Loading...
27 LEAVITT ST - BUILDING INSPECTION (2) y� The Commonwealth of Massachusetts Department of Public Safety yl Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Famil i • (This Section For Official Use Only) Budding Permit Number: Date Applied: 2.'Z- I �J Building Official: SEC"CIO 1:LOCA'TION P ase i ca lock and Lot R for locations for which a street addr s is not available) O O 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❑ I Repair Alteration ❑ Addition❑ 1 Demolition ❑ (Flease fill out and submit Appendix 1) Change of Use S ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes No ❑ Is an Independent Structural Engineerin eer Revie required? Yes ❑ N o Brief Description of Propose Work: r S 1 N Ea. ABM 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 CNLR 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-1❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-1❑ F2❑ I H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ L• Institutional 1-1 ❑ 1-2❑ 1-3❑ 14❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ 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 ❑ Ill ❑ ❑A ❑ I111 ❑ ILIA ❑ HIB ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 730 CMR 111.0 for details on each item) Trench Permit: Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal.. Licensed Disposal Site❑ Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be required❑or trench or specify: S. Private❑ or indentify Zone: or on site system❑ permit is enclosed❑ Railroad right-of-way: 711arzards to Ai[Navigation: \Ir\.I,h h n�) mvm si n It cicw I r r cs: Not Applicable❑ withinairportapproacharea? 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: Mats- -ro c®r.rf��caor� r._ f SECTION 9: PROPERTY OWNERAUTI)jDRIZhTION d Name and Addres w of Property Srty Owner oavN c�� 27 i( - Name(Print) No.and Street City/Town Zip operty Owner Cot t Infognation: 7�l_ 3Y6 y-7 the Telephone No.(business) Telephone No. (cell) e-mail address f a lic le,the p p ty owner he eby authonz s Name Sfefeet Address City/Town State Zip o 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) If building is less than 35,000 cu.ft.of enclosed space and/or not tinder Construction Control then check here O and skip Section 10.1 0.1 VALgist ed Profe 'o Res onsi le for Construction Control " a- `l2"9Xs? (s' L16 m (Re strant T• one Nail addreyyq � Registration Numbed`/ Street Ad ess ity/Town State Zip Discipline Expiration Date 1 .2 Gep&Kal Cqfktractor - - - " � S� aySSZ� N" a of Pe n Res ibl oils on License No. and Type if Applicable Street Adt r s City/Town State Zip 2,)V_2277&37 7 r_ 3Z Telephone No. business Telephone No. cell e-mail address SECTION 11:WORxeR5'CPbB'I.-,NSAI[ON INSUNANCHAFFIDAVIT M.G.L.c.152.§25C6 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 O SECTION I2:.CONSTRUCTION COSTS AND PERMIT FEE. Item Esthnated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1. Building $ Z P30.00 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 able to 6.Total Cost $2 ot� payable 2 30 . (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 tmeji4i accurate tothe b•st in novel 1 and m I tariding. 1 ase at r t vile Title Telephone No. Date ,et Addre veil Sate Z ^2 `zv CJ L Municipal Inspector to fill out this section upon application approval: Name Date i l e�HO onsuni'zre�� EReBME l t. O y fMF 0 C us ss7Fe. " xPiration: 1/,3 q� OAfIRACTORG MOECINGAND _. Type: f `. 2 YAN OL/220TT1 CpNST RUCT/ON /NCrivate CorPoratio'hr jdddddd " pANVFRs MAQ�23 11 ( ` husetts -Department of Public Safety Massac t ulations and Standards Supp' Board of Building Re Cunatnrcuun en isor I License. CS.045529 JOHNSPOUZZ[ . i 220 YANKEE DIV HGW�' l panvers MA 01923 y Expiration { 1013112014 t cOMMISSIOner — .J 4 CITY OF Si1L.ENf INWSACHUSETI-S I t ' SuiLmG DEP.iRnl&NT 120 MASHNGTON STREET,311°FLOOR = THL (978) 745-9595 KIJBBRL.EY DRISCOLL F.kx(978) 740.9M *VL-%YOIII T14osasST.PtERRB DI.