315 LAFAYETTE ST - BUILDING INSPECTION (3) „t
The Commonwealth of Massachusetts
Department of Public Safety
/\ Massachusetts State Building Code(780 CMR)
^� Building Permit Application for any Building other than a One-or Two-Family Dwelling
0` (This Section For Official Use Only)
Building Permit Number: Date Applied: Bur7ding Official:
SECTION 1:LOCATION(Please indicate Block#and Lot If for locations for which a street address fs not availab e)
, �averv'P tv-- �A�e M AIA- t3/�i�i'
No.and Street City/Town Zip Code Name of Building(if applicable)
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❑ 1 Alteration ❑ 1 Addition❑ 1 Demolition ❑-(Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ 1 Other Wpecly: Z gre cJ
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No O' '
Is an Independent Structural Engineering Peer Review required? Yes ❑ No F�
Brief Description of Proposed Work: afo J > %�5�^ CLF'1�tX G�r d�1. SE=-F
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): a 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(R)
SECTION 5.USE GROUP(Check as applicable)
A. Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ All❑ A-5❑ 1 B: Business ❑ E. Educational ❑
R Factory F-1❑ F2❑ I IT: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional 1-1❑ I-2❑ I-3❑ 1 4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R 1❑
S: Storage Sl❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION&CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ IIA ❑ LIB ❑ MA ❑ DO ❑ 1 IV ❑ 1 VA ❑ VB ❑
SECTION 7:S1TE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Supply- Flood Zone Information: Sewage Disposal Trench Permit Debris Removal•
Public W” 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❑ L
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 Budd enclosed❑ Yes❑ or No❑ I 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?: SpeciaNtipulations:
X(ew—V e PT1e
t SECTION 4 PROPERTY OWN R HORIZATION
Name and Address of Property Owner �- G Q '�(,p
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 budding permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 0 and skip Section 10.1
10.1 Registered Professional Responsible for Constriction Control
Name(Registr rt) Telephone No. e-mail ads Registration Number
�gi4 Y y�rM, �3
Street Address City/Townes State Zip Discipline Expir�at''o Date
102 GGeneral Contractor
t � �ie Cn^�rS CV W lir� QG1 NSJ�C.isP n/ L LC
Company Name
JFifC A 1034�y CSL (jvjRe ng;e e1
Name of Person Responsibl fostruction License No. and Type if Applicable
2 / 4dl7.x,15 C_-v EQ Sr k�Me c � 2—)
Street Addre ������resss( City/T� State Zip
Telephone No.(business) Telephone No. cell e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT G.L.c.152.§25C 6
A Workers Compensation Insurance Affidavit from the MA Department of Industrial Accidents most 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? Yes O No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(labor
and Materials) Total Construction Cost(from Item 6)_$
1.Budding $ Building Permit Fee=Total Construction Cost x (Insert here
2 Electrical $ appropriate municipal factor)_$
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municip " )
5.Mechanical Other $ Enclose check payable to
6.Total Cost Is 0 (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 to the bes of my knowledge and understanding.
PI aseRnot and signpname V Title ele No. Date
(h tSrf YI O ZZ�j v✓ l
Street Address City/Town to 71p
Municipal Inspector to fill out this section upon application approval•
Warne a
CITY OF S.U.Fm, NW&A cHusons
• BuiLDLNG DEPARTMENT
120 W ASHNGTON STREET,3�FLAOR
TEI.. (978) 745-9595
FAX(978) 740-9846
KINIBERLEY DRISCOLL
MAYOR I1 OMAS ST. MME
DIRECTOR OF PuBlic PROPERTY/BuUmmiG ComffSSIONER
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 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 MGL c
111, S 150A.
The debris will be transported by:
A4 c, 57eelS 7-�C
(name of hauler)
The debris will be disposed of in
(name of facility)
(address of facili y)
JIM
s a e o a i[app is 7
t
�- Zdate �.I
d<bri�Rd«
/ r
The Connrtonwealth of Massachusetts .
Department of lndustrtdl Acetdent,�.
Office Of Investigations `
600 Washington Street
Boston, MA 02111
www,mdss.gov/dta
Workers' Compensation Insurance Affidavit; Builders/Conti,actors/Electricians/Plumbers
Applicant Information Plegse P[tnt Lc'Ibif
Mime (Fiuslness'Orgaa:lization/Individui7l)�L���j sn�V5 W����� � L����4
.^cidrzs5 . 0
Ctp,'Siateizip _�lzsffw Mp of rloq Phouel4:
..xre do an employer? Check the appropriate box!
j - m a employer with q [6.
