156-158 LAFAYETTE ST - BUILDING INSPECTION V \ The Commonwealth of Massachusetts
Board of Building Regulations and Standards Town of
Massachusetts State Building Code, 780 CMR, T"edition Budding Dept
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One- or Two-Fmnih'Dwelling
is ction For Official Use Only
(� Building Permit Number: Dale Applied: '
\� Signature:
Building Commissioner/I pectorof Buildings Date
SECTION 1:SITE INFORMATION
1.1 Adds: \ \ 1.2 Assessors Map& Parcel Numbers
Mn�'J So \ c c- - CP
I.I s Is this an accepted street?ycs_,2Q no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(I1)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Public❑ Private❑ Check if yes❑ P p y
SECTION 2: PROPERTY OWNERSHIP'
2 1 Owner of Record:
\91p�� 7fh r -I,oe e \S( \5% k-A
Name(Print) Address for Service:
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ I Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work':
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item Labor and Materials
1. Building S 1. Building Permit Fee: E Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost(Item 6)x multiplier x
3. Plumbing 5 2. Other Fees: 5
4. Mechanical (HVAC) S List:
5. Mechanical (Fire $ Total All Fees: S
Su ression
Check No. _Check Amount: Cash Amount:_
6. Total Project Cost: S ,cP 13 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) ��,:��y ,� '4 1-JA3�
L
License Number Expiration Date
Name of CSL-Helder List CSL Type(sec below)
Address/) T Description
I U Unrestricted(up to 35,000 Cu. Ft.)
SignatureR Restricted 1&2 Family Dwelling
M Masonry Only
RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered� ' � lam,Homrovgment
e ImpContractor(HIC)
\.1 \\
HIC Company Nag9t or HIC Registrant Name Registration Number
Address Itq ��_
/ y ��"'� ExpiranorriDate
Signature Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
Workers Compensation Insurance affidavit 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.
Signed Affidavit Attached? Yes ..........❑ No........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner of the subject property hereby
authorize to act on my behalf,in all matters
relative to work authorized by this building permit application.
Signature of Owner Date
SECTION
/J7b::OWNERt OR AUTHORIZED AGENT DECLARATION
1, ,as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
Print Name
Signature of Owner or Authorized Agent Date
(Signed under the pains and penalties of perjury
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and 110.115, respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq. Ft.) (including garage, finished basement/attics,decks or porch)
Gross living area(Sq. Ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost'
CITY OF SALEM
Y & t
PUBLIC PROPRERTY
DEPAR"I'MENT
-
I11 'I'8-'4;.v;;I; I \s. ')'8 'a:'t�a
Construction Debris Disposal Allidavit
(I'C(.Itllled for all demolition and renovation work)
In accordance \v ith the sixth edition of the State Building Code, 780 CNIR section 1 1 1.5
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 he disposed of in a properly licensed waste disposal facility as defined by MGL c
I11. S 150A.
The debris will be transported by:
C �
(name of hauler)
I lie debris will be disposed of in
(name ul lacility)
5 S�
(address of Iacility)
signature of p:rmit applicant
-
date
CITY OF SALEM
PUBLIC PROPRERTY
a
DEPARTMENT
\I t1•NI 12. WA It IITGIVNSIALL I • SAtl'N, IefA%SU III it I IiJ197-�
I'I:I. 08.713.93`03 • I tx Y79-.'410')x46
'iYurkers' Cumpensation insurance liffidovit: lfuilders/ContracCurs/Electricians/Plumbers
%milicant Information C\ Please Print LeeihlY
Nai nC lllu.ueis l]r�anlnuinNlndluduall: �.a'.���• c�� .) !�'`;-o-�
ltldress: -I:yo
Ciry,Srarc.7ip �x^' ��� I'honr
.%rc. 'u an employer'Check the approprime box: Type of project (required):
I am a general coulractor and
1.�:I :un a employer with 4� - ❑ fi. Q New construction
anployces(full amLur part-bnic).' have hired the suh-contractors
2.❑ 1 .un a sole proprietor or partner- listed on rhe anachcll sheet. 1• Q Remodeling
ship and have no empluyucs These sub-contractors have S. Q Demolition
working for Inc in any capacity. workers' comp. Insurance. q. ❑ Oudding addition
INo workers'culnp. insurance 5. Q We arc a eniporation and its
I required.]
officers have cxerciscol their I0.❑ Electrical repair or additions
3. ❑ 1 im it homeowner doing all work right of exemption per MGL I LQ Plumbing repairs or additions
myself.(No workers'comp. c. 152, ¢1(4),and we have no 12.Q Ruuf rcpuirn
insurance required] t employees. (No workers' 13.[j 011ier
camp. inwrinco:required.]
