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40 WARD ST - BUILDING INSPECTION (3) ,a The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Building Code(780 CMR)Seventh Edition City of Salem Building Permit Application for any Building other than a 1-or 2-Family Dwelling _ (This Section For Official Use Onlv) Building Permit Number: Date Applied: .O Building Inspector: 44 SECTION 1: LOCATION (Please indicate Block# and Lot# for locations for which a street address is not available) 4o wArJ S- , ;41�w C) -7 o No.and Street Citv /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 ❑ T Demolition ❑ (Please fill out and submit Appendix 1) Change of Use O 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 Reviewi requi red? 1 Yes ❑ No ❑ Brief Description of Proposed Work: SPQ if 1e t- -V- Mty d/.4 �onf5 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): S 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.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2r ❑ A-2nc❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ . ar'. ; T H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional 1-1 ❑ 1-2❑ 1-3'0 0-4❑ 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 ❑ IIB ❑ IIIA ❑ IIIB I 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 Pennit: Debris Removal: A trench will not be Licensed Disposal Site❑ Public ❑ Check it outside Flood Zone❑ Indicate municipal ❑ , required ❑or trench or NPecity: Pi va to ❑ or indentifv Zone: or on site se<tem ❑ permit is enclosed ❑ Railroad right-of-way: Hazards to Air Navigation: VA I li.tur1,L�nnmi��i�in Hoobw Pr....... Y - Not :\pplicabla ❑ 1 Is titruietum within airpnrt approach area:' Is their review completed? sir C nnseiil-IYr ISuild enclosed ❑ i Yes ❑ or:No ❑ Yes❑ .No ❑ SECTIONS:CONTENT OF CERTIFICATE OF OCCUPANCY LdiGon of Code: Use Group(s): Tx pe of Construction: Occupant Load per Floor: Dnes the building contain an Sprinkler System?: Special SGpu lations: 0CAK 7c)3��o�� SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Proper v Owner � C_,V r eaR�l f, u.e 2� wasG. i� e j # T w4 f� Mrt o2 4 S 3 Name(Print) No.and Street Cih/Town Zip Property Owner Contact Information: o �c Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable, the pn3perty owner hereby authorizes 5 Y- .Name - Street Address City/Town State Zip to act on the pro perty owner's behalf, in all matters relative to work authorized by this buildin, permit a p plicition. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) (If building is less than 35,0110 cu. ft.of enclosed s pace and/or not under Construction Control then check here O and Skip Section 10.1) 10.1 Registered Professional Responsible for Construction Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address Citv/Town State Zip Discipline Expiration Date 1-0.22 General Contractor Company Name: CS A O 1 -7 .. � .o. . , _ Name f Pe in rson Re sible for C6nsW,cti6n License No. and Type if Applicable o k� �l � A e /1 LAPc a2-j S3 Street Address City/Town State Zip - o3� a Telephone No. (business) ele hone No.(cell) e-mail address SECTION 11: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 O SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs: (Labor and Materials) Total Construction Cost(from Item 6) _$ c70 1. Building $ 5 5 O 0 Building Permit Fee=Total Construction Cost x_(Insert here 2. Electrical $ .Z D p p (--> appropriate mj cipal factor)_$ 3. Plumbing $ -2 a 4. Mechanical (HVAC) ," $ Note:Minimum fee= bhy(contact municipality) 5. Mechanical (Other)' $ Enclose check payable to 6.Total Cost $ 5 (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. Please print and sign name Tide Telephone No. Date Street Addess. Cih'/Town . to Zip Municipal Inspector to fill out this section upon application approval: A n e_-�Y Y 6 ame Date CITY OF S.U.ENf9 ,LASSACHL:SETTS BUR-DING DEPART.