Loading...
139 WASHINGTON ST - BUILDING INSPECTION (3) Q1, The Commonwealth of Mass!; ";9& SERVICES Department of Public Safety�t,t,,tm��� Massachusetts State Building Code(78t1a.�AIMC 2 2 A 11: Building Permit Application for any Building other than a One-or Two-Family Belling (This Section For Official Use Only) Building Permit Number: Date Applied: Building Official: ISECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) i �>C, W95Nta1c1r, GTILR r 6\9-0 No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK ^ Edition of MA State Code used_ If New Construction check here❑or check all that apply in the two rows below Existing Building Hr Repair❑ I Alteration 03' I Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ 1 Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes LR' No ❑ Is an Independent Structural Engineer�' gPeer Review required? Yes ❑ No 01— Brief De rip on of Proposed Work: T�1�1 �c�lL +L/ Q3N C WCtA 0,�5 t�l �u1c1FL - � [�� S. SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business E: Educational ❑ F: Facto F-1❑ F2❑ I H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1❑ I-2❑ l-3❑ I4❑ 1 M: Mercantile 03 R. Residential R-113 R-2❑ R-3❑ R-4❑ S: Storage S-1❑ S-2❑ U- Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ HB ❑ IHA ❑ HIB ❑ 1 IV ❑ 1 VA ❑ VB ❑ SECTION 7.SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information Sewage Disposal• Trench Permit- Debris Removal: Public MB Check if outside Flood Zone❑ Indicate municipal IN A trench will not be Licensed Disposal Site B' Private❑ or indentify Zone: or on site system❑ required ET-or trench or specify: permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable M� Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No I;L, Yes❑ No FY SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner 5PL, kiP1"aw. u( iq1 6VA3d"f1,J 51r 54-4 1 y1�1 �yS70 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: ()A,Jlo � ,.O1Y- G 14�- Z73� �a6�e�CfAeer•2tauae.G�y Title Telephone No.(business) Telephone No. (cell) e-mail address If ap licable,the property owner hereby authorizes A/e� �t.(prdc. Name Street Address City/town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 m.ft.of enclosed space and/or not under Construction Control then check here 0 and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control S�� —('QPdL 181 -ALL t- y--� — AkcA S�Lr e £, Q' ( (08 03ame(Registrant) Telephone No. e-mail address Regis ation Number o1< a5oc,91_ /Sn aaT.�� MA ozlai' �4ce,U - .5 rto Street Address City/Town State Zip Discipline Expiration Date 10.�2 General Contractor YtJtrLK. BtltcoS (aC mpany Name t nfb ST-AK( CS 5 GG 77 Name of Person Responsible for Construction License No. and Type if Applicable 31 ?AAa Sc\,o �l I�i�{ c`3-,t1a sC.V�- PU,%_ Ol9 U-7 Street Address Ci /Town State Zip 5?-1 Un " :V-2�- LfIZ-( ZX5'*r, e, p 3004-t 6Qlt.aEad . caw Telephone No.(business) Telephone No. cell e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152-§ 25C 6 A Workers Compensation Insurance Affidavit from the MA 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. Is a signed Affidavit submitted with this application? Yes 0 No O SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ t t}5 I ZZ,E — Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ 5 . — appropriate municipal factor)_$ 3.Plumbing $ p 4.Mechanical (HVAC) $ —1 00 O — Note:Minimum fee=$ (contact /munnii�cipality) 5.Mechanical Other } $ 5,900 �51V7 \/b Enclose check payable to (/V 6.Total Cost $ I'l V i q 9 rl , 0� (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this a p�lication iisse true �and accura to a best of my knowledge and understanding. \ J�IhS�N'�1 nsl0£+11 7�I - - 5Zo 12 2Z Js Please print and sign name Title Telephone No. Date '31 �i soar —bo- , S 0 ng5G7 Street Address C1 /Town / State Zip l Municipal Inspector to fill out this section upon application approval: Name Date '\ The Commonwealth of Massachusetts Department oflndustrial Accidents I Congress Street, Suite 100 Boston,MA 0211 4-2 01 7 www massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information {J Please Print Legibly Name (Business/Organization/Individual): Address: '�) \ R oA� S Q N7 -3> Lt JL City/State/Zip: M h D(c(o') Phone#: Are you an employer?Check the appropriate box: Type of project(required): LE]I am a employer with employees(full and/or part-time).- 7. ❑ New Construction In I am a sole proprietor or partnership and have no employees working for me in $_ 'Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]r 10❑Building addition 41:1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.Q1 am a general contractor and I have hired the subcontractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.[ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 5� tP�c�9 �t `ply tF) Policy#or Self-ins. Lic.#: 7�'l^1Z 9 — Zo Expiration Date: Job Site Address: Eit SCE H� d � 139 y64troSTe.1 S r. City/State/Zip: S kt-elw A41/ O/970 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required trader MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby nder thelur\rs and penalties ofperjury that the information provided above is true and correct Signal—-- ,-� Jd� Date: I2 Z Z 1 Phone#: 7 G'� ' S��`P —�S"z--,D Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Appendix 1 For the demolition of structures the building permit applicant shall attest that utility and other service connections are properly addressed to ensure for public safety. Please fill in the information below and submit this appendix with the building permit application. The building permit applicant attests under the pains and penalties of perjury that the following is true and accurate. Property Location (Please indicate Block# and Lot # for locations for which a street address is not available) No. and Street City/Town Zip Name of Building(if applicable) For the above described property the following action was taken: Water Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Gas Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Electricity Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) Details Page 1 of 1 r r,e Otnclal 4WLsifc Of,he F_xecuuea J riee of Pub!;c Sa`otp and Sc:z..