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5B GRISWOLD DR - BUILDING INSPECTION (2) ✓r 3 5 c K 1- (,A=� The Commonwealth of Massachusetts ' Board of Building Regulations and Standards CITY OF Massachusetts State Building Code,780 CMR SALEM U r n v l Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 1011 \n One-or Two Family Dwelling V" This Section For Official Use Only Building Permit Number. Date Applie . Q 9 "r9ww vt2✓ �✓�/� Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Addres • 1.1 Assessors Map&Parcel Numbers r' 1� f�I�t51 t✓ 1� ].to Is this an accepted street?yes-4K no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq It) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) L7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Ownert f Record: J�f3,Id Ir?s 5�,.IfIle .ram ?. �/.' � Name(Print) City,State,ZIP . )? f''�L✓� /LL �d 110411) No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction❑ Existing Building❑ 1 Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ASpecify: Brief Description of Proposed Work': 1 rw..••c?2 ¢ i7r119I ,r c'iG' e SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) 1.Building S — 1. Building Permit Fee:S Indicate how fee is determined: 2.Electrical S ❑Standard City/Town Application Fee ❑Total Project Cost"(Item 6)x multiplier x 3.Plumbing S 2. Other Fees: S 4.Mechanical (HVAC) S List: 5-Mechanical (Fire Su ression) S Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: S ❑Paid in Full ❑ Outstanding Balance Due: l �t57-0 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) Sufi ry _ Y 7 •%2?- ; � License Number Expiration Date Name of CSL Holder s!et //Z- /� N ]� List CSL Type(see below) Y _f o.and Street Y Type Description �C`,.„f 01 9 7c- U Unrestricted(Buildings u to 35,000 cu,ft.) Ct R'own,State,ZIP t / ^'T Restricted 18c2 FamilyDwelling M Imasonry RC Roofing Covering WS Window and Siding 7c (TO Z �y SF Solid Fuel Burning Appliances l�i,!` 6,��.yC'-yC'CH'It%'�•GC.•7�!�'L/ [;'Cr 1 Insulation Telephone Email address D Demolition 5.2 Regi—styerrimed Home Improvement Contractor(HIC) �i+�r i'&C 2-Cs IIts �jci� HIC Company Name or HIC. eg�s[nnr Name HIC Registration Number Expiration Date !No{�ndS eet yy trTrt� �✓'�..-y%�.nj.?/,"'�//'.r 4t;..,:'f ii• ! , {vat lY1k Gl-,71e ��? Eet w)6 e Email address Ci /Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(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 the building permit. Signed Affidavit Attached? Yes ..........0 No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT f,as Owner of the subject property,hereby authorize C �_ `✓'1fh ems:/ j j — T e to'a11ct on my behalf,]i'n�all maatters-relative to work authorized by this building permit appl cation. �^- Pont Owner's Name(Electronic Signa re) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this saapplication is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electionic Signature) Date 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 not have access to the arbitration program or guaranty fund under M.G.L_c. 142A. Other important information on the HIC Program can be found at Information on the Construction Supervisor License can be found at._,_c ,_ ,_ 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basementlattics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may substituted for"Total Project Cost" 120 WASHING--ON S T RF�T, 3 FLOoR "%F (978) 745-9595 Rky,(979) 740 9W, I:IotBER7._ Y DRISCrJV T. MA Y®11 t6Js3ra5 ST.PMRR:y DIRFCTIOR OF PUBLIC PROPERTY/BUH-DLNG COMMISSIONER Construction Debris Dispml 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 worts shall be disposed of in a properly licensed waste disposal facility as defined by MG;7 c l 11, S 150A. The debris will be transported by,,::l (name of hauler) The debris will be disposed of in (name of facility) (address of facility) signature of permit a ant jr Jc61i5a13�Jec �t:.• CITY OF S. N1, .L-kss kCI- usR-i S BUILDLNG DEPAR-17�,IEINT arm 0 120 WAS1112NGTON STREET, 3"a FLOOR \� s x (979) 745-9595 F.ax(978) 740-99-$ Kn%mERI-P + 'DRISCOLL N,f yoli Tpoius ST.gmRs DIRECTOR OF PUBLIC PROPERTY/BL'IY DD4G CO3LZIISSIONER Workers' Couripensation Insurance Afflidawit: Builders/Contractors EleCiricians/pgumlbers Applicant information y Please Print G_,e e6Hy Name (BusinessOrganization.'individual): �` GZ1/�/S ,/ ��?1 C•i t / L L Address: i/ 1 /-C li-rY /Z f' "Y City/State/Zip: .5.ff/- & 4111 //tIA �2 / hone #: e/77 .yt�CJ oZ Cc• Are v a employer?Check the appropeiate bar,: FF oject(required): 1. i am a employer with g. ❑ I am a general contractor and 1 construction employees(full and/or part-time).' have hired the sub-contractors 2.0 1 am a sole proprietor or p:atner- listed on the attached sheet.