¢ECCOR OF PUBLIC PROPEP Y/SLILDNG COSNISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 730 CMR Section 111.5 Debris, and the provisions of MGL c 40, S 54; 1 Building Permit i# 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 bIGL c l 11, S 150A. The debris will be trans ortcd by: V (nuntnofha er) The debris wiiell be disposed of in , (name of facility) a dress of tacility) i signature o p rrnit j Iicant (2-2- 13 date r gaUA NR4 E4Q Mlvufl vrnt MwrMY vtry 3 fiR6IW aK6FE r m•rtir n r nns nw mrars ro or wfLs iva �' F�rI3Cn 3)l•.3). K0.tArlO[s F nE IEGISIFl6 ff MESS. ' FG.yib f- •a1361 1349, a I m LOCUS MAP YA[rfn GnuA swaaFAl 5� su[c •z000' E _ IIE F{}{}i1��1pEigEE.rZAIS oiAl corm FlisliW'pMrn15 LI�YIr1' S SMIS S EEIIs FSIm lwWiH9lF5,LI 1s oIl'ISIOI O 3�•�)'16• FEY KIM ME 9F1[M. OW'IF]i 11 B.CIIa II 39.30' f FFI WlC— IEi,sI[FCM IF �Wf. �SF.�ISCq �, JD R $ wno IlElaer P8 I i F9 I)I MFA-L D.•h 9.i. PLAN OF LAND FOY Fr[mTnr us[ am I - w .[�, SALEM . Ce A '/T i T IOMISFq JOANNE E. MOIR 6 JANET L. GAGNON �-1 �/J/ / / (�TREE- w[e V.IS, alaoF n Issn J IAIIIF 9OE NlrEr N'✓P• I IFKN- 10 sfFf � A9 YFPIIISIOF 31FECI-Y[fll FK. 0 �) • 1 Cd11 OF Sc .r`.M, NNL-lJSi'1CHUSL1 dJ BUILDING DEPIRT%,W—NT Ir r 120 W.ISHNGTON STREET, 3se FLOOR TE1.. (978) 745-9595 F.+x(978) 740-9846 KI\BERL.EY DRISCOLL ;L1.iYOFt Tr10h1AS ST.PI>,✓eRa DIRECTOR OF PUBLIC PROPERTY/BCII-DNG CO\LUISSIONEF Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information A A A Plea he Print Legibly Name (Business Organi>atinm'Indivi(Iual): r ' ,r� \ Address: `� lk"i City/State/7i t4 A, ['hone : d' 65 Are yn mployer?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 ran a sole proprietor or partner- listed on the attached sheet.t 7. Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity, workers' comp. insurance. 9, ❑ Building addition [No workeri comp. insurance 5. ❑ We are a corporation mid 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.❑ Plumbing repairs or additions myself.(No workers' sump. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.) t employees. [No workers' comp.insurance required.) I3.❑ Other •Any applicant doss checks box k1 most also fill out the section below showing their workers'compensadun policy inib mation. 'I lnmeownen who submit this affidavit indicating lhcy arc doing all work and then hire outside contmctons most submit anew aMdavit indicating such. �C,m, wtors thus check ibis box most attached an nddidorwl sheet showing the mmne of the sub-contractors and lhcit workers'comp.puIiey infomution, I ant an employer that is providing workers'compensation insurance or my employees. Below Is the policy and fob site iaforaration. Insurance Company Name: 1'ulicy A or Self-arty. Lic. t!: �Aa Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Suction 25A ofblGL c. 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line orup to S250.00 a day against the violator. Be advised that a copy of this statement may bc:forwarded to the Office of Investigmians ofthe DIA for insurance coverage verification. I do here •ertify rat •r the t a d pe ties • 'ury that the htfonuation provided above is true and correct Simi t lrc' /� 2 Date: '�_ 13 Phone�: 9-1 U/c offici use m11y. Do nor write in this area,to be compleled by city or town officiuL City or Tuwn: __.__.._.. ___ Purmit/Llcense# Issuing Aulhurily(circle one): I. Board of health 2. Building Department 3.C'ityrrown Clerk 4. Flectrical Inspector 5, plumbing Inspector Contact Person: Phone p: ( A�OH JPREM01 OP ID: PA CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDYYYY) 11 ~THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THI S 11/263 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POL BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOICIES RIZED 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 endorsement s . PRODUCER 978-744-6715 NAME:CT ARMED Insurance Agency, Inc. PO BOX4a0 978-741-0127 AC PHONE No X0 A FAX Salem, INC,No: Gregory Ahmedmed E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURED & INSURERA:SCOttSdale