7 PARADISE RD - BUILDING INSPECTION (2) 1
The Commonwealth of Massachusetts
I, Department of Public Safety
v.-,..j %fassachuseu.State Building Code(780 CAIR)Se%enth Edition
City of Salem
Building Permit Application for any Building other than a I-or 2-Family Dwelling
(This Section For Official Use Only)
Building Permit Number: Date Applied: Building Inspector:
SECTION 1: LOCATION(Please indicate Block N and Lot M for locations for which a street address is not available)
Xo. and Street City /Tomcn Zip Code Name of Building(itapplicable)
• 1� SECTION 2:PROPOSED WORK
If New Construction check here❑or check all that apply in the two rows below
Existing Buildings I Repair❑ Alteratiun � Addition❑ Demolitiun ❑ (Please fill out and submit Appendix 1)
`;. Change of Use �-- Change of Ckcupancy 6'- Other Er-Specify: sz o &k
SAre building plans and/or construction documents being supplied as part of this permit application? Yes 0 No ❑
Is an Independent Structural Engineering Peer Rev igw required? Yes ❑ No ❑
P P 1 /U ��do c V--
� BriefDescri tier/�ufPru oxd/Wu/rk: �iJN.G�-•/��� 2h/ n
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SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) ❑
Existing Use Croup(s): Proposed Use Group(s):
Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34:
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
Nu-of Fbors/Stories(include basement levels)&Area Per Floor(sq. ft.) woo
Total Area(sq. ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as ap licable)
A: Assembly A-1 ❑ A-2r ❑ A-Znc❑ A- A-0❑ A-5❑ B: Business ❑ E: Educational ❑
1s F: Facto F-1 ❑ F2❑ H: Hi Hazard H-1 ❑ H-2❑ H-3 ❑ H-4 O H-5❑
1: Institutional 1-1 ❑ 1-2 ❑ 1-3❑ I4❑ 1 M: Mercantile❑ R: Residential R-113 R-2❑ R-3❑ R-4❑
;! S: Storage S-1 ❑ S-2 ❑ I I U: Utility❑ 1 Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ IIA i IIB ❑ 1 IIIA ❑ 11111 ❑ IV ❑ I VA ❑ VB ❑
t - 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:
PP Y�
Publi� Check if oubi&Flood Zone❑ Indic,ue municipal6l A trench will nut be Licensed Disposal Site❑
I'rirate❑ or mdentifm Zone: or on site scarm❑ required Our trench ur.pacify:
permit is enclosed ❑
Railroad right-of-way: Hoards to Air Navigation: \IA I li.turic t ,unmi..i„n Ito.Ira Pn err..:
Xnt \pphcable❑ 1.Structure rnthit,airport opprooch area.' L their re%ien completed.'
r
,a l'on;ciil to Budd end,ned ❑ 1'es❑ or No❑ Yrs O❑ \n
' SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
I[ditwn of Code: - L.',c• rm pe of Cunstrucuun: Occup,umt Load per Fluor:
D"e..the building Contain mlSprinkler Specl.11 pulaGuns:
J,
r
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Properly Owner
Name(Print) Nu.and Street Cih•/Town Zip
Properly Owner Contact Information:
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable, the property owner hereby authorizes
Name Street Address Citv/Town State Zip
to act on the pro perty owner's behalf, in all matters relative hp work authorized by this building permit a p plication.
SECTION 10:CONSTRUCTION CONTROL(Please fill,out Appendix 2) `='" ""= '
(If building is less than 35AM)cu. Mot enclo. d s pace and/or not under Construction Control then check here O and skip Section to.l)
10.1 Registered Professional Res onsible for Construction Control
ephgne No. r-mai�Qdrrss 12445 Registration Numb
r
Str et Addtleb V� ,ob y���U City/Town {State Zip Discipline Expiration Date
10.2\General Contractor
C-5n4:°,`�arzd �S 3Z8o l
Na e o Pe on Res onsible for Construction L' ense No. and Type if A plicable
1 �ct ram. �10 621A
Street Address City/Town State IV Up
ca
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS'CONTENSATION INSURANCE AFFIDAVIT(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 I] No O
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1. Building $ l?'3 Building Permit Fee=Total Construction Cost x_(Insert here
2. Electrical $ 00 — appropriate municipal factor)_$
3. Plumbing $ 0&0
4. Mechanical (HVAC) $ q — Note:Minimum fee=$ (contact municipality)
5. Mechanical (Other) $ Enclose check payable to
6.Total Cost $ 95;1 (contact munici alit )and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below, I herebv attest unifier the pains and penalties of perjury that all of the information contained in this
application is true and accurate p tthhe�'est v knowledge and Understanding. p
NA11-d v1 ,Gt Pkes B(�Co„ c j7j_ ?7 S'6Gs 7/3/t
I'I vlcs'rin an ign na/ne „ � /, Title Telephone No.7 I)alc
Street Address City/Town S Zip
.Municipal Inspector to fill out this section upon application approval:
Xame Date
l :1
pWUHTq.4 CITY OF SALEM, MASSACHUSETTS
v LICENSING BOARD
�T
120 WASHINGTON STREET
SALEM. MA 01 970 DAVID J.SHEA.G+AiRm Aro
.TEL 978-745-9595 EXT. 5648
JONr:H GASES
FAX 978-744-6775 RICHARDc.LEE
MEIJ;SA PAGLIARO
KIMBERLEY DRISCOLL C 1-F?K OF THE BOARD
MAYOR
HEATH DEPARTMENT
NOTIFICATION FORM
IF YOUR APPLICATION INCLUDES THE SERVING OF FOOD YOU MUST HAVE THIS
FORM SIGNED BY THE HEALTH DEPARTMENT PRIOR TO SUBMITTING YOUR
APPLICATION TO'THE LICENSING BOARD.
