55 LAWRENCE ST - BUILDING INSPECTION jl/ pp� The Commonwealth of Massachusetts
Department of Public Safety {
I�Ij'Q Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Two-Family Dwelling
t (This Section For Official Use Only)
Building Permit Number: Date Applied: Building Official:
SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available)
5 s law rater C-Q- sf S�-f'r ry Oil -a
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 DY Repair Alteration ❑ 1 Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other Cl Specify:
Are building plans and/or construction documents being supplied as put of this permit application? Yes ❑ No W
Is an independent Structural Engineering Peer Review required? / Yes ❑ No [3�
Brief Description of Proposed Work: �J2 WLo SKr C i vig /:IBC kC
��N�'�66t E'� N,2 ty GLeC h tz-f- S'n r.� v Lam•, fn i atn
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): S'n YYLC
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) 3 3
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-5❑ B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ FI: Hi h Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional I-1 ❑ I-2❑ [-3❑ Id❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3 09 R4❑
S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ I1I11 ❑ I 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 Site❑
required ❑or trench or specify:
Private❑ or indentify Zone: or on site system❑ permit is enclosed ❑
Railroad right-of-way: Hazards to Air Navigation: \I\ I listoric c anmissi n R v u"Process:
Not Applicable 1 i, Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed ❑ I Yes❑ or No lei 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:
X9 lele *0
SECTIO 9: PROPERTY OWNER AUTHORIZATION -
Name and Ad ss of Prop ty Own r
Name Print) No.and Street City/Town Zip
Property Owner Contact Information:
479__5.3.Y_ .37), KG pAQI(]A(G�(. RO[,c'0!I
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable, the property owner hereby authorizes
—0i`d`eri,��{-t"-_Rereo' k wcVi,t,_V?wtoro sfr `Raas tg, w 0IC1W
Nam' — e' dress 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). ,
R.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 Construction.Control
Name(Registrant) lephgne-Now— e-mail address Registration Number
Street Address.____--- City/Town State Zip Discipline Expiration Date
10.2 General Contractor -
W a n tAzi f� . ��.6z f ra Nu ntie no bro vrvf �
Company Name
F9(aJvF< 7:� s) -E CS— fs 9
Name of Person Responsible for Construction License No. and Type if Applicable
I`1 f�v tr S �i�c�socQy /ylC, o l`l.C'c7
Street Address City/Town State Zip
K_ Z_ 3aa 2 Ptzi5 te
Telephone No.(business) Telephone No. cell e-mail address
SECTION 11:VV0RKEItS'f OtIPF.N•SA 1[ON INSIJRA\CFi-ALF'ID;iVtT 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 $ Cl `j 00. dD Building Permit Fee=Total Construction Cost x (Insert here
2. Electrical $ appropriate municipal factor)_$
3. Plumbing $
d. Mechanical (HVAC) $ Note: Minimum fee=$ � (contact municipality)
5. Mechanical Other $ C/7� co/n
Enclose check payable to e..,
6.Total Cost I $ 'iJ(� • K) (contact municipality)and write check nwnber here /
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT if
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information c stained in this
application is true a accurate to the best of my knowledge and u derstanding.
M suete.�eev Now Tm1wavea7I- 06
Please rint and sign nnn`e JJ ` itle eph ne o. Date
Street Address City/Town St t i
Municipal Inspector to fill out this section upon application approval:
nme Date
.Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
lIf
Construction Supervisor
License: CS-082279
FRANK TOSTE
17 AYER ST = If.
PEABODY MA IF1906
5 `
J.4w^• n:,,+�`\ .Expiration
c
`0910312013
Commissioner -
E
i
Manuel A. Pereira - Home Improvement
119 Washington St. Gen.Liability #
Peabody,MA 01960 Work Comp. #
T 978-532-5506 CS License #
F 978-335-8260
Date / / 2012 Proposal #
55 Lawrence Street Condominium Trust
55 Lawrence st.
Salem, MA 01970
Estimate:
to make rear stairs for the building according to Mass building Code
1-Demolish rear stair struture.
2-All trash removed from the premise
3-Build 10" diameter, 4' depth footings.
4-Build Stairs (7" x 11") and platforms ( 40 " wide ) photo enclosed.
5-hand rails 42" high, attached with double screws
6-All wood in pressure treated and Dip galvanized nails and bolts
Total labor and material contract price for this work is $9,600.00
CONDITIONS
1-AII material is to be supplied by above contractor
2- Insurance ( work Compensation and Liability)to supplied by contractor
3-Permit fees by contrator
4-Payments Term: 30% upon acceptance. 30% upon complete and
40% at Final inspection
5-Time from start to final inspection two weeks ( 10 working days)
Acceptance
Owner/Respresentative Unit 1 Date Contractor Date
O nerARespresentative Unit 2 Date
Owner/Respresentative Unit 3 Date
CITY OF S.XLEII, 1N-L-kSSACHUSETTS
BUIMING D EPA RTNMNT
130 WASHIINGTON STREET, 3AD FLOOR
TEL (978) 745-9595
FAx(978) 740-9846
It
KINIgF%IT G F- DR
Y ISCOLL
MY THmusST.PtER s
DIRECTOR OF PUBLIC PROPERTY/BUILDNG CONI]MISSIONER
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 I 11.5
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:
Vi nc' '3. YMACL.S
(name of hauler)
The debris will be disposed of in
(name of facility)
-,11 if AA A 4A O l�cl�i
(address of facility)
2gYc a 1—
signature of permit applicant
aC 6 f�q1 a n J...9
date
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