17-19 GARDNER ST - BUILDING INSPECTION a: The Commonwealth of Massachusetts
'�• Department of Public Safety
Massachusetts State Building Code(780 CN1R)Seventh Edition
City of Salem
Building Permit Application for any Building other than a 1-or 2-Family Dwelling
(This Section For Official Use Oniv)
Building Permit Number: Date Applied: Building Inspector:
SECTION 1: LOCATION (Please indicate Block ff and Lot fi for locations for which a street address is not available)
— /I GotfC9lne4- s - 144—
No. and Street City /Town Zip Code Name of Building (it applicable)
SECTION 2:PROPOSED WORK
If New Construction check here❑ or check all that apply in the two rows below
Existing Building 04
Repair❑ Alteration ❑ Addition ❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ 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 Review1required? Yes ❑ No ❑
Brief Description of Pr u osed Work: /l"//f}K. � �i{ fC'lU�' C Ft r
/lam &Jtlj ITr I
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): a'
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❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
1: Institutional 1-1 ❑ 1-2 ❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2 E —R-3❑ R-4 ❑
S: Storage 5-1 ❑ S-2 ❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE (Check as applicable)
IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ 111110 1 IV ❑ 1 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 Permit: L(Licensed
Removal:
Public ❑ Check if outside Flood Zone ❑ Indicate municipal ❑ A trench will not be iposal Site ❑
Pri vo le ❑ or indentifv Zone: or on site sN tem ❑ required ❑or trench
permit is enclosed ❑
Railroad right-of-way: Hazards to Air Navigation: \I.\ I li>�c rti<e\nnmi+>iun Rveiry Pay o..;
Not Applicable ❑ 1,}lructure within airport approach area:' Is their re%iemc completed?
ur Consent to Build enclosed ❑ ® Yes ❑ or No❑ Yes❑ .No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
I_ditinn of C++de: Lee Croup(s): Tcpe of Construction: Occupant Load per Fluor:
[)ors the building contain an Sprinkler System.': Special Stipulations:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Propyrty Owner Q qf /�/ l l gr11C✓ �
Name(Print) No.and Street City/Town Zip
Properh honer Contact Information:.
Title Telephone Telephone No. (business) Telephone No. (cell) e-mail address
If applicable, the property owner hereby authorizes
Name Street Address Citv/Town Stale Zip
to act on the pro pert,owner's behalf, in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL (Please fill out Appendix 2)
(If buildin g is less than 35M)O cu.it.of enclosed s pace and/or not Wider Construction Control then check here O and skip Section 10.1)
10.1 Registered Professional Responsible for Construction Control
Name Registrant) Teleplione No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration D e
.A
10.2 General Contractor
u,l,e&-mow
Company Na7/j"z��
Name of Person Responsible fur Connstruction/�/K/ / Cl /License No. and Type if Applicable
6I4 A w S� �� �7d r-/on. -G/i a Z,/
Street Address ?pi9 City/Town n ' ' State ZW
Telephone No. (business) Telephone 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 ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs: Labor
and Materials) Total Construction Cost(from Item 6) _$ ❑
1. Building $ ,v `-' Building Permit Fee=Total Construction Cost x (Insert here
2. Electrical $ appropriate municipal factor)_$
3. Plumbing $
4. Mechanical (HVAC) $ �" Note: Minimum fee=$ (coma �um�ctR/\ality)
5. Mechanical (Other) $ Enclose check payable to
6. Total Cost $ 0 �� (contact municipality)and write check number here
SECTION 13: SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below, 1 hereby attest Winder the pains/'0 penalties of perjury that all of the information contained in this
application is true and accurate to the best of y knowI d understanding.
W)u' 1 eS G1/ - 8 °�i1�l
Neasc print and sign name Title Telephone No. Date
`6. 6IV"U 1'-4. . 6z 121J
titreet Address Qh/ToW ..tate Zip
Municipal Inspector to fill out this section upon application approval:
�lassachasctts - Dcpartmcnt(it'Public S;Ifvt%
`tipy• Board or Building Rcgulall and Snuulards
��wJJ Construction Supervisor License
License: cs 87511 -
Restricted to: 00
F
WILBER A VILLATORO
64A EUTAW ST#1 B
E BOSTON, MA 02128 WL
Jam- � Expiration: 502oij
( ..nrr
Tr#: 15269
HOME IMPROV lW 4 d6 .
