281 ESSEX ST - BUILDING INSPECTION (4) The Commonwealth of Massachusetts
Department of Public Safety
J U --, •�' .\I,tS.achu.ettS State Building Code(780 CMR)Seventh Edition
City of Salem
BuildingPermit Application for an Buildingother than a I- or2-Famil Dwellin
(This Section For Official Use Only)
Building Permit !Number: Date Applied: Building Inspector:
SECTION 1: LOCATION (Please indicate Block# and Lot N for locations for which a street address is not available)
'�Lg1 lr�5cX51
mar\ eve ��1TtY .r\c conbo
::\o.and Street Cit /To%%n Zip Code Name of Building (if applicable)
SECTION 2:PROPOSED WORK
If New Construction check here❑or check all that apply in the two rows below
Existing Building'[-. Repair❑ Alteration ❑ 1 Addition ❑ I Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: 00 V i
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No 40
Is an Independent Structural Engineering Peer Review regtory{i? Yes ❑ No In
Brief Description of Proposed Work: � rtg -} e t 17b W�� dud
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) ❑ '
Existing Use Group(s): Proposed Use Group(s): - r
Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34:
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
WFactoF-l
rs/Stories(include basement levels)&Area Per Floor(sq. ft.)
(sq. ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
ly A-1 ❑ A-2r ❑ A-2nc❑ A-3 ❑ A-4❑ A-5❑ a: Business ❑ E: Educational ❑
F-1 ❑ F2❑ H: Hi h Hazard H-I ❑ H-2 ❑ H-3 ❑ w H-4❑ ••` H-5'❑nal 1-1 ❑ 1-2 ❑ 1-3 ❑ 1-4 ❑ M: Mercantile❑ R: Residential R-1❑ R-2❑ R-3❑ R-4 ❑S-1 ❑ .S-2❑ I U: Utility❑ Special Use❑and please describe below: '
Special Use: -
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
FAO IB ❑ 4INFORMATION
IIB ❑ IIIA ❑ Ilia ❑ IV ❑ VA ❑ VB OSEC ION MATION(refer to 780 CMR 111.0 for details on each item)upply: Flood Zon Sewage Disposal: Trench Permiti Debris Removal:c❑ Cheek if"insi ❑ Indicate municipal ❑ A trench will nut be Licen.ed Di>p"sal Site❑required ❑or trench or ,pecily:
o❑ or indenti(c or un Site,t:Stem ❑ permit iS enclosed ❑Railroad right-of-wav: azards to Air.Navigation: %IA I lia,•rir C��nnni„ism IL•ci,„ I'nrr..:u re wuhin .1irpurt approach area.' I, !heir ret ii•nc completed'to liuild enclosed ❑ Ye,❑ nr.N"❑ 1'e, ❑ V'" ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
I Gdunvn .H Cnde: L,e Fc-peof C"n,trurli"n: ()ccttpant Load per Floor.
IAa" the budding;nnLienan Sprinkler S�,Icm': Special stipulations:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of PropurlY Owner
Name (Print) Nu. and Street CitY/Town Zip
Property Owner Contact Information:
Title Telephone:No. (business) Telephone No. (cell) e-mail address
If applicable, the property owner hereby authorizes
Name Street Address City/Town Stale Zip
to act on the property owner'.behalf, in all matters relative to work authorized by this building permit a a alication.
SECTION 10:CONSTRUCTION CONTROL (Please fill out Appendix 2)
(If building isles than 35,000 nt, it,of rndosxd space and/or not under Construction Con trot then check here❑and skip Section IU.I)
10.1 Registered Professional Responsible for Construction Control
Name (Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
L^
Co pany Name: C I' 4 5�
c l\6 c� /q- aZ It
Name oPerson
ers¢! 1�1�7on Respl ble for Construction ��,` License No. and Type if Applicable
eza,
S_trget Address ��� .�-�'Q City/Tow¢, State Zip �-
Telephone No. (business) Telephone No. (cell) e-mail address
SECTION 11:WORKERS'COWENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 2506))
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
Estimated Costs: (Labor
Item and Materials) Total Construction Cost(from Item 6) _$
1. Building $ 5'&'-7570 017 Building Permit Fee=Total Construction Cost x_(Insert here
2. Electrical $ appropriate municipal factor)=$
3. Plumbing $
$ Note: Minimum fee=$ (contact municipality)
4. Mechanical (HVAC)
5. Mechanical (Other) $ Enclose check payable to
6.Total Cost $ (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below, I ereby attest tinder the pains and penalties of perjury that all of the information contained in this
application is true and accent a the best of my knowledge and understanding.
