B-20-812 - 0040 BRITTANIA CIRCLE - Building Permitr
A
The_ Commonwealth of Massachusetts
Department of Public Safety
Massachusetts State Building Code(780 CW.)
�( Building Permit Application for any Building other than a One or Two-Family Dwelling
�(T1us Sechon'For Ofhcial UseOnl )
Building Permit Number + Date Applied Builduig'Official
= --
SECTIONA gLOCATION(Please indicate+Block#and+lot#_foiylocahons for,wluch a street address is not,available)' a
No. d Street City/Town Zip Code Name of Building f applicable
.- SECTION I ON 2PROP.oSED 1NORK
Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below
Existing Building Repair❑ Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other Specify:
Are building plans and/or construction documents being supplied,is.part.of this'permit application? Yes ❑ No X
Is an Independent Structural Engineering Peer Review required? Yes ❑ No
B."ef Description of Propos Work
SECTIO1Vf3'C011%IPLETIs THIS SSECTION IFaEXISTING BUILDING UNDERGOING RENOV_ATION iADDITION�OIt
CHANGE INdUSE'ORr.C1CCUPANCY _�� -
Check here if an Existing Building Investigation and Evaluation is•enclosed(See 780 CMR;34)`O
Existing Use Group(s): Proposed Use Group(s) - .
__ _ _SECCTION 4 iBUILDING HEIGHT,`AIVD.AREA
r Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft:)and Total Height(ft.)
A. Assembly.A-1,1J A-2❑ Nightclub ❑ A-3 0 A4❑ A,5 0 B: Business 0 E: Educational 0
F. Facto . F-1❑ F2❑ H:,Hi Hazard ,H-1❑. .H-2❑ `H-3 ❑ 11 4-0 r .H-5❑
I:Institutional I-1 0 I-2❑ I-3❑ I-4❑ M: Mercantile❑ R: Residential R-10 R-2 0 R-30 R-4❑
S =Storage, S.4 0 S-2,13 U:;Utility❑ Special Use❑and.please describe below:
Special Use: -
____ SECTION�6i CONSTRUCTION'-TYPE`(Check as pa p cable),
IA .O IB ❑ IIA ❑ lIB ❑ IIIA ❑ IIIBO --IV VA ❑ VB ❑
SECTION 7 SI I`EdNFORMATIIONf'(refer9to 780 CMRr1110`fordetalls 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 0 or trench or specify:
Private❑ or indentify Zone: or on site system permit is-enclosed❑
Railroad right-of-way: Hazards to Air Navigation:',' ,CIA Historic Commission Review Process:
Not Applicable 0 Is Structure within airport.approach area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ or No I7. Yes❑ No 13
SECTION 8.'CONTENT OF<CERTIFICdATE OF OCCUPANCY`
z AT ----- .
"Edition of Code: Use Group s): Type of Construction: Occupant Load per Floor.
Does the building contain an Sprinkler System?: Special Stipulations:
--. — - A TO O SECTON9: 'P ONNR N.
Name.and Address of Property Owner
War
Name.(Print)/' / 1r,U5,L No.and Street City/Town Zip
Property Owner Contact Information:
V-E- w qff-M-� rl � c�Mnpo—rowr�
Title Telephone No.(business) Telephone No. (cell) e-mail address Cl--6 An
If applicable,_the property owner hereby authorizes
/rl a ..LLXuv-e -
Name Street Address City own State Zip
to act.on the: ro er owners behalf,in all.matters relative to.work authorized.by this building Permit application.
SECTION 10,CONSTRUCTION CONTROL;(Ple'ase':fill out Appendix 2)
' ,ba dut is kless than35,000_cu,"ft.of enclosed-'-_ace and or not under Constiuchon{Control then check here,O and ski Sechon>10:1`_ g
10:1 Re "stared Professional,Res"_on4b!d'for Construction Contfot
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
AY—
Co aany Na de
Name of Person Res onsible for Construction License No: and Typo Applicable
Street Address city'
Town State Zip
•.
