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276 HIGHLAND AVE - BUILDING INSPECTION (6) Fa+�•�°r L Oct ��✓✓l•fzo� � 3v>7tr� , What is the current us.4144 K°Bpi? units?--- N dwelUng,how manyQfiP�a`) Material of Budding? Asbestos?_8 -- Wtp the Budding Conform to Law? a coy"t° Arohd'ites Name Ik" r c o✓L > 6 3 5 N S-hu=w (97v� u k - 2� C'ter* Address and Ptwt>• M���,✓O �� Sty�a� MechanlesNamme *-Ss 0I9°� 7 C� ()care V(u F S Address and Phone GS 58 �$ HIC Registration�-- Construction supervisors Uconse f/ Estimated Cost of pro! $ "�oO'• CO Permit Fee Caklulalion Estimated Cost X$11$10W Residential Pem►L Fee S - - Estknated CostX i11/i1000 Gommsrdal — -- -_- - . An Additional $5.0o is added as an Administrative duwg'L Make sure that all fields ars properly and legibly written to avoid delays in processing. The undersigned does hereby apply for 8 Building Permit to build to the above stated 2° SpeClflCatiOne, signed under penalty.of Perjury X Date t e N w at F Z a y s GITrOF XLEM PUBLIC*PROPERTY DEPART FLINT _f MGrait 130 W�sMttrc.Zcx+S`ne6T•1Uk:K.MA0AatiS6TR 01970 71?L 9711-745-9S"•FAX 97e-74e,9e1i APPLICATION FOR THE REPAIR. RENQX4n N CON TRUCTION DEMOLITION OR CHAN O OR FOR EXI • E FUSE OC ZM ANy STING STR UCTLrFZ OR BUlLtlrrr� 1.0 SITE INFORMATION " Location Name: oL9 ' ,Y- mwm A gi n G Building; Property Address-2-1 -t-H Gt't S<ti-C-+M mq-SS O t�i'1� PrOWtY is located in a:Conservation Area Ym�_Historic DWWd Y/N *I 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: C.C,3 T-G,e Co (fie-r,Ey P Pt�T C-S Ltd Address: Co 0 o LA U✓o- f'cv6 5t\u-m , 1,.,,a4a . o 1 g -7o Telephone: I- q. 7 S - 7 H i - 4-1�l o 3.000MPLETE THIS SECTION FOR WORK IN EYiajim a BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use New Demolition Existing 2 7 oq Sr Approximate year of Area per floor (sf) Renovated construction or renovation I Of existing building New Sdd Description of Proposed Work: \ ENAL1 u R o, C�1- /[•P�'{Lo�t w ''Ly Z ']p9 S� OF �U i 1n01 N(i• �k-( R Vt {�£K �JUI s ✓o!l Pox ,;e (31 Ke.� l=-)V61 Nisa, Mail Permit to: CITY OF SALEM PUBLIC PROPRERTY y DEPARTMENT KIMUR[IY DRItt:ULL M. Ayoft IMWASH1NCI'O:e STREET* SAL-%4.MASYACIncur]'IS 0197 TEL-978-7459595 •FAx:978-740.9846 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers .applicant Information Please Print Leeibly Name(13ushw.wOrganizationtindividual): M E74 1 IJ nl O CDU S,Tw_,A cx nj `71V C- Address: -Z C_ O.Tx,1 I t_L,(� , G——7 City/Starelzip:_ 1�1 v A I O / 9a 5 Phone #: 7 8 1 - 581 - 533 3 Are y90 an employer?Check the appropriate box: Type of project(required): I.E I am a employer with a O 4. ❑ I am a general contractor and i 6. ❑ New construction employees(full and/or part-tine).• have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. : 7• ❑ modeling ship and have no employees These subcontractors have g. Demolition working for me in any capacity. workers'comp. insurance. q, ❑ Building addition [No workers'comp. insurance S. ❑ We are a corporation and its required.] officers have exercise!their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions myself.(No workers' comp. C. 152, §1(4),and we have no 12.0 Roof repairs insurance required.] t employees. [No workers 13.❑ Other comp. insurance required.] •Airy apphcuul that checks box 01 most also fill out the section below slowing their workers'cumpanuaion purity infurnmtlon 'nom mu men who submit this affidavit indicating They are doing all work and than him outside eomaors mull sulmtil a new afrdavil indicating such. Contractors that chmic this box must anached an additional shcet showing the name of nla lab contraaors and their woken'comp.policy information. l ann on ennplayer that Ir providing workers'compensadon insurance for n{y enaplayees. Below is the pa/icy and job site infornnation. insurance Company Name: A Goa r rl� SAl Su 1<"t-4 CIE; COHn aO/17✓� Policy#or Sclr-ins. Lie.