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B-20-529 - 0099 BRIDGE STREET - Building Permit The Commonwealth of Massachusetts Department of Public Safety `. ° . Massachusetts CM State Building Code(780 R)_ Building Perini#Applica.,or _for-any Building other than a One-or Two-Farruly Dwelling' (This Seehon 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) -_ _- .- No.and Street City/Town. Zip Code Name of Building(if"applicable) ' SECTION 2:PROPOSED WORK.. Edition of MA State Code used If New Construction-check here O:or check all thaf apply in the two rows below Existing Buildingl� RepaiXr Alteration. 0 Addition❑ ;Demolition 0 (Please fill out:and submit-Appendix l) Change of Use, 0 Change.of Occupancy: ❑ Other 'CI Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes: ❑ No Is an Independent Structural Eng.n Peer Review:require ? Y s 0 _ No p Brief Description of Proposed Work v1n'U 2�. n �, CA , A r L ; Z t Y1 t ,GA / 1 SECTION 3:COMPLETE THIS SECTION IF.EXISTING$UILDI.NGyUNDERGOING RENOVATION;ADDITION,OR CHANGE IN USE OR OCCUPANCY<._ Check here if an Existing Building Investigation and Evaluati' is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Groizp(s}` __. SECTION 4.$0ILDIlV.G HEIGHT AND AREA Existing: Proposed No..ofFloors,/Sior%es(indude basement levels)&Azea Per Floor.(sq.f.), Total Area(sq.:fi.)andToial Height(#t) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2 0 Nightclub ❑ A-3 ❑ A40 A S 0 1, B: Business E E: Educational 0 F: Factory . F-1:0 F2❑ - H: ffigh Hazard. 11710, H-2.0 , _ H-3 0 _H-4❑ H-5 O k: Institutional'l-1 0' I-2 0. 1-3❑ 'I-4 0 M: Mercantile 0 R Residential 'R_1❑ R-2 0 R=3:❑ R� S: Storage SA 0 52 0 LJ Utility 0 Special Use❑and please'describe below:. Special Use:. SECTION 6 CONS.T_R 10N TYPE(Check,as applicable) M, ❑ M O 11A 0 IIB 0 Ink 0 11 . 0 IV ,0, vA o VB. 0 SECTION:7 SITE INFORMATION vfer_to.780 CNM _0 for details on each item). Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit; Debris Removal: Public❑ Check hf outside 1±lood Zone❑ indicate municipal❑ A trench will not be Licensed Disposal re wired❑or trench or s Private 0: or indentif y Zone:. - r site system 0' pe mit is enclosed Railroad right-o£=way: Hazairds"to Air Navigation;` MA Historic Commission Re new Process. Not Applicable:❑ Ts Strucime within airport;a.pproach area? ls'aheii review completed?* or Consent to Build enclosed O Yes❑ :or No 0 Yes❑ No 17 SECTION 8:CONTENT OF.CERTIFICATE OF OCCUPANCX Edition,of Code: Use Group(s): Type.of Consfruchon' Occupant Load per,Floor, S ecial St ulations Does the building contain ariSprinklerSystem? p p SECTION 0. PROPERTY,P."AUTHORIZATION Name and Address of Property.Owner „ Name(Print) No.and Street: City/Town .. zip: Property Owner Contact Information:. �mai!l Title Telephone No (business) Telephone No. (cell) If applicable;the property owner hereby authorizes Name Street Address City/Town State 'Zip to act on the roe owner's behalf;in all matters relative-to work authorized b this building permit a lication SECTION 10:CONSTRUCTION CONTROL(Please fill out.Appendix 2) buildingis less than 35,000 cu.ft.of enclosed s ace and/otnot under Cons€_rnction Control then check here O'a d sid Section 10.1 10.1 Registered Professional Responsible for Construction Control �� IJ1.c, 3 -R� 133f o� _m o.n�Saa,razf� 1-7r7 �7 � Name egistrani) elephone No. e=mail ad`" s C dvVl Registrati6 Number 3 i-7. o Lk4)A OAinb Street Address City/Town State Zip Discipline Expiz tion Date. 10.2 General Contractor t1�/1 S Company Name Name of Person Responsi for Construction License No: and Type if Applicable Street.Address Citygo , State Zip r S�� q3� _ 3t 3 (_ O�CaC4 lMc3n zn�'v,C�Soi'!�'7(} S , Tele hone No:.(business)- ' .. Tele hone No. cell a mail address .,. - SECTION 11:tNORICERS'COMPENSATION INSURANCE AFFIDAVIT(1VI.G.L.c.152.§ 25C A Workers'Compensation Insurance Affidavit-from the MA Department of Iiidustrial'Accidents must be.compieted and submitted with this application. Failure to provide this affidavitwill result in the denial of the.issuance of the:building:perinif, Is Asr ed Affidavit submitted with this application?,`_ .. Yes 0: No 0 SECTION 12..CONSTRUCTION COSTS AND PERMIT FEE ' Item Estimated;.Costs:(Labor and Materials) Total.Construction Cost(from Item 6) $ 1.Building $. t.