96 SWAMPSCOTT RD - BUILDING INSPECTION (29) EITX�6Fr _ _
� ��: � PUBLIC PROPERTY '�
i'
�` DEP�t�t�vT d
�i.mF�sr o•�•-•v� V�`
�Iwroa t30wwurwzcx�a'c�,�'� '
�nte►4 4wts�an;st�'�s Ot970
. . 'It�3:9'!{-T1S.959S�FNC 97L7d0.961�
APPI.ICATION FOR'1'AE REPAIR RENOVATION CONSTRUCTION
DEMOLITION. OR CRANGE OF USE OR OCCUPANCy FOR ANY EXISTINC3
STRUCTL�� OR BUII.DING
. 1.0 SITE INFORMATION �� ' '
Locattor► Nams: Buildtng:
I ---- - - - _ . . _ _. ..--- _ _ I
Property Addresx--- -- -- ---- — --- __- - -- ---
�1 G s w� ps�o rz- tz� --Sa-�-wi /�'�l9
4197D
' Property is bcatsd in a:Consarvatlon Aro�YM Historic Distrkx YM M
Z.0 OWNERSHIP INFORMATION
4.1 Ownar of Land `
Nams: �7" �^ddY�'1 � n�
Addreaa:
� 6 � ��-r�vsm r-r ��
re�epno�,s: �7 �' � s�a 1 S
3.0 COMPLETE THIS SECTION FOR WORK IN EICISIU+ui BUILDINGS ONLY
Additian Exfsting
RenovaUon Number af Stories Renovated
Change in Use N�
Demolitlon ExiaUng
Approximats year of Area per floor (s� Renovated
construction or renovation
ot exieting building New
B6et Description of Proposed Work: �
Tns�J) �o � n �a'�n ow�
v� i N fl �t7�(o, ,v e
/'oa,^
-------Mail Pertnit to: � �N, SCo - .�� ---- - -
-- C��e� .. .
What is the curreM use o(the Buiiding4
�r�` 0� Cu� S-F-��l��-�d�/� .
Material of Building? H dwelling.how many units? . _ ..
Will Uts Building Contorm to Law? Asbestos?
pvchited's Nams
nddress and Pt+onw - l )
� 11�Da�`�L� S �o�-e Sn �0� `i' W�n! n t� ,gu� P/�
Mechanica Name ��! P.t �� tM✓�
Addreas and Phone 7 1 Gt� l� T ��s'e� �
co�w�uon s�ve��u�e�se� � s o ��!793 Hic Regutratan# /Sa G 6 3
Estimated Cost ot Proled S a d� Permit Fs�Cak:ulaMon
Pertnil Fee f — �+���X S7/i1000 Reaidential
--- - - - - --___ _._ _ _ _ _ _ _. ._._.._. _ _ - Eatlmated eoat X 541/51000 Eomme►cia4=
M Addkfonal 55.09 is added as an
AdministratNe charSe-
Maks sure that aU fields ars properly and legibly written to avoid delays In processing.
The undersigned does hereby apply for a Buildiny Permit to build��e$���
^� � l
v / �/
speciflcaUons. S t g n e d un d e�p e n a l l y o i p e r j u ry /\ l
Date �-a a-o �
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• ' CITY C�F SALEM
���- O� PUBLIC PROPRERTY
• �`-:� • DEPARTv1ENT
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ta:vn»s•�s9s .F.�x:m�+a�wc
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Constructton Debri� DisposaC �1Ctidavit
(requirrJ Cor all demulitioa uid renovation work)
� fn 3ccorJancc wiih tht ri!uh edirioo of d�e State Buildin�Coda, 730 C1�lR soction l l l.3
� Debris, uid the provisions of vtGL e 40, S 54;
! Buildin�{ Peimit M _ _ is issued with the conditioo that the dcbris resuldn�8rom
� �his wurk shall be disposed of in n pmperly lie�nsed waste disposal faciliry as defined by�1GL e
� 1Ll.SISOA.
?he dabris will be transpoRed by:
� ��
--�.
