87 WASHINGTON ST - BUILDING INSPECTION � ,�6°�� Cz� o� Sr�Lr�z
j� , lr�''i PUBLIC PROPERTY
i
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�� I I�AItI i l l?V DRItiCO1.L
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720AX�'e\$FIING'IUNS'fRl'il'�1' � $iAI.I.M_�'I�A tiAG-IDS73LTS�197(.1
'Ce.�:978-745-9595 �l�+nx:978-740-9846
APPLICATION FOR PLAN EXAMINATION AND
BUILDING PERMIT
ALL BUILDINGS EXCEPT ONE AND 2 FAMILY DWELLINGS
IMPORTANT: Applicants must complete all items on this pnge
SITE INFORMATION
Location Name 6�eeN L`a�c� �m�e Building
Property Address
�� t�c� I,,;y�-4o�n S-}rcct S�,ler� N\R.
LoeaYed in: Conservation Area Y/N FlisYoric district
APPLICATION DATE �� �S . � vV V �
Use Groups
(check one)
Group Homes R3 R4_ . .
Residential (3 or more Units) R2
Type of improvement Residential (hotelhnotel) Rl
(check one) Assembly(Theaters) AI
New Building_ Assembly(restaurants& clubs) A2r�A2nc_ �
Addition Assembly(churehes) A1 _ '
Alteration�� Business B .
Repair/Replacement_ Educational E ��..
Demolition Feclory(moderate hazard) Fl 'i
Move/Relocate Factory (low hazard) F2 !
Foundation Only High Hazard H �,
Accessory Building_ Institutional(residential care) Il ,
Institutional (incapacitated) 12 �.
Institutional (restrained) I3
Mercantile M
Storage Sl Moderate Hazard
Sforage � S2_Low Hazard
OWNERSHIP INFORMA'PION(Please type or Print CleTrly)
OWNER Name RI W�.._�..c.�� � Strcc�- Re�1 Es-�E LLC
�V��,�T �S Address� Rnn1-(oc� �-frcc-i l3evc�lv, MR. �tqls
Telepltone q7� - �j ZZ- 0�533 ��
1������"^ C�berc�'- Si�nature C'�iYy(,L�
DESCRIPTION O WORK T BE PERFORMED " l`�' """"" �
Tv�Z�-all �UC'� n/' rU"Farc l<�icl.�c:� F,cln�.uS7�yJS'le.r.
i�.,�-��• 4, �-1 FlcesS n� L�cilcrQi �` �—Cln�ov��. Y�°af' � �AD
ESTIMATED CONSTRUCTION COST � 'I�SO o0
�%`�} CIT1' OF SALGIVI
�� ��,T�J� PLTBLIC PROPERTY
\��,'~�. s` /
����% DLPARTNI�N`I'
I<IblliL'RI.P_Y qkISCO1.L
I�L�Y'OA
120 Wnsi-rrNc.roN Sriaec'r � Snt.e.M.�4,�s�.�Ci iusr'rrs 01970
�Ce.t.:978-74>-9595 � 13��s:973-740AS4G
CONTRACTOR tNFORMATION
Name � )uck �E i�lr1R�1
Address 7S Sixth Sf• �I,�clSeu. /�A 02(S�
Telephone ('!'l '884' 8i10
Construction Supervisor's Lic# C'S �'7 2 f �9
Home Improvement Contractor#
ARCHITECT/ENCINGER INFORMATION
Name (.,n rr�n i2o.., P E.