> odeling ship and have no employees These sub-contractors have olition working for me in any capacity. workers'comp,insurance. ding addition [No worker-'comp.insurance S. ❑ We area corporation and its required.] - officers have exercised their . ectrical repairs or additions 3.0 I ran a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself(No workers'comp. c. 152,§10),and we have no 12.0 Roof repairs insurance required.]t employees.[No workers' I3 0 Other. comp.insurance required.] 'Anv applicam oat checks box BI most also fill out the section Movr showing their wort ts'campensadon policy infurmation. +llameownaO,who submit this affidavit indicating the•,•arc doing all work and then hire outside contractors most submit a new afrrdavit indicating such -Commcturs that ch�vk this box°nsr-lathed an additional Sheet showing❑to name of the subcontractors and their workero'comp.policy ins amtion. /am an employer that is providing tverlrers'competxsatlo:a insurance for my employees. Below is the pallcy uttd Jac sdte informarion. 77 �y _ Insurance Company Name: }N,•JCs %�IC �h ^� / 9� �� Policy if orSelf--ins. Lic. 1l__ �G /N�. _�y/y�S Z Expiration Date' ! �is' /(.i� Job Sire Address: ! 8 City/State/Zip: ' �f'l+'! Attach a copy of the worn"sers' compensation policy declaration pave(showing the policy number and expiratlon 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 S I,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 S250.00 a day against the violator_ Ile advised that a copy of this statement may be forwarded to the Office of Investigations of die DiA for insurance covcngc verification. I do hereby certify : r the pains and enaltres of perjury that the information provided above is true/and correct. fate: OJjciad use only. Do not rvrite in this area to he completed by city or town°jficiu/ City or Town: _. .. _ PermitfLicense issuing,Authority(circle one): 1.Board of Health 2. Building Department 3.City/ru-n Clerk 3. Electrical Inspector 5.Plumbing inspector 6.c'lther Contact Person: .. ._ _.._ Phone$: American Properties Team, Inc. RECEIVED . ,1,1SpECTiUNAL SERVICES 101b MAR 28 A ' TO: 5B Griswold Drive FROM: Jennifer Pappas, Property Manager RE: Deck Replacement DATE: March 23, 2016 Please be advised that the Board of Trustees for Pickman Park has approved the replacement of the deck at the above referenced unit. This approval is contingent upon it matching the existing deck(composite materials can be used) and following the Engineering Alliance Deck Specifications. The Board will not allow any design alterations. We also require that permits be pulled in advance (regardless of what your contractor may tell you), and then a copy of the final approved permit once completed must be sent to APT for the unit file as well. You will need to bring a copy of this letter to the Salem Building Department in order to receive your permit. Should you have any questions or require additional information, please feel free to call the APT Service Team at(781)932-9229. cc: Unit File 500 WEST CUMMINGS PARK SUITE 6050- WOBURN -MA -01801-781-932-9229 -FAX 781-935-4289 A CERTIFICATE OF LIABILITY INSURANCE 3/25/)16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsenenl(s). PRODUCER CONTACT NAME: Ingrid Benevento Insurance Agency Inc PHONE 761 599-3411 Fax N : (781) Set-7200 497 Humphrey Street E-NIAIL ADDRESS: Swampscott, MA 01907 INSURE R(S AFFORDING COVERAGE NAICN INSURERA:CommerCe Ins CO INSURED INSURERB:Guard Ins Co Emery Construction LLC INSURER C: Brett Emery INSURERD: 19 Kelly Rd. INSURER E: Salem, MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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-LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POUCV EFF POLICY EXP LTR TYPE OFINSURANCE I POU CY NUMBER MIDDNY Mr1mdYYYY UNITS A GENERALLMBIUTY y BDSJXD 9/6/15 9/16/16 EACH OCCURRENCE $ 1,000,000 X COMMERCIALGENERALLIABIUTY DA PREMISES MISE TOTE N O $ 50,000 CIAIMS-MADE Fx�OOCUR MED EXP(ANq one palm) $ 5,000 PERSONAL&ADVINJURY $ 11000,000 GENERALAGGREGATE $ 2,000,000 GEMLAGGREGATE LIMITAPPUES PER PRODUCTS-NMploPAGG $ 2,000,000 X POLICY PRO-JECT LOC $ BINED O INEDSIN LE LIMIT AUTOMOBILE LMBIUTY a e $ ANYAUTO BODILY INJURY(Per person) $ ALLOWPED SCHEDULED BODILY INJURY(P.,amitlenl) $ AUTOS AUTOS NOWOWNED PROPERTYDAMAGE $ HIREDAUTOS _AUTOS Peraoadent UMBRVUL LIAB OCCUR EACH OCCURRENCE If EKCESS IL CLAIMS-MADE AGGREGATE $ DIED RETENTION E I $ B WORKERS COMPENSATION BRWC341452 9/6/15 9/6/16 X I WCSTATU- H- LIN AND EMPLOYERS UABIUW ANYPROPRIETOWPARTNER,EXECUTIYE YIN NIA EL EACHACOCENT $ 100,000 OFFICERIMEMBER EXCLIDED? (MaWatnry in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 us,dwaibe under SCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT I $ 500,000 DUSCRIPTION OF OPERATIONS I LOCATONS NVEMCLES (Ai O ACORD 101,AMMnal Rene MA Sch ule,if moreapm is mquni,J) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Jean Donley ACCORDANCE WITH THE POLICY PROVISIONS. 