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326 LAFAYETTE ST - BUILDING INSPECTION The Commonwealth of Massachusetts 6oard'M3uilding Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR r SALEM Revised M1dar 011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: Date Ap 'Building Official(PraITN, a Signature Date SECTION t:-$$►TE INFORMATION - 1.1 Property a. 6 Address: 1.2 Assessors Map& Parcel Numbers 3• I.I a Is this an accepted street?yeses no Map Number Parcel Number _ 1.3 Zoning Information: 1.4 Property Dimensions: , Toning District Proposed Use Lot Ai;ea i,q ft) Frontage(It) 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: Public❑ Private❑ Zone: _ Outside Flood Zone?Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: G ` C�..�►ti' T k�c�e� ` u�lGw[ Ol g aft Name(Print) / City,Slate,ZIP 924 67- p.;�X - 7yY-&-1Z-_ No.and Street ' 'telephone Email Addiess SECTION 3: DESCRIPTION-OF PROPOSED WORK (check all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief D scrippttion of ProRosed Work'-: ©r{ 7'&� `p.rns fig. ry hor. � pp� SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials) 1. Building $ I. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costa(Item 6)x multiplier 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List:_ 5. Mechanical (Fire $ Suppression) Total All Fees: $ 6. Total Project Cost: $ (90d.1J Check No. Check Amount: Cash Amount: 13 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 614- �LoIK(�S ( ittrhbt,w License Number Expiration ate Name of CSL Molder a& 10,04 and Ld List CSL'fype(see below) No.and Street Type Description P�_ _lv .t A_ etw /t R Unrestricted(Buildings2 Fa u el ing cu. RJ t7a�� f�W. 7W R Restricted I&2 Fmnil Dwelling cayrfown,State,ZIP M Mason Roofingry Covering Window and Siding SF Solid Fuel Burning Appliances yF 531N� Ji 0 a�nl&jnt, je%, �— 1 Insulation Tele hone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) /Y6 -3 6 I-IIC Registration Number Expiration Date I1IC Compalty Name or HI Regisuant Name l�r� nt� f red uuf�Y clgnsca�o�6sy, ,�«k N�and S[ree[ Email address nt�b /N!c [9G2Z ; -�8�8/ City/Town,State,ZIP 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 A I,as Owner of the subject property,hereby authorize m t+ Z" PI ( 'y n �Jyer to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owne s Na (Electronic Signature) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION 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 knowledgq and understanding. ✓Ctt410�f (;[i►xM tOr �•t.17/7/rCGc.:•: _ //!! o�Of7s •• Print Owner's or Authorized AgA is Name(Electron !Signature) Date NOTES: I. An Owner who obtan 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 can be found at wxvw.mass.�>ov'oca Information on the Construction Supervisor License can be found at www.mass.,owdns 2. When substantial work is planned,provide the information below: Total floor 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 S.UENI, NW&AaiUSETTS BLIWLNG DEPARTMEINT 120 W.k.SHLNGTON STREET, 3i0 FLOOR T L (978)745-959S FAX(978) 740-9846 KIJIBF.RLEY DRISCOLL MAYOR THo.+us ST.PmRRB DIRECTOR OF PCBLIC PROPERTY/BCB.DLNG COMMISSIONER 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 # 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 of hauler) The debris will be disposed of in : 0UAAP6fCV'�- (name of facility) r3 vo CjA; �s��I �� (addres of facility) signature of permit applicant date i CITY OF SALEM fry PUBLIC PROPRERTY DEPARTMENT .i 1ii::N:I Y:1N IMl q 1 \f 11,xt 11'.WMta.Nli 1 t^J r%CL•T a 5,\l F.M.M.11h.\1.I it M,IS I.1•.1.:'178-7119395 e p 1x. 979-71C-13/6 1Vurkers' Compensation Insurance afndavit: Sul lders/Contractors/Electriclans/Plumbers �Unli1 rant hirormation X �7 plea V x Print Lemhly atncta ///��J�� rable,fl)lsanlrallnNInd,vulaall: trJ h ddrCss: /ma _��erY9dy. cA Cily,Stare'Zip: 1412V. */6 sue$ I'hone 0: Are Ina an employer?Check the appropriate box; I I.gI;uu a em lu era with -- 4. I3M of pnr)ect(nqulrrd): P Y ❑ lama a general contractor and 1 Lre ycus(lull and/or purr-lime).