32 CHURCH ST - BUILDING INSPECTION . ,
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\i , �► ',; 1"he Commonwealth of Massachusetts
`�� � �� I.`•� yi Department of Public Safety i
A.,,;�• f \la...irhu.rtb��.i�r tiwldinti C��dr 1;'3U C�IR)k��en�h Editi.�n
• \ City of$alem I
�� Buildin Permit AP lication for an Buildin other than a 1- or 2-Famil Dwellin
IThia<rchun Fur Ufficiai Use Unlv1
ffudding Prrm�t Numbrc Datr ApFilird: Bwlding InsF�rctur:
SECTION l: LOCATION IPlease indirate Block M and ot N r locations for which a streef address is not available)
32 Ck�<-e,k s� Sa,l� ory �C,
,\'��.and titrrel Citc i T�����n ZiF�Cudr Name�I Bwlding lif applicablr)
SECTION 2: PROPOSED WO[tK
It tiew Cunstructiun check hrrc O ur chrck.ill thal av�+ly in the twu ruws brlow
Esis�ing Building❑ Repair❑ Alteratiun CY Addition❑ Drmulitiun O (Pleasr fill out and submit Appendix 1) �
ChnngeuFUse ❑ Changeu(Occupancy ❑ Other ❑ $Prcify�
Arc building plans and/ur mnstructiun documents bring supplied as part of this permit applicatiun? Yes Nu ❑
fs an Lndeprndent Stru<tural Bnginrrring Perr Rrvirw rcquired? J' Yes ❑ No�
Bri�f Dexripti��n u(P(�up��+r�1 W�rk: 1 C NLOJG Cl2..�A:10�- /J/� 4��ca e c..�^Lq,
_� w-1- ad��UC f�P� [)��� a- � �S�e�
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SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
� CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) O
Existing Use Group(s): Proposed Use Croup(s): P
. Existing Hazazd Index 780 CMR 34: Propoxd Hazard lndex 780 CMR 34:
SECTION 4:BUIL�ING NEIGHT AND AREA
Existing Propased
No.uf Fluors/Stories(indude basemrnt levels)&Area Per Floor(sq.(c.) J
Total Area(sq. ft.)and TuWI Height(ft) �0 r' � l ,
SECTION 5:USE GRUUP ICheck ae a licable) !�`�-� ��
A: Assembly A-1 ❑ A-2r ❑ A-2nc O A-3 O A-4❑ A-5❑ B: Buaineee ❑ E: Educational ❑
F: Facto P-1 ❑ P2❑ H: Hi Hazard H-1 ❑ H-2❑ H3 ❑ H-4❑ H-5❑ �
L Institutional Ll ❑ Id ❑ IJ� I-1 O M: Mercantile R: Residential R-I❑ R-2❑ R-3❑ R-4❑
5: Storage SI ❑ S2 ❑ U: Utility❑ Spe<ial Use O and please describr beluw: '�
Sf�e<ial l;'se: I
SECTION 6:CONSTRUCTfON TYPE(Check as a licablel '�.
� IA ❑ iB ❑ IIA O 116 ❑ IIIA ❑ IIIB O IV ❑ VA ❑ VB ❑ 'i
SE.(TION�:SITE INFORMATION Irefer to 780 C�1R 111A(or details on each item) '.
� � Trench Pertnit: Uebris RemovaL �
� LWter Supp�y: � Flnnd 7.one Infomtafion: Sewage Disposal:
i Pubhc :\ Irench �vill nut he Liiem�d Ui�F�u..tl tiite❑
� C hcck d�mt.idc I�Lu�d /_��nr❑ Indiaite mumnp,il
rcyuired O ur trcnch nr.pcah':
I'rn'etr❑ nrutdcnlilcZ�rnv; ��rnn.ite.t'.trm0
� . — . ��ermit i.vndu.ed O
I~'— Railroad rir�ht-of-way: I Hazards to Air\'avigation: �I:\ I li.e.n. c „��nn�..i��n I:.��i���� I'n.,,�..:
! \��i \���d�:.�blr�]^� I I.tilruiiurco�IhinoirF,��n.�F, •rn.ich.irra' I. Ihuurc�ic�cr��inF�lotcJ'
'� ��rl�,��i.rnln� l4iul.ii�ncl,1.�•J ❑ I lr.� ��r\��� 1'r.❑ \i� ❑
SECTIO.V tl:�ONTEVT OF CERTIFICAI'E OF OCCUPANCY
' I.Jiii��n �.l (���J��_'__l..cl��r��up�.c ��pc�n ����n.tru.iiun: �)ccu�,.intl��aJf�erl�l����r ___�,�
� I)���. ihrbu�IJ�n4:��ni.iin.intiE,ru�Alrr}�.lv�n` . ?F�riial>IiF�ida�inn.� .._'_ '_ __" '
i SECTION 9: PROPERTY OWNER AUTHORIZATION
\.imv and Addno-�s�ij Pruperl�� O���nrr I ,�A ,/
CRS�- LNCIPk 2 GyU�� ,S � �.�P�v✓[ /rl/i'
� 1�.imelPrinU Vu.andtitrcrt Cih�/7u�vn LiF�
Pro�.c"rtv1 �Uwnrr C'�mtact lnlurmauon: �7��
- �.� �.�I.v�a.✓i �—L�� ---
Title TrlrphonrVu. (buzmrx>) TelrF+hunrNu. Icrll) �r-maJ.iddrt•ss
I(�'���i.a,le,ihrpn�prrh�u�rn�rhrrcbvauthunzr� �/�)�G �/ � / ���
N Crn,.s �.�ctio.-� �/7 k �..ti{s/�ce. ��,,,,
Vamr �trcrl Addrr.a CitvlTo���n titote Zip
cu,iit un thr xo,rrtc���vnrr's brhall, m all m.iltrn rclaticr io u�urk.iuthunzrd bv thi:buildin � +rrmi[.i � ,liration.
SECTION t0:CONSTRUCTION CONTROL IPlease fiil out Appendis 21
Ut buildm�is k�s tlun i3.UlN1 cu.it uf rnd��vd<+aic and/or not undcr C��nstrurtion C��ntrol lhcn check herc O.�nd<Ai+kdiun fU.11
10.1 Re istered Professional Res onsible for Construction Control
IVome(Rrgistrant) Telrphone Nu. e-ma�l addre» Registntiun Number
$treet Addre>s City/Tuwn 5tate Zip Discipline Expiration Date
103 Genera)Contractor �
C��mpzny Name:l"P�'C/�Q �py���� �'q, �� S / 7 [ �� I�eS�� �U�
Name uf r un Res��mible(ur Cun�tructiun Lic nse No. nnd Type if App ica le
�C�r. s v�c�.-� YY /3�v�s�o tx,.,o�s a�42 3
Street Ad ress Ci[y/Town Stat Zip
�I7`6��- ��££� %Z�� 6(o8z/ ('�il�S/��r.�Cc�rl� .U-Q
Tele hone No.(business) Tete hone No.(cell) � e-mail address
SECTION 11:WORKERS'COhII'ENSATION INSURANCE AFF[DAViT(M.G.L.c. 152. 25C(6))
A Wnrkers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this npplica[ion. Failure to provide this affidavit will resul[in !he denial of the issuance of the building permit.
Is a si ned Affidavit submit[ed with this a lication7 Yee❑ Na ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Estimated Costs(Labor /
Irem and Matcrials) Total Construction Cost(from Item 6) =S J �o
l. Building $ Building Permit Fee=Total Construction Cost x_(lnsert here
2. Electrical 5 appropriate municipal facror)=E �
3. Plumbing S
4. Mechanical (HVAC) S Note:Minimum fee=$ (mntact municipality)
5. Mechanical (Other) S Endose check pay.ible to
6. TnWI Cnst S y J�JJ (contact municipality)and write check number herr
SECTION 13:SIGNATURE OF BUILDINC PHRMIT APPLICANT
Bq entennh mV n.�me bdnw, I herrbv.itte>t under the paim and �rnalties n � rjury that aii nf the in(urm.itiun cnntained in this
.iF�plic.�liun i. trur,�nd,uc irate h�the be>I�d my knu 'rd � n i .indinh.
�r, 6 � P �d�_, � �?gs�Yz �9gs 6 �/�z�
i I'Ica.r pr�i .���iy;n �.sii}^��� , I �I �idr / � �rlcF�hune \�i. U.ric
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[ + fT- --- s=E
� �Irrct .\d.irc.. C�rtc T�n �n � . t.itr liF+
ii�
� �1uni:ipal Insprclor Io fi�l out Ihis sectimi upon appli<atiun approvaL --��Z 1
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� ' � CITY OF S.-1LEltii, i�'I.�SSr1CHUSETTS
$L'II.DL�1G DEP�R'TJ�'1JT
• ' k• i 20 W.�SHINGTON S'[REET,3"FLOOR
`� � "I�L (97� 745-9595
F,�c(978j 740-9&1d
[��,igFR�FY DItISCOLL
MAYOR TrioafAS ST.P�RRB
DtRECTOA OF PI:BLlC PROPERTY/HL'IIDLNG C4bLtiQ5StONER
. ._ . .__.___.. ,.....
Workers' Compensation Insurance A�davit: Builders/ContractorslElectrictans/Plumbers
.4 licant Infarmation P! ase Prfnt Le ibl
VaiT1C(Busim�OrganiZatioNlrWividualj: r �
Address: � �
City/State/Zip: ��.�3-m /"L fi' ��� 70 Phone N: � 2 1 l ��r'
,�you xn emplayer?Cheek[he approprfate bot: Type uf projcct(require�:
1. 1 am u employer with 4 � 1 am a�eneral contiaetor and I
�+ have hircd the sulse:ontractors 6. ❑New eonstxuctian
employees(full andlor paM-time).
2.0 1 am a sole proprietor or paimoo- tisted on[he attached s}teeL� �• ❑Remodeling
ship and have no employeex These subcontractocs have 8. ❑Demoli[ion
warkin for me in an ca acit , worket�'comp.insutance.
K Y P Y 9. ❑Building addition
(No workers'comp. insurance 5• D We are a corpocation and its
required.]
o�cers have ezerci�ed their ���� ���Mcat repairs or additions
3.� 1 am a homcuwner doing all work right of exempiion per MGL (!.Q Plumbing repairs or additions
myyelE[No workers'comp, c. 152,§I(4),and we hssve no �2.[] Roof rcpaiss
insurance required.J t cmptoycex.[ivo workers' 13.(]Othcr
eomp. insurance required.]
'h^Y�P1icaM ihuf cha.�ka box kl mucf aiso Rll.nd Ihe scctim bclww slwwing thcir workus'compenaaaion puliry inCucma[iqa ..
�liomeown�.�s who submit Ihis afYWarrt indica[ing they ue doing nll woric and tha hirc mnaide qpn�m�Rors must au6mit a tmw a(fiJavii indimting uucli
=C�mtrmxan IMI eM.e@ thia Eux munt atlachrd an:uldi�ia�l chsl shoaing ihe nvne of fhe rub-eoMracbn and their workera'comp.pa4iry infiumntion.
/um un emp/oyer lhat is pmviding>vorkers'comp¢nsa�lon tnsvra»cefor my empluyers. Beluw Is the pollcy and fab slte
injarmu�inn. s{ /
Inwmnce Company Vame: e P��.I LL�� ,,, _ __
{'oliay!F ur Self-icu.Lic.3l:_`P� J L���,g�� ���2��xpi�ati �Da�z � l� `
Job Si[e Ad�iress: � Z �"{G� � � CitylState/Zip: ����L
Attac6 s eopy of the workers'compensatioa policy dectaretloa page(showing the policy aumber aad explrallon date).
Failure to secure cove�age�.s required unJer Sec�ion 25A of�1GL c. t 52 can lead to the imposition of criminal penaltiea of s
finc up ro S I,i00.00 and/or one-year imprisonmen4�Weli as civil penalties in the form uf n STOP WORK ORDER and a fine
of up to 5250.00 a day against the violaror. Be advi..ed that a copy of this statement mny 6�: forwardnd to the Office of
invcsli�tions uf the DIA for i�vsurance mverage veriYicatiun.
/do/reieby certijy r h r pe tes ju ut the injormutlon provided abuv is trae a� cor'ret
Dat : 2-- 1
P on #: 7 � � , g -
O�cral uxe only. Do�io!write in Ih1s uren,!o be cu�xpleted by eiry ur mwa o�ciat
City or Town: PermiUi.Scense#
Issuing.lulhority(circle one): '
i. tivard oC Health 2.Building Dep•rrtment 3.Cityffown Clerk s.Electrical [nsptctor 5. Ptumbing Inspecmr
6.O�her
Contact Pcrson• . _ Phone#:
�e.- - .__-_. _. ........_ _...._...._...... ._____. . .._..
� _ ___`^-^._.,..�.�_ .__....�_�_.,,..�,.,,..m�_.�...._,w_..�m_ . .
i CITY OF S��LE;�I, i�'I.�SS.-�CF-IUS]ETI'S �'
BLu.n�sG Der.�aTCE.vr
• �N• 1?O W 1SH�GTON STREEC, 3'�PY.00R II
� '�"'D'� 'i'EL (978) 7i5-9595 II
FAX(978) 7A0-984b �
KI�iBERLEY DRISCdLL
MAYOR 'I7aonus Sr.P�xns ,
DIRECTOR OF PCBLIG PROPER7Y/HL'II.DQ�IG COJL�tISS[ODiER I
Construction Debris Disposal Afffdavit III,
(required for all demolition and renovation work) i
In accordance with the sixth edition of the State Building Code, 7S0 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # is issued wiih the condition that the debris resulting &om '
this work shali be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by: '
T �i �-X._ � ,�+z��i7'�N�
(name of hauler)
The debris will be disposed of in :
��
SC�j�M. � ✓'.c�n..,S
(name of facility)
/�"tarl bcX2� ��
(address of facility)
signahue of permit applican[
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� : �i�e��. :a ui tngReg'�ula'fiZons a`�an�c�a���
One Ashburton Place - Room 1301
��" Bostori. Massachusetts 021U8
H�me lmprovemenS Contractor Registration
� �Repisiration_ 153299
TVPe: �Private Gwporation
_. .;
E�cpiration: 11114/2010 Trk 276829
PRtDE CONSTRUCTION AND DEbELOPM. ` - -
, " ; �
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CHRIS70PHER YOGUM � - -- -
_. __..
471 HIGHLAND P.VE , _
,_ .. _. _
SALEM, MA 01970' -;
� Urydate AdAress and rettirn card.Ivlark reason forchange. I
' � � '�'"" •Em lo ment - <.Lost-Card �
.. Addrcss� - Renewn( V Y .
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� NOA9E iPlIPRl3VEMENT CONTRACTOH � . G:,fore the espirxtion dele. lf found remrn tai
- � � - � � 8uard of Building Regulstions nnd Slandards
Iteg�str��on 153299� One..4shburton Pl�ce Rm 1301 . � � .
, . ExPvaLon%-,ti9/14/�090. � Tr# 27fiC29 Bostnn.Mta.02d08 .
- Yype• PjrvaleGorporataon . ' � -
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13'M' BIJILT IN GJBIGLE �BI1LK DI9
FRIDGEF�EZER W����� 1
'm'"'' ARGHITEGtB LLC
�,o� � 32 CHURCH ST.
�s SALEM MA m19�0
9't8 -'{44 - 8982
�Z�fRST FLOOR PL�4N -
A�A SGALE: I/8" = i'_(d" � _ � �
EAST INDIA GROUP, LLC 1 June 2010
32 Church Street
Salein, MA 01970
Buildin Owners Standard Lease:
1. Parries East India Group, LCC, Salem, MA 01970. Lessor/Landlord, which expression
shall include its heirs, successors, and assigns where the context so admits, does hereby lease to: Milk
and Honey, owned and operated by Shazon Driscoii, 9 Barr Street, Salem, MA OT970
shazon.driscoll(a?�comcast.net.
2. Premises Lessee,which expression shall include it's successors, executors, adminisirators,
_ and assigns were the context so adinits, and the Lessee hereby leases the following described `
premises: Consisting of the first floor left front open office azea,back conference room and
storage room, approximately (1,200 squaze feet) in the building known as 32 Church Street,
Salem, MA 01970. '
3. Term The term of this lease shall be for Three ( 3 ) Yeazs. Commencing on
(1 June 2010) and expiring on(31 May 2013).
4. Rent The Tenant shall pay to the Landlord at or to such other person or entity and at
such other place as the Landlord may by notice in writing to the Tenant from time to time direct,
without prior demand or deduction of any nature whatsoever, Basic Rent at the following rates,
to be paid in monthly (as follows) which shall be due on the fust(lst) of each month during
the term without any further invoice from the Landlord beyond this Lease:
LEASE YEAR MONTHLY
OS/O1/2010 to 04/30/2011 $1,600.00
OS/O1/2011 to 04/30/2012 $1,700.00
08/01/2012 to 04/30/2013 $1,800.00
If any payment of basic rent is not paid to the Landlord when due,then if such
amount is not paid by the Tenant within fourteen (14) days to the Landlord, the Tenant,in
addition to all other remedies hereunder, sha11 pay upon demand to the Landlord, as Additional
Rent, interest thereon at an annual rate equal to eighteen percent (I 8%), such interest to be
computed from the date such Basic Rent was originally due through the date when paid in full.
Page I of 8
�
5. Security
Deposit Not applicable.
6. Rent
Adjustment See item #4.
7. Utilities The Landlord shall pay, as they become due, all biils and electricity (whether they
aze used for fumishing heat or other purposes) that aze fumished to the leased premises and all
bills for fuel furnished to the leased premises. The Landlord agrees to provide all other utility
service and to furnish reasonably hot and cold water and reasonable heat(except to the extent
that the same aze furnished tt�rou�h metered utilities to the leased premises), the hallways,
stairways, and lavatories during normal business hours on regular business days of the heating
seasons of each year, and to light passageways and stairways during business hours, and to
' furnish such cleaning service as is customary conducted in the buildings common azea, all
subject service interruption due to any accident,to the making of repairs, alterations,
unprovements,to labor difficulties, to trouble obtaining fuel, electricity, service or supplies from
the sources they are usually obtained for said building, or to any cause beyond the Landlord
control).
Landlord shall have no obligation to provide utilities or equipment other than the
utilities and equipment within the premises as of the commencement of the lease. In the event
Lessee requires additional utilities or equipment,the installation and maintenance thereof shall
be the Lessee's sole obligation,provided that such installation shall be subject to written consent
of the Lessor.
8_ Use of Leased
Premises The Lessee shall use the premises only for the purpose of: Business Use
As defined by Massachusetts State Building Code, CMR 780 , approved City of Salem
' Massachusetts and by the Landlord.
9. Compliance
With Laws The Lessee acknowledges that no trade or occupation shali be conducted in the
leased premises or use made thereof which will be unlawful, improper, noisy or offensive, or
contrary to any law or municipal by-law or ordinance in force in the city or town in which the
premises aze situated.
10. Fire Insurance The Lessee shall not permit any use of the leased premises which will make
voidable any insurance on the property of which the leased premises are a part, or on the
contents of said property or which shall be contrary to any law or regulation from time to time
established by the New England Fire Insurance Rating Association, or any similar body
succeeding to its powers. The Lessee shall on demand reimburse the Lessor, and all other
tenants, all extra insurance premiums caused by the Lessee's use of the premises.
