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6 BROWN ST - BPA-11-174 The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY Massachusetts State Building Code, 780 CMR, 7" edition OF SALEM Revised January Building Permit Application To Construct,Repair,Renovate Or Demolish a 1, 2008 jOne-or Two-Family Dwelling T This Section For Official Use Only Building Permit Number: Date Applied: VIVIO Signature: opq&o Building Commission nspector of Buildings Date SECTION 1:SITE INFORMATION Ll Propzrtyy Address: n� 1.2 Assessors Map&Parcel Numbers Lla Is this an accepted street?yes no Map Number Parcel Number 13 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: Zone: _ Outside Flood Zone? Public❑ Private❑ Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record z'e .9&0Wti N NaytE® t Address9 for Service: 1-7YX_G/K2 Signature Telephone ' SECTION 3:DESCRIPTION OF PROPOSED WORK2(check a that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: B ief Description of Proposed Work: n — C✓t o , /5 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ U ,UQ 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ __ [3 Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ / Check No. Check Amount: Cash Amount: 6.Total Project Cost: I $ / O b0() ai ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL)n y \ R C—'&J dl'UL License Number Expv on Date Name of CSL-Holder l 0oA List CSL Type(see below) Address T e Description U Unrestricted(up to 35,000 Cu.Ft. R Restricted 1&2 Family Dwelling Sign ure M Masonry Only RC Residential Roofing Covering Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Regis red Home Improvemeyyt Contractor(HIC) HIC<ompan�Nam r f Registrant Name Registration Number Address 71 Expiration Date Signffure 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 AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, , 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. Signature of Owner Date .. ,�/ SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION 1, �>� Y.L/��/ /P<sf'c)Y 4-1(r'c 17 �clas Owner or Authorized Agent hereby declare that the statements and information on tKe foregoing application are true and accurate,to the best of my knowledge and behalf. Print N Signa e o Owner r A ' gent Date (Signed under the pains and penalties of , NOTES: I.. 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 and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors 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"maybe substituted for"Total Project Cost" Masonry Restoration Company 75 Davis Street Revere,MA 02151 Office(781)284-4777 Fax(781)294-4778 Contract#BS62998 Toll Free 1(866)981-8448 www.mrcmass.com August 10,2010 Mr.Matthew Phelan T (978)744-0147 6 Brown Street Salem,MA 01970-01971 Attn:Matthew Phelan RE:6 Brown Street Salem MRC Corp. is pleased to provide the following scope and pricing for the above reference projecL We propose to furnish and-install masonry scope of work as outlined in plans and specs for the sum of: Ten Thousand Six Hundred Dollars.............................................................._..._..........._......................$10,600.00 Scope of work description: Right side of building(brick fagade) I. Cut out brick mortar joints on right side of building 100 percent to appropriate depth. - 2. Point brick mortar joints on entire right side of building 100 percent,with new matching cement 3. Point around all stonework on entire right side of building with new matching cement. (Lintels,sills,etc.) - 4. Repair all sills and lintels(brownstone)where needed using product Comproset Information for Comproset can be found at www.comprooD.com. 5. Apply waterproofing sealant to entire roof wall 100 percent using product Sure Klean Weather Seal Siloxane PD system. - Information for product Sure Klean weatherproofing sealant can be found at www.prosoco.com 6. Masonry Restoration Company 15 year warranty for pointing on entire right side of building upon completion. TIME FOR COMPLETION: The work to be performed by Masonry Restoration Co.in pursuant to this agreement shall be commenced within(tbd)days from this date or approximately on(tho: and shall be substantially completed within (14)days or approximately start(tbd):weather permitting. PAYMENT SCHEDULE:Three one third payments of$3,533.33 each. First at jobs start/Second at middle point of project completion(tbd)_ /Third upon completion of project Upon satisfactory payment being made for any portion of the work performed,Owner(s)shall furnish an unconditional release from any cllaim or mechanic's lien,for that portion of the work for which payment has been made.If accepted all required documents,shall be submitted to owner(s)prior to start of project. TERMS AND CONDITIONS: The Terms and Conditions an expressly incorporated into this Agreement THIS AGREEMENT: Consists of (1) pages and (4) attachment(s). [21 Matthew Phelan August 10,2010 6 Brown Street Salem,MA 01970-01971 RE: 6 Brown Street Salem ADD!ALT: Attached