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0021, 0023, 0025, 0027 MARION ROAD - BPA-13-896 The Commonwealth of Massachusetts T ��Wfl VV 0 Department public Safety Massachusetts State Building lding Code(780 CMR) Building Permit Application for any Building other t a -or Two-Family w (This Section Section For Official Use:Onl - Buildfrig Permit Numb ' : "=E ' '� rDate Applied ' " -Bu ding Offici �. _ _ECTION 1:LOCATION($lease indicate Block#and Lot#for location for'w street address is available) S, 21, 3 i ZSi L7 %✓Ifaf nv SA S,4rn,tV4' 019'70 r r+nN /7rrit CoK/ 5 . No.and Street City/Town Zip Code Name of Building(if applicable) w. - -T - 'SECTION:2i 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❑ 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 ❑ Is an Independent Structural Engineering Peer Review required? p - wYes .❑ No i❑ Brief --j-rr r C 1A $oc. col$ rre> C- C/ D �r0 life, G/ /7' . NcO� l SECTION 3:COMPLETE:THIS SECTION IF EXISTING BUILDING.UNDERGOING RENOVATION,ADDITION„OR - - CHANGE IN USE"OR.00COOAl C& ...,'. 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:=HEIGHTANDAREA` - 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❑ 1 B: Business ❑ E: Educational ❑ F: Factor - F-1 ❑ F2❑ 1 H: HighHazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5 ❑ I: Institutional I-1 ❑ I-2❑ I-3❑ 14❑ 1 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: M- SECTION 6:CONSTRUCTION TYPE(Check As applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑- IV ❑ VA ❑ VB ❑ SECTION7:SITE INFORMATION(refer ta780'CMR 111.0 for details�oneach 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 Site❑ Private❑ or indentify Zone: or on site system❑ required❑or trench oFsspecify: permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA i-tistoric Commission Revicw Process: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ I Yes❑ or No❑ Yes ❑ No ❑ 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:;PROPERTYOWNERAUTHORIZATION' ",' ' Name and Address of PropertyOwner + Name(Print) No.and Street City/Town Zip Property Owner Contact Information: ' \ Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable, the property owner hereby authorizes 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 application. :, uSECTION 10 CONSTRUCTION CONTROL(Pleasefill out Appendtx2)'; jn, - ,.. _., .... .- e xr If bmldin �s less than 35,000 cu.ft:of enclosed-s ace and/oi notiihder,Constriiction�Conteol`then`eheck here.f]and'ski"Section 101) f 10.1 Re isterec Professional Res onsible for'Constrtictio"n Control - G ;( :Name(Registrant) Telephone No. e-mail address Registration Number .\ Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor(. . o - " + = q °• -,t, .+,._ .a. Fi�I�Rv GO // / �aC7rON GaR'P, Company Name p 13hc'JT 5 - �r�t/2y Q5�Y3 Vq /V 131Dr�5 (AjklReS7rr-`C'1r-of , Name of Person Responsible for Construction License No. and Type if Applicable X" ici Kp//rY, Ad SA/cv� _ 01MO Street Address - City/Town State Zip 1778, -y'°- ZG S Telephone No. business Telephone No. cell e-mail address _ IVORKERS'COMPENSATION,NSUCdANCCAFFIDAVIT M:G.L:&152: 25C6 - -'- ` SECTION'll � ' ' 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 12i'CONST).;UCTIONCOSTS AND PERMIT FEE Item Estimated Costs: (Labor and Materials) Total Construction Cost(from Item 6)_$ 1. Building $ .S_ 8aO Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ appropriate'municipal factor)_$ 3.Plumbing $ d. Mechanical (1-NAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ /3 y, Xvo (contact municipality)and write check number here .' SECTION 11,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 be of my knowledge and understanding. 13AWr s �M ,y S� °`�'`/ter- Vy Av _ ZG 38 Please print and sign name Title Telephone No. Date I4 Kt//ry RAO �iA� 1�t D/97& Street Address City/Town State Zip Municipal,Inspector to fill out this.section upon application approval ` Name 7 Date 1 I /yrr < CITY OF 5:1.CzNf. iti ks&S CHUSETTS BL'MOLNG DEPAILT-M&NT 120 C(/.UHLVGTON STREET, 3'O Roca TEL (978) 735-9595 I=.'