0155 WASHINGTON STREET - BPA-14-1179 PASSAGE TO av-4pf 4_ �3
The Commonwealth of Massachusetts
Department of Public Safely
\Lt.achtsselI.?6t le BwldmMCode I:S0C\I R)Sea'enth Edi l ton
\it City of Salem
Buildinx Permit Application for any BuildinX other than a 1-or 2-Family Dwellin
(This Section For Official Use Only)
Budding Permsl Number: Date Applied: I Building Inspectur:
SECTION 1: LOCATION (Please indicate Block 0 and Lot I for locations for which a street address is not available)
rEx,',t,'ng
GV/4'.�h11NL� f4-L 01 ZQ / iS0.[ 2 /A/DjA-
. nd Street City /Town zipC,xle Name of Building litapplicable)
SECTION 2:PROPOSED WORK
If New Cunslrucuun check ry O or checkall thatapply in the Iwo rows below
Building O Repair❑ 1 Alteration Addition O 1 Demolition O (Please fill out and submit Appendix 1)
Change of Use . O Change of Occupancy O Other O Specify:
Are building plans and/ur cunstructiun documents being supplied as part of this permit application? Yes O No _.
Is an Indeleendenl Structural Engineering Peer Review r uired?� Yes ❑ No O
Brief DewripAkin of Props. W k: O V Q--%`- LZ
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) O
Existing Use Group(s): Proposed Use Group(s): r
Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34:
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)k Area Per Floor(sq. ft.)
Total Area(.,q. ft.)and Total Height(ft.)
SECTION St USE GROUP(Check as a licable)
A: AssemblyA-1 O A-2r O A-2nc O A-3 O A4 O A-5 O B: Business Er E. Educational O
F: Facto F-1 O F2 O H= High Hazard H-1 O H-2 O H-3 O H-4❑ H-5 O
1: Institutional I-1 O 1-2 O :1-3 O 14 O M: Mercantile O R: Residential R-1 O R-2 O R-3 O R-4 O
S: Storage 5.1 O S-1 O U: Utility O Special Use O and please describe below:
Special Usv:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA O ISO HA O 118 O IIIA O IIIB O IV O VA O VB O
5ECTION 7:SITE INFORMATION (it fer to 730 CMR 111.0 for details on each item)
Water 5upp1 Flood Zone Informations Sewage Disposal: Trench Permit: Debris Removal:
1'u blic C hcrk tf uub..lr PLM.d Lune Indicate municipal A trench well not br Licen.rd Disirs.l Site O
1'ne.ue❑ ur mJenuA Zane: ur un ate sc.trm ❑ nyuoed O or Irench ur .pectic:
permit is uncle O _
Railroad right-of-way: Hazards to Air.Navigation: eta ll,,to ors l,mum•-on,Id•,i,.. ter.•
\nl %pplc.d,la•O 1,their reeirw completed.'
a l' an•cnt lu Itud.l cnck.yJ 0 1 a•.❑ nr.N.,O Ye.❑ \n ❑
SECTION 8:CONTENT OF CERTIFICA fE OF OCCUPANCY
Idni.nn .a l-•ode. __-- Lvl�ruU)Ha. fa la•ot l.nnlruawrc lkcupanll�.a.l porlLu.r
l e„•• dna•( uiLlnti c.nuam.m Spnnkl.•r Sa.Iwn' Special Shpu Llnan.: -
• SECTION'S: PROPERTY OWNER AUTHORIZATION
.V.1 hat �aldre?�U Prul erN• Owner A-) S.T±,/--/ P'o l ��*
L ,d L« �'caf!r,ytAv � I;V �c
Name(Print) Nto.anj Arvel City/ Town zip
1'roperly chcner Contact Information:
Title Telephone Nu. Ibusine-s) Telephone No. (cell) a-rnad addrao.
1,1 alq•Ilk-able. IJt_r property owner hereby aunt hurl r+
.Name Street Address City/Town State Zip
to ad on the +ro aer1% m%;nvrs,behalf, in.ill matters relative lit work authorized by this building +vrmil a , Ilication.
SECTION 10:CONSTRUCTION CONTROL (Please fill out Appendix 2)'
11f buddin is Ia+s thin)S,WO cu.It.of encluvd space and/or not under Comfruction Contain than ch«k hen O and,buy Sa Iiun 10.11
10.1 Re istend Professional Responsible for Construction Control
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
LkAi- 141hek c �_
Namr"u(,Pr n rs tblr,f strict arose No. and Type if Applicabl
�tci' / / rZA. �iiLe•� �r , moo
Street Ry City/Town .�' State Zip
Trle hone No.(busiSn/rss) Telephone No. cell e-mail address
SECTION 11:WO V (M.G.L.c. IS2§ 2SC(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 O No O
SECTION 12.CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)-f
1. Building f Building Permit Fee-Total Construction Cost x_(Insert here
2. Electrical f appropriate municipal factor)=f .
3. Plumbing f
4. Mechanical (HVAC) f Note: Minimum fee>•f act
5. Mechanical (Other) f .m- Enclow check payable to
6. Total Cost f (contact munici alit )and write
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 conLuned in this
•application i., true and accurate to the best of my knowledge and understanding.
