7 MEADOW ST - BUILDING INSPECTION �Kttsi
The Commonwealth of Massachusetts
=Building
Department of Public SafetyMassachusetts State Building Code(780 CMR)+� Permit Application for any Building other than a One-or Two-Family DWelling
- (This.Section For Official Use Only) , . - c� =m
Building Permit Number: Date Applied: Building Official: N r
SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is notavalleble)
Mei400erl 37- 519lx:0� Ml1 oi9-)0
' No.and Street City/Town Zip Code Name of Building(if applical;Q
- SECTION 2.PROPOSED WORK rn
Edition of MA State C de used_ If New Construction check here❑or check all that apply in the two rows below
Existing Building Repair M1Alteration ❑ 1 Addition❑ 1 Demolition (Please fill out and submit Appendix 1)
Change of Use ❑ 1 Change of Occupancy O Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Q--_
Is an Independent Structural Engineering Peer Review,(e9�ired? Yes ❑ No B�
Brief Description of Proposed Work: R�P"o d' l-f= {�l�%C�r✓�' �i.NO y-1z1
1z;Ef(W S
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.it.)and Total Height(ft.)
SECTIONS:USE GROUP(Check as applicable)
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ 1 B: Business ❑ E: Educational ❑
R Facto F-1❑ F2❑ H: Hi h Hazazd H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional 1-1 Cl [-2❑ I-3❑ I-1❑ 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 U.
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA IB ❑ IIA ❑ IIBO 1 ILIA ❑ IIIBO 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 Cl 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: nLAI AI YAOrii;CO,nmss;ar Ke, I4,_r_s:
Not Applicable❑ Is Structure within airport approach area? FIs their review completed?
or Consent to Budd enclosed❑ Yes El or No❑ Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor:
Dues the building contain an Sprinkler System?: Special Stipulations: '
IV)IktL 'SU SQty�b3'IJ �ORV6LA
1 IYlfk�t-oD o Iz-
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SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
yS SC�oo/ s/� S /z Y`i/� O,i520
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
M('K (f 6"r k<A— `72S-90 IG
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
�cdk, Ifs}+ veY -700 C�90Le
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 permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2).
f buddingis less than 35,000 cu.it:of enclosed space and or not under Construction Control then check here O and skip 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 - .. .:. ..
--0/r" 1141ep-` Y L L L
Company Name 4 C�
CT 0
Name of Person Responsible for Construction License No. and Type if Applicable
"209Z &�_40t.E j,2 % SAI/e-1AI /yr/�
Street Address City/Town State Zip
92K 40 Of (� --
Telephone No. business Telephone No. cell e-mail address
SECTION 11:WORKEIS'CONIPFNSAl[ON INSURANCE AFF'IDAVTI` M.G.G 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 O
SECTION 12:.CONST'RUCTION COSTS AND PERMIT,FEE. - -
Item Estimated Costs:(Labor
and Materials) Total ConstructionCos[(from Item 6)_$
1.Building $ Building Permit Fee=Total Construction Cost x_(Insert here
2.Electrical $ appropriate municipal factor)_$
3.Plumbing $
d.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
S.Mechanical Other $ 000� Enclose check payable to
6.Total Cost $ O 000 (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,1 herebNittestunt� r the pains and pen ties of perjury that aB of the information contained in this
applicatiton is trueand accurate to th m � owledgeand derstanding.
Please print and si n na�n�e Title TelephoRe� O Date
Street Address City/Town 1, State Zip
Municipal Inspector to fill out this section upon application approval: � "" �l/
Name Date
i
The Commonwealth of Massachusetts
Department oflndustt'ialAccidents
1 Congress Street,Suite 100
Boston,AM 021141017
www.massgov/dia
Wworkers'Compeusation Insurance Affidavit:Builders/Contractors/E►ectiicians/Plumbers.
TO BE FU ED WiTB TBE PERMITTING AUTHORITY.