(_O Building Permit Fee=Totai 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 '> o; 6.Total Cost $. 2-60 (contact municipality)and write check number here SECTION 1$ 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 grid accurate to the best.of`myl 4owledge and understanding:, .,.- 4 s 933 ag31 G o Please.pr' and 'gn n Title Telephoht.No; Date LAW Street Address, City/Town State Zip Municipal Inspector to fill out tius;section upon application approval "t Name :_Date MurphyandSonRaofslnc. Phone:508-933.1331 I Date-May1 6th 2020: ' Work at 99.Bridge St Salem Ma Contact: Shane Yellin` Strip roof down to bare wood:.: install new'4 plywood.,Fastening_using 2.''Aspike Nails. lnstait:Certainteed Fiintiastic Base.. install new 33 metal cleat edge metal.. Apply Certainteed Flintiastic Primer to:metal. install Certainteed Fiintias tic'Cover.S%heet. ;Flash chinineyusing-same product.Also Install termination barto chimneyforlong gevity., For safety',A Police-officer will tie on Duty so.when fallenobiects fail,people&the rob wiWbe Protected. Removal ofatt`.debn wit-l'be placed;into work_dumpster_&,hauled away. MdrphyandSonRoofsinc will submit&6btain6uiidmg'pennit: 30 Year Warranty on:atlmatenais. 10 Year on all workmanship;. Total dost.$9;800.00 S3,200:0o due day of signing S3,200:A0 day asecond workday$3;000.00 due.dayof :completion, 'Thankyou MurphyandSonRoofslnc> r Sohn Murphy ceo,/President Y Commonwealth of-Massachusetts Division of Professiona{ Licensurd Board of Budding Regulations and Standards t Cons r t'i t%4e�visor -CS-071763 E�xpires. 17/11/2021 SEAMUS LY + 47 MAPLE SF ". MILLBURY M`4 01527:1 + r . ksr'f T 1 toa 1 Commissioner �inrn�irct��cl�r�?''ri<i}:iu�aielGs - office of Consumer Affairs&Business Regulatiort Re istration Valid for individual use only _ HOME IMPROVEMENT CONTRACTOR 9 TYPE:individual before the:expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation l$I79? 04/29/2021' 1000 WaAington Street =`Suite 710 Boston,0A 02118 SEAMUS<LYNCH ` r 4 MAPLE STCH Y 3 ryr-'f Notwall �t ut signature MILLBURY,MA 0152il— Undersecrefary � III "look© ceofiCansumerAf€aiss NTICO TYPE in-i idusl 1T1�65 0210212G22` JC1Hi�4:MURPFY, �a�';,.�-�*� D1B'A'MURPHY&SON-ROt�)FS g -S t -JOHN MUAPHY -4 . r + 31�SOUTH ST Al}Sc�R�V MA:OibOla. �.'"" 1[+l S i/iV VVIINIIiV/iII.V.KVVIi:V1.11.KUVWrIiKUViiY', __.. idents Department of Industrial Acc t Office of Investigations ' 600 Washington;Street Boston,MA 02111 wwn-rmass:go uldia Workers' Compensation Insdrance Affidavit:Bull iers/Contractors/Electrieia>ns/Plunmlbers Applicant Information Please Print Legibly: Name (Business/Organization/Individual) m, om/\d S�rn RnLls l Address: I �d t� 1� j City/State/Zip: & b in vy).c1 Q 5 Phone Are you an employer?Check the appropriate box: Type of project(required): 1.l I am a employer with 4. 0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contract 6. ❑New construction. ors 2.❑ I am a sole proprietor or partner- listed on the,attached sheet.;. T ❑ Remodeling; ship and have no employees These sub-contractors have g El Demolition: workingfor me in an capacity. employees andhave workers Y P tY• 9. 0 Building addition [No workers' comp.insurance; comp.insurance ` required.] Sa: We are a corporation and its' 10.E Electrical repairs'or:additions 3.❑ 1 am;a homeowner doing all work. officers have exercised their I LEIPlumbing repairs or,additions myself o workers'com right'of exemption per MU y [N p 12\.e Roof repairs insurance required.]t c. 152,§1(4);and;we have no employees: [No workers'' 13.0 Other comp insurance required.] wAny applicantthat checks box#1 must also Mi out the section below showing'their workers"compensation policy information:. t.Homeowners who submit this affidavit indicating they are doing all work and then hire:outside contractors must submit a new affidavit indicating such: ;conuactomttiat check this box must attached an:a.dditional,sheet showing the:name of the sub,contractors and state whether or not those entities have :mployees..If the sub-contractors have employees;'they must provide their workers'comp.policy number. II i am an employer;that is providing workers'compensation insurance for n y employees. Below is'the policy.and job site information. Insurance Company Name: A : n p . Policy#or Self-ins.Lic.