F�CIC�TeSS g� �i:c:c1�M S'} • WAKEFf6i� M(�•
Telephone �81 - 2y6- 03�30
Mass. Registration # 34SOS
PERMIT FE6 CALCULATION j
Estimated Cost x $11/$1,000 + $5.00=
COMMENTS
The undersigned applicnnt does /tereby attest t/iat al[i�xformation stated above is true to the best of my knowletlge
under the percalties ofnerjury �
� j �
Signerl �,,. (owner) (agent)
G'
APPROVED BY :
DATEAPPROVED: / L ' �� � �
� �� � CITY OF ���i.E�I; ���.�SS��.CHLSETTS �
Bti1LDt�IG DEP�R'R(E2vT
a } :�N O 1?0 W.�SHLrIGT0I1 STREET, 3°O FLOOI�
\ �°O' "I'F.L (978} 745-9545
F.�.Y(978) 730-9546
�j�,ggFRi F.Y DRTSCOLL
i�Y�1YOR THONtAS ST.PIERAE
DTRECTOR OF PC:BLIG PROPERTY/HI:II.DCVG COiLt/iSSYONER
6Vorkers' Compensation Insurance Aftid�►vit: 13uSlderslContracYar�lElectricians/1'lumhers
4pnlicant Informatiora Pltase Print l:,e�iblv
�IIItfl6(BusincsslC�rganizatiuNlndividualj: SEIdMAIJ L�QGS
.�.cl(�CC55: 2.S �\X1'� S'1' •
City/SEate/Zip: C�I�e�Sec. /�lA• �2iSO PhoneH:�1�-SBy� $118
A�re,/you xn employer?Check the appropriate boY: Type uFprojest(required):
1.L.� 1 am a cmployer witli�5.�,._ 4. Q I am a general contractor and 1 G. ❑New construc[ion
employees(full andloe part-[ime).° have hired thc sub-contractnrs
2.Q 1 am a sole proprictor or partner- lis[ed on t6e attached shee0. � �• ❑ Remodeling
. ship and have no empiuyens These sub-wntractors have 8. ❑Demolition
working for mc in any capacity. workers' comp. insurance. g, � Buil�iing addition
[No workcrs comp. inswance 5. 0 We are a corporation and its
required.]
officers have exercised their 16.0 Electrical rzpairs or additions
3.Q I am a homcuwncr doing all work right of cxemptiim pc:r MGL I 1.0 Plumbing rcpairs or additions
mysel£ [No workers'cnmp. c. 152, §I(4),and we have no �2,0 Roof rcpairs
insurance reyuiredJ i employeea. [l�'o workers'
comp. insurance requirnd.] �3.�Other D�a�wnrK
•Any appiic:vil 11wf chccks bux HI musl alw till out 4�c scctiun tklow shawing thoir wolkcrs'com{xnsa�ion�wlicy infurma�ion.
t 14rmeowM,�rs whu su6mit this a�davit indic�ting ihey ue doing ali work and thcn.hire omside mn«c�ors must su6mit a new amdavil indic.ding s¢ch
=C.mir.xior.�hul ch�ce thie hux m�wt anach.zi an:rWiliurul cheet showing ilu n:une of the sub�Contractors and their wmlu:n'cnmp,pulicy infumm[ion.
/ura an eu�p�uyer tha!is pravidin,q�sdorkers'compensallmi insurunce for my entpluyees. Be[aw Is Ihe po1lcy and fob srfe
injoimwion. M --7—
(iuuranceCompanyVame: PI '\C .J�U�SV�1�1Ce
E'olicy i1 or Sclf-ins. Lic. it: W C C�8�3y o 3 Expiration Qate:��31 �B�
Job Sire Ad�iress: �7 �C��i�'FO�'� S�PC e'� !CitylState/2ip: �M� M A ,
,�ttacb a copy of the tivorkers' compensation policy decfarallon page(showing the pollcy num6er and expirallon date).
F�ilure to sccurc coverage as required under Section 25A uf MGL c. 152 can tead Eo the iinposition of criminal penalcies of a
fine up to S 1,500.00 ami/or one-year imprisonmen4�s well as civil pcnaltics in the form of u STOP WORK 02DER and n Fine
of up to 5250.00 a day against tha violaror. 13e advir•i:d that a copy uf this statcment may be: fonvardcd�o the 011i�e of
fnvcs�igatiuivs ut'(he DfA Por insurance covcragc vcrificatfon.
I Jo Ifereby cer,t' rurder t/rr p+ina mrd��enallier ojperjury tbut rl�e i�+farrrrution proviJrJ above if true m�J corrrcL
Si��nat �re: � Uate• Z �25�0�'
/ q. [I ¢ Y '�--
Phonc't� C.v��7 '-[]$"1-0��� �
Ojrrirrl use oiily. Do not wri�e ire rbis u�eu m be curapleted by city or town nfJicial
City nr'Cawn: ______ Yrrmitl[.Iccnse#
_.__.,----._�_..-----..._.._.,�._
Issuing A Whurity (circle one):
I. (Suard uf lierith E. Ruilding Deprrkmcnt J. City/fuwn Cterk d. Electrical Inspector 5. Plumbing lnspector
6.Olher
Contact 1'crson: __ _.,.....__.._.._---...__ t'honc#:
�
' ;� ° CITY OF S��LLEE�I, ��-1SS.�CHL'SETTS
BLu.��G Dsr��rsc�,�r
a ' N O 1?0 W:1S'HL�IGTOfI S"L'REEF, 3°L FL.00IL
`� �.0""� 'I�L (97�) 7�k5-9595
Fas(978) 740-9�46
��,{g�gF.�Y DKTSCOLL
MAYO� 'I7-i0atas ST.PIEFtRE
DiRECTOR OF PL'BLIC PROPER"IY�HL'II.DIPJG CO�Li(%55[ONER
�:onstruction �ebris Disposa! Aftia3avit
(required for all demolition and renovation work)
In accordance with the sixLh edition of die State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S S4;
Building Permit # is issued with the condition that the debris resulting from
this work shall be disposed of in a proper]y licensed waste disposal f'acility as tlefined by MGL c
111, S 150A.
