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9 PICKERING WAY - BUILDING INSPECTION (2) %; , 1 ,;, � /��'�' , PUBLIC PROPERTY � �� '�� DEPARTMENT -�. f KI\MF.RI.EY DRI5(:Ull. Q' �'� MAYOR � . 1?O WASHINCI'ON S'IHFFC�SMBM��SAS5.1GiCS6l'IS 01�70 J ', � '[�i 9?8-745A595 � Fnx:97&740-9&I6 APPLICATION FOR THE REPAIR RENOVATION. CONSTRUCTION. DEMOLITION OR CIiANGE OF USE OR OCCUPANCY. FOR ANY EXISTING I STRUCTURE OR BUILDING �� 1A SITE INFORMATION ` v� LoCation Name: ��i�/�� ljt��/T�� Building: ��/�,��'� � Property Address: �G�—�//x� W n 7 Property is located in a; Conservation Area Y/N Historic District Y/N o - _ 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land . ' Name� �/G/�j2! �K�''t K'� �I2 �T `fJ Address: Z.�j Cv�G, ✓� �rS s� � 5�-� �t,{y�- O L q 7 d Telephone: 9'7$ b �L � 3.0 COMPLETE THIS SECTION FOR WORK IN EXIST�Nr BUILDINGS ONLY � Addition /U� Existing Renovation Number of Stories Renovated / s B,�/L� � Change in Use ��'� New � Demolition �'�� '�'�� Existing � SF � Approximate year of 2� Area per floor (s� Renovated �� construction or renovation � of existing building New f3riPf Description of Proposed Wo��T, s�p�� 7--tj G o�tJl/�✓LT l�� !�J��T l �C� v7`afLA-C� �'2�- �c`�'L oc�uP�d-u�r' � ►��G1�� w,ct.4-ll-�' �s��. i�2 � P�-�') ZZ 2,� � � � ��D /�GLv/�� S� aC�� — - - - - —, - - - - - - - - __ - — - - Z�- ��C9�/1=�55— -.--��t'C,��-r, /�f,4- - ' Mail Permd to: __ � � sT ��,c� // � What is the current use of the Buiiding? �1�T2 ��.�r� ��,Q�J Material of Building? WC��j-f�if�f dwelling, how many units? Will the Building Conform to Law? Asbestos? /�- � ArchitecYs Name �v/�p� ��L6K� G2�v�i GT'� - Address and Phone i�K ��J3 �='�� ( ) Y78 �� Mechanic's Name �� Address and Phone ��Cyi�7� �� P�'�� S� i tit 'L-!�� Construction Supervisors License# 05'4'1� 0 HIC Registration # ti(� ' Estimated Cost of Project$� <<'�� PertnR Fee Calculation Permit Fee $ Estimated Cost X $7/$1000 Residential ' Estimated Cost X$11/$1000 Commercial _ An Additional $5.00 is added as an Administrative charge. �( �3� ' �� ' Make sure that all fields are properly and legibly written to avoid delays in processing. ��'�� , Co�vS?'.eu cTl� , � The undersigned does hereb'y apply for a Building,Permit to build to the abQve stated , - �, . , . • I :� , , . � 1..4._..., � . . specifications. Signed under penalty of perjury � ' a :.. � - � ,; � ' � `Date -1` S O� � �'• I � �� . � 0 1� � � o :. � ` '�N • _ . ' �. . '�.� , ,' � �, • �., , � ., . ' � a 1 � � .. ,i' . OD ` � . � + � � N�� .�i� � � s . :d . , ti �, `' A � . . _ V �� 9 � (�.. � � • . �, t t � � ' ~ O d vV � w e" L� \ . o a '' �, � '' '^ � . . � , , . �k Q � L � a ` _ r V' � � � � � � ^ 1�. d --__--_� � d -- �-._._°a_._ _a- _Q---_,-..