49-51 WARREN ST - BUILDING INSPECTION ..f •1
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' � The Commonwealth of Massachusetts � I
• � � Deparhnent of Public Safety
's�' A-lassachusetls State�uilJing Cale(7S0 CMR)
Building Pertnit Application for any Building other than'a One-or"fwo-Family Dwelling
(This Section For Official Use Onl )
Ouilding Permit Number: Date Applied: Building Of(ici�l:
, SECTION 1:LOCATION(Pfease indicate 61ock k and Lot N for locations far which a street address is not available) `
^�f'
� � No.and Street ,City/Tuwn Zip Code Name of Buildin �f a lic.
8C PP �)
SECTION2•PROPOSED WORK� � - � o
Edition of MA State Cod¢useJ If New Cunstructiun check here�or check.ill tha[a I m[h �
� PP Y � Mo.ro��i�w � �,
Existing euilding❑ Repair� rUleratiun Addition❑ Demolition (Plcase fill out and submi�p�un �
Change uf Use ❑ Cliange o(OccuP����Y �� Other ❑ Specify: � r..L �
Are building pl.ms and/or constmctiun dixuments being suPplied as part of this permit application? Ycs �� p �
Is an Independent Struchiral Engincering Pee Re iew reyui J? /�
Brief Description of Propused Work: Y�S � � � G �
d
N c� �
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,� r-i i�
SECCION 3:COMPLETE THIS S@CTtON IF EXISTING UUILDING UNDE2COING RENOVATION,ADDITION,OR
` CHANCE IN USF OR OCCUPANCY
Check here if an ExisHng Building lnvestigation and Evaluation is enclused(See 7S0 CMR 3�4) ❑ .
Esis[ing Use Cruup(s): �� � � -� �� � Proposid Use Croup(s): '
SECCION 4:BUILDINC HEICHT AND AREA
Existing � Proposed
No.of Floors/Sturies(include basement levels)&Area Per Flatt(sy. ft.) � � �'6 �S. .
'Co4�1 Arca(sq.ft.)and Total Height(ft.) � -
SECTIONS:USEGROUP�Checkasa licable�� �
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-I❑ A-5❑ B: Uusiness ❑
F: Facto F•I❑ F2 E: Educationnl ❑
❑ H: Hi h Iivard H-f❑ H-2❑ H-3 ❑ � F44❑ H-5❑
. L• Insfitution.il 4t❑ I-2❑ !_3❑ 4.1 p NL h[ercanHle❑ R: Residential R-1❑ R-2❑ R-3❑ R-0 �
S: Storage Sf❑ &2❑ U: Utility❑ Special Use O and please describe beluw:
� Special Use: �
SECCION 6:CONSTRUCIION'lYPE(Check as a licable) .
�•� ❑ �o ❑ nn ❑ us ❑ utn ❑ msa n! ❑ vno vo ❑
SECTION 7:SITE INEORNfATION(mfer to 79U CM1IR 113A fot det.tils on each item) ,
Water Supply: Flood Zone(nformation: Sewage Disposat: Trench Permit Debris RemavaL• � I�
Public� Check if uulside Flood Zune� fnJicate municip;il� ��trench w'1 not be Licensed Dispusal Sitc❑
Private❑ or indentify Zone: ur on site system O myuireJ ur trench ur s ecify:
pennit is uiclused❑ ` : ,
Railroad right•obwa : tluards to Air Navi a[ion: \I, .
$ . \I lisl�ni l imnuas�m Il �u•.`S.._r ticis:
Nut Applicable Is Stmcture within airport ap roach�vea? Is tl�ur review completed? --�� r
nr Consent to Build cndused❑ Ycs O or No� . Yes❑ Nu ❑
SECTION 8:CONTENT OF CERTIPICeU'E OF OCCUPANCY
LJitiun uf Cudc: lJsc Croup(s): Typc uf Cu�utruction:. Occupant Luad per flnoc
Unes Ihe 6uilJiny,contain an Sprinkler System?:--- SF'eci�d Slipid.itiuns:
_ ' �M`� �lzy �1a;1 �o
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SECC[ON 9: PROPER7'Y OWNGR AUTFfORIZAT(ON
. Name nnd Addrcss of Property Owner
IJo�r�r w RQ,b..rTS z Rbse c�ia-1 e J4✓e S--P.�. �1 �o
Nnme(Print) No.end Street City/Town Z�P
Property Owner Cuntact In(ormation: .
