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135 LAFAYETTE ST - BUILDING INSPECTION (3) _ .: The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Building Code(780 CMR) O1W Building Permit Application for any Building er t n a One or Two-Family Dwelling (This Section For Official Itse Only) Building Permit Number: Date Applied: 11 1 Build' Offici SECTION 1:LOCATION(Please indicate Block#and Lot#fat locatio f r w stre e s not 135 Lafyette Street Salem, MA 01970 t. Joseph`s Chu- No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSEO WORK Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Buildingl Repair❑ 1 Alteration ❑ I Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ 1 Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No)a Is an Independent Structural Engineering Peer Review required? Yes ❑ No 1[R Brief Description of Proposed Work: R " n a the limpqrnnp CratnP 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): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) 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❑ 1 B: Business ❑ E: Educational ❑ - R Facto F-1❑ F2❑ 1 H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional 1-1 ❑ I-2❑ I-3❑ 1-4❑ 1 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 0 IIA ❑ IIB O IIIA ❑ IIIB ❑ 1 IV O VA 0 VB ❑ SECTION 7.SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit Licensed Disposal Site❑ Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be P Private❑ or indentify Zone: or on site system❑ required❑or trench or specify: permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process. Not Applicable❑ Is Structure within airport approach 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 Name and[Address of Property Owner 'C'ry of Salem planning Qffirp for Urban Affairs„ Inc. Name(Print) No.and Street City/Town Zip Property Owner Contact Information: David Aiken 617 - 350 8885 ext. 11-5 daiken@poua.org Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes Patrick J. Folan III 21 Kilsyth Road South Easton, MA 02375 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) If 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 Patrick J. Folan III 508. 400- 3362 folanh2o@aol.com C.S-094539 Name(Registrant) Telephone No. e-mail address Registration Number 21 Kilsyth Road South Easton MA 02375 CS 4/1/14 Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Folan Waterproofing & Construction Co. Inc. Company Name Patrick J. Folan III CS-094539 Name of Person Responsible for Construction License No. and Type if Applicable 795 Washington Street South Easton MA 02375 Street Address City/Town State Zip 508 238 6550 �508 -?,nn- 462 folanh2o@aol.com Telephone No.(business) Telephone No. cell e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? YeslK No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 36.300.00 1.Building $ 36 300.00 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 $ 36,300.00 (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 to7by; ledge and understanding. Patrick J. Folan III Project Manager 508. 400. 3362 Please print and sign name Title Telephone No. Date - 21 Kilsyth Road South Easton MA 02375 Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: Name Date CITY OF &UYm, i&'LkSSACHUS=S BI:BRING DEPARTIcNT • ��A 120 WASHINGTON STREET,Sae FLOOR b� TEIL 7 745-9595 \�- FAx(978)740-9846 5ffiFRf FY DRISCOLL THONw ST.PtEm MAYOR DIRECTOR OF PCHLIC PROPERTY/BL'B.DING CO\L\BSSiONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant.Information Please Print Legibly Name(Busim s%Organization/Individuat): Folan Waterproofing & Construction Address' 795 Washington Street City/State/Zip: South Easton.MA 02375 Phone #: 508-238-6550 Are you an employer?Check the appropriate box: Type or project(required): 1.pt•1 am a employer with SO 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).' have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its required,) officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.(No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.)t employees. [No workers 13 ❑Other comp.insurance required.] •Any applicant that whacks box 01 most also ell out the section below sbowing their workers'compensation policy infum"cbm. t I lnmem nvem who submit this affidavit indicating they arc doing an work and then hire outside contractors most submit a new affidavit indicating suck =Commuwrs that cheek this box most attached an additional sheet showing the name of the subeomrseWro and their workers'comp.policy infommtion, l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site information. Insurance Company Name: Associated Employers Insurance Co. Policy#or Self-ins.Lie.#: WCC-5007160-01-2009 Expiration Date: 7/1/13 Job Site Address, 135 Lafyette Street City/State/Zip: Salem, ,MA Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations or the DIA for insurance coverage verification. l do hereby certify wider the palmsm/',7�//dJJ��penahles of perjury that the information provided /above /is true and correct �jgnantre• ��AI��I Piro 22- QQ �L'An^ Date: At�C./ A,� rX Xj(l . Phone#: 5M— �3Z—G9 S5n U Official use only. Do not write in this urea,to be completed by city or town oJrchr4 City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: _ ._ Phone#: ACORD CERTIFICATE OF LIABILITY INSURANCE �'E'mme/23/t12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(es) must be endorsed. 