.<(978) 740-93-14 f<1J[L3E.QLEY DRISCOIL NUYOIt T�lonu ST.PIEa" DuEcTOrt OF PLOLIC PROP EATY/BCILDLYG CONNISSIO,NER Construction Debris Disposal Affidavit (required for all demolition mid renovation work) In accordance will' the sixth edition of the State Building Code, 730 CMR section l t 1.5 Debris, and the provisions of rbIGL c 40, S 54; Building Permit k 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 NIGL c I 11, S 150A. The dehrs will be transported by: f r' i (name orliauler) The debris will be disposed of in : (rianic of facility) '5 w R e O SCo, / A�W J �1 laddrcs.c of r�eilil�) vynanua of permit applicant ur ^ ze % 13 Lime e4r CITY OF SAUE.NIa AL S&, CHUSETTS . BUILDING DEPAa-n -NT 120 W.lSHLNGTON STREET, Ya FLOOR F.ax(973) �1Q-98-f6 :<I.%tBEALEY DRISCOLL MAYOR IltosrAs ST.FtEaRs DIRECTOR OF PUBLIC PROPERTY/BUMOrNG CO\LMISSIONER 1Vorkers' Compensation rnsurance,%fiTdavit: Builders/Contractorx/Electricfans/PlumberI 1 r illeant tnG)rmatinn �r--- tease Pr(nt Le ibl Va1flC t DusinesnOryniradary Individual): L'a�I ERV CC1Ns7rk CTfO/y( Address: I g1 K-t City/State/Zip: 5.91 f^n Phone M: 977 kkc • Are you, employeel Check the appropriate bole type of project(required): I, am a employer with_�_ 4. 0 I um a general contractor and 1 employees(full aad/or part-time).* have hfrad the sub•v:ontractars 6, ❑Now construction 2.0 lain a sold proprietor or partner. listed on the attached shaeL t 7. 0 Remodeling ship and have no employees These sub-contractors have a. 0 Demolition working{ for ma In any capacity. workers'comp,insurance, (No workers'comp.insurance J. 0 We are a corporation and its 9' ❑building addition e)uired.J oMccrs have exercised thalr 10.0 Electrical repairs or additions J.❑ I sun a hameownerdoing all work right ofexempllun per GL 11.0 Plumbing repairs or udditions myself.(No workers'comp. C. 1 J2,e)1(4),and we have no 12.0 Roof copairs insuranea required.) t employees,(No workers' cump.insurance required. J IJ•QOther •,hnyappltvanl dnrvhaekabaxrI mulls w till uut thr uttiw trulawvhowing thrir warkeo'"M sadunpulley innm nallon, '1 hunvuwaTe who eulm'it this 41111dwis indicating they undoing all work andshea hire aoside canimeton moat mhmh a new amdaril indleadng ruck ('un'raenn that chvsk Chia Err mwtr ana<hud an aeeerlund rhsl showing the mmne of tkit rubedetraerun an"'half wurkan'sump Polley Infommtian, !sun a,e rrarpluyer that/s provld/nR tvorkrr�'covnpauaddn/ururanee for dry fnfururuNon. Burp/uyerse Below/s rAe pol/cy and Jub alb Insurance Company Vamr. GO f> I'uliry 4 or Scil}im. Lic. d_13 R6!G. 3 Y f y r> Expiration Dota• g �' !�, sZ e Z c,l`wav �j.,{Ql . JobSita.kdJress: ('rekG,,,, /�' (•(JyVJ�p Cily/State/2ip:_`c.?rs��.-a, /Y/� Much a copy of the arorlters'componsutloe pulley declaratldn 000(showing lhepolley number and expfratloe data). FJilura to secure coverage as required under.Suction MA of MGL c. IJ2 can lead to the imposition of criminal penalties of s tine up to SI,S0000 und/or one-year imprisonment,as well as civil penalties is(hit farm ofa STOP WORK ORDER and a lino of up to S_'J0.00 a dry against rho violator. Ile advlaed that a copy of ihissratement may ba furwarded to Iha OffTca oe Invcsligatiuns ui the DIA top insurance cuvcrago verilicaliun. /du/r�rrby errrlf n dropal pal, nd patio/r/sr of prr/ury r/mr rAe Lrfunnw/ou provided ubuae is tree wrJ cornea iUj/ic•ru!rue only. Ou our write in dr/r ufe,R ra be cuurplNed by dry ur lawn n/JIr/u( I Citynr'I'awn: Permir/i.lcensel 1-tilag,lullwrity (circlo unc): I. Iluurd of Health '. Iluihltri nep.lrhnmll I. Glyfra'vn Clerk 1. Electrfead lnvpcctnr i. Phunbint;' S. Olhcr —--- Larpacrnr Cunt ' n � .