118 WASHINGTON ST - BUILDING INSPECTION (9) ;. .
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, ,.. ,- , The.Commonwealth'of Massachusetts , •, ; ;, ;;�
„ �� �y ,� Department of Public Safety •
�v.�....j \la...�rhu>iql.�lo�r Buddin�;Cudr 1%!3�C\IRl Sr��rnlh Editiun �
, , , City of$alem '
' � Buildin Permit A lication for an Buildin other than a 1- or'2-Fa`mil yDwellin'
�ihis Srctiun Fur O((icial U.�r lJnlv)
. liuildinti Permit Numbrr. Datr Applird: Building In+pectur:
SECTION 1: LOCATION IPtease indicate Block N and Lol M for loeations for which a street addreas is not available)
� 166 INd��iti6To�l � 5ale.rn, m f1'
\��. .ind titrrrt Cih• /Tu�vn Zi f�G�dr N.ime of Bwlding(if.ipplicablrl
SECT101Y 2:PROPOSED WORK �
If Nrw'Gmslructiun check hrrr O or check all that apply in ihe twu row�brlow • r�.
Etisling Building C� Rrpair O Altrratiun Id� Additiun� Drmulitiun O (Plra�r fill uut.ind xubmit Apprndix 1)
ChangrufUsr G7� Changruf�Occupancy ❑ Othrr ❑ Speci(y: �'� ' ' ' ` '
� . hre building plans and/ur corutruction ducumrnts bring supp:ied as part uf this permit applicatiun? Yes � No ❑
Is an Independrnl Struclural Enginrering Prrr Review rcquired? Yrs ❑ Nu [�
Bri�f Dr+criptiun�f Prupoxnl Wurk: -�w�.�.-� Q a� n.�� w aatiucew�,. }
1� GGtxn.S '
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. ; , .
SECTION 3:COMPLE"fE THIS SECIlON IF EXISTING BUILDING UNDERGO[NG RENOVATION,ADD1770N,OR
CHANGE IN USE OR OCCUPANCY
Chetk here if an Exiating Building Evaluatian is enclosed(See 780 CMR 3402.0) O � �
� Exisling Use Group(s): Propased Use Group(s): C ��
Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: �i
� SECTION 4:BUILDING HEIGHT AND AREA
� - Existing Proposrd
Nu uf Fluprs/Sturies(include basemen[levels)&Area Per Floor(sq. ft.)
Total Area(sq..ft.)and ToWI Height(ft.) -
SECTION 5:USE GROUP(Check as a IlcablN.
A: Aaxmbly A-1 ❑ A-2r A-2nc O A-3 ❑ A-4 O� A-5❑ �B: Buaine�� ❑ E: Educational ❑
F: Facto F-1 ❑ F2 H: Hi Hazard H-I ❑ �•, H-2❑ H-3 O H-4 O H-5�
L• Institutfonal 1-1 ❑ IQ ❑ 1-3❑ 1-1 O M: Mercanfile❑ �� R:,ReefdenHal R-1❑ R-2 ❑ R-3 O R-i ❑
S: Stoage S I ❑ S-2 ❑ U: Utility❑ Special Uee O and Irase dexribe brluw:
Sprcial U.+r: ' ..
SECf10N 6:CONSTRUCi'ION TYPE(Check a�a licable)
� IA ❑ IB O IIA ❑ 116 O IIIA O IItB O IV�O �VA O VB O
� SECTION 7:SITE INFORMATION Irefer to 780 CMR I11A(or detaila on each iteml
� Water Supply: ,Flood Zone Infortnation: Sewage DisposaL• � Trench Pertnit: Debris.Removal:
� Pul+lic� C hrrk i(nuL.idr Flu��d Lunc� Indic.rtr munic�p.il L� �\ Irrnch will nut br � �Licrn.r'i1 Di.p��..il tiitr($
� , rcyuirrd C��r trench ur.F.rrih':
I ri��,itv❑ .��r indcnlilv Znne: urun.itr.��.trm ❑ . ,
. . �� . . � . prrmit i.endosr.bO " � i�.