=---- --------•-� ----=— __ ----�_ - - - - - — -- -- - --_.._ . . - - - - --- - - _ _ _ � CITY OF SALEM ;;� - ' PUBLIC PROPERTY ��'�{ DEPARTMENT KIA(BERLEY DRISCO[l MAYOR 1ZO WTSHINGTON S'IAEEI'� SN.EM,i�SA1SACHUSETIS 07�70 . � Tec 978-735-9595 � Fnx:978-740-9846 Workers' Compensation Insurance Afiidavit: Quilders/Contraetors/Electricians/Plumbers :1 � licant lnformation Piease Print Le ibl Vel'riz (BusinesslOrganiza[iodlndividuul): Y / ,address: l�� CaE%!'�2 J 7r �T ( �� !�� /'�-�ll�'� Ui�J City/State/Zip: 0�1•�1/L�v�� Phone f�: 7g I 6�9 � �� :�rc •ou an employer?Check thc u�propriate Dox: . 'Pype uf project(required): 1�1 am a cmpluycr with 4. ❑ 1 am a gcncral contractor and I g. �Tew construction employces(full and/or pnrt-tima).' have hired thc ,ub-conlractors � �Remodeling Z.� 1 am a sole propricccx nr partnu- lisrad oa che nttached sheet.� ship:utd have no employcus These sub-contracrors have 8. ❑ Demoliuon working f'or me in:my capacity. workers' eomp. insurance. q, � puilding addition �1�o workers' cump. insurance 5. 0 We are a corpora[ion:uid its 10.� Elec[rical repai�s or additions . rcc�uireJ.] otlicers have eserciceJ their 3.❑ I am a homeownr.r doing atl work right of exzmption per MGL ��•Q P�umbing repairs or acWitions . myself.(No wo�•kers' cump. c• 152,§t(4),and we have no �Z,O 2oc�Fnpairs inwrancu reyuirzd.J t cmployet,. [No workers' �3.❑ Other � comp. insurance nquired.] •nuy:,>plicnnt�hut chccks box BI muct alao lill ual ihe uclion lwlaw showinq ihair wort�xi cumpenu�ion pulicy infurt�tion. . 'F Wmeuwm:n who aihmil this aHSdavit inJiuting ih�y am Joing ull work and Il�rn hUC uutside contmclon muxl aulmiil a new affidavit�indicaling euch. �Con�rxwn�ha�check�his boz muc�.ai�xh�xl�n od�fiiional xhee�showing tlu nsme of�he sub�coneracton and iheir worlceB comp.pdicy infurtnariun. I am ui� en�p(oyer lhat is pruviding�vorkers'compensntion ii�curnnce for my euiployee.c. Be/mv rs Ore palicy unJ j�b site .. ;�,f��„�u�,�,�. r_ P__ ,C�S_ �� •. z� I Insurancr Company Vame:�'�'�!s. ./_—_'_ � i, policy#or Self-ins. Lia fi: ��I�7'�/�� p�rat�on Dace. �l/ �II lob sl�e .�ddre�s: � ��'�—��IUF� � . City/Statt/Zip:-�-^=��[ '�s-""' �H� O� t 7� I .\Mrch a cnpy of the�vorkcrt'compcnsatiun policy declaration page(showing the policy numbcr und expiratiun datc). I�ailuro io secure coverage as requireJ under Sec�ion 25A of�tGL a 152 cau Iead to the imposition of criminal penalties of a tine up co S1,SQOAO anJ/or one-year iinprisonmcnc,as wcll us civil �x;nallics in the f'orm of a STUP WURK UltDE2 and a fine of up tn $2i0.00 a day against the violaror. [3c adviu:J thut a copy uf this s�at�:ment muy be furwarded to thn U17ien of In�'cstigaiious ol'thc DIA for insurar.ce covtrayc va'iticatiun. /do herrhy � ' tui e� r pr�ins miJ prn 'es uf perjxry that dte iiijor�nu!!an pruvideJ'uGove is trr�e unJ correcL SILt1iiI111'C: I)'IC: ` ` S�OL ,,h,,,,�.;. `78/ � �9 7��z `7g! 7"7S967s'- � Ojficiul rue mdy. Do not�vrire in d�ix urea,tu be cumpleteJ by cily ur rmvn af'JiciuL City or To�rn: -_-.__.--_— PermiUl.icense# Issuing Aulhority(circle onc): I. Do�rd uf Ileulrh 2. 