1-7 WATERS ST - BUILDING INSPECTION ll —Ic71 IZI �
Tom_L 13 RECEIVED
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The Commonwea t o Massachusetts
Depots Sta JA y l e�Sg( M CJ .
blassachusettsSttt (7 0 R)2
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only)
Bui±ng Permit Number: Date Applied: Building Official:
SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available)
' V 7
No.and Street City/Town Zip Code Name of Built fng(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 Buildin& Rcpairb- Alteration ClAddition❑ Demolition ❑ (Please fill out.out submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No
Is an Independent Structural Engineering Peer Review re uireal? Yes ❑ No
Brief Description of Proposed Work:
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)&Ama Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE CROUP(Check as applicable)
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ H: Hi h Hazard H-1❑ H-2❑ H-3 ❑ FI-4❑ H-5❑
L• Institutional I-1 ❑ 1-2❑ 1-3 Cl 1-4❑ M: Mercantile❑ R: Residential R-1❑ R-2❑ R-3❑ R-4❑
S: Storage S-f❑ S-2❑ U: Utility❑ Special Use❑and please describe below
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as a licable)
IA ❑ IB ❑ IIA ❑ [Ill ❑ IIL\ ❑ RIB ❑ 1 IV ❑ 1 VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CNIR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑
Private❑ or indenlify Zone: or on site system❑ required❑or trench or specify:
permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: �1-\Ll ,t n+ ��mmdsi n1 w•w l'r xcs:
Not Applicable❑ Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed ❑ 1 Yes❑ or No❑ I Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
fldilion of Code: Use Grou p(s): _ Type of Cooslniction:. Oartpant Loaf per FloorDoes the building coul,tin an Sprinkler System?: _ Special Stipulations:
-18 - 3C115— -7 -137
C4:k4� wl ��
SECTION9; PROPERTY OWNERAUT IORIZATION
N ie and Address of roperty Owner
a (Print) No.and Street City/Town Zip
;, r
Property Owner Contactlnfonn tic : .1 'fit 1t111
Title Telephone No.(business) Telephone No. (cell) a-mail address
If applicable,the property owner hereby authorizes
Name Street Address City/Town State Zip
to act on the property owner's behalf, in all matters relative to work authorized by this buddirig permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If building is less than 35,000 cu.R.of enclosed space and or not tinder Construction Control then check here❑and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control _
Name( •gj�tFa2 LJA Tcle phone No. e-mail address 0j Registration Number
Street Address ity/Town State Zip Drscrpline Espirat on Date
10.2 General Contractor
f C/Z$ v C/1
Company Name
N. of Person Responsi for Construction " License No. and Type if Applicable
Street Address City/Town State Zip
)Y?�5. "(7�f �72-36- 7237 SW 4)M4Sl�It✓F,sr L126,9S
Tele hone No. business Telephone No. cell ee-mares it address
SECTION 11:WORtiels'CONIPENSAI10NweuRANCEAFFIDAVII M.G.L.c.152.§25C6
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.
Is a signed Affidavit submitted with this application? Yes O No O
SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE'
Rem Estimated Costs:(Labor
and Materials) "iota Construction Cost(from(rein 6)_$
1. Building $ Building Permit Fee=Total Construction Cost x (Insert here
2. Electrical $ appropriate municipal factor)=S
3. Plumbing $
-1.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5. Mechanical Other $ Enclose check Y�P a payable to
6.Total Cost I $ -7 (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of the information contained in this
application is true and accurate to t e best of my knowledge anal understanding.
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Please p t rd si n n one Title Telephone No. Date
Street Address Wy/rown nn State Zip
Municipal Inspector to fill out this section upon application approval: .'L6r+�° � 1"1
Name Date
QTY OF SALEM, MASSACHUSEM
{ 1 ! BUILDING DEPARTMENT
120 WASHINGTON STREET,3m FLOOR
TEL. (978)745-9595
KIMBERLEY DRISCOLL FAX(978)740-9846
MAYOR THOMAS STTIERRE
DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris,
and the provisions of MGL c40, S 54; Building Permit# is issued with the
condition that the debris resulting from this work shall be disposed of in a properly licensed
waste deposit facility as defined by MGL c 111, S 150A.