b
Plea`c krint o d >ign non % Title Je WO o. Date
tit rc•cl Addrv,s U C1ty/Town State Zip �f nn
Municipal Inspector to fill out this section upon application approval: r/U
N, e I)a to
CITY OF S.U-EN[, ILxSSACH1USETTS
Bl mmil;DEPARTMENT
120 WASHINGTON STREET. 3aa FLOOR
"I1_ (979) 74S-959S
FAX(978) 740,98"
KI..,jBERL.EY DRISCOI1
MAYOR IllohtAs ST.PDERRs
DIRECTOR OF PUBLIC PROPERTY/11CMD12NIG CONDUSSIONER,
Workers' Compensation Insurance AlTidavit: Builders/ContractorslElectriclan%/Plumbers
A e Ilcant Information c PI rim e
Name1Busitt�a.Ort aaoon.lnd US aviduod): CO ` Y �1Z
Address: O City/StatdZip: /y b
(F��oa�, 0140101 b) Phone N: -77�
�
,%re you an employer'Cheek the appropriate box: Type of project(required):
1.01 am a employer with /P 4. 0 1 am a general contractor and 1 6. ❑New construction
employees(Cull and/or part-time)." have hired the&&&contractor
2.0 1 am a sole proprietor fir partner- listed on the attached shceL: 7. Remodeling
.hip and have no employees These sub-contraowea have s. ❑ Demolition
Workingrot me in an capacity. workers'comp.instuanoe
y p ry• 9. 0 building addition
I No workers'comp. insurance S. 0 we am a corporation and its
rs:quired.) officers have exercised thou 11
10.❑Electrical repairs"additions
3.0 1 am a homeowner doing all work right of exemption per MGL I I.0 Plumbing repairs or additions
myself.[\o workers'comp. c. 152.410).and we have no 12.0 Roof repairs
insurance required.) t employees.[No workers'
comp. insurance required.] 13.0 Other
-Any appacam this chwb boa Of must elan rill wt Ins arclim bola►rhowint heir workm'annpensufat policy infurpLuk a
'I I.ctwuwnwa who veto ie this affidavit indicting ihry an Joint all work and thas like oulside eonresespn tntat tuMnO a maw amthvtl indiceittt we►
{'.mdraron that.hack this bar mud anachad an a kfilk Col.hod stowing Out come of ttts a► fflrw on and Chair workers'emnp.policy inrornsom
/one an ensp/oyei that Is provid/nji,workers'comparmadon Insurance fer my employers, Below/s r1kepollcy a,rdM s/!e
In.urunce Company Name:
Policy I$or Self-ins. Lie.p: LVC0 0 rQ /5V N(;;- Expiration Date:
Job Site Address: 22l Es'S=V-SV City/State/Zip:s ) *41
,%torch a copy of the workers'compensation policy declaration pap(showing the policy number and explradoet date).
Failure to scs:um coverage a•required under Section 23A of MGL c. 152 can lead to the imposition of criminal penalties of■
fine up to S 1.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and t fire
Or up io S250.00 a day against the violator. Ile advi.•nxl that a copy of this statement may be rorwurded to the Ofrice of
Incesugmiuna OI the DIA ror insurance coverage verification.