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 endorsements). PRODUCER CONTANAME,C Maureen Curran Twinbrook Insurance Brokerage PNONE 781 IT'x 843-7000 N (781) Bae-6100 400A Franklin Street Aul SS mcurran@twinbrook.com Braintree, MA 02184 INSURE S AFFORDING COVERAGE NAICC INSURER A:Selective. Insurance Co INSURED INSURER B:Associated Employers Ins Co. _ Folan Waterproofing and INSURERC:North River Insurance Co. Construction Co. , Inc. INSURERD:AIG Environmental 795 Washington Street INSURER E: South Easton, MA 02375 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR 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 POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS IN R AWL SUBR POLICY EFF POLICY UP LTR TYPE OF INSURANCE im Jm POLICY NUMBER MMN NAUDdYYYY LIMITS A GENERALLIABILITY Y Y S 1843590-01 7/1/12 7/1/13 EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERALUABIUTY =11r3EToRENTED,cel $ 100,000 CLAIMSMADE [A]OCCUR NED UP("ore Palm) $ 5,000 PERSONALBADVINIURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELIMITAPPLIES PER PRODUCTS AGG $ 2,000,000 POLICY X JECPRO- LOC g IIJTOMOBILEUASIUTY 7/1/12 7/1/13 EOAaBccnentINED SINGLE LIMIT $ 11000,000 A Y Y A 9091602-01 ANYAUTO BODILY INJURY(Per Person) $ ALLOWPED X SCHEDULED BODILY INJURY(Per mdEent) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIREDAUTOS X AUTOS aac ert $ C X UMBRELLA LIAR X OCCUR Y Y 581-100533-1 7/1/12 7/1/13 EACH OCCURRENCE $ 10 000,000 aCESS Line CLAIMS-WOE AGGREGATE $ 10,000,000 DED RETENTION$ NY $ 10,000 B WORKERS COMPENSATION WCC-5007360-01-2009 7/1/12 7/1/13 ][ WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE °i E.L.EACHACOIENT $ 500 000 OFFICER/MEMEEREXCLLDED? NIA (Mardatery in NH) E.L.DISEASE-EA EMPLOY $ 500 00D If yes,tlesaiEe order OE SCRIPTION OF OPERATIONSWow E.L.DISEASE-POLICY LIMIT $ 500,000 D Pollution CPO 1445409 7/1/12 7/1/13 Each Loss 1,000,000 Aggregate 3,000,000 Deductible 25,000 OESCRIPnONOFOPEMnONSILOCATIONSIVENICLES (ACach ACORD101,AWMonal RerrerluTS uk,Ummspambmqur I Statue Removal @St. Joseph's Church Salem Banc of America Community Development Corporation, Bank of America, N.A. , Community Economic Development Assistance Corp,assigns ATIMA,City of Salem, Planning Office for Urban Affairs Inc, and Salem Lafayette Development LLC are listed as Additional Insured in regards to the General Liability, Automobile Liability and Umbrella Liability as required by written contract CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Bank Of America N.A. ACCORDANCE WITH THE POLICY PROVISIONS. CREB Collateral Administration Insurance Group-P.O. Box 40329 AUTHORED REPRESENTATIVE Mail Code FL9-100-03-26 Jacksonville. FL 32203-0329 Joseph P. Rizzo/dc ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: FOLAN WATERPROOFING & CONSTRUCTION CO., INC. INDUSTRIAL WATERPROOFING CONTRACTORS Tel. 508-238-6550 795 Washington Street Fax 508-238-9425 So. Easton, MA 02375 e-mail: folanh2o@aot.com INSIIiUTE Website: www.folanwaterproofmg.com August 27, 2012 City of Salem Building Department Re: Application for Building Permit : St. Joseph's Church 35 Lafyette Street Salem, MA 01970 To Whom It May Concern: I Patrick J. Folan III give the right to allow Jeff Souza, a representative from our firm to use my license to apply and pick up the permit for the above mentioned project. If you should have any questions please contact our office @ 508-238-6550 ext. 108. Thank you. Sincerely /1��KickFolaZrli� Women Business Enterprise e e S O M W B A Certified MASONRY RESTORATION AND WATERPROOFING CONTRACTORS -CONSULTANTS FOLAN WATERPROOFING & CONSTRUCTION CO., INC. AINDUSTRIAL WATERPROOFING CONTRACTORS v Tel. 508-238-6550 795 Washington Street Fax 508.238-9425 So. Easton, MA 02375 e-mail: folanh2o@aol.com IN571TUTE April 12, 2012 Archdiocese of Boston 66 Brooks Drive Braintree, MA 02184 Attn: Paul Morin Re: Statue Removal Salem Dear Mr. Morin, We submit the following proposal to furnish labor, material &equipment to remove the limestone statue @ St.Joseph's Church in Salem.We would provide all necessary access to selectively remove masonry,then remove in sections the limestone cross from the front elevation we would use a crain to take the sections down & palletize the pieces. We would then deliver the dismantled cross to the storage facility in Braintree. Total Price........................$36,300.00 Thank you for the opportunity to submit the following proposal.Should you have any further inquires please contact this office. Sincerely, Noreen Folan Vice President NF/af Statue Removal Salem Womens Business Enterprise • • S O M W B A Certified MASONRY RESTORATION AND WATERPROOFING CONTRACTORS-CONSULTANTS � g Massachusetts • Department of Public Safety Board of Building Regulations and Standards F Construction Supen isor License:CS-094539 PATRICKS F,O'LAN o--�. •.+� r 21 KMWTHx2D. z - South Easton,.MA 2375-s Expiration Commissioner 0 4/0 112 0 1 4