Telephone.No. business Tele hone.No. cell e-mail address
_ SECTION:II:WORKE[Zg.COMPENSATION INSURANCE:AFFIDAVIT,(IV O, c:i 2,,g,,49 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 uance of the building permit.
Is..a signed Affidavit submitted with this a . .lication?_ Yes .N; o 13
w$ECTION 12 CONSTRUCTION COSTS AND PERMITVFEE�
Item Estimated Costs:(Labor
and Materials) Total Construction Cost from Item 6)_$
1.Building $ 12 PO,00 Building Permit Fee=Total Construction Cost x_(Insert here
2.'Electrical $ appropriate municipal factor.)
3.,Plumbing $ --
4.'Mechanical.(HVAC) $ _ Note:Minimum fee=$ (contact municipality)
5.IVleelianical.(Other $
Enclose check payable to
6.Total Cost $ (�M, (contact municipality)and write check number here
SECTION 13 SIGNATURE OF+BUILDINO 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
apptication.is true and accurate to the b st f my kn ledge and understanding.
SaAn G ,E C.)) e95-0 o a
Please p hand si name J/ Title Telephone No. Date
Street Address Ci Town State Zip
= 8 � a Murucipal-Inspector to fill out this section upon application approval.
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Construction Supervisor
Unrestricted - Buildings of any use group which contain
less than 35,000 cubic feet (991 cubic meters) of enclosed
space.
Failure to a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For information about this license
Cali (817) 727-3200 or visit www.mass.govldpl
CO O4' aAU
CERTIFICATE OF LIA ILITY INSURANCE 071
THIS CERTIFICATE 18 ISSUED AS A MATTER OF 1NFORAMMN Old YAND NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOTAFFIRMATIVEI.Y OR NEGAINW AMEND. OR ALTER THE COVERAGE AFFORDED BY THE POU CIES
BELOiIiI THIS CERTIFICATE OF INSURANCE DOES NOT CON811ME AF-2
CT BETWEEN THE ISSUING INSURER(8),AUTHOR
REPRESENTATIVE OR PRODUCEK AND THE CERTIFICATE MOLDER.
IAD►ORTAN7: a flta telrttneatd holder N an ADDIfIQNAl. the poust have AO�TIONAL INURED provtatone be endorsed.
If SUBROGATION 19 WAIVED.subject is the Was and eondhlone of theteln popsies Clay requtre an embmmenL A staleme�d a1
this owiffbals does not corder tights to the CoMeate holder W lieu of ndorse N
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COVERAGES CERTIFICATE W AABER: =1 5181104M REVlgIObl ppmum;
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CATS HOLDER CANCELLATION
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ACORD 26(WISW) The ACORD name and logo troregistawmeftdAconD
The Commonwealth of Massachusetts
Department of IndustrialAccidents
I Congress Stree4 Suite 100
Boston,MA 02114-2017
www mas&gov/dia
Workers'Compensation Insurance Affidavit:General Businesses.
TO BE FILED WITH THE PERMITING AUTHORITY.
Applicant Information Please Print Lgdbly
Business/Organization Name:KTM EXTERIORS&RECYCLING LLC
Address:10 Hazel Drive
City/State/Zip:Hampstead,NH 03841 Phone#:603-895-0400
Are you an employer?Check the appropriate box: Business Type(required):
1.® I am a employer with 25 employees(full and/ 5. ❑Retail
or part-time).' 6. Restaurant/Bar/Eating Establishment
2.0 1 am a sole proprietor or partnership and have no 7• ❑Office and/or Sales(incl.real estate,auto,etc.)
employees working for me in any capacity.
