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11 CHURCH ST - BUILDING INSPECTION, 504
dK- Ve�acl '6z' 1� The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code,780 CMR S Revised dMar Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Ap red: _ Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers // e4voce4 ST yq.! ,r-oV 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(it) 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❑ Private❑ Zone: _ Outside Flood Zone? Municipal O On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP[ 2.1 Owner of Record: 7'•4w Ci/71i/r.' S9le"02 /Hut. Name(Print) City,State,ZIP j/ e4,A44 -SrvA,f f y 77f- 7,YV- 77.07 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other 19 Specify: A1;•A aW—f Brief Description of Proposed Workz: ;,#,r7*// L- elirf/t /ww� R P//r to rie L✓•/le/ i✓f o t 9 vY - SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Labor and Materials Official Use Only 1.Building $ g;So •o 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(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: $ S.re 0 Paid in Full 0 Outstanding Balance Due: f SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 4P9G,s'/ G P-P-/L ��y♦7,44% "-ee, s License Number Expiration Date Name of CSL Holder List CSL Type(see below) (✓ No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances Y78- yT' ysL 8 I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) h 7eT04' IVi�/�/a✓ 10- j RIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 19 i✓.lea ww..d sT No:and Street Email address 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 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. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNEW 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 uthorized Agent's Name(Electronic 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.gov/dus 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basementlattics,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" i CITY OF S.UX2N4 �'L-1SSACHL'SETTS BUILDING DEPARTMENT ` 120 WASHINGTON STREET,3w FLOOR TEL (978)745-9595 FAx(978) 740-98" IUJIBERI-EY DRISCOLL MAYOR THOMAS ST.PIER E DIRECTOR OF PUBLIC PROPERTY/BUMDING CO'-L%aSSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLylbIX Name(Busimx Organizationlindividual): �i''Tee4 !✓li�aV 94 9i ;gi iA //+7iifS Address: z 9 -,O.T .ww>e.l ,sue City/State/Zip: /Ff"I" Phone#: 7 YS- Are you an employer?Cheek the appropriate box: Type of project(restored): I.[9 1 am a employer with -7,—e6y 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the subcontractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers'camp. c. 152,§44),and we have no 12.❑Roof repairs insurance required.)t employees.[No workers' 13.�f Other /✓'n`��s comp.insurance required.] •Any applicant that ducks box#1 most also fill mtl the section below showing thou workem'compensation policy information. t I lorneownem who submit this affidavit indicating they me doing all work and then him outride commemm most submit a new affidavit indicating such. 'Curnratson that cheek this box must anached an additional sheel showing the name of the subcommctors and their workers,comp,policy information, I um an employer that it providing workers'compensadon insurance for my employees. Below Is the policy and Job site information. Insurance Company Name: ,�9.LRy T. /�'f�Re�ge j%r-1vR.4�2G.e Policy#or Self-ins.Lie.#:.Ale,f- .?/f - 6o 7[rl Y-o/,e�/ Expiration Date: /o Job Site Address: // 449.R C4 S% 4-0''t ,f'n y City/StatetZip: Xr 1e ov /H rL 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 ofa fine 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 he forwarded to the Office of Investigations ol'the DIA for insurance coverage verification. Ida Iterehy certify untder�the pains and penalties o perJury that the infarmatloa provided above Is true used tarred S�lttrr �'�/ /+'� Date •t Phone 9: 97rr - e/77- 9196:9; DJrciai use only. Do not write in this area,to he completed by city or town aft ci d City ar Town: Permit/I.icense# Issuing Authority(circle one): L Board of Health 2.Building Department 3.Citylfown Clerk 4.Electrical