#: WGA 007 If 116 It 1_5 M A Expiration Date: S i5 O S Job Site Address: 2Zce �-tte.�f-ktoi-wJ Ave;r - Cily/State/Zip: SA(-&n . vt­sA 019 Artach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of�IGL c. 152 can lead to the imposition of criminal penalties of a rind up to S1,5000)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 O17ice of lnvc,rtgauons ul'Lhc DIA for insurance coverage verification. - l do hereby certify tinder the pains andipenu�/d/es ajperjury\that the information provided above is true and correct. Sie:iaturc' .✓�'�rC� 3�t v'7l�Yf -� Datc- U t-td 2,G, Z DO7 Phone 1: 67 Fat - $61 - 5333 /Vlrt{-a mar S. MCg,.,Ao - �+usldti✓� Official use only. Do not write in this area,to be completed by city or town oJficiat City or Town: Permit/Liccnse#_____ __ Issuing Authority (circle one): I. Onard of health 2. Building Department 3.Citylfovn Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: ___ Phonc #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and if necessary, supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their .self-insurance license number on the appropriate line. City or Town Official; Please be sure that the affidavit is complete and printed legibly. The Department has provided a spare at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to till in the permit/license number which will be used as a reference nunmber. In addition,an applicant that must submit multiple pennitilicense applications in any given year,need only submit one affidavit indicating current -.policy information(if necessary)and under"Job Site Address!'the applicant should write"all locations in (City or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on rile for future permits or licenses. A new affidavit must be tilled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Otlice of lnvestigations would like to thank you in advance for your cooperation and should you have any questions, please du not hesitate to give us a call. The Department's address,telephone and fax number: q The Commonwealth of Massachusetts -x Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-7274749 Revised 5-26-05 www.mass.gov/dia CITY OF S.ULE,Nf, 1MASSACHUSETTS BUILDING DPPARTMENT 120 WASHINGTON STREET, 3"FLOOR TFL (978) 745-9595 FAX(978) 740-9846 M,\jBERLffY DRISCOLL MAYOR THot�IAs ST.P[ERRS DIRECTOR OF PUBLIC PROPERTY/BVILDING COJL%MIONER 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: (name of hauler) The debris will be disposed of in : (name of facility) (address 6f facility) signature of permit applicant ivc fivfo urs s'- r..-5,�im1c 1I ZS�o7 date dcbrimIT m CITY OF SALEM, MASSACHUSETTS a PUBLIC PROPERTY DEPARTMENT d" 120 WASHINGTON STREET, 3RD FLOOR SALEM, MASSACHUSETTS 01970 TELEPHONE: 978-745-9595 EXT. 380 FAX: 978-740-9846 Thomas J. St.Pierre Director of Public Property Zoning Enforcement Officer Section 116.0 Demolition of Structures Structures over fifty (50) tears old must have approval of the Salem Historical Society UTILITY DISCONNECTIONS REQUIRED Authorized Agent Date of Disconnection Water: ( (see attached requirements) Electrical: Nl"t tg�j i/Fire: Cf Gam:'��t. 5'�$- )�f5- �7 Sewer: Salem Historical Commission: t/ Dig Safe Number: t/ Pest Control: ***DOCUMENTATION OF ALL THE ABOVE MUST BE ATTACHED BEFORE PERMITT CAN BE ISSUED*** Fee for Demolition: $5.00 for application plus$2.00 per 100 square ft.gross area,minimum$15.00 CITY OF SALEM a ') FIRE DEPARTMENT - FIRE PREVENTION BUREAU s Salem, Massachusetts 01970 PERMIT Date : In accordance with the provisions of Chapter 148, G. L as provided in Section 10A this permit is granted to rbrf, - Name _ `ti°"'� 1—`-,TAM �� �LV�IQ/1 Ira n®.d p.non. W=a c r flm 0. 