please find a sample certificate of insurance showing all limits.A job specific certificate will be issued upon signing of agreement.A meeting will be scheduled prior to start of project Masonry Restoration Inc.will secure all permits for project as needed_ Work will commence with in 45 days of signed contract,or as weather permits. We at MRC Corp.appreciate the opportunity to bid on this project and look forward to working with you in the near future. Should you have any questions,please do not hesitate to call our office. Sincerely, Masonry Restoration Company .MASONRY RESTORATION COMPANY O /REP D TE 6 � �t FRANK LAVOIE (MRC REP) MA LAN " CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT 1.I\at'.Rt nY DNISCULI. �Lt Yd m 12C.W ASHING I ON S I KL Vr • SALIEM,MASSMA IFSE'I'I S 01970 Tta.:978-745-9595 0 FAX: 978-740'9846 Workers' Compensation Insurance Affidavit- Builders/Contractors/Electricians/Plumbers , foucant Information f� Please Print Leeibl_v Vance t01,sincssiOrBanizntiotdlndividuap: . -Address: City;StatcZip:&W Phone Are y an employer?Chec a appropriate box: "Type of project(required): I. 1 am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑ New construction employees(full i m6'or part-tile).` have hired the sub-contractors 7. Remodeling 2.❑ 1 mn a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity, workers' comp. insurance. 9, [j Building addition p• insurance l No workers' cum 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] Officers have exercised their right of exemption per MGL I I.❑ Plumbing repairs or additions 3.❑ I am a homeowner doing all work S P myself. LNo workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. LNo workers' 13. Other romp. insurance requi ❑red.] -Airy applicant that cheeks box iR must alsu kill nut the vectian Wow showing their wurkws cumpenautiun policy inlircnutiun. 'I lumcuwm:rs who Suhmil this affidavit indicating Ihcy are doing ukl work and Then him outside contractors must euhmit a new al'rdavit indicting.inch. �Contmcwrs that check this box muss attwhed an additional sheet showing the nine of the subcontractors and their workers'comp.guilicy information. /ton an employer that is providing workers'compensation insurance fur my employees. Belmv is the pu/icy and job.site iufurinatiom insurance Company Name: ` - Policy A or Self-ins. Lic.,*Q: Expiration Date/: 7/, Job Sitc Address: C %/" City/Stut&Zip:✓ 4 /�4 Attach It copy of the workers' compensation policy declaration page (showing;the policy number an expiration date). Failure to secure coverage as required under Section 25A of.%1GL 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 as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Invcsligalions of the DIA for insurance coverage verification. /du her�eby terti uu cr +e i«s and p «fries of perjury that the infunnulion provided uG re is!/r«//ywut carrece. _. / Dat • official use only. Do not write in this area,to be completed by city or town ojJic•iu/. City or Town: _-- Permit/License p__--_- -- __.---._.._ -. -__.-- - - Issuing Authority(circle one): 1. Board of Ilcalth 2. Building Department 3.Cityffoi%n Clerk 4. Electrical Inspector 5. Plumbing Inspector G. Other i Contact Person: _--_ __. _. ----_ Phone th Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an emplul•ee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more Of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of art individual,paanrcrship, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, ¢25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicunt who has not produced acceptable evidence of compliance with the insurance coverage required." :additionally, 'vlGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s),address(es)and phone nurnber(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their - self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department Itas provided a space at the bottom of the affidavit for you to till out in the event the Office of Investigations has to contact you regarding the applicant. 111case be sure to till in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permitlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address" the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town'may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be tilled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture 1 i.e. it dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. "I"he Ot'lice of lnvestigations would like to thank you in advance-.for your cooperation and should you have any questions, please do not hesitate to give us a call. - The Department's address, telephone and fax number: \ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised S-ZG-OS Fax #617-727-7749 www.mass.gov/dia 8/13/2010 5:04:11 AM PST (GMT-8) FROM: insurancevisions.corn-TO: 17812644778 Page: 2 of 3 .aco CERTIFICATE OF LIABILITY INSURANCE DATE(MM DDMYYY) PRODUCER R M CATALDO INSURANCE AGENCY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 