51 LAFAYETTE ST - BUILDING INSPECTION � �
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C�'r�t OF S�Nt
., PLTBLIC PROPRERTY
DEPARTMENT
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Woricers� Compeautlos Imnraact At�davi� gyp�yContracto
:�nolkaet InformatM� Ple .. p.t...r.�wti.
Name� . . . . �. �CG� �LC � � e„� La��--S L�C a,,,,n,�,
nd�: 17 1 v�r (oo Sd�, Sd-e �c� �
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ship aad h�w ao empbyaeu '1��haw
woricia� for m�io my eapacity. wakees'�anp,i�y, 8' �Demolitlm
[No Wroelcmr'eamp,inwona 3. Q We aee t�m aod it� 9' ���°i�ddiNm
3.� 1��a dhomeownar doin��ll walt ����� 10.[]Eixtrig(rap�irs a�
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!aw ow imoloyp tAat b provld/nr worRns'cowPenaodo�L�,trrowce or
lnfoiwaNat ,y � f �J'�"�1�Y�ts Belmr L MKPo�7'�JaI.rLM
I+uutance Comp�cy Name:_ �in�s K r� / �vl[e�i� {� rrQ
—J
Poliry M as Self-inr.Lie.M:_ w G ��`� � �'�'� y
Expindon Date:_ ��/�a�
�ae s;ce aa�w: ,3� P�- �„ S�I cchisawz;�: ���-�, �`1�- �/'70
AttacY�cop�of tb�workea�eo pe�aqo�poUe�,����P����� ��
Faihua w xeum coven � 017�Oi Po�f°umb�r and aplratlo�daN}
W raNi�ed uader Secdoo 2SA of MGL a 132 cap lad to th�imypripop o/arimiav
fine up w 51,300.00 and/ar aaayar impri�on��,�weU u civil penalda ia�he form of�STOP WORIC ORDE�R a�ad irAn�
of up ro 5230.00�daY aitiwt tA�vialua. 9t advixd tfue�capy of Nii mtement may be focwarded w�he OtIIee ot
Invesrigadow oP�he DIA fa in�uraoce eav��p����d
/do h�reb�uidJJr nnd ��anlPs olPu/wY tb�du In
lan�a�lowOrovldi/ aw an!corrtcs
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C(ry or Towe: PermltlLkenu M
Iauln�Aut6ority(ekeb ona):
1. Bo�rd of Heilt► 2. BuUdiat Department ).C(ryltow�C►erk �. Elatrial Impator S.Plumbla�Impector
6.Other
Confaet Pereae• � '
P6oae p•
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Client#:29552 RESOU '
. ACORD.M CERTIFICATE OF LIABILITY INSURANCE os;,,,a,°""�'
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
INSURANCE MARKETING AGENCIES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
306 MAIN STREET HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
WORCESTER, MA 01608 ,
508 753-7233 � INSURERS AFFORDING COVERAGE NAIC#
INSUREO iNsuaER n: Philadelphia lnsurance Companies 23850
RCG LLC iNsuaeae: American Guaranty 8 Liability Ins.C 26247
17 Ivaloo Street,Suite 100 iNsuaeaa American Home Assurance 19380
Somerville,MA 02143-3656 iNsuaeRo:
INSURER E:
COVERAGES
THE POLICIES OF INSUR4NCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDWG
ANY REQUIREMENT,TERM OR CONDITION OF ANY WNTR4CT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFlCATE MAV BE ISSUED OR
MAV PERTAIN,THE INSURANCE AFFORDED BV THE POLICIES DESCRIBEO HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REOUCED BV PAID CLAIMS.