q��29-1�� -
Title Telephone No.(busuiess) Tclephone No. (mll) rmail address
If applicable, the pruperty owner hereby authorizes
Nmne - SHeetAddress � City/Town State Zip � �
[o act un the ro er owner s behalf, in all malters rclative to wnrk authorized b this buildin ermit a lir�tion. �.
SECCION 10:CONSTRUCTION CON'CROL(Please fill out Appendix 2) .
� If builifin is less fhan 35,000 cu.(t.of enclosed s ce and or not under ConstrucNon CoNrol then check here O and ski� Section 101
101 Re i"stered Pmfeseional Res oneible fac Construction Conhol � �
r� .._,
-,.�.� r.�..
N:mii.(.Registmnf) � . Telephone Nu. - e-mail address - Registration Numbcr
.._.
Strce[�Address�' �- City/Town � State Zip Discipline Expiration Date
� �, ``—ido
� 10.2 Gerieni 6ontractor � � � -
�7 //�'
'to I�Q�C \ �'�Y ILQ� .
Co/m'�p:u�y ne //,�� f� �1p (�
C T+c�!-O.P l Y.�.r�.oI� �-U 'O L� ! � (
Name of rson Responsible fur Cunstructio��` c License Nu. and Type J Applicable
7G� S��e� . C�w:T .0 cJg�c.u� � Ul G�
Strcet Address � - City/Town � �, Shte Zip
�-2�1- �Z06 S4�'I'1� U�-e,t � .+1
Tcle hone No. business Tcle hune Nn. cell �mnil a �ilrcss
SECIION il:woal:ths cOnu�F.Nsn nbN w5ur.nNc�f;:V'P�unvn' M.G.L.c.152 25C 6
A 4Vurkers'Compensation liuurance Affidavit from the MA Deparhnent of[ndustri:il Accidents must be completed and
submitted with this application. Failure ro provide this affidavit will result in the denial of the issu ce of the building permit.
[s a si ned Affidavit submitt�al with this a licaHon? Yee 0 No�
� � SECTION]2 CONSTRUCI'[ON COSTS AND PERMIT FEE �-
Item Estunated Costs:(Labur
and Materials) � Totat Conswction Cust(from Item 6)_$
L DuIIding �� - Building Permi[Fee�Tutal Cunstruction Cust x_(fnsert here
. -2.EliYtrical � - � . �� ' approptiate municipal facror)_'�
3. Plumbing 3
, 4. �fechanical (HVAC) g ��" . Note:Minimum(ee=$ (contact municipality)
5. blechanical Other � /''A �. nduse ch��ck payable lu
6.Tota!Cust 3 �� (cont.ct mm�icipality)and write check number here
� SECTION 13:SIGNATURE OF DUILDtNG PERMIT APPLICANT
6y entering my name beluw, f hereby attest wider the pains and penalties of pequry that all of the information cuntaintwl in this .
applicatiun is true�md accurate to the besl of my knuwledge and understanJing. .
�t-GoJ'�i.� VG.�c<tAo�l _---
Ple�y�pri mid si a �e Title Tdephune No. Date
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Strcet A res�� • /�� Cit /�Tuwn O Q � tete ZiP
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�Iunicipal lnspector to fill out this section upan application appmvaL• `N �+'0 r L /�
Name Date
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�° CI'I'Y OF S:�LE.�I, l�L-1SS:ICHL'SETI'S
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. 4 E1l'l1.Dl\G DEP.�R'['�IE�iT
3 4 { '���� 1?O \X/.1SHL�IGTON S7TiEET, 3'D FLOOR
� �`�"°�� 'I'� (978) 7�5-9595
F.�.�c(978) 7d0-98�46
K1�lgERLEY DRISCOLL
�:tiL1YOR Ilaonus ST.Pt�exs
DfRECiUR OF PL'OLIC PROPEflT!/BCQ.DIVG CO\L�115S[OFER
1Vnrkers' Compensation Insurance ��Flidavit: DuildcrslContructors/Electrlcians/Plumhers
rlpplir.�nt Infnrmntinn PlcaSp Prfnt f e �g'bIY
�1,1111C (HusinessO�ganieatioro'ImlividualY v J'eC �
,�����,s: ?a �./oa/ ,Sf „�fi ,Q .