The debris wili be transpoRed by:
ass�.-11�
(namc of huuler)
'Che debris tivill be disposed of in : �il��JS�e/'
SElnrv��!—_�i2cas �h� ----
(name oY Yacility)
2S �ri-� S'1� . C�e�se�
� (address oY facilityj
\ `
igna[ure of permit applicant �
_ G /ZS O _
� iiate
dchrisalEiloc
n
CERTIFICATE OF LIABILITY INSURANCE . 3�3i°a oo s
JCER THIS CERTIFICATE IS ISSUED AS A MA7TER OF INFORMATION
Aseociatioa 8enefite ON�Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. TH18 CERTIFICATE DOES NOT AMEND, El(TEND OR
529 MA1A StYe6t ALTER THE COVERAOE AFFORDED BY iHE POLICIES BELOW.
Boeton, MA 02129
617-456-9800 INSURERS AFFORDINO COVERAGE NAIC#
NSURED BEIDMAN BROTFiERS, INC INBURFRA: ONR SEACON
INSURER B: BMC IN$URAD7C8
25 SI7CTH STRSET INSURERC:
CHELS&A, MA 02150 iNsuaeao:
INBURER E: �
COVERAGES
THE POLICIES OF INSURANCE LI3TED BELOW HAVE BBEN IS6UE0 TO THE INSURED NAMED A80VE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WMCH THIS CERTIfICATE MAY BE 19SUED OR
MAY PERTAIN,THE INSURANCE AFFORDED 8Y THE POLICIES�E&CRIBED HEREIN IS 3UB.IECT TO A4L THE TERMS,EXCLUSIONS AN�CONDITIONS OF SUCH
POLICIES.A6GRE6ATE LIMITS SHOWN MAY HqVE BEEN REDUCED BY PAID CW MS.
i sq� POLICY NUMBER P I � I P O uMnS
GENERAL L�ABILITY EAOH OCCURRENCE S �, OOO� OO
X COMMERCIAL GENEPAL LIABILITV PREMI3E9 e�occu e ca m 3 O O� O O
CLAIMSMAOE ❑X OCCUR MEOEXPIM one arsan) $ rJ� OO
A FS1V15893 09/15/07 09/15/OB PER&ONALBApVINJURV s 1,OOD,00
GENERAL AOOREOqTE $ a OQQ 00
GEN'LAGOREGAiELIMITAPPlIE3PEPo pRODUCTS-COMP/OPA00 $ � OOO OO
POLICY PR . Loc '
AV(OMOBILELIABILITY
ANYA�ITO . (Eaec�IEeD�INOLEUMR d Z� OOO� OO
qLLOWNEDAUT09 BODILVINJURY
X SCHEOULEDAUTOS (Perpe�ean) 6
A X HIREOAUTOS FH1803441 09/15/07 09/15/08 BODILVINJURV
X NON-OWNEDAUTOS (Poracddenl) $
GROPERTY OAMA�E $
(Perecddant)
OARAGELIABILffV , AUTODNIV�EAACCIDENT $
ANYAUTO OTHERTHAN �ACC $
AVTOONLV: AQ� �
FJ(CESB/UMBRELLA LIABIIITY EPCH OCCl1RFENCE S �.� OOO�O( ���,
X OCG1R CI C�A�MSMnOE A6GREOA7E $ S OOO� OC I
F81II15893 09/15/07 09/15/OB s
A OEOUCTIBLE
S
X RETENTION $ ZU ODO ' g
WORKERBCOMPENSATIONAND x T II
EMPLOyERS'LIA9ILITY
ANY Pf3oPRIeTwUPMTNENEIfECUTIVE E.L,EACHACCIDENT S SOO� OI
� officewmEma�vexauoeov WC6833403 03/31/OB 03/31/09 E.L.DISEASE•EAEMPLOVE � 100.Uf
Ifyes tleactlheuMer
SPE�IALPROVISIONShelm4 E.L.018EA9E•POLICVLIMIT 6 rJOO O�
OTHER
DESCRIPTION OP OPERATIONSI LOCATIONSIVEHICI.E9/EXCW910N8 ADDE�BYENOORSEMENT/9PECW.PpOV1910N8
CBRTIFICAT& A8 PROOS OF INSVRANCB ffOR CLI�NT: SBIDMAN SROTHERB INC.
