3-5 TRADERS WAY - BUILDING INSPECTION (2) i CITY OF SAL.ETNI INLA SSACHUSE'ITS
• ��� �J BUILDING DEPARTNIENT
' 120 WASHINGTON STREET,3m FLOOR
TEL (978)745-9595
FAX(978) 740-9846
KIMBER, Y DRISCOLL
MAYOR THOMAS ST.PIERRS
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMWS$IONER
APPEXATION FOR THE CONSTRUCTIOK REPAIR;RF.[tMAT1ON.CHANGE K LIU OR
OCCUPANCY,OR DEMOLITION OF ANY 8UMJMNG OR STRUCTURE
r' This 8usm to►OMkld Only -
qq"p ..reject 15 "16i
4 Dales: Start End:
t:orr�
IA SITE INFORMATION
Location Naaw Building:
ftWVAd S-5 traders Way
Salem, MA 019"10
Assessors~31odc LoUParcet
� ORNfiATfON
2.1 Owner o1 Land
Nams: F�I�+F}I.�Nt Z FLAZA TWST
AWE (P10 0l..D YOI2K. )tp _ 3WTE 220
JeN KIt-rrVWN, PA 19oq&
Telephone:
2.2 Ownw or less"of buNding or s&uaVm
Narns: J er MoLpaoewerlt, IM
Address: 4413 Wynnewood Ind
Narrls6Ur , Pp. 1.110q
Tetephons: `T 11 - (052 - 4900
3.0 AGENCY OR AUTHORITY AUTHORIZING CONSTRUCTION
Agency Name: DarwrS wank
Address: One CbrGunt st,
bwwh r5 r MA 01 q23
Agency Project Number:
Project
1 Manager Name: Ei Ieen L.trbVs TeLq�g-�39-ce,
3.0 DESIGN AND CONSTRUCTION UTIt.12!NO MGL Cs 112$ECTiON 81R EXEMPT10N9
(See noti'bikW)
Contractor i s &44L— WG
Name:
Address: 2100 6OC4ITUAOM P-4:>
FIa>aM I iWsy NbM, Mir OI'70 � Lea Qhn UUti((
k
ew,e goldclr: Drv�uv LWYe+000
sponsibility: 6t&eYad (,pY11'K1&fMe
umber." CS I—+3'7 Date of Expiratl«rr
Address:.
> Area of responsibility:
License Number. Date of Expiration:
Telephone: Fax
Contracts _.
Name:
Address:
Area of responsibility:
License Number. Date of Expiration:
Telephone:
portions n4' camp)
Note: For rtwna of work utifizi exemptions of MGLe. t 12&81R ete.the section above.,,
Use additional sheets if necessary and attach to application.
F
SIONAL CONSTRUCTION SERVICES: `Contractor
Telephone: Fax:
Responsible in Charge of Construction:
7.0 CONSTRUCTION DOCUMENTS -to be prepared by applicant
Item 4 as Applicable
7.1 Plans(Note 1 this page) Submitted Incomplete Not R ui' d
7.1.1 Architectural DeMoli+Ior'► A ,
7.1.2 Foundation
7.1.3 Structural K
7.1.4 Fire Suppression
7.1.5 Fire Alarm
7.1.6 HVAC X
7.1.7 Electrical
X
7.2 Specifications X
7.3 Structural Peer Review
7.4 Structural Tests & Inspections
Program, X
7.5 Fire Protection Narrative Report yt
7.6 Existing Building Survey y�
7.7 Workers Compensation Insurance V.
7.8 Other Documents(Specify)
(Energy Narratives, etc.)
Note 1 Areas of Design or, Construction for which Plans are not complete at the time of
this application must be identified herein. Work so identified must not be commenced until this
application has been amended and proposed construction has been approved by the
Depaftment of Public Safety District Building Inspector having Jurisdiction.
9.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
For new construction,comolete section 3.0
Addition
Renovation Number of Stones Renovated
Change in Use New
Demolition '( Existing 3,sm Sf
Approximate year of. Area per floor(sf) Renovated
construction or renovation
of existing building
Brief Description of Propoi Woitc
►N��'�-bevrtot►fior� � lin+�ehor' puri->itfcns flooNno��
A�eaxAiCal Ceit►`�'9 4ile . � �R � z
x
,U9 GttPUP ANfl coN TRuCTIP CLASSWI—CA'TIOH( zlsts 91 QnhiH
EXISTIIVt3Y -PROPOSED Chan'ge€' G'�OF(t3'(Rt�CTl0
USE Group(sy CEA38tFtORT10
Usk Hazard Use, Hazard Hazard i UwtewbrateporY): Group Index ` 6roup Index" Indez:" i`l?iapwtp•w•1
A Assembly,
B Business
E Educational:_ 2X
F Factory 2e¢
, i
H High Hazard ` '2C '
.. � .4
I Institutional.` 3A_
N Mercantile 3.G
R Residential, ,, 4..
S Storage" 5A
U Utility 5t3
Mx Mixed Use Hazard Index
Sp Special Use I I"
" 17T i --T--
Note: Include Hazard Index Modifier for Construction Type as applicable l —!
i
9.0 CONSTRUCTION COSTS(See 780 CMR Appendix L)
Total !vm Cost Building Permit Fee Check Number
(1) =(1)x$0.001
a coo
io.0 AUTHORiZA7YON OF STATE AGENCY FOR AGENT TO APPLY FOR BUILDING
PERAGT(when applicable)
1. on behalf of the audwxb imp State
Agency or Authority. hereby authorize. to apph
for the building peanut for project number.
Signature Date
11.0 SIGNATURE OF BUILDING PERMIT APPLICANT
LSA A"
Name j;14���� eA424L , E3f114rwe-S
Signature Date
12. Certificate of Occupancy required on completion of project? _,Yes _ No
Inspector's Notes:
e
CITY OF SALEM, TNLASSr1CHUSETI"S�lz
B=LNG DEPARTSMNT
i 130 WASHINGTON STREET, 3m FLooR
oT TEt_ (978) 745-9595
FAX(978) 740-9846
KINIBERLEY DRISCOLL
MAYOR THomAs ST.PIERRB
DIRECTOR OF PUBLIC PROPERTY/BUMI) G.CO\W ISSIONER
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 i 11.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit At is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in
LOH- i memos TVfiWAV'0f*hon
(name of facility)
l A 021�
(address of facility)
signature of permit applicant
5/5105
date
dcbris;riF.dw
a'
�•�` �V
a
Application for Permit to:
Location
Permit Granted
S' ao
Approe
in-speitor of Buildings
r
4.0 PROFESSIONAL DESIGN SERVICESt
4.1 Registered Architect ' ., s t'
Name: Pau bouvolom) Seal and Signaturo,"=
Address: RQyyQ` De
206 Mavke l 6Weet
w
; - .( -92(0-4633 Fa�c" Io0�S=9210-
4.Z R�TistN'ad Protesslq�,lsn�faaari: Na ad�ttana/rss�a Y riscesswy and at�h b apvingair)
Namw
Addre�_
Telephone: Fax � �
4
IVarr� SBeI and
Address:
a
Telephone Fax
Ares of Responsibility,
Name: Seal and Signature
Address:
Telephone: Fax
Area of responsibility: