271 LAFAYETTE ST - BUILDING INSPECTION (2) The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY OF
Massachusetts State Building Code, 780 CMR SALEM
Revised Mar 2011
Building Permit Application To Construct,Repair,Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number. Date Applied-.
t/ ll n 4ny la 3D �j
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 r nerrty Address: 1.2 Assessors Map&Parcel Numbers
L 1sstthis an ac/pted eet?yes__g'Zno Map Number Parcei NumUer i
1.3 Zuning infurnia6un: 1.4 Pruperiy Dimensions:
Zoning District Proposed Use Lot Area(sq tt) Frontage(it)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water S pply (M.G.L c.40,§54) 17 Flood Zone Information: 1.8 Sewage Disposal Sysie I
7nnc t�titidn Flood 7 t
. ...
SECTION 2: PROPERTY OWNERSHIP'
2.1 OwaffrRecor
1 �2 C- env,
Nam (Print) /I '' City,State,ZIP
7
No.and Street Telephone Email Address
SECTION 3:DESCRIPTIQDWF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building Owner-Ooari ? _ ; '_; ,- " "
rlo in n A. Id. n r6,m n£iln:4c nit,P:
SECT 4:ESTIWATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ / 1. Building Permit Fee: $ Indicate hoc:fcc N dC,1 rmirwii i
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees: $
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 3 / 13 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Constryetion Supervisor Lic a(CSL)
0 fS^a C S
icense Number xp'vati Date
Name of CSL Holder
List CSL Type(see below)
No.and Stq fy Type Description
U Unrestricted(Buildings to 35,000 cu.ft.
- a R Restricted 1&2 Family Dwelling
City/rown, a ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Reolatered Home IpWrovemept Contra oK(HIC) v
SIIIC Registration Number Expiratl
C rgp e r C R 'strant Name
N d t r/� Email address
-.
City/Town, S e ZIP 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 to provide
this affidavit will result in the denial of the Issuance f 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
I,as Owner of the subject property,hereby authorize 4 X
to act on my behalf,in all matters relative to work authorized by this building permit applica' n.
��� fie' -%') /0 L_S> J
Print Owner's Name(Electronic Signature) D to
SECTION 7b:OWNER!OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in i application is tme an ccurate to the best of my knowledge and understanding.
6 x/"
Print Owner's or Authorized A&nTs Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner cube` - '
(not registered in the Home Improvement Contractor(HIC)Program),will not have access=
„ ....
www.mass.eov/oca Information on the Construction Supervisor License can be found at www.mass.gov/d s
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
number of fireplaces Number of bedrooms
Number of bathrooms Number of halfbaths
Type of heating system Number of decks/porches
Type of cooling system Enclosed yOpen
3. "Total Project Square Footage"may be substituted for"Total Project.Cos ��{,/
Office of Consumer Affairs nd Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home lmprovem i Contractor Registration
3 Registration: 171254
Type: Supplement Card
M GENDRON & SON CONSTRUC I'ON:L_LC�I � Expiration: 3/1/2014
STEVEN HIOU = Yl� >�
6"ENGLISH RANGE RD ��� 7
DERRY, NH 03038
Update Address and return card.Mark reason for change..
SCA i 0 20M-os,i1 Qj - Address Renewal ❑ Employment Lost Card
gRegistration:
ice of Consumer Affairs&Business Regulation License or registration valid for individul use only
ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
-1! Office of Consumer Affairs and Business Regulation
Expiration�-t a1254 ; _Type: 10 Park Plaza-Suite 5170
31112074-- : Supplement Gard Boston,MA 02116
M GENDRON&S ION LLC.
vI
STEVEN HIOU
P.O. BOX 1024
DERRY. NH 03038
Undersecretary Not valid withoiltsignature
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Consfr wfiou Supen'isor
License. CS-103080
STEVEN CHIOU
2 NEPTUNE ROAD AP,T,140 INs
EAST BOSTON RA 021281
Expiration t
Commissioner 0112 712 01 5
CERTIFICATE OF LIABILITY INSURANCE
ICATE M MSUPO AS A MATTER OF IN ORNATION ONLY AND CONFERS O RNONRS upum THE C
NOTAFFMMA'WELYORNEGATFVftyAAWMFactenow.and
EHIW
OF I NSURANCCE DOES MOTCONSTIfUTEACOND,TRACf BETWEEN THE MR11IRGAIVE HOLDER THE MSUIIIG DISURVERAOEAFFORD®BY THE POLICIESEELOYY,
ER(S).AUTOR�Dcwtgkmb hotter g al ADDITIONAL INSURED.the porcRiss)must le@odorsW. NSUBitOGATION 15 WANED,cNsjlct bconditbuedBepWkY,eeltilnpoNieYsmayrepuiroandendeNYemanL Ad4leeenlonthisueUl'xetedoernoteMllkrrlBhttto
n4 hoWdm lieu at such eulorsuen CONTACT
NAME:
PLANRIGHT INS A'FWANCIA PHONE 224 MAIN ST STE 2A FAX
IMD.No.Er4: INCH*
SALfiK NH 03079.3192 Ems'
76HAM AGGRESS.
