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20-3 AMERICA WAY - BPA-13-993 REMODEL KITCHEN The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 730 CMR Sdkfar Revised Mur 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One or Two-Family Dive Chis Section For tctal Use Onl (Q� Building Permit Number: Da ppl 1 §wilding Official Pnnt Name) V. Signat .✓ D.to SECTIO is SITE? T[ON 1.1 Property Address: Ass sors Map& Parcel Numbers 7 U---3 aMZQGA LA' 1.1a Is this an accepted street?yes_ no 7 M umber Parcel Number 1.3 Zoning Information: L4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard n(Pri ed Provided Required Provided Required Provided Supply:(N.O.L c.40,§54) 1.7 Flood Zone Information: Lg Sewage Disposal System:' Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if es❑ $ECT[ON Z; PRO PERTIi'OWNERSHIPti rs of Record: � rJ (Citity,�,State,ZIIP( / / �.t 'F[- lD1ei^�CA- ' 4 b9747-s6!J mp 1!*A&a NcAnA,Je y,keet Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED.WORK"'(check allthat apply) ruction ❑ Existing Building Owner-Occupied Repairs(s) ❑ Alteration(s) lV,' Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ 1 Number of Units Other. ❑ SpecitJr: Brief Description of Proposed Work": SECTION J: ESTILNL4TED CONSTRUCTION COSTS Estimated Costs: item Labor and OfBclal"Only.--, Materials 1. Building $ 14,00D I 1..Building Permit Fee:'$' Tndicatehaw fee is determined: �. flectrieat S ❑Standaid.Cityff6tvnAppiicationFee ' ❑Total.Pioject Cost"(Item.6)x multiplier x 3. Plumbing S to p© 2. Other Fees: $ i. Mechanical (IIVAC) S List: 5. ,Mecltanie'll (Fire S Sn resiun) _ 'l'otal All Fees:.S_ - Cheek No. _Check Attwuut: Cash Antuunt n Total Project ('(IsC S 1(p)©OCR f ❑ Pdl'l in pull Cl Outstanding„ Il;dancc I)ua: V rP/ - (O..J e2 7 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisur Licerrse(C.SL) License Number — Expiration Date Name urCSL Ifolder List CSL Type(see below) No. and Street _ Description Unrestricted Build in s up to 35,000 cu. ft.) R Restricted 1&2 F:unii Dwelling Cityfrown,State,ZIP VI blasonr tot RC Ruutin Cuverin LL K 2ct WS Window and Siding r SF Solid Fucl Burning Appliances -Ifl &3q pot 5W�2(sGt�ller-4o•d, 1 Insulation Tula hone Email address III D Demolition 5.2 iRegistered Home Improvement Contractor�(HIC) bµ�� 7 I y'(•r t ¢� '�:12 ASc�v e�L_ ,k< r�rc Fill.Registration Number Expiration Date I tic Con an Name or HIC Re t mat N ne Z% p ffi�� ti, w r="2 i +k@Jeri ors r tkJo No.and Street`C>\q I to39 !Od Email address City/ wn 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 7a: OWNER NUTHORIZATIONTO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERINIff I, as Owner of the subject property,hereby authorize �r o U,�J �—t2�S—�✓t to act on my behalf,jp all ttaatters re Live to work authorized by this building permit application. rle r►?rv ,l� cer- v, 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 accurat to the be of my knowledge and understanding. I it's Namc(Electronic Si naturo) Date NOTES: 1. An Owner who obtains a building permit to do hisiher own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC) Program), will nnr have access to the arbitration program or guaranty timd under M.G.L. c. I42A. Other important information on the HIC Program can be found at oww.mass.euv%uca Information on the Construction Supervisor License can be found at www.mas .tuv JL 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) _(including garage, finished basementlattics,decks or porch) Oroii living area(sq. ft.) Habitable room count _ Minder of tirephtees.-.---------- Number of bedrooms --- --------_-----_-- Vumhcrotbathroum; NuunberafhalL-baths _,--_— — I'vpe of heeling iyslem .. _ .------- Number ot'd"k.,'porches I)peof cooling iyi11°t Fncloied . -- ()pen _---__- -- i I. I„t.J P[ ,I Oct 5yu.va Foot,i,e" may he iul?;nI it ror 'I'.