Page 2 of 8
I` - -
11. Maintenance
A. Lessee's
Obligations The Lessee agrees to maintain the leased premises in good condition, damage by
fires and any other casualty only excepted, acknowledges that the leased premises aze now in
good order and the glass whole. The Lessee shall not permit the leased premises to be
overloaded, damaged, stripped, or defaced, nor suffer any waste. Lessee shall obtain written
consent of Lessor before erecting any sign on the premises.
B. Lessor's
Obligations The Lessor agrees to maintain the structure of the building in which the leased
premises aze a part in the same conditions as it is at the commencement of the term or as it may
be put in during the term of this lease, reasonable to weaz and tear, damage by fire and other
_ casualty only expected, unless such maintenance is required because of the Lessee or those who
shall conduct the Lessee is legally responsible.
12. Alterations/
Additions The Lessee shall not make structural alterations or additions to the lease premises,
but may make non-structural alterations provide the Lessor consents thereto in writing, which
consent shall not be unreasonably withheld or delayed. All such allowed alterations shall be at
Lessee's expense and shall be in quality at least equal to the present construction. Lessee shall
not permit any mechanics'-liens, or similaz liens, to remain upon the premises for labor and
material fumished to the Lessee or claimed to have been performed at the direction of Lessee and
shall cause any lien to be released of record forewith without cost to the Lessor. Any altera6ons
or improvements made by the Lessee shall become the property of the Lessor at the termination
of occupancy as provided herein.
13. Assignment/
Subleasing The Lessee shall not assign or sublet the whole or any part of the leased premises
without Lessor's prior written consent. Notwithstanding such consent, Lessee shall remain liable
to Lessor for the payment of all rent and for the full performance of the covenants and conditions
of this lease.
14. Subordination The lease shall be subject to and subordinate to any and all mortgages, deeds of
trust and any other insh•mnents in the nature of the mortgage, now or at any time hereafter, a lien
on the property of which the leased premises are a part and the Lessee shall, when requested,
promptly execute and deliver such written instruments as shall be necessary to show the
subordination of this lease to said mortgages, deeds of trust or other such interments in the nature
of a mortgage.
Page 3 of 8
Recognizing that Landlord may find it necessary to establish to third parties, such
as accountants, banks, mortgagers, or the like, the then current status of performance by Lessee
under this lease, Lessee, on the written request of Lessor made from time to rime, shall promptly
furnish a written statement that the lease is in full force and effect and is unmodified except as
otherwise stated; that Lessee has accepted possession of the premises and that all improvements
required by the terms of the lease to be made by Lessor have been completed to the satisfaction
of Lessee; that no rent under the lease has been paid more than 30 days in advance of its due
date; and that Lessee has no chazge, lien, or claim of offset under the Lease or otherwise, against
rents or other charges due or to become due hereunder. Such statement shall be fumished within
ten( 10 ) business days after a request has been made for same.
15. Lessor's Access The Lessor or the agent of the Lessor may, at reasonable times after at least 24
hours oral notice and at any time without notice in the event of an emergency, enter to view the
leased premises and may remove any placards and signs not approved and affixed as herein
- provided, and make repairs and alterations as Lessor should elect to do and may show the leased
premises to others, and at any time within two (2) months before the expiration of the term, may
�x to any suitable part of the leased premises a notice for letting or selling the leased premises
_ or properiy of which the premises are a part and keep the same so affixed without hindrance or
molestation.
16. Indemnification
And Liability The Lessee shall save the Lessor hannless from all loss and damage occasioned
by the use or escape of water or by the bursting of pipes, as weli as from any claim or damage
iesulting from neglect in not removing snow and ice from the roof of the building or from the
sidewallcs bordering upon the premises so leased, or by any nuisance made or suffered on the
leased premises, unless such loss is caused by the gross and persistent neglect of the Lessor.
Lessee shall also indemnify Lessor for all claims with respect to the leased premises, which are
not a result of Lessor's gross negligence or willful misconduct including costs and attomey's fees.
The removal of snow and ice from the sidewalks bordering upon the premises shall be Lessor's
responsibility.
17. Lessee's Liability
Insurance The Lessee shall maintain with respect to the leased premises and the property of
wluch the leased premises aze a part comprehensive public liability insurance in the amount of
$1,000,000.00 with property damage insurance in limits of $1,000,000.00 in responsible
companies qualified to do business in Massachusetts and in good standing therein insuring the
Lessor as well as the Lessee against injury to persons or damage to property as provided. The
Lessee shall deposit with the Lessor certificates for such insurance at or prior to the
commencement or the term, and thereafter within thirty (30) days prior to the expiration of any
sucl�policies. All such insurance certificates shall provide that such policies shall not be
canceled without at least ten (10) days prior written notice to each insured named therein. Lessor
shall be named as additional insured as its interests may appeaz in any insurance policies
required to be maintained by Lessee hereunder.
Page 4 of 8
18. Fire, Casnalty,
Eminent Domain Should a substantial portion of the leased premises, or the property of which they
are a part, be substantially damaged by fire or other casualty, or be taken by eminent domain, the
Lessor may elect to terminate this lease. Substantially damaged "shall mean" damage of such a
chazacter that the same, in Lessor's judgment cannot, in ordinary course, reasonably be expected
to be repaired within 120 days from the repair work would commence. If fire, casualty, or taking
renders the leased premises substantially unsuitable for their unintended use, a just proportionate
abatement of rent shall be made, and the Lessee may elect to terminate this lease if:
(a) The Lessor failed to give written notice within thirty (30) days of intention
to restore leased premises.
(b) The Lessor fails to restore the leased premises to a condition substantially
- suitable for their intended use within ninety(90) days of said fire,
casualty, or taking.
_ The Lessor reserves, and the Lessee grants to the Lessor, ali rights which the
Lessee may have for damages or injury to the leased premises for any taking by eminent domain,
except for damage to the Lessee's fixtures, property, or equipment.
Tenant shall not be entitled to withhold or abate its rent and Landlord shall not be
liable for damage or for loss suffered by the business or occupation of Tenant arising from any
act or neglect of co-Tenant's or other occupants of the building (or of their employees) or of
other persons, or from earthquake, windstorxn, water, fire, leaking roof, leaking windows, boiler
explosion, steam, sewerage, illuminating gas, sewer, gas or odors or by the bursting or leaking of
water, gas, sewer or steam pipes, or plumbing or electrical works, electric wires, overflowing of
water, or any other kind of casualty by equipment or appliances, or cause in any other manner
whatsoever.
