19 SALEM ST - BUILDING INSPECTION (2) , .� ... „ ��:G� • -G�';��� ��
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,. ;�. � The Common'wealth of Massachusetts
�• �,� � • Department of Public Safety
�v-...j \la...cxhu>ell>til.ilr Buildin�6�ude 1%E3�C\IN)Se�•enth Editiun
� City of Salem
� Buildin Permit A lication for an Buildin other than a 1-or 2-Famil Dwellin
�/ '
(ihis tirctiun For Official U.<r Onlv)
liuilding Prrmrt Numbrr. Detr AppliaKl: Building Insprctur:
SECTION 1: LOCATION IPleaae indicate Block N and Lot N for loeationa for which a streef addre�s is not available)
� SAPM Sr' Sf� e.*� ew45S O/9j0
V��. ,�ndtilrrrl Cil�' /Tu�rn ZiE�Cudr NamrufBuildin�;�i(.ipplicablr)
SECT►ON 2:PROPOSED WORK
, If Nrw Cunstructiun check hrrr O ur chrck.iU that apply in thr�wu rowa brluw '
Eristing Building Repair O Alteriliun ❑ Additiun O Drmolitiun O (Plrasr Fill out and,ubmit Apprndix 1)
ChangrofUse O ChangrufOccupancy O Other ❑ $prcify:
Are building plan.and/ur corutruttiun d�xumrnls bring supplied as part uf this permit opplicatiun? Ye� O No O �
Is an Independenl Structural Enginrrr Peer Rrvirw required? �/ Ye� ❑ No ❑ �
Briif De+criptiun�f Prupo+cK1 Work:_��l � /u f���/��.f,� aT�9. 3D/�c�eo'
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SECTION 3:COMPLE'CE TH1S SECI70N IF EXISTING BUILDING UNDEWGO[NG RENOVAI'ION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) O � � '
Existing Use Group(s): Proposed Use Group(s): P
Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34:
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
Na of FIWrs/Stories(include basement levels)&Area Per Floor(sq. (tJ .
� Tutal Area(�. ff.)and Total Height(ft.) � �
� SECI70N 5:USE CROUP(Check as a licable)
A: Aseembly A•1 ❑ A•2r ❑ A-2nc❑ A-3 ❑ A-4 O A•5❑ B: Bueiness ❑ E:�EducaHonal O"�
F: Facto F-1 ❑ F2 0 H: HI Hazard H-1 ❑ H-2❑ H-3 ❑ H-4 O H-5 O
I: Instituttonal I-I ❑ I•2❑ I-3 O I-1 O M: Mercantlle❑ R: ReeidenNal R-1❑ R-2❑ R-3❑ R-t❑
� S:'Stonge SI ❑ 54 ❑ U: Utiiity❑ Special Use O and leaar deurilx 6etuw: -. ,
Special U,e:
SECI'ION 6:CONSTRUCI'ION 7YPE(Check as a Ilcable►
tAD IBO IIAO . IIBO IIIAO IIIBO IVO VAO VBO
SECTION 7:SITE INFORMATION Ire(er to 780 CMR �11A for detaila on each iteml
�Yater Su I Flood Zane Information: Sewage Di�posal: Trench Pertnit: Debria Removal:
PP Y� Licemrd Di.��i..d tiite O
Public ❑ C heck il uul.ide Piuud Lune❑ Indic.ite muNci�.al ❑ '1 trrnch will nnl be
, rcyuirrd���rtrench ��r.p�tiih':
I rn��ilv❑ ur indentd��Zunr: ur un.itr.��.trm O F,rrmit i>cndusr.t ❑
Railro�d righbof-way: Hazards to Air.Vavig��ian: �i:� i s.u„�, c,��mn�..���„ H.•���,. I'r�„�..
\nl :\F�F�ha.ddc❑ I.titruclin�c�ri.lhm airpurt,iF+��ru,irh arr.�' I.Ihry rc��ir�r cuni�,lclyd.'
I ,�r l�,�n.cnt lu Hudd rncL�vd ❑ . 1'c.O nr.Vu❑ '1'r.0 \n ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
li.iili��n��i (�,�dr:� l�r(;n�u�,l.l: ��f+cullun.l«iilwn: l/cai�+anlLnadE�crfln��c .
I����•.thvbuddmti.��nl,un,intiE�rinkli�r?c.lcm': �F,cci,iltilipulauun.�
� ' • • ,
SECTION 9: PROPERiY OWNER AUTHORIZATION
Vame,�nd Addrr�.ol Pn�p.rlv Ownrr
M�'c N9� t lrTrtt/� /7 �fJ�F�J�`T .Ss z�iu 1�165 a/j7 C�
� N.�mr IPnnl) Nu.and titrurl l i W/�own Lip
('nr�,a�rl�•U���nrr(�unWct Inlurm,iliun:
�(�1�P/ �l- SS S' S63 U _- � �
Tidr Trlrphuna Nu. Ibusinrs�) Trlrphunr Nu. (cr11) r-m.nl.iddn�s�
If,ippii.eblr, ihr�•ru�+erlr���rner hrrcbV authorars� � .
