53 JEFFERSON AVE - BUILDING INSPECTION (2) t
The Commonwealth of Massachusetts
n f\ Department of Public Safety
Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Two-, e
(Phis Section For Official Use Only)
Building Permit Number: Date Applied: Building Official:
SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is nt av le)
x;s 5- fry ka- —c4tie nr 1n4- d/girc- lzrm /cf* l b
No.and Street City/Town Zip Code Name of Buildmg(if app cable)
SECTION 2.PROPOSED WORK
Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below
Existing Building❑ 1 Repair Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ 1 Change of Occupancy ❑ 1 Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this pemrit application? Yes No ❑
Is an Independent Structural Engineering P r Review required? // Yes ❑ No
Brief Description of Proposed Work: 2-PG rr �/`�Gf-t_ePQ 4 l�
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):
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 ❑ A4❑ A-5❑ 1 B: Business E: Educational ❑
F. Facto F-1 ❑ F2❑ 1 H: High Hazard H-1 ❑ H-2❑ -3 ❑ H-4❑ H-5❑
I: Institutional 1-1 ❑ I-2❑ I-3❑ I4❑ 1 M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑
S: Storage S-1 ❑ 5-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ 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: Debris Removal:
Licensed Disposal Site❑
Public[I 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❑ Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor:
Does the building contain an Sprinkler System?: Special Stipulations:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
i//c1t%to d ";3 .T r.N 20
Name(Print) No.and Street City Town Zip
Pro�perty Owner Contact Information: �1
S, d� X-�'/_'L- N_i 30 P[C$-�-� 'Taya>2/"aS Z W
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes ,�1t
Name Street dress City/Town State Zip
to act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
(If building is less then 35,000 ca ft of enclosed space and/or not under Construction Control then check here O end skip Section 10.1)
10.1 Registered Professional Responsible for Construction Control
-�7j,gA , U)A+Hh-C k-N�� (ge(7 �IL� 3Y�fdb
Name(Registrant) Telephone No. e-mail address Registration Number
fot7 ASti1po�vn �4s� 4 �Fl-�PYN _ MA DY )0 5trucf-otal 3d /
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
Company No _ LL
Name of Person Responsible for Construction License No. and Type if Applicable
,�a /irvirpytew Sf- 414 Oj '�''Fs
Street Address City/Tom State Zip
Telephone No.(business) Telephone No. cell e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT G.L.c.152.§25C 6
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes❑ No ❑
SECTION 12.CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$
1.Building $ Building Permit Fee=Total Construction Cost x_(hvsert here
2.Electrical $ appropriate municipal factor)_$
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact muntsiya,ty)
5.Mechanical (Other) $ Enclose check payable to /" ��(�
6.Total Cost $ H`/, �� (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 gn na�g, Title Telephone No. Date
(09
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval:
Name Date
i CITY OF SiUX. . NANSSACHL'SETTS
BUILDING DEPART.%MNT
• 130 WASHINGTON STREET,Ya FLOOR
T L (978)745-9595
FAX(978) 740-9846
Ki.xC3 RT RY DRISCOLL
MAYORT1iOMAs ST.PtERttb
DIRECTOR OF PUBLIC PROPERTY/BL'iLDLNG CONMISMONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Analicant Information zz,, yy,� /M—� Please Print Legibly
Name (Busines organizatioMndividual): MQH'GtY r'l/,ZCGitt 4- i',c(�
Address: �E
City/State/Zip: � � � /`f Phone #:_(1?7
Are you an employer?Check the appropriate box: Type of project(required):
LRTJ am a employer with R 4. 111 am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet./ 7• [:] Remodeling
ship and have no employees - These sub-contractors have S. ❑ Demolition
working for me in any capacity. workers'comp.insurance. 9• ❑ Building addition
[No workers'comp. insurance S. ❑ We are a corporation and its )0.❑ Electrical repairs or additions
required.) officers have exercised their
3.❑ I am a homeowner doing all work right of exemption per MGL I l.❑Plumbing repairs or additions
myself. [No workers'comp. C. 152,§1(4),and we have no 12.❑ Roof repairs
insurance required.]t employees.(No workers' 13.MOther_�e�t
comp. insurance required.1
Any applicant that chucks box#1 must also fill we the section below stowing their workers'compensation policy information.
t I who submit this affidavit indicating they are doing all work and then hire outside centrnam most submit a new affidavit indicting such.
-C.mtracto s that check this box must attached an.dWitiwal sheet showing the name of the sub-comroctors and their wodmn'comp,policy information.
I am an employer that is providing workers'compensaton Insurance for my employees. Below is the policy and fob site
information,
Insurance Company Name: &-lepet 70;pw '73;S
��?? 3 Policy#or Self-ins. Lie.#: 7_n3 'Pg l Expiration Date: 7/�-)///J
Job Site Address: S-3 �� 'zerS�t�VE- City/Statetzip: �ee/7 . �2�01�'��j
,mach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition ofcriminal 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 fine
of up to 5250.00 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 hereby cerr/lfry under thepains and penalties ofleerfary that the information provided above Is true and correct.
W pt Sienatt(re• =1r-- ane• J �9�ra(
Phone#:
Official use only. Do not write in this area,to he completed by city or town offtcinE
City or Town: Permit/License# _
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.Cilyffown Clerk 4.Electrical inspector S. Plumbing Inspector
6.Other .
