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281 ESSEX ST - BUILDING INSPECTION (5) Q The Commonwealth of Massachusetts Town of J� f, Board of Building Regulations and Standards �. Massachusetts Stale Building Code. 780 CMR, 7'"edition Building Dept Imo' Building Permit Application To Construct. Repair, Renovate Or Demolish a \ . ^ One- or Ttt'o-Fumih Du riling This Section For Official Use Only Building Permit Nu hec _ Date Applied: ff /7 Signature: w /O v Building Commission Inspector of Buildings Daft SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers A51Ma Number Parcel Number I a Is this an accepted street?yes_ no p 1.3 Zoning Information: 1.4 Property Dimensions: Pr Zoning District Proposed Use ,, Lot Area(sq fl) Frontage(t ) 1.5 Building Setbacks(R) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G..L c.40.154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Public❑ Private❑ - Check if vcsO SECTION 2: PROPERTY OWNERSHIP' 2,.1 Owner of Recor Zgj( Name(Print) Address for Service: Telephone Signature SECTION 3: DESCRIPTION OF PROPOSED WORK'(cheek all that apply) New Construction❑ Existing Building❑ Owner-Occupied O Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: BrAief Description of Proposed Work ^-,;P 47rt 4410-7u�z /ADD /R/.$f/CA-'TTD.e7 7 GET _ 6 SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and Materials e o I. Building Permit Fee: $ Indicate how fee is deI I. Building S L� d4 ❑Standard City/Town Application Fee 2. Electrical S y06 ❑Total Project Cost(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S //��_ 4. Mechanical (HVAC) S List: S .Mechanical (Fire S Total All Fees: S Su ression � Check No. _Check Amount: Cash Amount:_ 6. Total Project Cost: ❑ Paid in Full ❑Outstanding Balance Due: ii'l 11✓4e., 7YJ -Al r SECTION S: CONSTRUCTION SERVICES 5.1 Licensed Construction S.u�nper,isor(CSL) 7 S— � �� 6f 0 �LyL c 5 7 c3 2 License Number Expuuuon Dom N4=of CS/L 1191d�er Jnt A Lot CSL Type lace below) Ad less /f /J�' T Description Unresir cted u to JS,000 Cu. FlJ R Restricted 1&2 FamilyDwelhn Signature ��I— r ( e T 7 / RC Residential Roofin Coverin Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition S.2 i e ed Home Improveme t Con ac r IIC) /!�6 f 2d C. 2✓L c t v� / HIC Com an Name or HI Rye Llstranl a /,,, Registration Number 1.p111AJG � 6o�C//✓A d 7504 7_��ZOL� Address 4 — � 7��Z 1—� Expiration Date OISESignature Telephone SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.f 2SC(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of a building permit. Signed Affidavit Attached? Yes .......... No........... O SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. �I Signature of Owner Date �SjECTIO�N7 7b:OWNER'OR AUTHORIZED AGENT DECLARATION 1, E1Qr' •)'p v r�/�'y ,as Owner or Authorized Agent hereby declare that the statements and information on thl foregoing application are true and accurate,to the best of my knowledge and behalf. Print Name �{ y Signature of Owner or thorized Agent Date (Signed under the pains and penalties of peru NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program), will M have access to the arbitration program or guaranty fund under M.G.L. c. I42A. Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I O.R6 and I IO.RS, respectively. 2. When substantial work is planned,provide the information below Total floors area(Sq. Ft.) (including garage, finished basemenVattics,decks or porch) Gross living area(Sq. Fl.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half baths Type of heating system Number of decks/porches Ty pe of cooling system Enclosed Open 1. "Total Pro)ect Square Footage" may he substituted for 'Total Pro)eci Cost" f Richard G. Berry & Associates, Inc. WATER DAMAGE REPAIRS THIS AGREEMENT,made as of August 4,2009, Between the Client: Mark Attia 281 Essex Street,Unit 401 Salem,MA 01971 Cellular Telephone: 978.590.7987 And the Contractor: Richard G.Berry& Associates,Inc. 49 Vine Street Saugus,Massachusetts 01906 781.241.8444 Massachusetts Home Improvement Contractor Registration Number: 113611 Massachusetts Construction Supervisor Registration Number: 036634 ARTICLE 1. CONTRACT