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27 LEAVITT ST - BUILDING INSPECTION , (0-q Lim/ The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Building Code(730 CNIR) Building Permit Application for any Building other than a One-or'rwo-Family Dwelling (Phis 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) • S No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Code used \dL"I-- If New Construction check here 9,6r—check all that apply in the nvo rows below Existing Building❑ Repair. Alteration ❑ 1 Addition❑ 1 Demolition Cl (Please fill out and submit Appendix I) Change of Use ❑- Change of Occupancy ❑ 1 Other ❑.Specify: Are building plans and/or Construction documents being supplied as part of this permit supplication?. Yes ITNo ❑ Is an Independent Structural Engineer ug P r(Z\evi w equire � f°ly/) Ls ❑ No Brief Description of Proposed Work: e , (1/J A_ - 4 ® N a m SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDI' N,OHS.= CHANGE IN USE OR OCCUPANCY Om Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CNIR 34) ❑ co 5 Existing Use Gruup(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing PropjWd < No.of Fluors/Stories(include basement levels)&Area Per Floor(sq. ft.) �p M CA Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-3❑ T B: Business ❑ E: Educational ❑ F: Facto F-I ❑ F2❑ It: Hi h Hazard H-1 ❑ H-2❑ H-3 ❑ FI-4❑ FI-S❑ 1: Institutional I-l❑ 1-2❑ 1-3❑ 14❑ 1 M: Mercantile❑ R. Residential R-10 R-2❑ R-3❑ R-4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ F Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCrION TYPE(Check as a livable) IA ❑ IB ❑ IIA ❑ 118 ❑ IIIA ❑ [I[B ❑ IV ❑ I VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CNIR 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❑ it trench will not be Licensed Disposal Site❑ Private❑ or iuideutify Zone: or on site system❑ required ❑or trench or specify: permit is enclosed❑ Railroad right-of-way: hazards to Air Navigation: \ r\I i .norm 41 n .ir" 1 r. "': Not Applicable❑ Is Structure within airport approach area? 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 Gruup(s):_ Type of Construction: Occupant Load per Floor: Does the building,contain an Sprinkler System?: _ Special Stipulaliuns: 1 crag cc7NT . ) Lmom ��l ` 34'C, • Nome and SECTION 9: PROPERTY OWNER AUT1 RIZATION ^- \ddress o Prop^rty Ow ner If hrLk� 4-v. J= , U4 olqx Name(Print) No.and Street City/Town Zip P operty Ow er Contact Information: fth /qi. 71cl Sy8'o)y Title Telephone No.(business) "rh,phone No. (cell) e-mail address f ap ica le, the ( •rty owne hereby authorizes P. `ZZ© rk.• 2 Name VStreet Address ' l City/Town State Zip )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 under Construction Control then check here 0 and skip Section 10.1 �10.jzqx st redjProfessional Responsible for Construction Control 76s,2 // S- 96,;� an •( ugi r nt) C> e-mail address Registration Number fL oNA C` 2 Stre re City/Town State Zip Discipline Expiration Date .2 GqWral NntractorA d Luz-I — npa Nan a- G5 b�f me of Pers n s ons' for struction License No. and Type if Applicable .20 � � ��• � � 0 f�' 2 3 StfeeF,Ar ireess City/Town State Zip •� /f�/3W 2132 Tcli"lone No' business Telephone No. cell e-mail address .t SECTION 11:1b'Orzla;16'C0M1'1;NSAI10N tNSUNANCti AFFIDAVIT M.G.L.c.152.§ 25C6 :A'Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and suO ittet ith this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. - I a- Is a si ned 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. Budding TZ7 20 Building Permit Fee-Total Construction Cost x_(Insert here 2.Electrical $ - appropriate municipal factor)=S 3. Plumbing $ .1. Mechanical (FIVAC) 54 Note:Minimum fee=3 (contact municipality) 5. Mechanical Other $ • Enclose check payable to 6.Total Cost S 'Z�, 'l� (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below, I hereby attest corder the pains and penalties of perjury that all of the information contained in this application is true and a orate to the best my r Ig-ind nderstanding. �pNu 4 . j ©�� zio 7i• �/� Ae2nAti 7_ 2207 7-Nly Please r_r an 'i n nan I 'Title Tole h N Date 22o g P,,w. J cl.,4. P7 �� Street Ar dress f City/Town ate Zi Municipal Inspector to fill out this section upon application approval: Nano Date ,A cT�ze �pomvneoottoeti�o�i?