13uilding Dcparhnent 3.City/fown Clerk 4. Electricul Lupcetor 5. Plumbing Inspector G.Olher _ Cnntact Person: _ Phonc ii: ._-------- - -- Information and Instructions D�fassachusetts General Laws chapttr I�2 reyuires atl employers to provide wurkers' mmpensation fur their employees. ' Pur;uant to this siatute,an emp(uyre is defined:u"...evzry person in thz service uf anuther undar any contract of hiro, express or impliud,oral or writ[en." :1n rinplop�r is dcfined as"an individual,partnership,association,corporation or other legal znbry,or any two or more of thc tbregoing engaged in a joint enterprise,and including[he tegal rzpresencaeives of a deceased employer,or ehe �� receiver ur trustee of an individuai,parh�ership,usociation or othet legsl endty,zmploying amployees. However the owner of a dwelling howe having not more than three apamnents and who resides therein,or the cecupant of the dwclling house of anorher who employs persons to do maintenunce,construcuon or repa'a work on such dwelling hause or on che gro�nds or building apputtenant thereto shatl not because of such zmployment be deemed to be ttn employec" �1GL chaptzr 152, §25C(6)also statas th•rc"every state or local licensing agency shall N•ithhold the issuance or renewrt ot a liccnse or permit to operste a business or to cons[ruct buildings in the commonwe•rtt6 Cor nny applicant who has not produced acceptable evidence uf compliance with the insurance covernge required." Additionally,MGL ch�pter 1 i'_, �25C(7)states"Neither Ne commaiweal[h nor any of its political subdivisions shall antzr into any contract for the perfom�ance of public work until acceptable evidence of compli;u�ce wi[h tht insuranee requirements of this chapter have h`etn presented to the contracting authority." Applican[s Please fill out the workers' compe�uation affidavit completely,by checking the boxes that apply to you�situation and, if necessary, supply sub-contractor(s)n;une(s),address(es)and phone nwnbet(s)alon�with their certificate(s)of insw'ance. Limitzd Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the , membzcs or paRners, are no[required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised tha[this affidavit mxy be submitted to the Depaztrnent of IndusRial Accidents for confimiation oP insurance coverage. Also be sure to�ign and date the uCtidavit. Tiie aftidavit should be rctume�to the city or town that the applica[ion for thz pennit or license is being requested,not the Department oF lndustrial Accidenfs. Should you have any yuestioas regarding the law or if yuu are required ro obtain a workcrs' compen,ation policy,please cail the Departrnent at tt�e number listed below. Self-insured companies shoutd anter their sclf-insurance license number on the appropriate line. City or Town Offlclals Plcase be sure that the affidavit is complete and printed l�gibly. The Deparhnent has provided a space ut the botwm of die afficlavit for you to fill ouc in the event the Office of Investigations has to