4 UNION ST - BUILDING INSPECTION (3) �,
r.
� The Commonwealth of Massachusetts '
, � ;
:,� I�iY Department of Public Safety
i ��.:f. ,:�'f � �IesSdchuscustil,itoRuildingCudo(iriUC�IR)
�""'°f 13uilding Permit Application for any Building ofher than a One-or 7'wirFamily Uwclling
I�/
� (l�his krtion for C)(ficial Usc Cliilr) ---------
Ruilding Pcnnit Numbcr: ------ Date Applicd: Building Offici�J: _
SGC 170N 1: LOCA'I'ION Q'Iease indicate Bluck k and Lot#fur locations for which a streef address is nol m�ailable)
�t UH iw. S . _ _ 0 9 _O -- - _
� \'u. .md Strcrt City I�li��cn %iF�C��dc Nnme uf Huilding(it applirablc)
SGCPION 2:PROPOSF.0 WURK
f:Jiliun nf�I:1 Stalc Cudc uscJ_ I(Ncw Cunslrurliun chrck hrrc O ur chccA ull thal.�FiF+I�' in Ihc hcu ru���s hclu�v —
� P�isling ISuilJin}; ❑ Rcpair❑ �Vtcrotiun ❑ AJdili�m❑ Dcmolili��n O (Ploasc fill uul und submit Appcndis I)
Changi�ulUsc ❑ ChangcufOr.upnncy ❑ Othcr ❑ SpcciFy:—
Are building plans and/ur cunstrueliun d�kvments being supplied as part uf Ihis permit applicatiun? Yes � Nu ❑
Is an Indcpendent Slru[[urnl 6ngineering Pecr Rcvicw rcyuired? Ycs ❑ No ❑
6ricf Descriptiu t uf Propu`sed l"V_urA:__
—��Q�`f c.u' �-O°
SECTION 3:COMPLETE THiS SGCTION IF EXIST[NG BUILDING UNDERGOING RENOVATION, ADDfC10N,Oli
CFIANGE IN USE OR OCCUPANCY
Chock hcre if.m Existing Building Investigation and Evaluation is endused (Sce 7N0 C�iR 3-F) O
Esisting Usc Grnup(s): Pruposed Usc GruuF�(5): __ �
� SEC'f10N 4: BUILDING HEIGHT AND A2EA
Erititing ' Prupnticd
Nn.of Fluucs/Sluries(indude bnsement Ievels)&Arca Per Rixv(sy.ft.) .
Tulal Arc�t(sy. ft.),�nd Tut.J Hcight(ftJ
SECTION 5:USE GROUP(Check as a licable)
A: Assembly A-1 ❑ A-3❑ Nightdub ❑ A-3 ❑ A-1 ❑ AS❑ 8: Business ❑ f:: Educational ❑
r: r.,�co F-I ❑ F2❑ H: Hi h Flazud H-1 ❑ H-Z❑ H-} ❑ H-�F❑ H-i❑
L• Institutional 1-1 ❑ IQ O i-3❑ N❑ M: Mercantile❑ � R: Residential R-I � R-2❑ R-3❑ 12-{❑
S: Sturage Sl ❑ S2❑ U: Utility O Special Use O and plcase describe bcluo•:
Spccial Usc
. SECfION 6:CONSTRUCTION 7YPE(Check as a Iicable)
L\ ❑ IB ❑ ❑A ❑ -- ` IIB ❑ IIIA ❑ ❑Ili ❑ IV ❑ VA.❑ VU ❑
SEC'CIQN 7:SITE INPOIiMAT10N(refer to 7HU CMR i]lA fur details on each item)
Water Supply: PIooJ Zune Infurmation: Sewage Disposal: 'french Permit: - Ucbris Re�nucai:
A tri•neh"will nul bc I,iccnsrJ Dispntidl5ilr ,
Publir❑ Chcck i(oulsidc Plu�xl 7_onc❑ Indiratc muniripal ❑ �
rryuircd ���r trrnrh ur sFicril)':_.._—_—___.