Ins Co. J.P. RemodelingConstruction INSURERa:Associated Employers Insurance John Polizzotti 220 Yankee Division Highway INSURER C; Danvers, MA 01923 INSURER D; INSURER E INSURER F: 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 WITH 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 CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE DL POLICY NUMBER MMIDI O/YEYYY MM%DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CPS1544256 05,08/13 05/08/14 PREMISES Ea occurrence $ 50,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,00 EGATE GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGR $ 2,000,000 X POLICY 7 PRO LOG PRODUCTS-GO MP/OPAGG $ 2,000,00 ECTAUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY person) AU O SCHEDULED ( p ) $ AUTOS Per AUTOS HIRED AUTOS NON-OWNED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAR OCCUR EXCESS LU1B CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ ' WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY X WC STATUMII� OTH B ( 11 ER OFFICER/MEMBER EXCLUDED?ANY N/A Y/❑N NIA WCC5011421012012 10/18/13 10/18/14 EL EACH ACCIDENT (Mandatory in NH) $ 100,000 If yes,describe under E.L.DISEASE-EA EMPLOYEE $ _ 100,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Payroll- Owner-28,600 employees- $5,000 Subs$6000 CERTIFICATE HOLDER CANCELLATION CITYOFS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Salem THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 120 Washington St. Salem, MA 01970 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD ivi3ion Ili&vay Flee Lblidi3leS ers, MA 01923 l.icellaed dad Inured 0000 cL. l�(Jr1.S'l/YZCC(Oft; e�ZC. lahsichusett.h Boloc Imuroeclnent Contractor#04C7 (978) 777-7637 Fax (978) 762-7606 UU'r''s.t'Moir 7$'1-346-4534 �1'014-13 +7 Leavitt Street Rebuild 2 story back yard deck. s.nrc.nazlrcom; Iou l.o nol�cn Salem_MAO197 —Same--We — "»S 1 . Support existing roof line, tear down existing 38'x87" deck 1st & 2nd floors & 2 sets of stairs. 2. Dig 5 new 12"x4'deep footings, filled with concrete & install 5 new 4x6 brackets. 3. Reframe using 2x8pt, lag 1 st 2x8pt into house sill or common studs using 1/2"x4" gal lags, lag 2nd 2x8pt into 1 st using 1/2"x4" gal. lags, as well as 16d gal. nails. Install 2x8pt joists 16" O.C. with 2x8 joist hangers. Install 4x6pt support posts from ground to 1 st & 2nd floors. Install W.R. Grace & alum/vinyle coated drip edge where needed. Install 2x4 pt where needed, close in bottom 3 sides with Tex 1-11. 4. Install 1 x4 T&G decking to 1 st & 2nd floors & at 2 sets of stair treads, 1 x8pp risers boards & outside perimter. Install 1 st floor fir handrail at 36" handrail height, balusters at 4" O.C. 2nd floor install fir handra height at 42" & balusters at 4" O.C. Install at 2 stairway 36" handrail & 4"O.C. balusters. $22,830.00 5. J.P.Remodeling & Const. will; A- issue a copy of insurance to owner & pull permit. B- be responsible for all waste from above work only. Caro,w,hbllgamd to irtorm Casl,ner of an,end alto... r.paint and reoWait.eld permit G.um vhmeeure lFJrn t p -,, ,It le hum the pilcaa,land a tilt ,Cea kuu,Ch.142 YaP vyma.L-cbc l+ r —cnmpleln in ucmniuncc uirh:.boca spctifkatima.for d.csnm of: $22,830.00 Twenty two thousand eight hundreds irtjf dbll'`�P�'�'©"��i�Tg°r Fnpneat tubemoa ac[allows: 1/3 depoist $7,610.00, 1/3 start of work 7,610.00, balance on comrpletion $7_,610.00 Sinn data: 14 2013 D.ae of Stb,ca ,...... h,,: r 3_ eeks. All irr cl . lot vlte lib , fl. All I,fko 1. onidto (/y ,i),kolearlike neorwrarIo,nna,so eladend cIIIIIII. Ay111 tan 11,dI111nion 7 &on.rbo,eIe'feadI,ia,ell 111,e,Ime :I:will be exautd only ap.n edu..n Aland S'i;t.ta_ __ ____ oiders, mid will become lot ever dta eo mew and ehnva it,, cabman.. All prc.no,as contingent upon'uh,.......ideals or dela,,beyond our coi.....l. Acceptance of Proposal Tn, Ia. I no,,Ix9fir( : and in i Aof sign if i ontract it that are any blank spaces t nil t ns me d paUm nil l h le ¢ePlad Y tl dz il rode the . ✓0`-ri 11,rk :spec fell kce.ea11d b n bJ\, outlined I Si t I Clearance has legal right to cancel contract within 3 dais of acceptance Cmtnhctor shall perform the work in cmafprmmse"fir such pilots and specific.