117 LAFAYETTE ST - BUILDING INSPECTION (3) The Commonwealth of Massachusetts
Board of Building Regulations and Standards
•i' Massachusetts State Building Code. 780 CMR. 7"' edition NIUNIcIPALI"I Y
USF
Building Permit Application To Construct, Repair, Renovate Or Demolish a Rrrlrcd Janum
One- or Tu o-Fu/nih Duelling 1, 2008
'^ his Section Fur Official Use Only
X, \ Building Permit Number: Date Applied:
Signature:
3 Building Conv issioner/ Inspector of Buildings Date
( � SECTION 1: SITE INFORMATION
1.1 Property .r ddres_s.�• 2 . ,,
1 AYas/sP l/? rr „f..-)yn '1 I I._ Assessors Map & Parcel Numbers
I.1a Is this an accepted street? ves no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq it) Frontage(11)
1.5 Building Setbacks (ft)
Front Yard Side Yards
Rear Yard
Required Provided Required Provided Required Pnwided
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.b Ow_n r'of R��cord:
Name(Printr7om &�L Address for Se vice:
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK' (check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) � Alterauon(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Bfief ascription o{Proposedff Work': "— V.L,( h
w .Pa� J tr G roe vx S Fz Ll n �uor .
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials) y
1. Building $ S ypJ I. Building Permit Fee: ndicate how fee is determined:
❑Standard City/Town Application Fee
°. Electrical $ dOO
❑Total Project Cost' (Item 6) x multiplier .x
3. Plumbing $ o. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $
6. Total Project Cost: $
S6co Check No. Check Amount: Cash Amount
❑ Paid in Full ❑ Outstanding Balance Due:
�_z VA tit o
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor (CSL) C5 -0 qq(,0 p
Sp �.b License Number Expiration Date
Ni nu of L-CHI older C List CSL Type (see below)
`en'✓v ���1 0 0 Ty2e Descn riton
Addres U Unrestricted lu to ii.000 Cu. Ft.l
R Restricted I&"_' Fantil Dwelline
Silt attic `� / M Masonry Only
dRC Residential Routine Covering
Telephone AVS Residential Window and Sidine
SF Residential Solid Fuel Bunting A ttltance Installation
p Residential Demolition
5.2 Registered me•Improvement Contractor (HIC) I It C`O
o Registration Number
HIC in a Nance or HIR giq strat Name
Address '� xpirahon Date
Signat re 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 a, 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
as Owner of the subject property hereby
I,
to act on my behalf, in all matters
authorize
relative to work authorized by this building permit application.
Date
Signature of Owner
SECTION 7b: OWNERt OR AUTHORIZED AGENT DECLARATION
as Owner or Authorized Agent hereby declare
that the statements n d information on the foregoing application are true and accurate, to the best of my knowledge and
behalf.
Print Name
Signature of Owner or Authorized Agent Date
(Signed under the ains and penalties of eduAto
;TES:
1. An Owner who obtains a building peis/her own work, or an owner who hires :m unregistered contractor
(not registered in the Home Improvement Contractor(FIIC) 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 and
Construction Supervisor Licensing(CSL) can be found in 780 CMR Regulations I I0.R6 and 110.R5. respectively.
I. When substantial work is planned, provide the information below:
Total floors area(Sq. Ft.) (including garage, finished base men Uattics,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'
J
CITY OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
iarVYetat/nrryr. - -
bLtrsta U C VAaa%aww*nlr a uust.NASAae yaiis 0lv*
T►L 9 &YU.vytg a Fts:9y4 4&%46
A Workers' Competuades Isuurases AtDdavit. SWidmiCaetnetwVEleetridun&Mmmbon
armadas Pleaw Mail L*t&lv
Assn tlnvaes�rgartirarioNlnJwrbwll: z�?
