7 POND ST - BUILDING INSPECTION (2) -- - - ---- -�33 G.0 l S�l ��
. RECEIVEO
INSPECTIONAL SE�2VICES
_'y� � The Commonwealth of Massachus�j -
t� ) � '� Deparhnent of Public Safety a°'� AUG —U A � ( b '
� 4 Aiassachuse[tsShiteBuiWingCode(7SOCMR)
Building Pemiit Applic�tion for�ny Building other than a One-or Two-F�mily Dwelling
� _(Chis Section Fur Official Use Onl )
� Building Permit Nmnbec Date Applied: Building O[ficial:
� (1 SECTION 1:LOCATION(Please inJicate Block k and Lot#for lotatione far svhich a street address is not available)
.' � rq`�v
�/�� No..md Strcet City/Tmvn Zip Code Name of Building(if,pplicable) .
ry � SECTION 2 PROPOSED WORK �
�• c
Edition of MA State C�xle used�h If New Cunstructiun ch�v:k here O or check.ill Ihat apply in the two rows belaw
Esisting Building Repair❑ Altcration fi� AJdition❑ Demulitiun O (Picise fill uut and submit Appendix I)
Ch:mge of Use 0 Clumge uf Oaupancy Other ❑ Specify:
Are building plans:md/or constmction ducuments being supplied ns part uf this permi[applic.ition? Yes No ❑
Is an GidependentStructural Engincerin Peer Review,reyuired? Yes ❑ Nu �
Brief��sc riptiun af Pmpused Wurk: '' � i t. 7�' �h" _ �
�eL,��,v -+ 1L 7nlb �I�IDTTPIOLj ¢�� s� BeL
SECTION 3:COMPLETE THIS SECTION IP EXISTING BUILD[NC UNDEftGOING RENOVATION,ADDITION,OR
CHANCE W USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluallon is enclos�vi(See 780 CIvIR 3�4) ❑
Esis[ing Use Croup(s): Propused Use Graup(s):
� SECTION 4:OU[LDING HEICHT AND AREA
� . - Existing Prupoced
No.of Fluors/S[uries(include basement levcls)d�Area Per Floor(sq. ft.) `L, 2
Tutal Arca(sy.f[.)and Total Heigh[(ft.) 3 d 25� .3
SECI[ON 5:USE CROUP(Check as a Iiwbie)
A: Assembly A-1❑ -2❑ Nightclub ❑ A-3 ❑ A-!❑ A-5❑ B: �Ousinese ❑ E: EJucallonal ❑
F: Facto F-I F2❑ - FL• Hi h Hazud H-1 O. H-2 O H-3 ❑ H-�❑ H-5❑
h instituHonal I-t❑ 1-2❑ 1-3❑ I-i❑ Nh MereanN�e� R: Residential R-l❑ R-2❑ R•5❑ R-0❑
5: Storage Sl ❑ � S-2❑ U: Utility❑ Special Use O and please describe beluw:
. Special Use:
SECCION 6:CONSTRUCCfON'PYPE(Clieck as a licable) -
L� ❑ 16 ❑ IIA ❑ IIO O tIG\ ❑ IfIB IV ❑ VA O VO ❑
SECTION 7:SITE W FORAIATION(refer to 780 CMR 111A for details an each item)
Wa[er Supp�: Flood Zone Information: Servage Disposal:
Trench Permit: Debris Removal:
A trench�w�' nut be Lice��sed Dispusnl5ite
Publir� Chitk i(uutside FlooJ Zune InJic.�te nwnicipal required'0 ur trench or specify:
Privale❑ or indentify Zune: or on site system❑ v�rmit is endosed❑ �
Railroadright•of-rva • Hazudsto AirNavigu[ion: �I,-\�h r_ri:��,�n.m�� y� �i I ..��_� ��,c�...:
Nuf Applitable� Is Stmdure within airport app ch arca? Is tliur rev��w complet�J? �
ur Cunsent to Ouild enduseJ❑ Ycs� or No� Yes❑ Nu ❑
SEC710N H:CONTENT OF CERTIFICATE OF OCCUI'ANCY
@ditiun ul Cude Use Grnup(s): 'f}'pe of Cunstnictiun:�_ Occup.m[Load per Plnur: � 7
Dnes Ihe buildiny,tunL�in.ro 5prinklcr Sytitem�: Special Slipidatiuns: ____
�► A ► �� g � l� � 2� C-�,
SECTION 9: PROPER7'Y OWNER AUTF(ORIZA'PION �
N;imc and Address of Property Owner
� I �i•- l�_��j 17ei�N $,f ��.2n.., O J 9 /�
Name(Print) No.and Stree�- City/Tow Z�P �
Property Owner Cuntact hifonnation:
�' o�ln e il' `�7$-1�-�".�`�- �-�� Tu.�,�=G la�ke�ao(�o�--�
Tille Telephone No. usiness) Tclephone No. (cell) e-mail address
If a licable,th pr � erty u vner hereby uuthorizes
,�, ��, ,6 �����,s� . s���� � ��qya
N.une St Ad ress City/Town State � Zip
to.�R on the ro er uwners bchalf, in all m.lters rclative lo work authorized b this buildin ermit a lication.