[No workers'comp.insurance required] 8• Non-profit
3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment
their right of exemption per c. 152,§1(4),and we have 10.❑Manufacturing
no employees.[No workers'comp.insurance required]• 11.❑Health Care
4.❑ We are a non-profit organization,staffed by volunteers, Residential
with no employees.[No workers'comp.insurance req.] 12.0 Other
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
**if the corporate officers have exempted themselves,but the corporation has other employees.a workers'compensation policy is required and such an
organization should check box#I.
lam an employer that Is provit ing workers'compensation Insurance for my employees. Below Ls the pollcy iq jormadom
Insurance Company Name•EMPLOYERS MUTUAL INSURANCE COMPANY
Insurer's Addms:40 Brittania Cirde
City/State/Zip: Salem,MA
Policy#or Self-ins.Lic.#51371638 Expiration Date.07101/2021
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 c. 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 up to$250.00 a day against the 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 hereb wen*,under the pains and penalties of perjury that the lnformadon provided above Is true and correct
Sign • Date:Cam► p�� S-q ao
ature � �.�
Phone#:603-895-0400
OfJlcial use only. Do not write In this area,to be completed by city or town offlciaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department.3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office
6.Other
Contact Person: Phone#:
www.mass.gov/dia
AGREEMENT
This Agreement,made this 29 day of July,2020 by and between;KTM Exteriors&Recycing,LLC hereinafter,
called the"Contractor"and Mariner Village Condominium Trust,hereinafter called the"Trust".
Accordingly,
Whereas the Contractor has entered into an Agreement with the Trust;and whereas the Contractor is in the
business to perform such work consisting of roof replacement.
Now therefore,in consideration of mutual covenants,promises,and provisions,hereinafter contained,the
Contractor and Trust agree as follows:
Representation:Contractor warrants and represents that it has carefully examined the premises and has made a
complete study of the site which the work will be performed,is knowledgeable with respect to all applicable
requirements of the City of Salem,Commonwealth of Massachusetts,safety standards required by its insurers,
guidelines for proper application of materials required herein as is customary in the trade.
Trust and Contractor hereby agree to:
SUBUdARY:
The Contractor shall supply all materials,equipment and labor required for the completion of the shingle
replacement at the following locations at Mariner Village:
a U2
Building 152(40 Brittania Circle)
• Building 144(2 Brittania Circle)
• Building 145(13 and 17 Brittania Circle)
• Building 155(53,55,and 57 Brittania Circle)
• Building 159(2 and 6 Good Hope Lane)
The Contractor is responsible for any damages to the property as a result of such services described in this
contract.
The Contractor will provide advance notice to the property manager at least one week prior to work on the
buildings to ensure proper notice to owners is given. All work shall be performed in a first class workmanlike
manner. The Contractor shall schedule and coordinate the work to minimize any inconvenience to the building
occupants and any disruption of the normal use of the building(s).
SCOPE OF WORK:
As defined in the attached proposal dated May 15,2018,marked as Exhibit"A"and this project shall include
all work necessary for the completion of shingle replacement at the above referenced locations.
Shingle Roof Replacement shall consist of the following:
• install tarps to protect lawns,decks,plant material and all other property
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to the satisfaction of the Owner at the end of each day's work.
• Any items stained or otherwise damaged as a result of the work shall be cleaned,restored or replaced at
the satisfaction of the Owner.
• Any vehicular damage to the landscaped or other areas around the building shall be repaired or restored
to the satisfaction of the owner.
• The Owner shall require a final inspection of the work,including final clean up.
WORK SCHEDULE:
The buildings will be occupied during the project. The Contractor shall take all reasonable measures to
minimize disruption of the normal use of the buildings and inconveniences of the occupants. Work may be
performed between the hours of 8:00 AM and 5:00 PM,Monday through Friday. No Saturday,Sunday,or
Holiday work shall be permitted without prior consent by the Board or Managing Agent.
CONTRACTOR TO SUPPLY:All labor,materials,taxes,fringes and insurance,all necessary
equipment and materials.
COMPLETION AND ACCEPTANCE: Contractor agrees to commence the work according to the time
periods outlined in the"scope of work"section of this agreement.