— �imma uC haulerl
. -
fhc:lcbris will br disposed uf in :
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(�,amr oi ia.iGty)
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CITY OF SALEM
� PUBLIC PROPRERTY
'��4 y
DEPARTMEN
",\ T
. n1�111FRIF.YUR15[:ULL
�1.�v�M I2C Wnuu.��roiv SiaeE7�SA�w.Mnanu n.�e�i�r�G1979
'Ch:L 97$-743`K95 •F:�x:y7N-7K�vs�
W'urkerx' Compensation Insurance Affidevit: BuflderslContractors/Electrlcians/Plumben
ap Ucant Infi�rmation Please Print Leeiblv
V8(TIZ�13uaiceulOrganintioNln�iv�ctwill: ��7DY110�S flAL�Dt /i/aT� S �O�e ���LLI'f' w/1V}�P�'
.addre�.:_? 1 G�E� D � S rr,e�
City;Sta�ciZip: t� Pil/2.t � � Phone t1: q 7 � qa7 $JSv�
An you yn employer? Chcek the•rppropriute Doi: '1'ype of project(requfreJ):
� 1.❑ 1 ;�m•r cmpluyer with 4. 0 1 am a gcncrrl couuaccot and 1 �
pluyces(full and/ur part-qnu).• have hireJ thc sub-cuniracwrs h' New coaitructiop
2. 1 am a sole proprietnr or partnu- listtd uo rhe attached xhcet � �• ❑ R°'°°da�ina
T6ese sub-contruwn have 8. !k u
ship and have im cmploy�ws ❑ moli on
workin tor me in:m ca .u:it . . workers' comp. insuronce.
S Y P' Y 9. � Building rddition
(t�o wocicen'comp. insuiance 5. 0 We�re a coiporation and its 10.0 Electrical repairs or additions
rcquired] ofticers havic excrcix�x!their
, 3.❑ I am a homeowner doin all wodc right of exemption per MGL I I.Q Plumbing rcpairs or adJiporm
S
�nyselP. [No workcra'cump. a 152,§!(4),aad we huvc no �Z,� uoFnpairx
1 r'
insuranee requited.J � �mpluyeex. (No worktn' �3.�ther�(/IND �il�bfNC
comp. in.wranw rcyuircrl.l
•niry u��pliwM tlut eM:cks bOx MI musf also lill wu ihe+ecliun IH;luw slwwioy ilstit wurt�xa'cumpenaWiwi puliry iofurm;uiwi
`1 Wmw�wron whu�uhmil Ihis aflldavit indi�in�Ihry ue Joiny aU xv�t an0�hen h4e wtside emtrac�ws musl•ut+mU a new a1T:Javi1 inJietlirtg vicA.
�C.�n�rxmn�Iw c6�ck tAis bmc muot atxhed;ut a�Wi�iwul Jwx��huwiny 4k na�po of tM tub.contrxtors and�hei�wuhen'comp.puliry informariun.
1 um un r���ployer thu!Lr pruviding workers'compcnsndon lusuranee Joi nry emp/uydex Belory is the pu/icy und Job site
iujunnativa
�I�, In.uranceCompanyVame: .-- -_. . ...._ .. ...--___—
�' Pnlicy+l ur Self-ins.Lic. #: _._ _._ Expirution Date:
Job Sicc AdJrc�: Ci�y/StatdZip:
.�ttrch a copy of the�rorkers'cumpens�tlnn pulicy dttlyr•rliop pa�;e(s6owinR�he pollcy number�nd e:piratiun date).
I�ailurc w x:curo coverage it requircJ under Sec�ivn 23A uC�IGL c. 152 cau lead ro the imposition of criminal penultia of a
rina up t��51.500.00�nJ/or one-year iinprisonment,�y��•cll as civil�naltics in ihc form of a STUP WURK URDER and�fine
nt up to 5250.00 a day againsl �he viola[ot. 13e advived thut a capy uf this statament nwy be CorwrrJed to thn Ullice of
lu��eangaiiuns of the DIA for iniurar.ce cooera�e��critiealiun.
/du hrreby rrni ui� er d�r prrias � prn /�ir.r uj��p�ry•'�qry thu�N�e i��jurmu1laa providcJ ubuve ia uue ueJ correcc
tit�:P,Ifl�fd: ,�v� " ��Z. C�2"`r' ✓� I)JIC' � — Z Z ^ � �
eh,�:ti:,: � 7 g q�� �' I sa
O�riu!ust uuly. Do noI wri�e ia d�l.r orru,!u be cuaip/eled by cily or Iowrt oJjie•iuL
Cityor 'Pown: __. _ PcrmitlLicense#
---- - _ ... _ _._.. _ . .
Issuing Aulhurily(tirdc onc):
1. Bo�rd uf 1(rallh t. 13uilding Dc���rhuent J.Citylfo�rn Clcrk a. Clectrical Iuspccfor 5. Plumbing Inspcctor
G.Olhrr
C�nu�ct Pc�son: -- - . --- Phonc p:
Information and Instructions "
htassrchwetu Gcneral Law3 chaptu l�2 reyuires all a�nploytrs to provide workers' compensation foc cheir emp�oyees.