Privah•O �+r ini�cn�i(c Zune: or on tiitc s�'tilcnl ❑ �
pcnnit is rncluticd❑
_--.____.________. _
Railruad righbof-�vay: Ilazards to Air Navigafion: �i � i i�.i,�i�, � .���,�,���.�.�,��: ��<...,..,. i•�..,,._.;
\'ul :\�+E+lirahlr❑ Is titrurturc�cilhin�iirport eppruarh,vca? Is thcir ro�'ic�v rninF+IctrJ.'
ar Coiurnt In Nuild rnrlo.sed � l�i�s O or N�i❑ � Yi•ti❑ Na ❑
tif'C"f10N N:CUN'1'GN"1'OF CP.R"f119CATE OF OCCUI'�WCY
. IidlUnn ul ludv:____"_'_ C90 Gruup(5): •__'___ I Yf�c ul CnntilruCli��n:__'_ Ll�cu��anl I.udJ Fn�f Plnu[
� - ._ __._ __.. ....
I)urs thr buildin�;r��ntdin an ti��rinl.lrr S��slont?'._—_-____�prci.il tilipul,�li�ms', ____..._._____—
�
�� ��� ��5�;��5-��
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ti[C'1lUN 9: 1'KOPIi12�IY UWNIiR AU'1'llOIi1ZA'IIUN ' �'.
\anic.md Aildre +ut Pn�prrl)' Utcnrr p
�'G' .. O
_L�_�k� � v�„�,,, -sE --s'���-�--- a _� : `
t�amc(Prin�) . � i\'u.and titrccl Cih'/Tuwn ��p �
1'ru��crt)'Ownrr CunL et 1 nrt'l.�liuic
�� �� - - �r?-_�sa-233�
Tille �_ � � --- l.e�ephunr No. (businctis) Tclephone No, (ecll) rmail aJdress --
If,i ,P4 Ii:.IL'le, lly pr'�tlorl��u��ureb�'authorizes
- �;��+-�1� r'•� i � Q-x�_��—CNk3��._S1�•_ �,�. _� aC . 1
Nan,e / 5[rcct Address Cit}'/P wn $t,tc Zip
tu art nn Ihc iru�crlv uwncr's bchalf. in all mattcrs rrlativc lu���urk,�uthurized b��lhis builJin cnnit o��licatiun.
SECTION lU:CONSTRUCI'ION CONTI20L(Please fill out Appendix 2)
If buildin�is Iess th.in JS,iriXl tu.ft of endoved s+ace end or nut imder Construction Contrnl then check hem O and ski Sectiun III.1
]0.1 Re istered Professional Res onsible for Conskuction Control
Sl���� �/�'�/ 7 � Q ZOO �CMn R-S ✓tY � ) � ' 0�
� namr(R yy�istraql) Tc honc Nu. c-LA.,i F�Y+ h � Registrahu i Numbcrp
/"U �J�'/V��. �c �c� �, O/ /rt�G� O 3 2���
Strret Address City/Tuwn Sl.rtc Zip Discipline Espir.�Hun Date
10.2 Generel Contractor
�-°--�v� l�'1 � � .rS �.� �
Cumpany Nam}� .
L,���l ��S� �zS �'
N,�me of Persun Resp msible fu unstructiun License Nu. and Type if Applicible � .
�f90 �1�,� �_� , — c,� a
Slrcet Address Citv/Tuwn Sta e Zip
��3-�G�3o �S/:>.6d YSB� s �w� � `�-,,�1,�. c�.-,
Tcle�hune Nu. business Tele ihon�Nu. cell e•mail i dress
SECCION 11:��t iRr.P:K�;'c t.mii'b�S:�n�.2�'L�'-Ui::\\�Cr:�ri�u��,��'I I M.G.L.c.152. 25C 6 �
A Wurkers'Compvnsation Insurauce Affidavit from thc MA Department of Industrial Accialents must lx�cumpleted and
submitted with this applicatiun. Failure tu provide this.ffidavit witl result in the denial of the' ance of the builJing prnnit.
