404 LAFAYETTE ST - BUILDING INSPECTION Y
The Commonwealth of Massachusetts' RECEIVE" OF
e Board of Building Regulations and Standard$NSPECTIONAL c ERV M
n Massachusetts State Building Code, 780 CMR Revised Mar 2011
Q Building Permit Application To Construct,Repair,Renovate Q P013140 c� 4 b
y� One-or Two-Family Dwelling
V' This Section For Official Use Only
t Building Permit Number: I Date pplied:
140..E /o /S
( Building Official(Print Name) ' '- Signature - Da
(� SECTION 1:SITE INFORMATION
• 4 1.1 Pr a Addres • / 1.2 Assessors Map&Parcel Numbers
auk S /
1.1a IS this an-accepted a accepted?yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
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:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP' -
2.1Owner'of Recor�t�. IIt TOp SQ�C I19 /�4SS• (j/97tJ
aroarer .
Name( ring ' City,State,
y 111dFur-r 'e Sr. III I?/ -IsiY3 rHSIAI&IIfOV fla Ver%s NFT
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ 1 Accessory Bldg.❑ Nrunber of nits_ Other ❑ Specify:
Brief Description of Proposed Work :
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ oV0 2. Other Fees: $
4.Mechanical (HVAC) $ List: `
5.Mechanical (Fire
Suppression) $ Total All Fees:$ ;
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ D Q ❑Paid in Full ❑ Outstanding Balance Due:
TnALL 'N S
y to LI i
Mr�v� �113 ta-:6
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) GS - o73
A✓ License Number Expiration Date
Name Mf Holder . /
71 a � r- S Lis[CSL Type(see below) V
No.and Street VJ T Description
Unrestricted uiiu cu.ft.
J [�'741 Iq49 R Restricted 1&2 Family Dwelling
tyC� /Town,Stat ,Z^� IPT M Masonry
RC Roofing Covering
�j ,(, WS Window and Siding
/?�7,;D 977 JY�� �JS-��il,.r SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
_
` � ^if4t�tTIc*, CRegistration-Ni n ber Expiration Date
TUC ame
o c (a d'sC:WPevlik,rac
No.and Snee[ �7F'7,�C��t jl Email address
,aa
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 IAPPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize j j ?'I/ _ SC� �l -
to act on my behalf,in all matters relative to work authorized by this bttildiftg permit application.
AraareT d. Siae% Ton -A,
Print is Name(Electronic Signature) Date
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 this application is true and accurate to the best of my knowledge and understanding.
Print Owner's mi2urthori2ild Agen!J Name(Electronic Signature) Date
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 not have access to the arbitration
program Or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
v^ ,v.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.aov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basementlattics,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 system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
, CITY of Siux-,,N4 NL-kSSACHusETTS
BUILDING DEPARINIENT
120 WASHINGTON STREET,3"FLOOR
TM (978) 745-9595
FAX(978)740-9846
Ki BERLEY DRISCOLL
T
;MAYOR HOatAs ST.PIF4aR
DIRECTOR OF PUBLIC PROPERTY/11CUMING COaLMSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information /� - Please Print Lettibly
Nameil3usinsiO srganizationAmtividual):�J i�dNi IF f �',gtit 7)Q•fd. .'��
Addresi'-7?w G
City/Statc/Zip: IM IJJ k JO✓` W101 019jq Phone#: '/ 7T 7,S�7 97q/
Are you an employer?Check the appropriate box: Type of project(required):
1 1 am a employer with-- 4. ❑ 1 am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).• have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet 7• ❑Remodeling
ship and have no employees These subcontractors have S. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9, ❑ Building addition
[No workers'comp.insurance 5. ❑ We are a corporation and its
required,] officers have exercised their 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself.[No workers'comp. c. 152.§1(4),and we have no 12.❑Roof repairs
insurance required.)t employees.[No workers' 13.❑Other
comp.insurance required.)
Any applicant that checks box#1 most also rill out the se:1ioo below showing their workers'compensation policy information.
'I Iomeowners who submit this affidavit indicating they ate doing all work and then hire outside cerlMaamS mug submit a now affidavit indicating such.
=Contmators that check this box must anadxd an additional sheet showing the aasne of as,auheomractors and their wodma'comp.policy informodpt.
