120 WASHINGTON ST - BUILDING INSPECTION (7) I
'Che Commonwealth of (Massachusetts
Department of Public Safety
q ,. .,• \Llssar htuvlls State llu ild ing Code(780 C,\IR)
1 Building Permit Application forany Building other than a One-or'11v rFami ) m
(Ibis Sec lion Fur affie al Use Oniv)
llt ilding l'cnnit Number Date Applie It � ,� _ Building 0fficia1:'
_ ECfION L• L(GC190N I'Iease indicate Illuck N and Lut p fur locations for which a street address ' not available)
No. mid`,tact 'ily i 1'Pwll Zip Code Nonni of Ih:ildinl;(if,gtpli(able)
SECTION 2:PROPOSED VV0I4K
LJiliun of\I:1 Stah•Code usrJ If New Construction check here❑orcheck all Iltat api'ly in the Nko rows below
1?,isrinp,Ituilding❑ Repair❑ AIler.niun ❑- -:\ddilion❑ Demolition ❑ (Please filluu L,unl subnlit,\ppendis 1)_--
Change of Use ❑ Ch,na;e of Occupancy ❑ Other ❑ Specify:_----
Are building plans and/ur construction d,avmenis being supplied as part of this pundit application? Yes No ❑
Is an Independent Structural Engineering
ngineerin � cr Re 'e require . 6.[ NoV
ll A Brief Ucs(riptiun of Proposed Work;_ ly
_ —
SECTION 3:CUMPLETE THIS SECTION IF EXISTING BUILDIj!ENERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR CY -
Check hero Ilan Existing Building Investigation and Evaluation is ee 780 CI .4L) ❑
Existing Use Group(s): ed Use Gruup(s):_SECTION 4:BUILDING M AREAExistinggC[3
m:s/Stories(include basentettt levels)h Area Per Floor(sq. fa oti.ft.)and rote) Height(ft.)SECTION 5:USE GROUP(Clicabie)bly A-1 ❑ A 2❑ Nightclub ❑ A-3 ❑ :1-1 ❑ A-i B: Business ❑ T:: Iiducational ❑F-I ❑ P'_❑ I1: fli h Hazud li•2❑ i I,t ❑ !i-J❑ II-i❑tional 1-1 ❑ 1-2❑ 1.3❑ -1-4❑ II: Mercantile❑ sidential R-1❑ R-2❑ R-1❑ It-4❑
e Sl ❑ S]❑ U: Utility❑ SrpecialUpleasedecribehchnv:e
sECrION 6:CONSTRUCTION IYPF(Check as a licabie)
1:\ ❑ IB ❑ IIA ❑ IIB ❑ III,\ ❑ IIIU ❑ IV VAE3 %'IS ❑
SECTION 7:SHE INFORMATION(refer to 780 CJIR 111.0 for details on each item)
Water Supply: Flood lone Information: Sewage Disposal: Trench Permit Debris Iteuuw al: _
Public❑ Check it outside 19ood Z,nhI❑ Indi(,no muni(ip,d ❑ A trench will not be I.1-11-d Di,pus,d Silo❑
I'm'I it.❑ or indenlih' Anne' or on,ltv syswin ❑ nrpl iced ❑or Ircn(It onpc(dN _
penoil is ,it,lnscd❑
Railroad right-of-way: Il,vards tu.\ir Navigation: .
Snt .\pih(ol'Ic❑ Iv titrurlure t,ithin Airport appro,u Ii.:me.' Ic Ihc:r rrvir,c i�omplrlyd.'.
:n Gimenl to llu:ld,it,lo,c,I❑ 1cvCJ ,IrVo❑ )r,❑ .A'u ❑
SFCIIUN 8:CONI'FNT OF CFR 1'IFI('Alli OP OC('L'I':\:VC'Y
Jiunn ul Can r: Cwcloup(•): Ape I lm,lnnlev:. lt„up,wl l •ad prrl6nr -
I tnr, Ihr ln:ilJiny,a nl.tiu.m 1prinklcr 9t sleill' tihn 1,11 �lipuLnion,
SR I ION 4 11(OI'hl(I Y OWNFRAU I IIORIL1lION
N. im l Adds as of Properly Owm r
Nano (Print) No purl Street Oily/town
Property'cotter G111.1ct Infunnatiun:
` Cf _2 228 G-- --- -
_- ------
I'tle Telephone No. (business) rclephune No. (cell) c-mail address
If applicable, the properly owner hereby authorizes
._-- Nance --- --- Street Address ----- -City/Town State Zip
o act on the 11roperly owner's behalf, in all matters relative»p work authorized b• this buildin ,omit a ,plic.ntion.
