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11 CHURCH ST - BUILDING INSPECTION (28) Srr��2 r 1 r► o cc • f-I ( © 3 c K Z% -7 2 The Commonwealth of Massachusetts • Department of Public Safe RECEIVED Massachusetts State Building�@ � L SERVICES Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only)2015 SE t Building Permit Number: Date Applied: Building Official: ich a street address ll` n� SECTION 1:LOCATION(Please indicate Block#and Lot#for locations fress is not available) 0 v No.and Street City/Town Zip,Code Name of building(if applicable) ( 1 SECTION 2:PROPOSED WORK U ! Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below 1 Existing Building❑ Repair Alteration ❑ 1 Addition❑ 1 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 as part of this permit application? Yes ❑ No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑ B 'erl f Description o ro osed W rk: n 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) O 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.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-1❑ F2❑ H: Hi Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional 1-1 ❑ I-2❑ 1-3❑ I-4❑ M: Mercantile❑ R: Residential R-1❑ R-2❑ R-3❑ R-4❑ S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA I] IB 0 IIA 0 IIB 13 IIIA O IIIB L] 1 IV O 1 VA O VB I] SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Debris Rem i Permt: ov al: Water Supply: Flood Zone Information: Sewage Disposal: Trench Licensed Disposal Site❑ Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be P Private❑ or indentify Zone: or on site system❑ required❑permit is enclosed trench or specify: ❑ Railroad right-of-way: Hazards to Air Navigation: FNIVHistoric 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: rvl)a 1 l.�-b TO S 1 CST (aL S-r I !b SECTION 9: PROPERTY OWNER AUTHORIZATION N e and Ad ess of Proper ner I$�c �, any, A4A ©f Name(Print) No.and Street City/Town -� Zip xwperty OwContact Information: J"1 $Gam/ . % ^ V JW _ ^ t 1�_°lt hIL .7/la)i Title Telephone No. (business) Telephone No. (cell) e-maif address ,lSapplicable, - property owner herb authorizes CW Sr, TrnFVVfjr_SS Diu Name I Street Address C ty/Town State Zip to act on the property owner's 6ehaff,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 0 and skip Section 10.1 10.1 Re 'stered Professional Responsible for Construction Control C _ ame(Registrant $,/4 elephone��il address _JN( Registration Number treet Address ity To n State Zip Discipline Expiration Date 0.2 General Contractor r1tainpany N e re o Person Responsible f r Construction License No. and Type if A plicable Street Address City/T wn State Zip _ Q7 -� � �e Telephone No. business Telephone No. cell a-mai address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§ 25C(6)) A Workers Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes 0 No Q SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs: (Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ 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.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ (contact municipality)and write check number here SE ION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I y atte t der a pains and penalties of perjury that all of the information contained in this plicatio i true and accura t e b of y dge and understand' . - 99e se t and sign na �� Title p,, Telep n No Date g 04�, Street Address C ty/Town State /- S Zip 9 71 Municipal Inspector to fill out this section upon application approval: `�' ` l t Name Date j t + t CITY OF S�U.E1%1, I&L-kSSACHUSETTS • BU DING DEPARTJlE2NT 120 WASH .NGTON STREET,3' FLOOR 'ILL (978) 745-9595 FAX(978) 740-9846 1Q-,(BERL.EY DRISCOLL 'lI MAYOR iOMAs ST.PtFxRs DIRECTOR OF PIBLIC PROPERTY/BunmLNc;comMISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40,S 54; Building Permit# . is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: (name of hauler) WLS:t The debris will be disposed of in y (naml of facility) WOMVtk (uddress of facility Sig a of it a icant date Unrestricted-Buildings of any use group which wntaj.les than 35,000 cubic feet(99"n )of enclosed space- Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing info'; iOn visit: W W.Ma5S.GovjDPS . 1�t Massachusetts -Department of Public Safety Board of Building Regulations and Standards ConstructionLicense: nseC -0827isor License: CS-082716 -y.f'fs is yx GREGORY F.HU$TLEY'- '. 