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137 NORTH ST - BUILDING INSPECTION (3) . � �Is�� G�� �,� . ; � � 'The Commonwealth of Massacl��IONAL S�RViCES �lI��A,, Department of Public Safety VYu : Massachusetts State BuIlding Code(780 CMR�n„�� �� ��S Z Building Permit ApplicaHon for any Building other than a One- I�FP aau y e ng (This Section For Official Use Only) Building Permit Number: Date Applied: 2�22�1 l0 Building Official: • C.p � SECTION 1:LOCATION(Please indicate Block#and Lot N for locarions for which a street addre ' not available) � �3�Not�l-h Sa�1�em , m A o� a fi� ^ No.and Sh�eet Gty/Town Zip Code Name of Building(if applicable) �J � SECTION 2:PROPOSED WORK � ,,(�� Edition of MA State Code used �TM If New Construction check here O or check all that apply in the two rows below �U-} Existing Building'� Repair❑ Alteration ❑ Addifion❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑ Brief Description of Proposed Work: (A�'tSi�luc��+r� 0� (�1 on2. w�( �J,r�rl (21 C�g,e�'S -tn �mnvw.f�� Q Lrn�uG� lovs�.ranm �n•io (Z� �v.sc� s,e�arQ�l-2 Vak.d.rc�nrn S� _ 1)r� `k i 5 A �nnd.a r�r, -1'V�v -IM.i(c1 �Luar o �' G �l'Ytre,2 A'F �'")V1 L WU�A SECTION 3:COMPLETE THIS SEC1'ION IF EXISTING BUII.DING UNDERGOING RENOVATION,ADDTTION,OR CHANGE IN USE OR OCCUPANCY.. . � Check here if an Existing Building InvesHgation and Evaluarion is enclosed(See 780 CMR 34) 0 ExistingUseGroup(s): 'GL-2 2.P.S�d2v��i� -Ihfec Fam�ly ProposedUseGroup(s): � SECTION 4:BUILDING HEIGHT AND AREA Fxisting Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.h.) Total Area(sq.fr.)and Total Height(ft.) � SECT'ION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ AS❑ B: Business ❑ E: Educational ❑ F: Facto F-1❑ F2❑ H: Hi Hazazd H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: InstituHonal I-1 ❑ I-2❑ I-3❑ I-4❑ M: Mercantile❑ R Residential R-1❑ R-2 R-3❑ R-4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Uae�and please describe below: Special Use: � SECTION 6:CONSTRUCITON 1'YPE(Check as applicable) IAO IBD IIAO IIBD IIIAD IIIBD IV O VA ❑ VBO SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Trench Permit Debria Removal: Water Supply: F1oad Zone InformaHon: Sewage Disposal: Licensed Dis osal Site❑ Public� Check if outside Flood Zone�( Indicate municipal� A trench will not be p Private❑ or indentify Zone: or on site system❑ required O or trench or specify: permit is enclosed❑ � Rail[oad right-of-way: Hazazds to Air Navigafion:�.�. , . MA Historic Commission.Review Process: .� : i::�.eNut�Applicable�O�:�:��., � . . IsStructurewithin.airporGap.pxoachazea2.:�- � - Istheir�review�completed�.rra. �;r;.a ,., � � or Consent to Build.enclosed❑ Yes��or.No❑ ^.::��� �� _:'.-�:` ' ' Yes� 1: No'0�:� - "'•" ��` ' � . � - � � SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY � - . . . � ' ... ,_.,__ .,Editionof�ode�;'f::.:�. ... -Use.Group(s): . ..,,...,.._;�y,p:eR�Conshvction;. � ,-:... . ..Occupant.Loadge.r;Flooi�. .:�•: - ��.,...., �—.-,�z. .. � �DoeStheli.uild?�g_contain�anSprinklerSystem?:�:Spec'9alStkp,al.a.rionsa �•>.cz .��_ •: ,_- ��� - ��� � .�.�i:ia[ �fi ..r;iicsi ' �< : -�_, �tAll.-tsY7 j( l i �'l7 C-O NT ° ; SECTION 9: PROPERTY OWNER AUTFIORIZATION , Name and Address of Property Owner �oi�, N fl'hr�l,aw, 2yto �S�exsi-�Z �a,l�w, ,mf} 01�[�-0 Name(Print) No.and Street Gty/Town Zip Property Owner Contact InformaHon: I n-I�c.i,rr '9-es;�r�o-� �-�-S I Z�- �_�o _ l�z-� � R�la S�Corr�•P�n TiUe 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 ro e owner s behalf,in all matters relative to work authorized b this buildin ermit a licarion. SECTION 10:CONSTRUCI'ION CONTROL(Please fill out Appendix 2) � buildin Is less than 35,000 cu.h.of enclosed s ace and/or not under Construcflon Control then check here O and ski SecHon 10.1 10.1 Ae 'stered Professional Res onsible for Construcrion Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date �10.2 General ContraMor ���uc�4�o�r �t �O�S '�lA-b�r�`91 Company Name Q_e_oi r� T,t�ov cJh9-�, C S— 0�-I Gl Ll(a 2-- ) 2 -2 a - � —� Name of Person Responsible for Construction License No. and Type if Applicable � �'?