##: w(/ D 1 a Z1 J Expiration Date. .. Job Site Address: city/State/Zip: .�at l e lM,)D o P f 7 a Attach a copy of the workers'61htunsation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the innposition 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 up to$250.00 a.day againstthe.violator. Be advised that a copy of this statement:may be forwarded.to the"Office,of Investigations of the DIA for insurance coverage verification'. I do hereby certify under'the pains and penalties,of perjury that the information provided above is#rue and correct.. _. Signature:"4-1 Dates 7 Phone# Official use only. Do not write in this area,xo-be completed by city or town official City or,Town: PermittLicense# Issu.mg;Authority(circle one): P. 1 Board of Health 2.Building Department 3 .City/Town_Clerk 4.Electrical`Inspector 5.Plumbing Inspector 6.Dther: _. Contact Person; Phone#°. MURPAND'-07 DBRUETT y►�®.. DATE(MMIDDfr" /�► ��sss CERTIFICATE OF LIA19ILITY INSlJRANCIE - 5/14/2020 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'CONTRAGT BETWEF�!1 THE ISSUING INSURER(S),,AUTF ORIZED REPRESENTATIVE OR PRODUCER,ANUTHE'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;holderin lieu of such endorsement(s). PRODUCER CONTAET. David Bruett Insurance Services PHONE rc,No Ext:(978)595308 , 4-023684 Highland Avenue,Suite 308A Salem,MA 01970 E-MDRLSS: m AI dave@davebruettinsuranceco ADE INSURERS AFFORDINddbVERAGE_ .. NAiC# INSURERA:Atlantic Casual InSUrarlCe.'Co m an INSURED INSURER-B:AIM Mutual Murphy and Son Roofslnc` INSURERC: 317 South Street INSURER L'L o Auburn,MA 01501 _. INSURER E: . A _ INSURER F.: COVERAGES CERTIFICATE NUMBER"i REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BE LOW: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 THETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES..LIMITS SHOWN MAY HAVE:BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR -` POLICY EFF POLICY EXP.'- - - - L TYPE OF INSURANCE I SD'WVID POLICY NUMBER.-`_ MlDD M D LIMBS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE g 1,000,000 CIAIMs MADE ❑X OCCUR L205002688-0' 1/28/2020 V2B12021 DAMAGE TO REnrrEq REMIS Ea ce S MEDEXP'Any:one pemn) $ 9' PERSONAL&ADVINJURY 5 _ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE . S 2,000,000 POLICY a JEST a LOC PRODUCTS:-COMPIOPAdd S . 2,000,000 OTHER: S_ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT E accident 5 ANY AUTO BODILY INJURY.Perperson). S OWNED .. SCHEDULED' AUTOSONLY.= AUTOS'" BODILYINJURY'(Per accident S IL HIRED NON WNED ROPER7Y ' AUTOS ONLY AUTO Perac0%7 AMAGE $ _. UMBRELLA UAB 'OCCUR EACH OCCURRENCE .S EXCESS UA6 CLAIMS-PdADE. AGGREGATE $ DED RETENTION$ S B WORKERS COMPENSATION X PER' -0TH AND EMPLOYERS'LIABILITY Yf N STA ER ANY PROPRIETORlPARTNERlEXECUTNE Ut►C-400-703g134=2020A 4l8/2020 4J9/2021 100 000: ( FICER tgMIREXCLUDED? ;NlA EL.EACH ACCIDENT S`- Ilviandatory m NH) 100,000 EL.DISEASE EA EMPLOYE S. If yes,describe under 500000 DESCRIPTION OF.OPERATIONS bela,4 L:�EDISEASE-POLICY LIMIT , . S-. .. _ -.. DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES(ACORD 101,.Additi6nal Rematks Schedule,may 6e aMched if more space Is required)' Roofing and Carpentry Contractor CERTIFICATE HOLDER. CANCELLATION SHOULD ANY.OF THE-ABOVE DESCRIBED.POLICIES BE CANCELLED BEFORE THE' EXPIRATION DATE THEREOF„ 'NOTICE t WILL BE: DELIVERED IN ACCORDANCE'WITH THE POLICY PROVISIONS. AUTHO.RIXED.REPRESENTATIVE ACORO 25(2016103) 1988-2095 ACORD"C012PORATION. AII'rights reserved:'' The ACORD name and togoare registered marks of ACORD i CITY OF SALEM) MASSACHUSETrS BUILDING DEPARTMENT 98 WAS14INGTON STREET FLOOR 2ND R w _. `I'L. 978-745=959$ KIA SERLEY DRISCOLL MAYOR TFOMAS'ST.PIERRE DIRECTOR OF PUBLIC PROPERTIESBUILDING COMIvIISSIQNER: �n tra ors a ris isposatAffidavit (requiredf r all denoli n. renovation war In accordance with the sixth edition of the State Building:Code,780 CMR,:5ectidn 111.5 Debris; .and the provisions of MGL 00,554, Building'Perniit# is issued-with the condition that the debris resultirfg from this+n�®rk shall be disposed of.-in a properly licenses. waste deposit'facility as defined by MGL.c 111,515.OA;: 9.. The debris will;be transported ywq (n e:of hauler).:: the debris will.be disposed of ins (name of facility),1 (adds of'facility): Signature of app i n (today'$date)