I am an employer that is providing workers'compensation insuratteefor my employees. Below Is the policy and fob site
information. �` I �r
Insurance Company Name:_._L✓J�.D C 1 to��/ [O
Policy 4 or Self-ins.Lie.#:_(( /! 5p0��h 1 aj�Q —en O/CLExpiration Date: 7�(w'f /,
Job Site Address: w T Ciry/State/Zip:S iv✓1 lI!Cf 7(�
Attach a copy of the worken'conall1ensatlou policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S 1.500.00 and/or one-year imprisonment.as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
/do hereby certify under the pains and rraltl fperfury that the information provided above is true and correct
t tre• Date:
Phone fJ- G3'7� 7 `/2/�!
Official use only: Donor write In this area,to be completed by city or town official
City or Town: Permit/I.Icense#
Issuing Authority(circle one):
1. Board of Ilealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
' J
CITY OF SALEM
ROUTING SLIP
New Construction
Certificate of Occupancy
LOCATION DATE
ASSESSORS DATE
93 Washington St.
CITY CLERK DATE
f
93 Washington St. jf
PUBLIC SERVICES DATE f
120 Washington St.
WATER DATE
120 Washington St.
CROSS CONNECTION DATE
5 Jefferson Ave.
PLANNING DATE
120 Washington St.
CONSERVATION DATE
120 Washington St.
ELECTRICAL DATE
48 Lafayette St.
FIRE PREVENTION DATE
29 Fort Avenue
HEALTH DATE
120 Washington St.
BUILDING INSPECTOR DATE
120 Washington St.
8
i
y
i CITY OF SM EM, 1ANSSACHUSETTS
BI:ILDLNG DEP.kRTm&Nrr
120 WASHNGTON STREET,3' -FLOOR
T EL (978) 745-9595
FAX(978) 740-9846
KI.NIBERLHY DRISCOLL
MAYOR T Hoa ns ST.Pmm
DIRECTOR OF PUBLIC PROPERTY/BI:ILDLNG COMNOSSIONER
(NOTICE SHALL BE GIVEN 48 HOURS IN ADVANCE)
It shall be the responsibility of the permit holder(owner or contractor) to contact the inspector
when the work has progressed to the point of needing an inspection.
0 Excavation: inspector to observe soil types: groundwater elevation, temporary shoring, site
safety.
0 Foundation: inspector to observe location, size& shape, width,reinforcing, height of
unbalanced fill, fireplace jog,ventilation, damp-proofing/waterproofing, foundation drainage,
and either first floor framing in place or proper bracing before backfill
0 Frame: call after all framing is in place and the sub-trades have finished all cutting, drilling
and notching. inspector to observe species& grade, spans, connections, cutting & notching;
and fire-stopping( after inspection and sign off from sub-trade inspectors)
0 Sub-trade Inspections: call appropriate inspector for individual inspections including, but
not limited to: Plumbing, Gas, Electrichl; Oil Burner
0 Fireplace/chimney: call following completion of firebox , throat and first flue set
0 Insulation: after insulation is in place: inspector to observe insulation type, vapor barrier,
and R-values
0 Mechanical: inspection of duct installation (for type and fastening), furnace plenum,
hydronic piping, wood &pellet stoves, dryer vents,bath exhaust_fans, heat pumps, etc.
0 Finish: call after sub-trade inspectors have signed for final approvals and building, or parts
there of, are ready for occupancy and/or use
Contact Telephone Numbers
Inspection Service Inspectors Name Contact Telephone Number
Building Inspection:
Electrical Inspection:
Gas Inspection:
Plumbing Inspection:
Oil Burner Inspection:
Bd. of Health Inspection:
Fire Department Inspection:
Conservation Commission
Dig Safe
1&21'amily_N04
'City of Salem,MA-Inspectional Services(Building Department/Public... http://www.salenLcom/Pages/SaleniMA_PublicProperfies/index?textP...
