59 WARD ST - BUILDING INSPECTION -5 3
RFCFIVEP
The CommonwealtfiMAH60ev&b
Department P Safety_
Massachusetts State Buu ildWj:M10: 2
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only)
Building Permit Number: Date Applied: Building Official: I.
SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street addrfWs is not available)
r1R %4/AV-o M Sat_t;rl
No.and Street City/Town Zip Code Name of Building(if applicable)
_ SECTION 2•PROPOSED WORK
' Edition of MA State Code used STN- If New Construction check here❑or check all that apply in the two rows below
C� Existing Building Repair I Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1)
J Change of Use ❑ 1 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? Yes ❑ No�,'
Brief Description of Proposed Work: gA n1 'rL ...nJp- +'r�1T��F N _A}ni v i W s nl Ao u-/
2GP6A V wtFA/T—
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s): 57 —
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-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ H: Hi Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional I-1❑ I-2❑ I-3❑ 1-4 O 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 ap licable)
IA IBO IIA ❑ IIB ❑ 111A0 I1111 ❑ 1 IV [3 1 VA VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
i Permit Debris Removal:
Water Supply: Flood Zone Information: Sewage Disposal: TrenchLicensed Disposal Site[3Public Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be P
Private❑ or indentify Zone: or on site system❑ required❑or trench or specify:
permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable K Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ or No K Yes❑ No A
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): 12`Z Type of Construction:7jG Occupant Load per Floor:
Does the building contain an Sprinkler System?:—ALQ Special Stipulations: NO ai=
1�4 cl�wzY� sf-\i0 "fv,lhtt_ ..� i Mitt r�J
C°C�tQ. �@v� Y"ecEy
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
UNii Ylt 611-920
Name(Print) No.and Street City/Town Zip
Property Owner Contact Informati n: I/�
� Mlr�-R&c �IA2��i�lek � � '� �VIIiKE f�121�L Ey►1r4fL,�d
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
/ —
(��,.! lTrnPa.r E Z '4�12 L\ n -�n -���ar< mr�f -0
Name Street A'dress Cfty/Town State 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)
building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 0 and skip Section 10.1
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
102 General Contractor
.Dl=/ C=D DF5T4^) 4ND LOAISTIZ✓CGXx OAJ
Company Name
?—�-/y' �mr-Ai�--z foNsrrz,,&T-,XnoN suPER.Ur-sop,
Names of Person Responsible for Construction License No. and Type if Applicable
-4-12. A A✓&i 2. � Aya �-f Y L2 PAe K —AfA o Zl3
Street Address '�— City/Town State Zip
617-13 5g61 gLg- S25_ i/ri;irr ,nG-Zdd r;n�Z ho6mci • c n
Telephone No.(business) Telephone No. cell �y e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT .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 0
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ Zoo Building Permit Fee=Total Construction Cost x_(Insert here
2.Electrical $ p appropriate municipal factor)_$
3.Plumbing $ l000. 6)
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipali>>
5.Mechanical Other $ Enclose check payable to f�L rV
6.Total Cost $ J✓ ,� (contact municipality)and write check number here
SECTION 3: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 Title Telephone No. Date
4RZ & /-l�Jo1on ,Avg ar ar/•; -NM oz134
Street Address City/Town State Zip'
Municipal Inspector to fill out this section upon application approval: �o/�-c / /
Name 15ate
DEL CID DESIGN AND CONSTRUCTION
TEL.617 833 5959
WWW.DELCIDDC.COM
Arlreement for the Provision of General Contractor Services
Ely Jimenez Del Cid & Ortega Brothers Client: VmMGkIAvt-
Del Cid Design and Construction
492A Huntington Ave
Hyde Park MA 02136
Date: November 24, 2015 Project Name: 56 Ward Street, Unit 4A
Location: 56 Ward Street, Unit 4A
Salem, MA 01970
Scope of Work:
Bathroom Area; remove all drywall, including walls around the tub, insulation,
bathtub, vanity, toilet, light fixtures and existing plywood subfloor.
rebuild bathroom area; remove and/or repair all rot floor joist, cure wood to
prevent mildew, installing new insulation, drywall and durock around the tub area.
Install ceramic tile on floor and around the shower. Installing new light fixtures
wood mouldings and paint.
Bedroom Area: one wall and partial ceiling drywall, install sheetrock, tape,
plaster, sand, prime and paint only.
Living Room: repair drywall where necessary, remove/install existing window,
replace rotten wood, (note: window included)
upgrade bath electricity
replace plumbing fixtures like bathtub, sink vanity and toilet
materials by owner, general contractor is responsible for pick and delivery, only
Fees:
Total Amount: $ 10,000.00
Fee Arrangement
I. Per this agreement the total contract amount of$10,000.00 will be split into three (3)
payments. An initial payment of$3,350.00 must be given at the commencement of the
project in order to begin any work. A second amount of$3350,000.00 must be given
when the project is at a 50% completion rate. And the final payment of$3,300.00 must
be provided at the end of the project.
Additional Provisions
Page 1 of 2
I. Any additional work will be charged at an hourly wage of$39.50 per hour, regardless of
the type of work.
Prepared by: Del Cid Design and Construction
Offered by: *ptedsignature date dare
Daniel Orte 2015By Jimenez Del id 2 1515
Pdnted name/titre Pd d name/titre
Page 2 of 2
E COMMONWEALTH OF MASSACHUSETTS
CITY OF LYNN µ INSPECTIONAL SERVICES DEPARTMENT
�a a
ZONING REVIEW CHECKLIST COMMERCIAL
Address:
Zoning District:
Conforming?
Current Structure: ❑Yes ❑ No
Current Use: ❑Yes ❑ No
Proposed Structure: ❑Yes ❑ No
Proposed Use: ❑Yes ❑ No
❑ Special Permit Required from Lynn City Council
Dimensional Requirements:
Dimension Required Provided Conforming?
Lot Area ❑Yes ❑ No
Frontage ❑Yes ❑ No
Front yard setback ❑Yes ❑ No
Right side setback ❑Yes ❑ No
Left side setback ❑Yes ❑ No
Rear setback ❑Yes ❑ No
Stories ❑Yes ❑ No
Height ❑Yes ❑ No
Building Area% ❑Yes ❑ No
Parking Spaces ❑Yes ❑ No
Open Space% ❑Yes ❑ No
Floor Area Ratio ❑Yes ❑ No
❑ Project Approved
❑ Project Conditionally Approved as Special Permit Required from Lynn City Council
❑ Project Disapproved: ❑ Dimensional Variance Required ❑ Use Variance Required
Inspector's Signature Date
Comments:
l
• CITY OF LYNN MASSACHUSETTS
Inspectional Services Department
T Room 401,Lynn City Hall, Lynn, MA 01901
p. 781-598-4000 —f. 781-477-7031
Website: www.lynnisd.com
WASTE DISPOSAL AFFIDAVIT
Name of Applicant l— J
Firm Name(if applicable) 'C! CT-
Address 51 A P D S'r M.4 ep l q 7O
Telephone Number ( 033 _ 5 q,5
As a result of the provisions of MGL c40, §54, I acknowledge that as a condition of Building Permit Number
all debris resulting from the construction activity governed by the Building Permit shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL c 111, § 150A. I certify that I will
notify the Building Official(two months maximum), of the location of the solid waste facility where the debris resulting
from the said construction activity shall be disposed of and I shall submit the appropriate form for attachment to the
Building Permit.
The debris will be disposed of at the following location:
CjXANTS GOMPA'Vr, VVC-
Facility City/Town N�/j�r i-AR-K P-8'AD J:Q HE MR
Facility Address 26 W0&r-oTT 1 12 FAP� • )30X 51 FAPV-r M/} 0z1.3`�
Type of container to transport debris(check one) Truck Dumpster
i an Date
BUILDING • PLANNING • HEALTH • ELECTRICAL • GAS PLUMBING MAINTENANCE
.,
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
1 Congress Street,Suite 100
Boston,MA 02114-2017
U1V www massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leelbly
Name(BusinesslOrganizatiorinndividual): -Dr- L C r 1:> 1�asr! ry � 6 nl STSZU C 'TL01 i
Address:4 2 A Nv tl tza\J c)ronl A y E
City/State/Zip: gjnE Yjw=K tjA_0111(pPhone#: l+} — 8 3 —5
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contrwors
2.WI am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
working for me in any capacity. employees and have workers' y ❑ Building addition
[No workers'comp. insurance comp. insurance.t
required.]