contact yuu regarding the applicanc. Please be sure ro tili in ehe permitAicense numbar which will be uszd as a reference numbzr. [n addition,sn applicant thut must submit multiple pennidlicense applica[ions u�any given yeaz,need only submit one affidavit indicating curtent � policy,information(if necessary)xnd under"Job Site Address" the applicant should write"all locutiuns in (city or [own)."A copy of the afticluvit tha[has baen officially sWmpcd or marked by che city or town �nay be provided to the applicant as proof chat a valid�fFid•rvit is un file f'or future pertnits or licenses. A new atliduvit must be tilled out zach year. Where a home owner or citizcn is abrrining a license or pznnit not related to any business ur commzrcial venture (i.e. a dug license or permit ro burn leaves etc.)said person is VO'I'required[o complete this affidavit. �fiic OI'tice oF Investi�ations woutd like to diank you in udvance for your coopera[ion and should you have any qutstions, ploast do not hesicate m give us u call. Thc Dcparunent's address,telephone and fax number. The Commonwealth of Massachusetts DepaRment of Industrial Accidents Oftice of Investl;aUons 600 Washington Strcet Boston, MA 02111 Tel. #617-727-4900 ext�06 or 1-877-MASSAFE Fax#617-727-7749 at�;.�d 5-zr�-os www.mass.gov/dia � CITY OF SALEM ia ,{," PUBLIC PROPERT'Y �,;��-� DEPARTMENT KIAfHERLEY DRISCOLL MAYOR 120 WdSHING"CON$'IREE'1'� $ALCM�MASSACHUSETTS 019�0 � 'fe.[.:978-745-9595 � F,vt:978-740A846 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 l t 1.5 Debris, and the provisions of MGL c 40, S 54; Building Yermit# ___ is issued with tne condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c lL1, Si50A. The debris will be transpoRed by: r �n�r, � � C'.�i-6 (name of hauler) Tlie debris will be disposed of in : ��'�� n� (n:une ot facility) �i'��I Gf ,4scc�Tr�- � (address of f'scility) ---��%%'/��'�---�_'�� signature of ptnnit appLcant �/�� date Jebrisat7.doe 07/12/2006 WED 12:50 FAX 1 781 639 2290 ROCKETT REALTY IQ 001/002 ACORL�, CERTIFICATE OF LIABILITY INSURANCE oa�zs�� + (617)720-6333 FAX (6177 723-747 S THIS CERTIFICATE 1918SUED AS A MATTER OF INFORMATION B. 'R. A1 exi�IdC� 8 Co., Inc. OMLY AND CONFERS NO RIGHTS UPON THE CERi1FICATE SO Con ress Street ��0�TMIS CERTIPICATE DOES N07 AMEND,E%TEND OR g ALTER TNE COVERAGE AFFORDED BY TNE POLICIES BELOW. Suite 530 � Boston, t4A 02109 - INSURERS AFFORDINO COVERACiE NAIC p asurs�W age Ca�stwct�on, Inc. �suaEan: Associated Faployers Ins. to. Atte: Rebecca May uuuR�a 190 Pleasant Street iNsuaaec Marblehead. MA 01945 Msu�ea QJSURER E: ' C� THE POLICIES�&iSURANCE t1STED BEIOW XAVE BEEN ISSUE�TO THE INSURED NRMED ABOVE FOR THE POLICY PERlOD WDM,ATED.N07WIiNSTANOMG ANYREQUIREMEM.TERMORWNWiKRV�ANYC�IiRACTOROTFffRDOCUMENTWRHRESPECTTOWF6CHTHISCER7'IFlCATEMNVBEISSUEDOR � MAY PERTAIN.TNE MSURANCE A1-FOR�D BY7HE POLIqES�SCRI�D NEREIN 6 SU&IECT TO N11NE TERMS.EX(AIJSIpNS ANp CONqT1pN9 pF