• hove hired the suh•amtracwys f'' ❑ New construction sole prnpricalr Or partner- listed on the attached sheet. : �• ❑Remodeling nd have no etnpluy art These subcontractor have II. Demolition ng for me in any capacity, workers' comp.insurance. orkers'sump, inxuralice 5. 0 We are a colportion and its 9 ❑ OwWing addition ed.) officers have exercised their lo.❑Electrical repairs or additions homeowner doing all work right of exemption per M1Ilil. I I.Q plumbing repair%or additions ,lNo workers'cutup• c. 152,§I(4),and wave no 12.®Ruul'reprirs ce required.) r onployecs.(No worker' comp. insurance rcyuind.) 13.❑Other 2 u,%p \n>.pplwuN Ihw etucka boa el mew alw%ill win'he,euwa Wave dwwies dwir wwkai 'Ilum.n,wran whe,ubmir ibis and""indiwimil thug are mains utl,fork and Ihae hire wlairvi cumyrnuuuNl iwlicy inliumwiwt, ,ml cuarncltrn,owl.uhlla a new alRdavil imliealmy.,wk. •C' ra,hwN the chalk this hmt mow anxhed an adeiliurul..%win,Iluwina the nanq of fir ruk.eoalracwe and Their uehen'cony.rnlltcy,ntbrmadun. /ant an eruployrr that/s prut'iding workers I connect inf'orinution elation iniurnnra/or ury amp/uprrx Br/ore fs rho pu/ky and fob a'ih Insurance Company Vame: A/'C %/ mo,-Ic li 7 I" licy V or Salf•ins. Lic.n:_ /✓ 6 Z,a 196- A-17 Frlpirrmon D;ue:��,✓a�y Job Site Address: 3aG L y yC� rfa� C'uyBlale/Llp:�rt.( /W& Attach a eupy of the worker'cumpeniallim policy declarullon page(showing the policy number and etpiratlun data). I"ailurc w secure co%ersge as required under Section 25A of NOL c. 152 can lead to the imposition orcriminal penalties Ora tine up bI S1.5110.q()and/ur one-year impris,minunt,ai well as civil ficnalhu in the form of a STOP WORK ORDER and i fine orup to 5250.00 it day.Iguilml the violator. Tic advi.+cd that a copy orthu.mtcmunf may be I•urwirded to the Office uC InY�snyaunns ul';hc UTA IOr In+ur:u'ce cr,vcragu 1crilicakun. / /u h.n•hy r,rti/y Iur,/era r prrinx,nrd p rdiiee Uhmi--Jury rhur r/89 infurmallon pruvided above is true turd correct il,;cm�r dk4 Date, 01 72y ,3(9,0 f I-Va/X/ 111, iu/roe an/y. nano,write in Mix area, too be cumplefed by city ur fo,vn of/icial I r fawn: __ Purrniul.teenie M I .\charity(circleone): rdolcaldl 2. Ihrildin� Uvlmrttuct . L•'Icctrical lo/pcctur 5, Pluwbinq In+ycctarers% 1'vnun: information and Instructions >I:u;achusetts Ucncral Laws chapter 1 i2 requires all C111ploycrs to provide workers' compensation tau ployees. th eir em I'orsu:ait to this statute, an empluree is defined as"...every Posen in the service Of another under any contract of hire, cspreas or implied,oral or written." �n ampluper is defined as"an individual,partnership,association,corporation or other 3 de eased or any two r t more o the Girogoing engaged in a Ions emerpnse,and including the legal represenlarivas of a decease)employer,or the ariats Of r legal entity,employing owner of a dwelling house having not more than three apartments and who resides therein, rnhe Occupantshdwelling ofv�r the ction or repair work On .Iwetling house of another who emrtlC1y persons.jig thereto shrlLnoinbeciuse of such employment be de med to ineempluyer.' or On the grounds or building app NtGL chapter 152. 025C(6) also surrey that , very.state orio$al Iicenslog�Xngs i shall withhold,the Issuance or renewal of a license or permit to.Oper ate a business or to construct buildings in the commonwealth for any applicanl'wlio-has not priidu ced'cie7t aba eele v"Neither the our nonw�lth oaric"ll is r any of u political subdivislissurgitilgcipyerage ions'hall kdJitionully,MGL chuper 15_, j_ ( ) enter into any contract for the performance of public work until acceptable evidence ofeuntpliarice with the insurance requirements of this chapter have been presented to the contracting authority." Applicants please fill out the workers* Compensation affidavit completely,by checking the boxes that apply to Your situation aitd if necessary,apply sub