City/Statc/Zip: ,S��r_,Nl m_ !j/`�7C� Phonell:J�7t� 77�-�Zd�O
�1re yau un cmploycr7 Check the appropriate but: '1'ypt uf prnJect(requlred);
I.0 I am�cmployar with a. � ��z generai canlrnaor anJ I 6. ❑New cunsWe�ion
2.��mployera(full and/or pan-�ime).• have hired Ihe sutscantractory ,,,___,,,///
1 am a soio propricror or p;utner lia�¢J on ihe attached vheet. : Z .�emodeling .
,hip and have no cmployces Thcse sub-eontroarors have 8. Demolition �
working li>r mc in rny capacity. �vork:rs'mmp. insumnca 9, � p�j�����g�����iun
�No twrkcn'comp. insuronct 5. � We are o carparation mid iu
� rcquimJ.] . oflicen h�va exercised their IO.�Elecrrical repairs or addieiorts
3•O I om a hmncuwncr duing all wurk righc ui exa�uptiun par MGL I L�Plumbing«puirs or udditiom �
myself. (No workcrY'cump. c. I52, §I(4),and w¢havr no 12,[� Raof rcpuiry
insuranet reyuireJ.� � empluyea. ��'o warken' �},Q Othor
cump. insurance rcyuircd�
•.\ny�pplicv�t ilul check�hux f I miu�aisu fill uw the s.ctiun bcluw�howing thcir warken`cumpewiiun pulicy inlinmolfun.
�I L+m¢nwn.n�rho whmi11hi1 olAd�vi�indicaliny�hry a�e doinN all�wrk anJ ih<n hirC uutsiJe mmmc�on mml mihmil�new afl?Javil indinliny.uch
�<'��mcncwn�hW chak ihi�buS mml:tnuhal�n a�4li�iuwl ahral shuwiny ilw n:unc of thC subeanlnctort anJ iAelr wnAcn'cump.yullcy inlurmalion. '
!uiir urt rurpluyer Ntut ia praviJing ivorkert'comptusadun insurunce jo�my eurpluyers ltelury ls fha pollcy und Jub sI(e
iufi��nrulinn. � /�
Insur,mccCmnpanyVainr: C Q_�pSJ(`4h.Ge L�O. .
Policy �!ur SclGim. Lia N: �OA �%�}rp �a� — ((7 Ezpiration Dnte: � ' 2�T '����T �
Jub Siro iWdre'ss: �/ ' r� �oere�t � Ciry/State/2ip: VQ�'2/!'� Lj/(�„ 0�97�
A�tach u copy uf lhe ivurlc.n'compensatluu pullcy�ecl�ratfon po�;e(showing the pollcy nurn6er and ezpin�inn d�te).
F'ailuru w sacuro covarvge�ts requireJ undet Seclion?SA of�(GL c. 132 can IeaJ to�he imposi�ion ofcriminal penaltizs uf a
iinc up to SI,SOQUO unJ/ar une•ytar imprisomncn4�s tvcll ay civil pcnafli�s in lhc I'ortn uf u STOP LVURf(OR�ER anJ n lin�
nFup co 5?i0.00 a day�g�inst rha viulacnr. De aJvised ihat a cupy uf ihis.�atement inay fx funvardcd to ihc Ofliea o(
hivc,iigaiiuns ol'thc nL1 for insur�nce covunge verili��lion. � .
� /do hrrrby croniJy mrJr�thr pain�r {J prno!(lr.s o�pui/ury rhur rhr injurnm/Jon pruvideJ uGuvr i.s�rur and corrreG
Ci����.�i�,.... �7u..�cJ�� /�C p 1,'t�__ /
— ,� U:ifd: _./�` ��
Phiine 1
OJ/iciu!w�e ou/y. Du nm�viiie in d�i.e urru, fo bt compltleJ by city u�town nfJ7aiu1 . . .