%M%4T 120 W-ASNINGTON STREET, 3w FtoOR TIEL (978) 74S-9595 K)SBEA EY DRISCOLL FAX(978) 740-9&M MAYOR THOnu ST.PMJLU DIRECTOR OF III BLIC PROPERTY/8CQDNG CO>MDSSlo.%Elt %Vurkers' Compensation Insurance AMdavit: builders/Contractors/Electricians/Plumbers Applicant Information PI Prin e .N21TId Busimw Or irmiomin kvtdual �� ( Address:_ /// ST City/Statc/I 1 yam- , heCZ�c 12 A„ Phone k:/-;W1-Akg- S amb Fam era employer?Cheek the appropriate boa: a employs witb _ 4. I am a general contractor and 1 Type of project(required): loyees(full and/or part-time).* have hired the subcornracton S• ❑ tew construction a sole proprietor or partner- listed on the attached shceL : 7. emodeling and Novo rw employees These sub-contractors have ing for me in any capacity, workers'co V. ❑Demolition workers'comp. insurance S. ❑ We arc a eon tnstua/tee. 9• ❑building addition ired. gwration and its 1 officers have exercised their 1 o.❑Electrical repairs or additions a homeowner doing all work rightorcxemption per MOL I I.Q Plumbing repairs or additions lf.[No workers'comp, c. 152.f 1(4),and we have no nce required.) t employees. [No workers' 12.0 Roof repairs comp. insurance required.) 1 J•❑Other 'Any applicant out chocta has el mrW alas UU wit the scan=below sla wins their worium,rartrpa+ttution policy infurmarloa 't I.v,teowrwra who subent this affidavit indicating they am doing21 work T.enra-fora that.hsk rho lqa mud anactgt an a,lditi,wad+hs ,howing Il,a and titstoe Nt6a.uauh=him outside�i rW�mum suhmil a new amdavit indicating wck racbn and ohc4 wwttwn'comp.policy information. /urn an enap/oyrr rhor h providing workers'compeftendan lnrrtronce fen ssy enrp/rryees Below(t fhe po!!ry aedJob rfp informwion Insurance Company Names � %G p.ic✓ r�� Policy M or Seir-ins. Lic. q: L J C 67� 2 Expiration Dare: Job Site Address:�66 ��Fl/!/ � . 0 /,j70 City/StatdZip:�9/PM fib' attack a copy of floe workers'required u satbn po8ry declaration page(&bowing the policy number and expiration data} Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of■ III up to S 1,500.00 and/or one-year imprisonment,as wall as civil penalties up to 5250 in the form of a STOP WORK ORDER and a fine .00 a day against the violator. lie a ,: tl that a copy of this statement may be forwarded to the OtTice of Inugmiuna ul'I he DIA for insurance covcmgo v¢ririticatiun. I"vca /do hereby c reify and r rho pains rm/ifes of perjury that the ftrfonnm/an provided above is true and correct Phu U iOflicia/oar mdy. Da roof write in rbir urea,lathe campfeted by wiry or rows n/fe•iaL City or Tusvn: Prrmit/Llccnse N I Ksuing Aulhonly(circle one): ---- -- 1. Ituard of Ileulth 2. Ruilding Depurtmene J. City/rown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other t-untact Person: — -- Phone p• CITY OF SALLM l s� PUBLIC: PROPRERTY DEPAR"I'�IENT \\' 'i".Y 'J: vi to Construction Debris Disposal Affidmit (rci uired lirr all don ' \ I uhta n .utJ renovation w ulk) Iit ace r u dance \\ith the sixth edition ul•the Stag Building Cole, 780 LAIR section 111.5 Dcbris, and the provisions of:- MGL c 40, S 54; Dui Wing Permit It is issued with the condition that the debris resulting from this work shall he disposed of in a properly licensed waste disposal lacility as deliued by MGL c 111. S 15UA. The dchri -ill be transported by: l name tit hauler) I he debris will be disposed of'in (name of laultly) LiJdreiv nl'gcdny) ap�atwc of p:Holt al•phcant lalr CITY OF SALEM DEPARTMENT OF PLANNING AND COMMUNITY DEVELOPMENT 120 WASHINGTON STREET SALEM, MASSACHUSETTS 01970 TEL: 978-745-9595 ♦ FAX: 978-740-0404 Kim DRISCOLL. MAYOR LYNN GOONIN DUNCAN, AICP DIRECTOR HOUSING REHABILITATION LOAN PROGRAM WORK WRITE-UP PROPERTY INFORMATION: Dan Botwinik Homeowner(s): Date: 1-Jul-09 REVISED 40 Ward St, Salem , M A (781) 589-4113 Prepared by: Cliff Ageloff Case#: Housing & Construction Consultant 1. LICENSE: The contractor must meet all local and State licensing requirements and be duly licensed. 