(s a si�ned Affidavit submitted H�ith lhis a lication? Yes No ❑
SECC[ON 12:CONSTRUCTION COSTS AND PERM[T FEE
Item Estimand Custs: (Labor
and Matcrialsj Tutal Cunstruction Cust(kom Item 6)_$
1. BuilJinti �� � Boild'uiq Pcrmit F�Y=Totel Construction Cost x_(Inscrt hcre
_'. El�Ylrical S ���� nVpropriatc mwiicipal factur)'S
3. Plumbing 5
-4. \�I�t'haniral (HVAC) !$ Nute: Alinimwu fcc=5 (cuntact municipalil}�)
i. \Icih,inical Olhrr '� F.nalusc thix'k p.i�'ablc lu
n.Tolal Cost � �� (rontact muniripality)and N�ritc ihcck numbi�r hrrc
SGCPION 13:SIGNATURE OF DUILUING PERMIT API'LICANT
R��cntrring nry n.unr brlu�v, 1 here6v allesf:ynJcr the p.�ins,md pen,illirs uf perjuq• Ihat,ill uf Ihe infurm.itiun rnnl,iined in Ihis
:ip�ilir,�lion is true dnd aceuratc tu thc hosl u(m)'I.nu�cicdgi�.�nd undcrtilandin �l
�-�-�ot�-e��S.�— -- �� - -- '16G.3Q--
�'-`,---- -
Plc.�tic +riirt.md si2,n nai»c �Pillc �Icphu ��Ju. Ddlc
_��`�� �� E,..,__S�---_------ -----'/�'�'�'7�'�-`-�-_---- a15°�
tilrrcl :\JJn•sti � C'lM1'/Trncn Slal 'l.iFi -
' Nunicipal In.pecfor fu Eill uuf this section upon application approval: _--- - --__(1.�_
Namc D,nr
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• � ,; s� ,�'� CITY UF SALEM
,
, �;.,'�;l' [�UBLIC l'RUPRERT'Y
' DEPARTI�IENT
i�u�.. M:1 Y-�MIN��I 1
\�H�y�
�!�1bnNUA�:IU.�jlet'kl'� $.11hN. M.111.p.111 q�1 nJl'/7,^,
��'urk�n' Cumpen�aUon Insurunce �Illduvih UullAcrs/Cuntnctur�/�le trlclynyPlumb�rf
\ i ilfcun In unnuNo
/y��� � ' � � e 'hl
V:IITI{;�IhWiK�YI)I�y�INI1nNIrl�IhdYYIi: n,l� / •/ �S S� �O�1 / (` �
i�i i� �C�
lildr�.ir: _—�} 7� l.(� �, ,�1 S{� J
c��Y,s�:�«,ir�� . Ql 7
I 'hunr ih�/ �3 lE�� ? n
I .1 w�uu�n.mptoror7 CAeek th�xpprnyrlu�� oa:
I.Q 1 :im a.mpluyur wi�h 4. :ue�y�ncrol cou�rxtor and 1 �fM°f prn�vet(ruyulrr�):
��OumpluyecM(lull�mYur parb�inir).• huv�hired�Iw aub-cuntracwri fi• ❑�'�w�uiuuruetiun
1,un�tulv prnprichw or p�AnuF lia�cd un rht an�ched shcet : 7. emal�lin� .
.rhip;u�J B:Ivp no uinpluycuy Thra�iubeon�neron haw
��urkiny �iir ma in;uiy c�p��iiy. wurken'eomP, ,nyurane�. �' ❑ �^�oliriun
I nn work�n'cump. i�qur�na J. Q W�yn o m�ponti�m unJ iW 9• ❑DwWinr aJJi�iun
n yuircJ,J m
oN?aen hava us.ni.r�y�ihcir 10.Q Eleerriea!repain u�aJdition�
l.C7 1 am�hnmcuwnw Juiny�II work riyht uf m.�emptian pet MOL 1 I.Q Plum6in n; '
�nyxlf. (�b�.ork�n'cum . ua u
p e. S Y �a �
1 2, �}�N).anJ we Anva na Iw JJui��n�
in.rurancn rcyuirod.� � cmpluye�M.�I�o workart' 12.0 RWI'mpuin .
.runp, il4WIi11lVlt'4Y1R'{I.� 1).QUqirr
•��y.y�pLc+i�iliW.I;�eMs Ar�I muY:Jw lill uw iM�r��l�un 41ur�JwWin�iMii wurYri eun�yw�uYfuw�uli� u�hw
'�i.,�,�.�w�.�.,.rw��mnu��en.ma..i�c�wk.��.��h„y H.�w����ri wurt�nJ i
�C�.n�nMnin ihM tMeY i11�1 Eq TyM�Iq�AN��e W��I �A���iM ruw�n� Y �� '
��al dial.MuMin IM iu�y �O1"^wi.ulwiw a nw�.IRJ�v�1 iw,lf�a,l�n�yw•�,
/u�w mr employ�r rh�t/r prrvlJlnX rvwA�rt'ruinprnmdoe G�.r�n�nrr/'w� m+ewn aM�Aw wurt+n'eviy.y�Kr�nMnwiw
i���anauibna pl J�r.R Br/ury/s�M pu/lay unJ/a1.ri/� �
In�ur�ncc:Cump�ny.Vama .