VIva.a prom. �a •n name frtlr — r.•Ivphunr \u. Date
Stra•a•1 .\al r", Cof%Town �LI- tr'��. op
Municipal Inspector to fill out this section upon application approval: (J
Nome
c-.
,REMOVE EXISTING UPRIGHT
COOLER,INSTALL NEW ICE MAKER
E-�ISFWG-
EXISTING 3TRAOM_
STORAGE ROOM '
EXISTING 50"TV r
.ABOVE TO REMAIN
]
REMOVE EXISTING
j COUNTER AND EQUIP. I —. ; VERTICAL GATE
I ERAMIC TILE._ITYPI _..EXISTING.PARTITION [TYP] _
9{ MELAMINE CABINETS pl =1 j [NO NEW PARTITIONS]
}' BELOW.COUNTER.ITYP,I
9 ABOVE SEMI-GLOSSPAINT _ ` t ml ' _,.5'-0• S.3_ COOLER
ABOVE- COUNTER [TYPLaI
a 42' HIGH COUNTER WITH
42' HIGH.COUNTER WITH - 1 EPDXY RESIN FINISH
y EPDXY RESIN FINISH 2:-0' S.S. DISHWASHER.
o:.
BEER.TAPS --- !j
O _
FLOOR DRAIN : ! TRIPLE
E S S.S.
T
TRIPLINK
FILLER PANEL 40 I.S. GREASE TRAP
—h LOCATED BELOW
42• TV ABOVE I I I
S.S. COOLER PASSAGE TO INDIA
HAND SINKI " - I z9-s• MAIN RESTAURANT
z•"8! f
FILLER PANED .f_. _[ LCARPET [TYP]
-.SINK COLD PLATE
' BEVKRAGE GUN
EXISTING ACCESS—�
ENTRANCE' TO RESTAURANT
i
EXISTING DOOR J _
AND STOREFRONT
PUBLIC SIDEWALK
PROPOSED FUNCTION ROOM ALTERATIONS
PASSAGE TO INDIA BORON. % EF+
157 WASHINGTON STREET, SALEM MA. MASS.MASS. y n�
114"=1`-0" . JUNE 10,2010 PETER K. GEARHART
CITY OF SAL.EM, MASSACHUSETTS
I . .PUBLIC PROPERTY DEPA-RTMENT
120 WA.SHINETON STREET, 3A"O FLOOR
SAirM, MASSACHUSETTS 01970
STANLEY J. USOVICZ, JR., 7FLEPHONE-. 978-745•9595 EXT. 380'-
MAYOR FAX: 978-740-9846
CONSTRUCTION.CONTROL AFFIDAVIT
Project Number. Aly Date: :::rvNir' Iv, -old
Project Title: 16E2i 07 12 I FI SA A
Project Location: � lN_Tl CtA 504-w
Name of Building:
1�-� i� ��Y6��i� ��Ili /hfiz�"< I e•�1 �1�r� - _ _
Scope of Project: i1�LL1P!—� r
IhI CCORDANCE WJTH SECTION 116.0 OF THE'MASSACHUSETTS STATE BUIDING CODE, I
�(` K_�a�i #I 4fLt MASS. REGISTRATION NO.d�]"-82 BEING A REGISTERED
PROFESSIONAL ARCHITECT HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY
SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS, AND
SPECIFICATIONS CONCERNING:
Civil Architectural 4X Structural Mechanical
Electrical Fire Protection Other(specify)
FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEDGE, SUCH
PLANS,COMPUTATIONS, AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE
MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES AND
ALL APPLICABLE LAWS FOR THE PROPOSED PROJECT.
I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES
AND BE PRESENT ON THE CONSTRUCTION SITE,ON A.REGULAR AND PERIODIC BASIS TO
DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS
APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING
AS SPECIFIED IN SECTION 116.2.2.
1. Review of stop drawings, samples and other submittals of the contractor as required by the:construction'
contract documents es submitted for building permit, and approval for conformance to the design concept.
2. Review and approval of the quality control procedures for,all code required control materials.
3. Special architectural or engineering professional inspection of critical construction components requiring
cont{olled materials or construction specified in the acceptad engineering practice standards listed in
Appendix I.
PURSUANT TO SECTION 116.4, 1 SHALL SUBMIT PERIODICALLY, A PROGRESS REPORT
TOGETHER WITH PERTINENT COMMENTS TO THE BUILDINGrIN, P CTOR. UPON COMPLETION
OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS O TH ATI� SFACTORY COMPLETION
AND READINESS OF THE PROJECT FOR OCCUPANCY,
Signature
SUBSCRIBED AND SWORN TO BEFORE.ME THIS 1 DAY OF IL 29G4 -� 0/ 0
C4. r �L�`-� MycAmrnssion Expires S ��d
Notary Public