5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.]t c. 152,§1(4),and we have no 13 ❑Other
employees. [No workers'
comp.insurance required.]
*Any applicant that checks box RI most also till out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContmctom that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the subcontmctors have employees,they most provide their workers'comp.polity number.
I am an employer that is providing workers'compensation Insurance for ary employees. Below is the policy and Job site
Information.
Insiuvace Company Name: GG
Policy#or Self-ins.Lic.#: E7 S6 Z( 11R- ���� �� Expiration Date: D 5 — Z 6— Z0 16
]ob Site Address: 5q VNAV-C ST City/State/Zip: 0 Iq r V
Attach a copy of the workers'compensation policy declaration page(showing the policy number and ex iratiou ate).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$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 hereb certl under the mins and enables of perjurythat the Info provided above is true and correct
Signafore: Date
Phone#
Official use only. Do not write In this area,to be completed by city or town offlciaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Cityfrown Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
01
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for thew 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 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 Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space 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 fill in the permit(license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license 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 file for future permits or licenses. A new affidavit must be filled 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 bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
\ Office of Investigations
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext 406 or 1-877-NlASSAFE
Fax#617-727-7749
Revised 7-2010 www.mass.gov/dia
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Supercrsor
License: CS-107721 ¢
ELY JIMENEZ ;
492A HUNTINGTON
Hyde Park MA 02136 � M
Jam„ Expiration
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Commissioner 04/18/2018
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Office of Consumer Affairs&Business Regulation
A"IME
IMPROVEMENT CONTRACTOR
stration < 96 Type:
ration - Individual
ELY JIMENEZ f" I t''
ELY JIMENEZ
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492 A HUNTINGTON A� �Q� y
HYDE PARK,MA 02136
Undersecretary
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01/04/2016 11:16 7815968634 BARMACK AND BOGGS PAGE 01/03
facsimile transmittal
To: Harry Fax: (978)740-9846
From: Michael P. Martel Date: 1/4/2016
781-799-8826 (cell phone)
Re: 56 Ward Street Pages:
Unit 4A 2
Permit Application
Notes:
This is in reference to the permit application submitted by Ely Jimenez Del Cid for repair to be
done at 56 Ward Street, Unit 4A.
Harry from your office called me last week requesting a letter from the condominium association
acknowledging that it has been advised of the scope of the repairs to be undertaken. That letter
is attached as requested.
I can also advise the City that I.have directly notified each individual owner in addition to the
association.
Could you advise if you require additional information or documents in order to issue permits?
Thank you for your cooperation.
01/04/2016 11:16 7815968634 BARMACK AND BOGGS PAGE 02/03
facsimHe transmittal---
To: Harp Fax: (978) 740-9846
From: Michael P. Martel Date: 1/4/2016
781-799-8826 (cell phone)
Re: 56 Ward Street Pages:
Unit 4A 2
Permit Application
Notes:
This is in reference to the permit application previously submitted by Ely Jimenez Del Cid for
repair to be done at 56 Ward Street,Unit 4A.
Harry from your office called me last week requesting a letter from the condominium association
acknowledging that it has been advised of the scope of the repairs to be undertaken. That letter
is attached as requested.
J can also advise the City that 1 have directly notified each individual owner in addition to the
association.
Could you advise if you require additional information or documents in order to issue permits?
Thank you for your cooperation.
01/04/2016 11: 16 7815968634 BARMACK AND BOGGS PAGE 03/03
56 WARD STREET CONDOMINIUM TRUST
56 Ward Street
Salem, MA 01970
December 30,2015
City of Salem
Board of Health
Salem,MA 01970
RE:Association acknowledgement of Repairs
Unit 4A
Dear Sir/Madam:
The 56 Ward Street Condominium Trust has been advised by Michael P.Martel
the owner of Unit 4A that there will be repairs occurring in that unit in the near fixture.
Both the association and other individual owners have been advised that there will be a
remodeling of the bathroom and other minor repairs occurring.
Feel free to contact me if you have any questions or wish to discuss.
� yo
Cha 1,Trustee
781-799-8826
Christopber Knight,Trustee
56 Ward Street,Unit 2A
Salem, MA 01970