292 LAFAYETTE ST - BUILDING INSPECTION (2) -' - - - -- • - � �•• �aKtci _KITCHENS 17814853304 P. 01
� ' ' ��" O� 1•800•244•5333 Tntlfren
1@1�485•3303 St�own�m
781•48.�
, -L 1 atn �eno�q� .
Direct F inait dir�kHcheng�ve�=on.net
� 195 Squiro Rd Reverc, MA 02151
Contracting
TO:
First Beptlst Church/ GO Dennis P�ONE ' �T�
292 Lafayette St. l/172008
Salem,Me. �oe�oc�noN
Same
J09 NUM9ER - JOB PHONE
Submit Architect draayings�o town ha�l to receive building pernvt
Frame & finish 2 I�endicap bathrooms on 1 st, tl. 1 Ladies& 1 Mens Room with all necessary plumbing
including ftxturea ;� toilets,2 sinks, 1 urina(, 2 hosebibbs,2 floor dtains.Change all PVC in Bavement to bring
up to code.
All nocesaauy electe.jep� jncluding tixtures and all safety devices,fire alarnzs dc smoke detectors. Tile mud
job on floors.
All nacessary duct work hest Bc axhaust ,flash vent stack thru state roof.
B��b°�d& Plaster all wells mady for paint.
Supply dt inytail suspended ceiling in baths.
Removal & Diaposel of all construcHon debris.
Cammerciel�ade steel &sme& solid core doors with com�emial grade Iocicsets.
Bathroms will be !00 %comptete to cuatomers yaNsfaction.
Tofa1 Price: 535,000.00 (Thirty Five Thousand Dollars)
Peyment Schedula 1/3 at Signing of Contract,]/3 After rough inspeotions and 1/3 Fina1 Payment at
Completion
c�a. oxn '
MI mrmd u C�. OKD
mwMr�wwdin6 ta�nq�m b.r rowtfl�d.Aii ..mY ro h�aomelaoed ia.vMiaiee.l
mrolWn sbn com will � ����°f�d0e aX°�n�r�� Autl1oNDW
�M aa rd�bo.�tlr e'tlm�. nI�Y woa wtlmn adrn.md Wlt beoome em m� 9ieneurc
�NN�Wodour�o�el.OWlvb ��mmW OenGu�e[Wne WNa, scidml�m
�Y �oMWD.�od afhn nxyoy INm�nre. 4m�. TN MtA A'w MM uaV�p vMMn J �yy�,
AccYPTANCC oF PAOPOBAL—ne.ho.r mba..am�ew:e,.aa awtli�io.�
P�Y���b eWe Y uNinW��e.//JYw m b do the waY u+oeoifuA. S���R: � � ..
dtoofAcpDW100: ( ! $ieflilyR: ',
u . �
' � CTTY OF SALEM
PUBLIC PROPRERTY
� DEPARTMENT
;,i���R�Fr uaiax�u
�I.�r�� �2t`Iww�w'raH Stxsr�S�i+y.N.�a�u.yn:a7•�x0�97s
'fr�97i)�SyS% �F.�x:v7L)r4W�s . .
