336 LAFAYETTE ST - BUILDING INSPECTION (2) „
The Commonwealth of MaSSaChUSett
l �i' / Department of Public Safety
a / Massachusetts State Building Code(780 CMR)
U ' Building Permit Application for any Building other than a One-o amity Dwelling
(This Section For Official Use Only)
Building Permit Number: Date Applied: Building Official:”
MEd
1:LOCATION (Please indicate Block#and Lot#for locations for which a street addr/e�sjs�+isnJ available)
City/Town Zip Code Name of Building(if-applicable). -
SECTION 2:PROPOSED WORK
State Code used If New Construction check here O or check all that apply in the two rows below
ng❑ Repair Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
❑ Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No IS,
Is an Independent Structural Engineering Peer Review required? Yes ❑ No $k
Brief Description&Proposed Work:
S% i eReo = G-47 07
—
� C —
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): 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:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business ❑ E: Educational ❑
F: Factor F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H 4❑ H-5❑
I: Institutional I-1 ❑ 1-2❑ .1-3❑ I-4❑ M: Mercantile❑ R: Residential R-1❑ R-2❑ R 3❑ R-4 El
S: Storage S-1 ❑ S-2❑ - U: Utility❑ Special Use❑and please describe below:
Special Use: "
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA IBO IIA ❑ IIBO IIIA ❑ IIIB ❑ IV p VA VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 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 Process:
Not Applicable❑ Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ or No❑ 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?: Special Stipulations:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and`Address�of Property//Own/ery
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
��%� t�q' jJy _
Pule Telephone' . (business) Telephone No. (cell) e-mail address
If ap licable,the pros ertySwner hereby authorize
Name Sirget 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. -
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) a_
If building is less than 35,000 cu.,ft.of enclosed space and/or not under Construction Control then check here❑'and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contracto?-
CC
Company Name
Name of Person Responsible for Constru on License No. and Type if Applicable
Street Address City/Town State Zip
Telephone No. busin ss Telephone No. cell a-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFTI AI'IT 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? Yes❑ No ❑
SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$
1.Building $ ee Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)=$
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5. Mechanical Other $ Enclose check payable to
6.Total Cost $ (contact municipality)and write check number here
SECTION 3: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 are the best of my knowledge and understanding.
Please print and sign name . Title Telephone No. Date
19 G S .�,�rTrx Si ; a�-r- zC �1 0i930
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval:
Name Date
CITY OF S.UEM, i%LxSSACHUSETTS
BUELDIING DEPARTMENT
130 WASHLNGTON STREET, 3iO FLOOR
TEL (978) 745-9595
Fla(978) 740-9846
KI\fBERLEY DRISCOLL
MAYOR THo.%w ST.PtERRE
DIRECTOR OF PuBtic PROPERTY/BUUMNG CONMSSIONER
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:
(name of haul
The debris will be disposed of in
��—� f�� ��
(n'ame of facility)
(address of facility)
satur of��c permit
date
Jubrisu(f dew
Our Proof is on Your Roof!
T.G.L.R.0
._...
265 Winter St I iaverhill MA 911930
Phone 978-374-9224 "
Fax 978-521-5791
TO:Bill Keane(bkean44),scapur[cu.otk)/ r `L, _ October 27,2011
Salem Seaport Credit Union
336 Lafayette St
Salem MA 01970
RE: Partial Roof Installation Vault roof Unit roof Area as discussed with Bill Keane (not to exceed 1200 S.F)
Salem Seaport Credit Union
336 LafAette St
Salem MA(11970
Lambert Roofing Inc proposes the followin
• Renlos'o ccisting rubber root laid insulation to expose original tar and gravel roof.
Note:Any rotted damage plywood on walls and roof deck will he replaced at the rate of S2.95 per square foot.
All other work performed above and beyond the scope(if work its outlined below.
• All structural mid naming by others.
Supnly and Install the Followin
• 1/4"per foot PolyiSosyamlnne insulation mechanically fastened over lar and gravel roof using screws and plates per
manufactures s)x:cilleations.
• A Fully adhered.ow I'pDM black nihber'rool"syswm Per manufactures spn;ilicalions cold declilS completew'i01 n
I5 Year Manufactures Warratlly
• Base Plashing to Parallel walls told all root trains and overflow,-uppers per nlmud2i`ctures SPecifa:utions and details
• Pla,hing for all tool'lop penetrations pee uuunnactuns slxcificutions and details
• New 032 Kynar finish aluminum drip edge(in st:mdard colors)to einire perinleler edge where required TOTAL JOB COST....FOURTEEN THOUSAND FIVE HUNDRED DOLLARS S1 r ell,INt
General Exclusions: siding,fascia wood and metals,solar panels,roof hatches,Coaduit/lighting Yivtures beneath roof
deck,water u0nditiolls,$,low Shoveliag,weather delays,roltctr/larnagal decking,Prevailhlg wages,union labor,asheslos,l'olice details,parking pennits/lies. Notes: Any additional work beyond the above static of work will be done at
a rate of S65,00 per man per hour for nmfing and$70.410 per man per ur r sheet metal,Pius materials,portal to
porter.Lambert Roofing requires access nest to building tier trucks,an •rare. c nlay withdraw this proposal if not
aecegted tsithin(30)days. Payniene I/3 Ucposi[lBal:race du xal eo lie u
Date: t
hill RO k G INC
Aceeplancv: Theabove pricey,specciflallim all tditions:ue smisfacto and t t nbv acce7)tel. You are authorized to do
the work as specified. Payments will be nla c as outlined above _
Dale:/02R /i ce
Name(Print&Sign )Title
l +f 1C 1Ll ) U,/,Of-cNll
A� CERTIFICATE OF LIABILITY INSURANCE D1/01IDO011
11/L1/2011
THIS CERTIFICATE IS ISSUED AS A MATTER OF iNFDRMATION QNLY AND CONFERS NO`RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER`THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed, if SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu Of Such endorsemnrl s .
