100 HIGHLAND AVE - BUILDING INSPECTION a -
"Number:
The Commonwealth of Massachusetts
De artment of Public Safet
p y
Massachusetls Slate Building Code(780 C\IR)Seventh Edition
gCity of Salem
Permit A lication for an Buildin other than a 1- or 2-Famil Dwellin(This Section For Official Use Only)
Date Applied: 0 Building Inspector:
/Vl SECTION 1: LOCATION (Please indicate Block M and Lot M for locations for which a street address is not available)
Il�t1 �i,S�n�S\A� 11'U � �S�QWI
..\'o. and Street City /Town 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 ❑ Addition ❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Qther I8. Specify: 0 0
Are building plans and/or construction documents being Supplied as part of this permit application? Yes ❑ No 19
Is an Independent Structural Engineering Peer Revi w r`�ijed? ` Yes ❑ No 12
Brief Descrir� , not Prupi>_sed Work:\hewn re- S gytp �A26e/ cxn�, \ �y\� 1 •` +�
\�e�./ al Kf��f il`oo� tid -F f-stoog U � e5 -� (Grs OJT v �v\�uw-r SxlitlS
R�,okc.•L �-
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): t•
Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34:
.-SECTION 4: BUILDING HEIGHT AND AREA
Existing Proposed
No.of Flours/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-2r ❑ A-2nc❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
1: Institutional 1-1 ❑ 1-2 ❑ 1-3 ❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2 ❑ R-3 ❑ R-4 ❑
S: Storage S-1 ❑ . S-2 ❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ IIA ❑ JIB ❑ IIIA ❑ IIIB ❑ 1 IV ❑ VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 710 CMR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
Public❑ Check it outside Flood Zone ❑ Indica le municipal ❑ \ bench will nu[ be Licenc•d Disposal tine❑
I'rivah•❑ ur nxicnlily Zone: or un site s\stem ❑ required ❑or trench or'pecily:
permit is enclosed Cl
Railroad right-of-way: Hazards to.Air Navigation: \I:\ I li>I �ri�t ,nnmi�.iin IL•\ir„ I'n
Gtt Apphcahly❑ I.Structure ,,Whin airport approach alea.' In their rec m\c completed'.
nr Cnn�unt to Build cnrLncd ❑ Yv,❑ or .No❑ 1"es ❑ \n ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
l Ii.1Won lCodc, L.r Gnnip(nl: Icpuof Construction: Occupant Load per Ilour:
Ur* the hu riding ionlaum,con Sprinkler S\,tem.': Special Stipulations: .
i
. 4 r
SECTION 9: PROPERTY OWNER AUTHORIZATION \\ A
Name and Addre. of Propec•Ow ner 117'n c-`t1 'l� c0yl�il 1�tS� 1Ot) ��.1��Ica9.l VTy e_
KI u
Name WraU�— No.and Street City/Town Lip
Properly Ow ner Contact Information:
Grnwte =
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable, the pmpertY owner hereby authorizes
Name Street Address City/Town Stale Zip
to act on the property owner's behalf, in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
(I f buildin•is less lha n 35,tx)0 cu. it.of endued s race and/or not under C.mstrudion Control then check here❑and skip Scdion IU.I t
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
§1/1
Co �m : k1t �� �C,1Z 9 gS1 CS
Name of Person Reswsible for Construction 'I �` y License No. and Type if Applicable
�)
2c r0�d 7 AJ
Cit / own rt S Zi
s 4�"`'3� Ll�f 2bS - 731�t y �<<cr iZ\�./� �MiST
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS'COWENSATION 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 $ 3y \—� Building Permit Fee=Total Construction Cost x_(Insert here
2. Electrical S appropriate municipal factor)_$
3. Plumbing $
Note: Minimum fee=$ (contact municipality)
4. Mechanical (HVAC) $
5. Mechanical (Other) 1 $ Enclose check payable to
6. Total Cost $ '3L'\ \� (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
applicat m is true and accurate to the best of my knowledge and understanding.
A Q (V\
I I ase print .).ed i�name 1` Title Telephone.No. Dale
� V 9� e9 a 17fL 019 b
weet Address Cih iTown State Zip
Municipal Inspector to fill out this section upon application approval: )0 I I
Name Date
CITY OF S.U.E.`I, NLvL-kSSACHL:SE_aS
BUILDNG DEPARnmNiT
120 WASHINGTON STREET, 3'°FLOOR
TEL (971) 74S.959S
F.tx(971) 740-9846
KI%BFME�Y DRISCO[1 -
MAYOR Tliohw ST.PMRRR
DIRECTOR OF PLBLIC PROPERTY/lICI DING CONMUSSIONElt
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electr(ciansiPlumbers
-tinolicant Information Please Print Legibly
n �
Nagle IBusinca.Ortanizanon,lndtvndual): `,A (q, G'l�,O 1✓l
Address: U»X _? `V�
city/State/Zip:y�_ Q 06 Y�l � o � l Phone 0: q-345- - � _5a—(__73�0�
,tre you to employer?Cheek the appropriate boa: - Type of project(required):
1.[5 1 am a employer with 4. Q I am a general contractor and 1 6. ❑New construction
employees(full and/or part-time)." have hired the subcontractors
TO I am a sole proprietor or partner- listed on the attached sheet : ?- ❑Remodeling
:hip and have no employees These sub-contractors have a. Q Demolition
working for me in any capacity. workers'comp.insurance. 9. Q Building addition
[No workers'comp, insurance 3. Q We are a corporation and is 10.❑ Electrical repairs or additions
required.) officers have exercised their
3.Q I am a homeowner doing all work right of exemption per MGL 1 1.0 Plumbing repairs or additions
myself.(No workers'comp. c. 132.g1(4),and we have no 12.Q Roof repairs
insurance required.) employeea. [No workars' IS.QOther
comp.insurance required.]