/GG,asacruitec(4 ex riee ofConsumerAffairs&Business RegulationMEIMPROVEMENTCONTRACTOR gistratlon: 115467 Type: piration: ;.1/30/2016 Private Corporatior J.P. REMODELING AND CONSTRUCTION, INC JOHN POLIZZOTTI 220 YANKEE DIV HYWF-, ry DANVERS,MA 01923 • Undersecretary Massachusetts -Department of Public Safe* Board of Building Regulations and Standards Construction Supervisor License: CS-045¢29 JOHN S POUZZ4?TTI 220 YANKEE DIV HGWY i Danvers MA 019Z3 1 J(,, "'"r' Expiration Cornmissi0oer .10/31/2014 1 ! P a Q j d 0 1 7 zr_ _ _ Af i ee% � ' T `T t 5 I � I`t � i ° d i 3 PrOpOfsAI t �-y 220 Yankee Division Highway �� "Q N" Free Estimates Danvers, MA 01923 000 Lict nmcd and Insured (fCi t�oft6�%{rll(',1,lO//ij eJ/LC% Massachusetts dome Improvement Contractor#115467 (978) 777-7637 Fax (978) 762-7606 K'N"Ors Moir 1YT-598-0747 °27-2014 STREET loE NANVU t eavltt & Salem Street platform & stairs. CITY,STATE and UP CODE .8 LOCATION SalemTMa 01970 am We hereby Samoan specifications and esnmmes for: Leavitt Street platform & stairs- Demo existing stairs & platform. Dig 2 new 12"x4'concrete footings filled with concrete with bracket. Frame new platform Approx. size 62"x60" with 2x8pt. 1 st 2x8pt lag into house sill or common studs with 5" gal lags, 2nd 2x8pt lag into 1 st with 3" gal lags. Install W.R.Grace & alum drip edge. !. Install 4x6pt support posts, 4x4 vertical fir posts carrage bolted,. Install 1 x4 fir sq. edge fir decking & stair treads, 1x8 pp risers boards, stair treads made from 2x12pt. I. Install fir handrails top & bottom 36" rail height with 2x2 fir balusters at 4" O.C. Close in sides of stairs & platform with Texi-11. Install handrail on house wall with brackets. $4,662.75 1. Salem Street platform & stairs built same as above . $4,662.75 i. J.P.Remodeling & Const will; A- issue a copy,of insurance to owner & pull permit. 13- be responsible for all waste from above work only. Contactor obligated to inform Customer of my and all necessary,permits and m obtain said permits.Customers who secure their we permits will be excluded from me g..a,vc fund of Mass.Gen,Inws Ch.142 Nine thousand three hundred twewtVF1ge i far s��laten"tdsl'bor—`°rap""i"a"° `wlm°eo""p`armor°"..f°"h`a"m°c $9,325.50 sayment to be made as follows: 1/3 deposit $3,108.50, 1/3 start of work $3,108.50, balance on completion 3,108.50 imr date: June 2014 Date afsubstarmal eom le 10 days %H mmerial is guaranteed to be ea specified.All work to be completed in a vorkmanhke manner according to standard practices.Any alteration or deviation rain above specifications involving extracosts will be executed only upon written Aumodred Signature_ aders, and win became an exm charge aver and Shove me estimate. All agreements contingent upon stakes,accidents or delays beyond our comma, kcceptance of Proposal —The above prices, specifications and o n ign this cgntraet if there are any blank spaces auditions are satisfactory and are hereby accepted.You am authorized us do the 07Z cork as specified.Payment wi be made m outliineed above. Signa)amofAccepmncc: / �Signa. // omer has legal o c ncel contract within 3 days of acceptance :ommclor shall perform the work in conformance with such plans and specifications,if any,as have Contractor shall not be liable for an delay due to circumstances beyond its control including strikes, ¢en provided by the owner or the contractor,which plans and specifications shall be deemed casualty or general unavailability of materials or the discovery of the conditions or defect upon the sill ncorperated into this contract by reference,and will do so in a workmanlike manner.Contractor Is or in the structure(s)thereon not known to the Contractor at the time of execution of this contract and rat responsible for performing any work not specifically referred to in this contract. which may be discovered during the course of the Contractor's completion of the work.In addition,the a the event any installment is not paid when due,contractor may stop work without breach until Owner acknowledges and agrees that in certain remodeling work the demolition of portions of the pre. payment is made and for five(5)days thereafter.In the event any installment is not paid within ten(10) existing structure may reveal additional defects,conditions or the need for additional work which must ays after it is due,contractor may,at its option deem this contract terminated by the owner and may