PO4CYEFFECTIVE POLICYEXPIRATION
LTR NSR TYPEOFINSURANCE POLICYNUMBER DATE MMIUO DATE MMI�O LIMITS
/� GENERALLIABILITY PHPK223092 0$�20/Q] Q3�ZQ�Q$ EAGHOCCURRENCE $� QQQpOQ I
X COMMERCIALGENERALLIABILITY �AMAGETORENTED $�OOOOO
CLAIMS MADE �OCCUR MEO EXP(Any ane personJ $S OOO
' PERSONALBAOVINJURV $'I OOOOOO I
GENERALAGGREGATE S?OOO OOO
GEN'LAGGREGATELIMITAPPLIESPER' PRODUCTS-COMP/OPAGG $TOOOOOO
POLICY PR� LOC
JECT
AUTOMOBILE LIABILITY
GOMBINEDSINGLELIMIT $
ANV A11T0 (Ea accident)
ALL OW NED AUTOS -
BOOILV INJURV $
SGHEOULED AUTOS (Per person)
HIRED AUTOS �
80DILY INJURV $
NON-OWNE�AUTOS (Per accitlent)
PROPERTV�AMAGE 5
(Per acciden�)
GARAGELIABILITY AUTOONLV-EAAGGIDENT $
ANYAUTO EAACC $
OTHERTHAN
AUTOONLV: qGG $ '�
B EXCESSIUMBRELLA LIABILITY AUC900701003 �3�20�07 03�2���9 EACH OCCURRENCE $25��Q QQQ
X OGGUR �ClAIMS MAOE AGGREGATE $YS OOO OOO
5
OEDUCTIBLE
8
X aErENrioN 810000 g
C WORKERSGOMPENSATIONAND WC6840833 OSI'ISIO7 OSI'IS/OS X wGSTATU- OTH-
EMPLOYERS'LIABILITY
ANV PROPRIETORIPARTNERIEXEGUTNE EL EACH ACCIDENT §'I OO OOO
OFFlGERIMEMBEREXCWDEDP E.L.DISEASE-FAEMPLOVEE $�OQOOO
Ifyes,descnbeuntler
SPECIALPROVISIONSOeIow E.I.DISEASE-POLICVLIMIT $SOO,OOO
OTHEft
DESCRIPTION OF OPERATION51 LOCATION51 VEHICLES I EXGLUSIONS ADDED BV ENDORSEMENTI SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULO ANY OF THE ABOVE�ESLRIBEO POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Salem DATE THEREOF,THE ISSUING INSURER WILL EN�EAVOR TO MAIL �p_ DAYS WRITTEN
720 Washington Street NOTILE TO THE CERTIFICATE HOLDER NAMEO TO THE LEFT,BUT FAILURE TO DO 50 SHALL
Salem, MA 01970 IMPOSE NOOBLIGATION OR LIABILITY OF ANY NIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE I
ACORD 25(2001/08)1 Of 2 #134794 GCE o ACORD CORPORATION 1988 �I
IMPORTANT
If the certifcate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer,and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25S(2001/08) 2 Of 2 #134794
/
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i �`' ' PUBLIC PROPERTY
`` DEPr1R"I'1bIENT
I1:I�MEl1.EY DRISLt1LL
�^� t'�W.�w�r�cfcw 5[xEEC.�yurx�(nssnat;st»s 01970
. 14L•9'l-74i959S�FNC 9767iQ9616
APPLICATION FOR THE REPAIR RENOVATION. CONSTRUCTION.
DE�IOLITION. OR CAANGE OF USE OR OCCUPANCY, FOR ANY EXISTIl�IG
STRUCTURE OR BUILDING
, 1.0 SITE INFORMATION '�
Locatlon Nams: e. L,�-}� Buildin9: [��, � '
PropertyAddress: 3�.0 �e„�y S�-r�3-�-
U
propeAy is located in a; Con�ervaUon Ares YM�_Hiatoric Distrkt YM
2.0 OWNERSHIP INFORMATION
4.1 Owner ot Land
Name: �� Lv��l-S LI-C-
Address: C�o (� G L�C S,v ,� 'Da
�7�eloo lef�i�l� O�/
Telephone: 6' 7 615� 8'3( '�
3.0 COMPLETE THIS SECTION FOR WORK IN FY�QTiN�= BUILDINGS ONLY
Addition Existing ,6
Renovation x Number oi Stories Renovated
Change in Use New
DemoliGon Existing (�N(�ru.+�
Approximate year ot � Area per floar (s� Renavated
construction or renovation '1004
of ezisting building New
&ief Description ot Proposed Work: ,�
. $��o�i���� Dw� l,�Fds U�,t C-1�n�c�aA � � �� a
�w;�- C-1n- R� A7� s�F�- c-�A�-�,u�a� a��:<<w ���
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. �nctosr� p� �/'�,�(�� L,,
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. getlw� elt.rF,•rc4� �' C-
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------------Mail PeRnit to: �G U 7"�� � �� �a z�Q "��
u�
LIFE SAFETY LEGEND
� FL FIRE ALARM SPEAKER WITH FLASHING LIGHT c � � � S� F� ti,o � I
n� MANUAL FIRE ALARM STATION .11 FL EXIT � \ oTafO I I y�pCG�!�/ i
I ' v f � � �
\p �rTl�� \a o/ �
. enc FIRE ALARM SPEAKER I I � FL \ Sf0/��O,S �`OJ�O�(
e
O ADDRESSABLE SMOKE DETECTOR � �3��CP t �0�0 �%/ � �
ExIT ILLUMINATED EXIT SIGN I I I O \ �9'o '��' I
STORAGE AREA � / STORAGE AREA �
UNIT C-2A—R
JUp �
_ � NOTE: exi i
— _ � Existing wall
� and ceiling to ______ -----1---
\ Employee only remain at � . --
toilet room with ° New 1 our tenant separation wall: , basement
sink, gyp bd. I UL # U 65, 1 layer �" gyp. bd. � ------ —,
� - finish walls to i� � I each side on 3 �" metal studs. E Existing chain link fence � Gas meters �
\ deck Seal wa I assembly to underside of I I
structur�l deck
� O 6' 0" O
� \ UNIT C-2A—L Align �
S � � Basement Floor Plan
% � Ne 1 hour rated
sh ftwall soffit
`�� � New 1 hour � �r _
� � rated stair E � ex ting pipes CODE SUMMARY:
� enclosure ��_5^ � Use G�oup M
"' � Number of exits: 1
r' � � N w gyp. bd. wall to �
�, � ry�� � z 11 —o" A.F.F. 780 CMR Section 1017.2 "SPACES WITH ONE MEANS OF EGRESS"
�S \ �„ W Maximum occupant load: 50, actual occupant load: 28
yr � o m i Maximum travel distance: 75 feet, actual travel distance: 58'-5°
� a� Ex sting ceilings to
\ `o� �rei ain, typical Actual Occupant ,load: �EQED Aq
'�� Per 780 CMR Table 1008.1.2 @`��PK �y�.c�l��,�
� EXIT � �L i � i Exir � F� F . First floor Mercantile 1 per 30sf gross ym
745 sf / 30 = 25 occupants
; Basement Storage Mercantile t per 300sf gross 7083
785 sf / 300 = 3 occupants � M� ���
// L M i Total Occupant load: 25 + 3 = 28 ��n+' OF Ma`'��
�Remove center window and install New door
� with hardware and transom to match existinq Actual Maximum Total Travel distance:
� building standard From Basement to top of stair 37'-9" + 20'-8" = 58'-5" �
Fi rst FI o o r P I a n '�r;°°�''LD� , _, , _,--�'
iL'�".r9:i0 F�<".C: .