� SECCION 10:CONSTRUCiION COMROL(Please fill out Appendix 2)- �
ff buildin is less thnn 35,000 cu.ff.of enclosed s ace anJ or not nnder ConstruclionConkol then check here O and ski SecNon 301
10.1 Re istere Profeasion Rea onsibte for ConstrucHon Contzol
�
- .�z�, r` r� �-7��r` z,. � � � � - t��A-
N� me( egist ant) kp ne Na �mail a s •G'�"� R�eg�stJ�atton Numbcr
��2��1�-� l 0 �l�6�4.1C��rlFf � �%l
Strcet Addres � City/Town Slate Zip Discipline - Expirafion Date
10.2 General Conhactor � � � � -
� . � �J �
V�
Co :viy`Nam - /
%ln.kv� 1����°�i -gG�. �YJDU`e-
Name of Person Responsible for Cunstruction License No. and Type if Applicable
Strcet Address City/Town , Sta[e Zip
Telc hone No. business Tcle hone No. ceil �mail addmss �
SECI70N11:4VURFEI:S'Cl7hIPENSKIIONWtiUIt:\NC1I:IPF'IUAVl7' M.C.L.C.152 25C6
A Workers'Compensation Iusurance AffiJavit from the MA Deparhnent of[ndustrixl Acciden�s must be compieted anJ
submitted with�this application. Fuilure to provide tUis affidavit will result in the denial of the issuance of the building permit.
[s a si ned Affidavit submitted with this a IicaHon? � Yes� No ❑
SECTION]2 CONSTRUCTION COSTS AND PERMIT FEE �
��e� Estimuted Cos[s:(Labur -
� and Materi.ils) Total Constmction Cust(from Item 6)_$
t. �uilding � � 8 D Building Permit Fee=Tutal Construction Cust x_(Insert here
2. Electrical Y� � � nppropriate municipal factor)=S
;1. Plumbing 5
d. �Ii�ch.mical (HVAC) $ Nute:Minimumfee=$ (contactmunicipalily)
5. bl�rhanical Other � '6 Endose check a ��ble. to
P'Y•
6.Total Cust � Q Q d (mntact municipality)and}vrite check number here
SEC7'ION 13:SICNATURE OF 6UILDING PERMI'I'e\PPLICANT
6y entering nry n.me below, 1 hereby attest undet the iins and penalties of perjury that all of the informutiun contained in this
nVplic�tion is true anal accurate o the best f i ,Y 6�io ��ge a understanJing. ' .
` z r��_ �-�� -s�-t
Plecue p mt an sign na ne � Title clephune i lu. Date
( L�,vu�oy r i�a Y� ��.�i1,� D l 9 77�
Strcet Atltlll'S5 City/"Pown State Zip
i�lunicipal Inspector Fo fill out this section upan application appmval: ��M Q �a �'
Name Datc
-- - ___ --- �
• � CI'TY OF S��LE:1�i, i1�r.�SSr1CHL'SETTS
BtiIID4�iG DEP�A'P�ffS1T
:.� ' � l20 WASHiNGTON$'CREET,3'O FLOOR
'I�L (978)745-9595
F,�x(978)740-9&16
��tgFR} FY DRISCOLI.
j�1AYOR TrtOhus ST.P�RR&
� DIRECTOR OF Pl:BL2C PROPERIY/Bl'1LDLNG COJL�QSSIO�iER
Workers' Compensation Insurance Affidavit: Suiiders/Contractors/Electricians/Piumbers
Applicant Information Plcass Print Leelbiv
Vame �s�:��.�:o�6,naa�iomin����auaq: 0,i�d 6��^titie� d6q l3��h.,n.,� CMS'f�K�;�n
Address: t� I 1� ��e�� S}.