2. INSURANCE: Contractor must show proof of adequate liability insurance and workmen's compensation coverage be provided. 3. PERMITS: The contractor must obtain all required building permits prior to starting work. Copies of the required permits must be submitted to the Housing Program. 4. CODE REQUIREMENTS: All workmanship must conform to the Program's guidelines, all applicable Massachusetts Building Code and local codes and must be of acceptable quality, as determined by the Housing Programs Inspector. 5. WORK AREAS: The owner must completely remove all furniture, stored items and other obstructions in the work areas identified herein. Items must be moved to a non-work area and covered by the owner or relocated to temporary storage as needed. Neither the Program nor the Contractor is responsible for owners' items improperly relocated during construction. Work can not proceed unless work areas can be freely accessed by the contractor(s) on a regular basis during the term of the contract. Failure to provide regular and unfettered access to work areas may be cause for contract termination. Contractors are responsible for verification of field conditions, measurements and quantities. Submission of a bid is presumptive evidence that contractor has evaluated all site conditions which pertain to the work herein. Permits and Permit Fees to be included in all bids. WORK SPECIFICATIONS for REPAIRS 7 Unit Multi-Family Building 1. Plumbing General Scope: 1. Provide and install new bathroom sink with faucet set, pop-up and new trap, shut-offs, drain, waste and vent to code 2. Provide new tub and tub surround; include new drain assembly 3. Provide and install new stainless steel kitchen sink and faucet set with new traps and shut-offs in coordination with installation of new base cabinets (specified herein) UNIT SCOPE ALLOWANCES SPECIFICATION 1 L Install bathroom sink and $110 sink; $70 faucet Wall-hung sink; vitreous plumbing to code or composite 1 R, 1 L Install new kitchen sink $110 sink; $70 faucet, SS Medium gauge sink and plumbing to drain, and Delta single-lever waste and vent to code faucet 1 R Install bathroom sink and $110 sink; $70 faucet, Vanity base, ply box and plumbing to code $100 vanity solid wood front HUD- compliant standard cabinet 2L Install new kitchen sink $110 sink; $70 faucet, SS Medium gauge sink and plumbing to drain, and Delta single-lever waste, drain and vent to faucet code 3 L Install new kitchen sink $110 sink; $70 faucet, SS Medium gauge sink and plumbing to drain, and Delta single-lever waste, drain and vent to faucet code 3 L Bath to be gutted to $110 sink; $70 faucet, Drain, waste and vent to frame $100 vanity, $340 tub code. Install S-96-2 Owner to provide bath Shower valve and low- trim and accessories flow 1.6 GPM head 3 R Install new kitchen sink $110 sink; $70 faucet, SS Medium gauge sink and plumbing to drain, and Delta single-lever waste, drain and vent to faucet code LOWER APT/ BSMNT Bath to be gutted to $110 sink; $70 faucet, Drain, waste and vent to frame $100 vanity, $340 tub code. Install S-96-2 Owner to provide bath Shower valve and low- trim and accessories flow 1.6 GPM head LOWER APT/ BSMNT Install new kitchen sink $110 sink; $70 faucet, SS Medium gauge sink and plumbing to drain, and Delta single-lever waste, drain and vent to faucet code 2 2. ELECTRICAL UPGRADES and REPAIRS for CODE COMPLIANCE 1. General 1.1 Provide 4 additional receptacles and switching in each apartment as noted 1.2 Provide and install GFI's where required by code throughout 1.3 Re-install all non-compliant wiring in basement 1.4 Upgrade panels as needed to accommodate scope of work; bid accordingly. UNIT SCOPE SCOPE SCOPE 1 L Provide GFI at Kitchen Provide wall switching for Install 4 additional kitchen lighting; 3 way receptacles to eliminate switches at entry points to overloading kitchen 1 R Provide GFI at Kitchen Provide wall switching for Install 4 additional kitchen lighting; 3 way receptacles to