Onus IARVFMMODVERArE NAICI
INSURED INSURER A: RARIFORDUNDERWREfEaS W8UAAR(SCohemy
M &SON CONSTRUCTION LLC DBA MGS pgUpES B;
CONSTRUCTION
BeN1A6t C:
P O BOX 1024 OISUNER D:
DERRY.NH 03038 INSUMERL
dituRet
COWERAGES CltrMCA-ENIAAB6t:
r+E1RSM NUMBOt:
��A111'I�q�Ir./NereNLClO1rtYOFAaYCM11NCtM O11<iddGaBf M1MA1$!gT l0 N'ICN/1iC[#7F47E WYBENN�DORMY
IMYE BMMXbtk=&VHIM aT1NEFO1AStaBgR®IBA IS co"MyTo ALL DMTO a,rTG =MAIM COMMONSOF ouatputAEi LMM=ONA NMT
rail
LTR TYIEWSSLIRAN L e PoUcYNNRM pouty 8*DATE EWDATE
NM peeO01TYTY1 UNITS
OENerAI WBLLITY
COMMERCIAL GENERALLIABLDY OCCURRENCE s
CLAIa6aADE OOCCLR AMAGETOREMIEO 9
SFS(Eveocvmlcy)
EXP1ArYo<e l@rrCrM 3
GBft AGGREGATE LIMIT APPLIES PER- BADV INJURY t
POLICY ❑PRO.IF=❑LOC ALAGGREGATE t
•COLPA7PAGG S
AUiONOBILE WRUTY
ANYAUTO J�m
INGLE t
ALL OYdNED AUTOS i
mtlaNl
SCHEDULE AUTOS A1RY t
IGG
RIRED AUTOS A1RY g
NOMOVVNED AUTOS N
DAMIA[f t
ela)
11MBRETLA IAAB OCCIR OCCURRENCE t
EXCE&I LUB CLAMASAIAOE WE g
DEDUCnItF
RETENTION t t
t
A 1VORKt32'S COW-SMTIp1AIM
OpLDYefaLanam YM U64297P`.W13 Oar!14 13 OSOD40111 9AllIrORV OVERAIEMBERE OJTNE j
H ACCIDENT t 100 am
r pbpdmw~� ASE-EA EMPLOYEE SSE-POLICY LIMIT S SOp,OOp
N1IESCRIP1gN OFO1ERAIMNS(OgOpfOlygt4>3�1p�,ri®B '
rMsaEMACESAM MM CSRIDICAmI98Um TO TT$®aTIReATEHOLDER AFEECTRNO WORan COMPCOVRRAOR
I
I
CERTIFICATE MOLDER rJU10ELLAT10N l
SHOW D ANY OF THE ABOVE OEKMM POLICIES BE CANIELI.ED
REFORE THE EXPIRATION DATE THEREOF.NOTICE RB.L BE DELIVERED
M ACCORDANCE BRIT{THE POl1CY Pwm
AUTIN0R03IRI3RgETITATIVE �._.