1.d p.rmll) to conduct demolition operations per Salem Fire Code . State clecrly Massachusetts Fire Prevention Regulations and purposes for Massachusetts State Buildin which permit og Code. is granted Restrictions As per Klass. State Codes and City of Salem Ordinances. Clearance from Salem Historic Comnission. at b lAnd - ----IGI..-IxaUm .IrNI and w., . d..etlb. In such me..r m to—pe. 1 -ad.puel. Id.ntlllevlbn of 1m .l'- Fee Paid $_ t —aS. t�0 ,.of.umlal V.®Ib.y p..mn) This permit will expire IJ.) !)v' (THIS PERMIT MUST BE CONSPICUOUSLY POSTED UPON THE PREbUSM) Sri Form #29C of 5' ttlpm, Aussadjusettg Birr i9spartmrnt 3irabquartrra PRE-DEMOLITION APPLICATION FOR PERMIT in accordance with the provisions of the Salem Fire Code, and Salem Fire Code, and Salem Fire Prevention Regulation #29C made under the authority thereof; an inspection is requested of the proposed structure to be demolished, and a permit issued subject to the following rules or recommendations whych shall be complied with under provisions of the law. Owner of Land C,5i re2 Cow-'a R-�_ PAWe-YutG-s L-Lr Address of Project 2_1 1-171 C—hAwYl AVE �iA 7^C xnA- O i 9 ?n Inspection requested by: µ&,�,v,.•o Co>vtY� Address of Applicant G c,oDVIr 1. Per the Salem Fire Code this structure shall be demolished in a workmanlike manner under provisions of the Mass. State Building Code and the permit issued by the-Salem Building Inspector for said demolition. — — 2. All debris from each day's activities shall be kept apart from the basic structure and wet down at the end of each workday. No debris shall accumulate over twenty-four (24) hours at the site, and no more than twenty (20) percent of any one day's debris, at any time. 3. The use of City of Salem water shall be approved by the City of Salem Water Department or by use of a paid off-duty firefighter on watch. 4. The contractor shall have a current welding and cutting permit in effect. Use of said welding and cutting equipment shall be subject to the Salem Fire Prevention Bureau regulations. A paid off-duty firefighter fire watch may be required by the authority having jurisdiction in cases where it is deemed necessary, because of increased fire hazard. Failure to perform the operations in an approved workmanlike manner, may be cause for an imTediate "around the clock" fire watch by a paid fire departrrent detail. This shall be taken into consideration by all contractors and shall serve as notice of this regµirem=-nt. An advance p%ment ._ha1 . be recr'dr_=d whe: _,ered necessary for this fire watch. Applicant's signature sic-r✓ n.n C.eNs�-M.4+z�o� Fomt #29C (Rev. 9/77) 07/23/2007 NON 15: 60 FAX 9787451223 CENTERCORP RETAIL 0002/002 07/23/2007 16:09 7915927641 AIEXTERMINATORS PAGE 02/03 A Al Exterminators pest control professionals DATE: JULY 20, 2007 TO: BOARD OF HEALTH Ci /'Town of SALEM AT THE REQUEST OF: 276 HIGHLAND AVE LLC 600 LORING AVE - SALUM MA,. 01970 A RODENT CONTROL DEMOLITION SERVICE WAS 1711t1'ORMLD AT: 276 Ii1GHLAND AV13 SALEM MA 01970 THE PROPERTY SERVICED WAS: A COMMERCIAL. FROPERTY IF YOU HAVE ANY QUESTIONS, PLEASE_DO NOT kIE:,I'C:4'I'E TO CALL. SINC.E...RE-LY, A-Z EXTERAHNATwu 183 Shepard.9b ud Lynn,MA 0 1 9 02-4597 781-592-2731 $00-525-4825 781.592-7641 rax SMITH& WESSEL ASSOCL4TES,INC HAZARDOUSBUjWM MAMMAL AND AIR QUALrIYSPMALI AIR MONITORING AND RELATED SAFETY AND HEALTH PROCEDURES DURING ASBESTOS ABATEMENT PROJECT 276 Highland Avenue Salem, Massachusetts Prepared for: Terri L.Desjardins Director of Property Management _ Centercorp Retail Properties,Inc. 600 Loring Avenue Salem,Massachusetts 01970 Prepared by: Smith&Wessel Associates,Inc. 8 Church Street Merrimac,Massachusetts 01860 Project No.07230 July 23,2007 8 Church Street Telephone:(978)346-4800 Merrimac,Massachusetts 01860 FAX:(978)346-7265 CONTENTS SECTION PAGE 1. SUMMARY._............................._.......