controctor(s)nume(,$),address(es)and phone number(s)slong.with their cedificue(s)of insurance. Limited Liability Companies(LLCworLim, com ited Liability oe nuurance(It an)LLC or with uLLP does have employees er than the members or purtners,are not required to carry Pe ees,a policy is required. Be advised that this•affdavit may be submitted to the Department of industrial employ m Accidents for confirmation of insurance cowrogs. �Iso be sure to sign and date the ufndavlR Tlu affidavit should t e chimed 1e the city or town that the application foala regarding permit ito luw�iis be are reing quired to obtoted,not uslu workerit of Industrial Accidents. Should you have any quest" compensaatiun policy,please call the Department at the number listed below. Self-insure)companies should enter them self-insurance license number on the appropriate ling- City or'rown Officials Please he sure that the affidavit is•cumplcte.,ttndprintcd legibly._The Depamnens hay provided a.space at the bottom of the affidavit for you to till out in the event the Office of Investigations has to contact you regarding the applicant 1'I.u'sa ba<ure to-till in the permiulicense nwmbci'which will tie'uied as a ref'ercricc numM r. In addition,an applicant dint moat submit multiple pennit'licmise applications in any,given year,need only submit one affidavit indicating current y or policy iiiformut of lie uttidavitd under-job Site Adds Yhat has been officially stamped or marked bydm city or townnay beV the Lip provided to the D tuwn)."A COPY applicant as proof that a valid affidavit is tan rile for future permits or licenses. A new affidavit must be tilled out each year. Where a home owner or citizen is obtaining a license or pennit not related to any business or commercial venture affidavit. a dug license or permit to burn leaves etc.)said person is NOT required to complete this f he 0I I,cv of Investigatiuns would like to thank you in advance fur your cooperation and should you have;uiy qu"11011 , please Ju nut hesitate to give us a call. f he Ucparnnau's address, telephone and fan number "The Commonwealth of MaiMchuseits Depa=cnt of indusi ili`ACCidtiits• Otttee of lavesdQadons 600 Washington Street Boston, MA 02111 'Pei. I{ 617-727.4900 ext 406 or 1-877-MASSAFE Fax M 617-727.7749 ;t:.iscd 5.'a-u5 www.masa.gov/ilia �V A•-V -V 713�� w p�y� p{J�7PryafgJ,eys 111.1II 4�`JameS Currier HIII Coll0SM1+111,�1'l0® � : a, /rr.�laenr R r15hR�es/Sta[ej oppec. Kat> Wnbne'Takl'Maggensris,d/b/a C K.T.M.Roofing 6 ConsMu�eytlon,Co �� 3ZOoean Memo Urul4 au fiYmraa Rd. 19 off, J Daorers,ala orga3 ?Lynn,MAO1902 Y' (817)733.938< Offm#978'750-888 r & Cho k MA CSSL 1012181-'MA MILL 1324" = W Fin.#978 490 18, s Proposal Submitted To: - _ - Job Nam I Job# 32-9 F Cu l�M1MU %T� ZA/M �71 -Ire� I 32� Address Job location h 3Z 6 Ul r4-(6-7 6 �C SI 16 F(5ff _ - Date Date of Plans' Phone# _ �. Fax If - .Architect We hereby submit specifications and estimates for. �_. 1 .✓� �-1._: `�—'�' ? 11.7� Q _, 2 U L!Lr- 1Ne tielN� of _s�►�P�.s�� FhQ�(�l`l_�/�,rS��2_f!�3-�' C�'IY�.�s'o F:�G�C,,b_�c��r�/N� ffK - � `r��,rt ��_�L41�.i'�t/EL,/ a�KMf••N�_le�'_�1�'�Q�eat�h�L.�'a�_. ' y�,.rf �71°� s�E v€_ ua_3 0 _v I-0LI .� -1? ►c 7! r?�i/v 6eo -7?/M 's`l�Y o Cf� :�cro t i� � i t 4C Ate. r r'N. c1 rt�try OurI 11>a - et 6"9 Ij Erta yE flll� I�ispar6 o� b6-AA !4)' OF bv1-tpI7 A 031v /I/N6`JZ [beyond ose hereby to,furnish material and labor -complete in accordance with the above specifications for the sum of: 12,060.0 — k�L # , UY Dollars e/ ments to be made as follows:'-30 � � d o oT/t� �!�f/6L 0/t/ on or deviation from above specifications involving extra costs will -Respectfully only upon whiten order,and will become an extra charge over and - s y�J stimate.All agreements contingent up on stnkes,acci ents,or delays submitted control G Note—this proposal may y us if not accepted/within- days. x._ > Cc me of r osat — The above prices,speclticationsrand conditions are satisfactory and are hereby accepted You are authorized to do the work as specified. Signature J r r Payments will be made as outlined above. Date of Acceptance f'�? 