Derby Lofts Condominium Unit C-2A Subdivision ��=' �k� '' _=
;.�: �. .
51 Lafa ette Street, Salem , MA = ,, � ,J� � ' „ '�
y Scale: 1 /8�� � �—��� c ^ °n � � '-
Date: 5/16/2007 r �` ' � �{
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W I N T E R 5 T R E E T A R C H I T E C T S, I N C. F L`r�- �7�'��,��r_{r , F` c r�c, r
� =� F�c� �i�' ��� .Uiu� L° — o'ZR —l.i
u
LIFE SAFETY LEGEND
� FL FIRE ALARM SPEAKER WITH FLASHING LIGHT c — � � I � F� �o � i
n� MANUAL FIRE ALARM STATION y F� EXIT � \ fTofO/ I I y�oCp�%� i
I ' u
l tJ �
enc FIREALARMSPEAKER I I I � FL ` � fO�e/d' OJ�p`�,// I
� I
O ADDRESSABLE SMOKE DETECTOR ���3j�CP t �0�0�`% � i ..
EXIT ILLUMINATED EXIT SIGN I I � \ ``9'� v.�' I
STORAGE AREA �
UNIT C-2A—R
� I STORAGE AREA �
JUp �
NOTE: ew �
_ _ � �
— Existing wall
` I and ceiling to ______ -----1---
\ Employee only ,I remain at —
toilet room with � New 1 nIour tenant separation wall: basement
sink, gyp bd. I UL � U465, 1 layer �' gyp. bd. � ------- —�
� finish walls to i� � I each side on 3 �" metal studs. Existing chain link fence
�--- Gas meters �
\ deck Seal wa!I assembly to underside of I I
structur}�I deck
\ O s o' I O
�
S � � Basement Floor Plan
� UNIT C-2A—L Align �
% � Ne 1 hour rated
} sh ftwall soffit
`�� ` New 1 hour � �� — .
°� � rated stair E � ex ting pipes CODE SUMMARY:
� enclosure ��_5�� � Use Group M
`'' � ° Number of exits: 1
N � � N w 9YP. 6d. wall to
�, � �,�� � z 11'-0" A.F.F. 780 CMR Section 1017.2 "SPACES WITH ONE MEANS OF EGRESS"
� � �„ W Maximum occupant load: 50, actual occupant laad: 28
y� � o m i Maximum travel distance: 75 feet, actual travel distance: 58�-5"
� � a� Ex sting ceilings to
�z re ain, typical Actual Occu ant load:
I _ P
� �o � �
h� First7fl or Mercantile1l�oser 30sf ross �.�'St�hKP+F���fr`�
� EXiT S� FL � � I eXiT � FL F P g � PQ �'
745 sf / 30 = 25 occupants yc^
� Basement Storage Mercantile t per 300sf gross ,�
785 sf / 3Q0 = 3 occupants gp�p� �y"�`�
L Total Occupant load: 25 + 3 = 28 �, �u�Ss�
M ��ny oF ��S
Remove center window and install New door Actual Maximum Total Travel distance:
with hardware and transom to match existing
i bu�idtng standard From Basement to top of stair 37'-9" + 20'-8" = 58'-5"
First Floor Plan
�
.. ,:...
Derby Lofts Condominium Unit C-2A Subdivision J,�- 2 �� i` ': ' ;:' =i: T
51 Lafayette Street, Salem , MA Scale: 1 /8�° _ � �-o°° r_�=`�=�'�� _ �°.==-�-��;�'= J -
Date: 5/16/2007 y� ;�
W I NTE R STRE ET ARC H ITECTS, I N C. o.,;. _ , ;��:;; _ ;.
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Fi..''r._"i�iT;ti:J�.!.;:%C
. AC]Cc:';ITt:Tue e�pe CODE.
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