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18-20 MASON ST - BUILDING INSPECTION (2) a/ys co sT t= S 3fo.2S T�-1� 1225 zl �rs r ( q-1 The Commonwealth of Massachusetts Toles(. C'W-rl Department of Public Safety QS 000 Massachusetts State Building Code(780 CMR) f Building Permit Application for any Building other than a One-or Two-Family Dwelling (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) �( t41T ��-ace �1gSo� Sr ,Sl9leru ©/S�� (v No.and Street City/Town Zip Code Name of Building(if applicable) (� N SECTION 2 PROPOSED WORK. Edition of MA State Code used If New Construction check here❑or check all that apply in the two rna!�below; Existing Building Repair❑ I Alteration ❑ 1 Addition❑ Demolition Please fill out and submit App"-1ix Ir 74 r Change of Use ❑ 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 Engineering Peer Review required Yes ❑ No . Brief Description of Proposed Work: 7 T J491 C q% S lc ri G N 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 ❑ A4❑ A-5❑ I 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 W❑ I-2❑ 1-3❑ 14❑ 1 M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑ S: Storage 5-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ Ill ❑ ❑A ❑ IIB ❑ 1 IIIA ❑ 111B ❑ IV Cl I VA VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supp�j! Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public I� Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ required❑or trench or specify: permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA I_I„i i C m,,issnn q.:i,;,, 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 Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?:_ Special Stipulations: 1012-9 crxt y e. U . '1 SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner �lifvr'Pe� Por'AJi 4 YVC/ry XW 310t1; "', Name(Print) No.and Street City/Town Zip Property Owner Contact Information: MARC 'JY—"�f4DS 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 budding permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If budding is less than 35,000 cu.ft.of enclosed space and or not under Construction Control then check here O and 5kip Section 10.1 10.1 Registered Professional Responsible for Construction Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor L^e Company Name �Lrn N/4/LL/e�/ eS - OS37©ic Name of Person Responsible for Construction License No. and Type if Applicable 30 .4 at* o ?O Street Address City/Town State Zip 9?vf Y�/6 _ �GN#�e��Y�I/, cos=-, Telephone No, business Telephone No. cell e-mail address SECTION 11:%VORKF.S'CONIPEN'SA'I[ON INSURANCH AFFIDAWF 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 $ eoo Building Permit Fee=Total Construction Cost x_(Insert here 2. Electrical $ O d0 0 appropriate municipal factor)_$ 3. Plumbing $ 9FO,©o O 4. Mechanical (HVAC) $ 3® erg C) �' Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ (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 th best of knowledge and understanding. vie r Please print and sign name Title Telephone No. Date I' G.f%Oc0 Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: Name Date l q S�-PO `� = �l S, DSO Zr �ISJ: = r—:53 Z5 The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 ' www mass.gov/dia Workers' Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le¢ibly Business/Organization Name: Mt//n 9 4fL ve-x LL C Address: '70 4 �j�O ye— City/State/Zip: 0/9?hone#: 7 L/.�L 0 6 '-/y 6" Are you an employer?Check the appropriate box: Business Type(required): 1.❑ I am a employer with employees(full and/ 5. ❑Retail art-time).* 6. ❑Restaurant/Bar/EatingEstablishment 2. I am a sole proprietor or partnership and have no 7, ❑Office and/or Sales(incl.real estate,auto,etc) employees working for me in any capacity. [No workers' comp. insurance required] 8. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152,§1(4),and we have I0.❑ Manufacturing no employees. [No workers' comp. insurance required]** 11.❑ Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12.0 Other *Any applicant that checks box#1 most also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#I. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name: p Insurer's Address: fJ — �!"2 M ASCO tJ City/State/Zip: Policy#or Self-ins.Lic.# Expiration Date: 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 MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 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 coverage verification. I do hereb erL{\`�1+,, u the pains and penalties of perjury that the information provided above is true and correct. Signature: `fti Date: Phone#: d.0 bNq (7 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit7License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4. Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia 4 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However,the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply your insurance company's name,address and phone number along with a certificate of insurance. Limited Liability Partnerships LLP with no employees other than the members Limited Liability Companies(LLC)or L ted ab y p ( ) or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required.Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. . City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number.In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary). A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street Boston, MA 02 1 14-20 1 7 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 www.mass.gov/dia Form Revised 02-23-15 o ChyoFSAmm MmAaimn SimiBt>IIW*VDWAMM Nr uDiFiva�w�vS'�,3�Aioox ft 7454M. rnaggirmmorl , XL FAX 740-M" MAYCK 7tr0ustST.P�rcE DMBcw&CFPu=MOwTAuxLvmaamwxm Construction Debris Disposa/Affidavit (required forall demolition and.renovation work) In accordance with the shah edition of the State SUM09 Code, M CMX Seidon lii.s Debris, and the pro*1ws of MGL clo,S 54; Buiidhw Permit if Is issued with Me condition that the debris resu ft from this work shall be disposed of in a paper licensed waste deposit WIRY as defined by MGL c 111,S JWA. The debris will be transported by. (name of hauler) The debris will be disposed of in: (name of fadiity) (address of facillty) 4 nature of ap icant M)tLG Date � I I JlI } 0 • • CA 0 . 195 . 000 - 4 • _ 48 . 750 • I 0 - I 2 > 145 - 4 • _ 536 . 25 i 0 • 0 ° G * A 536 . 25 x 4 • = 2 + 145 - 0 - i 0 • G E P� 48a750 • x tZic✓ 4 • _ 195 + 000 • Commonwealth of Massachusetts s 3 City of Salem F 9 Inspectional Services RECEIPT 120 Washington St,3rd Floor Salem,MA 01970 Phone:(978)745-9595 x5641 Application For Building Permit (One- or Two- Family Dwelling) Permit No#: TS-16-1222 Date Applied: 10/20/2016 10/21/2016 Building Official (Print Name) Signature Date Issued SECTION 1 : SITE INFORMATION 1.1 Property Address 1.2 Assessors Map&Parcel Number 18-U1 MASON STREET 26-0310 1.3 Zoning Information 1.4 Property Dimensions R2 24800 Zoning District Proposed Use Lot Area Frontage(ft) 1.5 Buidling Setbacks(ft) Front Yard Side Yard Rear Yard Required Provided Required Provided Required Provided 15.00 0.00 10.00 0.00 30.00 0.00 1.6 Water Supply: 1.7 Flood Zone: Outside Flood 1.8 Sewage Disposal System Zone?Check if Public Zone: yes_ Municipal SECTION 2: PROPERTY OWNERSHIP Owner of Record JUNIPER POINT INESTMENT CO LLC 130 BAY VIEW AVENUE SALEM MA 01970 Name Address (978) 762-3858 Phone Email SECTION 3: DESCRIPTION OF PROPOSED WORK Permit For: Repair/Replace Brief Description of Proposed Work: DEMO & REMODEL UNIT 1: KITCHEN, BATH%WINDOWS SECTION 4: ESTIMATED CONSTRUCTION COSTS/PERMIT FEES Total Project Cost: $48,750.00 Payment Date Amount Paid Check No Total Permit Fee: $536.25 10/20/2016 $536.25 1477 Total Permit Fee Paid: $536.25 r - - - -_ _ — -- - -_.._... _ - _.. - .