ICity nr�fu�rn: _-- Pcrmit/f.lccnsc q • I
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I (>suing,\whurity (circiconc): �
I. ItuarJ ul'Il�vlih I. Uuildlnq I)cp:�riwcnt J.Cilylfnnn Clcrk J. M:icetriril Intpcetur 5. Pluinbiu� Inspactor I
IG. Olhcr ...__ _. . ... . �
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„��°' .:��, CITY OF SALEM, MASSAQ�USETTS
, _j;
�< <, � �y�;) BUILDING DEPARTMENT
�' ,��;- �.�; `��' 120 WASHINGTON STREET,3AD FLOOR
'\��+�' � TEL. (978) 745-9595
FA3c(978) 740-9846
KIMBERLEY DRISCOLL
MAYOR TY3o�s ST.PiE�
DIRECTOR OF PUBLIC PROPERTY�BUILDING COMMISSIONER
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 111.5 Debris,
and the provisions of MGL c40, S 54; Building Permit # is issued with the
condition that the debris resulting from this work shall be disposed of in a properly licensed
waste deposit facility as defined by MGL c 111, 5 150A.
The debris will be transported by:
D NS � S� .
(name of hauler)
The debris will be disposed of in:
(name of facility)
(address of facility)
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Sig ture of applicant
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�' � �� I BEOROOM BEDROOM I � �
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� E%CWSIVE USE EXCLUSIVE USE
UNIT 49B UNIT 51B
�. � � . PANTRY PANiRY
KIT�N
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ROOM ROOM
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, ROOM BED OOM DININC
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NiRpNC I NiRPNLF UNIT +�p
UNIT 496
AREA m 890 t S.F. ,�. I ,,�� �►REA � B90 t S.F.
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EXCLUSIVE IUSE I EXCLUSIVE USE S70RAGE
UNIT 496 UNIT 516 EXCLUSIVE USE
UNIT 49B
KITCHEN PANTRY PANTRY KITCHEN
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-' n STORAGE
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BATH BATH EXCLUSIVE USE
UNIT 518
ROOM ROOM
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' � CLOSET
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� DINING CLOSET
ROOM BEDROOM BEDROOM DINING PROPoseo I BATH
BATH ROOM
ROOM RooM
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F 19.5 I 19.5
�I CLOSET � CLOSET
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't.� � BEDROOM
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N
ENTRANCE UNIT J�B
I UNIT 496 AREA = 880 f S.F. Walls to be YemOVe� UNIT 516
� AREA = 890 f S.F. MA,N UNIT 49B
E"�""cE AREA = 410 f S.F.
; uwNc AREA = 410 f S.F:
LIVING ROOM
ROOM UP UP
3RD FLOOR
2ND FLOOR
,
,
FOR REGISTRY USE ONLY
FLOOR PLAf�S
I CE
RTIFY THAT
THIS
PLAN CONFORMS TO THE RULES FOR
AND REGULATIONS OF THE REGISTERS OF DEEDS. � _
49 5
1 WARREN STRCET CONDOMINIUM
I CERIIFY THAT THIS PLAN FULLY AND ACCURATELY DEPICTS THE SALEM
GRAPHIC SCAL� �SN�FM
LAYOUT, LOCATION, UNIT NUMBERS AND DIMENSIONS OF THE UNITS �r qss SCALE 1'� = 5' 't SEPTEMBER 30, 2014
DESIGNATED 49A, 496, 51A & 518 AT 49 & 51 WARREN S?REET, a o a s ia so ,��`'� 9cy�: NORTH SHORE SURVEY C�RPORATION
SALEM, MA. AS BUILT. � GAII L. m
- � � ' o SMITH � 14 BROWN STREET — SALEM, MA
_ � No a�3 " (978) 744-480Q
' ( ar �Er ) � �F o
1 inch = 5 fk sS ��srea��
DATE PROFESSIONAL LAND SURVEYOR ��` `�"�5
J � . #4075
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