Salem City Hall 93 Washington Street, Salem, 1970
ph:978-745-9595595
Inspectional Services (Building Department/Public Property)
Contact: Thomas J.St Pierre,Inspectional Services Director,x-5640
Michael Lutrzykowskl. Public Property Assistant,x-5648
Dennis M. Ross, Plumbing Inspector,Gas Inspector,x-5639
Harry Wang,Assistant Building Inspector,x-5643
Address: City of Salem Inspectional Services, 120 Washington St.,3rd Floor
Salem,MA 01970
Phone: (978)745-9595 x5641
Fax: (978)740-9846
Hours: Monday-Wednesday 8AM-4PM
Thursday 8AM-7PM
Friday SAM- Noon
Counter Hours(Inspectors present):
Monday-Thursday 8AM- 10AM and Noon-1 PM
Thursday 5PM-7PM
Friday 8AM-9AM
Inspection Hours
Monday-Friday 9AM-Noon
Monday-Thursday 1 PM-4PM
Additional Links:
NEW CODE CHANGES 8th Edition Fees Permit Applications
and"stretch"Code
New Licensing Reguirements as of Zoning Ordinance Massachusetts Office on Disabilities
July 1, 2008
Historic Districts(PDF 806K) Building Code Inspections Scheduling
Electrical Inspections Plumbing and Gas Inspections Fire Protection
Smoke Alarms and CO Detectors Frequently Asked Questions Installing a Swimming Pool Spa or Hot
Tub
2010 ADA Standards for Accessible Housing Receivership Questionaire
Design for Swimming Pools
Staff Directory
Name Title Phone(978)
Thomas J. St. Pierre Inspectional Services Director 619-5640
Michael Lutrzvkowsla Public Property Assistant 619-5648
Harry Wagg Assistant Building Inspector 619-5643
John Doyle Sealer of Weights&Measures 619-5619
Dennis M. Ross Plumbing Inspector, Gas Inspector 619-5639
Mission Statement
Our Mission is to provide the residents of our community quality service in a timely manner,and to provide answers to
questions regarding building and zoning issues. To conduct inspections and enforcement actions so as to protect and
I oft 8/4/2015 11:03 AM
'City of Salem,MA-Inspectional Services(Building Department/Public... http://www.saleryLconi/Pagcs/SaleaMA PublicProperties/index?textP..
safeguard all residents and visitors to our city,and to evaluate,maintain,and repair those Public Properties within our
charge.
Responsibilities:
Public Properties-responsible for numerous buildings within our City, namely City Hall, City Hall Annex, Old Town
Hall, Fire Stations,and other City owned properties, including those properties aqquired through enforcement actions;
such as tax seizures,abandoned properties,or structures deemed unsafe by accident or neglect.
Zoning Enforcement-tasked with ensuring the compliance throughout the City with our numerous Zoning
Regulations and Ordinances,as well as the interpertation and explanation of the same to the members of our
community. Our Zoning Officer is also tasked with determining the Allowable Uses for the various properties within our
City, based on our Zoning Ordinance and Building Code.
Building Office -comprised of our Building Commissioner,Assistant Building Inspector, and our Plumbing and Gas
Inspector, as well as our two Clerks. Our task is to take in all Building, Plumbing,and Gas Permit Applications; review
of all plans and application packages,and the Granting or Denial of these Applications for Permit. Further,we conduct
all required inspections pertaining to the same,and where applicable the granting of Certificates of Inspection and/or
Certificates of Occupancy.
2 of 2 8/4/2015 11:03 AM
- �-��.a.=..._ —»r•z-..._:�'.. VILF (OdI3LKldK[l1Cu.Lt/L O�VL�6J([Ge[GIC�d f
k r� '
_ } + Q\ OITce of Consumer Affairs&Business Regulation
UOME IMPROVEMENT CONTRACTOR
egistration: u;'j81294 Type:
:— Corporation
- J&S CARPENTRY f�N5.CON3TRU;CTION,INC. �
JEFF SCHULTZ
k, -i
I 22 FOREST
MIDDLETON, MA 01949 -'' Undersecretary
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supenisor f,
i License: CS-073424Ilk
-
. - JEFF A SCHULTZ,,` 09
`I L.
_ PO BOX 655
MIDDLETON MA.0
Expiration
. - - Commissioner 0 2/0 612 0 1 6
t q..
i
f :f tea. .."�°.,:;Y�?,d,, h��� '6:"�F4,,.... .. ,.«. :.-`.� .,-, ." ,.. , . n -- ..k d":''":i. ,xw. . ' .. �r•�+.�i
J&S Carpentry and Construction,Inc.
22 Forest Street
P.O. Box 655
Middleton,MA 01949
License.#CS 073424/HIC 181294
CONTRUCTION CONTRACT
Agreement entered into this 28 day of July, 2015, by and between John and Peggy
Singleton of 464 Lafayette Street, Salem Massachusetts 01970,hereinafter called the
"Owners" and J&S Carpentry and Construction, Inc., and its authorized representative,
Jeffrey A. Schultz, President,hereinafter called the"Contractor".
Witnessed, that the "Owners"and the "Contractor", for the consideration
hereinafter named, agree as follows:
Scope of the Work—The "Contractor" shall furnish all of the materials (except as noted)
and perform all of the work necessary for the following job: Renovate 2"d floor bathroom
• Remove moldings and save for possible reuse.
• Walls, ceiling and floor shall be striped to sub floor and wall studs etc.
• Framing shall be verified and simple repairs made. Repairs required for code and
or structural needs may be additional cost.