«._._....._.»««......._..»»._..._._....._._..._._._.._........._1 2. ABATEMENT SCOPE OF WORK....__._._«_._»....._.._......_........._...»_....................1 3. SAMPLING AND ANALYTICAL METHODS..........................«...._...»......._....._...............—1 4. HEALTH AND SAFETY PROCEDURES........_........._....... 2 ..._._»..—.........»««._._««..____...«....................._............. ._..««.....2 Appendix A: PCM Air Sample Results Appendix B: Daily Construction Reports Smith&Wessd Associates,Inc. SW A 07230 7/23io7 1. SUMMARY Centercorp Retail Properties,Inc.(Centemorp)retained Smith&Wessel Associates,Inc. (SWA)to monitor an asbestos abatement project located at 276 Highland Avenue in Salem,Massachusetts. This report presents the results of S WA's oversight during asbestos abatement activities conducted on July 18,2007. S WA's oversight included post abatement visual inspections and clearance air testing in the contained work area. In addition,area air samples were collected just outside the main entrance during the removal of window caulk. A Massachusetts licensed Project Monitor representing SWA was do-site to conduct the post abatement visual inspection and clearance air testing. A-Best Abatement,Inc.(A-Best)of Salem,New Hampshire, was the Massachusetts licensed Asbestos Abatement Contractor who performed the work. S WA's area and clearance air monitoring indicate that fiber concentrations were below the Massachusetts Department of Labor and Work Development,Division of Occupational Safety(DOS),clearance criteria of 0.01 fibers per cubic centimeter of air in the work area. Therefore,the work area was made available for occupancy by all personnel. No suspect visual debris was observed during the post abatement visual inspections. 2. ABATEMENT SCOPE OF WORK The asbestos abatement scope of work included the removal and proper disposal of the following materials from the building located at 276 Highland Avenue in Salem, Massachusetts: • Approximately 800 square feet of asbestos containing floor file and mastic adhesive • Asbestos containing exterior window caulking from the windows located at the front of the building 3. SAMPLING AND ANALYTICAL METHODS S WA's Massachusetts certified Asbestos Project Monitor Scott Howard,(Cert.#AM- 035814)conducted the area air sampling;post abatement visual inspection and clearance air testing. Air samples were collected onto mixed cellulose ester filters(0.8-micron pore size)in three-piece 25-millimeter cassettes aligned open-faced. The cassettes were tilted downward at a 450 angle and placed between three and four feet above the floor. Air was dmwn through the cassettes using high-volume sampling pumps. Immediately before and after the sampling periods,the sampling flow rates were calibrated using a precision Smith&Wessel Auodau ,Ian SWA 07230 Page 1 7/23/07 rotameter. Air samples were analyzed on-site by PCM in accordance with National Institute of Occupational Safety and Health(NIOSH)7400 Method,A-counting rules. SWA's Project Monitor utilized the Olympus CH-2 optical microscope at 400x magnification for analyzing the samples. The PCM method determines the total concentration of all fibers (not exclusively asbestos)that exhibit a length to width ratio of greater than three and are at least five microns in length. The PCM air sample results were compared to the Massachusetts Department of Labor and Workforce Development(MA DLWD)cleaner air criteria of 0.01 fibers per cubic centimeter of air(flee)following abatement activity. Results of all area and clearance air sample results are presented as Appendix A. 4. HEALTH AND SAFETY PROCEDURES A-Best prepared the interior abatement area by covering all critical barriers and walls with two layers of 6-mil polyethylene sheeting adhered with duct