Applicant Information Please Print JAgJbI
Name(Business/Orgaaoizationflndividual): t
Address: 7(9/1
�r
City/State/Zip: J l F✓`— Phone#: S/ aO � Y��
Are you an employer?Check the appropriate box: Type of project(ni4rdred):
I.Ell am a loyei with .employees(full and/or part-time).' 7. New construction
2. am a.sole proprietor or partnership and have no empbyees working forme is 8. 2-1tem odelimg
any capacity.[No workers'comp.insurance, required] -
3.❑1 am a homeowner doing all work myself.[No workets'comp.insurance required.)t 9. El Demolition
10 Building addition.
4.Fj I am a homeowner and will be hiring contractors to conduct all work on my property. ]will
encore that all contractors either have workers'compemation insurance or sm sole 11.0 Electrical repairs or additions
proprietors with no employees. 12.0 Plumbing repairs oradditions
5.❑I am a general contractor and J have hired the sub-tontractors listed on the attached about. 13.❑Roofrepairs
These sub-contractors have employees and have workers'comp.insmanx:.l
6.0 we are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other
152,§1(4),and we have no employees.[No workers'comp.hismance requited.) -
*Any applicant that checks box#1 must also fill out the section below showing tbeb workers compensation policy information:
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such
lContracrors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. Ifthe sub-cmmactors have employees,they must provide their.workan'.comp.policy number. -
I am an employer that isproviding workers'compensation
pensation insurance for my employees. Below is the poliiy and job site
information.
Insurance Company Name: -
Policy#or Self-ins.Lic.#: 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 MGL c. 152,§25A is a criminal violation punishable by 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 a ' the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
covera verification
I do here a un a pains and penalties ofperjury that the information provided ab ve is rue and correct.
signaforeAZ--
p r to a 5 1
Phone#:
Official use only. Do not write in this area,to be completed by city or town offlwial.
City or Town: Permit/Ucense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other 11
Contact Person: Phone#:
f
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 sub-contractor(s)name(s),address(es)and phone number(s)along with their certificates)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members 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 pemmnittlicense 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)and under"Job Site Address"the applicant should write"all locations in_(city or
town)."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 d(?g license or permit to bum 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, Suite 100
Boston,MA 02 1 14-201 7
Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
City of Salem Sign Permit Application Worksheet
I(fZ RECEIVED
26-Oct15 I SPECTIONAL SERVICES
Revere Tanning
138 Canal Street
1015 OCT 29 P 1= 40
Zoning(res/non-res) 1
Entrance Corridor(Y/N) Y
—� Lot frontage n/a feet
Building or tenant frontage 60 feet
1 #of businesses on site 1
Bldng dist from street center <100 feet
Ln Multiplier 1
maximum area permitted 60.00 sq ft
total proposed sign area 60.00 sq It
sign 1
Sign length 168.00 inches
height 30.00 inches
sign 2
length 120.00 inches
height 30.00 inches
sign 3
length 0.00 inches
height 0.00 inches
sign 4
length 0.00 inches
height 0.00 inches
sign 5
length 0.00 inches
height 0.00 inches
maximum area permitted 32.50 sq ft(per side)
maximum#of signs permitted 1 signs
maximum height permitted 12.50 ft tall
sign 1
proposed sign area 14.00 sq ft
length 84.00 inches
height 24.00 inches
proposed sign height 0.00 ft(approx)
sign 2
proposed sign area 0.00 sq ft
length 0.00 inches
height 0.00 inches
proposed sign height ft
Application meets standards set
forth in the Salem Sign Ordinance Yes
Recommend approval Yes
Free standing sign is a replacement of face on two-sided multi-tenant
sign.