51 Central Street Topsfield MA 019N3. f'f 10 Expiration Commissioner 051IW2016 :��C 'Feb//uimntaCu�(�cf�G 11,;orinjr/(j . geglj"',T�e of CoosamerAffairs&Business Regulation E IMPROVEMENT CONTRACTOR Type: stration: 123815Expiration: 3114/2077 Supplement Ca- Schemecker Propedy ServicaS.Inc. - GREG HUNTLEY -. 283 Second Avenue Waltham.MA 02451 Undersecretary _ License or registration valid for individul use onty before the expiration date. If found return to:. Office of Consumer Affairs and Business Regula won • 10 Park Plaza-Suite 5170 1 Boston, A 0211 vali ith t ignature {{..e f CONTRACT This AGREEMENT is made as of the_�day of / U S in the year aOO6- Between the Owner: The Essex Condominium Trust c%Crowninshield Management Corp. 18 Crowninshield Street Peabody, Massachusetts 01960 and the Contractor: Schemecker Property Services, Inc. 283 Second Avenue Waltham, Massachusetts 02451 The Project is: Masonry Repairs& Related Work The Essex Condominium Salem, Massachusetts The Engineer is: Noblin&Associates, L. L. C. One Washington Street Suite 3050 Dover, New Hampshire 03820 i The Owner and Contractor agree as set forth below: ARTICLE 1 THE CONTRACT DOCUMENTS The Contract Documents consist of this agreement, Standard General Conditions of the Construction Contract, Supplementary General Conditions, Drawings, Specifications, Addenda issued prior to the execution of this Contract and Bid Documents, and are as fully a part of this Contract as if attached to this Agreement or repeated herein. ARTICLE 2 THE WORK 2.1 The Work shall include the Base Bid, Alternate#1, Alternate#2, Alternate#3 and Alternate#4 in Masonry Repairs&Related Work, as described in the Specification and shown on the Plans bearing the title"Masonry Repairs& Related Work" The Essex Condominium, Salem, Massachusetts".prepared by the Engineer. 2.2 The Contractor agrees to perform the Work, as described In the Specification and shown on the Plans. ARTICLE 3 DATE OF COMMENCEMENT AND FINAL COMPLETION 3.1 The date of commencement shall be the date of this Agreement, as first written above, unless a different date is stated below or provision is made for the date to be fixed in a notice to proceed issued by the Owner. 3.2 The Contractor shall achieve Final Completion of the entire Work within 180 days from the date of commencement. Page#1 of 3 ARTICLE 4 CONTRACT SUM funds for the Contractor's performance of II the Contractor in current 4.1 The Owner shall payP the Contract the Contract Sum of$372,500.00,subject to additions and deductions as provided in the Contract Documents. 4.2 Unit Prices are as follows: Description Contract Unit Quantity Price 1. Through-Wall Flashing as noted on drawings $330/LF 2. Brick Repointing 500 LF $15/LF 3. Large Hung Window $2,500/ea. 4. Small Hung Window $2,000/ea. 5. Double Inswing Door $8,000/ea. 6. Misc. Repairs $55/man hour 7. Material Mark-up 15% ARTICLE 5 PROGRESS PAYMENTS 5.1 Based upon Applications for Payment submitted to the Engineer(for review and approval) and forwarded to the Owner,the Owner shall make progress payments on account of the Contract Sum to the Contractor as provided below and elsewhere in the Contract Documents. 5.2 Each Application for Payment shall be based upon the Schedule of Values submitted by the Contractor in accordance with the Contract Documents. The Schedule of Values shall allocate the entire Contract Sum among the various portions of the Work and be prepared in such form and supported by such data to substantiate its accuracy as the Engineer may require. 5.3 Applications for Payment shall indicate the percentage of completion of each portion of the Work as of the end of the period covered by the Application for Payment. 