/Jo he cr j u ha puns and yen /tier ujprr/ury that the in�onnaelon provided above it true and curreK
� _} 1( �1a( Dbte �i/ 3/aQl
O�ciul u�r mdy. Du nor write in Chit urea, ra be:uurp/sad by dry or/own tr/jlriuL �
City or ruwn: . _ Permit/1.Icense t
Ivsuoill Aulhuriey (circle une): --
1. Ruard of Ilvallh 2. nwlding Deparfmcne ). Cityrrown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Cher
l,,nluet rerson: _ ._ _.. Phone e:
BUILMAI-01 BEME
ACORD. CERTIFICATE OF LIABILITY INSURANCE DAr81412009Y"
PRODUCER (508)852$500 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Protector Group Ins.Agency,Inc. - ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
100 Front Street, Suite 800 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Worcester,MA 01608-1435
INSURERS AFFORDING COVERAGE NAIC#
INSURED Building Maintenance Corp dba US Roofing INSURER A:Acadia Insurance
BMC Realty Trust INSURER B:National Union Fire Insurance Co of Pitts
58 R Pulaski Street INSURER C:
Peabody,MA 01961 INSURER R
INSURER E'
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW RAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR Alml POLICY NUMBER POLICYEFFECTIVE POUCYEXPIRATON OMITS
DATE IMMIDDIYO DATE fMMIDDNY)
GENERAL LIABILITY EACH OCCURRENCE E - 1,000,00
A X COMMERCIAL GENERAL LIABILITY CPA0085685 12/23/2008 12/23/2009 PREMISES Ea occurancej $ 250,00
CLAIMS MADE 111 OCCUR MED EXP(Arty one Person) $ 5,00
PERSONAL&ADV INJURY $ 1,000,00
GENERAL AGGREGATE $ 2r000,00
GEN'L AGGREGATE UNIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 21000100
POLICY X PRO- LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00
A ANY AUTO MAA0086652 12/2312008 12/23/2009 (Ea accident)
ALLOWNEDAUTOS BODILY INJURY $
X SCHEDULED AlTT05
(Pet Person)
X HIREDAUTOS BODILY INJURY $
(Per accident)
X NONdWNED AUTOS
PROPERTY DAMAGE $
(Peraoddent)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE a 5,000,00
A X OCCUR CIAIMS MADE CUA0085698 12/23/2008 12/23/2009 AGGREGATE $ 5,000,0D
E
DEDUCTIBLE $
RETENTION E $
WORKERS COMPENSATION AND X TORY OMITS ER
B EMPLOYERS'UABIUTY C005015848 12/23/2008 12/23/2009 E.L.EACH ACCIDENT $ 500,00
ANY PROPRIETOR,PARTNERIEXECUTIVE
OFFICERAIEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,00
If yes,describe under 6j00,0Q
SPECIAL PROVISIONS below E.L.DISEASE-POLICY OMIT E
OTHER
A Installation Floater CPA0085685 12/23/2008 12/23/2009 Job Site Limit $100,00
A Equipment Floater CPA0085686 12/23/2008 12/23/2009 RentedlLeased Equipment $170.0010
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Latitude Condominiums, 281 Essex Street,Salem,MA&all other projects In the City .
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Salem, Massachusetts DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL10 DAYSWRITTEN
Attn: Public Properties Dept. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
120 Washington St.,3rd Floor
Salem,MA 01970- IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR
REPRESENTATFIES.
" AUTHORIZED REPRESENTATIVE
ACORD 25(2001/08) Q ACORD CORPORATION 1988
CITY OF SALLM
PUBLIC PRc)PRERTY
' - DEPARTMENT
r1M V _
Construction Debris Disposal AI'lidasit
(retltiiied Ii)r al demolifion w1J rcnue.lI,un wurk)
In accurrlance a Ilh the sixth edition ul•ilie State Building Code, 7SU CNIR sccnuu 1 I 1 5
DCbris, and the provisions of%IGL c 44), S 54;
Building Permit N is issued with the condition that the debris resulting from
this work shall he disposed u(in :t pruperly licensed waste disposal Ibcility as dclined by MGL e
I11. S 150A.
The debris will he transported by:
L_9 of Yl�19 e0%mic A
manic al hauler)
I he debris will be disposed uf'in
ovine tit I.xt tt.0 -
I.iddre" ut tit lily)
a�n�IwC .,I pituul .gq,hi Jill
,I,t.
P.O. Box 3118
Fa00P1rJC3 Peabody, MA 01961-3118
Telephone: (978) 532-6300
Fax: (978) 977-0803
CONTRACT
The Owner(s)of the premises described below ("lob Address"), hereby contract with and authorize U.S.