tape. A three-stage decontamination facility was constructed contiguous to the work area and was used as the only means of entrance and egress. Negative pressure was established in the work area relative to adjacent areas using High Efficiency Particulate Air(HEPA)filter equipped air filtration devices(AFDs). During abatement activities,access to the work area was limited to authorize personnel only. All personnel who entered the containment area donned appropriate personal protective equipment(PPE)and,before exiting,followed the required decontamination procedures. Removal of the asbestos containing floor tile and mastic adhesive was performed using chemicals and hand tools. The removal of the asbestos containing exterior window caulking was performed using chisels and other hand tools and disposing it directly into 6 mil labeled disposal bags. Prior to removing the caulking,A-Best placed polyethylene sheeting from the base of the building out 10'directly below the work area. After all ACBM were removed,complete cleaning of the abatement area was accomplished. This included collecting all visible debris and wet vacuuming the poly floor,all exposed surfaces and cleaning all abatement equipment. All ACBM waste was packaged into asbestos warning labeled 6-mil polyethylene waste disposal bags for transport to an approved landfill. Upon completion of all asbestos removal and fine cleaning in the interior containment area,S WA's Project Monitor performed a mandatory visual inspection to ensure that no suspect debris remained before performing post-abatement clearance air sampling. Following removal of the window caulking,S WA's Project Monitor visually inspected the window openings for any residual caulk. 5. DISCUSSION SWA's Project Monitor was on-site part time during the abatement activity to assure quality control and compliance with applicable state and federal regulations. Air samples Smith&Weisel Associata,Inc. SWA 07230 Page 2 723107 were collected and all determined to be below the 0.01 fibers/cc,the MA DLWD clearance criteria following abatement activity. Because successful inspection and air monitoring results were obtained,the work areas were cleared for occupancy by all personnel. Centercorp Retail Properties,Inc.should not consider the project complete until they receive all waste shipment records(WSR) documenting the proper disposal of all generated asbestos waste. All daily construction logs are attached as Appendix B. Smith&Wesel Associate,Ins SWA 07230 Page 3 723107 APPENDIX A PCM Air Sample Results Smith&Wend Awmietn,Inc. SWA 07230 7/23/07 Sampr SamINA olume Result e No. Date Petiters) Deaeriptioo/i oeedo. (fibera/ce) 1. 7/19107 NNA Field Blank 0 fibers/ I00 fields 2. 7/18/07 N Field Blank 0 fibers/ 100 fields 3. 7/18107 10:31,080 Clearance Sample,inside <0.004 tcontainment following floor tile12:0 and mastic removal4. 7/18107 10:31,080 Cleemnce Sample,inside <0.004 tcontainment following floor theI2:0 and mastic removal 5. 7/18107 10:48 am 1,080 Area air sample,outside by main <0.004 to entrance following window 12:18 p.m. Can remove] 6. 7/18107 10:51 am. 1,080 Area air astride,outside by main 0.005 In entrance following window 12,21 p.m. caulking removal Note:All samples were analyzed according to NIOSH 7400 Method. Analysts:Scott Howard Smith&Wessel Associates,Inc. SWA 07230 723/07 APPENDIX B Daily Construction Reports Smith&Wessel Associates,Ina SWA 07730 723/07 Bond expires 111/13/08— COMMONWEALTH OF,MASSACHUSETT I. .. lT;Y.OF �- w December 5`" 2006 Thisisiocertify-'thIt at,,rMeninno.,Gonstruction C,o. ' , 7ti Oakville st' "' OL905 is the holder of a DRAINLAYER -' December 31, 01127 License expihng CITY CLERK.' 