�
� Vamr Stn�rt Addrry Citv/Tu�vn titatr Zi�,
tu.ut un the +ru,rrlc u�cnr(�brh.ilf. in,dl m.iltrrs rel.�tire tu wurk auihurand bv this buiidin• �rrmit a ,�lic,rtiun.
SECTION 10:CONSTRUCTION CONTROL IPlease fill out Appendiz 2)
p(buildin•is lass dwn.li,UW iu.ft uf�•nduvd s+au anJ/or m�t unJ.rCaa�trudiunCuntrol Ihen chetk hrre O and s6 S.aliun IU.0
� I0.1 Re istercd Profeaslonal Ree onsible for Constrvction Contml
�-.,F1�✓ T�c� � ���G�GG �S°o G�!
Namr(Registranl) Telrphunr - r-mail addrrss � Regi�tratiun Numbrr
�,�. ,��� S� w.�� `�� ia _ � - �_ 6 _ 2��,
Strrrt Addrrss City/Tuwn 5tate Zip Dixipline Expiraliun Date
10.2 Genenl Contnctor
�,. �i i c,c� v��op'�'S "
Cumpany Namr: . . �
Namr of P�[:.)n�R�.+�p +iblr fur Cunstructiun � License No. andType if Applicable ,
. d/�� 7tIG G /
Street AddressS�— -- City/Town State Zip
Tele hone No.(business) Tele hone No. cell) Pmail address
SEC1iON 11:WORKERS'COAN'ENSATION QVSURANCE AFFIDAVi7(M.G.L.c.152. ZSC(6))
A Workrrs'Compenxation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
,ubmitted with this application. Failure to providr this affidavit will result in the denial of the issuance of the building permit.
Is a si ned Affidavit submitted with this a licationl . Yes O No O
SECTION 12:CONSTRUCf10N COSTS AND PERMIT FEE
• � Estimated Costs:(Labur ,�- -
Item. and Materials) �Tutai Construction Cost(from Item 6)=S �IS�O �
L Building $ � 6 � Building Permit Fee=Total Cons[ruction Cust x_Qnsert here
2. Electrical S appropriate municipal factor)=S
3. Plumbing S
4. Mechanical (HVAC) S Note:Minimum fee=S (contact municipalily)
� 5. Mechanical (Oehrr) $ Encluce check payable ro
6.Tutal Cust 5 (contact munici alit )and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPl.ICANT
f3��rnlrrinK my n.�me brluw, I hrrrby.ittest undrr Ihe p.iins and prnaltirs��f pe�jury that all uf thr in(urmatiun o�ntained in Ihix
aE,plic.itiun is trur and accurete tu thr br.l ul my knuwled�;r and undrrstandinti.
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I'I •.n F,r 1 1� l�,�mr fitlr T�Ic hunr.\'u. I)ale
I >trev :1./.ire.. n .. / ' I a� Citt�iTu�.n .titatr 1 � i � � .
IJd r� a F' �,
I Stuni.ipal Inspeclur to fill out Ihis section upan applicalion approvaL• � Z 2�
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I EXISTING FIRE kAiSD WALL'. I � �
�� I UPGeADE E%ISTING�fMI51NG ��t �St
�°—��P� I WALL Wl 5/e'ME x FiRf RnTED � SIOBAGE TEN4M SPACE w
(NO CHFNGES) � GwH ni wTERiOR FnCE. � (NO ClNNGES) (NO CHANGES) �
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� GFIOUAD-OUTI£T � I
I 1YPICAL Q EA. PROPoSE� I ^ �
I SfAt.� BARBER SHOP � 5 �
� W� 4 SFA75 � L
� (NO CWWGE IN I W C ^
� U5� � J G LL
- � FX15TIUG FIRE RATED wALC � 1 , 1
� 5/B'11Pf X FIRE RATED GNB EAC � ' � � • O
Si�E OF 3-SIB'STL STUDS.n�D
� IAYER OF S/8'Mf%FlRE R4TED i (n J �
� GwH Q fACH FACE.STAGGfR I - v� �
� JOWT524'FOREACM I HOUR �/� (n
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_ I I . I ROUR RATfD 2'X9 CFILING I T /y�
� I I TILE StSTfM INSTALLED PER � I � W/�
MANUFACTURER5 � I �SISLNCz � O L.L
� � RfCOMMFNDNTIONS,VfRIF! I �
_ I I • INFEILD. I (�� //\
I I •�:5;8"*wE%FlRE�RATfDGNiB I (NOClWIGE$) ' v�� �`
I I Q E%ISTING CFIONG. ' ' � -
I ' I • FIRECAULKALLPENETRATIONS � � ' �f2 C � �
�� I I G ALL RATfD WALLS ANO - % -
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�1 PROPOSED PLAN scale:
' ��e°=,�-o° AS NOTED
date:
04.12.2010
dwg no:
.A 1 . 1