Loading...
10 HERITAGE DR - BUILDING INSPECTION (2) The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number: Date Applied: Building Official: SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) d e v - M& O[570 i No. and Street 4ty/Town Zip Code Name of Building(if applicable).. _ SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Building❑ Repair❑ 1 Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No`lam Is an Independent Structural Engineering Peer Review required? Yes ❑ No`9- Brief Description of Proposed Work: Slt�y tbcTP N-' It \ Ino 3:1- IQ— /hsntf U h C4t SECTION 3:COMPLETE in..SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed (See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq. ft.) Total Area(sq. ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A. Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ 1 H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5 ❑ I: Institutional I-1 ❑ I-2❑ I-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3 ❑ R4❑ S: Storage S-1 ❑ S-2❑ U. Utility❑ i Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ 111 ❑ IIA ❑ IIB ❑ IIIA ❑ im ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal• Trench Permit Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal required❑or trench or sp ify: Site-C! ec Private❑ or indentify Zone: or on site system❑ �! permit is enclosed❑ uv- — Railroad right-of-way: Hazards to Av Navigatiom MA Historic Commission Review Process: Not Applicable-Et F Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or NoZ-- Yes❑ No-El-- SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: SECTION 9: PROPERTY OWNER AUTHORIZATION Nayne and Address of Property Owner ��� q n Princes V� C(-05.5- A I-P )Jls -We, r-c� st" lr4-w 01gS1 Name (Print) NN—�t —City/Town Zip Property Owner Contact Information: �;�bl"the���pVrtv � " /o03 CN j0025onp Dfnn(e orl Titlpp}� Telephone No. (business) Telephone No. (cell) e-mail address (,0/tIIf am, wner hereby authorizes I Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit a22lication. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control nn[ S ILI6�Ll R1101,I-Q-71--�LOlin e nftpSfD Prd, TOOYS2 Name(Registrant) �xTelephone No. �U/ e-marl address Registration Number Ref \1lP>�A>��d MJ4 D16dK- e- c 5 L4- A/ Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor \ c, a\v.nik l Ons�h_,r tDrl Company Name 1 � 3e-IZZ hPtC, Name of Person Responsible for Construction License No. and Type if Applicable Q qot-"\Ai Le �o0-ci �arbk��d M&- omm S Street Address City/Town State Zip M-J23-1a-7tIz ?Ft 11 W3 )p 4 Q oreglor'onc,om Telephone No. (business) Telephone No. (cell) e-mail address SECTION11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.@ 25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs: (Labor and Materials) Total Construction Cost(from Item 6)_$ 1. Building $ — Building Permit Fee=Total Construction Cost x (Insert here 2. Electrical $ appropriate municipal factor)_$ 3.Plumbing $ 4. Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5. Mechanical (Other) $ aD 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 hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. �(ZCl. in nt� ,� / aknc 17mSfrll�i.c�- 7�i Please pri t and si name Titl Tel ephone No. Da e 9 LYt���� t t� Rom f�i"� n I (- Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: Name Date ,< CITY OF S. .F.M, 2ANSSACHUSETTS BUILDING DEP AR-MENT • p 130 WASHINGTON STREET, 3iD FLOOR TEL (978) 745-9595 Fnx(978) 7404846 KIN {gERLEY DRISCOLL MAYORTHo.%w ST.PtERRE DIRECTOR OF PUBLIC PROPERTY/BU:ILDLNG COSLUISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) in accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: /0o—nn15 /,�akns (name of hauler) The debris will be disposed of in o sma L._- (name of facili ) Glec 0 n n (ad&Ass of facility) . signature Of permit app scant L-j n -I3 — —� date JcAris�IT.Jw CITY OF SM EM, 2AXSSACHL'SETTS BUILDING DEPARTMENT • p• 120 WASHINGTON STREET, 3aa FLOOR dj TEL. (978) 745-9595 FA.r(978) 740-9846 tBFRi FY DRISCOLL MAYOR11iOMAS ST.PsFttnB DIRECTOR OF PUBLIC PROPERTY/BCIIDLNG CONMIISSIONER Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly v Name (BusilxSsOrganizz(atiorulndividual): R2� Y Atn'k na -F Onf)5711)f TT 0a Address: R C\l`4-s�Nlv-ep��oac\ City/State/Zip: conk.