� �(`�'hv( St 5�,1'P�Yn 1�1 OI°I� Street Address City/Town State Zip �tg-3�- 03oS °�-.zs�5-�8�3 ��� .o bauch@ �m`a�-P • Can-, Tele hone No. usiness Tele hone No. cell e-mail address � ��SECTION 11:WORKERS'CONII'ENSATION INSURANCE AFFIDAVIT .G.L.c.152.§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Indastrial Accidents mast be completed and submitted with this application. Failure to provide this affidavit will resvlt in the denial of the issuance of the building permit. Is a si ed Affidavit submitted with this a lication? Yes 0 Na 0 � �� SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE � �� Item Estimated Costs: (I.abor �. � and Materials) Total Construction Cost(from Item 6) _$ y. '�J�� . UO � —� ' 1.Building $ � �•U� gtilding Permit Fee=Total Construction Cost x�Ylnsert here ' � 2.Electrical $ appropriate municipal factor)_$ �. 3.Plumbing $ I� 4.Mechanical (HVAC) $ Note:Minimum fee=$ eJ•4l� (contact municipality) ! 5.Mechanical Other $ Enclose check payable to �i1'� v 9 SGl�'�(r1 �, 6.Total Cost $ ��Cj NQ. 00 (contact municipality)and write check number here (o q y �I SECTION 13:SIGNATURE OF BUILDING PERMTT APPLICANT I By entering my name below,I hereby attest under the pains and penalties of perjury that all of the informatiom m�tained in this I application is irue and accurate to the best of my lmowledge and understanding. '� -- - � � Please print and sign name � �- ' � Title� � � �� Telephone No. Date . � � ..� �---"' _ :r:�:t.... .�::�1i'_ . 'hr-.6.;. . .,., -. �..�P.'= )v .,. , ... . _ � . . . . - _ .-ra:' ,. . . , . "—'_ . - .—.:., _.._._ ._„' __.' StreetAddress �- ���� �� ''� � � � City/Town , _- "���"- Stafe� Zip - � � � � �` a�. �— .....�. _.nu � ., t } ..,� ..":�.tr �.. . . . .. :. lu�� t . J p .,.,. V . , � , � -Mvnmipal Inepedor tofill out�tkus aec�tion ugon applicarion,approval . . ,.ti4` Ti �^i. � ,..�•..., a . .. ,_.', . J - - i.y;'._, tsc�`�*,: , .,._ , ...,.�,_ .r � . . . . . ..._ � . . . . . . ..._. .... . � . �, .. . .Name Date . ._. ,•_ Appendix 1 For the demolition of structures the building perxnit applicant shall attest that utility and other service connections are properly addressed to ensure for public safety. Please fill in the information below and submit this appendix with the building permit application. The building permit applicant attests under the pains and penalties of perjury that the following is true and accurate. Property Location (Please indicate Block # and Lot # for locations for which a street address is not available) No. and Street City/Town Zip Name of Building(if applicable) For the above described property the following action was taken: Water Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Gas Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Electricity Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) - Appendix 2 Construction Documents aze required for struciures that must comply with 780 CMR 107. T'he checklist below is a compilation of the documents that may be required for this. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x'where a licable No. Item Submitted Incom lete Not Re uired 1 Architectural 2 Foundation 3 Structural 4 Fire Su ression 5 Fire Alarm ma re uire re eaters 6 HVAC 7 Electrical S Plumbin includelocalconnections 9 Gas atural,Pro ane,Medical or other 10 Surve ed Site Plan tiliries,Wefland,etc. 11 S ecifications 12 Shvctural Peer Review 13 Structural Tests&Ins ections Pro am 14 Fire Protechion Narrative Re ort 15 E�dstin Buildin Surve /Investi ation 16 Ener Conservarion Re ort 17 tlrchiteclvral Access Review 521 CMR 18 Workers Com ensation Insurance 19 Hazazdous Material Miri aHon Documentation - 20 Other S e ' 21 Other S 22 Other S e ' `Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced unril this applicafion has been amended and the proposed construction document amendment has been approved by the authority having jurisdicHon.Work started prior to approval may be subjected to triple the original permit fee. Registered Professional Contact Information Name(Regisfrant) Telephone No. e-mail address Registraflon Number Street Address City/Town State Zip Discipline ExpirationDate Name(Regisfrant) Telephone No. e-mail address Registralion Number � Discipline-� Expiration Date _ Sireet Address -Ci /Town � �� State Zi ..,,.,:.