JMCORD25(7gightif T1mAWRDnmstud"9;Hsr7WWQ—ftw;;0TjCDIED GORFD=7mwmmpbmumoo
1U/10/LU1J lU.VO JIOIYJJ/l! ./GNIY !'VRKLLV VIVJIV / NVL VG
PROPOSAL/CONTRACT
FROM: Roof Replacement
'
MGS Construction LLC
PO Box 1024 PAGE NO. 1 OF 3 PAGES
Derry,New Hampshire 03038
Email:mgsconshud@aol.com DATE. September 25.2013
Office:(603)216-2633
Fax;(603)432-3282
PROPOSAL BUSNUTTSID TM
Name: The Joseph Simon House ADDRESS: 271 Lafayette Street
Address: 271 Lafayette Street CITY/STATE: Salem MA
City St Zip: Salem MA 01970
Phone: 978-745-5553 1f B NAME: Roof Replacement
Email:je rcelloAverir met
We hereby submit specifications and this proposal/contract for the tollaving:
ROOF BREAKDOWN:
MGS Construction will remove all existing roofing and flashing materials to free standing garage in rear of property
MGS Construction will remove debris and coordinate all trash removal
MGS Construction will supply and insWI 6'of GAF Weather Watch ice and water shield at all roof eves
MGS Construction will overlap the GAF Weather Watch ice:uid water shield I"over t8scia boards to help protect against
from ice dam damage
MGS Construction will supply and install 1001%of GAF Weuhet Watch ice and water shield to dormers and entry roofs(3
pitch and tinder)where necessary
MGS Construction will install 3'of-GAF Weather Watch ice and duster shield at all rakes
MGS Construction will install 3' of GAF Weather'Watch ice and water shield around all penetrations(vent pipes,chimneys,
and skylights)if necessary
MGS Construction will supply and install GAF deck Armor to the remaining roof field
MGS Construction will supply and Install GAF Pro-start manufactured leading edge to complete the roof perimeter 58 the
manufacturers suggest
MGS Construction will supply and install now flashings and white drip edge including mleading of any/ell existing
chimneys
MGS Construction will supply and lnstall GAF Timberline Lifetinre architectural shingles(color to be chosen by owners)
MGS Construction will hurricane Hall 6 nails per shingle to p rotect against blow offs
MGS Construction will out and prepare all ridges for proper entitlation as needed
JOSEPH SIMON HOUSE 1
ROOF REPLACEMENT
SEPTEMBER 2013
MM
10/18/2013 10:4tl yltl l453/// .IGPoV YUK,MLLU nlww
MGS Construction will supply and mwtall GAF Cobra ridge vtnt according to the manufacturers suggestions at ridge
locations
MGS Construction will supply and install GAF color match carps to all ridge locations
In the event that unforeseen rot is found.A plywood replacent mt charge in the amount of$50.00 per sheet(labor and
material)will be billed additionally to the contract amount.
Any items not stated above are to be considered as an extra charge and will be invoiced separately from this billing.All other
agreements to be made in writing between the customer and NIGS Construction.
TERMs/NOTICES:RnmENTIAIXOMMERCYAL
It is the hone owner'stassociations responsibility to ensue that prig•to the start of the project all areas of concern are prepared for am of
project.All planters,grills,patio fltmiaLiogs,and otber precious objrots should also be moved prior to the cart of any mufiog or vinyl
siding project.All vehicles should be prirked at least 15 filet away fmm the home during all work in progress dtis is due to debris that
could fall and or hit the vehicle.MOS Construction is not responsible for.nty damages to this property should these guidelines not be
followed as this should be considered as a formal notice.All interior wall hangings,including shelving,pictures,and other precious
objects should also be removed due to heavy hammering umdl the project has been completed MGS Construction takes extreme care in
the seeing up of the equipment,scaffolding,and tarps used on each project in order to protect all property and landscapes.Any exterior
damages to property incurred by MGS Construction will be remedied repuired/resolved by MGS Construction.However,we cannot be
held liable for damages to plant and or flower beds,shrubbery,etc h"ecl.within 15'of the perimeter of the work area
MGS Construction will not be held liable for cracked or damaged drywall or for any interior objects that may vibrate,shake,or fall due to
heavy hammering or normal construction work.
WARRANTY SHINLE ROOF:
Labor:MSG Five Year Craftsmanship
Menufactrner's warranty:GAF Fifty Year System Plus Niaoeriat Warranty
PAYMENT TERMS:
We hereby propose to furnish labor andmaterials to complete in are:ordaince with the above specifications,for the sum of Three Thousand
One Hundred ant Fifty Dollars($3,150.00)with payments to be made as follows:
Payment Is due immediately upon completion of project.
ACCEPTANCE Ol?1PA'1 MENT TERMS
All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any
alteration or deviation from above spectfications involving extra coats wil ex 1y upon written orders,and will become an extra
charge over and above the estimate.All areements cow ant upcn es el beyond our control.This proposal subject
to acceptance within 30 days and it is void-thereafter at tt ption o i
Authorised Signature L' it
Ad
JOSEPH SIMON HOUSE 2
ROOF REPLACEMENT
SErMM]M 2013 .