Wuriten' ComperuaHo� lasunnte AtYidavlC Hullders/Cantnctors/Electricfans/Plumben
annileant Informatfon Please Prtet LegiDtv
Vame�u�wnewa�an�n,iavtmu��►: C�2cci eac�Tr2rdc°rtw�, Pva��vucti M<��.uGlKih
.addre�s: 1`i� S C1��trz� 21��
r�y�s��z�P: 2evc�.e , Mre Oa1Sl i��: ��i—�l�ss`-�363
.\n yo�ya eepMyv!C�eek tM aPproprlsq�
'hP�uf Proleet(rMrlrad):
i.� 1 •rm a empbysr wi�Y 4. am a y�pueral eootrxwr and 1
tmpluyeac(full uuYur p:ut-�inu)•' hava hircJ�he aub-cwunceon b• ❑T�ew conrttueti�
2.� 1 aut a sok praprictar w panna. listed ua df�atached yheet f 7.�►ai
ship and have m omployuw TheM wb.eanaaem�s h�w tl. ❑ D�moli�ioo
woAcin� tor mc in rny cqpociry. worken' comp. inwronod q, � g���;y�ditim
(I�e arork�s'ewnµ inwranp 3. � W�aro a eorpondm und ib 10. Electriea!r
nquircd] ot7fan hsve excrcirad�heir ❑ �rt or�ddidons
J.0 I am a Aomeownc Juin�all worlc ri�6t of exemption per MGL I l�lumbing re�ain or a�klirion�
myxlf.(Ko worken'cump. e. 132,�t(4),aad we have no 12.❑ Ruofrepaits
insunnce requixd.J � �mpbyeet(T�o worlcers', I].�Otl�er
comp. inwran�rcquirwL]
•n�n.ppti�ap iM ehc�iu boa/I mrn also till w Ow+aa�u�labw�horia��Mir wrts�'ew°PaW{u�Pqi�y iofur�io6
' IIww�W,ws rM�u0si10i�sAltlpu iWica,w�qry an Jwy dl wvk ntl Nw AYe w�ffdr emroflsn mrN.ubnil a Iry alM6vi1 inJiaiiny w�i.
�f',wu.x�uws�Iw c4st Uw�ba�w anxl��w adANmd+Ir�.6o�rin�iAe naor dtlr we.eonpapps aW dtir Wmkrn'cvi4•PaKY�Ib�erfoa
/unr un ciuploytr that 6 provldlnR wai�a'compentadoa Luaia�e jor iny emp/uytet Bilow!r rhe puBry anOJob aife
iw�urwufiuAl �
Incunncr Company Vame: -- _ .. - --.. _-
Pnlicy M ur Solf-iN. Lic. N: _ .. _. Expinuion Date:
lob 5itc AdJress: Ci�y�SW�ti2ip:
�n�ch�cuyy of th�worken•eomperoatloa p��lley daelar�llos paK�(s6ow�in;the polley numbcr and�:pir�tlun d,te�.
i+.iluru�x;cu�e coveraee ss«quircJ unJcr S��ivn?3A u!'�IGI c. I 32 eaa Iead ro�he impoiition of criminsl penaltia of a
ri nc up to 51.500.00 anJ/or ona•ytar imprir��mncnt,�wcll:u civil pcnalti�in ihe form of a STUP WORK ORDER arn1 a fine
of up tn��50.00 r Jay�ruiast ihe violawr. I!e adviud Mut a wpy uf this a�atcuunt rwy bn iurwarJaJ�o ihn Ullice of
Im�,�ngnumu��I'Aw DI.� for in.urar.c.:oocrl;c c.rific�liun.
/Ja herv6���.rri/y uadar thr puinr und�unuhlrr u/prrJary�hw r/a!n/ararl/oa oroviJed ubow ia nwi unJ corrcct
�;�•n:�ti,re' _ . �� }V�1 t�—����. 1)�rc• O�'�l �U�'
rr�,�:�,: �kr -y&s-35o� .
U/J7rir/�rt uw/�t /�wa wrlit IM iA6 arrr.tu bi ruwplHei/by dIr oi roivw o/jli•/uL
Ciry or 'fnwn: _ PermiNl.kcnse Y
b�u1nK Au�huritr (circb onc): — -- - .
!. IS���rJ nf Iln�lth 2. Iluildin� Dep�rtmc�rt J. Cityll'oNu Clerk J. Electrical Insyarror 5. Plum6in� Inspecror
4.O�her
C��ul�cl Pctsa�: . .. . . 1'honc q:
Information and Instructions � .�. .
�tais:khu,etu Gcrxral Laws chapttc 152 crquit�t all employ���t�etvice u anoi�una.fu any coawu o[hire.