SUCH POLtGES.ACaGREGATE LdARS SHOWN IdAY HAVE BEEN REDUCED BY PA�CWMS. � INSR tYPEOFitM11NANCE PoLICYNUMBRR POIACY6FECINE Pol1CY iION UbIRB a��Y EACHOCCURRENCE f COMMERdAIGHdERALLIRBiIT' DAMAGETORL3JfID $ . CLAIfdSMADE ❑OCGJR ��I/�Y�Pe�nJ S PERSUNALBADV�NJURY $ . GENERALAGGREGAIE E C+INIAGGREGAiELIMRAPPLIESPER PRODUCTS-COMPIOPAGG 8 �. POIICV JE�GT LOC AUTOAfO&LELU1&I.ffY COMBWEDSMGLELIMR ANVAVfO (��b� E ALIOWN�AU705 BODILYMJURY . � SGWEDULEDAIlfOS l�rP��) $ � MIRmAVf0.4 BODILVINJURY NON-0WNEDAVTOS �� f � PROPCaittDAMFGE $ (PoraaitleM) ONNOELNBILITY AUTOONLY-EAACGDENT 4 � ANVAUtO OTHERTHAN EAACG $ AUiO�ILY: AGG S EXCE9SUMBREl1ALU&LITY EACHOCCURRENCE S � OCplR , �qAIMS M0.bE AGGREGA7E 8 . E O�UCTiBLE y . RETENfiON $ g woauenscoxra+ra�u�o MKC5001342012006 03/11/2006 03/11/21W7 WOSTAn- X °TM� taanav�cs•uaeiutr J� ANYPFtOPR1ETORIPARTNERl�2l.VtNE ELEACHACGOkT)T S SOO OO � . OFFICETLMEMBER IXCLUDED? � ELDISEASE.EA@APlO S SOO �tl dex�Deuntler .. 8w�vaowsotusceww E.�wsens�-voucrumfr s S00 � rnxei oE.urtwnon oF a�eamr�s i wcnraas r voxc�Es r e�ca.uuswws noo�ev e�oortseaar�svEeua rnovrswns C FlC (� SMOUIDRNYOFT1EA80VEDESCRlB�PO4GIESBEC1iNCB.IEDBEFORE7HE . E%PIRIUION OYqE 1MHtWF.7NE(SSUINO MSURER WILL QIOFAVOfl TO MAiI �W05YIRqTB7qOi10ET07MECQtTIFICNTEIWLOERNpMEDTOTXELEFl, , � &J!iA1LURE M MM SUCN NO7ICE S/UW.IA�OSE NOOHLIGAiION OR LN&LITY OF ANY qND UPON TME iNSURER.RS AQHJIS OR REPRESEN7ATIVES Rxkett Managanent & Realty Conpany AU�I�R@RESIXrATNE ACORD 25(20D9lOSy - OpCORD CORPORATION 1888 .iune 23, 2006 � Thomas St. Piene, Salem Building Inspector Salem Building Department 120 Washington Street Salem, Massachusetts 01970 Re: Tancook Storage Project (06-074) Pickering Wharf Wharf Street, Salem, Massachusetts Mr. St. Pierre, Based on a review of 780 CMR table 3403 (hazard index), renovations for a moderate hazard storage use (S-1) at the first floor of the Tancook building in an azea that has formerly occupied for both assembly(A-3) &mercantile (M) does not increase the hazard index of the renovated section of the Tancook building. 1. Moderate Hazard Storage use (S-1) Hazard Index (3) 2. Assembly(A-3) Hazard Index (4) 3. Mercantile (M) Hazard Index (3) Based on a review of Salem Zoning Ordinance article V— 5.2 (use regulations), the renovation for a moderate hazazd storage use (S-1) at the first floor of the Tancook building in an area is a permitted use within the BS zone. 1. Moderate Hazard Storage use (S-1) Accessory Use (17) If you have any questions regarding this project, please call my office. Sincerely yours, Ste W. ivermore P ' itect SWL/tancook storage lnl Rumpf Desi�n Group, Ltd. Architec[ure, Engineerirsg, & Construcrton Consul[ing 70 Wharf Street Box 4483 Salem, Massachusetts 01970-6483 978.590.5555 978.740.5000 fax June 23, 2006 Thomas St. Pierre, Salem Building Inspector ' Salem Building Department 120 Washington Street Salem, Massachusetts 01970 Re: Tancook Storage Project (06-074) Pickering Wharf Wharf Street, Salem, Massachusetts Mr. St. Pierre, Based on a review of 780 CMR table 3403 (hazard index), renovations for a moderate hazard storage use (S-1) at the first floor of the Tancook building in an area that has formerly occupied for both assembly (A-3) & mercantile (M) does not increase the hazard index of the renovated section of the Tancook building. 