-t.J I' Oct l'a;t'• ,ma..o_psw•«r.+wxt4.,...s-..�-.w. .z:.��-: ... --' . ._ ...�. .ems--.—+i�+nr+r •'+we--ver.'w.=r.�-..s�a�v..-..�,...- aw.. . r..�ew.•�qm CITY OF skyIN12 NLkSSACHUSETTS BUILDING.DEP ARTSIENT ♦ t 120 W:1SHtNGTON STREET,31°FLOOR I'm (978)735=9595 Fmc(978) 40.98.36• .,{BERi F-Y DRISCOLL THObtAS ST.1't1=xR8 MAYOR DIRECTOR OF PUBLIC PR6PERTY/13l:BDLNG COAL%til'S[ONER Workers' Compensation insurance Affidavit:Builders/Contractors/Eleetricians(Piumhers 4nnlicant Information /J Please Print Legibly Name(Ousine>vorganiratioNlndiviaual): ' ` �%1� �/LI Sf_.(C 6CJ� I41 `_� i �/t,rY.�tiTs/ Address: City/State/Zip:--AA 1(/�t. Phone F ,%rc you an employer?Check the appropriate ox: Type of project(required): 4. 1 am a general contractor and 1 1.❑ lama cmploycrwith� 6. ❑New construction employees(full and/or part-time).* have hired the sub conttactars " ` 2.El am sole.proprietor or partner- listed on the attached sheet t �• ❑Remodeling ship and have no employees These subcontractorg.havo S. ❑nemoiition working for me.in any capacity: workers'comp insurance. 9, ❑Building addition [No workers'comp.insurance S. ❑ We are a corporation and its officers have exercised their to.[]Electrical repairs or additions required.) 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs,or additions myself.(No workers'comp. c..152,¢I(4)`,and we have nci 12;❑ Roof repairs insurance required.)t employees.[No workers'" !3.❑Other comp.insurance required.) ;Any applirml that checks box it f mutt also Gil out the section below showing their worker'compensation Policy information. - t l fnmeuwncis who submit this iflidavk indicating they ate doing all work and then him outside cantroclors must submil a new affidavit indicating such. :qunimtors that check this box.must attached an askfiaurnd sheet showing the name of the suts rontnactors and their workers'comp,policy infomution... f am an employer that is providing Ivorkers'compensadoo hrsurance for.my employees Belety is the pulley and Job site information.' Insurance Company Name: ''�1'"' ' Oq(,( � C' CIO Policy H or Sclf--ins.Lic.#,._ I - Expiration Date: 313da Job Site Address: City/State/Zip: �alf7o Attach a copy of the workers'compensation policy declarail page(showing the policy number and expiration ism). Failure to secure coverage as required under Section25A of MGL c. 152 can lead to the:imposition of criminal penalties of a' tine up to S1.500.00 and/or one-year imprisonment.as well civil penalties in the form of a STOP WORK ORDER and a fine - ofuptoS250.00Ia day against:the violator. l3e advised that a copy of this:statc.ment may be-forwardedto 11ii-Offlee of- -- -- - Investigations-of the DlA for insurance coverage verification: I do hereby c errijy ruder rh el s on a s ofperlary that the fuformsithin provided above is true and correct Date' P3 OJliciat use wdy. Do nat write in this area,to be coutpleled by city or Iowa aflk•Igt City or'fown: Permit/IJcense# _ Issuing Authority(circle one): 1. Hourd of Hcalth 2.Building Department 3.Cityrrown Clerk 4.Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: .___- _ Phone#: Verizon I MyVerizon 2.01 Verizon Message Center - Fwd: 20-3 America Way, Salem M... Page 1 of 2 �' Verizon Message Center Monday,Jun 3 at 5:39 PM From: <jpearlmanl8@comcast.net> To: swfrisch@verizon.net Subject: Fwd: 20-3 America Way, Salem MA 01970 She[, Just received this from Cyndi. If there is a problem, let me know. Jeff -----Forwarded Message----- From: EastCoastPro@aotcom To: snfrisch@verizon.net Cc:tmcgrath@sa[em.com Sent:Mon Jun 3 09:05:59 UTC 2013 Subject: 20-3 America Way, Salem MA 01970 .This e-mail will confirm that the owners of 20-3 America Way, Salem, located in the Weatherly Drive Condominium Trust, have received approval from the Board of Trustees to do remodeling work in their condominium unit. If you need anything further, please do not hesitate to contact the undersigned. \Cyndy N East Coast Properties, LLC, Manager i,Weatherly Drive Condominium Trust Cyndy Anselmo 400 Highland Avenue, Ste 11 Salem MA 01970 Tel 978-741-2003, Fax 978-745-9684 EastCoastPro@aol.com www.EastCoastProLLC.com http://mail.verizon.com/webmail/public/print.jsp?wid=vz_widget_MailOpen_l&type=mail... 6/4/2013 CITY of S:u..Em. Aus:kcHusETTS .