inspector 5.Plumbing Inspector 6.Other Contact Person: __ Phone#: DATE(MMIDD/YY1'YI ACOR W CERTIFICATE OF LIABILITY INSURANCE 1111a2o14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICABY TE HOLDER. THIS BELOW CERTIFICATE AFFIRMATIVELY NSURANCOE DOES NOTLY AMECONSTTUTEXAECONTTRACTND OR TBETWEEN ER THE COVERAGE ISSUING NSURORDED ER(S)?AUTHORZIED 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 tloes not confer rights to the certificate holder in lieu of such entlorsement(s). NTA - BARRY J KITTREDGE INSURANCE NAME: FAX PRODUCER PHONE LAIC No 81 S MAIN ST -- BRADFORD, MA 01835 E-MAIL ADDRESS: NAIC d _INSURERIS)AFFORDING COVERAGE 33600 INSURER A: LM Insurance COroorali0n� i INSURER e INSURED HI-TECH WINDOW& SIDING INSTALLATIONS INC INSURERC: 29 ARROWWOOD ST NSURER D: METHUEN MA 01844- msuRERE: INSURER F COVERAGES CERTIFICATE NUMBER: 22315250 REVISION NUMBER: LISTED HIS IS INDICATED CERTIFY IFIAT IDINGONV REQUIREMENT TERM OR CON OF ANYCONTRACT OR OTHER DOCUMENT WITH RESPECT ALL TIP ECH THIS EXCLUSIONS AN DD BY THE POLICIE DESC CERTIFICATE MV 8 ISSUED OF MAY PERTAIN, I SUCH POLICIES.LIIMITS SHOWN MAY HOAVEEEBEEN REDUCED By PAID CLAIMRIBS HEREIN IS SUBJECT TO ALL THE TERMS. POLICY EFF 7 POLICY EXP LIMITS INSR PD LSUB POLICY NUMBER MMIDDIYY"I MMIDDIYYYY LTR TYPE OF INSURANCE I T�EACH OCCT(U�RRENCE S COMMERCIAL GENERAL LIABILITY j PREM �c rrence S ^_I CLAIL".S MADE J OCCUR i 'I i j MED EXP(Any one person) S PERSONAL_ &A_ OvIN.IURV IS L� I I �GENERAL AGGREGATE 5 GEN'L AGGREG--AT1E LIMIT APPLIES PER: i PRODUCTS COM?LOP AGO I S I POLICY IJI JPRO 7LOC I S OMB I NED SIN LE LIMIT I S OTHER I I Ea.Oipenl AUTOMOBILE LIABILITY BODILY I I !I BODILY INJU Is .ANY AUTO `BODILY INJURY(Per acmdene I S ALL O'ANED j SCHEDULED I '! PROPERT°DAMAGE Its 1 AUTOS [Per accidem —� NON OIANED I 5 L_ HIRED AUTOS _�AUTO$ ! I EACH OCCURRENCE $ S UMBRELLA LIAR !OCCUR i AGGREGATE 1 EXCESS LIAR `_I,CLAIMS MADE 0 M- I DEO I RETENTIONS iWC5.31$-6W814B14 j 1 013112 0 1 4 i 1 0/3112 0 1 5 ' STATUTE I Eft 500000 A ;WORKERS COMPENSATION EL EACHACCIDENT :S 500000 AND EMPLOYERS'LIABILITY YIN 'ANY PROPRIETOR'PARTNERIEXEOUTiVE a'NIAj EL DISEASE YE,S 560BDD OFF[CER%R.E�MIaER EXCLUDED' - (Mandatory in NH) E L DISEASE POLICv LIMIT .S _ HlyyEas descnbeunde[ '.OSCRIP i ICN OF OPERATIONS oelow i I l DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD tot,Addilional Remarks schedele,may Oa enached it more space is mquiretl) Workers compensation insurance coverage applies only to the workers compensation laws of the slate(s)of NH This certificate cancels and supersedes all previously issued certificates.only as they relate to Workers compensation coverage. CANCELLATION CERTIFICATE HOLDER SHOULD TION HE ABOVE DESCRIBED DATES THEREOF, NOTICE WILL CANCELLED DELIVERED BEFORE THE EXPIRA IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVEC�AIiL(� L LM Insuran ed. ce Corporation ©1988-2014 ACORD CORPORATION. All rights resery ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD .. ..,,.a ... AN _ST, :s,a - of Hi-Tech Window & Siding, Inc. �aslnrra Windows P.O.Box 8234,Ward Hill, MA 01835 MA Reg.# 11883E 29 Arrowwood St. Methuen.MA 01844 Z. = MA tic#016201 1-600-851-0900 - MEMSEA TV www.hitechcorp.biz _ i 11 rllt Date:. . . _ 1-�+�_ f .- Consultant:Job Name: Un¢ 5..?!Yu .. — Telephone: Il_ F, -- RS•�.5o _. Town: M ..- ------Job Address. - �- - ' C.,,tractor m,ecs la I',I d-: the ',.-I •vo Sda s.Corn t^.00r sh:ll nl t•�Y _ade lr.r dvasor c ... E a,lr, Y 1::. .1.: I..;) ,J'una ,111.1e,o'pk Is.Cen.lndcr :rball nri R 1.a_le( ,In, Var"I"l -nll ll. sll .tl..rf Gfa.ln'FI .. .. i;'..: I .n41 vrlinC r, Yh Dltg.ldlhCEvell: ,at a:_n ch Is:sbcull crre.at ne ire on a, ..r:mr, Toy loaning c:r:rk lncwaes.11 twsr micn,n.cr'l .d to.vnrpk<'y-• 1 n . ....u.,.,-� Job Includes Window Color To Be Used G (-,w,bimlinn Juh \\indn.,.O ill.t Illy Abrk : hill ln'nh.i\hil, I luwid, Inni.lne l•nrmit it K,,ninn l r l:. OnWil. .� I......mdt...l'.rAayv -. :I1�rxl•rn in hnidr Il hit,Omcklo �E2 ❑duv in,'sartiln- ., ,vnl all 11,I1n,Lim9unl �I11...d�.ain in-i,le liripr Uneidc i� 8 n.h.,lin:,cnnp'Pnrylrn uU.,nraAai,un,.....- Glass Options To Be Used Rn n ina ILlhr,1.