`-U\et�i� ,\\\e O«i l 0 Phone #: g l C43\'3rl�2 Are you an employer?Check the appropriate box: Type of project(required): 1(95,1 am a employer with�_ 4. 0 I am 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 or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. workers' comp. insurance. 9. 0 Building addition [No workers' comp. insurance 5. 0 We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing all work right of exemption per MGL 1 I.0 Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no .Roof repairs insurance required.]t employees. [No workers' COMP. insurance required.) 13.0 Other Any applicant that checks box xl most also fill out the section below showing their workers'compensation policy infurmation. f l lorneuwneni who submit this affidavit indicating they am doing all work and then him outside contractors must submit a new affidavit indicating such. 'Contmcton that check this box most attached an additional sheet showing the name of the subcontractors and their workcrs'comp.policy informmtion. l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and fob.site information. Insurance Company Name: �n\nSL1R9-V�CY� Policy#ur Self-ins. Lie.#: _ .� B���J 3 —f Expiration Date: 3—/S—/ �Job Site Address:, Qlt���ca2 JnVC� City/State/Zip: ,Jt�MC, 01�—f0 Attach a copy of the workers'compeng'a-lium policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to 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 S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. l do thereby M the pains and penaltes of perjury that the information provided above is true and correct Sienuttire: Date' Ll — 13 Phone x: r) 8 l-C.e L\Z Official use only. Do not write in this area,to be completed by city or town official City or"ruwn: PermittLicense Issuing Aulhorily(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: _________ Phone#: ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDYWV) ACORO , 4/11/2013 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 endorsements. PRODUCER COTCT NAM Select Dept ext 66807 E: Eastern Insurance Group LLC- Main fPZCNEa.E - 7 FAX No ),508-653-8089 233 West Central Street E-MAIL Natick MA 01760 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC F INSURER A INSURED 24359 INSURERB;Safety Insurance 4 Presto Painting&Construction INSURER C:National GrangeMutual 8 Yorkshire Road INSURER D: Marblehead MA 01945-1028 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:2115583231 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 ADDLSUBR POLICY EFF POLICY EXP rypE OFINSURANCE LTR INSR MD POLICY NUMBER MWDIVYY MWDD/YYYY LIMITS A GENERAL LIABILITY MPOS9800 11/15/2012 1/15/2013 EACH OCCURRENCE $1.000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $500,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $2,000,000 POLICY X I JE PRO LOG $ B AUTOMOBILE LU181LRY 6203010 /5/2013 /5/2014 Ea accident $1 000 000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NONO MED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per a.dent $ C X UMBRELLA LIAB X OCCUR CU089800 11/15/2012 1/15/2013 EACH OCCURRENCE s2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 OED X I RETENTION$5,000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N T ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Salem ACCORDANCE WITH THE POLICY PROVISIONS. Inspectional Services 120 Washington Street, 3rd FI AUTHORIZED REPRESENTATIVE Salem MA 01970 n il/'�ftrw ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Office of Cooeomer ABain&Bwi6ns Regulation ;,y :d;OME IMPROVEMENT CONTRACTOR egistra0on: 153422 Type: expiration: 11/30/2014 Private Corporatit PRESTO PAINTING AND CONSTRUCTION COMPANY IOANNIS MAKRIS 8 YORKSHIRE ROAD MARBLEHEAD.MA 01945 Undersecretary INS Massachusetts - Depanmem or Pubic Sater; Board of Budding Regulations and Standards (nnNructlnn Suh.n iwr Spacralty License:CSSL-100452 IOANNISMAIERIS 5 YORKSIM ROAD. ' MARBLEHyfAD MA 01945 Commsswner Expiration OU2712014 OPRESTO fFNTRY PAINTIN6 • N0& N(:i 8 Yorkshire Road 100452 HIC#153422 - CSSL# Marblehead,Ma 01945 FID 420-5794889 (978)3S6 5419— (866)PRESTO-7 www.PrestoCPR.com PROPOSAL AND ACCEPTANCE PROPOSAL SUBMITTED TO• WORK TO BE PERFORMED AT.