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11 CHURCH ST - BUILDING INSPECTION 219 RECEIVED The Commonwealth of MaA;� kQjV'L SERVICES, Department of Public Safety�tr���r,:1V L' Massachusetts State Building Code(780 ttFt9`A'iH l ( U A P 3 2 � Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number. Date Applied: Building Official: SECTION 1:LOCATION{P ease indicaie Block#and Lot#for locations for which a street address is not available) 1 h 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❑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 ❑ 1 Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑ Brief Description of Proposed Work: t I N UOVA�_ c e C,PNneux 9� SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.h.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ All❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F: Factory F-1 ❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1❑ I-2❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑ S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA El IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ 1 IV ❑ 1 VA VBO SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details 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❑ Private❑ or indentify Zone: or on site system❑ required❑or trench or specify: permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: SECTION 9: PROPERTY OWNER AUTHORIZATION ame and Address of Property Owner 1 (� Name(Print) No.and Street City/Town Zip Property Owner Contact Information: 0 fj_(T­ I (g $ 22y- 2��2 g_1-3_I3-4LI S v �`�251Q c�t � o Title Telephone No.(business) Telephone No. (cell) a-mail address CQ� If applicable,the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control S (Reapt) `a^ � Tfl hone o. a-mail dress Registration Number Street Address I City/Town State Zip Discipline Expiration Date 10.2 General Contractor h Co D any y Nanr�'`�t\r�5 Name of Pe so(nRes onsibl for Construction License No. and iype if Applicable ` � Street Address T City/Town \ State Zi Cf 1a�83 "•'�� -C , � I1Y`\S �1JIH`WtTZJ a9 i l6�(vV Telephone No. business Telephone No. cell e-mail address— SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§25C(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 issuance of the building permit. Is a signed Affidavit submitted with this application? Yes❑ No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6) $ 1 1.Building $ Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ appropriate municipal factor)_$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$-ZZECC(contact municipality) 5.Mechanical (Other) $ C • i Enclose check payable to 6.Total Cost $ q (contact municipality)and write check humber here SECTION 13: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 tm ate to th best of my knowledge and understanding. le on Please�,print an�st�q na e ( Tgtle Telephone No. Date S"l�{ �J'fjS�ltt,Ll�h C. , \�cIC_0_1 r O Street Address -� City/Town State Zip Municipal Inspector to fill out this section upon application approval: d� Name Date The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THVPERMIT G AUTHORITY. Applicant Information _ Please Print Legibly Name (Business/Organization/tndividua[): Address: 9 1U t City/State/Zip q Phone #: 171 a� Are you an employer?Check the appropriate box: Type of project(required): l.Q I am a employer with employees(full and/or part-time).• 7. ❑New construction 2. I am a sole proprietor or partnership and have no employees working for me in ❑ 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself[No workers'comp insurance required.]t 9. ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole I I.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.�a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof re airs These sub-contractors have employees and have workers'comp.insurance.= 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Othei 152,§1(4),and we have no employees.[No workers'comp.insurance required.] tq 'Any applicant that checks box H I must also fill 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 anew affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. n Insurance Company Name: n/�/ VCPA? ZIVSU ( AIC-e Policy#or Self-ins.Lic.4: W N 501 OW Q — �� Expiration Date:- —/ Job Site Address: f I CI 1 U' ch V unit 219 City/State/Zip:SHlrm rn/7 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereh nder the at nd pe ees pe ry that information provided abo a is tr a and correct. Si Date: ° 15 Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: - Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: fit Massachusetts - Department of PubliAafltp f Board of Building Regulations and Standard Construction Supervisor , Lice:::se: CS-064233 CHRISTOPHER pALAZ,ZOfLK-• .r 594 WASHINGSTON GLOUCESTERMA 0t930{M� Expiraiion Commissioner 0 6/1 312 01 6 - (J/�e�qur-riio,noca�/�n�C?�f�rJdnr9tR,Jn.//J ffice-of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR egistration: 176679 Type: kfjExp,rat ion. 9117/2015 Individual I CHRISTOPHER ANTHONY PALAZZOLA CHRISTOPHER PALAZZOLA - 4 594WASHINGTON ST GLOUCESTER, MA 01930 Undersecretary i Appendix 1 For the demolition of structures the building permit applicant shall attest that utility and other service connections are properly addressed to ensure for public safety: Please fill in the information below and submit this appendix with the building permit application. The building permit applicant attests under the pains and penalties of perjury that the following is true and accurate. Property Location (Please indicate Block# and Lot# for locations for which a street address is not available) No. and Street City/Town Zip Name of Building(if applicable) For the above described property the following action was taken: Water Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Gas Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Electricity Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) Appendix 2 Construction Documents are required for structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required for this. The applicant shall fill out the checklist and.provide the contact information of the registered professionals responsible for the documents: This appendix is to be submitted with the building permit application. Checklist for Coilstruction Documents* Mark'Y'where applicable No. Item Submitted Incomplete Not Required 1 Architectural 2 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing include local connections) 9 Gas Natural,Propane,Medical or other 10 Surveyed Site Plan Utilities,Wetland,etc. 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investi ation 16 Energy Conservation Report 17 Architectural Access Review 521 CMR 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction.Work started prior to approval may be subjected to triple the original permit fee. Registered Professional Contact Information Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zi Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Discipline Expiration Date Street Address City/Town State Zip y11/2015, (26 unread)-seasideglass-Yahoo Mail John,Kadim Today at 2:05 PM To seasideglass@yahoo.com Hi, I am the Property Manager for The Essex Condominium in Salem, MA and this email is to confirm that Seaside Glass & Mirror and Chris Palazola are permitted to do work at The Essex Condominium, contingent upon the following: Both received the letter form The Association to the owner and have read through the requirements. Both are properly licensed and insured with workers compensation and general liability insurance. Both name The Essex condominium as an additional insured. Thank you, John Kadim, CMCA®,AMS®,ARM® I Property Manager Crowninshield Management Corporation, AMO 18 Crowninshield St. I Peabody, MA 01960 Office: 978-532-4800 ext. 217 1 Fax: 978-532-6023 ONE CROWNINSHIELD MANAGEMENT CORPORATION Amoe Visit us on the web! www.crowninshie!d.com data:texVhtm I;charset=utf-B,%3Cdi v%20class%3D%22thread-item-header%22%20role%3D%22presentation%22%20id%3D%22yu1_3 16_0_1_143136788908... 1/1 NIT.Brennan Unit 219, The Essex Condominium 11 Church St. Salem,MA 0'1970 Dear Mr,Brennan, 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 nor can they be assured that the final product will be in accord with the plans. 'thus you the Owner retain the responsihi lity for ensuring that the finished work does not"affect the appearance or structure of the Condominium,or the integrity orits systems",that"all materials used and Work performed shall comply with all OSELA, 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 Iry the Essex Condo Documents* (vis a vis hours,removal of refuse,noise,etc.). Regarding replaccnteut 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 fie building; Flashing must be to Massachusetts code standards. Please contact the Management Company if you have additional questions. Good luck with your project. t ,. Signed: LVWY V`� Date: November 13 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 101 169,Pg. 84. Both are available in the black bound copies of the Essex Condo Documents available from the finnt office.