ype of project(required);
_�_ ❑ I am a general contractor and I
employees (Cull and/or part-time). have hired the sub-contractors ❑ New construction❑ t am a sole proprietor or partner- listed on the ahached e t Remodel
sh et. ❑ ngshp and have no em log-ee
s These su
F , b contractors have Demoli[ion
,corking for me in any capaci(,, workers' comp. insurance ❑?�'o v;o:kers' tom incur 5. ❑ Building addition
p insurance We are ,❑ corporation B hon and its
regwrea.l officers have exercised duir 10 ❑ Glecirical repairs or addieee;
-' ❑ I am a homeormzr dome all acork right of exemption per fifGL I I.❑ Plumbing repairs cr addmcns
mys,l F (No workers' comp. - c. 152. §1(4), and we have no
idled 12.(] Roof repairs
Insurance re
9 J ' employees. (TJo workers'
MIT. nsurance required.) 13 E[' fher�'4,�-La��e.-��'
r ppl: m liar cr ec. mwt also fll on fne scaion below showing their workers'
o rouners by s,b Compensation policy info maatieo.
cm : it is arf,on vn indicating Nei are tloing all worD.and then hire olb ideeonlractors must submit a new lffid:.vit md:ca:iog such
Cenn.actors that"i"k this boa must "ached an additional sheet sh,e'in the name of the sub-coaoactors and their e,ou:e n'comp, poh..r m(orm;oo n.
/am an ample Per th a!rs providing workers' conapensa(fort insurance for my crap toyees. Below is ,Ile polies unr(/oF site
'nfo rm a ri p n.
5"g 3("q 88 -,-----
Expiraron Date;�/Z
G.
City/StareiZip 5 �
a.rtnch a copy of the workers' compe sation policy declaration page (shoving the policy number and erpirarion cis tel.
:!urc tc szcure ce•.Brace as required under Section 25A of lYfGL c. 152 can lead to the imposition of enminal penalties of a
S I,i00 00 and%or one-year imprisorvnenu as well as civil penalties in the fonn of a STOP WORK O
Co' up to 3250A0 a dag aeainst the violator P,DER and o file. Be advised that a copy of this statement may be forwarded to the Office of
'rrresu�aiions of the DIA for insurance covera¢e veefication.
i do hereby cerrifl Itmer the PC.ills and penalties afperJvT rhai the in(ormatiwt provided above is true oil correct
r
-- Date
i --
Oir:�tn!
ore „l.. r- De rot „vita rn (hi; ar:n rc t t L e cootP lured by city or rorvn affieinG
C: -r III Toll ..
ii Issuing Author lry (circle one) i
I. Board of Henith 2. Building Dcparnuent 3, City/Town Clerk 4, Electrical Inspector 5. Plurnbing Inspector
11 b. Other
r
!� Contau Per;on:___
04,'03/2011 22: 17815955520 AMBROSE INSURANCE FADE n1/03
QQRTIFICATE OF LIABILITY INSURANCE _
Ir�;IHr j Ii,v qi ll�aMlUgNYY'.I
: AatbrOse Insurance Agency, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
5n` Central n encY/ Inc, i ONLY AND CONFERS NO RIGHTS UPON 7wE AVM- . ALTERHOLDE . THIS CERTIFICATE DOES NOT AMEND, EXTEND
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! A,11 Seasons Windows 6 Insulation w";L ---" NAICa
P. O. Box 6229 -RrFn_ScottBdalc
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Lynn, MA 01904 .._..p�=b�a Pzotect.ien _ _
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-I."'p°''cPF"A"�--�n8--''rrr r'rhC VpPJCi•,p.3I.1C IJ?IONS nODEOtiy ENOCRtiEMfNT;9rfCIAL PROVI5�ON5 � —�— �
s-,pen'try/Insulation/EleCtrieal
EST; ATE HOLDER
CANCELLATION --- --"'�—'-------
Cxty Of Salematcv[nlac9lgr�ro.If,!ES nE rerrll -n rEr lurrn. '>rn+, I :.,
Attn. : AUil.dinq Dept. u,rP TITRFOr 'HE ISMAN I AsjrTR wnl cNnrnvor ., 20 RA"', 'eel"I v
City Hall I WOKE To nr .r:Rrn lr/Tr IOLnrR Nn.,.p r0'o
Salem, MA 01970 :"'OSZ NO r I<an'rlov CR unns,rcv IT nNy NINn UPON usL' n