DOCUMENTS 1.1 The contract documents consist of this agreement, general conditions, construction documents, specifications, allowances, finish schedules, construction draw schedule, information disclosure statement, all addenda issued prior to execution of this agreement and all change orders or modifications issued and agreed to by both parties. All documents noted herein shall be provided to the Contractor by the Client. These contract documents represent the entire agreement of both parties and supersede any prior oral or written agreement. ARTICLE 2. SCOPE OF WORK 2.1 The Contractor agrees to repair water damaged ceiling and walls at 281 Essex Street,Unit 401, Salem, MA. The scope of the project is: 1. Secure necessary permits for repairs from the City of Salem 2. Install R-30 fiberglass insulation and plastic vapor barrier to ceiling where missing. 3. Repair damaged electrical bathroom vent and lights and complete installation of recessed light trim after plastering repairs and painting completed. 4. Install ''/,blueboard and skim coat to match existing ceiling and walls. 5. Paint ceiling and damaged walls with one coat Benjamin Moore Fresh Start Primer and one coat Benjamin Moore eggshell latex. Color to be selected by client. 6. Clean and repair any damaged surfaces due to staining from water leaks. 7. Clean all floors. 8. Remove all debris from premises. 9. Rearrange all furniture, install drapes. ARTICLE 3. TIME OF COMPLETION 3.1 The approximate commencement date of the project shall be upon completion of roof repairs and clients determination that there will not be any more leaks. The estimated completion date will be three weeks later due to the required time necessary for plaster to dry and for painting to be completed/ ARTICLE 4. THE CONTRACT PRICE 4.1 The cost of the project is: $10,600.00 a A ARTICLE 5. PAYMENT SCHEDULE 5.1 First payment of 50%($5,300.00) is due upon signing of contract. 5.2 Final payment($5,300.00) is due upon sign off by Inspectional Services for the City of Salem and approval of the project by the Client. ARTICLE 6. DUTIES OF THE CONTRACTOR 6.1 All work shall be in accordance to the provisions of the plans and specifications. All systems shall be in good working order. 6.2 All work shall be completed in a workman like manner, and shall comply with all applicable national, state and local building codes and laws. 6.3 All work shall be performed by licensed individuals to perform their said work, as outlined by state law. 6.4 Contractor shall obtain all permits necessary for the work to be completed. The local permit process requires the inspection of the rough plumbing, electrical and building work prior to insulation and plastering ceiling and walls. After completion of construction a second round of building inspections must occur to receive final approval from City of Salem Inspectional Services. 6.5 Contractor shall remove all construction debris and leave the project in a broom clean condition daily. ARTICLE 7. CLIENT 7.1 The Client shall communicate with subcontractors only through the Contractor. 7.2 The Client will not assume any liability or responsibility,nor has any control over or charge of construction means, methods,techniques, sequences,procedures, or for safety precautions and programs in connection with the project, since these are solely the Contractor's responsibility. ARTICLE 8. CHANGE ORDERS AND FINISH SCHEDULES 8.1 A Change Order is any change to the original plans and/or specifications. All change orders will be discussed and an estimate will be provided by the contractor for the materials and work required to complete the change order. If the change order is related to work that must be done by a licensed subcontractor a change order quote will be provided. Any discussion of the work or cost will involve the subcontractor general contractor and clients. Any cost associated with a change order will either be paid` in advance or included on a weekly invoice upon completion of the change order. Additional time needed to complete change orders shall be taken into consideration in the project completion date. ARTICLE 9. INSURANCE 9.1 The Client will maintain property insurance to the full and insurable value of the project, in case of a fire, vandalism, malicious mischief or other instances that may occur. 