CitylState/Zip: p��bvd� Phanell: G�S S3 !• �3�3
Are you an employer?Cheelc the appropdate box: Type uf project(requlret�:
1. I am a em lo er with�_ 4. 0 I am a gencml conaactor and 1
� P y + have hired the sub-conuacmrs 6. ❑New constcuction
employees(full andlor part-dme).
2_Q 1 am a sole propriccor nr purmer- lis[ed an�he attached xheet� 7• �Remodeling
ship and have no employeex These subcontractors have 8. ❑Demolition
workin for me in an ca aci workers'comp.insurance.
8 Y P 9'• 9. ❑Quilding addidon
[No workers comp. insumnca 5. � We are a car�wration and its
required.] . o�cers have exerciscd fhe'v
l0.0 6lectrical repairs or addiuons
3.Q 1 am a homeowner doing ail work right of exemption per MGL I i.�Plumbing repairs or addiNons
mysclf.(No workers'snmp, c. t 52,§1(4J,and we have na �Z,[f Roof repairs
insurance required.J t cmployzes.[No workers' �3.0 Other
. comp. insurance required.]
•Any oppliunt Ihat chcclm box dl muct aiw Ril uut ihe scetioo bcloweMwing thc'v urorken'compe�saiiun policy inCumudon.
�14�meownm w}w sudmit Ihis a�dav9 iMicating Ihey am doiny ail wo�ll and thaf hirc outside contr.�ctp�mWt wbmit a naw afliJavil indirWiaB suclt
�Comraton iM1 ch rY�hia Dox m�t�Hxhe�an:Wditiu�ml chxt shawiup�M name oEtM aub-eentnclon and iheu avrkcra'cwnp.poiiry infomu�ion.
/um un aap(oyer thut fs providing workers'compensadon inaurance far my empluyees. Be%w is tke poltcy and Jab siur
rnjorrawion. �
Insurance Company Vame: ���'��s�1 �• ���c� / �����S �n �,���w
Policy H ur Sclf-ins.Lic.H:_�_ i'� U Q ' ���5 g P�/• / Expiration Da[e: 9I1��IS ..
JobSireAd�in�ss: `1 P�+al $�cC� LirylStatelZip:__Sa�cm� f�'lfl �) q?d
,�ttach a copy ot the workero'eompensatioo polity declaration page(showing t6e policy number and ezptrallon date).
Failure to secure cove�age as rcquired un�r Seclion 23A of�iGL c. 152 can lead to the imposition oferiminal penalriea of s
� finc vp;o St.500.�0 and/or one-year imprisonmcn4 ns wetl ae civil penalties ia the Corm of b STOP WORK ORDEA'a�d e fine
of up to S2i0.00 a duy a},reinst dm violator. I)e advi.ud[hat a copy uf this staccment may b�:fonvarded to lhe Office of
Invcsligaiioac ul'ihn DIA for insurence coverage veritieation.
/do lrerrby crrtijy under the palns m�d penaltles of perjury thut the injormutlon pravided ubove is/rut artd corrrct
Sirnature: X °� �-ue,.{�,ain.(hn Uate• R�l9IlS
Phone�: �'1)R 531� 13�3
O�cial usr anly. Du rmt wrrte ix�his areq te be eurnplefed by crty or fown o�ciaL �
Ciy or'Cuwn: PcrmiNf.lcense#
l�suing Aulhority(circic one): _
I.lluard o(Fle•rlth 2.Building Department ].Cily/I'own Cferl� 4.Electrical [nspector 3. PNmbing Inspeetar
6.Other
, Cuntact Pcrson: ' _. Phone#:
' . .. . .___._ _ . . . . -
._ _
C�TY OF SALEIV� MASSACHUSE 7TS
{ .� BUILDINGDEPARTMENI'
120 Wnstm�rcro�vS�r,3'�Fr.00x
' 7�L(978)745-9595.
FAX(978)740-9846
RIIvIBERLEYDRIS�LL
MAYOR 7l�oMns ST.P�xxE
D7RECTOR OF PUBLiCPROPERTY/BIIII.DII�aDhIId[SSIONER
Construction Debris Disposa/Affidavit
(required for all demolition and,renovation work)�
.In accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris,
and ihe provisions of MGL c40, S 54; Building Permit�1 is issued with the
condition that the debris resulting from this work shail be disposed of in a properly licensed
waste deposit facility as defined by MGL c 111, S 150A.