Rr-I(PEScNi'nTN.ES I
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}�\ Otficr nC Cnatamc�.VT.7r.&1P4..cn R"Wt,doa Lic<mc•'.. .... irirrtior,Telid for igdiHdul ate only
HOME"MPROYEMENT CONTRACTOR. 6<ferc tAc etpira(eoa de[c. If found r<furn ta:
RepiVt-'g—: 1d4581 �ff1<e of'Co nsamer Alfalr3 and 13011n< Rcf Iwio'n
Exyratt m IOO Y20t 1 Tr 28982 f 19 Park f lv -Svite 5170
TYCa: ItxliviJual Bn<too.W!A 02,16
.EFF'REY MAY OTTE
JE FFRLY MAYOT7F
29 ANOREWS LN. ✓��,. ,_
EAST KINGSTON.NH 03827
w id withaaf igaxur<
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Kn:u'd i,( liuilllni_ 12i ulal�..... ....d
CS 103474
Re slnc: :,. Iot 00
JEFFREY MAYOTTE
29 ANDREWS LN t
EAST KINGSTON. NH 03827
/2 312 01 3
".• a 103474 '
ACTION, INC
47 Washington Street
Gloucester, MA 01930
Agency: NS AP NORMApplication#:
PROGRAM: AARAWAP 0
JOB NUMBER: 0
DOE Work Order# 0 E.S.C. performed? No
Work Order Date: 05/02/11
Primary Contractor: All Season Windows&Insulation
Other Contractor: NA #Bulbs installed S0.00
Cost ofBulbs $0.00
Client: Elzola Trotter Inspt$175.00 Max $0.00
Street: 315 Lafayette Street Apt: 3/Floor 3 Other In Kind W.0I1
City; State;Zip: Salem,Ma 01970 Electrical Work $0.00
Telephone: 978-741-7882/978-979-2236 $Amount KeySpan $0.00
$Amount National Grid $0.00
Blower Door Test: No - Other Utility $0.00
Inspect Knob &Tube: No
Date Job Completed: Estimated Repair Total $155.00
Actual Repair Total $0.00
Weatherization Est Act Cost Est Cost Act Cost
Door Kit 5 $43.00 $215.00
Regular Door Sweep 3 $15.00 $45.00
Automatic Door Sweep $22.00
Air Sealing 2-pan Foam(per hour) 3 $75.00 $225.00
Anic Air Sealing 2-pert Fa.(per hour) 3 $75.00 $225.00
Weatherstrip Window(per side) $5.00
Seal Ducts-Mastic $62.00
W/S&Insulate Attic Hatch R30 I l $30.00 1 $30.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
Weatherization Totals: $740.00 $0.00
Insulation Est Act Cost Est Cost Act Cost
Seal Kwall Transition Dense Pack 48 $2.40 $115.20
Attic Flat R30 open - 728 $1.30 $946.40
Attic Flat/Slopes R30 restricted $1.41
Slo es R20 restricted 628 $1.35 $847.80
Attic Kneewal R13 FG $1.25
Attic Kneewall R15 Cell w/Membrane $1.65
Attic Kneewall Floor R30 restricted 192 $1.41 1 1 $270.72
Insulate Attic Stairs&Walls $130.00
Siciewalls-Vinyl R15 DP $1.70
Kwall Foam Board Blow DP 305 $1.81 $552.05
1" Rid Foam Board 305 $1.85 $564.25
Duct Insulation R5&Seal Seams 100 $2.95 $295.00
Hydronic Pipe Insul to I" R5 $3.25
Steam Pie Insul to 1.25"R5 $5.25
DHW Pie lnsuation R5 6 $2.50 $15.00
Kwall Doors w/FB (1"min) 1 $44.00 - $44.00
Sill 2-part Foam w/FG Batt R19 $2.00
Insulation Totals: $3,650.42 $0.00
Elzola Trotter Page 2 DOE 0
Other Measures Est Act Cost Est Cost Act Cost
Gable Vent Kwall-small 2 $76.00 $152.00
Gable Vent Attic-rectangular 4 $88.00 $352.00
Recessed Can Cover $30.00
CudFinish Attic/Kneewall Access 1 MOM $100.00
Test Drill Sidewalls-4 sides $60.00
Blower Door Test $45.00
Vinyl Replacement Window- I Ol ui $350.00
Steel Pre-hung Door w/Lite $610.00
Solid Core Door w/Flardware $350.00
Faucet Aerator $15.00
Low Flow Showerhead $25.00
$0.00
$0.00
$100.00
Other Totals: $604.00 SO.00
Energy Conservation Est Cost Act Cost
Totals: (Max $10-000.00) $4,994.42
Repairs Est Act Cost Est Cost Act Cost
Handle I $15.00 $15.00
Adjust Door Striker Plate $20.00
Door Threshold $4.0.00
Re air Door Hinge $25.00
Slide Bolt 2 $20.00 $40.00
Sash Lock $9.25
Glass Replacement- to 64 ui $42.00
S,�,b,dk ml $415.00
Buildine Permit Fee 1 $100.00 $100.00
$0.00
Health & Safetj