MM
ACCEPTANCE OF PROPOSAL
By signing this proposal it will then in fact be considered to be a legid and binding contract between the agent representing
The Joseph Simon House named above and MGS Construction.The above prices,specifications and conditions are hereby
accepted.You are authorizing MGS Construction to do the work as specified above.Payment will be made as outlined above.
Shall MGS Construction not receive payments in accordance with the above stated trams all work in progress will be stopped
immediately until payment has been received from you the client.Upon not receiving the fmal payment for the completed
contract/project,MGS Construction has the right to hold you the clic.nt responsible for all and any reasonable legal,filing,
ern!attorney fee's necessary for MGS Construction to collect psymeut at your expense.
ACCE
DATE�E-& L� ZQ 13
SIGNATURE
This proposal Is vatld for 30 da;rs from data of receipt
ALL ACCEPTED PROPOSALS MUST BE SIf PIED AN])RE'rURNED TO OUR OFFICE UPON ACCEPTANCE.
JOSEPH SIM ON HOUSE 3
ROOF REPLACEMENT
SEPTEMBER 2013
MM
IV/N!/ZUiJ at7:40 tlrU 4311111 J:_fuV rutcL.cLLu V1wrV r«VL w
r
Salem Historical Commission
170 WASNp1GTpft$TREE T.;AL ebl.9g55ACMUSETTS V'Sa
'S�91 N1y.u)95 FAX nI?9r]aV-0+Oa
APPLICATION FOR A CER11FIQkTE OF NON-APPLE ABI ITY
Pursuant to the Historic Distlrict's Act (M.G.L. Chapter 40C) and the Salem Historical Commission Ordinance.
application is hereby made for issuance of a Certificate of"Yon-Applicability as described below for:
D New Construction U Moving n Reconstruction
U Demolition U Painting Cl sign �,/ Ot Alteration
� Other
District: Ooerby Street Lafayette Street ❑McIntire
U Washington Square
Address of Property: d; Cn 7 I^ �A(,) I1 !�
Name of Record Owner(s): jrF�
Owner Mailing Address: 1�
D_Md on of Work Proposed:
IFUJIUM
Name of Applicant: s :0wr:er ; ;Contractor i'iTcnant : !Other:
TO. k
E-mail Address:_
C lrfi/irute it-it/he tnailtal fo 1/re nnvfer unlrsT nfhenvixe indii;rtivJ pore:
Certificate should be m;uile;l ha: Name
Mailing address:
�._ City:, st've• i.
' lb/ltl/Yr11J ltl:4tl 7Itl140,]lll �e.w� rui�w��e, vew.v, • .+..` ..—
PROCEDURES FOR FILING APPLICATIONS
A. Ile prepared to apply for approvals well In advance a rcummeneing aal'czti rior work. Before making an tdmogoi to the f acrim of a property
in an historic district,the owner should all or visit Ibc Commission relrresenative al the Otpmtmrnt of Planning&Commumtso evelopment to
discuss proposed alterations and to determine the augury of the a pp`•ication(Appropriateness,Non-Applicability or flardAip).
is. The Commission normally mats an the first and third Wtxlnesthmye of eech month and notices ate postal at City I fall. The theetings are held to
120 Washington Street,3rd 11am,and begin of 7:00 p.m. All mtctinge:arc open to the public and tiny person is entitled to appear and be heard
on tiny mutter before the Commission be6me it reocines a dccisinn.
C. An appiladim fur a Certificate of Appropriateness or Hardship muss be received by 3.00 p.m.on the Monday 16 days before the mating in
order to make the agenda An application fora Certificate of Non-Applicability may normally be added to the agenda up to the day of the
meeling. In some cases,s Certficate of Nan-Applicability may be issued by the Clerk,without review by the PoII Commission.arbor notifying
Commission members and allowing 24 hours Poe any objection. There is nu is for ony applications
U. All applicuUons for Certificates of Apprimpriaterwss or Hardship requi re a public hearing. Notice uflht hearing must be posted with the City
Clark 14 Jaya before the hearing and abuuen must he notified iii writing. Commission staff will handle these procedures. A public hearing is
not required for a Certificate of Non-Appliabl0ty.
E. Applications must be submitted by the owner of the property. A contractor for the Owner,m the Ounc srelueaLmaysubmitanapplicationon
the owner's behalf. In case of a tenant,a waiver of the owner's appcar.ma may be gmnlal at the discralun ufthe Commission ifh is maltreated
by the owner.