19. Default and
Bankruptcy In the event that:
(a) The Lessee shall default in the payment of any insta(lment of rent or other
sum herein specified and such default shall continue for ten (10) days after written
notice thereof; or thirty (30) days ftom rent due date without written notice.
(b) The Lessee shall default in the observance or performance of any other of
the Lessee's covenants, agreements, or obligations hereunder and such default
shall not be corrected within thirty (30) days after written notice therein.
(c) The Lessee shall be declazed bankrupt or insolvent according to the law,
or, if any assignment shall be made of Lessee's property for the benefii of the
creditors, then the Lessor shall have the right thereafter, while such default
continues, to reenter and take complete possession of the leased premises,to
declaze the term of this lease ended, and remove the Lessee's effects, without
prejudice to any remedies which might be otherwise used for arreazs or rent or
' Page 5 of 8
other default. In the event of a default,Lessor shal] be entitled to accelerate all
amounts due under the lease from the date of said default through the expiration
of the term. Such amounts shall be immediately due and payable by Lessee.
(d) In case this Lease is terminated due to an Event of Default, Lessor may (i)
re-let the leased premises or any part or parts thereof, either in the name of
Landlord or otherwise, for a term or terms which may at Lessor's option be equal
to or less than or exceed the period which would otherwise have constituted the
balance of the term of ttus lease and may grant concessions or free rent to the
extent that the Lessor considers advisable and necessazy to re-let the same and (ii)
may make such reasonable alterations, repairs and decorations in the leased
premises as Lessor in its sole judgment considers advisable and necessary for the
purpose of re-letting the premises; in such re-letting or the making of such
_ alterations, repairs and decorations shall not operate or be construed to release
Lessee from liability hereundcr as aforesaid. Lessor shall in no event be liable in
any way whatsoever for failure to re-let the leased premises, or in the event that
the premises are re-let for failure to collect the rent under such re-letting. Lessee
hereby expressly waives any and all rights of redemption granted by or under any
present or future laws in the event of Lessee being evicted or dispossessed, or in
the event of Lessor obtaining possession of the premises, by reason of the
violation by Lessee of any of the covenants and conditions of this lease.
(e) Lessee shall indemnify the Lessor against all loss of rent and other
payments,which the Lessor may incur by reason of such termination during the
residue of the term. If the Lessee shall default, after reasonable notice thereof, in
the observance of the performance of any conditions or covenants on Lessee's part
to be observed and performed under or by viriue of any of the provisions in any
article of this lease including, failure to vacate upon termination of this lease, the
Lessor, without being under any obligation to do so and without thereby waiving
such default, may remedy such default for the account and at the expense of the
Lessee. If the Lessor makes any expenditures or incurs any obligations for the
payment of money in connection therewith, including but not limited to,
reasonable attomey's fees in instituting, prosecuting or defending any action or
proceeding, such sums paid or obligations insured, with interest at the rate of 18%
per cent annum and costs, shall be paid to the Lessor by the Lessee as additional
rent. Any default by Lessor under this lease shall not be considered a default
unless Lessor has received 30 days written notice by Lessee.
Page 6 of 8
20. Notice Any notice &om the Lessor to the Lessee relating to the leased premises or to the
occupancy thereof, shall be deemed duly served, if mailed to Vernon Martin, 32 Church Street,
Salem, Massachusetts 01970 registered or certified mail, retum receipt requested, postage
prepaid, addressed to the Lessee. Any notice from the Lessee to the Lessor relating to the leased
premises or to the occupancy thereof, shall be deemed duly served, if mailed to the Lessor by
registered or certified mail, retum receipt requested, postage prepaid, addressed to the Lessor at
such address that the Lessor may from time to time advi'se in writing. Ali rent notices shall be
paid and sent to the Lessor at 32 Church Street, Salem, Massachusetts 01970.
21. Surrender The Lessee shall at the expiration or other termination of this lease shall remode
all Lessee's goods and effects from the leased premises (including, without hereby limiting the
generality of the foregoing, all signs and lettering affixed or painted by the Lessee, wither inside
' or outside of the leased premises). Lessee sha11 deliver to the Lessor the leased premises and ali
keys, locks thereto, and other fixtures connected therewith and all alterations and additions made
to or upon the leased premises, in good condition, damage by fire or other casualty excepted. In
the event of the Lessee's failure to remove any of the Lessee's properiy from the premises, Lessor
is hereby authorized, without liability to Lessee for loss or damage thereto, and at the sole risk of
Lessee, to remove and store any of the property at the Lessee's expense, or to retain same under
Lessor's control or to sell at pubiic or private sale, without notice any or all of the properiy not so
removed and to apply the net proceeds of such sale to the payment of any sum due hereunder, or
to destroy such property.
22. Brokerage No broker involved.
23. Recourse
Against Landlord Landlord shall be liable under this Lease only while owner of the premises and if
Landlord shall be one or more persons a¢ting in a trustee or other fiduciarycapacity, Landlord's
obligations hereunder shall not be binding upon such fiduciaries individually nor upon any
beneficiary or shareholder for whom such fiduciazies act, but shall be binding only upon a
fiduciary as fiduciary and upon his trust estate. There shall be no personal liability of Landlord
or any general or limited partner of Landlord as to any of Landlord's obligations hereunder, and
in the event of a default by Landlord, Tenant shall look solely to the equity of Landlord in the
premises for satisfaction of Tenants claims.
24. Other Provisions Not Applicable
Page 7 of 8
Executed under this seal �`� day of `��` �� � , 2�l G
Landlord:
EAST INDEA GROUP, LLC
32 Church Street, Salem, Massachusetts 01907
Property Man er uthorized Agent (s)
h� �/�%���
Peter F. i an, and not individualiy, managing on behalf of East India Group
Tenant:
Sharon Driscoli
/�
gY: ,������-- 't,ts��r�1
Page 8 of 8
, `
AIA Document A105
Standard Form of Agreement
�etween Owner and Contractor
for a Small Project
where the Basis ofPayment is a STIPULATED SUM
1993 SMALL PROJECTS EDITION
Because this document has lmportant Legal conseguences, we encourage you to consult with an
attorney before signing it. Some states mandate a cancella[ion period or reyuire other specific
disclosures, including warnings for home improvemen[contracts, when a document such as thrs
will be used for Work on the Owner's personal residence. Your attorney should insert all
language required by state or local daw ta be included in thrs Agreemenl. Such statements may be
entered in the space provided below, or ifreguired by law, above the signatures af the parties.
This AGREEMENT is made this 10'�June, 207 0:
BETWEEN the Owner:
Sharon Driscoll&
William Driscoll
9 Barr St
Salem,MA 01970
and the Contractor:
Pride Construction and Development,Inc.