230 SQUIRE RD ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE REVERE, MA 01901 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 781 289-5286 781 289-5289 INSURERS AFFORDING COVERAGE NAIC# INSURED FHL MASONRY INC INSURERA: LIBERTY MUTUAL GROUP DBA MASONRY RESTORATION COMPANY INSURER B. 75 DAVIS STREET NSURER C. REVERE MA 02151 INSURER D: INSURER 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TOALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. VIER IL POLICY NUMBER POLCYEFFECTNE POLK:YEXPIRATIONkNcF LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES a ocru,renoe $ CLAIMS MADE ❑OCCUR MED EXP An gne rscn $ PERSONAL ADV INJURY $ GENERALAGGREGATE IS GEHL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ POLICY PRO- LOG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea eccidmi) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Pe,person) HIRED AUTOS BODILY INJURY $ NON-OWNED AMOS (Per ocddent) PROPERTY DAMAGE $ (Pe,ecdde ) GARAGE LIABILITY AUTO ONLY-EAACCOEHT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO $ EXCESS UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION WC2-31S-377930-010 5/19/2010 5/19/2011 1 WCSTATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR,PARTNEWEXECUTNE E.L.EACH ACCIDENT $ 100000 OFFICERIMEMBER EXCLUDED? (M.Pdalary is NH) E.L.DISEASE-EA EMPLOYE $ 100000 If yea desabe antler SPECIAL PROVIS IONS bebw E.L.DISEASE-POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS Workers Compensation Insurance: Part One of the policy applies Only to the Workers'Compensation Laws of the State of MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION MATTHEWPHELAN DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYSWRITTEN 6 BROWN STREET NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL SALEM MA 01970 IMPOSE NO OBLIGATION OR LIABLL ITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORMED REPRESENTATIVE Jeff Eldridge .�• �Jl,�j�,:`LTC�q.L ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. CERT n0.: 8039346 Anne CAandlec 8/13/2010 5:00:53 AN Page 1 of 1 IinTE(MNYWIYVYYI F. c CERTIFICATE OF LIABILITY INSURANCE OB/12/10 THIS CERTIFICATE IS ISSUED AS A MATTER ]F INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY Of NEGATIVELY AMEND,EXTEND OR'ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE ITOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE DERTIFICATE HOLDER. IMPORTANT: R the certificate holder M an ADDITION AL INSURED,the polkylleg)must be endorsed. If SUBROGATION IS WAIVED,subleCt to the terms and wnllhlons of the policy.Cents"P011CI hs may require aft endorsement. A statement on this CLVUflcate does not Coafbr rights to the Cer9f ate holder In Beu of such nationseme s. PRODUCER jgMT. DEREK CATALDO R.M.Cateldo Insurance Agency Inc PHONE (781 289.5288- FAX Neh. (781)288-5289 230 Squire Road '.1, deerek rlTCataldoihSUrSLM Dm Revere, MA 02151 PROo VD NEReE DA. - Phone (781)289.52$0 Fax (761).!Ba-5209 _ INSURERtS)LLAFFORMNGCOVENAGE NAlca INSURED INSURERA. NGM Masonry Restoration CIm1PanY INEURMI _ 75 Davis Street INSIIfUSRC: -.. Revere,MA 02151-2202 msuRntsR D: INSURER E: .. U INSURFRP: COVERAGES CERTIFICA fE NUMBER: REVISION NUMBER: THIS ISTO CERTIFY THAT THE POLICIES OF INSUP ANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURFA NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREME;NT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY FERTAIN,TI IE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH FOLIOS:.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLANS, INSRLTR TYPEOFINSURANCS Q POLICY NUMBER WN),G,DCf0v M LIMITS GENERAL LIABILITY EACH OCCURRENCE s 1,000,000 Q COMMERCIAL GENERALLIABLRY PREML neeeul--- a" 500.0%) ❑ ❑ CLAM" SE ❑J OCCUR MPDSS85T MED EXP My we effmi a 1D,000 A ❑ . 03M MOIO 03/11/2011 PERSONAL a ADV INJURY a 1.000,DDD ❑ GENERAL AGGREGATE a 2,0W,0IX) GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGO S 2,000,000 ❑ POLICY ❑ PEA ❑ LOC_ a AVIOD09ILE LIABILITY _ COMBINED SINGLE LMRT s (Ea aeeldeM) ❑ ANY AUTO 80OLY INJURY(Pw par.e ) S ❑ ALL OWNED AUTOS 8001LY INJURY(Pwaeeldent) S SCHEDULED AUTOS PROPERMDAMAGE s ❑ HIRED AUTOS - (Perecekeral S ❑ NON•OvaNED AUTOS ❑ a Q UMeRELLALIAS ❑ OCCUR EACHOCCURRENCE a ❑ EXCESS LIAB ❑ CLAIMS.AWOE AGGREGATE a © DEDUCTIBLE a rl RETENTION S a WORXERSCOMPENSATPON0TI♦- AND EMPLOYERS'UAMUTY ANY PROPRIETOR)PARWERIMCL)"Yr NIA E.L EACH ACCIDENT a iMar�rory In NM) EXCLUDED? yyam�,, E.L DISEASE-EA EMPLOYE a DEBCRIPTIONN OF OPERATIONS bOm E.L DISEASE-POLICY LIMIT I a DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLFA (A lath ACORD 101.AdAua Remarks Schedule,If apace la requlrerq MASONRY RESTORATION CERTIFICATE HOLDER CANCELLATION SN D ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TH E (RATION DATE THEREOF,NOTICE WILL BE DELIVERED IN MATHEW PHELAN R CE WITH THE POLICY PROVISIONS, S BROWN ST SALEM,MA 01970 R REP SENTA '" 1 ORD CORPORATION. All rights mset'V , ACORD 25(2009109)QF The ACO name and logo ale registered marks of ACORD