Purwa�u ro�his�:uw�.a���w/��Y��s defu+ad as'...cvaY P�
oa��ess�x impliod.�xa�ot writted"
.. a�o�.ao�Ya�rim ar od+er k�al�+�Y.ar any nw a mar
.V+er�Ya��� u is�+d�.P��P.
of�he fuce�oin�m�a�yed�u�Joia�c�Tr�aod ioclwW��h�e lepl repreaenudva of a decenaed emPloyer,or�he
�awe�aaon or orhar leyal eudq.w�pbYat�Y� �wever t6�
recaiver at«usYet uf+o iudividuN.P���P. md wh0[eaidet�Atiti4�Iht oau�l of dM
uwrt�er of a dwdtin�Aour 6�vi�oot mae th�s��
,��6ouss ot aoodrr�w�P�OYs P�rwna oo Jo maiaeaance.a�oatruccauu or repair work oo wcA Jwallia�houa
s merero sAoll aot beaun ef aud aa�pluyiomi be deemed w br m empbYu."
or on�he�nd�a buitdine PV�*�^�
�tGL chapter 132. 42�(b)�O smces�hu�"w�ry uw w beal lke�t iN�7'+�witi�eY tlw tuw�e�o►
a o nb�Mslaat ar b tovnu�b°�Idl°¢�tM eemmo�we�f�r W�
nKwd sf�Ikew or y�rmlt Pe �W Iosun�ee eowr�p requlrN."
�pptles�t wM W�t Orud�e�d�eeeOqWtwidrae�o[eo�ptla�oe .
.�dditwmlly.MGL chapter 153.$2� �'NeitAer tbe conurtoawea�lsvi'deuce�caopliaace w�u�nsuranee
mnr iato my conuact for the perC 61ic worlc uncl ucepc�b
requiromnna o[thia cbap
nr haw been presenud to edc conaactini aud►ority."
Applkast� _ z
Pteaae fitl out the woAcaes' eanpeosaaon rMFdavit eompkoelY.bY checkma[he boxa chac apply w your si�uarion an4 i[
naeessary.p+PMY���)°���'��)�P�au�nbals)aloa�wit6 rheir certiticatc(s)ot
;�. Limicad Liability Compaoia(LLC)or Limtted Liabiliq Pornrcnhip lL�[.P)wiW no emPbYed wher rhm the
memben or pnctcas.ue na��0D��'a���°0�06��°��' If au LLC or LLP doas hsve
amployees.a poliry is rcQuired. Be advi�ed dut�hu aftidsvit may be submitred w the DePrrhn°^t of fndustrial
.�ccidew for coaticm+cion oP insu�snea�°v`'�ia �°a��to�Ip aod dute tAe yflldavlt 11ie aFtidavit shoWd
6e retumed w�he city rn rown that�he application for the pennit or licensa is bein�requescad. sat dfe Dapat�ent of
InJwcQixl Ac�iJenu. S6auld you have any quesdoos reQardin��he law or if you are required co obtain a worken'
� u�he nwnber Gaed below. Self-inared companiu s�ould enter tGe'u
cu�npentation Pc�uY.Vka�t call the Dep�
,elf-irourooce lieense numbar on ehe t�.
CIry o�Tow�ORfetab
Plcax bc wre tha�[he a�davit is complete and printed IcQibly. The Deperanent har provided a spaca'rt the botWm.
oP ehe affidavit for you to fi�1 uut�n the°�°n��OtTice of lnvesti�aons has ro conwct you reQordin�the applieane
�'I�a� be sure ro till ia�he p�:re+iuliceeu�e number which will be u5ed aa a retbrence number. In addidun.�applicant
ih•rt muct►ubmit multiple permitlticense applicarioiu ia any�iven year,need only submit one affiduvit indieatin`curteu f
policy information litnecessuY)�nd undar"lob Site AdQrcsr"the•rpplicant should wria"all losaeions io�('��Y
cuwn6"A�OY of�he ufYidavit ihat hat been ofTually stampe�l or muked by ehe airy or town may be pro�idcd w�he
applie•rnt a�prooPrhat a valid affidavu is on fila for future permia or licensas. A new atTidavit mwt be tilled out euh
year. Where a homa owner or citiun is obuiniu`s licenae or pennit na rclated to any business or�ommercial vennue
i i.e. a��{����a(K��O���VQf�'�u��°O°�YOT required to complete this�ffidavi�
Chc O�ii:c ot lnves�iy�uuns w'uuW Ii:ee w thank you in nJv:uue fv[your.oapenciun anJ�hould yuu h•rve +uty questians.