Roofing, a division of Building Maintenance Corp. ("Contractor"), to furnish all necessary materials,
supplies, labor and workmanship, and to install, construct and place improvements at said lob Address,
according to the following specifications, terms and conditions:
i. Owner's Name: Latitude Condo Association
281 Essex Street
Salem, MA 01970
2. Job Addresses: 281 Essex Street
Salem, MA 01970
3. Specifications Contractor agrees to perform the following services in a good
and workmanlike manner:
- Remove all existing roofing down to exposed roof decking and disposing-of
per Massachusetts State Laws
- Visually inspect existing roof deck; a building owner's representative will be
contacted if any structural defects are noted before new roof is installed.
- Replace all rotten or damaged decking necessary to accomplish the
installation of a new roof
- Mechanically-attach one layer of 3.3" Polyisocya nu rate insulation (MA State
Code) over roof deck using manufacturer's fastening specifications
- Install non-corrosive 2" x 6" nailer around perimeter of roof to meet height of
newly installed insulation Where needed
- Fully adhere Carlisle .060 EPDM membrane over all newly-Installed insulation
- Shop-fabricate and install at outer perimeters, .040 mil aluminum edge cleat
with hook strip and slip connectors (to prevent wind uplift)
- Flash all drains, walls, penetrations and all newly installed perimeter metal
according to Carlisle specifications
Supply lift to access roof area behind elevator shaft to replace roof
(All cell antennas must be disconnected by third-party tech prior in order to
replace this roof section)
Only install as much existing roofing materials as can be completely re-roofed
that same day. Make watertight night tie-ins on a daily basis
Provide and install Carlisle rubber walk pads at all roof access points
U.S. Roofing shall be responsible for all engineering to obtain building
permits, necessary crane lifts, police details, dumpsters and compliance with
local building code
Includes Carlisle Syntec Systems" 15-Year Roof System Warranty
Wood Deck:
There may be some compromised wooden roof decking that may need to be replaced during this
project. To counter this unforeseen possibility, I have included a square foot deck replacement cost as
an ADD/Altemate to the final cost if any compromised deck is found.
Procedure If replacement is required:
- Contact property representative and notify of existing deck rot
Photograph before, during and after
Deck replacement performed with minimal business disruption and in accordance to
OSHA regulations and local ordinances
Cost to replace rotten deck (Hany) ADD an additional $4.00/sq.ft. replaced
S. Warrantless The above work comes with 15-Year Carlisle Roof System Warranty
(furnished to Owner from Carffsfe direcdV)for materials and for labor.
6. Payment Terms: The total cost of the contract is $ 58,750.2Q Payment shall be rendered in
the following manner:
50% due upon commencement of roofing work
50% due upon successful completion of all work
7. Attorney's Fees: In the event of default, the Owner shall pay costs for collecting amounts
owing including, without limitation, court costs, expenses and reasonable attorney's fees, in
addition to any sum that the member may be called on to pay.
S. Entire Agreement: This contract constitutes the entire agreement between the parties and any
prior understanding or representation of any kind preceding the date of this Agreement shall not
be binding upon either party except to the extent incorporated in this Agreement. The Owner
agrees that Contractor has made no statements, promises, commitments or representations not
contained herein.
9. Modification: Other than that required as a result of paragraph 4 above, any modification of this
Agreement or additional obligation assumed by either party in connection with this Agreement
shall be binding only if evidenced In writing signed by each party or an authorized representative
of each party.
10. Unforseen Circumstances: Contractor is not liable for delays due to weather, strikes,
accidents, acts of God or other circumstances arising out of causes beyond its reasonable control
and without its fault or negligence.
11. Governina Law: It is agreed that this agreement shall be governed by, construed, and enforced
in accordance with the laws of the Commonwealth of Massachusetts.
IN WITNESS WHEREOF, the parties have signed their names hereto:
Date: 7-14-2009 Date: -,t-,;L4. p-01
S. Roofing, y it agent, Ag nt for Lati ude Condo A ociation Trust
Willard H. Murray
2
�lassathu�ctls-'pelt a tmcnt ul Pulllil Safety
Bnarll Ul Buildilt, Re �ula[ionti and StapllJrilx;
Construction Supervisor License
License: CS 99551
Restricted to: 00
PETER ALLARD
2 CARVER ST
BEVERLY. MA 01915
Expiration:.3r2512012
_ . :Tr#"99551-.