2 01 S Signature S 'Z - :NC33,g wnsbWioncontractor@hotmaii.com BBB Accredited Business M'e lber in'Good Standing of the Referral Card For free information on services B01 I OV6 TWES ASSOCI ON from Accredited Businesses in Fir Additional Information and Verification your area - Call Tog Free 1-NO-326-7800 1 F 'm BNN CONSTRUCTION,INC. Check Out a Business at: i. r. e >? Front 1�1/00 To 10/01 ` bbb.org t, r Qj t.tfY OF.SALEM #1834 ONE IMPROVEMENT CONTRACTORit �� BUILDING LICENSE Registration 126962IN° 1 Type - PRIVATE CORPORATION r this is to certify That r Expiration 08,112100 JAMES L. CURRIER S 276 NEQBURY STREET st.,XZARODV ,Mau., p BONN CONST CO INC JAMES L. CURRIER ( Has been rantp a license 6 the Building Inspector as a [ li�; NEWBURY ST/PO BOX 491 MINOR/ AIRS l. ADMa+StaA-S�ABODY MA 01960 OCTOBER 23, 1998 Issued Buil mg Inspec+or " OSHA�I 002330883 - U.S.Department°[latxx ` D Sari afi1 Inc' Occupational,Sal �}aM Health Admmeivahon l< { 1 �{ CeF7rficate of Techrtiral Proficiency r IJames Currior R I V JAMES L. CURRIER `f zt r1 has successfully cmpieled a tWrour Occupational safety and Health t haSsuLCes gully completed a two-day Sarnahl introductory homing Corse in I ' Yraining Course for Samafil Installers under the supervision tbnstrucoon Safety 8 Health of a Samafit instructor. p '. < During the training session,the hearer showed a proficiency m Wilharra Kershaw-NE01009 09�09�09 heaiweltlmganddemonstratedprnc6ca apphcahonproce ?' dear o using Sam ant materials in simulated iob sine conditions. q 1lrauwvt , •' I0ate1ujist �: Daze �tructnr t�I Offic of Consumer Affairs&BAssoess Regulation " V9FIOM(c IMPROVEMENT CONTRACTOR )IS Massachusetts-Department of Public Safety Reghtrabon 140520 Type Board of Building Regulations and Standards Expiration 10232013 PrivateCorporatio oinst ruction so pen isorSpecialty _ _ License:CSSL-099357 a e BONN CONSTRUCTION CO-INC T. rr s s� {{ s - Fi t I f y JAMESLCUR&R JAMES CURRIJ-R .Y ! 20KROCWAALR ADif r} 100 FERNCROFT ROAD UNIT PI)4 - 1 PEADODY#A 11960 P DANVERSj MA D1923 - Undersecretary I z ' r J.L•� r`ra"• Expiration Commissioner 7y17/2013 I SAFETY + OSHA 10 EQUIPIEIil,INC. �L Aeriali$ CertificafeofCompletion Training 8c C N.nsulting Services Forklift Authorizild OSHA Outreach Trainer it a Has successfidly completed a 10 Hour Occupational Tel.: 508-332-8959 i Safety and Health Trammg Course in Construction Bill Kershaw Fac 506-567.6743 1 Safety &Health S Consul Cant 61 Eisenhower Rd,Swansea,MA 02TT7 I - E Mail:sefetye9�pPe� . , Member of A SE a'"^v-sat'e0'W°tpped'c°m I 0': " mxp - �— 1 ramer Date Office of Consumer Affairs and Busmess Regulation e 4 z 10 Park P1217a Suite 5170 ' * �" vfi4tr Boston, Massachusetts 02116 y k` '� Home., provement Cd [Gto ReglstI'ahon� �x Registration. 140520 _ - * Corporation, m 4j, t .. iExpuatton 10/23/2015 Tr8 245961 , .4 ' 1 BONN CONSTRUCTION CO INC' 7�n O 100;FERNCROFT ROAD UNIT 204 'f F'aDANVERS, MA-01923 'a sf '�dtSVey if Axddress and return card.Mark reason for change ��`�� + F t r r ,?;fscat 0 2ort-os/n sf -` lr ha€�h- t1Y`rEs:s� �sw i� Add s Q�R�newal Employment' Q Lost Gerd{`ti Fr } ;•st f Mmi Otrice of ConsamerARairs&Basiaess'R alahoo pt License or registratwnvalidfor mdmduluseonl y,n `. IMPROVEMENTCONTRACTOR before the expirationdate."If found return to r gist2Bon ri0520+'�r z _ Type I '" Office of Consumer AffagsandBusiness Regulation r4 Y�X,#a..pirabon: JO 3r->o 5>.,�+ .3 private Corporabor 10 Park Plaia=:Suite 5170h � u ` �a r Boston MA 02116' r a . BONN CONSTRUC'fIO I '-ss`"'" -,+-a ' " t DAMES.CURRIER — Fl s FERNCROFT MO NfF204�' ''` DANVERS MA 01923 ze-g5e•:] �r� Y - 1 ,, .t' .�. lr+�.� - e . Uodersecrrtary ' ?' Not valid without slignature 'a �`` e s° �` c• Y t � '� •"3' ^fit � ? Y = K,i t-3L f.' d � r-� �x: t ��ti t , 't' r 2 1 J i A F f �T h'.. t r �i V �•—„'fie. x ..