�tf(EGPSSt Etas<_.G, ,Hdmc Stale Agencies enetails ull Beam : DINO STATI ender: er Name: dress: ddress 2: ity: SWAMPSCOTT State: MA pcode: 01907 o nt : U 'ted tates License o: S- License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 8/8/2014 Issue Date: Expiration Date: 9/19/2016 License Status: Active Today's Date: 1/6/2016 Secondary License: Doing Business As: atus Change: o rere uisite Information No Discipline Information ocumen um CClose Window ©2011 Commonwealth of Massachusetts Site Policies Contact Us http://elicense.chs.state.ma.us/Verification/Details.aspx?agency_id=1&license_id=245636& 1/6/2016 Appendix 2 Construction Documents are required for structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required for this. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark'x"where a l'cable No. Item Submitted Incomplete Not Required 1 Architectural 2 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing include local connections 9 Gas Natural,Propane,Medical or other 10 Surveyed Site Plan tilities,Wetland,etc. 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review 521 CMR 18 Workers Compensation Insurance x 19 Hazardous Material Mitigation Documentation 20 Other S eci 21 Other S 22 Other S *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction.Work started prior to approval may be subjected to triple the original permit fee. Registered Professional Contact Information ScAtA —tcaa,J 4 2?2- 817 acG4_ AtC45 e_6AeR3T. rtLT Name(Registrant) Telephone No. I e-mail address Registration Number �t ;Nar- Ozt? bisci line Street Address City/Town State Zip Expiration Date to 1C,aA&L Sc 41 L L 1#34 -78 - 331 - qM K 514,0 fs Name(Registrant) Telephone No. e-mail address Registration Number 2- & ���,a9t�a S,' iJela,oQna NA OzlJIB L �,-s- W Street Address G Town State zip- i Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Discipline Expiration Date Street Address City/Town State Zip t �I ( Salem Renewal LLC Real Estate Revitalization 141.Washington St Salem,MA 01970 Phone(978)979-9278 Fad t978)744-7558 dpabich@�salemrencwal.win 12/1.7/2015 Ronald Richer Vice President Real Estate Operations Eastern Bank 195 Market Street Lynn, MA 01901 Dear Ronald: Salem Renewal has reviewed your proposed construction plans for your rental space at 139 Washington (Unit C1),and approves your plans. Any structural modifications to be performed in accordance with engineered plans stamped by a Massachusetts registered professional engineer. tfi-SFeelo to call or e I me if you have any questions or concerns. Y, David Pabich,P.E. Manager Salem Renewal LLC Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional forwork per thee edition of the Massachusetts State Building Code,780 CMR,Section 107.6.2 Project Title: fir` '�- Daze: [`1 ZO [r Property Address: Project: Check one or both as applicable:U New consttuctionpEnsting Construction Projectdescription: (20 N6(.J Q�Y)�� L iG 1 S r i�1 1AnJ L �' I �,1Outl& MA Registration Number. 9 l(o Expiration date: tp am a registered design professional, and hereby certify that I have prepared or directly supervised the prepara' n of all design plans,computations and specifications concerning: [ ] Entire Project Architectural. [ ] Structural [ ] Mechanical [ ] Fire Protection [ ] Electrical [ ] Other for the above named project and that such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),and accepted engineering practices for the proposed project I understand and agree that I(or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept,shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become.generally familiar with the progress and quality of the work and to determine if the-work is being performed in a manner consistent with the approved construction documents and this code. When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent comments,in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a `Final-Construction Control Document'. Enter in the space to the right a"wet"or �, 1 electronic signature and seal: so ,+N, - STOiU, ct � MA 1; Phonemrmber. 7pJ� J�.Z 1 FM Email: ArLLbt SIZE C'i C�MCit � l � Building Official Use Only [Building Official Name: Permit No.: Daw. Trial Version 10 09 2012 Initial Construction Control Document To be submitted with the building permit application by a R e Registered Design Professional for work per the 81h edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Eastern Bank Date: 12/18/2015 Property Address: 139 Washington Street Salem, MA Project: Check(x)one or both as applicable: New Construction (X) Existing Construction Project description: New Building Renovations I Michael K. Schilling MA Registration Number: 51900 Expiration date: 06/30/2016 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': Architectural X Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information, and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted engineering practices for the proposed project. 1 understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'. OF MASS Enter in the space to the right a"wet"or o electronic signature and seal: AE m L y 5 00 Phone number: 781-331-5898 Email: mckinnonengga gmail.com FS NAL ECG` Building Official Use Only Building Official Name: Permit No.: Date: Note 1. Indicate with an`x' project design plans,computations and specifications that you prepared or directly supervised.If`other' is chosen, provide a description.