,;eaae du no�heaicare co give w •r call.
The Dcp•artmrn�'�uldrass. eelephone anJ fu numbu:
The Commonwealth oPMassachusetts
pepaRmeot of Industrial Aocidents
OQIa ef[�wsdptlo�s
60o w.�„�s�a
9o�ton, MA OZl t�
Tel. p 617-727-4900 act 406 or 1-877-MASSAFE
Fax N 617-727-7749
i,�„�� ;-�v-os www.mase.gov/dia
, ' � CI'TY OF SAL.EM
PUBLIC PROPRERTY
DEPAx�rrr
..v,.�.t• �r.►vL
at.••+ t!G'I.��:�+5 sesT�iu:+�1L�v►��r.►ns::+.
'ti:r0�1�6+�9M�f.�te 97N�6�M1�
r-
-�
Coastrucdoa Debris Dispaat .�►CRdsvit
cratuieai Rx�i1�anotitiaa m�e�enovatia�worfc)
(A�w itA tlft slxdl editiaa o[t!r Stats Buildio�Ccd�,7�0 Cl►!t soetiae i l 1.t
pebri��ad dr povisians ot�tGL e 4Q 9 S4.
8uildtn�Premtt* _ . u iaw�ed ait6 t6�eoodldce fiot t�debri�cautefns �os
�hii wat shall b�diaposad otia a pcoprrly liemuad wast�disposd AieiUry as deMad by�!(31.e
i t t.s ��o�.
rt,e eebr9.wiu be transpoKed bY:
Or��cT �'L:j'���e�S.
" �mmr af t�t.A
fhaJcbrii witl bM di�po�ad uf'in :
�✓Cl D 0 c.��AST� .o� �vP✓�ci�-
h»mr uY fa.�bry)
�'VeK.c1Z'. .
�+.M:ts�.•�u'Yx:l.ty/
\)
.��.._Ir...N,:.(n.U.��.t��.Y ' �--_
a' �� _� f5.
- .�, -
� \.
a � LS �, ,� �r
n � p �� /' _. �
n ✓fte l�JainilxaoLu/el[�//L O�..KQb1aC�tudCad
'} {E BOARD OP BUILDING RE`GULATIONS
H�. License: CONSTRUCTION SUPERVISOR � �
� Numper CS 074406
,���� � ��� Birthdate;�D6/OS/1961
� ��� �� �r Expirey:..06/05/2008 Tr.no: 26681 �
i.ons��ucuon-w.� - y
Restricted� 00-�� �
PATRICKJ MCLAUGHLW �
329 BROADWAY . �j"� � . .
REVERE, MA 02151 Commissioner � I
' , ------- — ei-r�r-o��.��r- --
� �f-� PL'BLIC PROPERTY
��y0• O�' DEP�1R'I iVIF.►�IT
AI�OIFJL6Y Ouv�v
Mwraa 13D�W,�vurrc7'nN Sn�,T� '
].ur��(.�st.�O��St'1'Is 01970
T4i 97F)ii959S�F.VL•97L7�96N
APPLICATION FOR THE REPAIR ItENOVATION. CONSTRUCTION.
DErtOLITION. OR CAAIYGE OF USE OR OCCUP�INCY. FOR ANY EXISTING
� STRUCTURE OR BUILDING
. 1.0 SITE INFORMATION � �
Locatlon Nams: C�a25 i 13�PtlS"f Gt4vI�C.� euilding:
property Addreas:�a L.fl�+4`/�1�2 �
Sr4�eV� (i'l�}'
proparty is bcatsd in a;Conaervatlon Aroa YM�_Historlc Obtrbt YM ! _
2.0 OWNERSHIP INFORMATION
2.1 Ownw of Land �
Nams: �
Addreas: Sqn�� <
Telaphone: 9�&- 7 -D 1lOa.