471 Highland Ave.
Salem,MA 01970
for the following Project:
Milk and Honey Grocer
32 Church St.
Salem,MA 01970
The Architect is �
Pitman and Wardley Architects,
LLC.
32 Church St.
Salem,MA 01970
The Owner and Contractor agree as follows:
�Copyright 1993 by The American InstitWe of Architects, 1735 New York Avenue,N.W., Washingtoq QC. 20006-5292. ReOroduction of the ma[erial herein or substantial
qnotation of its pravisions without ihe wolten pennission ofihe AIA violales ihe copyri6ht laws ofthe United States and will subject the violator to legal prosecution.
AIA DOCUMENT AI05. OWNER-CONTRACTOR AGREEMENT-SMALL PROIF.CTS EDITION.
• AIA" . QI993 . THB AMERICAN MSTITUTE OF ARCHITEQS, I]35 NEW YORK nveHUE N.w.. 1
WwSHINGTON.DL 2iuwr-53n. WARNING:Unlittnsed OM1olotopying viol3t¢S U.$. fOpy�isht 13w5 a 105-1993 1
and will subject the violaror ro legal pmsecution.
. ' THECONTRACT DOCUMENTS
The Contractor shall complete the Work described in the Contract Documents for the project The Contract Documcnts consist of:
.l this Agreement signed by[he Owner and Contractor.
.2 AIA Document AZOS,General Conditions of the Contract for the Construction of a Small Project,Current Edi[ion;
i .3 the Drawings and Specificatiuus prepared by the Architecf,dated through revision of'June 4,2010 �
and enumerated as follows:
Drawings:
A-IA
Specifications: As included on above plans,Tenant build-out.
.4 addenda prepared by the Architect as follows:
N/A
.5 writcen change orders or orders for minor changes in the Work issued after execution of this Agreement;and
.6 other documents, if any, identified as follows:
AIA DOCUMENT AIO$. OWNHR-CONTRACTOR AGREEMGNT-SMALL PROIECI'S
EDITION.AIA". 1Q1991.1'HE AMERICAN INSTITUTE OF ARCHITECTS.1"135 NC W YORK
AVENUE.N.W.,WASHINGTON,D.0 IDOW-S193� WARNING:Onlittn5etl pM1obropying VIOIeI¢5 A�OS-�99.;2
U.S.copyrigh[laxs and will subjecC the violator�o legal prosecufion.
. • ARTICLE 2
DATE OF COMMENCEMENT AND SUBSTANTIAL COMPLETION DATE
The date of commencement shall be the date of this Agrecment unless othenvise indicated below. The Contractor shall substantially
complete the Work not later than 6wks subject to adjustmcnt by Change Order.
(fnser((he da(e ar nuneAer n%calendm days'ofie*(he dale ofcommencemeni)
TBD Upon receipt of building permits 2 week duration. Contractor is not responsible for delays
due to changes by governing official's owner or landlord.
ARTICLE 3
CONTRACT SUM
3.1 Subject to addi[ions and deductions by Change Order,the Contract Sum is:
Fifty Four Thousand Seven Dollars($54,007.00)
3Z For purposes of payment,thc Contract Sum includes[he following values related to portions of the Work:
Per attached breakdown "Exhibit A" Scope of Work(dated June 10,2010)
3.3 The Contract Sum shall include all items and services necessary Por fhe proper exccu[ion and completion oPthe Work.
AIA DOCUMENT AI05. ON'NER-CONTRACTOft AGREEMENT-SMALL PROIEQS HDITION.
AIA".(�1991 . THE AMFRIfAN INSTITUTE OP A2CHITECTS, iD5 NeW YOftK AVENUE,N W., A�05-�993 3
WASHWGTON,D.C.30006-5293.WARNING: Unlicensad photocopying viola[es U.S.copyright
laws antl will subjec[tha violatorto legal proseeu[ion.
� ' ARTICLE 4
PAYMENT
4.1 6ased on Contractor's Applications for Payment submitted to the Architec[by the Contractor and Certificates for Payment issued
by the Architect,the Owner shall make progress payments on account of the Contract Sum to the Contractor,as provided below and
elsewhcre in the Contrac[Documents. The period covered by each Application for Payment shall be seven (7)calendar days ending
on the last day ofthe week,or as follows:
30% Upon signing of contract,as a deposit
30% At past of rough plumbing and electrical inspec[ion
30% At 100%completion of projec[and prior[o Store Opening
10% Retainage, upon completion of all Punch-List items and hand-in of Certifcate of Occupancy (Punch-List to be
supplied within ten(10)days).
Each Application tor Payment shall be accompanied by the appropria[e Lien Waiver from[he Contractor.
4.2 Payments due and unpaid under the Contract Documents shall bear interest tinm the date paymcnt is due at thc ra[e of
NA,or in the absence thereof,at the legal rate prevailing at fhe place ot`the Project�.
(Dsury law.c and regviremen(s under(he[�cdera7 Zrulh In l.ending AG, s(milar state and[nca[rnnsumer credf[laws and rnhnr regedalians ol tive Owner;c ond i_bnrracmr's
principal plocea'ofbusinG'.v.U�a localion nf(hn Prpjecl and al.vmvhere rnuv�iat/he vnL�Gty n/'Uvs provLVlo��.J
ARTICLE 5
INSURANCE
5.1 The Contractor shall provide Con[ractor's Liability and other Insurance as follows:
([nserl spec fc insveroncc reguired by(he CTvner.J
Cemfiwte of tnsuranoe showing Genernl LiabiHty and Worku's ComOensation covera6e and such insurance as may
be required by owner's lease,naming South Slwre wok,inc.DBA eourbon St.Cafe as certifica�e holder and naming
the Landlord as additional insured.
5.2 The Owner shall provide Owner's Liability and Owner's Property Insurance as follows:
(7nser(specifia insurance fumi.ahed Ay Ihe Ovnver.J
N/A
5.3 The Contractor shall obtain an endorsement to its general liability insurance policy to cover the Contractor's obligations undcr Paragraph
3.72 of AIA Document A205,General Conditions of the Contract for Construction of Small Projects.
� 5.4 Certificates of insurance shall be provided by e""�,"-^^��� General Contractor showing[heir respective coverage's prior to
commencement of the Work.
AIA DOCUMENT A705. OWIVER-CONTRACTOR AGREEMENT-SMALL PROJECTS EDITION.