•
NI" .yplioul That chccka box 0I must:1130 lilt dolt the wchan IN'Iuw.huw{Ila Then wurkwa'cumpenvnivn Iw my nnirmatium
' I lomeowoen whit submit Chia affidavit indic.t,Ina they am Joint'ell work ami Ihen hire uuUlde CdowraCtwM must.uhmil a new al rJOVII indiul ma mch.
-C••nlcwuor,that Occk[hit box mllat m1whid nn addlliuru131wtiI.huwiny Ile uane of Ih0 sok-, nrxwn and their rwh0n'comp,p„hcy mfwmanun
/our un roupluyer Ihu!ix pruriding fvurkers'comprneariun in.mrnuce fur ray eurpluyrex. Behnv fs rhe pit/fay mfd Jab site
brjurnuriwn.
In,itrancc Company Nnme:—C�C'
t rl• b x it 11 Date:
ya' •`��
I oli;;v :t ur Sclf-ins. Lic. . r-D O� E p a un e.
Job Site Addreis: u 'i City;SlataZlp: CJ V\ 'I
.Utach it copy of lite warkers'compensation policy declaration pale(showing the policy number and expiration date).
haBJurc to secure cuverage as required under SeL ion 25A ul'>1GL c. 152 can lead to the imposition of criminal penalties of a
tlnc up to]1.5110110 anol'ur une•year imprisonment,as well as cis J penalties in the I•uim of a STOP WORK ORDER and a fine
of till to 5n-50.0018 Jay .Igainst the violator. Be advl.;cd that a copy of this mutur em may be lbrw arded to the Olf icc ul
Int,.h.:a urns ul :hc ULA :or io,w ince uner.hc tcnliLacon.
/Ju hereby r nrifv under r//he pwi, i and penalricv ujperjury Thur the information provided ubus•e is true and correct.
I
,ificiulruewily. Do motor wrirein chis arca, toiry ur fnwn: Pcrmiul.iccnic 0
ssuing .\ulhilloy (circleone):
ih 2. Iiuddim; Mparuncnt 1 Cit�.-I'uwn Clerk 4. Electrical Inipccror i• Plumbing lu,peclor
. Olhcr'Inita❑ l'cnun: .. -. Phone rt:
information and Instructions
la�S.tdw.:au Gcncral Laws chapter 152 requires all employers to provide workers' cuinpen:ition for their employees.
111inu.mt to this staune, All empluree is defined JS- .es cry poison in the service of another under any contract of hire,
e%preys or imp bed, ural or written..'
An .onpluyrr ii defined as"an individual, partnership, .usociatwu, corporation or other IcgaI cot lry,or ally two or inore
. legal •m luscr,or the
, representatives 'aJeeea.eJe
.tr the tvregomg engaged in apnnt cmerpnx. and including the .�sul r�preienrau vs of V
reeet%cr Or liuDlee of AIR individual, paltnership, Association or other legal conty,employing cmpdoyees. 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,itch Jwclling house
or o❑ the grounds or budding appurtenant thereto shall not because Of such employment be deemed to be in employer."
\IGL chapter 152, �25C(6)also states that"every slate or local licensing agency shag withhold the issuance or
rene)vul ora license ur permit to operate a business at to construct buildings in the commonwealth for any
applicant w bo has not produced acceptable evidence of compliance with the insurance coverage required."
kddiuunally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any Contract for the perfomtance uf'pubdic work until acceptable evidence ufcumpliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please rill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary.supply sub-contractor(s) name(s),address(es)and phone nulnber(s)along with their cerinfleatc(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
.%ccidents for conArtnaliun of insurance coverage. Also be sure to sign and date the al'Iidnvlt. The affidavit should
he reunited 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.
('fly or Town Official
Please he Sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit fur you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
I'Izane be sure to fill in the pennit/license number which will be used as a retbrcnce 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)." % copy of the affidavit that has been officially stamped or marked by Ilia 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 nwst 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 i.e. it dug license Or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
I h. 01 o(IuvesrigAtiuns wuuld hie to thank pnu in aJv:uuc fur your cooperation and shuuld you hasc:my qucAioni,
please Ju nut hesiratc to give us a call.
ncc Deparnncnt's address, telephone and fax number-
The
umberThe Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. q 617-727-4900 ext 406 or 1-877-MASSAFE
Fax M 617-727-7749
www.mass.gov/dia
it
Shea Roofing Co.
A*� Salem, MA 01970
,ti (978) 745-7313
PROPOSAL
March 78,2009
SUBMITTED TO: 156-158 Layfayette St. Condo Assoc.
158 Lafayette Street
Salem, Ma.
We hereby submit specifications and estimates for.
To remove slate roof from right side of main roof.
To install asphalt saturated felt paper over exposed boarding on right side
of main roof.
To install architectural (30 year windseal) roof shingles covering entire
main roof including shed dormer roof.
To install ice and water shield along lower roof edge and under flashing
points on entire main roof and shed dormer.
