51-71 LAFAYETTE ST - BUILDING INSPECTION (2) Now City of Salem Ward
f
APPUCATION
FQ!I-
PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTIC
IMPORTANT-Applicant to conwAlwao.nwns in stir amiss:414 p4 N,and IV
LOCATION {;.a: w rlow-1,
OF BETWEEN - _. .._... .. AM .
(macs eTf1Ea11 1CFAM s1NaD
BUILDING . LOT
SUBpMSION LOT BLOCK SIZE
L TYPE AND COST OF BUILDING -All applicants complete Pens A-D
A. TYPE OF IMPROVEMENT D- PROPOSED 118E-FOR"DEMOLITION"USE MOST RECENT 11SE
1 ❑ Nov buiArri 9aeldowdW- - - alorrardeniel
2 ❑ AddMoll(M raeidentlµ wrier mmbw 01' 12 ❑ ono family - 18❑.A MN110t raoaetlurel -
(oueinp urdb addaQ y any,inWrt 0, 13) is 0 13 ❑ Two or m fw*-EnW numau 2D 13 advin raapiolMl
kwuww
3 ❑ Alteration(Sae 2 ab") of ur" 21 ❑ Pokkq Onuia
4 ❑ Repek MPIMMa 11 14 ❑ 7MIslot halts,now,or domefory- 22 ❑ service decor►NPek wrow
EMarnumEer d uM—�.__—.—.
. 5 ❑ Wreakkrp(e mukyurMly raoHentlal enfu nwMu 23 ❑ NoaDeel irrWlrelorrel
of unite in tM**V it Port O. 13) 15 ❑ qw!T _ 24 ❑ Oifoa balk pdeeaiorW
i ❑ Mm*V(relocation) 160cwpwt, 25 ❑ Public utility
26 ❑ ad"allary,odw adueamrW
7 ❑ PourWallm orgy 17 Q 011w-SW* 27 ❑ slwae.nlaK;erga.
- B.OWNERSHIP 26 ❑ Tergra facers
i ❑ Private(individual corpareticm n pmflt ❑ oily- �,
habludlon,etc.) 29 -
9 ❑ Public(Federµ Stale,«local aavunmud
C-Corr 0m4 overt Nwwan er"-Describe in dsui Proposed use d twidknia,oau food Procesekq Place.
MdA dop Wwxky didYq d hoepAK denw"edwA sseard.y, ooiepa
10. Call d improrerrwn — _--_—_ i Pero .. sdod.pwkkV Wrap far dome we dons,nrMY dlbs blritlYni.dice buadkni
_,.... at-kxhmbW Plant.a use of eMistiry buil*v is bent c w04 user Proposed use.
TO W k/areBed tkd not k)ckWW
in tW above cod
a EleMcel --_.-.-----------__---.
b.
a Hestirla air wntlobvq.__—_--_-- , 00 -
CL Cow(ew4dw.aim)
11. TOTAL COST OF IMPROVEMENT
IIL SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, complete Parts E-L;demdition.
complete only Parts J&M aH others skip to IV
E- PRINCIPAL TYPE OF FRAME F. PRNCVAL TYPE OF HEATNO FUEL fL TYPE OF SEWAGE DISPOSAL L TYPE OF MECHANICAL
30 ❑ Mwony(wd bea inp) 35 ❑ On 40 ❑ Public W Prrv4U oorrpeny Will thue be central ak
cddebnklQr
32 ❑ Seuchxd steel 37 ❑ Electricity41 ❑ Privies(septic tare(aic) 44 ❑ YOM 45 ❑ Nb
f7. TYPE OF WATER SUPPLY
33 ❑ Reknloread eacreM 38 ❑ Cad Will inert by an aiavalar'r
34 ❑ Odw-SW-AV 39 ❑ Oiw-sPeoih 42 p Public d Winos cwgwW 4e ❑ yes 47 ❑ No
43 ❑ Private(wail ciatem) '..
