner %�c 'r-uzrrrrr m•ftl/�c �"-.�(fr.;lrrc�n�e//; Office of Consumer Affairs&business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Corporation R_ eaistration. Expiration 103611 07/08/2020 BROWNS KITCHEN&BATH CENTER INC BRIAN F.MURPHY 72 HOLTEN ST. r DANVERS.MA 01923 Undersecretary COMiVIONWEALTH OF MASSAC ISETTS.- >! e911013e e i BOARDOF PLUMBERS AND GASFITTER$,. ISSUES THE FOLLOWING LIC5NSE MASTER PLUMBER a BRIAN F MURPHY 1.1 KENMORE DR . Pt DANVERS;MA-01923-].126;,:`'- ;z. .V 9326 0510112020. 446847 CITY OF SALEK MASSAaiUSETI'S BUIIDING DEPARTt&Nr 120 WASH NMN STREET,3"D FLOOR TEL(978)745-9595 FAX(978)74 M46 KBOERLEY DRISOOIL T MAYOR �iOMAS ST.PIERRE Dnmcrm OF PUBLIC PROPERTY/Bw DING CObIlv MOMR 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 debris will be transported by: T-6M (name of hauler) The debris will be disposed of in: (name of facility) (addre s of facility) g ature of applicant 11qll � (today's date) I