(this form MUST be signed and returned with your application).
NAME OF BUSINESS I ZZ f `f" 1122f�
Corporate name:
d/bb//a: J �
LOCATION: ( PIq /1 �/l I Q- J 1 `b4 — /eI
TELE.# q 7 0 -7 li ( — �
TYPE OF LICENSE -T o D p
APPLICANTS INFORMATION p�
Name: G'e0n-J
Home address:
City: State: Zip:
Home Tele.# 9 78 7 2-9 - 3 C? (�/
g79) -P1 i _ z-// 8
HEALTH AGENT/INSPECTOR'S COMMENTS:
14 Po ivl -j tj
a'�4°��rJ✓ti:><�yTl-lip t�,-c>`a\, �` Ln� 5 '1\„�� .'� ��i�' �:F)na��,�1 •DlilJiS'z��-
DATE
Health 4ggn t
health dept.notif.Form 2/09
4L 10
1067 457
x
m
I i Ln
.._— K a o
m co
E m
CO
MIS'
N..... Clear: Floor
: ::::::::: : :]. Space E N
:: :; {::{:::::1 30" x 48" iv CO
:.,
c '� n
- I ::1 762 x 1219
N
90" L
2286
Accessible Unisex Toilet Room
Figure 30d
30.7.2 Location: The centerline of the water closet shall be located 18 inches (18" = 457mm) from the
nearest side wall and at least 42 inches (42" = 1067mm) from the farthest side wall or the closest
521 CMR: ARCHITECTURAL ACCESS BOARD
30.00: PUBLIC TOILET ROOMS
30.9.1 Clear floor space: A clear floor space complying with 521 CMR 6.3, Wheelchair Turning
Space shall be provided in front of a sink to allow forward approach. The clear floor space shall
be on an accessible route and shall extend no more than a maximum of 19 inches (19" _
483mm) underneath the sink. See Fig. 30g.
171
48'
1219
432 :i'
I I
I j
1
l..:,t..:..:::._ ...:.
I g
�19"
483 $�Y
Clear Floor Space
Figure 30g
30.9.2 Height: Sinks shall be mounted with the rim no higher than 34 inches(34"=864mm)above the
finish floor. See Fig.30h. Sinks shall also extend aminimum of 17 inches(17"=432mm)from
the wall to the front of the sink or counter.
mirror
pp
0 � i l �\I \` t n
I N
811
203 152
Sink Elevations
Figure 30h
1/27/06 521 CMR- 144
CITY OF SeU.&M, U-iiSSACHUSEM
8DLNG DEPARTMST
t'_O L'B WAiHQVGTON STREET, 310 FtoOR
D& (978) 743.9595
F.ut(978) 7449846
KI.®cAi FY DRlSCOLL
�(AYOit TrIO&W ST.P1ERRA
DIRECTOR OP PLBLIC PROPERTY/IlUaMNG CO.%DBSSIO\ER
Workers' Compensation Insurance Afltdavit: DuilderslContractorWElectricianslPlumbers
knolicant information p^ / Please Print Leeill
ValTleleutin OrymtslionlroLv'idnnu4i)'
Address: 1Z 13
City/StatdZip:9), /Mild) l✓�lo- ®IFi0 PhoneN: 9 'I8�37S-S6(3
tre you a employer'Cheek the appropriate box: Type of project(requlraQ:
I.❑ 1 am a anploya with 6. $3 1 am a geneval contracror and 1 6. ❑New construction
employees(full and/or part-time).• have hired the subcontractor
2.❑ 1 am asole proprietor or partner- listed on the attached shaet: 7. ®Remodeling
ship and have ao employcea Then sub•contnctars have s. ❑Demolition
working for me in any capacity. worker'camp.inwrsnou 9. ❑Building addition
(No workers'comp insurance S. ❑ We are a corporation and its
rcquirrtl.)
of cars have exercised their 10.0 Electrical repairs or additiom
1.❑ 1 am a homeowner doing all work right of exemption par MOL I I.❑Plumbing repairs or additions
myself.(,No workers'comp. e. 152,4101 and we have no 12.0 Roof repairs
insurance required)t employed.LNG worker' I1.❑Onba
comp insurance requited.J
•Any app#cao tMr dweb box rl mtwl ate rig ua thr section below shoring Ikk warbm'tampwtudm policy infimralou
'I hwnrawrwn who subway this aaldevis indicating they an doing all weak ad than him auuida caluecNo Kraal suhmin s new anldevil indiorins sod
!r.mus+en our cheek his ban mum anaehd an a diliwul der Jawing ew true dtM otheemndar and thh.when'carp.policy inrame see.