Punuant to this stamte,an rmployes is defined as"...every person in the sccvice uf another under any contrut of hict.- .
expcess or impli�d,oral or writtea'
:1n unpluyer is detined as"an in�vidual.pa[utership.association.coryo�ation or other legal tntiry,oi any two or morc
of�he furegoing engaged in a joint encarprise,and incluAing the legal represen�aeives of a dece:ued employe�,or the
re�iver or truaiee uf m u�dividual.p+umuah+P•essoc'atiuu or oNu lagal cndry,amploying tmployeea. Nowevcr the
ownet of a dwdling houae hshog o«m°re th°°�6+��p�^°ab and wtw rcaida therein.ot the occupant of the
Swelling houae of another who emp►oys persons to Jo m�at�nanca,cunstruction or repair work on such Jwelling house
eped to be aa em lo tt."
not because of
such em lo
ent be dCe P Y
or buildin a urtenan�th�Kw s�1 p Y�
or on the grounds 6 PP
htGL chaptcr 152,§25C(6)also staces�hu�"every state or tocal liceosine agency shaU Mithhold tAe issusnce or
renewal of r lfeense or permlt to operab a busieeas or ro coeatruet build{ngs ia tha commonwealth for sny
applieant wbo has nat prodocod acceptabk evidenee of compUanu witA►6e lasuranae covera6e required:'
:��iitiunatly.MGL�hapier I S?, �25C(7)states"Neither the commonwealth nor any of its politicsl 5ubdivisioos shall
ancer inw any contract tbr the perform:�ncn uf public work un�il acceptable ovicfence of cumptiance wi�h che insuranee
requirements uf t6is ch•rpttr have 6een preunted ro the contracting authority."
Appi�canq �
Please fill out the workera' compensaaon atTidavit completely,by chec�ing che boxes eha[apply w your situation an4 if
necessary.Yupp�Y Yub-�ontractor(s)name(s),addcess(es)and Pho°o nwnber(s)along with thair certificate(s)of
insurance. Limicul Liabiliey Companies(LLC)or Limited Liability P�rtnerships(LLP)with no emplayees other than the
membets or p:irtners,are not rcquired w carry workers'compensation insurance. [f an LLC or LLP does have
employees,a poticy is roquired Be advised that ihis affidavit maY be submitted to ehe Depxrtmnn[of [ndustrial
Accidtnts for conftcmation,of insursnce covarage. Alyo be sure to siEn und dute the•rfTiduvi4 The at'tidavit should
6e retumnd to�he ciry or town that the application for the permit or license is being requasud, not the Depamnent of
tndustriul Accidon�v. Should you havn any yucs[ions regarding the 1aw or if you arn roquued co obtain a workors'
compensation poliry,please call t6e Depamnen�ut c6e mm�ber listed below. Sclf-insured companies should enter their
.etf-insurrnce�icense numbu on the a ro riate line.
City or Town Otflctab
Picase be sure thuc the affidavit is comptete and printed Icgibly. The Department has provileJ u sp�u:e ut the bottom
uf tha afficlavit for you to fill out in the event thr Office of lmastigations has to contact you regarding the applicant
Picase bz surc co tilt in�ht p�:rmfU;icense num6er which will be used as a reterence numbar. In addidon,an applicant
thut mwt submit multiple prnniUlicense applications in any biven yeaz,netd only submit one e�davit indicating curtent
policy inFormation(if necessary)and under"Job Site Address"�he applican[shoutd write"all locaeions in (ciry ur
cown�,'•A cupy of�he affidovit�h•rt has been officially stampeJ or muked by che city or town may be provided[o ehe
spplicant as proof chat a valid�ffidavit is on file for futurc permita or liccnsea. A new affiduvit muxt be tilled out each
yaar. Where a home uwner or ci[izen is obtaining a license or pennit not related to any business ur commercial venture
�i.e. a dug licen.0 or permit to burn leaves etc J said person is?JOT required co compla[e this affidavit.
1'hc Oi ti�c vY[nvzstigatiuns wuu1J like to ehank you in aJvance for your coopere[ion rnd should yuu h•rva any quastions,
pkax du nut hesicace co givc us u call.