Contact Person; Phone#'
CITY OF SM EM, 2UNSSACHUSETTS
BL'ILDLNG DEPARTMENT
120 W.�sHLNGTON STREET, Yo FLOOR
TEL. (978) 745-9595
FAx(978) 740-9846
KINIB RT RY DRISCOLL
MAYOR THo&w ST.Pw-RRE
DIRECTOR OF PUBLIC PROPERTY/BUI DLNG CONMaSSIONER
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 It 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 be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
(name o auler) e
The debris will be disposed of in :
5,6e -
(name of faciliitnt //
(address of facility)
signature of perm' applicant
1� Z��Z �
date
dcbrisat7.dce
Structures North 0®®® 60 Washington St AD1401
97
O O Salem, MA 01970
wn .structures-north.com
CONSULTING ENGINEERS, INC. T 978.745,68171 F 978,745.6067
Hourly Work Authorization - DRAFT
Terms and Conditions:
The attached Structures North Consulting Engineers, Inc.—Terms and Conditions are a part of
this agreement. By signing this Hourly Work Authorization the client herby acknowledges and
agrees to these conditions.
Limitations of Liability
For any damage or cost resulting from error, omission, or other professional negligence in the
performance of our services,the liability of Structures North Consulting Engineers, and its
partners, employees, and subcontractors,to all claimants with respect to this project will be
limited to an aggregate sum (including attorney's fees)not to exceed$25,000.00 or our fee for
consulting services,whichever is greater.
Your formal authorization is requested. Signed, dated, and returned fax will constitute your
authorization for us to proceed with the work described above.
e
Au orized by:
e�`` Total Amount Authorized:
/®�'
Title/Organization: Date:
Dorchester Historical Society November 8,2012 Page 2 of 2
Lemuel Clap House
f .
Murray Masonry & More, Corp.
Cell: 978.578.0940
Office: 978.594.1138
)Mailing Address: Office Address:
P.O. Box 8454 10 Rear Jefferson #1
Salem,MA 01971 Salem,MA 01970
CONTRACTING AGREEMENT
Read this agreement and make sure you understand it before signing it.
This agreement has legal force and effect and binds those who sign it.
Notice: All home improvement contractors and subcontractors engaged in home
improvement contracting,unless specifically exempt from registration by provisions of
Chapter 142a of the general laws, must be registered with the Commonwealth of
Massachusetts. Inquiries about registration and status should be made to the Director of
Home Improvement Contract Registration, Office of Consumer Affairs and Business
Regulation, Ten Park Plaza, Suite 5170, Boston, MA 02116.
Designated Registrant's Name: Brendan Murray, President
Murray Masonry&More, Corporation
Registration Number: HIC License# 169898
This agreement is made on(date) /`t l between Murray Masonry&More. Corp.
hereinafter called"Contractor."
10 Rear Jefferson Ave. Suite 1
Salem, Massachusetts 01970
Telephone- (978) 594-1138
and Name: C/O Luis Arocho -North Shore Recycled Fibers
hereinafter called"Owner."
Address : 53 Jefferson Ave. Salem,MA 01970
Street City, State Zip Code
Telephone: (978)815-8831
I. DETAILED DESCRIPTION OF WORK TO BE PERFORMED
1.)Erect staging to access area of building damaged with winter precautions
2.)Remove and dispose of CMU wall area specified by engineer
3.)Rebuild wall to engineered specifications
4.)Clean wall
5.)Paint wall to match existing
6.)Remove all staging, equipment, excess materials/debris and leave site clean
All materials and installation procedures shall comply with all current local and
national building code requirements. All materials meet or exceed ASTM
standards/Code.
H. PRICE
Contractor agrees to do all work described in Section I for the total price of:
$44,737
Note: Price is based on engineered specifications and is an ESTIMATED cost.
Unless conditions are discovered beyond those specified by engineer cost is to be
considered a ceiling and will not be exceeded. Final job cost to be based explicitly
on Time and Materials.
Mason=$80/hour
Tender=$60/hour
Laborer=$50/hour
All pricing estimated:
Materials: $3000
Disposal: $500
Structural shoring and staging by Murray Masonry &More: $1500
Total Estimated Materials/Disposal/Structural: $5000
Winter heating/protection=$3750
Set up/winter protection/break down/clean up=$7600
Demolition/selective demolition= $4560
Preparation= $1520
Construction=$15,200
Cleaning=$1520
Coating=$1520
Incidentals/permit fees= 10%
III. PAYMENT
Payment will be made as follows:
20%of contract balance due at contract signing or first day of work= $8950.00
If the Owner cancels this Agreement,
gr t,the Contractor shall within ten business
days of receipt of the written Notice of Cancellation: 1)refund all payments
made, including any down payment made under the Agreement, 2)cancel and
return any copies of the Agreement and any negotiable instrument signed by the
Owner with a notation indicating that it has been cancelled, and 3)take any action
necessary or appropriate to terminate promptly any security interest created in
connection with this Agreement.
A CANCELLATION NOTICE IS ENCLOSED WITH THIS CONTRACT.
OWNER:
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES OR
YOU HAVE NOT RECEIVED TWO COPIES OF THE NOTICE OF
CANCELLATION.
-7
OWNER'S SIGNATURE DATE SIGNED
OWNER'S SIGNATURE DATE SIGNED
MURRAYMASONRY&MORE, Corp.
BY: X34 Ll-z -,✓" 1�R
BRENDAN MURRA resident DATE SIGNED