Pulicy w�K SvlGiny. Lic.rh � �— -�----
. —�--.—'_'- . .. . Eepi�u�wn Datc
/�b Sit� �\ddres.r: . �'�-----_
. Nt�ch u enyr u!�h� worNan'eumpun��No�p,�llcy Ju.lur�Hun puyi f�howlnK rh�'polley numba��nd��plr�rlun dr�y,
1•�iluru tu wcuro cweruy�y requireJ wiJar Scciiun JA�I'.�IGI u. I J7 tau lead Io th�iinp��itian of eriminal yaneltias o/a
rin� „p �,�.q I.JuO.rM�mYur mw•ye�r I�nprir„n,ncnr, �� �rcll a�ci.d�n�luu in ihn lunn of� �7r)p 1VURK UROER and� fint
oi up rn i1JQ OA,�J�r IMJIIUI III� Viqldfqf. IIC iJVI.K{I IAYI J CU(lr UPIAI\a1W�'MYIII IOLr by IUMJNI•1I IU IhQ Ullllp„1
Ln�..�i���nnm�Y;Iw UI,\ lor in.naueca:mcr�yu �:�ili�aLun.
/du h.vrAy i,rii/y nnJ.v ihw p�iinr,iuJ pa�nlNcr u/p�r/ury rhrl ih�i�i uronrl/ow
�� ,,i— � yrvriJa�ubuv�i���u�,��„��•onvra
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i)/Ni�iu/�ni on/y. po nni�rrii�iii d�l�urvu. lu A�ruwy/elid dy aiiy ur/oire n/�frirL
� ( ifv or 1'�nrn:
' I��uin \Whurii � -�--�-- N�rmif/I.Itcn�pY �
! M � ) (tirrlo nne�:
I. R�,.n'J �,(I le,llll 1. Dwldury
I � Uij�artnnv�l I. /.ill.'I�JNn ('Ic(� I. L'��cCfI1C.1� 1u�1f�N♦ {,
I G. �)iher i rn,�,�o��� i�„��<<o.
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i
tnformation and Instructions r .
�I.us.�.lw±cus t;cnar�l L�ws:h�par I i2 rrywrci�II eveplay°ion m �he scry�e ol�noiherenmler n�ry:��nct flh re.� .
Ih�nu.uu w uur.uwie. an r�nOluvrr I+���ineJ as". .e �Y in
,.�«.y,,� ��„�i�"�. ��,i or wnitsn." Iwo or m�r�
uMsnhip..iysoci��wn.�aryurauan ur ud+ar legal cnnry.or�lu �r or�he
�n .onpluyei ia Jciined as"an inJrviJuol. P �� �n �m lay'ee�. Now.ver�hs
,�i ihc I��tCQJ�II� Cn�J�CJ �n a�umi muryr�s�.�n� in.luJin�{ihe legal repreien�ativaf of 1 JectaseJ emp �
�ece�var ur uuaia�ul'.m iudiriduul. Diumenh�p� ��a�Wo ut o�her leti�l end�y.omp Y 11 ' P
wn�uu�tion or repu'a wurk on such Jwdlin�huu�
„wner uf a Jweltin�{hous�havin�{na more�ap�hrn�p��anu anJ who reside��en�M ur th�acup�°t
lo � non�ro�o mrinununc�. ' �u y� �n employer..•
.h��Il�ny huui� ��(�Aa�het whu emp Y• f' -
.�r,,���he grounS�„r builJiny+ppurten,u+� �eneo shull no�beea�w of wch employm�ne���tlm
��at�or laeal Ilern�la�{�R+�er rhaY wi�uhold th�b�uuacr or
�li,l ch:+p�er I 32. �=3C(6) alto scaeer ihat"�v�ry ulnd.'
reneN+l uf r Ilceo� ur prrmll lu uy�ra���buile�u or te eo�U�aa wit\tA�In�urane�ov�o���aqor arr
. �P rndu��d��C+�P1°bJ1e���Naaher he ommonwe+��h n�c any aY iu politie+l�ubdivi�iom+h+ll
� Ileunl Nlio ho� not p
1UJiu�nully, �IGL chup�er I3_ i 3 UbI1C Wuf� �II)]CCC 11:IbIC CV11Id���uPl'0O1�7IIJ71C0 NIlI1lAf 1111Uflllt
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en�er ina�ny cun�r�M t°r�he pertumwnY�n�C J ro tht controctin4+whoriry..•
reqwr�m�nu uC ihir chup��t haw heen p
.aypUcent� lately.by cheekin{th� boaes�hut�DP�Y�o Yu�situa�ion an4 if
Q��i�don at'fidavit comp �M nwnb��l�)o1O^�wi�b ihek��cuteU)uf
Pl�:�+r 1i11 out the workar�' cump r���tl�);�P Pa�r��pi ILLP)wirh na employwr whar�han iAt
nacc�r�'•supply�ubcon�ncw�(s)n;une(�)� '
insw•�ne�. LimitrJ Liability Cmnpani��(LLC)or Limitad Liability
membars or P+u���s•ar�not requiraJ tu curY workan'eomp�nsrd��bu�?�d w�i Depwaean of��a�ol
employaat.�{�liey i� raquirod. 8�aJvi�eJ that�hi�+Hldavit nuy �m�at of
Alw e��un�o y1�M anJ JuN�h�uaned,�aol dit Uup�vit xhou
�ccidanu tor contlrtnaiiun of inauranee eov.ro�w nnit oc licana is bain4 rc4 ���o obuin u worken'
h� �.��i�n�a�tu th�eity or town nu Ir+�u�Y`4��°r°�fe4�n���t luw u�il'yuu+e+n4 �iai�hauld en�u their
1nJua�riul AcuiJanu. ShoulJ y ent r(du nwnbar Ifaud below. Salf•in�uraJ comp
�umpeneatiun poliey.pIQ�call ih� DepuRm
.alf•in�urane�lieam�n�bK,n th�a ro aro lina.
c-„�,,��r,M.om�i,�. Th� Da arunant hw pruvidaJ u�p�a+t�ho b�iwR
rinted Ic �bly. D ihe�pplinnt
�
Plcasc Ac wro�h���ha aftlduvi�ia cumplet� ;md p hcant
��i cha uifidavi� iur yuu w IiU auc in cha��Cn� �h�Oltla�uF lmesti�{�tiona h+u to cun�•rct yuu rc�{or n� .
Pl:usa 6a sute�o lill in iha p��iUlicenx� nwubsr which will b+uxe���eid o ily sub nit unu':nttlduvit n�d ea p^{�`i°�r
�I�:u�nuat submi� �nultipl�yennio'lica�uia aPPlieu�ians in any�{iven y
�J ur mark�d by �h�city or wwn may b�proviJaJ tu�ha
p,dicy inl'armwian lit necessaryl',++�J undar"Jab Sia AdJresi'tha�pplicant.+houlJ writa";dl I�cu�iun�in ' Y
tuwnl.••�\c�py°f�he utTl�uvit ih+t hat b+�n offteiully xump' 6uyinas�ur commerci�l vanrur�
1ppli.ant:u p�► that o vr1iJ�I(lJuvit i�ua fil� 1'or fLtun pa�miu ut licansaf. A n�w aiTlJuvit nwal h� Illled eut eoe
y ecu. W'hare+hum+ �wn�t u�ci�izcn is ubminin�a lianya or pennl� not rala�eJ�o�ny
�i.,.. ,i du�{liun.0 a�permit w burn Idove�ute.) �a,u�c'J�v ���Olut yourfeo psruinm ��Q�hl�u J yaua h��o.my yua�ua�f.