F. All upplHvllom must Include photos of existing conditions,to oat from all public ways. Nocartlfieates an be issued until receipt ufphotm.
G. An application will not be considered complete unless giLwork item ire thoroughly described on scaled Jmwlrop and include specifications
regarding dimensions, materials, and any other infornatlon nteded fur the Commission to vlstwlize die changco in Order to make a
Jelerminadon. Applications fbr paint colon should include a point chlporehon. The following Items should be included inyuurdrawingsas
applicable(ethibfts should be I%,x I f or beable hi be fbltkd w 0%x 1 I):
1. She plan showing location of improvements:
2. Elevation dnwingsor the specigclmprovenaw
3. OelaiLs/proRlas(i.e.moldings,face caps.cornices,vatm,etc.):
4. Materials(i.e.wood,brick,ttc.X
S. fiimemimat(i.e.size oftrim),and
6. reausformtrs,boot pump ad Condense locations.atutriea. entries and natters,lamp pia shave pipes
fl, At the hearing,the Commission will discuss the application with the aGrollcant or his representative,hear the abutters aW take a vutt. Owners
having professional consultants such as architcou;or contractors am urllcd to have them be present at die haring,il'dre oppticadmt is opproved.
a Certificate will be mailed to the moiling address provided on th a application and copies will be sent to that CiO Cierkarkl Building Inspector.
Pica"nvk that the application can be continued until the next meetl ng if the Commission deems necessary(i.e. fat reasons ofincwmpkte
drawings,to palmist a site visit.etc.). in any case,the Commission araist make adetainnituation within 60 days famn the Jolt the application is
received,unless the applicant wolves that requirement in wrifiry,
L' A property owner or a ca mracwr cannot receive a building pemift unless a Certificate has been issued. Plsse be sure to obtain appropriure
permits Rom the Inspector of Buildings(or other nccessn ii permits and approvals)prior to eummatcing inttk.
J. 'Me homeowner may apt not to eammence the work approved(at iloss it relates to resolving an outstanding violation). Work commencndmunt
be completed within one year from The Certificate Jude unless olherwke indicoteLL
K. The City of Salem reserves the right to Inspect the pivjcct to Jetrmino compliance with the conditions set forth in the Carificate issued.
V5010i1itdS
A person commencing or completing work to the exterior of a b wilding in at historic district without the necessary approval of the Commission is subject
to lines crop to 5500 per day from the date ofviolaion. The Commission i:i not nasponsibie foram owncesncgbovt to inquire aboutrxcaeawry Cky permits
and approvals. All records arc public aid we will confidentially:assist yore if you at concerned that someone in your neighborhood is in violation.
AssiffA
'Me C Ls,49nisguidelinesarcavailableforvictvingatheCiityofSn1eabcpartmentofPlanningaCommunityNvelopment(01'l3D).attheSalem
I'uhlicl.ibmryoron•lineatlua•/;wwtvsalum.eonvl'n:mutialeuihlA I iaoric/hula_. 'fhcguidelinaprovideexomplesmfwhatishistaricullynppmprian¢
(or inappropriate) for lalcm's neighborhoods including trim siding, hairier fiat :feces. down, fences. gulnenldimaspouts, masonry. inch:mical
equipment,point colomparkingsolutfunsporchcs/shipt romfrms,satellitetrishcyasoliventxgys)+tans avnnJuryeyuss,skyliglNs uilitietwindmss
etc. Tbcsc auiJclines help you understand what chansa arc likely or unlikely to he approved. 'I'be Commission supports afar edicts ai improve lour
property and can guide you on historical appropriakecss Furnhcr intinrmmion. including Citytvide architemutal imcntorim is availahle. For more
iufi+mvuitm.aimacr nce('Icrk ofthc C'onnaissinn an the Itl'CI). 1?0 Rashinµton Street.Salem.41:1 01970,973 619.39113. Rev.hyll
l b/1131 IV:4tl 7I tl(40A1II Jiu-uv rumucL.L_u uluoiu
CITY OF SALEM
DEP (•OMnIAUMITOY DEVCLOPME F pLAf4NjHG �T
NAvyes V"""'
CoMM�rm`�
1979)919.9999
"ALL ANNEX FFA)L( 70)7A" .
120 WA91111NGTON or.
SAL.EM,MA 01070
• f