-. - .- _. THIS IS NOT A PERMIT Commonwealth of Massachusetts f 3 City of Salem Inspectional Services RECEIPT ) 120 Washington St,3rd Floor Salem,MA 01970 Phone:(978)745-9595 x5641 Building Type: Single Family Condo Existing Proposed No.of Floors/Stories(include basement levels&Area Per Floor(sq.ft.) 0 0 Total Area(sq.ft.)and Total Height(ft.) 0.00 0.00 0.00 0.00 SECTION 5: CONSTRUCTION SERVICES SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT 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 On File? False SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property hereby authorize JOHN HARVEY to act on my behalf, in all matters relative to work authorized by this building permit application. JUNIPER POINT INESTMENT CO LLC 10/20/2016 Print Owner's Name(Electronic Signature) Date Submitted SECTION 7b: OWNER OR AUTHORIZED AGENT DECLARATION 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. JUNIPER POINT INESTMENT CO LLC 10/20/2016 Print Owner's Or Authorized Agent's Name(Electronic Signature) Date Submitted NOTES: 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 HIC Program), will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps When substantial work is planned, provide the information below: Total Area(sq.ft.) 0.00 Type of Heating System Number of half/baths Gross Living Area(sq.ft.) 0.00 Type of Cooling System Number of decks/porches Number of Fireplaces Room Count Enclosed/Open Number of Bathrooms 0.0 Number of Bedrooms 0 r THIS IS NOT A PERMIT Mason Street Q Condominiums QEf ' jQ t 1 8-20 Mason Street o Salem , MA _ cm Red Bam Architedvre 89 t11Gl15TREEf IPSIMCH,MA 01938 (9]01595-6]69 GROSS SQUARE FOOTAGE Project Description FIRST FLOOR 238G 5F THE PROJECT CONSISTS OF A COMPLETE INTERIOR RENOVATION OF AN EXISTING 3 SECOND FLOOR 2261 5F STORY BUILDING AT 1 8-20 MASON STREET IN SALEM, MA. WHEN COMPLETE THE THIRD FLOOR 1621 5F BUILDING WILL HOUSE(4)CONDOMINIUM UNITS. UNITS I + 2 WILL BE FIRST FLOOR FLATS, UNITS 3 +4 WILL BE TOWNHOUSES SPREAD OVER FLOORS 2 +3. TOTAL 6468 5F No. Date Desch [ion UNIT DESCRIPTIONS: UNIT I - I,105 5F 1 10,6.16 SD-1 N 2 Bed C 2 Bath UNIT 2- 1,050 51' 2 BED 2 BATH UNIT 3 - 2,025 SF w 3 BED Sheet Title: 2 BATH O OFFICE AND 100 5F PRIVATE DECK coveRSHEFr z 3 UNIT 4- 2,075 SF O 3 BED 2 BATH OFFICE AND 100 5F PRIVATE DECK Sheet Number: A-O WALL LEGEND EXI5TING WALL TO REMAIN [� PROP05ED NEW WALL E � � � t n Q Cn C) o p O � S o N m 0 UNIT k DV 1080 5F+/i Lr�h�l—J, — Recl Bam Architecture ® Ha HIGH sTREEr ( ,, , O � O IPSNnCn,MA DI93H OQO (9"18)595-6]64 u) o0a m L13 e 0 w UNIT 0 I los sF u No. Date Description I 10.6.16 SD-I Sheet Title: �1 PROPOSED FIRST FLOOR PLAN PROPoseDFIRST -I SCALE: 1/6" = 1'-0" FLOOR PiAN Sheet Number: A- IA WALL LEGEND EXI5TING WALL TO REMAIN 0 PROP05ED NEW WALL N � N G&-2" E N +, n Q N O O N O N N ^ C) N O ❑ � U � UP UNIT#3 2025 5P+/- Red Bam Architecture ®� ''. ea rnrn sTREEr �e irwncn,MAolsse DN ❑ 000 DN - tsve�sss sosn 0 0 m UNIT#4 UP 2075 No. Date oescn lion I 10.6.16 sD-i Sheet Title: �1 PROPOSED SECOND FLOOR PLAN PROPosEDSEcoND -Z SCALE: I/6" = I'-a- FLOOR PJW Sheet Number: - A-2A WALL LEGEND U15TING WALL TO REMAIN O • FROF05ED NEW WALL 4^1, W E Gb'-2" Q Q E o Q N n C) O x�Tllr, ono;. m -_-- UNIT#3 a mcean �a "- Red Bam Architecture 89 HIGH STREET -r-�renn..auni �— -- I�VAGH,MA0193B D _ (9J8)SAS£]64 DN MECN m UNIT #4 i, No. Dale Deson lion 1 10.6.16 5D-I Sheet Title: EXISTING THIRD FLOOR PLAN PROP05EDT IRO _3 SCALE: 1/8" = 1'-0" FLooR PUN Sheet Number: m.. A-3A