SECTION 10:CONSTI(UCFION CONTROL(Please fill out Appendix 2)
If building is less Than.5,01M1 Cu.ft.of enclosed s pace and or nut under Clnlstruction Contrail then check here D:uW.ski Section I».I
10:1 Registered Professional Res onsible for Construction Control
Name(Registrant) relephone No. e-mail addressRegistration Number
Slim Address City/Town State Zip Discipline Expiration Date
I11.1 Generel Contractor
C
any Name
Na111e of Person Responsiki`lot nstruction rase No. and Type t Mpplicable
Street Address City/Town State Zip
►r� _ �� ram- - -
Trle phone No. business Telephone No. cell e-mail address
SECTION 11:V,i Wf-rl::.<r1,,w'I tp,N Iv�'t11", q, l M.G.L.c. 152.1 25C 6
A Workers'Compensation Insurance Affidavit from the NIA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
Na si red Affidavit submitted with this a lication? Yes 0 No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Estimated Costs:(Labor
Item and Nlateriak) Total Construction Cost(from Item 6) '
1. Building b Building Permit Fee'Total Construction Cost x_(Insert here
'_. Electrical S appropriate municipal factor)-5
1. 1'luudping $
I. Nlechmnic,d (FIVAQ S
Note Nlininnun fee=5--(contain numicipality)
S. Nledwilic, Other S Pnclose check payable to _ _--
t,. folalCust '� (anllactnumici,alilv),uxlwritcchccknunlbcrhrrc —.___... .- _-
SECTI(A l3:SIGNATURE OF BUILDING PEI(NIIT AI'PLICANT
Rv entering my name below, I hercbv attust under the pains and penalties of perjury that all of the information contained in this
I .ipplicatiou is troy aild ac orate to the best of n1y knopp Icdge and w,derstanding.
�w 3� 4� 62
Please print and ,igu wore _. Ttlle Telephone %o_ hate
it nr .2llr,,i _. ih'� 11,wn .. 't tte O12 L.J
J yt/ VE e1
Nlunicipal Tnspedor to fill out this section upon application approval:
Nome Palo
CITY OE S.tt_ENr, Aus,kCHuSETI'S
8l'ILONC Dt?v.1ATtE�iT
IAWAMNGTONSTX , 1"FtOCIt
� lam. l97� r4s•�s�s
F.Vt(979) 71Or984d
!U1COFALfiY ORLSCOLL
�UYOI! rko.w s ST.FMXA{
01""OrtOPPLHICPROPERTY/a nNGCO alISSIONEll
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition otthe State Building Cad,, 730 CUR section I I I j
Oebris, and the provisions of UCL o 40, 3 34;
Building permit b is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licemed waste disposti facility as defined by&lGL c
11 I, 3 1 SOA.
The debris will be transported by:
a
�O.�I¢rl ram,
(n.+ma ul'heubr)
The debris will be disposed of in :
(n�m�of facibiy)
tn.0
ddrar or I,iy)j
C
in�m n ic,nr _
2 (2
i
CI"I'Y OF S:ttlLEm, A\SSACHUSETTS
BUILDING DEP.IRT>(ENT
0j"-
120 WASNLNGTON STREET, 3-FLOOR
1�L (98) 735
7 -9595
FAx(979) 7.10.9844
vj_\(BEnr EY DRISCOLL MO.NLUST.PIFFsea
LM&
DIRECTOR OF PUBLIC PROPERTY/ECBDfNG fO1L`I1SSI0\ER
1Yurkers' Cumpensadon Insurance Atlldrvit: 13uilders/Contructurs/Electricians/Plumbers
t rlleant Information Iease Print Leaibl
,
V;1117C tOwinus,Urgamralion lmlividua:a: rA C
I� Cily/Srate/Zip: Phone* h
Are Yalu to cmplaytry Check the appropriate boxt 'rype of project(required):
1.❑ 1 am a employer with a. 1 am a general contractor and 1 6. ❑New construction
employees(full and/or pan-time).• have hired the sub-contractors
2.0 lama sale proprietor or partner- livedon the attached sheuL t I. ❑ Remodeling
,hip and have no employees These subcontractors have R. ❑Demolition
working for me in any capacity. workers'comp,insurance. 9. Building addition
(No workers'.comp.insurance 1. ElWe are a corporation and its
10.❑ Electrical repairs or additions
required.) officers have dxeraised their
3.❑ I am a homeowner doing all work right of exemption per MOL I I.❑ Plumbing repairs or additions
myself.(\o workers'sump. c. 152,41(4),and we have no I2.Q Roof repairs
insurance requited.)t employees. LNo workers' (},Q
comp,insurance ruquirefl
Other—
any applitant dot dtwlu but rt must also flit uut the awliuo butow showing thair waken'comynudun pulley innrrmudon.
'1 h"vuwnn who,ubmit this sentklvit Indicating ihey um doing ail rwrle end ihce him"Isids Contractors mtut solgnit arm anldavit indi"ing.ueh
<'amrxrun shall uhak this kux moot roauhod can.Wdrliurud.heat rhuwiny the nwno of the subeuntruwe end their workm'wrap,pulley InWtmadee.
/urn an employer that provldhog rvorken'cumprarerlun Ltsuranet for my employees Below/s rht policy andJob site
iurnreu o.
I o,murmru Company Vama:—� „��(,�� ,,
Policy 4 or Self-ins. Lis �C d: 3 40 Expiration Date: (�/' C90'
tub Sit*Addruss: Q Cilyislate/Zip: U I
,Utaeb a copy of the workers'compensatloo policy declaration pails(showing the policy number and sxplratlon data]
Failuru to secure cuvdrngo as required under Suction 25A of VIOL c. 152 an lead to the imposition of criminal penaltias of a
tiro tip to i 1,500.Uo and/or one-year imprisonment•as wall as civil penalties in the form of STOP WORK ORDER and a tine
Of up to S2A.00 a Jay against the violator. Ile adviseU that a copy of[his,ratument may be furwardud to the Oflicu of
Invcvtigaliun.v of the n1A la insurance coverage vcriticafiun.
I du/tereby verri ru r tht pa%all air peaalrlev'rf perjury that the inr/unnurlat pruvidrJnabove iv true and earrrca
.. 011f iul rise wdy. Do nor write he dri.v area, to he catapletted by city at town'Offlciul
Gry nr-I'�nnt:__—. .. .__ I'crmif/T.lccnre i__, . ...__ . . ...
l,tuin,,\ulhurily (circla and):
I. l;Uard cal'I(eallh !. fluildln; Uep.lrtweul I. ('itYflbun Clerk I. I•:Idetrical Inytcchtr i, Pltunhinq Iwpecntr
6. Oilier
Cu,tl.td V rwo:
r *-�' � rl n�tti ustrh Ucp.:u hnint ut Pufdt� S:d'ch'
a Bu u d uC Burin n q. U HmQ and R rndxrds
Con tt€t�Yfrtnw,u�p4i' Ut 'L;cene
Ltcense .(S 91042`
' w W w
!4
DANIEL RUBY ,
293 SAWNHILUAVE ,1 ;
DORCHESTEN, AO 02125c
,. Expiration: 9/?7/2012
('ouuniasium.r Tr#: 2689
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AA EE EE
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OFFICE
E
5'4" 1 4, T-0„ 71-4"
E
ALIGN
o
N
E 85" TOP OF WALL
(E)FA HEATER
85" TOP OF WALL
E
CONFERENCE ROOM
ENTRANCE
CL WINDOW&WALL
FLOOR PLAN ��� @&�.
SCALE: 1/4"=1'-0"
u 0`
GENERAL NOTES: E
1. PARTITION CONSTRUCTION 3 5/8" METAL STUDS @ 16" OC WITH 5/8" GWB EACH SIDE. M"
2. HOLLOW METAL WINDOW FRAME WITH 1/4" GLASS AT CONFERENCE ROOM.
3. PROVIDE ADDITIONAL FIRE ALARM DEVICES TO MEET CODE. �^
EXISTING CEILING
TOP OF WALL
HM WINDOW FRAME ELECTRICAL DEVICE LEGEND
E EXISTING DUPLEX RECEPTACLE
R' = REMOVE EXISTING DUPLEX RECEPTACLE
N
n :�)7 NEW DUPLEX RECEPTACLE
n io NEW QUADRAPLEX RECEPTACLE
6'-0" 9 ED EXISTING DATA/TELEPHONE
N W> REMOVE EXISTING DATA/TELEPHONE
ELEVATION @ CONFERENCE
SCALE: 114"=1'-0"
THE LAW OFFICES OF SARAH H , RAMA ESQ. 120 WASHINGTON STREET SALEM MASSACHUSETTS
26 APRIL 2012
www.nitro dp f.com
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CENTERLINE OF PARTITION
REFLECTED CEILING PLAN AND CEILING TILE
SCALE: 1/4"-V_0" Qkb�s F. 611lJP,
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THE LA/ OFFICES OF SARAH H , RAMA E,90. 120 WASHINGTON STREET SALEM MASSACHUSETTS
26 APRIL 2012
www.nitro do f.com