--- _ t Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supcn'isor License: CS-059344 n _ BRETT S EMERY 19 KELLY RD - SALEM MA 01990 t7� �� Expiration 09/25/2014 Commissioner V-`1DRIVER`S_LICENSE " F � KS31450790 'A F D9,25.2013 �9 2 ' P EST XGT UA56 SELL ` `, a. ..s i „ EN EMERY sort M r Mws N. ICN ETT S w a F 79 KELLY RD �° ^� CERTIFICATE OF LIABILITY INSURANCE °�'�(P�"5/28/ 5/28 13 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 INURED,the policy(les) must be endoreed. 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 erdorsemen PRODUCER uAMe: INGRID Benevento Insurance Agency Inc 7 1 599-3411 Fax N (781) 561-7200 PIaaE 497 Humphrey Street o�AEss: Swampscott, MA 01907 INSURE SAFFORDINGCONERAGE NAIC0 INSIIRERA:Commerce Ins Co INBIRED INSURBta:Guard Ins Co Emery Construction Corp. INSURER C: Brett Emery INSURER D: 19 Kelly Rd. INSURER E: Belem, MA 01970 INBURER 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 MAY 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 A L POLICY EFF Pml FLIP LM TYPE OFINSURONCE INSR WAD POLICY NUMBER fmMICDN WODYYYY LIMTS A GENERALLAMAJIN N BDSJRD 9/6/12 9/6/13 EACH OCCURRENCE $ 1,000.000 X COMMERCIALGEPERALLIABIUTY DAMAGE TO RENTED S 50,000 CtAIMSWADErx]OCCUR MEDE)VIAr ore Persw) $ 5,000 PERSONALS ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000.000 GEN'LAGGREGATE LIMIT APPUESPER PRODUCTS-ODMPIOP ADD $ 2,000,000 POLICY PRO, LOC $ MTOMOSILELMBILITY IN L a accitleN E ANYAUTO BODILY INJURY(Per Person) $ ALLOWIED SCHEDULED BODILY INJURY(Per a enp $ AUTOS AUTOS PROPERTY DAMAGE HIREDAUTOS _AUTOS ED eractlaern $ $ UMIREULAUAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION E B WORKERSCOIRIMMATIOIV BRWC341452 9/6/12 9/6/13 g WC STATU- OTH- MIAND EMPLOYERS'LIABILITY YIN YPROPRIETORIPARTNERIEXECUTNE 7NNIA E1.EFGHACOCENT $ 100,000 OFROERIMEMBER EXCLUDED? TIIaMabry In NH) E.L.DISEASE-EA EMPUCPYEE S 100,000 If ,mdesbiI,eander E.L.DISEASE-POLICY LIMB 500,000 DESC RIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (AVeM ACORD 1a1,Adlitlawl Renato Selreub,Nmora apaw breAUretl) Carpentry LOCATION 52 PICKMAN RD SALEM MA 01970 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN AMERICAN PROPERTIES TEAM, INC ACCORDANCE WITH THE POLICY PROVISIONS. ATTN JENNIFER PAPPAS 500 WEST CUMMINGS PARK #6050 AUTHORED REPIESENTATNE WOBURN, MA 01801 Bryan Benevento ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: b emery@comcast.net p American .Properties Team, Inc. ®® TO: Salem Building Inspector FROM: Jennifer Pappas, Senior Property Manager RE: Carpentry Work DATE: May 24, 2013 Please be advised that the Board of Trustees for Pickman Park have approved a carpentry project at 21, 23, 25 & 27 Marion Road and 2 Hart Way at the Pickman Park Condominiums. This work will be completed by Emery Construction Corp. Should you have any questions or require additional information, please feel free to call me directly at (781) 569-2675. 500 WEST CUMMINGS PARK-SUITE 6050- WOBURN -MA •01801.781-932-9229 -FAX 781-935-4289 American Properties Team, Inc. TO: Residents of 21 Marion Road FROM: Jennifer Pappas, Property Manager RE: 2013 Restoration Project DATE: May 23, 2013 As you may or may not be aware, the Board of Trustees has contracted Emery Construction Corp. out of Salem to perform the carpentry work on your building this year. Carpentry work at 21 Marion Road will start on Wednesday. May 29, 201.'3 (weather permitting) at 8 a.m. Specifically, work will start on the gable walls at 21A& 21D Marion. We would like to take this time to inform you that any interior items on an outside wall that are valuable should be removed in order to ensure that they will not fall off during re-construction. In addition, any valuables on your deck and/or your front/rear lawns should be removed and cars should not be parked in the driveways. Should you have any questions or concerns, please feel free to call your Condominium Coordinator at (781) 569-2626. 500 WEST CUMMINGS PARK-SUITE 6050- WOBURN -MA .01801.781-932-9229 •FAX 781-935-4289