be reported,altered or carried out in order to commence or complete the work called for in this due such action as may be necessary,including initiating legal proceedings,to enforce its rights contract,In such case,the Owner agrees that the duration of the work and any scheduled date of cmunder.At all times during construction,owner shall provide and maintain free and unobstructed completion may vary from that which may be set forth herein and Owner agrees execute a change ecess to all areas of the site where the work will-be performed and.shall provide,at owner's Sol. order detailing the cost and scope of.theadditismal work.necessary to repair.correct or alter finch xpense,water and electrical service,including 220 amp outlet. additional defects and conditions. :ormactor shall not be responsible for claims for damages to persons or property occasioned by owner Contractor warrants all work for a period of 36 months following completion. r bie rare. 11 ird marline aria of r.m ne n,hnr rnuane 1—,—h rnnlror,m v rnn,ml n--eFnll LnU /l... —cornea.,�,...rb.......r.r L.r..——... ..—, —,l...................dl.,...................n...,.n_,t r_. CITY OF S:V_EM, NL' sS cHL•SETTS / Y .l BUILDING DEPARTNEENT 120 WASHLNGTON STREET, 3'FLOOR TEL (978) 745-9595 Fox(978) 740-98445 KI\IBERL F_Y DRISCOLL `',1 L1YOR THonus Sr.P1ERRs DIRECTOR OF PUBLIC PROPERTY/BCILDrNG CMMISSIONElt Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Nain0 IflusinassOrganiratiuro'Imlividual : y—`.,(fvq • Address: ' �y City/State/Zip: 'Tfx'/WQM, l Phonelt:_ 7n ?9? )6 :Arc yn n employer:'Check the appropriate box: Type of project(required): I. I am a employer with 4, ❑ I am a general contractor and 1 6. ❑New constniction " employees(full and/or part-time)." have hired the sub•contracters 2.❑ I mu a sole proprietor or partner- listed on the attached sheet. t 7, ❑Remodeling ,hip and have no employees These sub-contractors have S. �] Demolition working me in any capacity. workers'romp. insurance. 9. Building addition (No workers'comp. insurance 5. ❑ We are a corporation and its required.) officers have exercised their 10.❑ Electrical repairs or additions 3. 1 ant a homeowner doing all walk right of exemption per MGL 1 I.❑ Plumbing repairs or udditions myself,[No workers'comp. C. 152, §1(4),and we have no 12,❑ Roof repairs insurance required.) t employees.(No workers' jl.❑ Other comp. insurance required.) •Any applicmt Jut clmcks but s I mat also rill out the acctiun below showing(heir workers'compeaution Puliry intinmullun. 'I h+mctwian.rho.,uhn,it this alTklnvit indicating they arc doing ill work and then hire outside contractors must suhmit a nmv 31rdavil indicating such. C•vurwwn thul check This bus;most mtachal an addiltu,,I:hut showing the mono afiho subeonlrscturs and[holy workers'cutup.Policy infmmalion. f ant an employer that Is providing workers' •an`pmrsailon 6t.turuuce for my employees. Beloly is rho policy and jab rile infurnrmion. Insurance Company Name:_ Policy it or Self-inn. Lie,N: Expiration Date: Jub Site Address: 72 City/State/tip: ,Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of SIGL e. 152 can lead to the imposition of criminal penalties of a line up ro S1,500.00 and/or one-year imprisonment,as well as civil penalties in the Ibrm of STOP WORK ORDER and a line of up car S230.00 a day against the violalor. Ile advised that a copy of this statement may Ix runvordcd to the ofl%c or InvestigAotis ul'Ihe DIA for insurance coverage verification. I do hereby -errify m er the ah s uJ p lalrleq v perjury that the infunnatlon pro vfdd vd above is true and correct. re ` ( ^/ Official use only: Do not rvrite in this area, to be completed by city or to ova ojjlciaf City car l'nwvo: ___ .__ I'ermit/Llceme 4— Issuing Authurity (circle une): -- t. Board cal'Ilealih E. Building Bepartmcnt .l.Citylfuwn Clerk J. Electrical luspcclur 5. Plumbing Inspeewr 6. Other j Cunlacr Person: I ' I J CITY OF SALEM, MASSACHUSEM BUILDING DEPARTMENT fiasl R�j, 120 WASHINGTONSTREET,3m FLOOR TEL. (978)745-9595 F KIMBERLEY DRISOOLL FAX(978) 740-9846 MAYOR THomAS STTIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER 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: Q- LJ1 (name of hauler) The debris will be disposed of in: )ANJ Uat�L (name of facility) L,,4A 94 (address of facility) 4 Signatur of applicant 7' �_� % . Date