Regrsai,l6On: RACTQ
147177 R
�Plrat7on;
Type_ P 15/2011 .
COI4NECIyON artnership Tr# 285556
WILBER VILLATORO
CO
�AEUTAWST#fB
IF.BOSTON,MA 02128
Administrator
CITY OF SALEM
„ o:,lei PUBLIC PROPRERTY
M; DEPARTMENT
M 120 W Ail lING IONS I'lt LET ♦$A I I?1, MASi V I it ii I.1 i J I'L"..
Tn:'17'6-R1 9i95 ♦ 1:,%X:978-740.9846
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 It __ 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
l I1. S 150A.
The debris will be transported by:
lDi/�� �vcle
1 name of hauler)
The debris will be disposed of in
sue-
(name ut faahty)
(address of facility)
fit a �licant
h�l.� 6
date
kln racT d„c -
CONTRACTOR AGREEMENT
THIS AGREEMENT made the 14 day of october 2009 (year)
by and between Ja;-Jy cx� ' , hereinafter called the Contractor
and ,`(ram 1/j44177�6a , hereinafter called the Owner.
WITNESSETH, that the Contractor and the Owner for the considerations named agree as
follows:
ARTICLE 1. SCOPE OF THE WORK
The Contractor shall furnish all of the materials and perform all of the work shown on the
drawings and/or described in the specifications entitled Exhibit A, as annexed hereto as it pertains
to work to be performed on property at:
17-19 gardner st salem ma
ARTICLE 2. TIME OF COMPLETION
The work to be performed under this Contract shall be commenced on or before
(year), and shall be substantially completed on or before (year).
Time is of the essence. The following constitutes substantial commencement of work pursuant to this
proposal and contract: (Specify)
demolition of a front deck and rebuild. see plan
ARTICLE 3. THE CONTRACT PRICE
The Owner shall pay the Contractor for the material and labor to be performed under the
Contract the sum of ten thousand five hundred Dollars ($10,500.00 ), subject to
additions and deductions pursuant to authorized change orders.
ARTICLE 4. PROGRESS PAYMENTS
Payments of the Contract Price shall be paid in the manner following:
30%down payment 30%work in progress 40%work complete
ARTICLE 5. GENERAL PROVISIONS
1. All work shall be completed in a workman-like manner and in compliance with all
building codes and other applicable laws.
2. The contractor shall furnish a plan and scale drawing showing the shape, size
dimensions,and construction and equipment specifications for home improvements,a description
of the work to be done and description of the materials to be used and the equipment to be used
or installed, and the agreed consideration for the work.
3. To the extent required by law all work shall be performed by individuals duly licensed and
authorized by law to perform said work.
4. Contractor may at its discretion engage subcontractors to perform work hereunder,provided
Contractor shall fully pay said subcontractor and in all instances remain responsible for the proper
completion of this Contract.
5. Contractor shall famish Owner appropriate releases or waivers of lien for all work
performed or materials provided at the time the next periodic payment shall be due.
AHAAAHAH
6. All change orders shall be in writing and signed both by Owner and Contractor,and shall
be incorporated in,and become a part of the contract.
7. Contractor warrants it is adequately insured for injury to its employees and others
incurring loss or injury as a result of the acts of Contractor or its employees or subcontractors.
8. Contractor shall at its own expense obtain all permits necessary for the work to be
performed.
9. Contractor agrees to remove all debris and leave the premises in broom clean condition.
10. In the event Owner shall fail to pay any periodic or installment payment due hereunder,
Contractor may cease work without breach pending payment or resolution of any dispute.
11. All disputes hereunder shall be resolved by binding arbitration in accordance with rules of
the American Arbitration Association.
12. Contractor shall not be liable for any delay due to circumstances beyond its control
including strikes,casualty or general unavailability of materials.
13. Contractor warrants all work for a period of months following completion.
ARTICLE 6. OTHER TERMS
Signed this day of 964 lem).