CERTIFICATE HOIDER CANCELLATION
, BHOUlO ANY OF THE ABOVE UESCRIBEO POLICIEB BE CANCELLED BEPORE THE EXPoR
QISID�ANS SROTHERS INC DFTE 7HEREOF,TI1E ISSUINO INSURER WILL ENDE4VOR TO MAIL1� DAYS WRfl`.
Z S 3IBTH 3TR$�T NOTICE TO THE CERTIFICATE HOlOER NAMED TO THE LEFT,BUT FAI4URE TO 00 SO 81
CH8L3EA� MA O Z ZSO IMPOSE NO OBLIOpTION OR LIABILITY OF ANY NIND UPON 7He INeURER,R9 AOENT6
REPRESEMATIVES.
AUTHORIZED REPRESENTATIVE
FA]C: 617-884-4284
ACOR02S(2001/08� �ACORD CORPORATION 787
� ` BROS. INC. 25 S�'h S'
Chelsea, MA 02150 Sales Order Number: S06665
USA Sales Order Date: Nov 10, 2008
I mSri � + �r->i wt�� +r.� Shl B NOV 10, 2008
Drs(C; » i u.X�h � .u.jK, � nt,dinu.cr5csren�t VOIce: 617-884 811 0 P Y
• d Page: 1
C��,r�;ra57e,;dr,-�SkziFr.tn�iu,;i,�n Fax: 617-884-4254
�.. �. m u . � -� : u„ ....-f.� '�.`�.',�-+��,- -"��' ;.,�mm--.�*".,7-,-.:-,.""""�;,�
�T� =�3t��tl ni r .-i=,� '� _�"�'^ k� , ��4 -= _'�i,��k.! Shlp TO �' �_... � ��ia �.�, _ rr ,.�
Green Land Cafe Green Land Cafe
87 Washington Street 87 Washington Street
Salem, MA 01970 � Salem, MA 01970
Voice 617-413-9148
Fax
m ,. m,n �.m .
' <: ,.,�. _'Customer.ID: '� g;'� �i '+: y.. �=,;� PONumber ., d;; ,� G. :`. y ��.� E'�' ; SalesRep`Name�� -
& s;
, .,. m_ , ,
Green Land Cafe Jack Seidman
� .; , �Customer Contact - , �: �,� Shipping Method�s = ,. ;r �r a Payment Terms " � �
_. . m .... ,... .�__ m� .� . . .7�_ .. . u.z � . _.. w �., _m
Paul Bolden Our Truck C.O.D. �
�`.Quantrt .:;a ' y�_-Item , ,.'_.- �� ' ;._! ��' y `Descriptwn �!_��'�� „�F�� ; 'UnitPnce ° ' 'Amount =�- �'
y a:
� C�___ � � � - � �:J
1.00 se exsys Exhaust System with 24", 1hp, 2 speed, 120v. 4,350.00 4,350.00
upblast Fan, Roof Curbing, Grease Vap, and 14"x �
25" welded Dud. 4800
CFM @ 2075 FPM. The dud will run through the i
interior of the building up three stories to the roof and
then run inbound from the property line above the
roof. �
I
1.00 Job-engdrvv Drawing of the exhaust duct and shaft for the Building 250.00 250.00 ��
Dept.
1.00 Job-Prmt cnslt Time for Consulting with Inspectional Services in your 250.00 250.00 'I
town.
I spoke with the building Inspedor, and he stated that
an engineers stamp will not be required for this part
of the project. He wants a plan showing the shaft
construction, the duct size and materials, and
clearances. He wants to see me with it, and he will �
amend the existing permit, so we will not need a
separate permit.