I ha �)I li����1 Iilvi�fIL71W0Y ��JuI�I IIA�W �IYItI{)
�,le�,e du nu�ha�i�ats to yrv� uy+c�ll.
fhc U:Q:1(IIO�I11�3 dII�II�'��. ��Icphune and Cu nu+�b+r
The Comraonwealdt of Massochuuns
ptpuanent ot I�d��� Aceiden�
OfAe�ol[svaU4�dana
600 W�in6ton Street
Bwton, MA 021 I 1
fal. M 617•721�ON 617J06 °7�49"-MASSAFE
;.,��.ii5 wwW.rtlstt.�Ov/di�
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� CITY OF S.�L.E.�f, ��L-1SS.�ICHL'SETTS
BI;II�L�IG DEP.1RTlErT
� 1?0 V7.�.iNL�1GTON STREfiT, 3iO FLOOR
� It+L (97� 7�5-9595
F.�x(97� 7449&f6
KIJBERIBY DRlSCO[l
.�UroR tHo.�usST.P�
DIpECSOL OF PI:BLiC PROPEATY�HI'IIDL�fG CO\p1I55[ONER
Canstruction Debris Disposal At'ttdavit
(required for al! demolidon and renovation work)
In accordance with the sixth edition of the State Building Cade, 780 CMR section l I I.5
Debaa, and the provisionn of MGL c 40, 3 54;
Building Permit /� is isaued with the condition that the dcbris resulting from
thia work shall be disposcd of in a properly licensed wacta disposal facility as defincd by MGL c
l 1 l, S I SOA.
The deb�a will be transportcd by:
� ' M
�
uune oYhaular)
The debris will be disposed of in :
��� ���
(name of fanliiy)
�s��l-�P. � P�,-,
(address of fatiliry)
, siynanrre oCpermit applsa t
� 2G Za�
/ � �
��m
;.n,�w�t,i,.
�,::�.� ..,::
� . . "����,[_s �.;:�f�za,�
Y�`'%�":`F.,`�r
�' � � ��
MCKee ROOf DeCk DRAWING INDEX qEVISIONLOG a:�,, �;. 3�,Qg N
. '� :.'�it';:?filDGE �
� $HEET DESCRIPTION �' �"�� - \9A J�
�.;'.
4 Union Street Salem MA ��;Fq` PS `
' A-1 ROOF PLAN AND FLOOR PLAN
A-2 NORTH,50UTH,AND WEST ELEVATION5
A3 ELEVATIONS S SEGTION
A4 WALL SEGTION/DETAILS V o
Owner■ Z NO
�eeMcKee GENERAL NOTES PROJECT INFORMATION � ��
4 Union Street, Unit 3-c � "' _
Salem, MA 01970 �. rhese documents are the property of the orchitect and 5ha�� not be copied� pROJEGT� ROOF DEGKADDITION = m�
dupl lcated, altered, modlfied or revised In any way wlthout the expressed �ppATION� 4 UNION STF�T,UNIT 3t,SALEM,MA � Q�
written approval of the archltect. .urzisoicriari Essexcoumr Q �
i APPLIGABLE LODE5: 2009 INTERNATIONAL FXISTINB 6UILDIN6 CADE(IEBL) � �
■ 2. Ta the best oF the architects knowledge these construction doaments are soo9 iNr�wnriann�eui�virw cooe pew W � �
Architect: �"`�'�
In conformance wlth tha requlrements oF the bul lding authorlties having vti nn srn�erH novinory nrineorm+rs (� p d
�urisdictlon over thls type of constructlon and occupancy. ZONING AND BUILDING DATA N ��
Seger Arehiteets, I11C. 3. All work performed by the general contractor shall comply and conform with
10 Derby Square, Suite 2N local and state building codes, ordinancee and regulations,along with ail ZONING DISTRIGT: GENTRAL DEVELOPMENT(BS)
Salem, MA 01970 other authoritles having Jurisdiction. 'fhe general contractor is responslble ExisriNe use: �siveNrin�
to be aware of these requirements and governing regulations. 2ooa p�cJ secrior+�oe.a z HR Fiae sePerznrioN
Phone: 978-744-0208 Fax: 978-744-0145 SEGTION�04.1 LEVEL 2 ALTERATIONS
4. The general wntractor is responsible for plumbing and electrical deslgn Q
I and installation, Including Ilfe/safety items per State and Local codes. �nar oF wo�PetzFORr�o, Y �
REMOVE PARTIAL AREA OF RCOF TO INSTALL A DORMER AND ROOF U �
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DATE:7/22/11 Salem, Massachusetts 01970
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DEfAILS MCKEE ROOF DECK SEGERARCHITECTS, INC. ���''��� q`���„
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