5B Griswold Rd Salem, MA 01960 AUTHORIZED REPRESENTATIVE Bryan Benevento ©1988-2010 ACORD CORPORATION. All rights resenIed. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: bemery@emeryconstruct.com Emery Construction,, LLC Estimate 19 Kelley Road Date ! Estimate# Salem Ma, 01970 j 2/9/2016 j E15-218 978-880-2638 Jean Donley _ 5B Grizwold Dr Salem,Ma.01970 - - 1 I I ` Description Cost j Total j i As requested,we have prepared an estimate for the replacement of the rear deck. Remove and dispose of the existing deck. f Frame new pressure treated deck frame with 2 x 8 framing material. ( i I All stringers&4 x 4's to be pressure treated as well. ( , it All decking to be 5/4"x 6 pressure treated decking. I All rails to be pressure treated balusters and 2 x 4's. II i All hangers and fasteners to be to code. j I Permits will be obtained. f I jPainting and staining by others. j I All existing footings to be re-used. i } 1 I i i j I i t Total Stock&labor f 4,650.001 4,650.00 Aj I i t i j � I j I i i i 1 f � I I 1 i f � f I Total yz sv To: Brett Emery<bemery@emeryconstruct.com> Subject: RE: Estimate E15-218 from Emery Construction Corp. Thanks Brett, I am set to close on my refinance on or before March 21. So I will be able to pay you the full amount at that time.'I would like to get into your schedule, weather permitting Thanks! Jean Jean Donley PDMBioanalytical Compliance/Vendor Quality Manager o Pfizer Inc 1 Burtt Road, Andover, MA 01810 Office+1 978 247 3839 "This e-mail and any attachments to it are solely for the use of the intended recipient and may contain confidential and proprietary material. If you received this email by mistake, please notify the sender and delete this email and any attachments associated with it. From: Brett Emery [mailto•beme[yCo)emervconstruct.com] Sent: Friday, February 12, 2016 1:45 PM To: Donley, Jean Subject: Estimate Ely- 218 from Emery Construction Corp. Jean, Please review the attached estimate. I apologize for the delay. As discussed, I can make a $400 deduct. Feel free to call me with any questions you may have. We can get to this sooner than later. Regards, Brett S. Emery Emery Construction, LLC 19 Kelley Rd Salem, Mo. 01970 978..880.1636 www.emeryconstructionlic.com 2 w Brett Emer y From: Donley,Jean <Jean.Donley@pfizer.com> Sent: Thursday, February 18, 2016 8:03 AM To: Brett Emery Subject: RE: Estimate E15- 218 from Emery Construction Corp. Great—thanks!I Jean Donley P/DM�Bioanalytical Compliance/Vendor Quality Manager OR Pfizer Inc 1 Burtt Road, Andover, MA 01810 Office+1 978 247 3839 "This e-mail and any attachments to it are solely for the use of the intended recipient and may contain confidential and proprietary material. If you received this email by mistake, please notify the sender and delete this email and any attachments associated with it. From: Brett Emery [mailto:bemery@emeryconstruct.com] Sent: Thursday, February 18, 2016 7:48 AM To: Donley, Jean Subject: RE: Estimate E15- 218 from Emery Construction Corp. Jean, I think we are doing a few other decks next week and the week after if weather permits. I will keep you posted as to when the men will be coming. We can settle the finances at a later date. Thank you. Regards, Brett S. Emery Emery Construction, L L C 19 Kelley Rd Salem, Ma. 01970 978.880.2638 www.emerVconstructionllc.com From: Donley,Jean [mailto:Jean.Donlev@pfizer.coml Sent:Sunday, February 14, 2016 4:03 PM 1 CONSTRUCTION, LLC Commercial • Residential NV i y A Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supe�isor _ License: CS-as93" BRETTSEMERY= i 19 E:ELLY194 RD R SALEM MA 0 Jam-�&-esto�- " t'r Expiration Commissioner 09/2512016 ft DRRlER S:LICENSE -+ w 0 -25-2013 09 25-10%' war EMERY ,� t 9RETrS SAR' 9tmtt414 / r-'J�r Yrruriunirtncn�(l n/C'�l�r.:.(nc�riic(/' .14WOffice of COa9uiner Affairs&Business Regulation License or registration valid for individul use only A,-MOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: i Registration: 176626 Type: Office of Consumer Affairs and Business Regulation Expiration: 9/10/2017 DBA 10 Park Plaza-Suite 5170 EMERY CONSTRUCTION Boston,MA 02116 BRETT EMERY 19 KELLEY RD - S SALEM,MA 01970 : - Undersecretary Not valid witho goature