9.2 The Contractor shall purchase and maintain needed Workman's Compensation and General Liability insurance coverage as required by law and deemed necessary for his own protection. ARTICLE 10. GENERAL PROVISIONS 10.1 If conditions are encountered at the construction site which are subsurface or otherwise concealed physical conditions or unknown physical conditions of an unusual nature,which differ naturally from those ordinarily found to exist and generally recognized as inherent in construction activities,the Contractor and Client will promptly investigate such conditions and, if they differ materially and cause an increase or decrease in the Contractor's cost of, and/or time required for, performance of any part of the work,the parties will negotiate an equitable adjustment in the contract sum, contract time or both. ARTICLE 11. HAZARDOUS MATERIALS,WASTE AND ASBESTOS 11.1 Both parties agree that dealing with hazardous materials, waste or asbestos requires specialized training, processes,precautions and licenses. Therefore,unless the scope of this agreement includes the J specific handling, disturbance, removal or transportation of hazardous materials, waste or asbestos, upon discovery of such hazardous materials the Contractor shall notify the Client immediately and allow the Client/Contractor to contract with a properly licensed and qualified hazardous material contractor. Any such work shall be treated as a Change Order resulting in additional costs and time considerations. ARTICLE 12. ARBITRATION OF DISPUTES 12.1 Any controversy or claim arising out of or relating to this contract, or the breach thereof, shall be settled by arbitration administered by the American Arbitration Association under its Construction Industry Arbitration Rules,and judgment on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. ARTICLE 13. WARRANTY 13.1 Contractor offers no warranty for the work performed due to the prior construction issues that caused the water damaged to interior space and the possibility future construction issues may surface. ARTICLE 14. TERMINATION OF THE CONTRACT 14.1 Should the Client or Contractor fail to carry out this contract,with all of its provisions,the following options and stipulations shall apply: 14.1.1 If the Client or the Contractor shall default on the contract,the non-defaulting party may declare the contract is in default and proceed against the defaulting party for the recovery of all damages incurred as a result of said breach of contract, including a reasonable attorney's fee. 14.1.2 In the event of a default by the Client or Contractor, the non-defaulting party may state his intention to comply with the contract and proceed for specific performance. Signe this day/b+ ,2009: Contractor Signatur&I Client Si re CITY OF S.U.&M. 2ANSSACHUSE'ITS BuilimmiG DEPART]1ENT 120 WASHINGTON STREET, r FLOOR TM (978) 74S-959S FAX(978) 740-9846 KI,(SERIEY DRlSCOLL MAYOR THO&LU ST.PMARE DIRECTOR OF PLBLIC PROPERTY/BLILDLNG CONMDSSIONER Workers' Compensation Insurance AMdavit: Builders/Contractors/Electr(clans/Plumbers Applicant Information Please Print Leeiblr ValTlefOusieevOrtartrsioroltwdtvttltad): �icHfl�J � 13�.�'{ `� ASSocsyt-'CS, /N�. . Address: qe7 0 JA) L City/State/Zip: CIW601 / Wi fl - fly r306 Phone q: 78f'Z1(s` Stf tf ,Are you employer!Cheek the appropriate box: Type of project(required): 1.BI am a employer with -7 4. ❑ lam a general contractor and 1 6. ❑New construction employees(full and/or part-time).• have hired the sub-contractors 2.❑ 1 am a sole proprietor to partner- listed on the attached shell : 7. ❑Remodeling ship and have to employees Them sub-contraetoes have V. ❑ Demolition working rot me in any capacity. workers'comp.insutencie 9, ❑ Building addition (No worker'comp.insurance S. ❑ We am a corporetion and its rt.'gtdred.] officers have exercised their10.❑Electrical repairs or additions ).❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.