PRODUCER c W"T Jerrold Ramer"
NA
ALLAN INSURANCE AGENCY INC. PHONE (978) 745-5905 '---
63 1/2 Jefferson Avenue 2nd Floor e.Mall Jerroldgallaninaurance.com
P.O. BOX 511 ADDRESS
SALEN INSURERS AFFORDING COVERAGE NAIC A
MA 019?D-O511 INSURERA:Seneca ecialt
INSURED INSUREReiBafet Insurance CO[ii an
TGLRC Inc. INSURER C:Alterra Excess & Surplus Ins.
265dba Lambert treeing Company INsuRERD:Chartis Insurance Co an
65 Winter Street INSURER E:
Haverhill MA 01830- IN9URERP
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS
IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VATH RESPECT TO WHICH THIS
CERTIFICATE MAY BE. ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDij!4NS_OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IN SR POUCY EFF POLICY EXP
LTR TYPE OF INSURANCE POUC4NUM
M LIMITS
GENERAL LIABILITY / ! / f EACHOCCURPENOE S 1000000
X COMMERCIXl OENCRALLMJUTY S $0609
A CLAIMS-MADE aOCCUR i-COL0000000696-01 11(1212011 1/12/2012 MFDFXPI meperscn) S 1000
PERSONAL&AIN INJURY $ _1000000
GENERAL AGGREGATE - S 260 000C
GCN'L AGGREGATE L'VI'r APPLIFSPEN: / / / PRODUCTS-COMP(OP AGG S 2000000
I POLICY PRO , / / / ! g
AUTOMOBILELIAStLIW ! / ! ! 811SNdent INGR0QB ANY AUTO / / / 1 UOUILYINJURY'I.� ALL OPAFO SCHEDULED b203819 07/16/2011 7/16/2012AU7)SAUTOS BGDICY INJURY(XXAUTOS NED ! PROPERTY DAMIiINEO AUTOS AVTOS r P r mid -
/ 1 / !UMBRELLA ETAS X OCCUR / / r ! EACH OCCURRE0CX ExCESS LtAe CLAIMS-MADE 3.W5000D040 1/12/201111/12/2012 AGGREGATE00E
DEC I I REI ENTIONS Is
WORKERS COMPENSATION uvti STAi'U- X OTH-
ANDeMPLOYERS LIABILITY iplL
ANY PROPRIETOR:PARTNERIEXECUTNE YIN ! ! / /
OFFCSRAArM5FR EXCLUDEW EA.EACH ACCIDENT a 100000E
N/p
D' OMndatory In NH! COOL-60-2396 48/28/2011 9l28/2012 E.L.DISEASE-EA EMPLOYE S 100000(
IR)RyyOs.doscrbe under
''I-DESCRIPTIONOFOPERATIONSOe;aV / / ! / EL LLDISEASE_POUCY LIMIT I.S 100000(
l 1 f !
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AUech ACORD 101.AddRbnel Ramerka Schedule,N more apace is required)
CERTIFICATE HOLDER CANCELLATION
i ) -
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
n f
ACORD 25(2010105) (D 1988.2010 ACORD CORPORATION. All rights reserved
iNS0251mIOD.,Le± The ACORD name and logo are registered marks of ACORD
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Board of Building Rcgs,I (ti() and i is, 1 s
C OgStrUCt3Cn supervVso, ".Cease - -- "
Lioense: CS 78130
RICHARD J LAMBERT
94 PICADILLY RD
HAMPSTEAD, NH 03841
txnirat 6l2/2012
— T-i 30062
✓Aie 'onumomv�e¢ o�./ adoarfiuesdib
Office of Consumer Affairs&Business Regulation
HOME IMPRW_EMENT CONTRACTOR
. . Registration; .549221
Exp1ratofr l6f U11 Tr!# 290268
Type il ation
. LAMBERT R00044
r
RICHARD LAMSEpF t.--
265 WINTER STRE�E7"
HAVERHILL, MA O. Undersecretary
T. G. L. R. C., INC.
DBA LAMBERT ROOFING CO.
265 Winter Street
Haverhill, MA 01630
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