AIA . n1993 . THE AMERICAN INSTITU'CE OF ARCHITECTS, 7735 NEW YORK
AVEHUE.N W..\VASHINGTON.�.C.3qpl�$$93.WARNING:Ilnli[[nxtl yM1o�IXop��^p,VIOIBICS U.S.CO�I}'�Ig�II
laws and will subject the violaror to legal prosecution.
A105-1993 4
• ' ARTICLE 6
OTHER TERMS AND CONDITIONS
(lnsar!any ather lerm.r oraondi(ion.v belnw.f
This Agreemen[entered into as of the day and year first written above.
(1(rey¢ired by/aw,!na'ert cance/(atlon perlod,d/.vc[nsure.v nr alher warning.r(afeneentv ahove/he slgmm�res) �
OWNER CONTRACTOR
Sharon and William Driscoll Pride Construction and Development, Inc.
Milk and Honey
���� ��V — '
(Sign
� � / (SignatureJ
(SignatureJ
(printed name, iltle and addressJ
(Prtnted na�ne,tiRe and addressJ �,'}1T1St0]JIleT 1'OCL1T11�
Sharon Driscoll President
William Driscoll 471 Highland Ave
9 Barr Street Salem, lV1A 01970
Salem, MA 01970
LICENSE NO.
NRISDICTION
z�y��r�����n��� AUTTON: You should sian an original AIA documei�it which has this caut�on �rinted in re�d. An
^������3 � riQinal assures that changes wiJ� not be obseured as may occur when documents are reproduced. See
2 �� � ns�raction Sheet for Limrted Lieense fbr Reproduetion of this doemnent.
1"�i�t��, ��
�� =�in����
AIA DOCUMENT A705. OWNER-CONTRACTOR AGREEMENT-SMALL PROJECTS EDITION
AIA 199J � THE AMERICAN INSTITUTE OF ARCHITECTS. 1'IJS NEW VORK AVENUE, N W,
wnSHINGroN,D.C.20005-5292 . WARNING: Unlicensed phorocopying violatcs U.S. A105-1993 5
copyright laws and will subjec[[he viola[or[o legal prosecution.
L
Pride Construction and Development, Inc.
471 Highland Avenue, Salem, MA 01970
Phone: (978)542-1988 Fax: (978)542-1989
Scope of Work:
7ob: Milk and Honey Grocer Date: June 10, 2010
Location: 32 Church St., Salem, MA 01970 Time:
Firm: Pitman& Wardley Prepared By: Shawn
Address: 32 Church St., Salem, MA 01970 Approved By:
Type of Work Fit-Out Phone #: 978-745-0414
Work Included Amount of Bid
Demo- Includes removal of all existing carpet flooring, two (2) front entrance doors, and
ceiling tiles. Price includes removal and dis osal of all debris. $1,850.00
Concrete Cutting- Includes all necessary saw cutting of existing concrete floor required
to facilitate new tenants fit-out(i.e. plumbing drains). Price includes cutting of floor,
rempval of existing concrete, back filling, and re-pouring of new concrete. (Allowance
for up to lO lineal feet) $1,200.00
Framing and Drywall- Includes framing over existing door between front of house and
back of house scheduled to relocated. Framing in of new door in proposed location in
F.O.H and B.O.H partition wall. Construction of new knee wall required to facilitate new
granite counter top. Price includes labor and materials required for hanging, taping, Included in
mudding, and sanding to level 4 finish of new GWB. Carpentry
Ceiling- Includes re-use of existing ceiling.
NA
Granite Countertops- Indudes installation of new granite counter top at cash wrap azea
(approx. 35 sq. ft.). New countertop to be 2" thick granite, sealed, and buffed to shine.
Price includes labor and materials required for the templating, fabricating, and
installation of new countertop. Color TBD. Price based on allowance. $4,500.00
Carpentry- Inciudes construction of built-in cubicles and bulk display (approx. 13'x5')
with rough sawn cedar. Installation of new rough sawn cedar panels on newly framed
cash wrap knee wall (sections approx. 5'x2' & 10'x2' and up to 42' w/2 shelves).
Installation of new crown molding above divider wall ($2.00/ lineal foot allowance). $6,800.00
Painting- Includes painting of existing interior partition walls, ceiling grid, and staining
of all new rough sawn cedar panels. Price includes one (1) coat prime, two (2) finish of
Benjamin Moore paint. Colors of paint and stain TBD. Note: Price includes new EPA
regulation. ' $2,350.00
Interior poors- Includes installation of one (lj new commercial grade interiar door with
hardware, and steel (knock down) frames between sales area and restrooms and
installation of one (1) Eliason (double �wing) kitchen doar between F.O.H and B.O.H.
Price includes an $600 per interior door allowance (total of 1) and a $1200 eliason door
allowance (1 for kitchen entrance). $2,300.00
Entrance Door- Includes installation of two (2) new commercial grade storefront doors
with (glass) lites and hardware. Price includes a $1,500 allowance per door with
hazdware. Price includes labor and materials. $3,400.00
• � 1
Plumbing- Includes all plumbing supply and drain lines (as per code) required to
facilitate new tenants fit-out, installation of new wall mounted Insta-hot water heater
(located in B.O.H, to feed new sink). Price includes new sink, fixtures, Insta-hot water
heater, and all connection. Price includes labor an materials. $2,600.00
Electricai- Includes all electricai wiring required to facilitate new tenants fit-out (as per
code), moving of existing electrical panel to office area, and upgrading of electrical
service required to facilitate installation of new walk-in unit. Instailation of six (6) new
industrial look pendant li�hts in sales area and up to four recessed can lights in B.O.H
area. Relocating of IT cable to B.O.H. area. Installation of four (4) new ceiling mounted
speakers (price based on $100.00 per speaker allowance). Price includes labar and �
materials. Note: price is an estimate based on proposed equipment list. Actual price to be
determined upon receipt of finalized equipment schedule and specification sheets.
Pendant allowance to be $200.00/ea. Price inciudes upgrading existing life and safety
fixtures. $12,000.00
HVAC- Includes re-use of entire existing HVAC system including thermostats.
Equipment- Pending
TBD
Flooring- Includes installation of new bamboo flooring through-out entire space. New
flooring to be pre-finished. Price includes all labor and materials (including padded
underlayment). Price includes a $4 per square foot allowance on materials. Includes
major prep and leveling of existing concrete floor. $7,158.00
Fixturing- Includes unloading and installation of all new fixtures in both front of house
and back of house. Price includes labor and fasteners. $1,600.00
Fire Caulking- Includes caulking of joints on all existing demising walls as to create fire
separation between tenants as reyuired by building depl.,Price includes labor and fire
proof caulking. $840.00
Store Front Sign- Includes installation of new owner supplied storefront sign. $200.00
General Conditions- Includes dumpsters, insurances, administration, etc... $2,300.00
Permit- TBD (to be billed at cost)
Note: Price excludes all equipment.
