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76 LAFAYETTE ST - BUILDING INSPECTION (8)
W `7—& QC G � J The Commonwealth of Massachuse (ray \ Department of Public Safety Massachusetts State Building Code(780 CMR Building Permit Application for any Building other than a On or Tvv amily i (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 stye address' vailable) ��0 1.L. �{-�c S^� • �g ke Yh 1,�-lA No.and Street City/Town Zip Code Name of Building(if applicable) 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❑ Repair a<Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑. Specify: - er`-e - +v- Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑, No Is an Independent Structural Engineering Peer Re�view required? Yes ❑ No mp / Brief Description of Proposed Work: /V leg Yn O ve t�X+ IMP I /lG aLs Z l�+ e.S e i 5 � c 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): r Proposed Use Group(s): rrl r e-565 X. SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Se Wt Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-1❑ F2❑ H: Hi Hazard 19❑ H-2❑ H-3 ❑ H-4❑ H-5❑ 1: Institutional 1-1❑ 1-2❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑ S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ HIA ❑ IIIB ❑ I 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: Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site Private❑ or indentify Zone: or on site system❑ required❑or trench or specify: permit is enclosed❑ Railroad right-of-w Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable Is Structure within airport appr 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 tie and Address of Property Owner Fl(C LL.c � ) �.9r CLc 17 t look i 5ac�e�'v: l(e .19�d tom_ Name(Print) No.and Street City/Town Zip Property Owner Contact Information: a o✓i - - ��t�[ Oc7.1r� Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes Name Street Address 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) building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control c15e O,ti ' -?W-� 39Sy e, , ya(Re�rstrant) Telephoneo. -m ' address Registration Number F �Co�At "/4- --5-3-1v Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor c ,�r� ��Om-e a, 5- S 01L. : J-✓�l - Company Name Y )/ «Ql., saop",' o36C)5%-/ �aa //3 Name of Person Responsible for Construction y� OLicense No. and Type if Applicable Street Address City/Town State Zip -A ,3i 395y - Tele hone No.(business) Telephone No. cell e-mail address SECTION 11:WORKERS'COWENSAUON INSURANCE AFFIDAVIT M.G.L.c.152.§25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents m4st be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the zjP016ce 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 $ ec, ' ' 0 Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)_$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ (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 th t of my knowled a and understanding. Please t and sign name }tie Telephone No. Date o cl r tee r t�d4 el Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval• Name Date Joseph S. Savini, Inc. Mass Builders License # 036954 Contractors Registration# 135743 Roofing & Gutter Contractor Phone: (781) 395-3954 40 Canal St. Fax: (781) 393-4926 Medford, MA 02155 Proposal Arm. Jim Gagnon 4/5/13 RCG LLC 17 Ivaloo St. Somerville, MA 02143 Fax: (617) 625-8345 Fax: (978) 578-1014 Job Address:'"]/.Lafayette St. Salem, Ma. 1. To remove existing metal panels from exterior of building. Four separate sections, 12 panels in all. 2. To remove any rotted or defective plywood, insulation, from the area behind the panels that are being removed. 3. To repair, or install new, insulation, plywood, as needed. 4. To cover plywood with new Grace ice and water shield. 5. To install new .040 Bronze Aluminum Panels. Panels will be fashioned to match existing as closely as possible. 6. To clean remove and dispose of all job related debris. Please Note; owner has agreed to allow Joseph S. Savini Inc. to work off the staging that is currently erected at the property, owner has also agreed to have platforms set up on the staging at each of the elevations where the work is being done. Carpentry portion of Job will be done on a time and materials basis,which will be $65.00 per man per hour+the cost of materials. Panel work will be done for a Total Sum of= $1,995.00 Total cost of entire job will not exceed price cap of$7,000.00 Job will carry a ten year warranty against leaks caused by installation defects. Th ou, Josep . Savini ARCLLCm Gagnon Appendix 1 For the demolition of structures the building permit applicant shall attest that utility and other service connections are properly addressed to ensure for public safety. Please fill in the information below and submit this appendix with the building permit application. The