The debris will be transported by:
a
(name of hauler)
The debris will be disposed of in:
(name of facility)
(address of facility)
Signat r/e+ of applicant
l V
ate O\Y\
J
CVK Wanti,<a
_ Office of Consumer Affairs&Business Regulation
ME IMPROVEMENT CONTRACTOR
gistration: 123553 - Type:
xpiration: 3/6/2015_, DBA
Preserve Painting
- Sean O'Connor
203 WASHINGTON
SALEM,MA 01970 Undersecretary
Massachusetts -Department 01 Public Safety
Board of Building Regulations and Standards
Construction Supervisor403
License: CS �3
SEAN OCONNOR=.
26 C"STNUT ST
SALEM MA 01970 '
��� � Expiration
1y31/2015
Commissioner
CITY OF SM.E1,I, NL' SSACHUSETI'S
4
BUILDING DEPART>IE—NT
120 WASHLNGTON STREET, 3"a ELOOR
TFL (978) 745-9595
PAX(978) 740-98.16
KINiBFRT FY DRISCOL-L '
Trto6G1s ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/BL'LLDING CONL IISSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Informatina \ /I Please Print Lealbly
V;Ilnc (��sinessFOrganiralion InJividuall:__ //� I�/(nC/U to C • /}`/` s A / s�/(�7GC�
Address:�y� �111SUZ±�eO
City/State/Zip: Phone #:__
Are you on employer'!Check t ppropriate box: 'Type of project(required):
I.�I am a employer with 6 4• ❑ I am a general contractor and I .
employees(full and/or part-time).' have hired the subcontractors 6'F❑New construction
t 2.❑ I ani a sole proprietor or partner- listed on the attached sheet. l 7. ❑Remodeling
,hip and have no employees These sub-contractors have S. Demolition
working for me in any capacity. workers'camp. insurance. g. Building addition
(No workers*comp. insurance 5. ❑ We are a corporation and its
required.) oRicers have exercised their 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL II-El Plumbing repairs or additions
myself. (N'o workers'comp. C. 152. §1(4),and we have no 12.[] Roof repairs
insurance requited.) r employees. (No workers' l3.❑Other
comp. insurance required.)
•M,y aVrh,.sI tlwt checks but at most also fill out the ccctiun below showing Illicit watken'cumpewtian policy inlirrmatton.
r I Lmaowtwn who whmis this alydnvit indicating they an doing all work and then hira uutsido eulloacim must suhmit a new afCdavit indicating such.
('n Im, tun thus chvvk this box must mtachol an addoiurul ah"I showing the n:unc of the subaantncton and thoir worken'camp,policy information.
I ant an eurpluyer that is providing workers'eanspeu.mdon insurance for my eurpluyees. Ueluly Is rho pulley cord fob site
information.
Insur;usc Cunlpany Vmne:_��✓ G1_$ H..�\r `i
... ..' C..�
Policy it or Sclf-ios. Lit. N:� �� Expiration Dole:-
Job Sifd Address: �`� IZZIZ4 City/State/Zip:_ �-
Attach a copy of the vvorhers' compensation policy declaration page(showing the policy number and explrmdon data).
F'ailuru to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties ofa
line up to S 1,5C.00 und/or one-year imprisonment,as well as civil penalties in(fit! form of a STOP WORK ORDER and a line
of up to S230.00 a day against the violator. Re advised that a copy of this statement may lx furwarded to the Office of
Inecstig:uions of the DIA For insunnce a)vcrase verification.
/da hereby certify under the pubis cord penalties of p,,rjury Just the infunrtutlan provide)ubbirvvie i /rrIu and correct.
1P9t rC �y-I Date'
ys
Official use unly. Oa not write in this area,to be curuplered by city or tarva gj1cial
City nr'fown: I t r,
rmit/l.lccnsc At �
Issuing,luthurily (circle one): ---
I. 11oard of ilaallh E. Iuilding Delml(Illent .i.Cilyfrnvvn Clerk 1. Electrical Inipcctur 5. Phlmbing luxpector
G. Other
Contact Verson: Phone lr: I
r
i
City of Salem August 3 , 2014
Department of Engineering Salem Maritime Townhomes
Attention:
David Knowlton , PE
City Engineer
Dear Sir ,
This is to confirm that Preserve Services is authorized to obtain a permit to replace the first story
siding at the rear of the condominium units 1,3,5 and 7 located on Waters Street , Salem .
Yours truly ,
authorized signature
authorized signature
The Trustees ,
Salem Maritime Townhomes
Karen Letterman , Ajay Narang
Ritu Narang , Guisseli Reyes ,
Harold Santucci