The debris wil! be transported by:
� � � �i�. �
(name of hauler)
The debris will be disposed of in:
�� �,
(name of facility)
(address of facility)
Signature of appiicant
Date
�
_ ' ��r:, �
� �t�tias�,' Z d
��� �'�NL�O��`;� � ~ ro
� U
_vo. ia�.= ` ��:; ll' � °r' o
SALE7A �ft � — j
0
. .. R9A ���� =w � �
, Ty,�'� � U�- rn �
' " � ��oF�� � Qu�i � ¢
I r � z ¢ �
oW � =
wo �
c�
� W a J �
� (j� � a
— AREA OF WORK - — - - - I • — - - — - - — - — = w OOO
U o� �
3' -6" EW LANDING PLATFORM I � � w
❑
LUSH W ITH EXIST.DOOR TRHESHOLD �
AND WITH REMOVABLE PLATFORM TO
CCESS EXISTING PLUMBING CLEANOUTS
1 tn N SLAB BELOW j� _
}�
o la I
O
11 ' — ' — ' ' ' — ' ' ' ' ' � -'
' I` I I � _II
� II � r �
2 7"RISERS AND
1 11"TREADw/HANDRAILS B.S.@36"AFF I�i F- � � M
U �
T
� EXISTING TO REMAIN — I I � m w J
� - - - II � � Q U
� _ - - _- - - - �'� dZ � v7
� II
� II
m ii
� - — -
SCOPE OF WORK
� 1.ADD LANDING AND TWO STEPS AT EXISTING ENTRY TO 1 ST
I FLOOR �
2. BUILD W ORKSHOP OFFICE AT SECON D FLOOR;ADD
PARTITIONS AND DOOR AS SHOWN ON DRAWINGS,AL50 ADD � �
DROPPED CEILING, DUPLEX WALL OUTLETS,AND LIGHT FIXTURE
' PER TENANTS SELECTION AND OW NER'S APPROVAL. J O
( J Q
CODE ANALYSIS � r^ �
BUILDING TYPE:3B EXTERIOR MASONRY BEARING WALL, � v/
UNPROTECTED (SS (IS �
EXIST.TOILET RM. � USE GROUP:F-1 INDUSTRIAL MODERATE HAZARD p v �
I -FIRST FLOOR FURNITURE REPAIR AND REFINISHING
-2ND FLOOR-WOOD CABINETRY SHOP. � (n
ACCESSIBILRY:NEITHER BUSINESS FEQUIRES PUBLIC ACCESS,
EXSITING WALL OF CLOSETS � � �
AND W ILL BE CONSIDERED PRIVATE USE,THEREFORE MASS 521
CMR DOES NOT APPLY,HOW EVER,TOILET ROOMS ON BOTH .0 J �
-_ � FLOORS HAVE BEEN CONSTFUCTED TO COMPLY W ITH 521 CMR i O �
� - - -_- SHOULD THERE BE A FUTURE USE CHANGE. �
.. . . ... . . .... .....
� _ �
� N o
a
� U �
DWG NO.
� FIRST FLOOR PLAN 1 •„
� 3/16" = 1'-0"
INSTALL MOISTURE-PROOF }F....�7.�' . � . �
- BLOCKING BTW.WALL AND GLASS � # . _ ` n
r ,.rpF �
Cf..._ �
V�A � O
,S �����}�G�,�,�+� � � ^ I
�( �
... ._. ,� � � ` � U �
-b. l�S1a � �.6.: �— LLI O^i
� p SAi.'",c /4t': 4� ~ �
y � .� 6in s ,4�. � = o >
+ W NEW � F'f� . �c :�`s n..,�,C'� � �� o w
. �•�� � QzQ �
- r. Z.
n � WORKSHOP r
' � OFFICE EXIST. W O � _
`D w FURNACE
LL ` � � Q �Q � (.7
MAINTAIN ' � �C7 a �
� o� MANUFACTURER'S � (n �/7 a
� REQUIRED-I �j+�
AREA m CLEARANCt� Ir , w �
OF I r` V � Q
WORK
9'- 7 1/2"+/- � O
0
FIELD VERIFY � �
- — - — - — - - - � - — - - — - -
0
n �
I N T
� � II
r T �
Q
M M
� � �
I EXIST RAMP UP 5"+/- w m O �J,j
� � �-- Q
OC � Q U
I � Z � Cn
0
r
U �'
J o
I EXISTING OVERHEAD � J Q
DOOR O (n �
EXIST. j �! �
TOILET ROOM I � Z �
� � �
c� J a�
� .� � �
- s�� � _ �
� N �
0
s'- o�� c� U �
MIN. DWG NO.
n SECOND FLOOR PLAN n.A
3/16" = 1'-0" �