%1 1:0 kl:nnu, ........,l Glu., hndJr Nrc111❑tan.. �r�—nnMa l.l:vod JTriPIr GLrz,vl Window Model 1 11r I' a 1 i a- 1\ind--ru)hcl-liar'ry I it Rr1,immcn.1 E Ldl.r ltn,rrrin, Grids Options To Be Used I lnnwn,durerImo- Su r.nlna ,dn,..I um edit,r \to,l.i I1C 19.Y ..•%.t .a; .L.',;.;6'lt ,';'�y •byt-�ri- `' ❑r,.nnn,ml �rlat G; I Number of Windows To Be Installed ` Screen Options To Be Used Dann').Mr., Inu,vnn III'rL,n,.r..lt El umtr '_tile[Ikten �r .l'do-rGin,. �othar I Lim hfilrn i��P ;'fivJlx L] 1.1 ❑ sn Window Trim Options To Be Installed ri.wn Ilmn,.., N-IIlk,n,.t ,I......d rwnr I an rn,nal,I'-nand Blind St ulMins ylhln , )':Intent. ` \u'1'I4 I\I IIP:IM,i T O EREU C; 11:'° C:1ill E "'it, P Special Notes na.It in In., Clhndllrflanr%,at. limn 1)halo n ,�a Lk. ❑ :t.:1,. � h Lhe 11 ip Bud 1 Writ k,.r —1 1'np1Kr Istio slidingssr, ❑n•onl:r ,] r01.n' Payment Policy Inside & Outside Woodwork To Be Included nank Firn,m;le_ C Uuner T„Ir L] ui-Tleh rn.Irrnni, ❑N..r-\nI Il,n,d„nrh N—kd ails ill111a r ra,h nl('bnd. ❑ v:nha Card In,ide s...... ] ill-h 1 .11, b,dd.sal 'total In cc\I1n.111 S ":.77.i �Uld,idr Xbq„ L t luhide t'u.i,y. {(i Ilepa.il u Ihn.i is M I i P;l"nenl al(':ur6%lrswre 5 odwr 51)" Ito lance I):n"If Gnn III,lin ll You may cancel this agreement it it has been signed by a party thereto at a place In a than the address of the seller.which may be his main Office or branch thereto,provided you holly the seller in writing at his main oflica or branch by ordinary mail posted,by telegram soot,or by delivery,not iatw than midnlgM1l the Third business tlay lollowirg the signinn of this agreement Sce the a:uehed nolic¢of cancella[ien form /or an etlplanalion of Ibis righ[ r An In leresl charye cl I5'-�.per'n0nth 11 c'k Pu -n\".be added to any a1110un unp%iid after 37 at troll ir\o.e data. i1n Tc_h S:gnn:urd L'd L69ZVVL8L6 yosaoiW egV Ol V l g0 AON Feb, 11. 2015 1 : 12PM No. 2032 P, 1 t `1 Feb. 11. 2015 1 : 12PM —No. 2032'�, 4. 2 Pss. 12)L a, 3 � The Essex Condominium C. o� sa. r Telephone, 978-532.48001 Fax: 978.532.6023 Stirs eEs clo Crowninshield Ma:nagernent Corp. IS Crowninshield Street ao Peabody,MA o196o SaR�, c�va o�4~�0 Ms. Cimini Unit 504,The Essex Condominium 11 Church St. Salem,MA 01970 Dear Ms. Cimini, The Essex Trustees have reviewed your request to replace the windows of your unit.The Trustees have given their consent for you to proceed with your project,but with the following qualifications: The Trustees are not in a position to assess the engineering details of your request not can they be assured that the final product will be in accord with the plans. Thus you the Owner retain the responsibility for ensuring that the finished work does not"affect the appearance or structure of the Condominium,or the integrity of its systems",that"all materials used and Work performed shall comply with all OSHA, other federal,state,county,and municipal laws,rules,ordinances, codes and regulations,"and that the work is carried out by the contractor in the manner specified by the Essex Condo Documents* (vis a vis hours,removal of refuse,noise,etc.). Regarding replacement windows and doors,please be aware that: Windows must be of a quality equal or greater to the original windows; Installation shall be done by a reputable contractor with a good work record and references; The appearance from the outside must be identical to that of the original windows, specifically as to color(white),number and spacing of mullions(grids),and location of mullions/grids on the outside the outer pane(not between the panes); Screens must cover only the bottom half of the windows to match those throughout the rest of the building; Plashing must be to Massachusetts code standards. Please contact the Management Company if you have additional questions. Good luck with your project. Signed: & Date: November 10.2014 for the Essex Trustees *Exhibit C of the Certificate as to the Rules and Regulations,Book 23224,Pg.241, South Essex Registry of Deeds and Sections 5.2 and 5.15 of the Declaration of Trust,Book 101169,Pg. 84. Both are available in the black bound copies of the Essex Condo Documents available from the front office.