0051 LAFAYETTE ST 71 - BUILDING INSPECTION 0051 LAFAYETTE STREET 71 270-2004
GIs#: 1362 COMMONWEALTH OF MASSACHUSETTS
Map 34 ''kl—
CITY OF SALEM
Block »
Lot: 0485
Category: DEMO
Permit 270=2004 BUILDING PERMIT
Project# IJS-2004-0412
Est.Cost: $7,500.00
Fee: $30.00
,Const. Class: J PERMISSION IS HEREBY GRANTED TO:
UseGroup:' Contractor: License:
Lot Size(sq. ft.): 20752 James J. Welch&Co. Inc. General Contractor-CS 067486
Zoning: B5 Owner: DERBY LOFTS LLC
Units Gained: Applicant: DERBY LOFTS LLC
Units Lost "
AT: 0051 LAFAYETTE STREET 71
Dig Safe#:
ISSUED ON: 19-Sep-2003 AMENDED ON. EXPIRES ON: II-Mar-2004
TO PERFORM THE FOLLOWING WORK:
270-2004 DEMOLITION WORK ONLY FOR DERBY LOFTS. TJS
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Electric Gas Plumbin¢ Building
Underground: Underground: Underground: Excavation:
Service: Meter: Footings:
Rough: Rough: Rough: Foundation:
Final: Final: Final: Rough Frame:
Fireplace/Chimney:
D.P.W. Fire Health
Insulation:
Meter: Oe:
Final:
House# Smoke:
Treasury:
Water: Alarm: -
Sewer: Sprinklers:
THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS
RULES AND REGULATIONS.
Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
BUILDING RFC-2004-000427 16-Sep-03 016590 $30.00
GeoTMS@ 2003 Des Landers Municipal Solutions,Inc.
JAMES J.WELCH i'CO.,INC. 0,
VENDOR#-09409 -City, of Salem
NAME DATE-09/11/03 165 0
YOUR _fNV6"iCE; NO INV I DATE AMOUNT -DIS/RTN6" REI�ERFNCE NEP�;§iT
4010/DEMO PERMT ;,09/11/03 30 . 00 00
4010 30 . 00
5
'-M
TOTALS 30 00 DO30 . 00
'A�
co OF SALEM. MASSACHUSETTS
3� PUBLIC PROPERTY DEPARTMENT
120 WASHINGTON STREET, 3RDFLOOR
gp SALEM, MAO 1970
�s TEL. (978)745-9595 EXT. 380
pmru FAX (978) 740-91346 .
STANLEY J. USOVICZ, JR.
MAYOR
DISPOSAL OF DEBRIS AFFIDAVIT
In accordance with the provisions of MGL c 40,S34,I acknowledge that as a condition
of Building Permit# all debris resulting from the construction activity
governed by this Building Permit shall be disposed of in a properly licensed solid-waste
disposal facility,as defined by MGL c III, S150A.
_ w
The debris will be disposed of at: CHA(2 forge j�2uc��q
Location of Facility
Signa of Permit Applicant Date
FULLY complete the following information.
(PLEASE PRINT CLEARLY)
Name of Permit Applicant
/a9-mE5, J. tr/Et-cH if CO. rNC.
Firm Name,if any
27 CONG2ESS ST 5/f( eM M6 I o1,0170
Address, City & State
The above statute requires that debris from the demolition,renovation, rehab or other
alteration of building or structure be disposed in a properly-licensed solid-waste disposal
facility as defined by MGL cM, S 150A, and the building permits Or licenses are to
indicate the location of the facility.
The Commonwealth of Massachusetts
- ere Department of Industrial Accidents
office of/ovesvffa//oos
600 Washington Street
Boston, Mass. 01111
Workers' Compensation Insurance Affidavit
MEMOOn —..t %'—plesse-piff
nun.,
ltb:lli0n�
city
nhon M
0 1 am a homeowner performing all work myself.
0 I am a sole proprietor and have no one working in any capacity
I am an employer providing workers' compensation for my emoloyea working on this job.
coriinanv name: James J. 6J _ ch & Co. Inc.
address: 27 (nnaress Street
tit.. Salem MA 01970 phone ro: 978 744-9300 x 129
insurance cp American International Companies narierft WC 00725313200 (2003)
(] I am a sole propnetor,general contractor,or homeowner(urcie one) and have hired the contractors listed blow who have
the following workers' compensation polices:
comoanv name;
1d d ress:
CI~' - ohone p-
irtsunnce[o eolievM
company name:
Address,
cirv;
nhon u
insurance co Doli ft
.>.mc a dl000■ z E �aesss:aa w
Failure to secure coverage u required underSection 25A of MGL 152 can Ind to the imposition of enmmal Iinaities of a fine up to 51.500.00 and/or
one ycan'imprisonment u well as civil penitin in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me, I understand that a
copy of this statement may o arded to the Once of Investigations of the DIA for coverage verification.
I do hereby Certify er he aint and Penalties of pc7ury that the information provided above is true im-d CO22
Signature ` D
Date
Pnntname EMILY H. TURTELTAUB, Controller Phones 978 744-9300 x 129
oRicial use only do not write in this area to be completed by city or town official
c,ry or town: permitAieeue M nBuilding Department
[31 - Board
3 O check ir,mmedute response is required �Sdcctmen"OR ce
0HnIth Dcpsrtmcnt
contact person: phone a; rIOther r.J
1m-")m)FIA) --
30
-PLIAOST-eE ffLf�-APPPROVED 8Y T44E
WS.P,I:CTDR ,PFWfl TDA PERMIT.B,EW G GRANTED
CITY OF SALEM
No. 7 p-ZOO I "� Date q"
\.
Is Property Located In Location of
the Historic District? Yes No Building 5r-71 c,4FAY6-77E sr
�r9G,r=0� OLi.4
Is Property Located in
the Conservation Area? Yes No v
BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other:
PLEASE FILL OUT LEGIBLY &COMPLETELY TO AVOID DELAYS IN PROCESSING
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name D E(L$y LoEYS
Address & Phone f*3 M>9 SS 405. CAMdRIbIrE ( 6l7) # 9( - f 3 f 5
/,I#. oz/ 9
Architect's Name WjIVTc'A STgEET AgCki7f0lr /AIC, .
Address & Phone Sr. 5,¢6EM M,& 744 -
O/ ?
Mechanics Name
Address & Phone L )
What is the purpose of building? fZ E 5 i Dc`NT 119 G j R—E 7`.4(L
Material of building? CONC: ./8jZ1 C k/,S7'N5LIf a dwelling,for how many families? Sof
Will building conform to law? Yc-f Asbestos?
Estimated cost 5-0 j City License # N A State License # 4
aJ�oo K �1bS4� Borne Improvement v �/ _: _ ��
,A1 vSignature of Applicant
SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE, / ^
an
MAIL PERMIT TO:
.r
y �
No.
_ry
APPLICATION FOR
PERMIT TO
LOCATION s
� yz°
PERMIT GRANTED -
11673 10
APP OVFD
INSPECTOPI OF BUILDINGS