Add 6
cityiseuwzip:��n reoo.,w. L)
Are as atwpbytfr? the appreprlue bop
Type oI pealed(reqf4edk
1. 1 am a emphfyd with 4. ❑ 1 an a gmaed eoffraelor and i
amptul'cm(full Music prrt-tim).• have hired the sub-comm-tors S ❑New tanenretios
2.Q 1 am a sole propr6am or paruw- listed a the attached shaft 1 7. ❑ Rerood fins
ship am bave on amployon Than sab-oonnons n hew II p t3ersolition
wortins for ma in any capacity. workers'oontp i/wuenoa
(ne Workers.creep. Innuance S. p we an a oorpontine and its 9 ❑ ft ad 'tiO°
r-quir") otlloera haw aarreisod tbaw 10.0 Electrical repairs or additions
3.p I am s homeowner Joins all work right of exemption per MGL I I.p Plumbing repairs or additions
1 yu1L Wo workers'camp. C. 132.f 1(4).and we have no 12.0 Ruof repair
inrsuamce required J► ;Mploycm[Na workers' 13.0 Other
comp insurance required.]
•A,n+PPheew the cease bw of row sir nor ma on,wp a 1wW dewids tb*wmawa'awgweeAket try feayaret"
'I lwreirwe wbe urwil dtis ndtldsvii Ir�irg dry aw doing an wart rut on b1w eeerHe eoreoswe muss tabark a new anlbvr ie.anslinre wan
C'.'goo—a one tbydt tbb bat muse attarbed w adtMtierl AM.hariq nbe none ardle w►a wwaa a atl spit wAbw•nrq.Palky,ta6rwdea
/aim uw eispfayer that IF PMWdVwg werbn'co wyewradeo/nsfro/eai jar ne2r etsp/orses Bi/ow Is the pYNar wrt/Jos slip
In+uran a Company.lq r ✓/`�r '�{u
Policy a at Self-ins.Lis.e Eapirauon Data:
lob Site .adLhnw: City,State/2rp:
\ttaeb■copy of the werken'comperuatan pulley declsratlon palls(showing the policy number and a:piratlua date)
];at lure w Weare coverage as required under&cfioa 25A of.%IGL c. 152 cam lead to the imposition of criminal penalties of a
fin.up at$1.500.00 and/or one-year irnprisamncnt,as well as civil penallias in the form of a STOP WORK ORDER and a fors
,rfup to S350.00 a Jay iduint Ida vialator. lie advi.4cd that a wpy urthis slawwont may be Iurwardel to the Office ut
ta.':.n"auoln ol'tha DIA Con in,urarc;:rev;ra;ti v;rificattun.
/JY hsn•Aj c.rr%/j� r pY%/q Y//I pfnYl//fl Ylpe/fYrr/Ida//�e I/rjer/a//aa ppMtfe� `aye is few Yni rorree&
Ci•Stah,r� ) 6 \
U/J7r%aI YraYNljt /.b wav vr/ii/w tA4 arrei,to ba rawp/Na/Ijr�ar rorwr o,�4•/a(
City or Tow*: PcrniN kcees p
1vsulxx Aulhurity (circle one):
1. Iluurd ur llralth Z. fludding Oepartrncnt ). citylfona Clerk J. Electrical Inspector S. Plumbing inspector
G. Olher
C.ntlacl per Sall: _ _ Phone q•
Information and Instructions
Ufa sachusett►Gcneral laws chapter 132 requir"all employees to provide workers' compensatine foe their employees
Pursaatat to this atatws.au emplew"is defined M""Avg Perm is fie service of another under any contract of bite.
.%pease or unplied.oral or written'
aasseiaeol►easpexaacs or niters kepi eotiry,or-my two or mote
sera empbyr is dceMUd a WOvidsal past and inch�lefty repraenttldves of a deceased employer•or the
tf the se o f tr as engaged i ammaeoa a<otbr e"MWW amity.empMyist amPMya► NOeY61°e the
receiver err dwells of s M ba'dnd.pasmssabfps tad wbe resides tI I se the oecupent of do
owner otter dwelling bsuM bavim f trots rearm ties ryes apname•at work m such dwelling house .