Sub Total $49,098.00
Ov�rhead and Profit(10%) $4,909.00
Total $54,007.00
�.. �_=_--_�-- -- ------
-�
1 �
�
David E. Zeller Insurance Agency, Inc.
T'EL (781) 595-2071 FAX (781) 598-6430
370 Lynnway Lynn, MA 01901-1708
davidrdlerC�davidreller.com
March 19,2010
To Whom[t May Concern:
RE: Pride Construction &Development Inc.
471 Highland Avenue
Salem, MA 01970
This letter will conFim that our insured has Workzrs Compensation coverage in force for
the term of 12/09/2009 to 12/09f2010, policy information is as foltows:
Insurer: Hartford Underwriters Insurance Company
Policy#6S60UB-4080P28-A-09
Limits: 1,000,000/L,000,000/1,000,000
We wst you will find all to be in order. Should you have any questions, please do not �
hesitate to contact us.
Sincerely yours,
tt"'"��j�?-___
M Ellen Alessi Goodwin
AUTO * BUSINESS *WORKERS COMPENSATION*LIFE*HEALTH'k HOMEOWNERS '��.
� . _ J
Print Review IRS Form SS-4 EIN Page 1 of 1
Fo�m SS-4 Application for Employer ldentification Number E'"
�Rev.December 20Dt� (Frn use by employers.capwa6ons.paMerships.WSLs,wtates.churches, Zp.2857064
Depanmem M Me govemmen�agencies,Indian Uibal enMies,ceAain indivitluals,and ofhers.) � �
Treasury ► g¢e se rale inshuqions tor each line. ► �¢e a�o for our recortls.
Intemal Revenue Senice � P PY Y OMB No.15450003
1' Legal name of entiry(or individual)fw whom Me EIN is 6eing reQuested
Pride ConsWction and DeJeloDment Inc
2 Trade name ol business(il�Herent from name on line i) 3 Executor,hustee,'care oP name
Pride ConsWction
4a' Maling addiess�room,apt,suile no.and sfreel,a P.O.ba<) Sa Slreel address(if diHerent)(Do no1 enier a P.O.boz)
75 Canai Street UnA 28 -
4b' Gry,state,and ZIP code 56 City,state,and ZIP code _ .
Salem h1A 0197D -
6' County and slate where prmdpal business is bcated
Can Essez Stale MA
7a` Name ot prinppal otficer,general parNer,grantor,owner,or trustor 7b' SSN,RIN,EIN ���
Chrislo herJamesYocum 013-70-2133 �
Ba' Type of en6ty(check only one) �Estale(SSN ot deceden�)
r Sole Proprietor(SSN) r Poan administratm(SSN) - �
r Partnership r Trus�{SSN of grentw) �
r Corporation(enter form number to 6e filed) ► 1120 r National Guard � r Statellowl govemment .
r Personal Service r Fartneri rnoperafive r Federal govemmenl/military
- r Church or church-wntrdled organizaUon r REMIC � r Indan�ribal govemmenVenlerprises
r Other nonprofit organizalion(specity) ► Group Exemption ND.(GEN) ► �
r Ofher s ed • ► �
Bb' If a coryoration,name Ne state w foreign country State Fwegn country
� (if appiicable)where incorporated MA -
9' Reason for apphing(check only one) r ganking purpose(specify purpose) ►
�'. S1aRed new business(spedfy lype) r Changed rype of organ¢a6on(speofy new type) ► --
� Construclion r Purchased going�usiness .
r Hired empbyees{Check ihe box and see 6ne 12) r Crealed a trust(specify type) ►
r Canpfiance wAh IRS withhWding requtations r Crealed a pension plan(spedfy lype) ► -
r Olher s �
10' Date busmess staAeC or acquired(monN,day,year) 71' Closing monih of aaroun[ing year
MAY 17 2005 DEC -
12 Firs�date wages a annuilies were paid w will be paid(monih,day,year) Note:l(appAcent is a wiThholding egent,entei date
inrome will first 6e aid fo nonresident aiien. month,da , ear ................ ► MAY 17 2005
13 Highesi number of empbyees expecletl in Ne next twelve montl�s Note:l/the ap�cant Agriculture HousehWd Otlier
dces nol e�ect to have any employees during the penod,enfer'-0'.............. ► 5
14' Check box ihat besl descri�es Ihe principal aUivity ol your business �Healih care 8 sodai assistance r WAolesale-agent@roker
r�ConsW cfion r Rental 8leasing �Trenspata6on&warehousing r Accanmodation&food service r WhWesaleoWer
r Real eslate r Mawfacturing r�Finance&msurance . r Retail � -
r Other s eci
75' Indicate prinapal line of inerchandise sdd;speafic consWc6on wak done;products produced;or services prwided.
Buildin ConsUuction
i6a' Has the applicani ever applied for an employer identification number fa Mis or any other business7........... Yes r No
Note 1('Yes' tease com ete lines 166 and i6c
i6b If you checked'Yes'on line 16a,give applicanCs iegal name and(rade name shown on prior application if diBerent han line 7 ar 2 above.
Legal narne � Pride Construclion Co Inc
Trade name ►
i6c'Approximate dale when,and dty and stale where,fhe appfication was filed.Enter previous employer idm�ca6on number 8 knorm.
Apprarimale Oate when filed(month,day,year) Ciry and stale where filed Previous EIN
APR 27 20U5 Beverl MA 20 - 2545448
CompMe scwtion oNy d you want b aWiwi¢e�he named indiviCual l0 2ceive Ne entity's EIN and answer qualror¢aboul Ihe complelion d Na form
Third Designee s name Desy�e's��ptro�number[mclude area mtle) .
Party Robert M Shzsnick
Dwgnee Address aod ZIP code ( 978 ) 740 - 6633
Desgriee's tax numhw(mdude area code)
70 Washington Street Salem MA 01970- ( 978 ) 740 - 6644
Under penal6es of pe�ury,l declae Nat I have examineE th¢app�cairon,and lo Ue besl o/my knowledge anE beGef,il is true. ApDficanYs IeleDhone number(i�dude area co0e)
correc�,and comD�ete.
Name and 6tle(type or prin�dearly) ( 978 ) 580 - 0684
� Applitanl'S iaz number�iMIWe area codej
Signature ► Not Required Date ► May 11,2005 GMT
h[tps://sa.www4.irs.gov/sa vignlreview.do? 5/17/2005