(No workers'comp. C. 15Z 11(4).and we have no 12.0 Roof repairs insurance required.)t employees. No workers' 13.0 Other comp.insurance required.) •any applicant this Aecte loss 01 most ahp tin wet the ratios taunt sbawitta their evokes'wnpen plow puticy inWmmloa 'I Lwneaasraa who subaut this aAlbvit itdicuine thry ate damn 311 work and thte him auaide comnaemm erect s hmil a site alltdsvil isdirriq else► :C.Mtravn the chek this bon must attached an 3"eiwd dwell showtna the acme of the adsontmeps sne their wvrhro'cony.policy infamtauas. l mu awe rmpbyer that it providing barters'compensodoet buurotax for my employers BNo1r�btr rho Pettey owed Jab sties information, 07l0 —A) Insurance Company Name: 60 A" Nk I iI -A acz c-o m P/t-,u-t Ram/tiSJ Sf teoe _ YKf(- Paliey f err Self-ins. Lie.#: A% eJC'_ �7i3 CL(76 Expiration Date: O-Zx -0 Job Sire Address: g2U( C5S EaC S% 6W 1 Z&/ City/StatNZip: SALE M MA Ol` ?( ,Attach a copy of[be workers'compensation policy declandsix pogo(showing the policy number and expiration daft). Failure to secure coverage as required under Section 25A of MGL a 132 can lead to the imposition of criminal penalties of a 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 a fine of up to S230.00 a day against the violator. Ile adviwxl that a copy of this statement may be rurwarded to the Office of I nveangaiiuns ofilia DIA for insurance coverage verification. /do hereby corlify under the/pa as and penalties ofPedurY toot tM informa'/an provided above is true and correct te Phone A (7fficial a we d/Ili fro leaf write in whir area,to be.omplered by city or town o/Jlciat City or Tuwvn: PcrmitaAcense M___ hsuing Awhurily (circle une): — — 1. Iluard of Ileallh 2. Ruilding Department J. Cilyfrown Clerk J. Electrical Inspector 5. Plumbing Inspector 6.01 her Loatact Person: _ _ _ __ Pliant#: ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYV) 08/03/2009 PRODUCER (978) 745-6464 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Rose Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 66 Loring Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 958 Salem MA 01970- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA'.MERCHANTS INSURANCE GROUP Richard G Berry & Associates Inc INSURERS Guard Insurance 49 .Vine Street INSURER C. INSURER D'. Saugus MA 01906- INSURERS COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR 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 ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YYI DATE MM/DD/YY LIMITS A GENERAL LIABILITY CCP1042132 10/28/2008 10/28/2009 EACH OCCURRENCE $ 1000000 X COMMERCIAL GENERAL LIABILITY PFEMISES ERENTED "arce $ 50000 CLAIMS MADE OCCUR / / / / MED EXP(Anyone arson) $ 5000 PERSONAL B ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2000000 POLICY JECT X LOC / / / / NOW AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS / / / / BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS / / / / BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY'. AGG $ EXCESS/UMBRELLA LIABILITY / / / / EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE / / / / $ RETENTION $ $ B WORKERS COMPENSATION AND RIWC913470 10/28/2008 10/28/2009 X WC STATU- OTH- TOR,LIMITS ER EMPLOYERS'LIABILITY 1000000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERRAEMBER EXCLUDED' / / / / E.L.DISEASE-EA EMPLOYEE$ 1000000 If yes,describe under 500000 SPECIAL PROVISIONS below E.L.DIBEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Both policies are renewing CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT City Of Salem FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHOREED REPRESENTATIVE ACORD 25(2001/08) ©ACORD CORPORATION 1988 INS025 pics).m Page 1 of 2 `, CITY OF SALEM 3i PUBLIC PROPRERTY DEPARTMENT �OtiIM PR`� \I 1u l< 120\X'.\.,I IING"I ON SI'R LET #S.\I I'\I,tif.\S5.\I.I It SI-.I'i Trf:978-745.9595 • I':\s:978J4Cr9M46 Construction Debris Disposal Affidavit (required fur 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 It - 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) The debris will be disposed of in (name of face ny) address of facility) signature of permit applicant date dcbi ratl i:ue