ersons to do munwassoe,cueaanctim at repast
app��t.w shag met bernew of sash ateploymoss be do@MW a be rat employer"
at on the grounds at building
�tGL chapter 132.423C(6)also smm thn"e"07 aft es sir Mealse osels{army dog widd add*a bsueae or
to sparats a baslesse w to eematrmat buildings is sloe ee..estwee ft be w►
resell of•aces»!or Peru* of essepossacoverallswm the insurance r 61�"
appose""be beat set prsdend seeptabM sot say of its pol(tisal abfvidees!drag
Addilioeally.MOL ch pe r32#�� aloe cn accepts In e
enter iota any coatteeat of watt until accepts In evidence o(eatmplisaes with sloe irwrma
requitemetts of this cbapmw have been peadmd to the contracting audio ft
AppdMuts
Pteass gat out tuts wakes • conVens•�"a�"le aamP�y.by`'belting dte boxes that apply tn your shoo"and'if
necessary.supply ems)=me(ab address(es)and phone number(!)along with chair cmti>jeats(s)of
inatrntee Limited Li•bibty cmtpamieo(LLC)at limited Liability Partnerships(LLP)with no employees orbs mum the
ioMrsoec if an LLC or LLP does have
members or portntts,are not requiredadvised
to re& ��that affidavitsubmitted to the Department of Industrial
employees.a policy is req o insurance�� Abe be aura b sign and date the NINCIR L The affidavit should
Accidents for cmAntotion tias far the permit at license is being requested, sat the Depetsne•t of
be retuned to the city err town that the app 'Itca the low or if you an required to obtain a,workers'
ladustwial Acasidonts. Should you
sloeve an�1ut 1� United at the atualter below. Self-inured companies should enter their
cotnpanatios policy,places
callself-ittsunmct license number on the
City or Tows OQkkk
legibly. The Daparmwm has provided a space at the bQUUML.
P0.a,a bit sure that the affidavit is comptete and printed g by )s
of rlw affidavit far you to fi not
tact you regar ll out in the event the Office of Investigations has to con a
plicant
Please be sure to till in the Pumiulicetw number which will i e used r,s reference
!submit ne aRidavittindieadng current
that mum submit multiple permitllicenss applleatiaut in any given year, should write"all locations in )city or
policy information(if necessary)and under"Job Sits Add ra"me app
town)."A copy o(ths affidavit that has been officially stamped or marked by the city of
town maybe provided to sloe
applicant as proof that•valid affidavit is an lib for f6tuns permits at licenses. A new aAldavit roust be filled OUR each
yeas. Whore a harts a va a aides u obtaining a license or permit not related to any business or commercial venture
6.4. a dog lieena m permit to burn leaves ate.)said person is NOT required to complete this affidavit.
l'ha Otiice of t»vesfilAduns would like to thank y.w in advance for your cooperation and should you have any questions.
,jleaae Ju rwt hesitate to give us a caU.
The Deparment s address, telephone and fax numbs.
The Conlnlotlwealth o(Masaachusetts
Depafoment of Industrial Accidents
Odke oflntyatldpWN
600 WWWDSW Slfreet
8otoodr MA 02111
TeL /617-727.4900 eat 406 or 1-V7-MASSAFE
Fu 0 617-727-7749
tevr�cd 5-'_G•US www.nlay.Sov/din
and 4w'
(Vme d (adn&�
PROPOSAL
Thursday, February 14, 2008
Caritas Communities
Tom Nee
117 Lafayette st. Salem
Unit repairs
Task A $1,000
- Demo plaster and lath from all exterior walls inside the unit down to studs
- Bag and dump all debris
- Thorough cleaning
TASK B $4,800
- Install R-19 insulation on exterior wall
- Install vinyl sheathing on said wall to protect from drafts and moisture
- Install 5/8ths fire rated drywall on exterior wall
- put down joint compound and prep for paint
- Install trim on windows
- Install baseboard trim
- Paint entire unit w/two coats of Benjamin Moore paint
- Remove existing 12x12 flooring in bathroom
- Install new 12xl2 tiles
- Install new vented bathroom vent
0 4"vent hole will be drilled through-exterior wall and installed either above or next
to window
o Will be connected to existing line and does not include new line or switch
TOTAL ..... ....... ... ...... ... .. .... ... ... ... ....... .. ..............$5,800
-TONY 781-727-3146-SERGIO 781-727-3147-FAX 781-842-4492^-EMAIL TONYNSON@AOL.COM-
W W W.TONYNSONGC.COM