Permit Number
APPLICATION FOR PERMIT TO ERECT A SIGN
60)
NOTE:BULLRING PERmrr MUST BE-OBTAINER BEFORE SIGN Is ERECTERLocation,ownership and Detail Must Be Correct,Complete,and Legible
Salem,Massachusetts 1 012 0/20 1 5
Date
To the Building Inspector:
The undersigned hereby applies for a permit to at Erect, o Affair, o Repair a sign on the following described buildings:
� I
❑Urban Renewal Area atntrance Corridor
138 Canal St. L o Historic District o None
Telephone. 1 floor '
• - Joe BarreSi 2 floor
Address. 0 Buttemut Rd. .Wakefield 3 floor
Telephone 81-589-5390 4 poor
E n reveretan@comcast.net
How many businesses are in the building?
If.a corporate body,name
of resocinsible officer Imearfeet
- Star Si n companyB°i'�"960
Corrsfructlrna Sr�s uomm No Applicants Space(d muiti-ienant) (y p linear feet
I - linear feet
Address 324 Rantoul St. property
Mail Sign Pet rnit to
Telephone 78-927-7057
E-Mad ❑Sign Owner a Sign Erector o Other.
ess starsi nma_com
Si"I Sign 2 Sign3
N Surface IN Surface o Surface
o Right Angle to Building o Right Angle to Building a Right Angle to Building
o Free Standing o Free Standing ❑Free Standing
❑Awning o Awning ❑Awning
a Portable(A-Frame) o Portable(A-Frame) ❑Portable(A-Frame)
❑Other(specify) u Other(specify) N Other(specify)ii w faros for existing pylon
Sign Materials Aluminum,Plastic,Vnyl Sign Materials Aluminum, Plastic, Vinyl Sign Materials Texan, Vinyl
Sign Dimensions 2•5' x 14' Sign Dimensions 2.5' x 10' Sign Dimensions Z t it
Sign Area Sign Area
Sign Area 35 s $ g 25 s 8 ft
Sign Height(if free standing) Sign Height id standing) Sign Height(if free standing)
Estimated Cost of Net Work.
g (D t.too
Type - Sign Area To Be Removed? 4Soowoae,�Uth��
�^�� -
*Surface —sq It *.yes ❑no o no
o Right Angle to Budding —sq ft o Y� ❑no trve
o Free Standing —Sri it o yes ssq it ❑ye ❑no
o Awning
o Other(specify) _sq it o yes p no
nning&Community Development ueparhnent Historical Commission
I
1 l Budding inspemr aart+rm.n„i V
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Fabricate&Install: One 2.5'X 19 sign&one 2.5'x 1W sign with 3-dimesional letters mounted on backer.
Customer Name:Revere Tan
„0MA Company:Revere Tan
$L G M4 Sreet Canal St.
•(978)927.70 , City:Salem State:MA Zip:01970
(978 .7867 Phone: Fax:
E-mail address:reveretan oomeastnet
y my ¢a Commonwealth of Massachusetts w
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sy Citv of Salem
a
120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641
'n Return card to Building Division for Certificate of Occupancy
Permit No. B-15-1192
FEE PAID: $0.00 PERMOIT TO BUILD
DATE ISSUED: 11/4/2015
This certifies that STAR SIGN CO.
has permission to erect, alter, or demolish a building 4,142 CANAL STREET Map/Lot: 330006-0
as follows: Signs SIGN PERMIT AS APPROVED FOR:
REVERE TANNING @ 138 yCANAL STREET
Contractor Name: "utx
DBA: i 9
e'9
a '14
r
Contractor License No:
Pq
11/4/2015
r r f Building Official s °i Date
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within sixmonths after issuance.The Building Official
may grant one or more extensions not to exceed six months each upon written request ^,,b
All work authorized by this permit shall conform to the approved,application and the approved construction documents for which this permit has been granted.
f ' a
All construction,alterations and changes of use of anybuilding and structures shall be in compliance with the local zoning by-laws.and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same.
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this;permit.
X � �
cx;•,,+ z&¢, - fir.
HIC#: "Persons contracting withunregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A).
Restrictions: f
Building plans are to be available on site.
All Permit Cards are the property of the PROPERTY OWNER.