All work will be completed when all conditions described in this Agreement have been performed the by
Contractor to the satisfaction of the Trust.
PAYMENT: The Trust agrees to pay the Contractor agrees to accept for the full,dutiful and prompt
performance by it of the work described herein,the following sum: $59,520. Payments will be made as
follows:
• 33%($19,840)(1/3 upon delivery of stock)
• 33%($19,840)(1/3 at halfway complete)
• 33%($19,840)(1/3 final payment after receiving roof warranties)
INSPECTION&DEFECTIVE WORK: All workmanship and materials entering the Complex shall be
subject at all times to.the inspection and approval of the Trust or their Agent. Contractors will cooperate with
the Trust or their Agent to facilitate these inspections.
STORAGE OF EOUIPMENT: Contractor,at his own risk,may store materials on site in such locations as
the Contractor may propose and the Trust may accept.
TERMINATION OF AGREEMENT DUE TO CONTRACTOR DEFAULT: Should Contractor fail in any
respect to prosecute the work with promptness and diligence or fail in the performance of any of the agreements
herein contained except for causes beyond its control,which include:strikes,natural disasters,etc.,the Trust
shall be at liberty to provide any such labor or materials and to deduct the cost thereof from any money then due
or thereafter to become due to Contractor. Said Contractor,for itself and for its subcontractors,and for all
parties working through or under them,covenants and agrees that no mechanics'claim shall be filed or
maintained by it,or any of them against the above described real estate. No notice of this Agreement shall be
filed or recorded in any Registry of Deeds of the Commonwealth. All subcontractors and material will include
the above provisions with respect to liens and fees or Contract as contained herein.
REGULATIONS.PERNUTS AND COMPLIANCE WITH APPLICABLE LAWS: All services and
materials furnished hereunder and all work performed by Contractor under or pursuant to this Agreement shall
comply with all applicable laws,codes,ordinances,requirements orders,directions,rules and regulations of the
Federal,State,County and City governments,and all other governmental authorities having or claiming
3
jurisdiction over the work to be performed hereunder,and all other respective departments,bureaus and offices
of insurance,underwriting board or insurance inspection bureaus having or claiming jurisdiction,or any other
body exercising similar functions and all insurance companies writing policies covering the work to be
performed hereunder on the site or any part thereof.
DAMAGE TO WORK.PREMISES AND POSSESSIONS OF TRUST: The Contractor shall effectively
secure and protect its work,the premises and the possessions of the Trust,his tenants or invitees and shall bear
and be liable for all loss or damage of any kind of which may happen as a result of Contractor's own,his
employees',suppliers'or subcontractors'actions or omissions to Contractor's work,the premises and the
possessions of the Trust of the premises,his tenants or invitees at any time prior to final completion and
acceptance of the work. The Contractor agrees that before final payment is made all areas shall be inspected for
damage and the cost of said damage will be held until the areas were damage occurred are corrected. If the
Contractor cannot complete repairs in a reasonable period of time the Trust shall contract for the work on its
own and withhold an amount equal to the repair work from the final payment.
SUBLETTING CONTRACT WORK: The Contractor agrees to provide a list of all subcontractors,if any,to
be used to perform work on the site.
ADVERTISING: The Contractor will not be permitted to display any sign,poster,etc.,on or around the
structures or premises.
SOCIAL SECURITY,UNEMPLOYMENT,SALES TAX: The Contractor,for the Contract Price herein
provided for under the section entitled"Payment",hereby accepts and assumes exclusive liability for and agrees
to pay Last saved by APT. APTwhen due and shall hold the Trust harmless against payment of:
A. All contributions,taxes,or premiums which may be payable under the Unemployment Insurance Law of
any State or the Federal Social Security Act,measured from the payroll of employees,by whomsoever
employed,engaged in the performance of the work included in the Agreement
B. All Sales or Use Taxes,arising out of the furnishings or installing by the Contractor of any kind of
personal property under this Agreement.
