418 LAFAYETTE ST - BUILDING INSPECTION (2) I
The Commonwealth of Massachusetts FOR
Board of Building Regulations and Standards
F Massachusetts Stale Building Code. 780 CMR, 7 edition USEBuilding Permit Application To Construct, Repair, Renovate Or Demolish a Revised Junuat.
One- or Two-Family Dwelling 1. Q)8
O This Section For Official Use Only
\� Building Permit Number: Date Applied:
\�\ Signature: yy
g Commissioner/Itfspcoor of Buildings Date
SECTION l: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map & Parcel Numbers
1.la Is this an accepted street'?yes ✓ no Map Number Parcel Numlxr
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lo[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: /
Zone: _ Outside Flood Zo ? ❑i
Public Private❑ Check if yes❑� Municipal ❑ On site disposal system
SECTION 2: PROPERTY OWNERSHIP[
2.1 Owner[of Reco
--aunl `th 'cc�� l�
Na (Print) Address for Service:
nature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specit'y:
Brief Description of Proposed Work':
�39Y
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $(Labor
94,100 _ 1. Building Permit Fee: $ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $ 4100 ❑Total Project Cost (Item 6) xiplie`�C/
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $
List:
5. Mechanical (Fire $ Total All Fees: $
Su ression)
Check No. Check Amount: Cash AmounC
6. Total Project Cost: $ 641
❑paid in Full 0 Outstanding Balance Due:
F
SECTION 5: CONSTIeUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Number Expiration Date
Name of CSL-Holder List CSL Type(see below)
Address - T Description
U Unrestricted top to 35.000 Cu. Ft.)
R Restricted I&2 Family Dwelling
Signature M Masonry Only
RC Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Apl2liance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name Registration Number
Address
Expiration Date
Signature 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 ........... Cl
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, as Owner of the subject property hereby
authorize to act on my behalf, in all matters
relative to work authorized by this building permit application.
Signature of Owner Date
SECT 7b: OWNER'OR AUTHORIZED AGENT DECLARATION
1, ' J ,as Owner or Authorized Agent hereby declare
that the Ialemenrs and information on the fir1regoing application are true and accurate, to the best of my knowledge and
behalf. ---Sqa p
ieQ 0) %!>o
Print Name v2 3 O p bO,
Signature of Owner or Authorized Agent Date 1Y.tV d-
(Signed under the pains and penalties of perjury)
NOTES:
1. 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 gol have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and 110.115, respectively.
2. When substantial work is planned, provide the information below:
Total floors area(Sq. Ft.) (including garage, finished basemenUattics,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 SALEM
PUBLIC PROPRERTY
DEPARTMENT
n.\C:�XItC I'dil..�Il 1.
\1AWK 12C VVnit IIVG:JN EET . S:\Li'\1, St.\ii.\(art ,61-li
rn;971-745-959s . r•..X:979-74C-9846
Construction Debris Disposal Affidavit
(required fur all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CNIR section 111.5
Debris, and the provisions of'JtGL 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 define by v1GL c
The debris will be transported by: WC
— --- (name of hauler) /VI,
1'he debris will be disposed of in 77',E�3�
(name of LJ11ty)
2 <4��d�.Q 6
�r I
ate
CITY OF S.U.EM
PUBLIC PROPERTY
DEPARTMENT
lVlOY NwYY
MANVR 130 WASUNGMN STUIFF•SALM M. ALtAO/t.'SfiM 01970
713-973-735-MS•FAiL 976-746984
HOMEOWNER LICENSE EXEMPTION
Please Prue
Date y��
Job Location
Home Owner Address
Home Owner Telephone 7 —
Present Mailing Address
The current exemption of"Homeowners"was extended to include owner-occupied
dwellings of two Units or less and to allow such homeowners to engage an individual for
hire who.does not possess a license,provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Penwn(s)who owns a parcel of land on which he/she resides or intends to reside, on
which there is, or is intended to be,a one or two family dwelling, attached or detached
structures accessory to such use and/or farm structures. A person who constructs more
than one home in a two year period shall not be considered a homeowner. Such
'•homeowner"shall submit to the Building Official, on a form acceptable to the Building
Official, that he/she be responsible for all such work performed under the Building
Permit.
The undersigned "homeowner"assumes responsibility for compliance with the State
Building Code and other applicable by-laws and regulations.
The undersigned "homeowner"certifies that hatshe understands the City of Salem
Building Department minimum inspection procedures and requirements and that he/she
will comply with said procedures and requirements.
HOMEOWNERS SIGNATURE
APPROVAL OF BUILDING INS R
See other side for state code
r
418 Lafayette Street
Salem, MA 01970-5347
Phone/Fax: (978-741-0218
April 23, 2008
BY HAND DELIVERY
Building Inspector
City of Salem
120 Washington Street
3`d Floor
Salem, MA 01970
RE: 418 Lafayette Street, Salem,MA
Dear Building Inspector:
December 31, 2007, a fire in the carriage house used by my family and me
located at 418 Lafayette Street, Salem MA, caused a certain amount of damage that must
be repaired.
After looking at the damage, it is my belief, and the belief of other licensed
construction supervisors,that the entire structure does not have to come down. The
foundation does not appear to have any damage, and more than fifty percent of the
existing frame can be saved. However, the entire roof must be replaced, and half of the
floor on the first floor must be replaced. The exterior walls are in good shape, except in
the area of the fire where I intend to reframe that corner of the building. I intend to
restore everything to the original condition. Therefore, I am submitting an application for
a permit to perform the work. Once you issue a permit, I will rent a 20 yard dumpster to
clear out the debris so that I can start the reconstruction. I will notify your office as to
which license hauler I will use, and his license number.
Enclosed please find a check in the sum of$456.50 to cover the application and
permit fees. Thank you for your help and attention.
Your y
e cci o c
Enclosure
� a
<< S
0
I�rt+(l N
rL ST,
Owc11•:q ' v3 3
J
V •
3 m
77 '--
f'L
z���n�a� � PV'•e��ve�l r r
a
gp.0 CS v t-dtowyl i AC)
fl cv �cr� Tom. '�� t coc ur vr',
0
L ►QiF►<1y� T ry ST