• Exterior wall shall be insulated.
• Ceiling shall be a minimum of "gypsum board.
• Walls shall be prepped for tile. Tile areas will have Yz" Hardie backer board
applied. Non tiled areas will be gypsum board.
• Floor shall be prepped for tile.
• Electrician will install one GFIC outlet color white decor to the left of the sink.
Install customer supplied light unit over sink. Install bathroom fan unit supplied
by electrician.
• Customer responsible for the supply of bathroom fixtures, wall light,tile and
grout.
• Ceiling shall receive one coat of latex primer and two coats of latex white ceiling
paint. Walls will have one coat primer and two coats of latex finish. Base board
primed and two coats of latex finish. (Paint finishes TBD by customer).
• Dumpster 15 Yard to be in driveway.
• Area of work will be kept neat and safe during the construction duration.
• Work area swept end of each day.
• Trash and building permit in addition, billed separately.
• Warranty on labor is 5 years.
• Material warranty by manufactures.
1
J&S Carpentry and Construction Inc.
22 Forest Street
P.O. Box 655
Middleton,MA 01949
Licenses: #CS 073424/HIC 181294
1. Time of Completion—The work to be performed under this Agreement shall be
commenced on or about TBD once building permit is obtained, and shall be
completed within a reasonable time, weather permitting.
2. Contract Sum—The "Owners" shall pay to the "Contractor"for the performance
of this Agreement, the sum of Eighteen Thousand Forty Five Dollars and 00/100
Dollars, ($18,045.00). This price includes the following: See scope of work.
The"Owners" are responsible for paying any amounts due for plans, drawin
architectural work,permits, and any other related fees.
3. Impossibility of Performance—In the event that any contingencies beyond the
control of the"Contractor", now unforeseen, including but no limited to Acts of
God, shall arise which shall render temporarily impossible the performance of this
Agreement by the "Contractor",the performance hereof shall be suspended
temporarily until such impossibility is removed: and if such impossibility of
performance by the"Contractor" shall continue for more than thirty(30)days,
then it shall excuse performance by the"Contractor"and shall discharge both
parties from all obligations under this Agreement.
4. "Or Equal" Clause—Whenever any item in this Agreement, defined by
describing a proprietary product or by using the name of a manufacturer or
vendor, the terms term "or-equal", if not inserted shall be implied. The specific
article, material, or equipment mentioned shall be understood as indicating the
type, function, standard of design, efficiency, and quality desired, and shall not be
construed in such a manner as to exclude manufacturers' products of comparable
quality, design, and efficiency.
5. Extra Work or Changes—No extra work or changes shall be done except upon a
written order signed by the"Owners" and the "Contractor". Such order shall state
the cost of such work and the time allowance for same, if any.
6. Settlement of Disputes—If payments are not made by the "Owners" and
received by the"Contractor"by the due date ser forth in this Agreement,the
"Contractor" shall charge interest on the balance overdue at an annual interest rate
of twelve percent (12%). In addition, if said payments are not paid when they
become due,the "Owners"agree to pay all costs and expenses of collection,
including reasonable attorneys' fees.
7. Entire Agreement—Except as otherwise stated expressly herein, this Agreement
constitutes the entire agreement among the parties hereto. This Agreement
supersedes any prior agreement or understanding and may not be modified or
amended in any manner other than as set forth herein.
2
J&S Carpentry and Construction Inc.
22 Forest Street
P.O. Box 655
Middleton,MA 01949
Licenses: #CS 073424/HIC 181294
8. Miscellaneous—The covenants and agreements contained within this agreement
shall be joint and several obligations of all parties, and shall be binding upon the
successors and assigns of all parties.
9. Governing Law—This agreement and all the rights of the parties hereunder shall
be governed by the laws of the Commonwealth of Massachusetts.
IN WITNESS WHEREOF,the parties hereto have executed this Agreement the day and
year first written.
Witness Owner
Witness Owner
Witness Authorized Rep.
Jeffrey A. Schultz, President
J&S Carpentry and Construction, Inc.
3
CITY OF SALSA MASSACHUSE M
Bu%DING DEPAR7wmr
120 WAsmNGTONS7mT,3RDFLwR
TkL(978)745-9595.
FAX(978)740-9846
RIIvIBERIEYDRISOOIZ
MAYOR TkloarM ST EM
DIRECTOR OFPLM11CPROPERTY/BUWMOM' &%0I ER
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:
CI PC)
(name of hauler)
The debris will be disposed of in:
ame of facility)
(address of facility)
Signature of applicant
Date