2 LAURENT RD - BUILDING INSPECTION (2) Microsoft,Word-form_bbrs_mimicipal_Widing_lernit_03_16 2011.... http://www.salemconi/Pages/SalernMA PublicProperties/applications/...
(P O
All
q The Commonwealth of Massachusetts
I1 Dv� Department of Public Safety
Massachusetts State Building Code(780 CMR)
State Building Code(780 4'M1R)
Building Permit Application for any Building other than a One-or T amily Dw ling
(This Section For Official Use Only)
Building Permit Number: Date Applied: _ Building Official:
SECTION 1:LOCATION(Please indicate Block#and Lot 0 for locations for which a-ftreet a k ail 1
No.and Street City/Tor+m Zip Code N of B ding 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❑ Alteration ❑ 1 Addition❑ Demolition ❑ (Please frill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other pr Specify: "( S r
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No 21
Is an Independent Structural Engineering Peer Review requi/r'ed? Yes ❑ No tS
Brief Description of Proposed Work: Rr lrc-v" s'Fcr�PlQS-P
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 ❑ A-4❑ A-3❑ 1 B: Business ❑ E: Educational ❑
F: Facto F-1 ❑ F2❑ I H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional I-1 ❑ 1-2❑ I-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑
S: Storage 5-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 111 ❑ IIA ❑ IIB ❑ IRA IRB ❑ 1 IV ❑ 1 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 Sited
Private❑ or indentify Zone: or on site system❑ required❑or trench or specify:
permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation i\IA Histors Commission Review Process:
Not Applicable❑ Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ m 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 anSprinklerr SSyysstt�eernh Special Stipulations:
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SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
k;.n�Pr�v Lar 1 eslen� e e.T( !�1Pit���P. wtl�
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information: /3
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 building ermit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
(If building is less than 35,000 co.ft.of enclosed space and/or not under Construction Control thm check here 0 and slap Section 10.1)
10.1 Registered Professional Responsible for Construction Control
Name(Registrant) Telephone No. e-mail address Registration Number ZS 92tMerv,ew SE_ e r/ G/ _ A I� 911te Xi.
Street Address City/T rim State Zip Discipline Expiration Date
10.2 General Contractor
/rlt_er/Qf
Company Name
6rero�� l�ur�e• tf��� ll� rid�`1d' 8���/�
Name of Person Responsible f r Construction License Up. and Type if Applicable
&>/I&�11 �rs� P 01q
Street Address City/Town State Zip
/r3�
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS CO,,NII'E\SATION INSURANCE AFFIDAVIT M.G.L.c.152.S 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 0 No
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=S
1.Building S Building Permit Fee=Total Construction Cost x_(Insert here
2.Electrical $ appropriate municipal factor)=S
3-Plumbing $
4.Mechanical (HVAC) S Note:Minimum fee=S (contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost 5 ,.rl?S (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 best of my knowledge and understanding. q�� d�j 0,0/6
Q1",n 7
Please rint and sign name"" Title Telep�a No. Date
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval:
Name Date
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CITY OF S�UEN11 NIASSACHLSETTS
Bu DLNG DEPARTNIE.NT
• 120 WASHINGTON STREET,3so FLOOR
TE L (978)745-9595
FAx(978) 740-9846
KINIBERLEY DRISCOLL
MAYOR DIRECTOR
ST.P�tns
DIRECTOR OF PUBLIC PROPERTY/HL'IIDLNG CO\L\DSSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leelbly
Na1pe (BusimssOrganizatiotvindividuaq: I LAQmy- (0&4.
Address: �� �P/fir3egerson A-y-2 -tr-1
City/State/Zip: etP��� �0/��S Phone #:
Are you an employer?Check the appropriate box: Type of project(required):
1 g1 am a employer with$_ 4. ❑ I am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).' have hired the subcontractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling
ship and have no employees These subcontractors have g. ❑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.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 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' I3Odter, STLetrS
comp. insurance required.]
Any applicant that chucks box e1 most also fill out the seclia t below showing their worked mmpensuion policy infmmatioa
'I laneuwn rs who submit this affidavit indicating they ate doing all work and then hire Outside contractors;must submit a new alfdavil indicating suck
=Cuntrrwn that check ibis box must attached an additiuml sheet showing the name of Ilse subcootractors and their workers'comp nc.policy info atien.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site
information. - / / ® /_
Insurance Company Name: lLpf�lt�l Ql2�TP�i{ Y- S Le&2z L- ]
Policy#or Self-ins.Lic.#: T3 R`nnI / Expiration Date: �7 �9 t
Job Site Address: � Za OP8,1T Rom( City/Statc/Zip:- n',AWClQ,nity
Attach a copy of the workers'compensation polity declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a
fine up to S 1,500.00 and/or one-year imprisonmcn4 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 covcmge verification.