The D�panmtnt's addcess,celephone�nJ fax number:
'the Commonwealth of Massachusetts
pepacm�ent of Indusuial Accidents
OSlce of[nvatl�adoos
6pp Washington Street
goston, MA 021 t I
Tel. ri 617-727-4900 ext 406 or 1-877-MASSAFE
Fax#617-727-7749
Rcvi.cJ i-26-0S WWVY.I178SS.gOV/d18
Three - MAT Foundation �
� i
The MAT foundation is presented'in Rg.B6.The foundation is a 6 foot by 6 foot (I,8 m x I.S m) square with a depth of 3 feet'(.9 m).
The MAT fou�dation is designed for an allowable vertical bearing pressure of 1,500 PSf (IBC C�ass 5 Soil perTable 1804,2).
s
Ganerelnotee � -
1� ThemetlountlellonwestleclpneENecmrtlencewlthNe19C2007 -
]i Aprobssianelen8�^eernglstereCMMesbbwM1areNepmjec�ISloceteEnhallassumeresDonelElliryfor
� Ihesite-spectlic'EesIB��TheP.E.ahells�elleasureOealpnau11a6111qb�verylnpellaenCsallconElibn . ,
auc�ae soil cleveillcefrom,weter leEle,exislenca o/ezDereivalcalle0eib�eoils,susceD�IpiFry b
liqvetaction,hoel CepN,ek.
' ]) The m¢I bundetlon le ior a allowa0le vaNdelOsatlng preaeum o(1,500 PSF(19C tlaea 5�oii per table
180d.1J
i) AII�ouMetlon ebmanb e�ell beer on pmdatly preDareE soll
5� Soll rypee arM propaMiee ahall�e vedl�aE byt�e O�olect P.E. '
8� Concrete woM ehell be in conbrmance witti Ihe reQulremenk seUotl�in AC�301i31B
]) Anchor bolt dealgn ahell be DmvWed by alMn, Anc�or bolh numtiers,elze,NDe,enE conllguration ehall
be capabb oi re�htine ell appllatl momant,eheat entl exiel forcas 1-I/4"DIA ANCNOR 80LT5�8 PLACES)
8) Concreb ahell heve min P,500 P312B�Eay etrenpU enE 5%elr enUelnment H�fY. Concmte unll welghl
� ahellnotexceed1501be1tl3
9) Ralnforcing staet e�etl De ASTM A615 grede 60 tlefarmetl Eers
10)WiM loatle per IE'C 200a were celculatetl by olhars: -
Be¢e momenf. 2fi,290 XAbe
Besa sheai: BBl lbe '
Arialbad: 1801bs . IT'diab011h01CCRdC .
6" 6'-0 .
k6�8"both wats,
top and boftom o 0 0 0 0 0
6'-d' , grountlelevation
3'-0" 3
� o 0 0 0 0 0
J'-0 .
, b`a� , 3"cover
� . . k6�8"bofhwoys toPand
Mat Foundation Seetion topandbottom bottom
, Fig.86Technical drawings tor Mat foundation �
3-1 Refnforcing Bars
� PosRion reinforcing bar"mats"as indicated in Fg. 66.Reiniorcing bar is #6 bar spaced at E inch (20.3 cm) intervals.Reinforcing bar mats
�, positioned wRh minimum 3 inch (7.6 cm) concrete cover top and bottom.
p
ITWllcicb
�emOb�e
� .
Y-0"a0erolounEol'an �
� $
� 2-3 Pfer Foundatlon Speclfi�atlons:
Diarneter 24 inches (61 cm)
Depth Depends on soil cond'Rjons
„��,n�,�,� ���� Minimum 2500 PSI,28 day strength,
�em,e„ �� 5%air entrapment I
_ Pier Projection 6 inche; (I 6.24 cm)
,.. — Above Grade
$
�
r e,°°"°�'"" � Reinforcing Bar ASTM A615 Grade 60
#4 rein�orcing bar,
GrcularTies 17-18 inch (43 cm) diarneter,
:'�� 29 inch (73b cm) overlap
�����a
:.,:
Vertical Reinforcement 12 equaily spaced #6 reinforcing bar
42 inch (I m) length,
Anchor'J" Bofts 1.25 inch (3.1 cm) diameter,
'� 6 inch (1614 cm)"J"
'J" BoR Projection
1 7-8 inches(17.8- 20.3 cm)
, � Above Foundation
. � Fig.BS J botts and template . , , ,
.
\ �
` NOTES
' — - — - — _ --\— - � IpVDGR0.Pitt NIN arIUAL ON-i4E-dE0lIN0 SVRVEV 9Y NOHIH y1pHL SVHY�Y GqtPDRqTON,fEBRL'MY
_ GRAf'HIC SCALE I'""C°0H APP1L. 'O�.