❑on.,if:my,as pare Contlnctor shall.lot be liable foranc dellry due to circmnstanecs beyond its aoatrol meltding strikes. been provided by the owner or[lie contraco,which plans and specifications shall be deemed cmuNfy ur gun erul unarailabifrty of mawria's of the discorery of the conditions or defect upml the, incorporated into this contract by reference.and will do so in a workmanlike manner.Contractor Is or in If,ntrucwrefs)feecon oo1 known to the Contractor at the,unto of e,,,atioo of thu coln,la am not responsible for performing any work not specifically referrer)m in this contract. o'hich may be dlscosecd dorm,_the corns of the Contractor s completion of the,cork.In addition.I In the event m v installmmn is not paid when due,contractor low stop work,vithoat breach ontil O,s,are tell I 4.lee a 11 .-t that in rain Icm,dO.t the Jun lit.n I portions of the ph payment is made and he five(5)days thereafter.In the event any in,tallmeul is not paid within ten(in) ,arson Ica uve ma i al additional drlrel.. conditions n ill,need for addili..I n,rork which mu days after it is due,eoNlactor may.at its optinn.deem dais contract lenninaicd bit the owner and neiv he I p .l d,altered or can i d lot in I,der t. .noun,.or complete Ili ,olk .Ip d.or in this take such action as may be necessary.metalling initiating legal proceeding,To aniolce it rights coati a I In s nth ruse the ONvinel Iflees that the theatmi,of th nark an 1 un schodaled art,of hemunder.At all tithes during constriction,owner shall provide and maintain fr and t nr t emceed mn.pler n mo,vlo) toner that which m be set limb h n and Own r t . e s eeenec a h loge access e)till drat,of the site where the work will be perforated end shall prom le rt au ner',sole lode,d loirl_Ill,""I told"ols,of Oa, rddnional,rork...... ry to rep ur correct or alma such "Intent,,ame,and deemical 9ei',icc includine 220 amp mnlet adau s nil deo,,ts and et editions. Contractot shall not be responsible for claims fl,ttam'I yes In persnts or Propeller ccca.ioned by oen,r Conli ed r,"-rants ill ,k for 1 pair d of i(mo ohs fiollo,ir,-cotnpl ll I or his agents,third parties,acts of God or other causes beyond contractors canaol O,n ere shill hold Clo net r r s Ihat Ili tilee'crl it hecol r : ace my for C nntre.tor at e ill 'I an, I,.alert Bulled fo contractor completely harmless from.told shall indemnity.mitt mlpl fan all clo11.dlonag ,.loss.and hetvul d ror to erbl c i n Laonslon of this t menu O,a r shall be oe,pondble fix the colts of expenses,including judgements and ummevs fees resulling from claim.in ing fia n cau.ec such crdectoco or enlrucmenl including reas,nahle alone,y s fees m in , enuerated this paragraph.la the event the parties are f oiml}at fault,each party shall inder"I"'the If a depute ari, s out of pre oelates to Ihi m Ag ecitte .[it,p;otfe,shall end_,nor to mole the dispute other to its rclalive fault t Ihrou¢h direct disnlssum. To the fullest eztem p,rmited by law.Subcontractor shall defbnd and save Ihi Owner and Ccok,lnr Tbo.aridity and inierpreladun oI di alletallial shall be g(nemed b)the Ica„of Ilse Camnlmnr cull' irritates,and indemnified front and agonitm any call all claim for handily imary and death and lot .f M a . hl'set . property damage or any I,that less or dcnmge:ahtrd or lectured by the Dune. an, paste _ _- _ _ .. .... ......_. contract,,,, m eoloved by the Oiler.or by the Contractor or an)Subcontractor empl„ell by the Owner This eroom lefle.e t, a tire cnn t ed agicceirin lba cn the rate,re and olocis-,de,all pro, 978-777-7637 Kitchens • broollIS °iation[s Doors Bx Windows • Siding —]P.RemodelinBA�odConscroctionlnc.� MDznvers, M6�01923 2 ZOjYankee//Divisioi HidhwzY AA A-Q4 40 T - _ ,- --,--- = z 1_ -: - fi� - -- -- - - � P ol 7t Mlt L I a Ito