� S ubtota I 4,850.00
Sales Tax �230"00� �
Freight � � �� 0.00
. . .,.. .,. . � _ ._, . . ,.. � ., . ._ . .,,.._.
TOTAL"DRDERAMOUNT� ,': � '�M � '` "� `' S,080.00
,
nu.. . _:... . ._ __ ..._-.. -.6� �31k... �, -, �
....�,_. . ..�__a-... �� ._—_ — fLd1 - .�_:.:...
Finance Charqe is computed at 2°/a monthly (24% APR) on all
balances over 30 days old.
E��IPMENT SCHEO�LE:
�� MLI-1
, s° a[e p�eNUMN EXHAIJST H0�0 - STAINLESS STEEL REAR �ISCHARGE EXNAUST H000, �
I2'-8", X 48" X 24" HIGH, WITH FIJLL LENGTH FILTER RACK, ALL WEL�E� GREASE SHELL � � �
� • • REMOVABLE GREASE CIJP, ANO 11L LISTEO BAFFLE FILTERS AND LIGHT FIXTIJRES. � �
EF -I - 24" 11PBLAST EXHAIJSi FAN WITH IHP, 120V, 2 SPEEO M�TOR, ANO REMOVABLE GREASE TRAP. �
� �
i� 4800 CFM @ 2075 FPM IN A 19" X I9" OR EDIJIVALENT WEL�E� 16 GA GALVANIZEO 011CT. � � �
� � THE �IJCT WILL RIJN IJP THREE ST�RIES TO THE ROOF THR�IJGH A FIREPRDOF SHAFT. � � �
CHASE
4B� MIJ-I - MAKE-t1P AIR SYSiEM WITH IS", 1HP, 120 V. 2 SPEE� BLOWER FAN IN A �
—1 WALL MOIJNTE� FILTEREO H�IJSING. 4400 CFM = 92% RENRNEO TD ROOM �
�o� nin I FIRE SUPPRESSION - A IJL-300 FIRE SIJPPRESSION SYSTEM WILL BE INSTALLEO ID COVER THE HO��S, �' � q
� OUCTS, ANO APPLIANCES IJNOER THE H00�. � � �
� z B � , N�TE�� LIPON ACTIVATION �F THE FIRE StJPPRESSION SYSTEM, THE EXHAl1ST FANS SHA�� REMAIN ON, � � �
� ANO THE St1PPLY SYSTEM, GAS FEE� AN� ELECTRICAL FEEO TO ITEMS IJNOER THE H0�0 � �
l0' nIry (INCLU�ING LIGHTS7 SHALL SHt1T OOWN. � � �
SYSTEM IS BIJILT T� MEET NFPA 9fi AN� ALL LOCAL 61JILOING COOES. ��j
i ;: i EF-i '
� _ y
- O�
RODF TOP PLAN O W O
0 � �
_ � c-v
10' MIN� �l0' MIN _II w _
� �
� �
EF-I EF-1 .—, y �
CLEAN W � m _ m
MASi1NARY WALL O�T CLEAN Q (� z � � W
(BRICK) O�T U p[ Q �
OIJCT MAS�NARY' � O O
12" N 31' BDARO I I I�
I I � -
Nn
y4G.
1R°rl V. �,. .
INTERIDR SHAFT �CW' �
SIZE 19' �
O @ ,
&a� ,e��.'�
iE
19" % t9" Ol1CT
�INTERIDR SHAFT METAL STIJOS
SIIE 44"
\,
i�
12'- fi' -
FIRE PRDOF SHAFT
DETAIL r - 1 �
- - � r � i � r - - � �
i i ,' i i za^ i �� i � � � .
i
- '� - - -'
_ _ _ J Pl1L� STATION � � �
LOCATEO AT CGRESS �
IJL LISTEO � �
6AFFLE FILTERS
/ q0, ANO LIGHT FIXTIJRES
� III _ ___ YIII 111111 000a 1110 o fi,_ fi � � '�
_ ___ � � �
OL 300 FIRE Z � � �
St1PRESSI�N SYSTEM O
rti � �
Al1TOMATIC GAS U � � � �
- SHOIDONN VALVE 0 rv, �
J ry� � �i
FRONT ELEVATION SIDE ELEVATION o � � � I
� �
�
��' �Z� �'�' 6 �'��"��H� 800? S I 8�� `d�?��s r�� 6
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