1. Moderate Hazard Storage use (S-1) Hazard Index (3) 2. Assembly(A-3) Hazard Index (4) 3. Mercantile (M) Hazard Index (3) Based on a review of Salem Zoning Ordinance article V— 5.2 (use regulations), the renovation for a moderate hazazd storage use (S-1) at the first floor of the Tancook building in an area is a permitted use within the BS zone. 1. Moderate Hazazd Storage use (S-1) Accessory Use (17) If you have any questions regarding this project, please call my office. Sincerely yows, / St en ivermore P jec chitect SWL/tancook storage ltrl Rumpf Design Group, Ltd. Architec[ure, Engineerirsg, & Constr¢crion Consul[irsg 70 Wharf Street Box 4483 Salem, Massachusetts 01970-6483 975.590.5555 978.740.5000 fax - - — , . 1_ ' " ' _ ' _ _ ' _ ' ' ' ' ' ' ' ' ' _ " ' ' ' " ' ' ' " ' ' ' ' _ _ _ _ ' ' ' ' ' _ ' ' _ ' ' ' ' ' ' ' ' ' '." _ ' ' ' " ' ' ' ' _ ' ' ' ' ' ' ' "'' _ " ' _ _ " ' _ ' ' ' ' " ' " " ' ' ' ' ' ' ' __ " ' ' ' ' ' ' ' ' ' _ ' " _ " ' " ' _ ' ' ' ' ' ' ' ' ' ' ".' os�s aa�� ' ' ' ' " � � � {I � .. . � y/°G'�gi��y Hi~° � �. ; �� q4+�� ' � � a o �1 ; � � � y No. 5294 � � i � I �' SALEM, ; ��o� � S. s ; � � � � 'n�4 ' RnmPf�80 �P iI 2 3 C) �✓ .I �o ; s�.�e�n�me mv�re�.w� , ------- ' , �-------- ------- ---------- --- ; � -� ; � � � � � � �� , 6781'p*!tl fa ', � � � amum � � � \ � i � , � � � �� ; � � � � , � � — — — � � I � � � I I � ' �.N� � - - - � I I I I ,, I II � I �� rdg ��-(I�96 , � � . , � I � , � ; .1 II � ; 11/26/�h � ----- ------- ------ � � , I —J I . \� x> us ua.w q: � � � , � — — --- -------- — — —O � �, m�eams � � � —————— � \� � � �aims Lapuc w ; I I I I - I- \ ,q.� ; ; Ret I Space CI,11m± se) 1 , , 1 , � ; 1 , - , � , ; 1 ; - � � , �,� g Condominiam ; � � I �'� I �3 I �� I � I �6 1 � I � — � � Storage Facihty � J LJ LJ J L � �J Hotel S r � ; 4'�"' C14�+ sfJ � , ; Storacje Unrts �1 - �o - 3m+ sf � gi I ; R,�`°°�`�• ; � I � � C838± �.=�) � � � � � ; es wn�r sv�c I � 5alem,Meaea eecta ' . � � y�' r� � � , � 0 � � //�� i . Q . r g,_0. _— T_ _ _ �(r ,. � . � � L� __ _ � � v , + ' I I I ' � Trash oom � I � I � I � ; i---� � � C2�l4+ s ) � � i F �� --i--- � � � i ; First Floor Pfan � � I � � � � � � � 5'�. � ' ' �---� �� I - --+-- - I ; I ; I � ' � I ; � I ; ; I � � � ' � � �� , � ' L----�------ ---------- -------------� � 1/4. _ ��_�� -p-� � �� LQ.L�� 1.leJS� � ; Y {50°!o OF NOTED SCALE) ; A 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -_ - - - - - - - - - - - - � - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -_ � �, - - � 1 �irst �loor Plan CSch�me #2�, I/�-" 1 -� ��, �� ,04� � ,