•Any applicant th d date"boa 01 must abte rill uut the section below showing their wortrcn'compnurwm policy infomnatba
t I Lnn Lowness who submit this aflldavis indicating they are doing all work and then him amide eanmdors mum submit a raw aMdavil indicating asks
i',au:wn chat check ibis but max attached an slditirawl than showing do nano of the mbsvnuadon and slick workem'camp.policy Inramaaea.
I am an employer that b providing workers'comparrados lasaraeee jar nay employees, Bdow/s Ike pollry and Job site
injormatiom
Insurance Company Name: er D�e'c�O t� �1('D tq X2
Policy Nor Self-ins. Lit. N: l/✓ GN'h�-9 Expiration Date: / Z Z 7;f OS
Job Site Address: 10 0 r 1S�a��A City/StatrJZip:S6f1 'M
Attack a copy of the workers'compensation policy declaration page(showing the policy number and expiration dnto)L
Failure to secure coverage as required under Soction 25A of MGL c. 152 can lead to the imposition of criminal penalties of■
fine up to 51.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$230.00 a day against the violator. Ile advised that a copy of this statement maybe rurwarded to the Office of
I nvcsu gaiions ol'the DIA for insurance coverage Yen tieation.
I do her c ei Under the p�w�penu/Iles of perjury that the injormarlow provided above is true and earrectt
eat .L1Q2z
Phon �: ailc - `2
iOfflcia/use only. Do not write in this area,to be completed by city or town a/Jlcial
City or Tuwn: __ Pcrmitll.lccme N
hsuing Authurity (circle une):
I. Ituard of Ileallh 2. Building Department 3.C'ilyffown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.01 her
C"Illact Person: _ _ ___ __. Phone N'
BUILMAI-01 BEME
ACORD. CERTIFICATE OF LIABILITY INSURANCE °A sia2009 Dr(YYY)
PRODUCER (508)852-8500 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Protector Group Ins.Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
100 Front Street Suite 800 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
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 D:
INSURER E'
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 ADUL POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
-LIM& TYPE OF INSURANCEGENERAL LIABILITY EACH OCCURRENCE $ 1,000,00
A X COMMERCIALGENERAL LIABILITY CPA0086686 12/23/2008 12/23/2009 PREMISES Ea=urerne $ 250,000
CLAIMS MADE OCCUR NED UP(Any one person) $ 5,00
PERSONAL B ADV INJURY $ 1,000,00
GENERALAGGREGATE $ 2,000,00
GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,00
POLICY X PRO- LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00
A ANY AUTO MAA0085652 12/23/2008 12/23/2009 (Ea accident)
ALL OWNED AUTOS BODILY INJURY
X SCHEDULED AUTOS
(Par person) E
X HIRED AUTOS
BODILY INJURY $
X NON-OWNEDAUrOS (Per ecddern)
PROPERTY DAMAGE $
(Per aWdenq
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
rESS/UMBREUA LIABILITY EACH OCCURRENCE $ 5,000,00A OCCUR CLAIMS MADE CUA0085698 12f23/2008 12/23/2009 AGGREGATE $ 5,000,00
DEDUCTIBLE $
RETENTION $ $
WC STAT
WORKERS COMPENSATONAND X TDRY UM IS OTH-
ER
B EMPLOYERS'LIABILITY C005015848 12/23/2008 12/23/2009 E.L.EACH ACCIDENT $ 500,00
ANY PROPRIETOPrPARTNERIEXECUTIVE
OFFICEWIFNIBER DCLUDEDT E.L.DISEASE-EA EMPLOYE $ 500,00
U Yes,deso a urMer 500,00
SPECIAL PROVISIONS Ielm E.L.DISEASE-POLICY LIMIT $
OTHER
A Installation Floater CPA0085685 12/23/2008 12/23/2009 Job Site Limit $100,000
A Equipment Floater CPA0085685 12/23/2008 12/23/2009 Rented/Leased Equipment $170,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Latitude Condominiums, 281 Essex Street,Salem,MA S 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
Public Properties Dept.120 Washington St.,3rd Floor NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 50 SHALL
Salem,MA 01970- IMPOSE NO OBLIGATION OR LIIA&LITv OF ANY KIND UPON THE INSURER ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE �� /J
ACORD 25(2001/08) 0 ACORD CORPORATION 1988
_M
CITY OF SALEM
i PUBLIC PROPRERTY
.r � DEPARTMENT
\I ttic 1_0W.%.QIIN(;;0NSTREEr♦S.\I I'M. bt\�i.\t:I It q.I"i�Jl'LC
fr.1:978-'43.9i95 ♦ I'.\r:978-740-9846
Construction Debris Disposal At'lidavit
(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 N - - is issued with the condition that the debris resulting from
this work shall he 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 : \
(n:une of faclhty)\/�.— •
yt vt/�
(address of facility)
Y `
signature of permit applicant
date
1
U.S. Roofing
: �� a division of Building Maintenance Corp.
