41 LAFAYETTE ST - BUILDING INSPECTION o /10
-0 \ The Commonwealth of MassachusaYS`` l t
Department of Public Safety $ ��
J Massachusetts State Building Code(780 CMR)' 181)1 SEP IR A
—4 Building Permit Application for any Building other than a One-or Two-Family Dwelling
1� (Chis Section For Official Use Only)
Building Permit Number: Date Applied: - Building Official:
b SECTION 1:LOCATION (Please indicate Block#and Lot#for locations for which a street address is not available)
/ el
No. and Street City/Town Zip Code Name of Building(if applicable)
SECTION 2:PROPOSED WORK
Edition of NIA State Code used� If New Construction check here❑ or check all that apply in the two rows below
Existing Building M" Repair❑ Alteration B/ I Addition❑ 1 Demolition &K(Please fill outand submit Appendix 1)
Change of Use VChange 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[eer Review required? rz Yes ❑ No
1 Brief Description of�P,/(oposed Work:- L D ti +Z ,e 't 7�-T*,foo 1
/�J/✓l LO 0 V 'ems O
H L h
SECTI 3: NAE
TE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,Oil '
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CNIR 34) ❑ �I
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories (include basement levels)&Area Per Floor(sq.ft.) c t
Total Area(sq.ft.)and Total Height(ft.) - d b
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2 VNightclub ❑ A-3 ❑ A-4❑ A-5❑ I B: Business ❑ E: Educational ❑
F: Factor F-1 ❑ F2❑ H: High Hazard H=1 ❑ F1-2❑ H-3 ❑ H-4❑ H-5 ❑
I: Institutional 1-1 ❑ 1-2❑ 1-3❑ I-4❑ M: Mercantile❑ R: Residential R-1❑ R-2❑ R-3❑ R-4❑
S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use ❑ and please describe below:
Special Use:
SECTION 6:CONST UCTION TYPE(Check as applicable)
IA ❑ IB ❑ IIA ❑ IIB IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑
SECTION 7:SITE INFORMATION (refer to 780 CMR 111.0 for details on each item)
Water Supp�.y: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal
Public L Check if outside Flood Zone❑ Indicate municipal %� trench w I not be Licensed Disposal Site
required or trench or specify:
Private❑ or indentify Zone: or on site system❑ permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: NIA_ttunrzic C:onnousion Pevi w A'nvoss:
Not Applicable M/ Is Stricture within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes ❑ or Nov Yes ElNo (IY AA
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code:_M _ Use Group(s): f6l - '7� Type of Construction: _LZ Occupant Load per Floor:
Does the
building contain an Sprinkler System?: Special Stipulations:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Ow ier
T C fA Th
Name (Print) No. a d 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.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
[f building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1)
10.1 Re istered Professional Responsible for Construction Control
Na e(Regstra�t Tel!=N e No. e-mail ac ss Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
Con nv Nan
�C C�9 r C-15 - �(WZY
Mime of Person Rsponsible for Construction I ^ A�License No. and Type if p licable
Street Address City/Town,�pI State Zip
�
� -5� "762_1_ �t1,4�c11 ��N 9 CCDM
Telephone No. business - Telephone No. cell) e-malYaddress
SECTION 11:I%IORK6RS"COMFIFNSATLON 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 0 No 0
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs: (Labor
and Materials) Total Construction Cost(from Rem 6)_$
1. Building $ O Building Permit Fee=Total Construction Cost x (Insert here
2. Electrical $ 00.) appropriate municipal factor)=$
3. Plumbing $ dvJ
d. Mechanical (HVAC) $ 1j Opp Note: Minimum fee=$ (contact municipality)
5. Mechanical (Other) $ otmN Enclose check payable to
6.Total Cost $ (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 pi int and sign name Title Telephone No. Date
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval:
Name Date
Commonwealth of Massachusetts
a City of Salem
m 120 Washington Sl,3rd Floor Salem,MA 01970(978)745-9595x5641 ,
Return card to Building Division for Certificate of Occupancy
Permit No. B.16-753
FEE PPERMIT TO BUILD
AID: $170.50
DATE ISSUED: 7/13/2016
This certifies that JCH RTY TR/HOOPER JEFFERSON C/O SALEM LAUNDRY
has permission to erect, alter, or demolish a building _- 41.LAFAYET,TE STREET Map/Lot: 340429-0
as follows: Other Building Permit DEMOLITION & REMOVAL OF: ALL WOOD NON-BEARING WALLS.
APPROX 2800 SQ FT ASPHALT, COBBLESTONE & CONCRETE FLOORING
Contractor Name: KENNETH J DEVINCENT
DBA:
Contractor License No: CS-101958
7/13/2016
Building Official , ' Date
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six'months after issuance.The Building Official
may grant one or more extensions not to exceed six months each upon written request.
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. -
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same. y -
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit - -
HIC#: "Persons contracting with unregistered contractors do not have access to the guaranty fund'(as set forth in MGL c.142A).
Restrictions: r
Building plans are to be available on site.
All Permit Cards are the property of the PROPERTY OWNER.
OONaI'p Commonwealth of Massachusetts C '
A Citv of Salem 19
120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641
Return card to Building Division for Certificate of Occupancy ki
Permit No. B-16-1060 PERMIT TO BUILD
FEE PAID: $1,804.00 P,it
DATE ISSUED: 9/26/2016 Cy
This certifies that JCH RTY TR/HOOPER JEFFERSON C/O SALEM LAUNDRY
has permission to erect, alter, or demolish a building 41 LAFAYETTE STREET Map/Lot: 340429-0
as follows: Tenant Fit-up NEW RESTAURANT IN UNIT 2
TO INCLUDE DEMO OF EXISTING PARTITIONS, FLOOR, PLUMHING, OVERHEAD DOORS,
WINDOW, ADD NEW FURNISHINGS, TOILET ROOMS, WALLS, SEATINGS, CASEWORK, KITCHEN
EQUIPMENT, ETC. PLUS ADD MEZZANINE ABOVE TOILET ROOMS FOR STORAGE & PRIVATE
OFFICES.
Contractor Name: MICHAEL BRODERICK
DBA: BRODERICK CONSTRUCTION O14e
Contractor License No: CS-101128
11-00: _ 9/26/2016
Building i ' Date
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official
may grant one or more extensions not to exceed six months each upon written request.
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same.
The Certificate of Occupancy will not be issued unfit all applicable signatures by the Building and Fire Officials are provided on this permit.
HIC#: "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A).
Restrictions: fie