!der hereby certify under the pains and penalties ojperjury that the brjormatlon propided above is true and correct
Signature, q � q Date:
Phone ;��je
OJfchd use only. Do not write in this area,to be completed by city or town offiriaL
City or Tuwa: Permit/I.1cense
Issuing Authority(circle one): �~
1. Board of health 2. Building Department 3.CityfTown Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
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CITY OF S.0 E.NI, .Liss kCHUSETTS
BuMDLNG DEPARTMCLVT
120 WASHLNGTON STREET, 3' FLOOR
TEL (978) 745-9595
FAX(978) 740-9W
KI\fBERLEY DRISCOLL
1VIAYOR THows ST.PmRRE
DIRECTOR OF PUBLIC PROPERTY/BUU-DLNG 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
l 11, S 150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in :
(name of facil'
2 e9� f f MA
(addr ss of facility)
signature of permit Wplicant
l/!
date
dc6riia0'.dx
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Koat-tl del' B,iildiwt Reottfatimis and Sl,tt,d and O
.... C onstru .t c' Supervisor License
License. CS 104223
BRIAN BEOTE
32 RIVERVIEW ST p:
BEVERLY, MA 01915 69
- -- -y -� Expiration: 3/29/2014
C eet�tntE� iw���t�r Tt�t: 104223
_ �../l2� 1Q0077//YI.Q�/UAlP.�L/AZ Q�C%(�GQQQC�7�CCQPLr�b
Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
Boston,Massachusetts 02116
Home Improvement Contractor Registration
Re9lstfa0on: 169898
.. - T"o: Corporation
EximmUon: 8716/2013 Trill 215951
MURRARY MASONRY&MORE,CORPORA
BRENDAN MURRAY
P.O. BOX 8454 —
SALEM,MA 01971 —
Update Addrea,and return earl.Mark reason for change,
non, o aou�v„
Address 0 Renewal ❑ Employment ❑Lost Card
jL_ fu.�CA(W &BoMonoo
OR eof Gueanr AihksABaddm AagWOoe onlycapitation
for
W:
WE'
CONTRACTORhelorc ffeontai er date. andBusressRm:Type: O/Rwo[Copsumer AHeln and Bmloeaa Regelaaoo
n 911Sr2013. corpoation lQPnrk Plaaa-Suite5170
1. Boston,MA 02116
MURRARY MASONRY 9 MoRE CORPORATION
BRENDAN MURRAY
10 REAR JEFFERSON STREET S - a
MW MA 01970
Uederserthry Not valid without eigeemre
13 _ Uc,1
Murray Masonry & More, Corp.
Cell: 978.578.0940
Office: 978.594.1138
Mailing Address: Office Address:
P.O. Box 8454 10 Rear Jefferson #1
Salem, MA 01971 Salem, MA 01970
CONTRACTING AGREEMENT
Read this agreement and make sure you understand it before signing it.
This agreement has legal force and effect and binds those who sign it.
Notice: All home improvement contractors and subcontractors engaged in home
improvement contracting,unless specifically exempt from registration by provisions of
Chapter 142a of the general laws,must be registered with the Commonwealth of
Massachusetts. Inquiries about registration and status should be made to the Director of
Home Improvement Contract Registration, Office of Consumer Affairs and Business
Regulation, Ten Park Plaza, Suite 5170,Boston,MA 02116.
Designated Registrant's Name: Brendan Murray,President
Murray Masonry&More, Corporation
Registration Number: HIC License# 169898
This agreement is made on (date) between Murray Masonry&More.Corgi
hereinafter called"Contractor."
10 Rear Jefferson Ave. Suite 1
Salem,Massachusetts 01970
Telephone-(978) 594-1138
and Name: C/O Leslie Management
hereinafter called"Owner."
Address : 2 Laurent Rd. Salem,MA 01970
Street City, State Zip Code
Telephone: (978)372-2853
Email: Lesleymanagement@comcast.net
necessary or appropriate to terminate promptly any security interest created in
connection with this Agreement.
A CANCELLATION NOTICE IS ENCLOSED WITH THIS CONTRACT.
OWNER:
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES OR
YOU HAVE NOT RECEIVED TWO COPIES OF THE NOTICE OF
CANCELLATION. /
1-2313
OWNER'S S SIGNATDA ITEM G�
OWNER'S SIGNATURE DATE SIGNED
MURRAY MA SONR Y&MORE, Corp.
BY: I- /A3 4�
�it''�/
BRENDAN MURRAY,P ident DATE SIGNED
I. DETAILED DESCRIPTION OF WORK TO BE PERFORMED
Rebuild side entrance to 2 Laurent Rd.
1.) Demolish and remove existing stairs, sidewalls, and landing
2.) Excavate for new staircase,turned sideways along building facing the street
3.) Install drywell under center of landing in front of door with drain
a. Landing/Slab will be 6"thick 350OPSI concrete reinforced with 6"wire
mesh
b. Landing will measure 4'x4' in size
4.) Build sidewall 24"tall 7' long with 8"CMU's tied into slab with ''/z"rebar
a. Fill cores with 350OPSI concrete
5.) Build stairs with 8"CMU's and cap with Limestone Treads
6.) Stucco rise of steps and sidewalls
7.) Sand and paint existing railing,reinstall upon completion
8.) Build roof over stairs approximately 8' x 4'
a. Support with two pressure treated 4"x4"posts
b. Roof to be'/T plywood painted white on the bottom
c. Cover plywood with ice/water shield and roofing paper
d. Shingle and caulk where it meets building
9.) Remove all excess materials/debris and contractor tools upon completion
All materials and installation procedures shall comply with all current local and
national building code requirements. All materials meet or exceed ASTM
standards/Code.
IL PRICE
Contractor agrees to do all work described in Section I for the total price of:
$5950
Note: Price is based on material costs at time of contract signing. Should material
costs increase before start date of job or throughout the duration of the job it will
be brought to the Owner's attention as soon as it is made known to the Contractor.
With supporting documentation and a Change Order the change in costs will be
added to the total price of the job.
III. PAYMENT
Payment will be made as follows:
1/3 of contract balance due at contract signing=$1975
/z of remaining balance due when excavation completed and foundation poured=
$2000
Final balance due when work described under Section I completed=$1975
Terms: Service charge of 1.5%per month on past due accounts.