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22 SUMMIT AVE - BUILDING INSPECTION (7)
e . The Commonwealth of Massachu;Editum "Dwelli, YSOY� r/ Department of Public Safety \la.,.achux•lls Stale Building Code(780 C%IR)SeventhCity of Salem Buildin Permit A cation fBuildin other than a 1- _\ (This Section For Official Use Only) (W^ Budding Permit Number: Date Applied: Budding Inspector: .� SECTION l:LOCATION 4Please indicate Block 0 and Lot 0 for locations for which a street address is not available) 'I 2 S V Y"1 M t ! f� S;AL.G M M A 199D No.and Street Citv /Town Zip Code Name of Building(it applicable) SECTION 2:PROPOSED WORK If New Construction check here O or check all that apply in the two rows below PNanlnde;p:eondent ildings Repair Alteration ❑ Addition❑ Demolition 0 (Please fill out and submit Appendix 1) Use ❑ Change of Occupancy 0 Other 0 Specify: plans and/or construction documents being supplied as pan of this permit application? Yes O No Strudural Enginrrri Peer Review required? Yes O Nu Brief Desc ript�io t of Prupoid Work: A. r wit � )��on u io X i2 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) 0 Existing Use Group(s): Proposed Use Group(s): r Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: 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.) SECnON 5:USE GROUP(Check as applicable) A: Assembly A-1 O A-2r 0 A-2nc❑ A-3 0 A4 0 A-5 O B: Business O E: Educational 0 F: Facto F-I O F2 0 H: Hi Hazard H-1 0 H-2 0 H-3 0 H-4 O H-5 0 1: Institutional 1-1 ❑ 1-2 0 1-3 0 1-1❑ M: Mercantile 0 R: Residential R-10 R-2❑ R-3 0 R-4❑ S: Storage S-1 0 S-2 0 U. utility 0 Special Use 0 and lease describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IAo IB ❑ IIA ❑ IIBo IIIA0 II/BO IVO VA VB0 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 d out>tde Flt..d Zone❑ Indicate mumapal❑ A trench will not be Licen. d Uis(xtal Site O 1'nvate 0 or mdcriuk Zone:_ or ran vtr>v.tem❑ required O or trench or.peYdv: permit t.enclosed O _ I Railroad right-of-way: Hazards to Air Navigation: (b\ Ih.n•n. ("..rtnnn..... I'rr..•..: \vt Ap)dtcable❑ I.5lnicture t ithnt aup..rt approach area.' I.their ref icty c,unpleted.' n'lnnvnl bi Hudd tncL...v1❑ 1e.0 ur Xu❑ Yes❑ \ t ❑ SECTION 8:CONTENT OF CERTIFICA TE OF OCCUPANCY I:dtli.mtC .dr -.--C+•l�nngtt.e rtpv.n(.ntsrucuon: Occupant Load per l loor I>,n-.the hud.l u+y,:anlam an tipnnkh•r}t dem': (betel?Itpul.tbunv V SECTION 9: PROPERTY OWNER AUTHORIZATION 'P Nameaml Addresspt Pruperh_•Owner 9 < �V/VIM:s F'fAU lf)�✓C� mu, �cSUhnv� J�h+3� Name(Print) No.and Street City/Town Lip Pro;wrh•(honer Contact InformAtion: Title Telephone No.(business) Telephone No. (cell) e-mail address I(.tp iicible,the pmprrth•owner hereby authonzrs �� nPL Cv.as: ray_ `f b :S«p,�n� s. m H b /9yf Name Street Address Citv/Town State Lip to act on the +ro eriv owner:behalf,m all matters,relative to work authunzed 6 this building permit a plication. SECTION 10.CONSTRUCTION CONTROL(Please fill out Appendix 2) (If building is lass'than 35,tsa)cu.it.of arck+vd s ace and/or not under Construction Control then check here O and ski SMiun I0.1) 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 'T' "ra t7 7 l57f Na (z r of Person Respmxi_blp fur C�u�structiun (� License No. and Type if Applicable Na net L�1k —L Street ddre s City/Town Slate Zi /^ 3 7� cx�z t <�I��P.x rJ �s, Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.15L ra 2SC(6)) A Workers Compensation Insurance Affidavit from the MA Department of Industrial Accidents most 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 O No O SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) I Total Construction Cost(from Item 6)=s �in 1. Building I S co I Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical is appropriate municipal factor)=s 3.Plumbing s 4.Mechanical (HVAC) $ Note:Minimum fee=s (contact municipality) 5. Mechanical (Other) s Enclose check payable to 6.Total Cost $ Cal (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By Avring y name bt(Io ,I hereby attest under the pains and penalties of perjury that all of the information contained in this ap ilica in d ur}t n .lV,f my knowledge and undrntanding. 19e.t.e rant and��gn name title relephone No. Date 4l � S 1-i� 'weet lddns ( Itvr'Toa n State Lip l � Municipal Inspector to fill out this section upon application Approval: (v \a r I>o CITY OF S.UX.%I, \fLXSSACHL'SETTS BUILDINGDEPAR OUNT a I-V WASHINGTON STREET,3"FLOOR Ter- (978)745-9595 FAx(978) 740-9946 KISBERj.EY DRISCOI-I. ;MAYOR T14ONW ST.PIERRFL DIREC[OR OF PUBLIC PROPERTY/BUI DLNG COMMISSIONER Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /1 Please Print Legibly Name(Business organizatioN /'lndividual): l o 'n`1/�"E' 1�-`A k c o/ j s 1 � Address: W b 14 E-06 P-Dt - i CitY/State/zip:n,AAYZ W e 4 eX Mom° ` /-phone : 7 9- 1- 6 3 9- 0 6 77 Are you an employer?Cheek t appropriate box: Type of project(required): Lod i am a employer with iL 4. I am a general contractor and 1 6. ❑New conswction employees(fitll and/or part-time).