� Railroad righbof-way: Huards to Air Navig�tian: �I:� I li>i�.n:�-,nn,ni..i��n Hv����� I'n,���..:
\�nl A����hialJa•� I.tilrurlurc�cilhm.urF�urt eF�F•ntirh.vr.i.' I. lhwr rc��ic�c a��mFdclr�i.'
��r 11�n.cn� �n RinIJ vnd��vd ❑ Yv.O ur.\'u� 1'r.❑ \��� ❑
. SEC�ION B:CONTENT OF CERTIFICATE OF UCCUPANCY
i I[.fili��n ��I ( ��dc: __ l�.r(�n�up�.l: ��f+cul Cun.lrurUun: llcaiF�ant Lu.id per Pl�n�r:
. . �)��r.Ihrl�wldin�;i��nl.�in.intiF,nnAlcrti��.lcm': ��,vcml�tipul,il�unv
' � t'�7 � 7_ �l 3 ?v o(�o G�i(zl S ��
F
� � SECTION 9: PRO�ER7Y�JWNER AUTHORIZATION '
�l.ime and Addrc>s ol Prupertv C��.'nrr � '
� �.b L�Qn c 1 t? 1 vc�\oo q�f_ �.��.Ll� _ _QZL�
N.�mr(Pnnt) Nu.and titrer� l ih•/iu�vn Lip
XPru�+�rl�� l)���nrr(�un�.ict Inlurmetiun:
A�Qti �',�..�.�— 1�-1Y4- xhc� _ _—_ L��,c�,.v..(J �` �-l.C°•
7iUr Trlrphuna Vu. Ibusinr..) Trlephunr N��. (crll) r-m.nl addre�s
I(applir.ibir. Ihr��ru�,rrt�•���vn.r hrrcby,iuthurars - .
X.imr �Ira�rt Addres+ Cilv/To�vn Sl.itr Zip
� t�i.ict �m �hr �ro,erl�' ���enrf'.brhalf, in all m.ntrr+relati��r tu w��rk.�uthunzrd bv thi.buildin � �rrmit a > >lic.itiun.
SECTION l0:CONSTRUCf10IV CONTROL IPlease fill out Appendix 2)
111 builJin�iy Ivs.ih.in}i.UOU.u.Ff.�H vnduvd s�a..and/or nut unJ.r C.�a�tru.tion Conwl ihcn ch«k hsre D.ind ski &�a'tion ILL 11
I0.1 Re istered Professional Res onsible for Con�trvction Contml
nti�., �����i��sk� �1-1�-�_ �fZ�JS�o ��
x N,imr(Rrgistrant) Trlrphune No. � r-mail addrrss Registratiun Number
14�k �nn��,,, -�f. .w � �.Z
Strrrt Addrrss City/Tuw titate Zip Di�cipline Expiratiun Datr
10.2 Ceneral Contractor
�� � _ . . ,� s. � . . t _ ,,:.
��nt�t`� � � �..]B�C..�
e� Company Namr• ,
s�.r,� -� � �.,.,��. c� a-z3.�s
Name uf Prr.wn Respmxible fur C�nstrucliun Licrnse lVu. and Type if Applicable
�LIZ �-C W�.u\�n St. ��. .�.�n�. Vu. �y� AIcQC.7
Street Address City/Town - State Zip
Trle hone IVo.(business) Tele hone�No. cell) rmail address
SECfION 11:WORKERS'COIW'ENSA710N QVSURANCE AFFIDAViT(M.G.L.e.152. 25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
,ubmitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
- Is a si ned Affidavit submitted with this a (ication7 � Yes O IYo O
SECT(ON 12:CONSTRUCTION COSTS AND PERMiT FEE �
Item Estimated Costs: (Labor �
and Materials) Total Construction Cost(from Item 6) =S�G�� ���
1. Building $ � � Building Permit Fee=Total Construction Cost x_(Insert here
3 `� appropriate municipal factor)=S
2. Electrical - E ,I O
3. P�umbing S • Note: Minimum fee=8��confact municipality)
4. Mechanical (HVAC) E / GB7�• �
5. Mrchanical (Othrr) S Enclosr check payable to
X � 6. Total Cort S � �v (contact munici alit )and writr check numbrr herr
SECTION 13:SICNA7URE OF BUILDING PERMI'f APPLICANT �
Hv rntrrinK my n.imr brluw, I hrrrby altrst und the p.iins and F�enaltirs uf prrjury that all uf thr infnrmatiun cunt.�inral in this
a��plic.�li��n i.tnrc and accurate t��the br.t uf nvled�;e nd ndrrstandin�.
r4.r��, � �ccas����� s�+ � � L � biZ-?3.3- � 6 � i0
19r,i.. pnnt and .i�;n n.imr : itlr i.•Icp ��nr.\n. � Uale
� � —��.t71,t Ulil rb.-v. S�'• IM.W
I tilrcr� Ad.irc.. Cih�iT�ncn . titatr Zif �
I �tuni.ipal Inspector to fill ouf this section upon application approval:
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-'� CITY OF S.�1L.E.�[, �L�SS.�CHL'SET'TS
BI;II�6YG DEPARTIE�iT
' I'_0 W.1�F14�IGTON S'TRE6T, )'�Ft.00R
�, (97� TiS�959S
F.�x(97� y�98i6
KI��ERiEY DRISCOLL
�tAYO� 711osW ST.P�1utt
DiRecroa of R:eccc rRovearr/e�aac�c co��rtss�a�ea
Wurker�' Campensation (nsurane���I1ldarit: Duilder�/ContraetoNElectrieirnalPlumAen
annlleant Inf�rmytlap Plea� Print Ledbht
` �
V��t1d IBu�uw+rOrymta�ionlrw4r�d�n1l: ��n(�\S �ev��._,�m�. �c IG�
AdJrcnr. (Ct 7�t I�.l����. Sf.
Cily/SatdZip: P1wne Nt � L 7 7�Z 7�8'6
.\r�yo���empNrv!CMet tM ayO�epri�te Sos: Typ�of y�oJsc�(requlre�:
I.O I an�unployv wi�► �. � i ais s IDeneral ewtraeoa�aod l 6. ❑Naw canawctios
employses(fWl and/or pan-dma).• h�v�hited Jr�ewrraemrs
i. I am s�oN pioprieeor�u pannea liated an�M uqoh�d aheR� 7. � RemoJelin�
�hip wul lrwa no rmpbyee Tfw�wdeonenemn luw N. � Ikmolition
workin� for me iq aey npociry. +rohus'eomy�insunaet 9. �DuiWini sdditioa
(No w«km'eomp iMYIYK� S. I] W�ait a eeepondas and is
rcquiraL)
oPfken haw c�ae(aed tM► IO.Q ELctriul rep�in or addieiom
J.� I am a homeovrnur doin�all woAe �li�a��Vrpp p�MGL 1 I.Q Plumbin�repain a�ddGbn�
myself.(Yo worken'comp. �- ���.4�Nb�d���w no 12.0 Raof rep�iis
insunnce required�► .mOlqrees.lNo wakas' 1).Q O�ha
comµ inwnnce requimd.J
� -nny apyuw ily dwsv Oa il mur alw(ul ur�M�s�iv edsw�s�iq�Idr+aitw•a�n�odn Pdk7 inR�le�
�11.wru��rle�u6ni1 AY aAldwii iMlouq ilr�aw Jdn��II wak ad d�Ab au�ii aviwnOa�nwY auAwi�nw a111Jni1 indidi�we<
T.nua�en�MI cVek�W Da 1n�w aNslr/a sld�w�l dr�Mvin�tl�.irr a!�b wievrweM�W drY raMw�'ro�F Doliry i�4emWs
/us ow nw�lsyq�A�r b�nrJ1ln�wwR�rs'rawrearMw/warnen jir�r�rwp/oyNft SNnr O�Ai pNlq�w//o1+11►
:n�or�wwlwa
Insurrnce[umpany Namei
Policy M w Self•ina. Lie.M: Expira�ion Dotr.
!ub Sirs AdJrcu: Ciq/Sta�e/Zip:
.�nacY�eopr ot tM w�rinn'eom���ub�poYer deeWatb�pap(��owln��V polle�orslK�N�iPlratlo� dW}
f'ailure to xtutt corenOe ar rsquired unJer Sccliw 2JA of�tUL a 172 ean Iad ro�h�impaitian of erimin�l p�n�lde�o/■
fne up ro S I,S00.00 an�1/w onayau impriaonmen�a�wall o�ciril penrltip ia Uer fam uf�STOP WORK ORDEA ard�Rnr
af up�0 5?30.00 i Jay oyains��h�violatw. Ik advi+w!�hu�comr uf this watemcn�msy be fu�wurd�d�o du 017fes of
Inr.�ug��ion�al'ihe f71A for imuranc�corerow rviticu�we.
/Je hirrbp¢alijp ueJii�h�Oriwf u yt p o P�r/rq rAai rAi i� �r Orovi�i�uAew it uwi rn/ranrd
`�^ � ' I)uror ,6 /i ��
P.`,�mc,i:
I O/J7cir!ua�md�s Do nW wrill iw rhu ait�. li A�w�w�.r�er.�,�o.,,�,.�../�/��ir( �
i
I Ciry or 1'unn: _ _ __ Ycrmitll.leen�t M__, �
i — - --
I��wnr.\whun�r Icircle une►:
I. RwrJ u(IIr�IIA 1. Hwldlny tlepv�menl ).('I�Ji�owe CIe�4 !. Ele.uiul ln+pccror S. PlumbinR tn�peerar
6.�)iher
I l„nlael Pcnon: . . _ ._ Pfl00t M:
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' � CITY OF SALEM ,
\
-�i PUBLiC PROPRERTY
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� �• �� DEPAKTMENT
� r.u> w�r� ��nir���u . _
\I .���N I.0 ��.�MII.V.:��v)1'Mkl'T �5.\I I\I. �1.\+�.0 I II J I..:1'I'.
1'n: ��:t-.'aY�}vS �1��!c:v7t•NS��:Iu�
C�nstrucdon Debris Dtsposstl Affldavit
(rcyuirr�l I'ur�II dcmulitiun:uiJ n:nuvution wurk)
In rccurJ:mcc with �hc si�di v�lrtion of thc Smte Duilding Code, 730 CMR scetiun I 1 I.S
Debris, anJ the provisiun�ul'MGL c �0. S 54;
puilding I'ermit l� is i�ued with the condition that tht dcbris rcsulting from
this wurk shall he disposcd of in a properly licens�d wa4te Jispoaal facility as dafincd by MGL c
l I 1. S I SOA.
The Aebris will be tr•rnsportcJ by:
�'1� .0
uwma o�nau�ed
1'lia Jcbris �vill be disposed uf'in :
' (n:urK ul xi �IY � ,
luddrcsa ul'I'uiliiyl
.ign�ture uf�xr i �pplicaN
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dacr
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� ' SCOPE OF WORK _ ' � �
Z �
1. The Work in this poject consists of a limited tenant fit up to facilitate the �
occupancy of a Restaurant. There is no structural work. � V °'
2. Existing Conditions to Remain � � o �
This includes all existing electrical, plumbing, HVAC, Sprinkler, ceilings as � = m W
noted, exterior envelope, perimeter wall finishes, and interior finishes where noted. (� V � vi
3. New Work Q g �
A) Equipment and Cabinetry Areas as noted on plan. g �
' � SEATING CAPACITY BASED B) New electrical as noted on plans. � � � �
EXISTING ON TOILET COUNT = LEAST C) New triple, single prep. & single handwashing sink as noted on plans. � � � �
BALCANY GAPACIT7 GENDER X2 = W
15+30 X2 D) Repair or replacement of existing ceiling tiles and overhead light fxtures as � �— � �
= 90 PERSONS required. . Q � W a
= 84 PATRONS, 6 STAFF E) Repair and Painting of new and existing partitions as required = w � O
KITCI-IEN � F) Replacement of any defective sprinkler heads. Relocate Sprinkler Heads as (� pC `n
�
° required to accomodate new partitions, and to maintain compliance with NFPA 13. � "'
z
G) New FA Pull Stations, Fire Alartns, Exit Signs, and Emergency Lights as �
�
__ i __ ��SiB4E noted on plan (re-use existing where available). ^
— _— _ __ ILET �
I
L BULKHEAD - �
� OF STAIR M� �i 60�PERSON C O D E R E V I E W
To 5Tow4GE � CAPACITY �
B� � � 1. General Building Data
A W� I 3o PERSON Building Use Group Classification: A2r-Assembly (Restaurant) W �
o � GAPAGITY Fire Suppression System Provided? Yes Code: NFPA 13 � � ��`+ W
� Existing Heads on Plan to remain -Sprinkler Head Height is always 18" min above ? � =�
Lo� BAR ;�, 0 � �----__ half wall heights. Contractor to verify compliance. Z 0 Z Z
--------- Construction T e: 2C - Noncombustible Un rotected g � �
AND D 1 KS , yP P a t- �� a
� Total Tenant Area: 1938sf � w
j Assembly = 1280sf, Kitchen = 400sf, Basement Storage= 1178sf � p �� a
INDOOR SEATING � 2. Chapter 34 -Table 3403 � a Zao y
� FOR 72 i Hazard Index of Assembly Use = 5
� Previous use was a Mercantile Use- both abutting uses are A-2r Restaurant
LOCATION OF LEASED STOR4GE AREA �
IN 8.45EMENT BEL�. . � Change of Hazard Index = 2 - means that access is required for persons [�
� with disabilities and provision of a carbon monoxide detector is required Q W
I 3. Means of Egress z W
iOccupant Load = %5 sf for 1280sf unconcentreted Assembly=70 Q a'
�_______ _____ _� ABUTTER � hsffor100sfconcentratedseating= l4 J N
UPPER CRUST j 1/200sf for 600sf Kitchen and Prep= 3 persons Total + 3 additional staff a U1
OUTDOOR r rr, PIzz�1 � = 90 persons total
SEATING for 12 � Number of Exits (section 1010) = 1 Required, 2 Provided ��, lWi Z,
15�XI0� i Length of exist access travel = 250'with sprinklers ( 39' provided) ��, � U Q �
� 4. Plumbing Fixture Requirements ���� �� � g [�
i Mass Plumbing Code Table 1 � �� �� � �
i .,..�n —,r. .., ,r»§'�. `'"i
� Restaurant Occupancy (45 men, 45 women) $...: . , �� Tn � Z O
� Women's toilets (1 per 30) = 1 toilet+ 1 shared unisex y'HESE `' _ �
I ,,,r
� Men's toilets (1 per 60) = 1 toilet+ 1 shared unisex KEP� `'"
� Lays: ( 1 per 56) f �—' � d
----------- � 1FSSF_�TG''t CS — �
-- -----_______� 5. Finishes - Existing to remain except where noted ,;-,; ,. � Qi
S�l�`J1Pv.>
Interior Finish Requirments: -. Z � �
Exit Access Corridors and open space: Class II
Enclosed Rooms: Class III ,���rc�, W � d
(+ class III wainscotting allowable over noncombustible backing) • � ,
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o- �• T8i4 � q
� S�U.F�, DWG N0.
1 LOCUS PLAN aA A 1
r, = 10,_0„ o s .
d �
� D(ISTING � m
BALGONY r
rn
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° SEATING GAPACITY BASED �
g�_p� z � � N z 000iz F2 INK � ON TOILET CAUNT = LEAST z �
� 2'-i � CAPAGITY GENDER X2 = m
5'-0' S'-�� �5+30 X2 � �' m �
�g Dlah Wmh SIMc � � q0 PERSONS � V �
w�� W��� y,� = 8.4 pATRONS, 6 STAFF � o j
Provide 6rra+e Tr� eised fa s � � _ � W
sink md DleFuimlw - � O N
3_o KITGI-IEN � � � U a W
� .
