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221 LAFAYETTE ST - BUILDING INSPECTION (2) The Commonwealth of Massachusetts t q[ Department of Public Safety Massachusetts State Building Code(780 CNIR) Building Permit Application for any Building other than a One or Two-Fa 'ly Dwelling ����✓✓✓✓ hisSectionFor,;Offictal,Use Onl (T Y) Building Permit Number: Date'AQplied Buii'din g Qffiaal SECTION 1:LOCATION(Please indicate Block ti and�Cof ff for locatiotis•for w u s"' ava . ,11 a�At,l-+1� r !j')a No.and Street City/Town Zip Code Name of B ing t . 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❑ Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ 1 Other pecify:� C- A QV •2 fw Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Oi Is an Independent Structural Engineering Peer Review required? Yes ❑ No Q�- Brief Description of Proposed Work: " SECTION 3:COMPLETE THIS SECTION.IF EXISTING;BUILDING-UNDERGOING RENOVATION;ADDITION;OR, '. .. `'. •. -. CHANGE-IIV USE-OROCCUPANCr, " 1" .. • , . . '-- . Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing UserGroup(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:U.I 'GROUP(Check as a lieable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: High Hazard H-1 Cl H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1 ❑ I-2❑ l-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 ❑ IIIA ❑ IIIB ❑ IV ❑ VAC] VB ❑ SECTION 7:SITE INFORMATION (refer to 780 CMR A1.0 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-way: Hazards to Air Navigation: MA Historic Commission Review Pra.css: Not Applicable❑- Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes ❑ or No❑ Yes ❑ No ❑ SECTION&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:;I'ItOPERTY OWN ER'AUTIIORIZ1TION Name and Address of Property Owner Done(Y :Id 4e aa\ LAFAYe IrST S� �ia/,t l©�77 Name(Print) No. and Street City/Town Zip Property Owner Contact Information: 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. lication. SECTION30:CONSTRUCTION CONTROL(Pleas`e fill ouEAppendrz 2)'i If buIIdin� is less than 35,000 c6"ft:of enclosed s aceand/or'not under'Construction,Control tfien check he O'and ski' �Sectlon 10:1'.'' - 10:1 Re 'stared Professional'Resp onsible for Con struction Control:- Naive(Registrant) Telephone No. e-mail address Reg' ation Number .IC\trfon.s. ST 1_yNr�/ 6 Q't� Q/4v _ t� a -/Q ' plf/ Street Address City/Town State Zip Discipline Expiration Date i0.2 General Contractor f. y.II,AM yyL Company Name lam, 1 ;AN T(1Pt1.4�T %cl/ � �a �F Name of Person Responsible for Construction License No. and Type if Applicable 95,42a�_) Street Address City/Town State Zip `2e-L 15�5- I a L I Telephone No. business Telephone No. cell e-mail address SECTION.11:WORKERS'CO'NiPENSATION 1NSURANCF-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? YesQ--`9Io ❑ SECTION_12:.CONSTRUCTION COSTS ANDPERMITFEE, - Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1. Building $ i q. Aco- 0C> Building Permit Fee=Total Construction Cost x_(Insert here 2. Electrical $ appropriate municipal factor)_$ 3. Plumbing $ d. Mechanical ("C) $ Note: Minimum fee=$ (contact municipality) 5. Mechanical Other $ &6c Enclose check payable to 6.Total Cost $ ems_6C7 (contact municipality)and writ4fAec 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 the best of my knowledge and understanding. Ln%t1,AA14Q,AUAw'1 ) J�f/'TAL�-tid. CYL-6,%az L. 91 lo2t Please print and sign name Title Telephone No. Date Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: .. . Name Date I 1 CITY OF S:UZN4 f, ,tiL1SS;1CHL5ETTS 1 ,,5 'Y •� , BI:tI NGDEPAI-M&NT r1 130 C(/.