Vent Clothes Drvcr to Exterior $85.00
Vent Bath Exhaust Fan to Exterior $85.00
Replace Dryer Hose $38.00
Knob&Tube Inspection $175.00
Bathroom Exhaust Fan $500.00
$0.00
Repair Tot: (Nlax $2500.00) 1 $155.00 $0.00
Work Order Sub Totall 1 $5,149.42
Measures Est I Act I I Cost Est Cost Act Cost
Other $0.00
Other
"Heating System Repair
"Action approval only
Estimated Job Total: $5,t49.42
Job cannot exceed $10,000.00
Job minimum=$500.00 Job Grand Total: $0.00
AUDITOR: Brandon Dorrington
NSCAP
98 Main Street
Peabody, MA 01960
Agency: NSCAP Client Application #:
PROGRAM: Keyspan/2011 24340
JOB NUMBER: 0
Work Order# 0
Work Order Date: 05/02/11 Job Limit:
Primary Contractor: All Season Windows& Insulation Per Unit $4500.00
Other Contractor: NA
Client: Elzola Trotter K+T Yes=1 No=O
Street: 315 Lafayette Street Apt: 3/Floor 3 K&T: 0
City; State; Zip: Salem, Ma 01970
Telephone: 978-741-7882/978-979-2236 Stand Alone: No
Fee Code: 2
Blower Door Test: No Yes=1, No=2
Inspect Knob & Tube: No Elec. Contractor:
Attic Insulation Est Act Cost Est Cost Act Cost
Attic Flat R38 open $1.40
Attic Flat R30 open $1.30
Attic Flat R20 open $1.23
Attic Flat RI O open $1.15 -
Attic FlavSlo e R30 restricted $1.41
Attic Flat/Slope R20 restricted $1.35
Attic Flat/Slope RIO restricted $1.24
Attic Kneewall R13 $1.25
Kneewall Floor R30 restricted $1.41
Finished Attic Access $100.00
Temporary Attic Access $75.00
Crawl Space R19w/Poly Vapor Barrier $2.53
Garage Ceiling/Floor R30 (with approval) $2.00
Thermadome $175.00
Roof Vent large $95.00
Roof Vent small $76.00
Turbine Vent $160.00
12" Stack Vent $145.00
Propa Vent $3.75
Gable Vent(all sizes) $88.00 .
Soffit Vent $26.00
Ridge Vent(per In. f.) $22.00
Attic Air Sealing 2-part Foam(2 hours max) $75.00
Vent Dryer/Bath Exhaust Fan 1 $85.00 $85.00
Knob &Tube Wiring Inspection 1 $175.00 $175.00
Page 2
Elzola Trotter
Est Act Cost Est Cost Act Cost
Wall Insulation
Single Nailed Asbestos/Asphalt R15 DP $2.10
Double Nailed Asbestos/Aluminum R15 DP $2.20
Brick/Stucco R15 DP $2.75
Interior Wall Blow - Plaster R15 DP
Clapboard/ Wood Shingle/Vinyl RIS .DP 249 51.70 $423.30
Test Drill 4 sides $60.00
Air Sealing Limit:
Single Family w/Blower Door=5400
All Others = 5200
Door Kit $43.00
Regular Door Sweep $t 5.00
.Automatic Door Sweep $22.00
.Air Sealing 2-part Foam (3 hours max.) $75.00
Sash Lock $9.25
Glass Replacement $42.00
Blower Door Setup $45.00
Total Air Sealing Cost:
Heating Svstem Measures
Duct Insulation & Seal Seams (sq. ft.) $2.95
Hydronic Pipe Insulation to 1" R5 $3.25
Hvdronic Pipe Insulation 1.25" +R5 $3.50
Steam Pipe Insulation to 125" R5 $5.25
Steam Pipe Insulation 1.5" -2" R5 $6.05
Boiler/ Furnace Replacement
Program Repair****
****Action approval needed: Max $500
Actual Total does not include$175.00 K & T chg. $683.30 Est Total
$0.00 lAct Total
Jun 15 2011 11 : 32RM Glover Property Memt 781-631 -5921 page 1
• r
WEATHERIZATION ASSISTANCE PROGRAM
WORK PERMIT
Marblehead Office, LLC
of 8 Doaks Lane
Marblehead, MA 01943 certify that I am the owner/authorized agent for
the property located at 315 Lafayette Street, Salem, MA 01970
I further certify that I have given my permission to allow work or the property
identified above in accordance with the following provisions:
1. W EATH ERi ZATION
2.
3.
4. _
5.
And such other particulars that may be attached to this agreernent.
Marblehead Office, LLC
By: Glover Property Management, Inc.
Real Estate Manager
SIGNED �� DATE 06/1 51201 1
Edward T. Moore, President and Treasurer
Owner/Authorized Agent