'+ coNVEcn cf� = 3`� Q � �
DOUBLE DRAIN Z b
e� SOAP 12-6' Mk � � � �W W =U'
e7W� SIN �
oi o SYMBOL KEY � � �
2-6 � _DW 5�-0� � UNISIX � � DUPLDC OUTLET � � � �
� �. W �U�NDU R ACCESSIBLE � 0 30 PERSON OT Tt1ERMO5TnT Q � ¢ �
GRIDO � _ = TOILET I b GqpACITY � PULL STATION = w � Q
' — — _
� — - - 3'-9�'i 3'-0� g�-0. � (15 F� SIX) $ V�RN STROBE AL4RM �
MIN. O cARBON MONOXIDE DEfECTOR � � w
6 BURN �y ;�UND � � Z�
�� o cJ�� Wf�IT BULIWEAD O TELEPNONE/DATA CONNECf10N JACK
3'-6' ��� r:7TAT��N ��.��� OF STAIR TO ❑ � ILLUMINATED IXIT SIGN F'
�' N �_ . ee�GE MEN �� I �
�AR _ � 6 ILLUI'11NATm IXIT SIGN W/EFIERG.LTS �
��� 0 51 LE 60 PERSON ,,,���ppp
I GAPACITY IEI E7'1ERGENCY LIGFt�S
i
3'-9° �
I82 F�Y . . , 3'-Qe � I z
� 5'-a w -1 .. '..'...' I IXISfING WALL TO REAWN Q
� 4 BURN.�? 3i�. A, O TIGN'fEN �0 I C _ _ _ � IXISTING TO BE REMOVED }- O
� �� °� Fppp � C�L.WRAP WOM p
� � oTnO�.E 51 LE I CAPAC� 0 NEw sruo wal w/ %' cwe 4 p c� W
BO7H SIDES TAPm k PAIHfm � -
C 51-I � oiu�siouiuc r�o� w - =�
u! � 1. INIERqR DINEN50NS ARE TO FACE OF SND AT J � W Z
R G. � I NEW WW.LS, AND FACE OF FlNI91 AT D(ISf. WALLS �
Z��Z� � 2NFXfQtlOR OYENSON�E i0 Fl�GE OF w f- � Q
�ca�.wtx�a,P � RE57AURANT� oe�00rso5ucH oawir�. u�xiEs"s m�i��se Narm. Z w m .. i:i
r BAR i �� SEATING L - - - - - - - - Q � WJ
� � � - - - - - - - - - J z �acai
� AND DRINKS - O� _ —I 0. � Z� N
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I N
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� d � � � `� �002 SEATING I I � O a'
� J E"i
�❑� ���E----�_ � a �
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❑ x� II j Q 0 0
� � � PART'N O
I LOCATION OF LEASED STORACaE AREA I U �
I IN BASETIENT BEIOW ---�
� � � �
I I ABUTTER � LL. Z O
UPPER CRUST I
PIZZA I � � �
I � � �
� o — J �
� — —` ,aor� i�t s�Eo wux �
OUTDOOR �o �-��DE M!
r z ao a
SEATIN6 for 12 �. L'�E .�'+NiN� ' P � W .—I d,
0 1 5'X I O' / / . � i�o.7@71 r z � � e�--I U]
/�' DWG N0.
� 3 � 6' STEP NEW ACGESSIBLE ��� 5�
��R ENTRY LANDING FLOOR PLAN ,� A2
� PAINT END � � 3�16�� - 1�_�°
��'0� OF LANDING
6�'6' 6�-0� ABUTTER
BLACK PTD 5T CHAIN AND BOLLARD5 OUTDOOR
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BOILER �OOM � w �
(NOT P RT OF Q � w a
TENANC ) _ (� � OO
DOOR TO ABUTTE V � �
(NOT PART OF w
TENANGY) � �
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