- Chet F'Amico Princeton Crossing it�r 12 Heritage Drive Salem,Ma Salem DATE OFPROPOSAL: (978)740-1700 February 4,2013 ys r Having visited and examined the site of the proposed project and being familiar with the conditions relating to the construction, including the availability of the materials and labor, c Presto Painting&Construction hereby proposes to furnish all materials, labor, equipment and supervision required and to complete the work in accordance with this contract document. ROOFING: <Building#10> 1. Strip off existing roofing shingles of building 410 dispose of properly& legally. 2. Inspect existing roof deck boards; renail as needed and inform customer of any rotted. 3. Install 6 feet(2 rows)of Ice& Water Shield to perimeter of roof to prevent ice backups. Install 3 feet(1 row)of Ice&Water Shield to valleys, along rakes,existing roof penetrations and at least 12" i up any adjoining walls. 4. Install white 8-inch aluminum drip edge to all perimeters of roof areas then apply a strip of fee& Water shield over the exposed edges of the drip edge. 5. Install new flanges around all existing pipes. 6. Install Type 15 (151b)organic felt on the remainder of the roof deck. 7. Check ridge vents for proper ventilation. 8. Use Swift Start starter and Shadow Ridge hip&ridge accessories for better wind resistance, upgraded from 70 mph to 110 mph wind resistance." 9.Install new CertainTeed XT25 asphalt roofing shingles in hurricane nailing pattern G0LOR:Star-W-hite-or-Groy-Front— EOST:4A� B� OPTION.• fpo• n If instead of XT25 we install landmark Architectural then the cost will be,$36tr"j I(�r OTHER COMMENTS: "Please,see inserts for details. EPA<Environmental Protection Agency>certified for Renovator,Repair& Paint(RRP)• OSHA<Occupational Safety&Health Administration>certified. Project will be performed tinder the state requirements& requirements of EPA. r 1 ' 1.866.PREST0.7 • 978.35Fi..5419 • infn(nlnroctnr,nr nnY„ . ,.,,,,,.,.,.,,..«,,....-....._ 4!0 B(Better Business Bureau)accredited business with an A+rating. Cover and tarp sides of building while stripping of existing roof shingles to prevent any damages. Care will be taken during the progress of the work,all surfaces needed,will be covered to prevent from any damage or harm occurring during the workday. Presto may withdraw this proposal if not accepted within ninety(90)days. All materials are guaranteed to be as specified, Work area will receive a complete inspection at the end of each workday and will be swept and cleaned daily as found. All surfaces will be prepared and finished in a manner that meets professional standards. Presto Painting&Construction will obtain all necessary construction related permits, any owner who secure their own construction permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. No work shall begin prior to acceptance of proposal.No verbal agreement is accepted INSURANCES. FULL PROPERTY AND LIABILITY INSURANCE IS THE RESPONSIBILITY OF PRESTO PAINTING&CONSTRUCTION INSURED UNDER NATIONAL GRANGE MUTUAL INSURANCE policy#MP089800 expiration 11/15/13 FULL WORKERS COMPENSATION COVERAGE INSURED UNDER GRANITE STATE }_ INSURANCE COMPANY policy#WC004326922 expiration 07/21/13 (insurance certificates are available upon request) PAYMENT SCHEDULE: Payments are to be made as follows: 7 One half upon beginning and balance including any extras in full when work is complete. - -- - NOTE: All home improvement contractors and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to registration should be directed to: Director,Home improvement Contractor Registration One Ashburton Place Room 1301 Boston,Ma 02108 (617)727-8598 -- ----- --- Do Not Sign This Contract If there Are Any Blank Spaces 1 ACCEPTANCE OFPROPOSAL: The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made as outlined above, I Authorized Signature_ Joann s klakris Q Presto Painting&Construction Signature _,# Princeton Properties roofing Building#10 Date of Acceptance "HIGHEST QUALITY AND CLEANLINESS--YOUR PRODUCT OUR BUSINESS" 2 1.866.PREST0.7 . 97R 3AF &I1Q wy�! ' �i � � � I � J � ��