— ``\ . �u vnnons stiov.H on rH¢uux�ac an�o oH nry ar sun onn.w (ur.w�ow w�i[n[�[vnr�o
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—�- J. lE4PqiI.qY BFNCM111RK5 H/�K gfFN SNiYFKD ql 1NE VNO BISEO M 1HE RRYINENi BENMMnN✓
/ ,`\ \ i iN PqC!) flF3WplCm IN NOif 2./.5 fIXLONS
. \ 1 me'� = 20 fl
/ � � 1dI�1' EINAPLN � 30]�PF M1AR 4� N FAYFHENL
19M�1 El£vI.TON- ] 55 P!(NnIL SEi N F.1Y1Ervi
\ ���� � �\ � � � ``\ \ � l. M5 PVH JCES M1O!SHOM I.1 UTIIIY LIHFS(M'D/Ofl UNCERGRdINL CONDU�Tj SWCE FlE3D AIFF"
{'i \\ �\ 4 �.� \h ��\ \ wi.s aExranum a sac Aeo�c cRwra smucn�xs ox�r. TME�acn a�s or�isnxt�xornav uN.
vnu�v ures s�ro�ry oH TMis a.iH uic ur¢onw�ensn a� TMr ecs, nvu�ac m�ronu na+-.:
�;\ \ \ � i0 RDE/.t F 4E K ttE RhP P TM Of 5 RAN. cRpP iO �T MpN 1H[5'E
CCHIRPCid 91AL1 O�f"OIG 5 fE PNJ�EPI 'CC TMS Of ILL IIPL'iY JNES ON ME 91E 0 `
\� \ \ � �OJICEN' O iE Si WIVIX i _A E 0� .ME SCWE 6 NORK PPoCR !OI CMSiNIICTON IHE S'li
T \ \� '\ \ �. CCNiRICiqt yIALL Kri..Y(1M1C/�. �EiERY. P� NVER15 M!0 e1EVAlIpi15 Cf PPE$(IHI.i�R M1
\ � �1� ``\ \ � I ' GF055R1G AVY GflGPpSFJ IIIILI � i0 F9JflE M1fHc Mf NO WMIICR XIIN pSTNG ViVJTFS.
. � 1 ' � �/�� wwsncrvrs a Nis uN(�a vaco)s ui eE Pcxraeuco av vinc(wa cuwr wirnH
� �'�',��1�.` �\ nu�vaniznnon)nrrEa Hcrrcnnnry.T.ow TME si*c cawra�c�oR e�vs[o a �c*u��FlEin�ac�m�vs s
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� \ '\ 660RE.OURNG ON L.^.LNNG�I"��X'AV�TW/CO 5'R 11
i \ \� � �� \� � 7�
� � - _ & \ � ! 5.LL I.NY PN�.1LL CONSIAIICiION MER WS M�1Eq M� 11 ]l CMS � LL C9tM_T M!N
� d� \ � � LMPI PNO SiAiE BULDNG LNES�L0.AL PIIB� Wfi :��v1 ( Lf iIFJ.
� � �\\ �\ `�\ \ LOCAL�PW/ENQNEFA N6�EPt.SFfdfICAlI0N5�NO ON0IIIGN _1 Of i.SPLCIfICRPLW$PNI)
_ � �� -qs �. IXIW ENGMEERNG/CONSIRIICPW p9pCPCES FOR 501111/P R NENI ON [ f LLV pLFA9N�
COMSIPVCIICN- AS PMi CF CONSIRUCIICN.li 15 �IL FSpM9Blllry Of IFN! IIL ttMIN f O FCP�Y
' � � \ �e � � � �NY�E91q1 OEGICCNCIES FWNO ON 1HI5 PIAN BY 1HE fA 5@�CIIW !IX HE� MPROVEM[ 1'S Ib
` / � � ``\ \ y CAMPLY N1R1 LOGL/SiAIC BUILOINC CWE$ MHO S4ECIfIG�ilONS.W�AtlOH { ONFL YEOIIPENENiS FOP
G y \'S� BY � ��� � � /� � tt1ry51RVL110N. R I'Mi Of iNE C}I1RPLl FOR CWSIRIICTON li IS IHE R! G :� I CF SIIE
a � � '`+ cuHrRncrtn ro/cA euun.N�caum�croA, ro��r[r+e u+o eorvsr+uc M vuovruar u nccrnoarva
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�y � , � \y�..P OBt�N ME NECESSAFY PFRYIi IYPROVPLS FRbI ME tOMi/l1UNCP.�II ! ]l)f09M5 MLL tIMC Y ql.
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