�SH6NGTO, STREET 3 D. FLOOR TEL (978) 745-9595 K!�(13ERLEY DRLISCOLL F.ILX(978) 740-9346 NLAY01 T�10-%G 8 ST.PIERRS DIRECTOR OF P(:BLIC PROP ERTY/BCiZDLYG COJWISSIONER Construction Debris Disposal Affldavit (required for all demolition and renovation work) fn accordance with the sixth edition of the State Building Code, 730 CMR section It 1.5 Debris, and the provisions of tbIGL 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 ttiIGL c 111, S 150A. The debris will be transported by: (name of hauler) The debris will be disposed of in (name of facility) (�ddress of facility) signatu ofpermit app icon[ (late I CITY OF 5:1Lmf) INL1SSACHL;SETTS SLIMING DEPART idi-NT z ) lr 120 WASHNGTON STREET, 3i"FLOOR TEL (978) 745-9595 FAx(978) 740-98.46 {C.,,fpFRt RY DRISC011 MAYORTHODLIS ST.PtEaRB DIRECCOROF PUBLIC PROPERTY/BUMI NGCOSLAIISSIONER Workers' Compensation insurance Affidavit: Builders/Contractor./Electricians/Plumbers Annlicant information Picase Print Legibly N:hale(Busituss.Organizatiowrndividual): (.:ti a/YM TlZA4-i.cA.r, JCL !^r7r��ktc r/rill Address: at S VP122012— S I city/Statelzip:� , 40,4 0190V Phone#: 7 f6/ Arc y tin employer?Check the appropriate boat Type of project(required): 1.&r I am a employer with�� 4. ❑ I am a general contractor and 1 6. E]Now construction employees(1`141 and/or part-time).* have hired the subK:ontractors 2.❑ I am a soic proprietor or partner• listed on the attached.shect.t 7• ❑Remodeling ship and have no employees These subcontractors have B. ❑Demolition working far me In any capacity. workers'comp. Insurance. 9. 0 Building addition (No warkers'camp. insurance 5. ❑ We are a corporation and its required.) officers have exercised their10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 lumbing repairs or additions myself.(No workers'comp. c. 152,§10),and we have no 12. 0000f repairs insurance required.] t employees.(No workers' 13,0 Otter, cump.insurance requircd.J •Any upplleum our vh asccks b el must atwr nil out IN uctim bulowshowing?heir wmkm'compenud /urm un policy inatlos. 'I(,vnuuwr em who mhmil this airdavit indicating they am chine all work and than him oursidecommet.most submit a new alrtdavil indicating suck �Conlmlun shot check this loss meat anachod an addtduwl,hoss showing Iho name of the tubrvninctem and their workers'comp,pulley infonna ica. l sun an employer that Is pravldlnlf workers'compensation Insurunee for my employees: Below/l thesto/fry and fob sits, inforrnullon. Insurance Contpany Name:_C.0 462�t"t S Policy !{or Sclf•ins.. Liie. 0: So sS 6 as! Expiration Date: 7 -/. - act e Y xyQ ' Job Sire Addmss /�AV F— �T City/Stateizip:.c�IC-/�LY),4 Attach a copy of the workers'compensation pulley declaration page(showing the policy number and expiration date). Failure to iccurc coverage as required undcr.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 punaitids in the form of a STOP WORK ORDER and a line of up to S230.00 a day against the violator. lie advised that a copy of this statemunt may be forwarded to the Oft ica of Investigwiutrs of tha DIA fur insurance coverage verification. /Jo lrerrby e//'ntlfy under due pulps surd per Ides of perfury tfrul the brfonnu/lon pro sided above is fruit and correct. Sienantre•"T�r,✓�� ��/t�// - Data• y—�F� "�O/J Phoned: oy)irial rise anty. Oa not writs,in Nr/tr aretq to be completed by city ar town aff slat I City