3.0 COMPLETE TH19 3ECTION FOR WORK IN ��AT�N� BUILDING8 ONLY
Addition Existing
Renovation � Number of Staries Renovated
Change in Use New
OemoliUon Existing
Approximats year af � Area per floor (s� Renovated
construction or renovation
of existing building New
ar;Pr Descriptian ot Proposed Work:
h1O� �. i-Ir�nplc�P (3asi�F2�n'!S .
/��� -
- - -- -- ---- -- - -
- Mail Permit to: � /' y/Q� � � ,�p AT
.
What is the cuRent use o(the Building? ��"��Ci} ' "
Materiat of Buildiny4 �L�-�— K dwelling. how many units9 i , ,
Wiu ths Building Confortn to Law9 '�'e S Asbestos9 n v
qrchitect's Name
Addreu and P�w�w � �
Mechank's Name 'A`�Li�-", N��L-�3UGct-Lrr�
Address and Phone i ts �S cs�u`✓�� �L� lL��ivvLB, s•'fs'8—'�G'�S'33a,.3
ConstrucGon Supervisoro License N C7? 4`I fJ(� HIC RegiatraUon N !`//U�7�'� .
Estimated C.ost oryf�Projed S '3S��o Ps�mN Fe�Calwlatfon
Pertnit Fee i��i� Estimated Cost X i7/i1000 Reaidential
€sUma-ted Cost X,S�1. /51000 Commerd ,
qn qdditlonal .00 ' added as an
AdminiatraWs charge.
Make suro that all fields are properly and tegiby writte� to avold delaya In procesaing.
The underslyned doea hereby apply for a Buildiny Pertnit to build to the above stated
speciflcatlons. Signed under penally of pe�Jury /� �
Date �— � �—��
,�( ol I
'I^ ~
� v•
� � � � � :
\ �'
� y � ^ �
Q ^,
\v y+
Y '� q � O
L •3 0 VO y s
x a •3 �1 "�. ` �
-- - - - '� - E- - - �- - � �--- � - ----
_
II��i I' IIY �I
VVV W� IV7
,�S �.l1�ld�t1'I Z6Z
�,z�i z,oi ��z ii z-�oi
��(1d55�7?d Q�ddN71QMlN 8�9/64 e�9io-4
s�iao,�dnb� a�sodoad --�--�- -�--�--� � � � -i--i--i --�--�,--
�� � �
—nena�u��ro a�aao_ra a�;oro zooa AVM.a u rro.a�aao ee aaso=n zooa
;�
I__� -� . 0 � �-�--��.
$NOLLV71�1�8dS dQd O11a5 S�fIlYJ�.'I'M i ��� /� / ���
213�1MDA4�'U15�NISJD710W1'MMdQd � � � �
d'�1MDAa18'11012b01dd'OJMIOWTMMVQd � \i i 3�HdNd3TJ9NII�LL ��`i — ��b��B
71�4ND A9 3MK CNM�ZK�'ILL 2100"Id i � I
Q'IUTAIVQ�Idfd�A3AQ"fI0N55NOKN3WIQ � •37rlddd3'D7NI�211i � i YM17'I�r411VC+V�S �
�� YM{71�3{MVCM�S i �� i
�� \`\` --- /' O O \`\` '---' ' /
I � � I
�,zii z-�oi ��aii z,oi I
&9/64 &9/04
�, � NAMO�'I!� � i
21017�1V31 ON ��\ � ❑ ❑ ��\ i
�. i `�\ I i
�Nn�nn aaozis wzd�d�ua � _-1--'" �--1---�:
�n
� 0"
51FDI1 k'Y�i1V9 A7N3�3N3 ��b'�g
� - ��1LL.?100=1d-'
sroanuz ���LL 2l'JO'I
- � ��,9 � , ��9=�1 wzsaiad�
W75�N�W —
� I I � ��
M LN�5IX801 VL?I'H A�NMI TNMM;Itl
��roM�an�us�ca
` ��. . ,