278 LAFAYETTE ST - BUILDING INSPECTION (2) VLU
The Commonwealth of Massachusetts IµgpECT10N L SFEF}�h4C�pS
Board of Building Regulations and Standards SALEM
Massachusetts State Building Code, 730 CMR �p Rere�ljP�3o11
Building Permit Application To Construct, Repair, Renovate Or D11191�a3
One-or Two-Family Dwelling
�— This Section For Official Use Onl
Building Permit Number: Date Applied:'
�-- Iz.1 14
Building Otticiol(Print Name). - signature Date
(��� SECTION t:SITE INFORNIATION
\bey d� I.1 Property Address: 1.2 Assessors Map& Parcel Numbers
o -77 1�4FA✓��-
M1la Number Parcel Number
1.]a Is this an accepted street?yes -/ no P
1.3 'Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq R) Frontage(It)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone? Municipal ❑ On site disposal system ❑
Public E Private❑ — Check if es❑
SECTION2: PROPERTY OWNERSHIP""
2.1 Owner of Record: !- �VVL74
F?ohe0- W111uJt26_ cily,smle,ziP
99�rne(Print)
No. and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New ccupied ❑ Re
Construction❑ Existing Building d Owner-Opairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work':fffy.rh Ooxh ±ty d'dr ktt i cf
SECTION q: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item Labor and Materials)
I. Building $ 7� s✓ 1. Building Permit Fee:S Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost(item 6)x multiplier x
3. plumbing s 3's Other Fees: S
t. %teclumic:d (FIVAC) S List:
5. \lech:micai (Fire S total All Fees:S
Suppression)
- Check No. Check Amount: Cash Amount:
6. Total Project Cost: 'S 7U v � ❑ Paid in Full ❑Outstanding Balance Due:
Z� 2 Gfaur p
CV�LL wt �
> I SECTION 5: CONSTRUCTION SERVICES '
5.1 Construction Supervisor License(CSL) _ G�S'�(t7 oZ s7� Da 06 R?0/�
74i4610 /`3) tl-XA ,trF„ License Number Expiration Date
N:unc of CSL Holder
List CSL'fype(see below)
/3 41,9j?4.4 1AIAC kill 5+ Type Description
No. and Street
U Unrestricted(Buildings up to 35,000 cu. 11.)
_wz)ovn_ „-- 9 //;'o R Restricted 1&2 Family Dwelling
City/futm,State,"LIP Ni Masonry
RC Rooting Covering
WS Window and Sidin
SF Solid Fuel Burning Appliances
Z�/-a/9��JGyljtoi2lz( j/o��rw[G•� - II Insulation
'role hone �r Email address - D Demolition
5.2 Registered Home Improvement Contractor(HIC) 1?,;ta-7-7 12 d o LY
64e)iv 41 t/✓i HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No. and Street 13/✓Ovtf 0- W A'✓d4Gr�I J —� Email address
City/Town,State 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 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
I, as Owner of the subject property,hereby authorize ko
t9=2�/ �
half in all matters relative to work authorized by this building permit application.
1 a/ y
Print Owt r' a ie(Electronic Signature) Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,) hereb it t under the pains and-penalties of perjury that all of the information
contained in this application is and carat a est of my knowledge and understanding.
Prim Owner's or Authorize r is Name(Hecunic Signature) D tte
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC) Program),will nit have access to the arbitration
program or guaranty fund under�1I.G.L.c. I42A.Other important information on the HIC Program can be found at
www.mass.eov:'uca Information on the Construction Supervisor License can be found at%vww.mass.�sov�'dys
2. When substantial work is planned,provide the information below:
Total fluor 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 half/baths
Type of heating system Number of decks/porches
'type of cooling systet❑ Enclosed Open_
3. Total Project Square Footage"may be substituted 1'or"fatal Project Cost"
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supen-isof
License: CS 102574
FABIOIALVES
13 NORTH WAR EN-S NO 1.3
Woburn MA 01801 .,
Commissioner Expiration
ovosfzols
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
egistration 132277 Type: Office of Consumer Affairs and Business Regulation
Expiration 12/20/2016 Private Corporation 10 Park Plaza-Suite 5170
Boston,MA 02116
FABIO'S PAINTING CO 1NC .
is
FABIO ALVES fF _
13 NORTH WARREN ST
WOBURN,MA 01801 "- UndersecretaryNotvalid without signature
Fabio's Contractor's
Sales Person:Fabio Alves
MA-CS LICENCE# 102574
13 north Warren street Woburn,MA 781.219.8764
Robert Willwerth
70 Summit LLC
278 lafavette st.salem-MA
781-7601140
11/23/14
Proposal/Contract 041/14
Scope of work: Front and side porch:Remove existing floor,repair joints,and install new flooring.
Repair existing railing and reuse(Keep original size.
Remove all rubbish during construction and general clean up after finishing the iob.
All work not related to this contract shall be the customers responsibility
All materials are guaranteed to be as specified.All work to be completed in a workmanship like manner according to standard practices.