eliminate switches at entry points to overloading kitchen 2L Provide GFI at Kitchen Provide wall switching for Install 4 additional kitchen lighting; 3 way receptacles to eliminate switches at entry points to overloading kitchen 2R Provide GFI at Kitchen Install 4 additional receptacles to eliminate overloading 3 L Provide GFI at Kitchen Provide wall switching for Install 2 additional kitchen lighting; 3 way receptacles to eliminate switches at entry points to overloading kitchen 3 R Provide GFI at Kitchen Provide wall switching for Install 2 additional kitchen lighting; 3 way receptacles to eliminate switches at entry points to overloading kitchen LOWER APT/ BSMNT Provide GFI at Kitchen Provide wall switching for Install 4 additional kitchen lighting; 3 way receptacles to eliminate switches at entry points to overloading kitchen COMMON AREAS Repair non-compliant wiring in basement 3. MASONRY REPAIRS 1. Wok scope to include up to 800 SF of masonry restoration including raking out deteriorated mortar and install new mortar compatible with the existing brick and mortar 2. 18 Sills to be amended or replaced, sealed 3. Joint Sealant and Backer—up to 250 LF 4. Repair up to 8 existing concrete step and risers 4. Cabinetry and Countertops 1. Where specified above and in conjunction with the replacement of kitchen sinks, provide and install new HUD-grade base cabinets with plywood boxes and solid fronts. Provide base cabinets only throughout where indicated. 3 2. Provide and install new countertops; in laminate with finished and sealed wood edge 5. Interior Finishes —Walls, Ceilings, Floors as indicated by Unit# LOCATION REPAIR REQUIRED SPECIFICATION 1 L Provide and install new Repair sub-floor finished flooring in Install 12 x 12 VCT per bathroom manufacturer's requirements for preparation of sub-floor 1 L Stabilize loose and flaking Remove loose paint, prime and paint at interior paint to match existing 1 R Stabilize loose and flaking Remove loose paint, prime and paint at interior paint to match existing 2L Stabilize loose and flaking Remove loose paint, prime and paint at interior paint to match existing 2R Stabilize loose and flaking Remove loose paint, prime and paint at interior paint to match existing 3 L Stabilize loose and flaking Remove loose paint, prime and paint at interior paint to match existing 3 R Stabilize loose and flaking Remove loose paint, prime and paint at interior paint to match existing LOWER APT/ BSMNT Provide and install new . Use MR board in all moist gypsum wallboard for locations bathroom and new plastic . Insulate exterior wall tub-surround; provide and where accessed during install all finishes for all scope of work new surfaces in bathroom . Remove loose paint, prime and paint to match existing • Repair sub-floor • Install 12 x 12 VCT per manufacturer's requirements for preparation of sub-floor 6. Roof Repairs, General Existing membrane roof: 1. Install new capping and flashing as needed to extend roof life-span. Provide up to 100 SF of rubber membrane patch, 100 LF of capping and sealing means/methods. 7. Basement Unit—Code Violations 1. Repair floor section at door area 2. Repair door to make intact 3. Repair wall in Master Bedroom to make intact, paint to finish 4. Repair toilet and flooring in bathroom to stabilize both toilet and floor 5. Replace mechanical vent unit in bathroom with Panasonic Whisperlite or equal Energy Star bath vent 6. Provide operable screens for all windows where screens are currently missing or torn 7. Re-set water heater to provide domestic hot water temperatures are required by code (110 - 115F) 8. Repair leaks under kitchen sink 9. Repair or replace as needed damaged baseboard heating section where fin-tube and cover are crushed 4 10. Repair shelving (1 shelf) and secure all knobs (1) for kitchen cabinets 11. Repair all cracks in walls and make intact; paint to finish 12. Re-install thermostat in bedroom 5