To install all new metal drip edge along all roof edges, both horizontal and
vertical on main roof and shed dormer roof.
To counter flash and /or reseal all sidewalls around shed dormer as
necessary.
To install four new roof air vents on left side of main roof and shed dormer.
To install new roof flanges on all vent pipes.
To counter flash and/or reseal chimney flashing as necessary.
To install new seamless aluminum gutter along roof edge of shed dormer
including downspout system into lower gutter.
To clean up and remove all roofing debris from job site.
We propose hereby to furnish material and labor—complete in accordance with above specifications,for the sum of:
Eleven Thousand Three Hundred ------------- —dollars ($11,300.00)
Payment to be made as follows:
Upon completion
All material is guaranteed to be specified. All work to be completed in a workmanlike manner according to
standard practices. Any alteration or deviation from above specifications involving extra costs will be executed
only upon written orders,and will become an extra charge over the estimate. All agreements contingent upon
strikes,accidents or delays beyond our control. Owner to carry fire,tornado and other necessary insurance.
Our workers are fully covered by Workman's Compensation Insurance.
Acceptance of Proposal—You are authorized to do the work as specified.
Authorized Signature: \
Signature: l��'M ,>''r x C�JTSJR•V
Pate of Acceptance:
'04/06/2009 15:43 978-777-9804 JOHN J DOYLE INS PAGE 01/01
ACORD,�, CERTIFICATE OF LIABILITY INSURANCE 04/o6/200
PRODUCER (978)777-6344 - FAX (978)777-9804 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Jahn 7 Doyle Insurancl,Inc -, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
- HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
85 Constitution Lane ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
Danvers, NA 01923
INSURERS AFFORDING COVERAGE NAIC#
INSURED it Tam I Shea INSURERA. First Financial Ins Co.
30 Echo Ave 11INSURFRB: Granite State
Beverly, NA 015;1 INSURER C.
.T .' INSURER D:
INSURER E;
COV
THE P
CIES OF I ANCE LISTED BELOW HAVE BEEN ISSUED TO THE I 11RED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NaTVJITHSTANbING
ANY QOIREp�E�'{TT, ERM OR CONDITION OF ANY CONTRACT OR OTHER C J T WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY EBtANAtH¢�TNSURANCE AFFORDED BY THE POLIdES DESCRIBED EREIN IS SOOECTw O ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
P0.0 CI �G GATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY P CLAIMS.
INSR TYRE OF INSURANCE POLICY NUMBER PO LICY EFFECTNE POLICY EXP11B4TION LIMITS
DA f-f ENERAL.LIABILITY 553FROO 0 07/03/2008 07/03/2009 EACHOCCURRENCE g 2,000 00
COMMERCIAL GENERAL LIAIMLMY K)AMAOE TO RENTED g 100,00
•✓ CLAIMS MADE ❑OCGVR ~aL MED EXP(Arty one p918Pn) S 5,00
A d! PERSONAL&ADV INJURY S 2,000 OO �I
"'s. '"0` GENERAL AGGREGATE $ 2,000 000
has..'LAOGREGATE LIMIT APPLIES PERPRODUCTS-COMPIOP AGE S 2,000,00(
:
POLICY JECO
GENT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S
ANY AUTO IEq eAdtlAM)
ALL OWNED AUTOS BODILY INJURY S
SCHEDULED AUTOS (Per person)
HIREDAUTOS BODILY INJURY S
NON-GAINED AUTOS IPar seclUem)
PROPERTY DAMAGE. S
(Per scddsnt)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 5
ANY AUTO OTHER THAN EA ACC S
- -..
GARAGE
ONLY: AGG S
EKCESSIUMBRELLA LIABILITY EACH OCCURRENCE S
OCCUR FICLAIMS MADE AOOREGATE S
5
DEDUCTIBLE S
RF•TENTION $ S
WORKERS COMPENSATION AND 0076864 08/29/2008 08/29/2009 WC STAN• DTH•
EMPLOYERS'LIABILMY E.L.EACH ACCIDENT $ 100,00
B ANY PROPRIETORIPARTNERIEKECUTIVE
OFFICERIMF-MSEREXCLVDED? E.L.DISEASE-EAEMPLOYE S 100,000
S.BeGo owdgr
ECIAL PROVISIONS bol. E.L.DISEASE-POLICY LIMIT S SOD,ODO
SP
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS r VEXICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOL CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
E;KP1RATION DATE THEREOF,THE ISSUING INSURER MILL ENDEAVOR TO MAIL
—ORY41URITTEN NOTICE TO THE CERTI FlCATE HOLDER NAMED TO THE LEFT,
City of Salem B FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
93 Washington St ,VAIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES.
Salem, MA 01970 •A x SENT TN
ACORD 25(2001/08) FAX: (978)740-9846 OACORD CORPORATION 1 ON