Any alteration or deviation requested by owner from above specifications,involving extra costs will be executed only upon written orders
and will become an extra charge over and above the specified pricing above. All work warranted for One(1)year.
Contractor warrants that he maintains up to date workers'compensation and liability insurance
Estimated time to complete the work will be of minimum 10 and maximum 20 days after the date the Permit is issued by
Building Department.
Total contract price and payment schedule.
The contractor agrees to fumish all materials and labor as specified and as necessary per design drawings for the
complete construction of the job for the SUM of: $7,750.00
Payments will be made according to the following SCHEDULE:
$ 40% upon signing contract
$ 40% immediately after half Inspection signed by Building Department Inspectors
$ 20% immediately after work completed
The customer agrees that any unreasonable failure to timely and fully pay all amounts due and owing shall entitle Fabio Alves to
collect from you all costs and expenses incurred in collecting said contract or change orders amounts,including but not limited to
reasonable attorney's fees and costs.
n
collect from you all costs and expenses incurred in collecting said contract or change orders amounts,including but not limited to
reasonable attorney's fees and costs.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
Upon signature of parties,this document and any attachments becomes a binding contract.
Customer's signature Contractor's si ature
Date: 1���// Date: /11,;e j
;T e Q-I-Y OF SALEM, NL-1SS.ICHL:SETTS
BUILDING DEPARTNIEINT
i
3 )9 I?0 1X/.�SHCVGTON STREET, 3'°FLOOR TEr_ (978) 745-9595
F.ALx(978) 740-9846
KINIgERLF-Y DRISCOLL
",VLAYOR THOistAs ST.PIE"E
DIRECTOR OF PUBLIC PROPERTY/BCQ.DrNG CMMISSIONER
Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electrlcians/Plumbers
nnilcant lnformatinn I Please Print Leeibly
NamC(Ilmindss,Orgytintiaro'Individuai): �,4-/�i(d a&L
Address: la AIO&I# G(/MAf w d-
City/State/Zip: 61JoL6,11/!rf/ zA Phoneh: '7YI J?` :�T`761K
F
employer'Check the •appropriate box: Type of project(required):
employer with 3• ❑ I am a general contractor and 1 6. ❑New construction
yees(full and/or pan-time).• have hired the sub-contractors sole proprietor car partner- listed on the attached sheet. �• ❑Remodeling
d have no employees These sub-contractors have 8. ❑ Demolition
g far me in any capacity. workers'comp. insurance. 9, ❑ Building addition
rkeri camp. insurance 5. ❑ We are a corporation and its
requred.]
officers have ezerciscd their I0.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself.[,No workers'comp. c. 152, §1(4),and we have no 12.0 Roof repairs
insurance required.) I employees.[No workers' 13.❑ Other
cutup. insurance required.)
-Any applic®n nor chvulis box rl must also roll out gild section brow showing ibcir workcn'comptnutica policy olianntlon.
I l lomcuwm"who nuhait this slYi,invit indiealing they am doing all work and ghca hire outride contractors mint submit arm aftldavit indicating such.
$'•nuuxtun but cheek this box must stachod an addigiouml ahn:t shuwipg the none of the subautnnctrtn and their workm'comp.policy information.
f ant un eittpluyer shut is providing)vrkers'compensation ia.turaaca for my employees. Baluty is the polky and job site
iofrmatution.
Insurunce Company None: -0
Policy it or Self-ins. Lic. th WC /00 601 Y?027 Expiration Date: 03 s- ao/S'
Job Site Address: -277 V-s A JL A- Lad City/Stateaip: 54/.Pz.t-, Allf__
Attach a copy or the workers'compensation policy declaration pale(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A ofSIOL e. 152 can lead to the imposition ofcriminal penalties of a
tine 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 line
of up to S230.00 a day against the violator. Ile advised that a copy of this statement may be furwarded to file O(lice of
Invesligmiuns ul'Ihe MA for insure yce co rage wrifiealion. -
/du hereby certify rand r/it a Is u Pena . of perjury that the infuratallorr provide)ubuve i.v true and c'arrerc
si"11,1111 C.
Phone is �7)/
Official use only. Ou n✓f wrile in this area, to be coutpleted by city ur loran ofjk•lu!
City nr'finen: _ __ . PermlUTIeense If
Issuing Aulhurily (circle one): -- _— --- --
1. Board of Ilcallh 2. Building Vella,tineut 3.Cilyfruwu Clerk J. Electrical luspector 5. Plumbing Inspector
6. Other
i Contact I'ennn:.__.._..__._—_.. _ .____.__ Phone A:_
CITY OF SALEM, MASSAQHUSE-M
Q BUILDING DEPARTMENT
120 WASHINGTON STREET 3' FLOOR
TEL. (978) 745-9595
FAX(978)740-9846
KIMBERLEY DRISCOLL
MAYOR ZHo"STTIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMNIISSIONER
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 c40, 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 deposit facility as defined by MGL c 111, S 150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in:
V/Z(QCdvAZ7 1 Ml�
(name of facility)
(address of facility)
Sign a of applicant
//y
Date