1
►as ra,mw a star M. DEMOLITION OF STRUCTURES:
+ ..._..._..._...._..._..._............._.._..._ _._
as Tar spurt ter of floor arcs. Hes Approval from Historical Commission been received
y r0°" o'se°°A°X0BA01 ._.__._. for any structure over fifty(�)years? Yes_ No—
....
So. Tar Wes aces.$a �B Number
IC NUIIBot OF OFF•STREu PANWNG SPACES Pest 6ontro@
Si. Endoetl _—.-_.__._.._—..__.—____--_.._—
.HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?
52 outdone_.— .------------- Yes No
L RESURIMAL euaoE"ONY WNW -
53. Encloeee -- Electric
Gas: .
Fue _. Sewer:
st N"n""`Of.
DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED
o'I`""" BEFORE A PERMIT CAN BE ISSUED.
IV. COMPLETE THE FOLLOWING:
Historic District? Yes_ No_ (If Yes.please enclose docurrrentatlon front Hist Cam.)
Conservation Area? . Yes___ No_ (B yes;please enclose Order of Condi MY
Has Fire Prevention approved and stamped plans Or applications? Yes_- No_
Is property located in the S.RA district? Yes_ No_
Comply with Zoning? Yes_ No_ (If no,enclose Board of Appeal decision)
Is lot grandfathered? Yea_ No— (If yes,submit documentation/if no,submit Board of Appeal decision)
if new construction,has the proper Routing Slip been enclosed? Yea_ No_
Is Architectural Access Board approval required? Yes_ No_ (If yes,submit documentation)
Massachusetts State Contractor License# Salem License #
Home Improvement Contractor# Homeowners Exempt form(if applicable) Yes_ No—
CONSTRUCTION TO BE COMMENCED Wri-HIN SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT
H an extension is necessary,please submit
CONSTRUCTION IS TO BE COMPLETED BY: 1 ' r in writing to the Inspector of Buildings.
V. IDENTIFICATION• TO be completed by all applicants
Name Ma&v address-Nundw sank car,and slab ZIP Code Tel N0.
1.
Owner a
Less6e
2 (°
Cawacw Salads
L.ioenY rILL
a
A,Ch ted or
Erpirr
I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application
as his authorized agent and we agree to conform to all 2peLcable laws 0 this jurisdiction
Signature of applicant Address Application date
ACORD_ CERTIFICATE, F`O LIABILITY INSURANCE BSSEX P3 03 13 D8
PaoouDER• THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION -
Mazonson LLC wcaw:mazonson.com ONLY AND"CONFERS NO:RIGHTS:UPON-THE CERTIFICATE
7g1';Edg'ewater,<DriVe HOLDER.THIS CERTIFICATE DOES.NOT AMEND;.EXTEND OR .
Sui te`,230 -' - ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Wakefield";MA 01880-6236 � ' ,
'Phone-'781.=224-5700 Saxc781-224-5777 ' . INSURERS AFFORDING COVERAGE - - NAILit
INSURED INSURER A. Hartford Insurance Co.
INSURER 8:
ESseX County Craftsmen, Inc.,Charlotte" Noyes '
60.•Ward St. INSURER C'.
- INSURER D:
-=Salem MA:;01970
INSURER E: -
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING -
ANV REQUIREMENT,TERM OR CONDITION OFANV CONTRACTOR OTHER DOCUMENT WITH RESPECT TO,WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
�'POUCIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR'-IN
SR rTYPE OF:INSURANCE POLICY NUMBER DATE(MM/DDIYY) DATE(MMIC•D/YY) LIMITS-
GENERAL LIABILITY - - EACH OCCURRENCE $COMMERCIAL GENERAL LIABILITY PREMISES(Ee o�T c� curce) $
CLAIMS MADE ❑-OCCUR - - MED EXP(My one person) $
PERSONAL&ADV INJURY -$ -
GENERAL AGGREGATE $ -
GENLAGGREGATELIMITAPPLIESPER: - PRODUCTS-COMP/OP AGG - $
POLICY --PEA F7. LOC -
-+:' AUTO MOBILE LIABILITY -
COMBINED SINGLE LIMIT $
PNY AUTO B.eccidenll -
ALL OWNED AUTOS
BODILY INJURY - $
SCHEDULED AUTOS (Per person)
. HIRED AUTOS.:
BODILY INJURY $ -
NON-OWNED AUTOS - (Pereccident)
PROPERTY DN GE -
(Per accident)
- GARAGELIABILT/ - - - AUTO ONLY-EA ACCIDENT $
ANY AUTO -
. OTHER THAN EA ACC $.