P.O. Box 3118
1qOOF=1MW Peabody, MA 01 961-31 1 8
Telephone: (978) 532-6300
Fax: (978) 977-0803
CONTRACT
The Owner(s)of the premises described below ("Job 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 Job Address,
according to the following specifications, terms and conditions:
1. Owner's Name: 100 Highland Avenue Professional Building Condo Trust
100 Highland Avenue
Salem, MA 01970
2. Job Address: 100 Highland Ave., Salem, MA 01970
3. Specifications Contractor agrees to perform the following services in a good
and workmanlike manner:
1. Removal and replacement of the existing ballasted EPDM membrane roof
with a new fully adhered EPDM membrane system. That includes:
a. Complete removal of the existing membrane and related EPDM and metal
flashings;
b. Removal and replacement of all wet, damaged or deteriorated existing rigid
insulation;
c. Installation of one layer of mechanically fastened 1" polyisocyanu rate rigid
insulation over the existing rigid insulation;
d. Installation of tapered rigid insulation saddles and/or crickets as required to
provide adequate pitch to the existing scuppers;
e. Installation of new pressure treated wood blocking at roof edges, curbs and
penetrations as required;
f. Installation of new .040" bronze aluminum hook strip and edge flashings at all
roof edges, including the installation of cover plates at flashing joints;
g. Repair of any holes or other openings in the rooftop HVAC units.
The contractor shall also provide a 20 year systems warranty from the membrane
manufacturer (Carlisle) for the new roof system.
Cost of Work: $ 21,74S.00
2. Removal and replacement of the existing fixed windows and above roof
siding. This work should include:
a. Installation of new double glazed, thermally broken aluminum windows with an
AAMA/NWWDA rating of F-HC80, including the installation of metal pan flashings
with side and end dams below all windows;
b. Installation of new mullion covers and exterior panning at new windows. All
panning and other accessories are to be by the window manufacturer;
c. Installation of butyl rubber (W.R. Grace Ultra) self-adhering waterproofing
membrane on all above roof wall surfaces. Membrane shall be installed to the full
depth of all window openings prior to window installation and extended over new
EPDM terminations at the base of the walls;
d. Installation of vinyl siding to match the existing; (Over roof only)
e. Seating of the joint between the new window panning and the siding with a
commercial grade single component urethane sealant including the use of backer
rod and/or bond breaker tape as required.
Cost of Work: $ 7,430.00
3. Removal & and replacement of the existing asphalt shingled roof
sections.
a. Removal of the existing asphalt shingles, underlayment and metal flashings;
b. Replacement of any damaged or deteriorated roof sheathing;
c. Renailing of all sound roof sheathing;
d. Installation of 6' of self adhering waterproofing membrane at all eaves and 9' of
membrane along the full length of the valley;
e. Installation of asphalt saturated felt paper or other underlayment in areas not
provided with waterproofing membrane;
f. Installation of new heavyweight architectural type asphalt shingles including the
installation of new drip edge at all eaves and rakes and metal cap flashings to
match the existing;
g. Installation of a cut valley between the two roof sections.
Cost of Work: $ 4,938.00
4. Extras:
Insulation/Steel Deck Replacement
There may be some existing saturated insulation and or rotten steel decking that may need to
be replaced during this project. To counter this unforeseen possibility, U.S. Roofing has included
a square foot replacement cost as an ADD/Altemate to the final cost if an saturated insulation or
qY
rotten decking is found.
Procedure if replacement is required:
Contact property representative and notify of saturated insulation and/or 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 saturated insulation (if any)ADD an additional$3.50/sq.ft. replaced
Cost to replace rotten steel deck(if any)ADD an additional $5.00/sq.ft. replaced
Additional Walkpad installation:
Cost to install additional walkpads : ADD$5/In.ft.
S. Warranties: The above work comes with Carlisle Roof System Warranty(furnished to
Owner from Carlisle directly)for materials and for labor.
2
6. Payment Terms: The total cost of the contract is$ 34,113.000 Payment shall be rendered in
the following manner:
50% ($ 17,056.50)due upon delivery of materials and commencement of work
50% ($ 15,350.85) due upon successful completion of all work; less 5 %($ 1,705.65)
retainage for warranty.
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.
8. Entire Aamement: 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. Unfgrseen 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. Governing 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: 9-14-2009 Date: C1 -ltl
S. Roofing, Yy it agent, A ent for 100 Hi land Avenue
Willard H. Murray Professional Building Condo Trust
Printed Name:
3