Signed in the presence of:
Witness :Witness
Owner Signature ire
(NOTE: IF YOU LIVE ANYWHERE OTHER THAN CALIFORNIA, THIS
CONSTITUTES THE ENTIRE FORM. IF YOU LIVE IN CALIFORNIA,
REPLACE THIS PAGE WITH THE FOLLOWING FOUR PAGES.)
AHAAAHAH
Seb CITY OF S.U.E%I, ',%LkSSACHL:SETTS
BUMDLNG DEPARTMEINT
120 WASHCVGTON STREET. 3aa FLOOR
TEL (978) 745-9S95
F.Ut(978) 740.9846
KI_%CBEj FY DRISCOtl
T
.MAYOR l{OhlAi ST.PIERRi
DIRECTOR OF PL BLIC PROPERTY/11V ILDLNG COSMISSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
koplicant Information Le�/ ( Please Print IN
Value Idusimvorgantration,InJrvidual): -�0?T�t \ill 1-ATa�
Address:(` W &j4a W S —
City/State/Zip:- Phone M.
Are you an employer'Cheek the appropriate has: Type of project(required):
1.❑ 1 am a employe with 4. ❑ 1 am a gencral contractor and 1 6. ❑New construction
employees(full and/or part-ums).r have hired the ads contractors
1 am a sole propriety it partner. listed on the attached shmL 7. ❑Remolding
,hip and have no employees Theca stsb•contrsetors have 8. ❑Demolition
working for me in any capacity. worker'comp.insurance. 9. Q Building addition
INo workers' comp. insurance 5. ❑ We are a corporation and its
required.)
ot7feen have exercised their 10.❑ Electrical repairs or additions
].❑ I am a homeowner doing all work right of exemption per MOL 1 I.❑Plumbing repairs or additions
myself.[Na workers'comp. c. 152.41(4),and we have no 12.❑Raof repairs
insurance required.)t employees. INo workers' 11.❑
comp. insurance required.]
Other-
.Any applicata ihsl chocYs boa at MUN alp fig nn Ras klia•bola►ahiMina Rhos Waite"'cmvm=due polity inWmotim
'I hw,itownen who tuhnit this anldnve inelelina they an doing all wort erne the hits outside contnmom t Via suhna a tow amdsvit indices%Vick
:C'.mtrm ors that check this bon mug attached an a Witi wal shot showing the ionise of IM aJ-avmraaga sd their workee.corer.policy infamuuan.
t arse an ampleyer that b Providing•workers'coeeparmadoa&rsereace for my earptoyees. Below is tArarPeltcy owdM star
informadow
Its.urance Company Name:
Policy N ur Self-ins. Lic.#:: q Expirrlion Date: A
Job Site Address: /I// lT'y City/StatrlZip. 4&�
,\ttsch a copy of the workers'compensation polity declaration page(showing the policy number and explradoe date).
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 S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a Rne
Of up to S250.00 a day against the violator. lie advi•.vJ that a copy of this statement may be rorwurded to the Office of
Invcaugatiuns ul'dte DIA for insurance coverage v• 'ticatiom
t de hereby cord,&nadir the p=d %*rdfpirrjury that the informadow provided above is true red renter
Phone A''
O�a•iai use on/y. 90 not Wife in thin area, to be rwrnp/tfed by city or rows 1.//&'iaL
City orruwn: _. _ Permit/LkcnseN__. _
hsuing.\tit huriiy (circle unN:
I. ❑card of Ilvulth 2. Ruilding Deparimcnt ]. City/rown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. 01her
l.untacl Person: _ ._. _.. Phone*:
17-19 Gardner Street Condominium Association
17-19 Gardner St.
Salem, MA 01970-4852
October 14, 2009
To: City of Salem
Att: Building Permits Dept.
To whomever this may concern,
Our condo association (17-19 Gardner Street Condominium Association — aka 17-19
GSCA) has granted permission to Nick Maggio to work on the association's front porch
according to the plans submitted.
Thank you,
RattheyJ Rhonke, Owner Unit #1
Ben d Marissa Hunt P eroy, Owner Unit #2
Barbara B. Hawlena, Owner Unit #3
Laureii Syk s, Owner Unit #4