C. All or any excise,property,transportation,income or other similar or dissimilar tax imposed by any
present or future law of the Federal Government,any state or any subdivision thereof on any materials,
articles,receipts,services or income earned by or furnished by Contractor including but not limited to
assessments or charges for hospitalization,pension and welfare funds which may be payable under
union agreements as now or hereafter in effect.
FAIR LABOR ACTS: The Contractor is familiar with the Fair Labor Standards Act and/or any State or Local
Acts,if any,in relation to wages and hours,and where such Acts apply to the work or materials fumished under
this Agreement the Contractor agrees to comply with the terms and provisions thereof,and agrees to hold the
Trust harmless from any violations of the same.
INSURANCE—PROVIDED BY THE CONTRACTOR: Contractor agrees to take out and maintain the
following insurance in a company or companies satisfactory to the Trust:
The contractor must furnish a certificate of insurance,naming Mariner Village Condominiums an additional
insured,evidencing workers compensation(at least$500,000),general liability(at least$1 Million)and auto
coverage(at least$1 million)before any work begins.Statutory Workers'Comp.Insurance and Employer's Liability
Insurance to be carried by the Trust.
Contractor prior to commencement of any work hereunder,shall furnish to the Trust Certificates or copies of
4
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policies showing that such insurance is in force and the premiums due there under have been paid. Certificates
or policies shall specify that the Trust shall receive 30 days prior notice of cancellation or material change.
In the event of the failure of Contractor to furnish and maintain such insurance,the Trust shall have the right at
its option to terminate this Agreement or to take out and maintain the said insurance for any in the name of the
Contractor and Contractor agrees to pay the cost thereof through the deduction of funds due him,and to furnish
all necessary information to permit the Trust to take out and maintain such insurance for the account of the
Contractor.
The contractor assumes complete responsibility to ensure all employees working on Trust clients/properties
have gone through security checks for drug/criminal and have successfully completed prior to working on our
property has the right to audit any employee file at anytime for the duration of the job. Contractor shall submit
a letter before work begins to assure that the above proper security checks have been performed.
DISCRIMINATION: The Contractor will not discriminate against any employee because of race,sex,creed,
color or national origin. The Contractor agrees to comply with all Equal Employment Opportunity Laws,
regulations,and directives,as required by any governmental body or authority.
PERFORMANCE OF THE COVENANTS: The parties hereto for themselves,their heirs,executors,
administrators,legal representatives,successors,do hereby execute the full and complete performance of the
covenants as required
NOTICE: Any and all notices served pursuant to or with respect to this Agreement shall be delivered by hand
or by certified return receipt,with respect to the Trust;
Mariner Village Condominium Trust
c/o Crowninshield Management Corp.
9 Atlantic Avenue
Marblehead,MA 01945
With respect to the Contractor;KTM Properties LLC
Any notice regarding default under this Agreement shall be confirmed in writing,but in order to expedite
corrective action a telephone call shall be deemed notice of default and after receipt by the defaulting party,said
defaulting party shall correct the default or otherwise respond within four(4)hours.
Witness: Whereof the parties have duly executed this Agreement the day and year above written.
Contrac r: Tara ton,for KTM Exteriors&Recycling,LLC
By:
Title: 'de t
Trust: Mariner Village Condominium Trust
By-
As and tin ' iduall
f
By-
As Tmstlond not individually
Re.Roof Reptacment Agreement 2020
5
CITY OF SALEM, MASSACHUSETTS
BUILDING DEPARTMENT
98 WASHINGTON STREET,2ND FLOOR
TEL: 978-745-9595
KIM13ERLEY DRISCOLL
MAYOR THOMAS ST.PIERRE
DIRECTOR OF PUBLIC PROPERTIES/BUILDING COMMISSIONER
Construction Debris Disposal Affidavit
(requiredfor 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:
(name of hauler)
The debris will be disposed of in:
(name of facility)
( 0 t4p L
(address of facility)
Signature of applicant
(today's date)