/anon tarp/oyer that lr providlnB w rrJAta'comptrnserbe/nsnromear fo/r cry employe" Below Is flea polley and/aI star '
Insurance Company Name:- fne
Policy 0 or Self-ins.Lie.p: Expiration Date: ld LO LPJ
Job Site Address: 'Z p4r,�614__ �/ /efb'1 City/State/Zip: A119 ,
.\rack a copy of tho workers'compensation policy dedmilon pap(showing the policy number and expired"date)`
Failure to secure coverage as required under Scctioa 25A of MGL C. 152 can lad to the imposition of criminal penalties of a
tine up to S 1.500.00 and/or one-year imprisonment,as well as civil peneltia in the form of a STOP WORK ORDER and a flue
of up to 5250.00 r day ayainsl Ile violmor. Ile advi*vl that o copy of Ihis statement maybe furwarded to the OlTtco of
Invcsngatiuna ut'the DIA for insurance coverage verification.
1,14 htrrby errtijy tot%r, r a d yrnr/list ojprr/try that tM injormatloo provided ubova is a and ear►a�
do
Data: o,/ - GO
Ptwnc A
O/J7cial use mr/r Do not write in thir area,to bt catnp1rttd by dry or town n/jlrial
City or fuwn: PrrmiUt.lcenre I �
i
Issuing Aulhurily (circle one):
I. Iluard of llrallh 2. nuilding 11l.partmcM J.City/town Clerk J. Electrical Impector 5. Plumbing Inipector
6.Other
L ofact Person: _ ._ _. Phone M'
OFFICE OF
Building Co➢7CIllC]issjL®ner
}CONSTRUCTION CONTROL
PROJECINUMBER: a� CCCld)tO��F � � ��
PROJECI"[TIIE:-
PROJECT LOCATION: —7 QQ'� ,SiJN4NE &j MA
NAME OF BUILDING, v 1�,"v� �SQ l7 y''
NATURE OF PROJECT; 1--�p-+v v-�'nbb,9S ,Ly C.lU.S �(Il S`�-1 jig
IN ACCORDANCE WITH SECTION 127.0 OF THE MASSACHUSETIS STATE BUILDING CODE, 4
.REGISTRATION NO.
BEING A REGISTERED PROFESSIONAL ENGINEERIARCHTIECT HEREBY CERTIFY THAT IHAVE.PREPARED OR DIRECTLY
SUPERVISED THE PREPARATION OF ALL DESIGN PLANS,COMPUTATIONS AND SPECIFICATIONS CONCERNING,
ENTIREPROJEC — ARCHIIECTURAL_,/STRUCTURAL MECHANICAL
mkFIRE PROTECTION_ELECTRICAL_ OTHER(SPEC4 �iD ��(e-5
FOR THE ABOVE NAMEDTROJECT AND THAT,TO THEBESTOF MY KNOWLEDGE,SUCH PLANS,COMPUTATIONS AND
SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE,ALL ACCEPTABLE
ENGINEERING PRACTICES AND APPLICABLE LAWS AND. ORDINANCES FOR THEPROPOSED USE AND OCCUPANCY.
1 FURTHER CERTIFY THAT I.SHALL"PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE
CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEDING IN
ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE
FOLLOWING AS SPECIFIED IN SECTION 127.22; _
I.-REVIEW"OF SHOP DRAWINGS,SAMPLES AND OTHER SUBMITTALS OF THE CONTRACTOR AS REQUIRED BY THE
CONSTRUCTION CONTRACT DOCUMENTS AS SUBMITTED FOR-BUILDING PERMIT,AND APPROVAL FOR
CONFORMANCE TO THE DESIGN CONCEPT.
2.REVIEW AND APPROVAL OF THE QUALIFY CONTROL PROCEDURES FOR ALL CODE REQUIRED CONTROLLED
MATERIALS. - -
3.SPECIAL ARCHITECTURAL OR ENGINEERING PROFESSIONAL INSPECTION OF CRITICAL CONSTRUCTION
COMPONENTS REQUIRING MATERIALS CONTROLLED MATERIA OR CONSTRUCTION SPECIFIED IN THE ACCEPTED
ENGINEERING PRACTICE STANDARD LISTED IN APPENDIX 3.
PURSUANIT0 SE ON 227271 SHALL.SU13MIT PE UODICALLY,A PROGRESS REPORT TOGETHER WITH.PE
COMEfENTS TO THE ' BUILDING INSPECTOR,UPON COMPLETION OFTHE WOAK,iSHALL SUB
REPORT AS TO THE SATISFACTORY COMPLETION AND - READINESS OF THE PROJECCFOR OCCUP
m�GV,S C. lFnf
4
No.. U99
C BOSTON,
SIGNATURE AND STAMP (no facsimile) ny
SUBSCRIBED AND SWORN TO BEFORE METHIS4/w DAY OA✓ICI-J,O v7010
MY COMMISSION EXPIRES 3 ' / -')o
�V
NOTARY PUBLIC -