building permit applicant attests under the pains and penalties of perjury that the following is true and accurate. Property Location(Please indicate Block#and Lot#for locations for which a street address is not available) No. and Street City/Town Zip Name of Building(if applicable) For the above described property the following action was taken: Water Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Gas Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Electricity Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other(if applicable) Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) Appendix 2 Construction Documents are required for structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required for this. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where applicable No. Item Submitted Incomplete Not Re uired 1 Architectural 2 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing include local connections 9 Gas atural,Propane,Medical or other 10 Surveyed Site Plan(Utilities,Wetland,etc. 11 S cifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review 521 CMR 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other S 22 Other S *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction.Work started prior to approval may be subjected to triple the original permit fee. Registered Professional Contact Information Registration Number Name(Registrant) Telephone No. e-mail address Re g Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zi Discipline Expiation Date Name(Registrant) Telephone No. a-mail address Registration Number Street Address City/Town State Z Discipline Expiration Date i CITY OF S�u.&%I, iNvLkSSACHUSETTS • $UILDmG DEPARTMENT 120 WASHNGTON STREET, S'°FLOOR TEL (978) 745-9595 FAx(978) 740-9846 KIN tBERLEY DRISCOLL MAYOR THOatAs ST.PtERRE DIRECTOR OF PUBLIC PROPERW/BUtt.DING CON MIISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5 Debris, and the provisions of MGL c 40, S 54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be transported by: /I }I (name of hauler) The debris will be disposed of in : t,t�-/IN _ (name of facility) 5"D (address of facility) J sigua e f permit applicant WZ'L date a�nd,Jtr.ax .s A13e, '' ' + ti�5 r3 r+�s Jf��G rya ' lruy t w .e d��`'a 4f rFri P '' fa Yf hJ �y�F. A4... M � e^".w �_ ,t � � ' n c�3• t .. _ y„c ': x '{�� f Yh s '+ 'C'L� `�.)f'qt /�>� ,}•L'x {crcr{,,,�1eA'Zy y,? 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IRIS' �t W�all t1Y91TY6R IN CREERPRT FQI0. BEL© - " .C@ oft tot t6mv AYDTL`R1�iCAill.l1bt19 ,,,, the terrt+a3(n 1�daft A6K aertaln-Pauhetasft To mlgr:i; rlge Yka a el ee PRODUCER - , :.. ., 'ttl the Eastern IDsua73n�g F� p 1 -fi31a1n . 233 West CeltiraT$�t - Natick MA 0}jl''s0 ' INSURE1I "'NAICi 31298 ..,f Joseph S.Sau1Ml,Int; I 40 Canal Street Medford MA 0215 -44 41 "d s a dM U + COVERA48 Cl CtiIFICA Ndfdt :151 THIS IS To CfiR LICE F INSUHANI UrITED' ,$ INDICATED.'' - +�N 75PMtf11AS;FANt11N0 ANY REgUJRENIENT,TERM OR CON15R1gN qF IO .Gi'L�J - �,. OI,�eYaBNT WRFI:Wi(�Ptth.^'{rTQ;Wf11CH THIS CERTIFICATE,MAY SS ($SU&p OR MAY PERTAIN, THE INSURANCE AFFQAppED' /'( I H [it:7N:IS Su 'F16 IfLf.;Tf1ECH THIS EXCLUSIONSANP4sN0 sOF SUCH POLIC(Es.LIMITSSHOWN MAY HAVL;BEEN�R 1J;. - '( ' - ILTR T 'EeFl ` - IN -VOU2Y f A GENERAL UASILRY ' A GL31238 r X COMMEriCMLaEtl�pi-40I91UTY CWMD iE �bCCUR aA6ttdtu �r aIs / GENL AGGA '. 1' 'LIMIT APPLIES Phi: 0`. �...., 0, .T � 2 A9 X AOIa, Ir,»cv21.111k . Loc � B AUY6M0BIL'B 7UTY - i2MM6 DNCVk EcrooD _ A o I A LL LL(}wNED SCHDpUCI31' - :, S 'ef1pL�`` CIRt' B, I,. i X HIREDAy;tbB D( i .,, (D ED w 'BC7�YX�V II (IhY�. '-`�•-- �` UMBRELLA UAB OCCUR , EXCESS t1Att," - f OHOSC(,BiR@ICE 9. CLAIM$-MADE 'AOgREELUI= g C W KE ONANY P C06805Y0. -. .. AND EMPI[AYE0S'U,�ARB}INLI@YRY:�.. OkFICERRAEMBXCLUDED7ElfECkJI'IVE Imo. N/A E L Ef1CH A6C ' Nr - 950DQOD (Mpianad,.roq.7na1R) ITI . . - ,,., oESC2° au s o 6F O '00/VBHICLEB (ARAchARD 101, uDESCRIPTIONy x 'N. CERTIFICA6` SHH8H i Wr�T1O tlL1VOED IN - AC6m19 :°NIA�:�LCd1�,Ft�Q1YISigNa: ::.... WON ;tltHa - wAiar ACORD 25(261210 S) The ACORD nameand Ingo aft I'eglttelady� gib. reserved. MasNachusetts- Department of Puhlic Sufetc -Board of Building;Re„rulations :mil Standards Construction Supervisor License License: C$ 36954 JOSEPH S SAVINI 84 RAVINE;RL➢ MEDFORD, WA 02155 Expiration: 722/2013 . ('nnmissiourr - Tr#: 18435 e ofCBusiness Regulation Office of Consumer Affairs&Business Regulation License br,regstration valid'-for iridividul-use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: ^:IP743 Type: - Office of Consumer Affairs:and.,Business Regulation Expiration 602W4 DBA .lO ParkPlaza--Suite 5170< c Boston,MA 02116 T'H . SAVII I`� G-iST Fi CO. �. JOSEPH SAVINI � IMF I'� - 40 CANAL ST D =91 MEDFORD, MA 02155 �— Undersecretary Not valid without signature i .