'ATTEST', - Bond expires' j -y THE COMMONWEALTH OF MASSACHUSETTS U.S.A. i ; ¢uf s ri CfTY OF Sd1[ EIVf� " December 7 , 2006. - This is to certify that Mere nno construction Co. 7b Oakville S;t. , Lynn;.,MA 01905 ." k CONTRACVOPERATOR: is the holder of a Ii ehseexpirrg 'December 31, `20'07" E/fs ATTEST:: „ _ - e�' CITY CL RK c t \ v ,IIBoard of Building Regulations and Standards � Construction Supervisor License License CS 38388 I Blrttldate 771371961 TAf 439 i Ex�—jrati on 7%1372009 R 6ttncuon 0�. i I NICHOLASS MENINNOz ;�f��_ ,yam � I 76 OAKVILLE ST . - Commissioner LYNN.MA 01905 , 7 \ v ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID L DATE(MM/DD/YYYY) 1 MENIN-1 d 03 22 07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DeSanctis;,Tnsurance Agcy, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 36 Cummings Park ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Woburn MA 01801 Phone: 781-935-8480 Fax:781-933-5645 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Acadia Insurance Company INSURER B: Meninno Construction Co. , Inc. INSURER C: 76 Oakville Street INSURER D: Lynn MA 01905 NSURER 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. MidLTR USU TYPE OF INSURANCE POLICY NUMBER DATEYMM/DD/YY GATE MMP/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 LAILU A X COMMERCIAL GENERAL LIABILITY CPA007495215 03/15/07 03/15/08 PREMISESEzoccurence) 5250,000 CLAIMS MADE [�C] OCCUR MED EXP(Any one person) s5,000 X XCU Hazards PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY PRO- LOC X JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO (Ea accitlenQ ALL OWNED AUTOS BODILY INJURY A X SCHEDULED AUTOS MAA007495315 03/15/07 03/15/08 (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTYDAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGO $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 10,000,000 A X I OCCUR F_1C1_AIMSMADE CUA007495115 03/15/07 03/15/08 AGGREGATE $ 10,000,000 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND X TORY LIMITS ER A EMPLOYERS'LIABILITY WCA007495415 03/15/07 03/15/08 E.L.EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (MA) E.L.DISEASE-EA EMPLOYEE 1,000,000 Des descdbe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS Drain Layers License CERTIFICATE HOLDER CANCELLATION SALEM-3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City OP Salem DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Department Of Public Services NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 50 SHALL Bruce D. Thibodeau, P.E. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR 120 Washington St. , 4th Floor Salem MA 01970 REP NTATIVES. A IZED REP ESENTATIVE ACORD 25(2001/08) ©ACORD CORPORATION 1988 i MENINNO CONSTRUCTION CO., INC. 76 OAKVILLE STREET, LYNN, MA 01905 (781) 581-5333 FAX(781) 593-2070 E-MAIL: meninno.construction@verizon.net August 7, 2007 City of Salem Inspectional Services 120 Washington Street, 3rd Floor Salem, MA 01970 Att: Tom St. Pierre Re: Demo Permit Application 276 Highland Ave, Salem, MA Dear Mr. St. Pierre: Enclosed please find the following documentation with respect to demolition of a portion of the building located at 276 Highland Ave in Salem, MA: 1. Completed Demo Permit Application. 2. Completed "Demolition of Structures" form per Section 116.0. 3. Worker's Compensation Affidavit. 4. Debris Disposal Affidavit. 5. Demo Permit issued by Salem Fire Department on July 25, 2007. 6. Pest Control Certification dated July 20, 2007. 7. Asbestos Abatement report dated July 23, 2007. 8. Meninno Construction Drainlayer license and Contract Operator license, expiration of 12/31/2007. 9. Meninno Construction Insurance certificate, expiration of 12/31/2007. Please let us know if you require additional information. Once the documentation is approved and the permit is issued we will make ourselves available to pick it up. Sincerely, Thomas Pascuccio Cc: Nick Meninno