� ,• ` �y� Bt:u.nLVc DEP.IRTSIE.VT ��• �` 120 C(/A3.1i VGTOV STREET, V FLOOR TEL (973) 745-9595 FUt(973) 7.10-9344 :CI1[OHRLEY D2ISCOLL MA 'rt10-%& 3ST.P1E2A3 DIaEMIt OP FLOUC PROPERTY/SLILDLVG COSLMISSIONER Construction Debris Disposal Af'fldavit (rcquired fur all demalition and renovation work) In accordance with t(te sixth edition artlle State Building Code, 730 C1,iR section I I L5 Debris, and the provisions of b(GL a 40, S 54; Building Permit M is issued with the this workcondition that the debris resulting m llI, S ISOA. be Ia pruperly licensed waste disposal raaility as defined by tti frodGL a disposed of in The debris will be transported by: Z (name ut'haulur) The debris will be disposed of in : (name or facility) —1,11e55 of ta.ility) siguanua nfpermit•applicant - �63 - ACORD CERTIFICATE OF LIABILITY INSURANCE DATE 04/2013 C 06/09/2013 PRODUCER (978) 922-0086 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Carmen-Kimball Insurance Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4 yr HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 48 Beckford Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO Box 73 Beverly MA 01915- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Technology Insurance Co Sheldon Frisch Development Inc. INSURERB:Essex Insurance Co PO BOX 811 INSURER C: 218 Humprhey Street INSURER D: Marblehead MA 01945— IN RER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR OD'L POLIINSAD TYPE OF INSURANCE POLICY NUMBER DATE(MMIEFFDU/YY) DATIVE ITE(CY MMIDWYYN LIMITS LTR AGUE B X GENERALLIABILITY 3DK8834 04/15/2013 04/15/2014 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea RENTED ) $ 50,000 CLAIMS MADE rX1 OCCUR / / / / MED EXP(Any one Person) $ 5,000 PERSONAL A ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO $ 2,000,000 POI JRCOT LOG AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT $ ANY AUTO (EA accident) ALL OWNED AUTOS / / / / BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS / / / / BODILY INJURY (Per accident) $ NON-OWNED AUTOS PROPERTY DAMAGE (Par accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY / / / / EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE / / / / $ RETENTION $ $ A WORKERS COMPENSATION AND WC990001B 03/31/2013 03/31/2014 X I TORV LIMITS OER EMPLOYERS'LIABILITY 500,000 ANY PROPRIETORIPARTNER,EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? / / / / E.L.DISEASE-EA EMPLOYEE$ 500,000 If Yes.describeurda, - SPECIALPROVISIONSbel. E.L.DISEASE-POLICY LIMIT $ 500r000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES)EXCLUSIONS ADDED BY ENDORSEMENT'SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT City Of Salem FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE- INSURER ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE Salem MA 01970- ACORD 25(2001/08) -� a ACORD CORPORATION 1988 INS025(of DB),m Page t of 2 hrA4�- 132n � 66" 30" 36" 3611�30" 30" 36" rag�a W27308 W3012B 1230 WDC2430R 00 W361224 �� _ Cn N 3 inch tall filler B276 30-GAS-RAN GE LS ml n u u 3/4 incf frig panel o P, wir W � N W q. N to T T 1. C W12�W243OBR N —{ N C3' o � P, � W w mew o _ w � VLC1884R 4 rollouts modiified to 21 inch deep All dimensions size designations 20 r This is an original design and must Designed: 7/25/2012 given are subject to verification on TECHNOLOGIES M not be released or copied unless Printed: 7/26/2012 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. Sheldon-weathersly-7-25 Legend Drawing#: 1 i