or"frown: Permlt/i.keme i IssuinstAuthorily (circles tine): 1. Board of lleulth 2.Building Department J.Citytruwn Clerk 4. Electrical tnspectur 5. Plumbing inspector 6.Other i Contact Person:. .. ._. __ Phoned: 04l02/2012 02 .4; rAA C&C NORTHEAST, LLC 9 King Philip Way East Freetown,MA 02717 Tel:617-922-6749 Email;decij729dhOtma1l_c0m WM_Trahant,lr.Construction, Inc. 4th Generation Roofing 215 Verona Street Lynn, MA 01904 Re: Roof Replacement at 221 Lafayette Street,Salem, MA 02970 To Whom it May Concern: C&C Northeast, LLC is the owner of the real property located at 221 Lafayette Street, Salem, MA 01970 and hereby authorizes Trahant Roofing to obtain the necessary permits and undertake and complete a roof replacement at the property. Please let me know if any additional information is needed. I thank you for your assistance in this matter. Very truly yours, C&C Northeast, LLC Donald E. Casale, ll, Manager WM. TRAHANT JR. CONSTRUCTION, INC. 4TH GENERATION ROOFING 215 Verona Street LYNN. MASSACHUSETTS 01904 {781} 599.3211 + (781)844-4551 • FAX;(781) sal-o855 H.I. t JC. #14177P AROPaSVL 9aawnTfC TO �+�ys� �^ STREET - �7/7/ o Q 7c'7�C�!} _..-..-- assHeME -------- Coy,,STATF And ilp coat;, .roc LOCAmON we hereby submh Specifications end"t;n ea for. We hereby submh spacificatbns and --- -' . $�1.E ItQ?®F estimates for: _ FLATLRin3aER RQQE S entire roof - -- _© S ee — p entire roof clean ,rR lace any bad boards up to 100 linear feet Entire roof ART - _. ®In H ice and water barrier first three feet up roof Mechanical fasten down ISO board-insul lion - - I tall ice and water barrier in all yalteys and along dormers f.7 Foetal-060 RubberRoofing ppflng on entire roof In_15ib• felt paper on remainder of roof ns metal flashing around --' l , - �•-.-. -_ g Perimeter of. ulMing In eight inch drip edge Try Fla himrle s �"`"`" ___ y( ), Pipe(s)and' all(s) !n II ridge vent dge caulk all seams Fla or re-flash chimney(s) �----^�-- _ 0 Install new copper center drain -- ins It new -- �__ .. Pipe flanges ---d ���,r . C7 Om ; I stall year shingle Otter (pa _ — ea up all debris ❑ Install gutters and downspouts - abor and materials guaranteed 100%for ve ears f� Install trim toff --, . .--------_..�--- y ❑ Install new fascia boards ~� - - C] Install new rake boards ©Install sky light(s) Clean up all debris ----- - All shingle roofs are guaranteed led and - - --....._ ,..,i.-._, -. %for flue years J y Xe?flxopOsr hereby to furnish material and labor -- complete in accordance with above specif[cattona. f the s m of: Total Price'(g •'"IF YOU ARE HAVING YOUR ROOK 2TRIPP9p, PLEAS& COVE® ALL YALUABLGa INATTIC, AS WE HAVE NO CONTROL OVER.OEBRla THAT aUIY FALL THROMM ROOF BOAROa.♦* . All materiel it puaran eea to be as specdled,All rank to bc cmrneeted in a amrimtanlika mmmer amending to IWM*d preetbe3.'Wry ahamfton w deeimm from Authodxee / —T lions involving extra caste'41.be eaacuted any Wen mitien above epo*ms n . . extra Charge over and above the eeeinal0.Aq CrdR9.and YAa b+Coma an wSiQflBturB.�'"�- r .� ace�nrs or deleye beyond om control.Owner tp tie Ore enH cantingerrt upon strikes,, . moment+.OurvmrkOrs ere fWiy covered by Werl;made r ado:and Other nae wary Oom . pmspban Inmmrxa CLY}JtttltCP LTE xp�31T$1It The show prices.Spe,,m aftm and conditions are ab"i factory and are hereby mcephad You are authorized Ce Sianetilre d0 the work as specified.Payment*It be made as Outlined ai Data of Acceptance: - �- PkmeAenYtlhrace Waevw mlbes:. SItgnature�__-`