AUTO ONLY: AGO- $ -.
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR '.'❑ CLAIMS MADE - - AGGREGATE $
DEDUCTIBLE.RETENT-ION $.
'WORKERS COMPENSATION.AND WC ST=
TORV LIMITS ER'
EMPLOYERS'.LIABILITY
A' ANY PROPRIETOR/PARNEFyEXECuTIVE OSWBK16804 _12/.31/07 12./31/08 E.L.EACHACCIDEW $ 1000000
x. OFFICER/MEMBER.EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ SOOOOOO ..
if yyes tlesPROVI69 IONSder - E.L.DISEASE-POLICY LIMIT $ 1000000 .
- SPECIAL PROVISIONS Oelow - -
'OTHER .. ._.
DESCRIPTION OF OPERATIONS(LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECD PROVISIONS -
CERTIFICATE HOLDER CANCELLATION
ENGINEH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
Lafayyett
EAgLa@Lafayette Street House Of Pizza IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,TITS AGENTS OR
- 71
Salem MA 01970 REPRESENTATNES.
' - AUTOO REPRESENTA
ACORD 25'(2001/08) 0ACORD CORPORATION 1908
h'ousc or pIzz9
—71
- GL 611d v Ur
Essex County Craftsmen, Inc.
°Your HVAC Comfort Craftsmen'
60 Ward Street
Salem, MA 01970
/ •i Joe
c a,
,9 LI
... _ . _ _, , ,,,�,,,,�,u t:59l:L CUt.:ti't'Y f1tAFTSM9�V f�0.li •.�
CITY OF S t LEM
e) PUBLIC PROORERTY
Ar r DEPARTMENT
-�t,t\Ylla
t?v W AliHINCTV N$T3P C7 •5n LyMy:✓lASydt^.h't�tiS'1'1'i 0;9:'^
TEL;97974F.M,5 • F•\x,1971l-7+0.9014
Workers, Compensation Inxurante Affidavit: Suilders/Contrpctore/F lNrrrlefans%Flruraberet
9aplit sent fnforinatf n _ _ .w 1 � t t.
tifune Itusines.iprga izatiowt:rdividual;.. f'<� y a 1Lli� {� rYtifrl�, !�
Ciry,rSrav rZip: y Phone
r --
-ire you an amrployer?Cbeck the uppriipriute box: —� i__
'y� "Cypr, al proJrxt(requ)red):
l.q, t ama employer with, 4, �..�.'am a general ;onimmor and I
j r] : nsttuctiop I
�mployres(full and/or pa.1-dme).y � have!rind the sub-.'CntacW[S i
2. 1 den a aoln proprietor or paR.nev listed on the attached sheet ; ,f�..! Rernodeling
Snip and hL%t no employees These iub-cuntr'actora have I A. 4J Ctemolition
workirq for me ui any capacity, worker'romp,insuranca. y, Building addition
['Go workers'comp, insurance " ❑ Via arc a corporation and its
rea'irxt•l at?iners hays extidsed[heir. )0.7 ( leeffcal repairs oraddidons
]. t an a horneownar doirg all work right of exemption per MOL 11.0 Plumbing repaita or additions
myself (No workara'comp. c. I r2, ¢1(4),and we love ne 12.n Rwfrepaim
iniurauee required.) r crrdlnyees, (No workers'
irrauranrx tegtured.1 13.0 Other_,-Any apP;icant dui elreakx ben el mot use Fj; Pv
p''t etr atxaoa'rtlaw rhawinb rkc;t i
a'orken xnpnnrati M1 iicy in;ormtuiaa.
t HomeoWrwro wAo ru!rrnir this atnd-it ioricetmj ditg'are deiau 6;work lbrir and tam Fire auuitk;vronlrxtu1(6 Atun submit s nrw i7rrda+it itgieatiryl sSUMtConrrulon tt!a check]his box must aur:fied on addir"'na"that rN .via the name ONO ryp.rx trrcton orti nankin;'co
P a T. tap.Pelia;r inPotnution.
