1 SEWALL ST - BPA-05-732 FIT OUT FOR PRESCH. & MUSEUM No. City of Salem we.a
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APPLICATION � 5
FOR
PERMIT TO BUILD ADDITION, MAKE ALTERATiONS OR NEW CONSTRUCTION
IMPORTAM•Applicant to eomp�ete all Rems in seeHons:l, ll, lll, IV, and IX.
L AT fLOCATIOM � � �c hJG f I S � D�j�{
LOCATION 1ND' '�"
OF e�eN .�s c� aw
BUILDING �c�asm�n �c�ssio n
SUBOMSION � �OT_B�OCK $V.E
11. TYPE AND COST OF BUILDING-All applicants complete Parts A -D
0. TViE OF IMPROVEMEHT 0. PROPOSm USE•FOR"DEMOLITION"USE MOST RECENT USE
1 � N�w euiltling RNltl�notl NON�tl�nWl
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13 Q Twodmasfamily-EnMnumOn
3 �AMmcn/See 2 aborel ol ueb—" _ 20 Q IntluWial
� � 21 Q Pa�Mng garage
a ❑ RepYv replapmnq 14 ❑ Try1lisnt MMI,nqbl,pr Cpimildy.
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OL SELECTED CHARACTERISTICS OF BUI ING •For new buildings and additions, complete Parts E-L:demditan.
com ete on Parfs J 8 M,all ofhers skip to IV
E PRINClPpL TYpE OF FAAME R PRNCOAL TYPE OF XEATHIG FlIEL G. TYPE OF SEWAGE DISPOSAL I. TYPE OF MECNAMCJIL
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31 ❑ OVoaO hYm� 38 Q OA al � P�ivaO�ImO�C YNt�IC.1 �
32 ❑ Stru�CaW steY 37 � EleNfeilY 44 Ves IS � No
33 Q Heiboea mmar 3a Q CoW !L TYPE Of WATEli SUPPLY wl�nris ey r�Mnm/r�
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J.DIMENSqNS M. DEMOLITION OF STRUCTURES: L �'� �
38 Numppr pi 5tOM5 _. �
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+9 Taa�sware rc«a n�a�ea Has Approval from Historical Commission been received �
a.:�oasea m e:�a _.._. _._.........__.... . fOf 3�Iy SVUC1UrE oVCf fiflY(50I Ye275? Y85_ NO_
so ro��una are�w.rt.......__.__._.__..__...-'--'-- Dig S3fe NUrtIbCf 1
K.NUMBER OF OFF•STXEET GANKING SPACES ���; /: Q�� no!J�
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HAVE THE FOLLOWING UTIL(TIES BEEN DISCONNECTED?
• s2. omaoo�s..._..._.._.._--.----------.— Yes No
��nomw aunrmcs orar , Weter:'T
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CaBS:
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54. NumOer ot
„�oa�s DOCUMENTATION FOH THE ABOVE MUST BE ATTACHED +
�-------- BEFORE A PERMR CAN BE ISSUED. �
1
N. COMPLETE THE FOLLOWING: �
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Historic District? Yes_ No� pf yes,please enclase documentation from Hisi Com.) �
Conservation Area? Yes_ No� pf yes, please enclose Order of Conditions►
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Has Fire Prevention approved and stamped plans or applications? Yes._ No_ i
Is property located in the S.R.A district? Yes� No_ �
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Comply with Zoning? Yes� No_ pt no,enClose Board of Appeal decisian) '
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Is lotgrandfathered? Yes_ No_ pf yes,submit documenta6on(rf no,submR Board of Appeal decision) �
If new construction,has the proper Routing Slip been enclosed? Yes_ No_ �
Is ArchiteCtural Access Board approval required? Yes_ No_ Qf yes,SubmR documentation) ?
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Massachusetts State Contractor License# �s m{�22�L, �m�cenye# '
Home Improvement Condactor# Homeawners Exempt form(if applicable) Yes_ No_ ]�
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CONSTRUCTION,TO BE COMMENCED WI7HIN SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT �
Ii an extenabn is necessary,please submit �
CONSTRUCTION IS TO B�COIWPLETED BY: � �j � in wntin to the ins
g pectoroi Buildings. �
V. IDENTIFlCATION • To be completed by all applicants �
Name MOYi�g aaorese-Numbgr.sneef.cM�eIW flaM LP CoOe TeL No. i
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I hereby certty that the proposed wak is authonzed by the owner of record and that I have baen auThaizetl by the owner ro make this applidGon �
as his aulhonzetl aent ana we a r to conform to all aooliwble laws of this iunsdiction. �
�Si of app Address `u, _ � � ApWicanon tlate
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� DO NOT WFITE BELOW THIS LINE
� VI. YALIDATION
� ' BUIIdIM,� fOFi DEPARTMEM USE ONLY
' Permit number
1 Building � ���
PermR issued 19 6 5
Fire G2dug
Building
P�rmit Fee $ � u.a�oadmy
Certificate of Occupancy 5 ��LOatl
APP� bY•
Drain Tile $ ��;,
Plan Review Fee $
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� NOTES AND Data-IFor depanment useJ
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� PERMR TO BE MAILED TO:
[ DATE MAILED:
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� Construction to be started by. Comoleted by.
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VI ZONING PLAN EXAMINERS NOTES -
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DISTRICT
I USE
FRONT YARD �
SIDE YAFD SIDE YARD
REAR YARD
NOTES
SRE OFt PLOT PLAN •For Applicant Use
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CONSTRUCTION CONTROL AFFIDAVIT
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Project Number: 0166.002 Date: February 7, 2005
Project Title: YMCA of Salem — First Floor Child Care Renovation
Project Location: Essex/Sewall Street, Salem, MA 01970
Name of Building:
Scope of Project: Interior and storefront renovations for new children's museum and
preschool
IN ACCORDANCE WITH SECTION 116.0 OF THE MASSACHUSETTS STATE BUIDING CODE, I
MARK MECHE, MASS. REGISTRATION NO. 7083 BEING A REGISTERED PROFESSIONAL
ARCHITECT HEREBY CERTIFY THAT I HAVE PREPARED. OR DIRECTLY SUPERVISED THE
PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS, AND SPECIFICATIONS COt•!CERt.'lNG:
Entire Project Architectural X Structural Mechanical
Electrical Fire Protection Other(specify)
FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE, SUCH
PLANS, COMPUTATIONS, AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE
MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES AND
ALL APPLICABLE LAWS FOR THE PROPOSED PROJECT.
I 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 116.2.2.
1. 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 quality control procedures for all code required control materials.
3. Special architectural or engineering professional inspection of critical construction components requiring
controlled materials or construction specified in the accepted engineering practice standards listed in
Appendix 1.
PURSUANT TO SECTION 116.4, 1 SHALL SUBMIT PERIODICALLY, A PROGRESS REPORT
TOGETHER WITH PERTINENT COMMENTS TO THE BUILDING INSPECTOR. UPON COMPLETION
OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION
AND READINESS OF THE PROJECT FOR OCCUPANCY. AA
/V\ Signature
*UBSD AN ORN BEFO ME THIS DAY 0 { 2005
ission Expira Notary Public
Commonwealth of AlasEVIr s
�JEorl MY Commission 6ipirea'
y4 September-22,20i1
MISS
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