5.4 The amount of each progress payment shall be the approved percentage of completion (less previous payments) less 10%retalnage. Payments shall be made within 30 days from the date of approval of the Application for Payment. ARTICLE 6 FINAL PAYMENT Final Payment, constituting the entire unpaid balance of the Contract Sum, shall be made by the Owner to the Contractor when (1)the Contract has been fully performed by the Contractor including the submission of all warranty related paperwork, (2) a final Application for Payment has been submitted and approved and(3) Release of Liens forms from all subcontractors and suppliers have been submitted. Page#2 of 3 � t , �y ARTICLE 7 TERMINATION OR SUSPENSION The Contract may be terminated or suspended by the Owner or Contractor as provided for in the General Conditions. This agreement is entered into as of the day and year first written above and is executed in at least three original copies of which one is to be delivered to the Contractor,one to the Engineer for use in administration of the Contract and the remainder to the Owner. ARTICLE 8 INTERIOR DAMAGE Notwithstanding any contrary provisions elsewhere In the Contract Documents, in the event of any pre-existing interior repairs which may be needed, and/or interior repairs caused by the Work which are to be reasonably expected due to the nature of the Work(for example, interior wall cracks, nail pops, etc.), any such interior repairs shall not be deemed part of the Work, but rather shall be addressed upon request of the Owner by Change Orders. The foregoing shall not apply, however,to interior repairs necessitated by the Contractor's negligence or failure to otherwise comply with the terms and conditions of the Contract Documents. The determination of whether a condition was pre-existing, such as was to be reasonably expected due to the nature of the Work or as a result of the negligence or other failure of the Contractor to comply with the terms and conditions of the Contract Documents shall be by the Engineer, whose decision shall be binding on the Owner and the Contractor. The Essex Condominium Trust Schernecker Property Services. Inc. (Signature) ( nature) y�Yrz (Printed Name and Title) (Printed Name and Title) GE Page#3 of 3 f 3 CITY OF SMMNI, 2Nv'LA.SSACHLS=S • BUILDING DEPARTJwA'T 130 WASHiNGTON STREET,3w FLOOR TEL (978) 745-9595 FAX(978) 740-9846 )O\fBFRi RY DRISCOLL MAYOR THOMAs Sr.PtFnles DIRECTOAOF PUBLIC PROPERTY/BI:ILDLNG COM!�BSSIONER Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Atiplicant Information 7 glease Print Legibly Value mui ' ationAndividual): Address. p.� City/State/Zip: ( Phone M. re pu an employer?Ch the appropriate box: Type of project(required): I. I am a employer with 4. ❑ t am a general contractor and 1 6. ❑New construction mployees(full and/or part-time).* have hired the subcontractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7.10crucideling ship and have no employees These sub-contractors have 201ro Demolition working for me in any capacity. workers'comp.insurance. 9• ❑Building addition (No workers'comp. insurance 5. ❑ We are a corporation and its required.) officers have exercised their 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.(No workers'comp. c. 1521§1(4),and we have no 12.0 Roof repairs insurance required.)t empbyecs.[No workers' 13.❑Other comp.,insumnce required.] •Any applicm that checks box el must else fill out the section below showing their workers'compensation policy infurmation. 'I Tema nss on;who submit this affidavit indicating they an:doing all work and then hire outside cont tacmn must submit a new affidavit indicting such :Cuntmeton that check this box roller atinched an additional sheet showing the come of the sob coatractnia and their workers'comp,policy inrotmatics. /am an employer that is providing workers'compensad n lnss ranee for 7employeez Below fa the policy and job site information. �. insurance Company Name: Policy#or Self-ins.Lie.#: l Expiration Date: 1obSiteAddress: 1, CAaLGc - City/State/zip: t.i'r/ .mach a copy of the workers'compensation policy declaration page(showing the polity 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 S1,500.00 and/or one-year imprisonment,as well as civil penalties is the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Ile advised that a copy of this statement may be forwarded to the Office of Investigations of t DIA for isumnce coverage verificalion. /do hereby ands h aI lid penalties of perjury that the information provided fbotir (i's'true and correct t tr Data L Phone Official use only. Do not write in this arcs,to he completed by city or town ofrciaL City or Town: Permit/l.lcense# Issuing Authority(circle one): 1. Board of Ilealth 2.Building Department 3.Cityrf own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phane#•t )