!rm pn urtploycr that re prorvdimE,r workalrs'cotNprtroriom insurdnce jot rr[y enrp.'oyres, Ballow fs the pol4y rrwd fob fib
lnjarnradon.
Insurance Company Name:,,,.„��i
Policy or 4e1l°•ins. Lic.it,
'ob Site
�=�--�••'�`
Attach a copy of the workers'compensation policy declaration pose(showing th# policy number and erplration datih
Failure to secure coverage as requt-od ender Section 25A of MCL c. l 52 cart leaf to the inapo5ioon of trim nsI penalties of a
""Itep to Sl.SCG.wand/or one-year!mprcoruntnt,is well as civil paraldsc in the form of a STOP WORK GIRDER and a fine
or,,a W S23U,00 a day against the violator. 9t adv:acri teat a copy ot'this s[atemenr MAY y.fu yarded to the Office of
Ir,reatigati..nls of tits AIA for insurance .overage ver:llca'ion.
ermfq rrreifj• r .alr tr po" odor r�r of /pry"Aar thr rr{furMaNp:r plYglvPAPd a/xrre is trde and eorrerL
one k•
_-.=armsavmmrr«t — __ _'--- - -?„�,���•�tmw�r�[�-1�..................�...�_....,.,....._..._.�.�.
gJTrrtpl use arlY, Do nor attire in this ureq to or cumpkrrd by ciiv or town O.Dyc471.
City or Town: Pormlt/Licenae Y
(truing .ynthor,h• trirclr oar 1: �_._._..._.._ y'�"�"-"-'
1. Board of Ileaith 3,-pui4ding Depar[mcet .7.C.ty,'Towa f'lnrk 4, t:lictricalltnspectur S. Plumbing Inspector
or
Oiher._ _
COatgct person;_
I
03/23/2008 13:48 .FAI 10787490113 - ESSEz (,,o m CRAFf - 19002
. CITY OE ;7LEM
PUBLIC PROORERTY
DEPARTMENT
.V�Lirhl r�' alv.l"L 11nii.1�'.'rl; .C:ia::h%:
\LN1•N L'C W.�+111u7:UA1�t3CET•5Alc,
tFI;gW45-0993 ♦FAIJ 9704- Y46
I
I
Construction Debris Disposal �%Mdavit
(required ror all demolition;utd renovaticja work)
in°rccorttance with the sixth"don of t3ta St=l;uildinS C+. 780 CMR section I 11.5
Nbris,ArA the provisions ofM- GL c 40.S 54,
puildinS Permit 0 _ _ is issued with the r0ndi ua thot the debtis resulting�m
this work shall be disposed of in a properly licensed waste dispo#al Pbeility,as defined by vIGL c
l l h S 150A.
i
The debris will be transported by:
�Ss e LL Crl , �r • ^
lmsve adfiaute �
1'1..e J.:bris will be disposed of in
inerw of fxllity)
_/1\Jw�lZ-cam -,Juw �n. SS /c»�� Y� � 1
! :J:J
e
ruild
O NOT WRITE BELOW THIS LINE
VI. IDATION
FOR DEPARTmEW uSE ONLY
umber use Group
g 19 Foe Grac"
issuedgFee 5 �� ocra.�vwcy Low
ate of Occupancy $ Apile Plan Review Fee $ "
—�—�L
mLe
NOTES AND Data (For department use)
Aj$ IL6 U
N
C S .
PERMIT TO BE MAILED TO:
DATE MAILED:
Construction to be started by. Completed by.
F
r
�yy
A ZONING PLAN EXANUNERS NOTES
DISTRICT
USE
FRONT YARD
SIDE YARD SIDE YARD
REAR YARD
NOTES
SITE OR PLOT PLAN-For Applicant Use
ON