* have hired the subcontractors 2.0 1 am a sole proprietor or partner- listed on the attached sheet: 7. A9 Remodeling ship and have no employers These subcontractors have 8. ❑Demolition working for me in any capacity, workers'comp.insurance. 9. ❑Building addition (No workers'comp,insurance 5. We am a corporation and its exercised their 10.❑Electrical repairs or additions required.] officers have 3.0 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.(No workers'comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.)t employees.LNo workers' 13.0Other comp.insurance required.] `Any applicant that ducks boa#1 must also HII ma the section below showing their woken'compunction policy inrumtatton. t I lomewmas who submit This affidavit indicting they as doing all work nod then him outside mnnactms must submit anew affidavit indicating such. :C.muacton that duck this bon most anwhed an additional than showing the came of the submntmcrors and their wortorr'comp.policy information, I am an employer that Is providing workers'compensaton lnsurancefor my employees. Below Is the pefley and job site information. Insurance Company Name: V A R- �. Policy q or Self-ills.Lis M GO yI C— 119 / / 'S Expiration Date: © S D. S L Ql a Job Site Address: 2 l� \M, 7' 1� 11 City/State/Zip. S!� G n'1 (1 V/3 // Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure m secure coverage as required under Section 25A of Mill.c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprismimeM as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 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. I do hereby cerdj n the palas and penaties ojperjary that the ftejormadon provided above Is true and correct $immure: � L�/� Date: 01Sl I Phone X: 7 O l t (03 /Q "- Q EJ 7 / DjTicial use only. Do not write in this area,to be completed by city or town of w&L City or Town: Permit/License q Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityffown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M CITY OF S.U.EM, -NL LA sS.kCHUSETTS • BUILDING DEP{RT.%M%T 130 WASHLNGTON STREET, 3�F1AOR TEL- (978) 745-9595 FAX(978) 740-9846 1CI\iBERLEY DRISCOLL �1AYOR T�IoatAs ST.PsFxaH DIRECTOR OF PUBLIC PROPERTY/BUILDLNG CONMUSSIONER 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: Ca 2 a (LA /, Coa,% r, .--r-/OC. (name of hauler) The debris will be disposed of in : (name of facility) ✓� SC o i t 5� l�,n-� Mt-3 (address of facility) signature of permit a plicant date dcbrivlT.dk: CORPORAL CONSTRUCTION INC. 22 HIGHLAND TERRACE MARBLEHEAD, MA 01945 DATE 6/20/2010 BILL TO SUMMIT PLACE CONDO ASSOCIATION 22 SUMMIT AVE SALEM,MA 01970 PROJECT 3rd fl roof deck WORK DATE LABOR HOURS RATE LABOR&MATERIALS AMOUNT 8,980.00 Corporal Constriction Inc.does propose to provide the 8,980.00 labor and materials needed to replace the third floor roof deck. Proposal is providing the existing-rubber roof does not need to be replaced. The existing wooden deck and rails will be removed and will be disposed of. The damaged side wall shingles will be removed. Grace Ice and Water Shield will be installed over any exposed sheathing. A new roof deck will be f-amed.using pressure treated 2x4 lumber. Roof deck not to exceed the exterior wall of the building. Lattitudes decking will be installed A Cedar railing system,m;4�will be installed to a height of 42 inches. A wooden railing system would be more structurally sound on the third floor deck. The exposed side walls will have new Cedar shingles installed Pre Primed. All construction and demolition debris will be removed from the site and will be disposed of properly. Once the existing deck is removed the roofer will inspect the rubber roof and make his recommendations on how to proceed. THE ABOVE PROPOSAL IS AN ESTIMATE ONLY. THE EXTENT OF DAMAGE UNDER THE EXISTING DECK IS.UNKNOWN AT THIS TIME, rast>�-� ,r�aint.�vir>ia ��i/ram✓erg WE APPRECIATE YOUR BUSINESS!!! Total $8,980.00 The above estimate does not include changes requested by the customer or unforseen / difficulties in completing the project. ( r License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR _ before the expiration date. If found return Registration: 128173 Board of Building Regulations and Standards Ex Oration: 314/2011 Ty1 281426 One Ashburton Place Rm 1301 - --Type: :Private Corporation Boston,Ma.02108 CORPORAL CONSTRUCTION DANIEL LEBLANC. " 22 HIGHLAND TERRACE MARBLEHEAD,MA 01945 Administrator Not valid without signature Vml, :Wl .�.nnnsuuuuo i ZIOZILIE :uoperldx3 .�•r� �� 9b610 VIN 'GV31-13188VA r ONV1831 1131NVU OO :01 pap"Isaa WILL SO :asuaoll li asuaoll JoslAradns uol3onj;su00 slmr.purrs pur suunr.InT�ia :u!PI!n8 do p.neo8 S�ij iWlr.j ni{yad.tu luawl.nsdad -sllisnyIV"W C �.