�.. , _.. � Name(Registrant) Telephone No. e-mail address Regisiration Number . , , . .. .. - .. : . : �. , _...—.. . -Disci�luie�,_=Exp'uation"Date .. . . ._ ._. � � Street�Address� Ci /Town � ' :�-!� -� � State Zi �:i � °� The Commonwealth of Massachusetts ,�4+}g,5 �$'C��ff;.. ,W �. Department of Public Safety � `�! Massachusetts State Building Code (780 CMR) •�`�,��� ,��i,�°af Building Pernut Application to Construct,Repair, Renovate or Demolish any Building other than a One-or Two-Family Dwelling Code and Other Requirements for Building Permits The Department of Public Safety has issued these building pemut application forxns so that municipalities across the state can move toward use of a single pemut form and consistent permit application process. The MA State Building Code specifies the requirements of building permits and the applicant is advised to review and be familiar with these requirements in arder to avoid some of the common permit application problems. Likewise the applicant should be aware that some municipalities require that the owner confirm, even prior to acceptance of the building permit application, that no outstanding property taxes,water fees, etc. exist. Filing Instructions 1.Please contact the city or town where the wark will be done to ensure that the city or town will accept this application form and if any additional informaHon is required, and obtain the correct mailing address. After doing so, print the application, fill in completely and then submit to the local city ar town where the work will be done. 2.All applications shall be considered complete and will be reviewed if construction documents, specifications, fee, and other materials that may be required as indicated in the Building Permit Application aze included with the application. 3.Please include a check for the Building Permit fee. The fee may be calculated using the information to be supplied in section 12 of the Building Pernut Application. The check is to be made payable to the local city or town where the work will be done. 2�.��� LINE OF 7'-0" - i °��° CEILING SLOPE — � o — - — - — - — - i � - � O i o � Bedroom 1 � 125 SF N w � fV _ N n --- v � Bedroom 2 � sT#2 o = � _ - - - - - - - - � - - - LINE OF 7'-0" 1 16 SF ` � CEILING SLOPE 12'•10" / � \ 3 Level � ve�=r-o• ' . PROPOSED PLAN Apartment#3 Renovation 137 North Sireet, Salem, MA 02.122016 1/8"= 1'_0" OPTION 4 - ROOMATES as�-a v2° � 2 NEW CLOSETS; FRAMED OPENING FOR REUSED BIFOLD DOOR 12'-10" UP � �W � . N � o o � � � — ' — — — o . — — — . — — — — — — .— — — — — — _ N � 2���� 0 fV � O t0 _ N NEW WALL ' REPLEACE EXISTING w zq DOOR � _ "' CHANGE SWING � = DIRECTION ZV n _8�� `-Q PATCH WHERE DOOR WAS REMOVED N � 2 NEW BEDROOM DOORS 8'-61/2" 4'-31/2„ � . .. ,..._ .. . .. :.... .. . .:.. : .::. :::.:. :.- ...... . .-.:-..,.. ..-; , i � � - R � PATCH WHERE � WALL WAS ' REMOVED .` ' ,„,, , , - e , _ , -� . w. . �� .. .. . ,, � PATCH CEILING WHERE ALCOVES 9�8��2� ; WERE REMOVED C 1.�C NEW PARTIAL WALL DIMENSIONS , �J Apartment#3 Renovation 137 North Street, Salem, MA 02.12.2016 1/4" = 1'_0" 48'-81/2" I 12'-10" 4'-21/2" 3'-41/2" v UP o 0 m 0 0 CV � N O CV � O O . � _ N - LL � � Q - ' I � � 0 �' 8'-61/2" 4'-31/2" � �� � � N ' � _ . ..�,. ,. ..,.. ,�. CV " Y � � � � � � � � � 1'-0' �5'-0'r �1'-01/2�0 �5�-0�r �a"� r � � r I � i ' — � � � � � � � : ,, . . .,..,_ . . � � �' 9'-81/2" C b t DEMO Apartment#3 Renovation 137 North Street, Salem, MA 02.12.2016 1/4" = 1'-0"