40-42 WINTHROP ST - BUILDING INSPECTION GK Z { s-7
The Commonwealth of Massachusetts
W
Department of Public Safety
Massachusetts State Building Code(780CMR)
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only)
�^ Building Permit Number. Date Applied: Building Official:
SECTION 1 LOCATION(Please Indicate Block N and Lot i for locations for which a street address is not available)
�n y�� va-
( No.and Street City/Town Zip Code Name of Budding(if applicable)
(n SECTION 2:PROPOSED WORK
' Editton of MA State Code used_ If New Construction check here❑or check all that apply in the two rows below
Existing Building Repair❑ Alteration ❑ Addition❑ Demolition Cl (Pleis fill out and submit Appendix 1)
Change of Use ❑ 1 Change of Occupancy ❑ 1 Other ❑ Specify-
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ Now
Is an Independent Structural Engmeen Peer Revte a L;red? p Y, t�❑ No,
Brief Descriptio of Proposed
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investi ation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): Proposer[Use Group(s):
SECTIONS: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 1❑ A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-I❑ F2❑ H: Hi h Huard H-1❑. H-2❑ H-3 ❑ H-4❑ H-5❑
1: Institutional I-1❑ 1-2❑ 1-3❑ !-1❑ M: Mercantile❑ R: Residential R-1❑ R-2❑ R-3❑ RBI❑
S: Storage S-t❑ S-2❑ U. Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as a plicabie)
W ❑ ID ❑ HA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA Cl 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�< Check d outside Flood Zune❑ htdicate municipa A trench will not be Licensed Disposal Site❑
required❑or trench or specify:
Private❑ or indentify Zone: or on site system❑ permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: "A I li_twic Gmngission R_�',',i"'ke,C
Not Applicable% Is Structure within airport approach area? Is their review completed?
or Consent to Budd enclosed CIYes El or No Yes❑ Nu ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): type of Construction: Occupant Load per Flour:
Does the building contain an Sprinkler System?: Special Stipulations:
SIN i t o�elNy AA16 4- ��
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Ali ess o Property Owner
/9 LvrZ ....5 e
D0.V 1 i> \o 44- ?0 Vy h'�r SO`� (�� S r�.�p S fJ f{ yl/,-1- O r o I
Name(Print) No.and Street - City/�vn Zip J
Property Owner Contact Information: pp pp
Aar (prtcxc.e l"o .lam
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
Name Street Address City/Town State - Zip
toad 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 35,6M cu.R.of enclosed space and/or not under Construction Control then check here❑and skip Siiq
10.1 Registered Professional Responsible for Construction Control
i , GIB -C�o -3 � an33SiC�r�ft;,Rf,
Nance(Reg' t Telephone No. e-mail address Registration Number
�� ae in',,.,�n /iI
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor - -
�a��+o 9T(
Company�Na
Na a of Person kesponsible for Construction License No. and Type if Applicable
/Street Address City/Town / state Zip
'ut �1�� - L,a ( 6/L6hfnitn
Telephone No. business Telephone No. cell L,Mail address
SECTION 11:1Y0RKEhS'COAIPENSA'1'ION INSURANCE AFFII.L 71 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❑ No O
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$ �U dO
t.Building $ 6 O l o U Building Permit Fee=Total Construction Cost x_(Insert here
2.Electrical $ 1,20 U(:2 appropriate municipal factor)_$
3.Plumbing $ UUcJ v
d.blechanical (I{VAC) $ CJei Note:Minimum fee=$ (contact municipality)
5.Mechanical Other $ c- Enclose check payable to
6.Total Cost $ OD Q (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
application is true and accurate est of y knowledge and understanding.
face ,� a 7S-
Ple:u e P �t and sign na m ee _ Titlle Telephone Nu. Date
3`7 l�E�nn� So �^/V�+Y Sc.�c—!�5 f� ✓�tJ- O ( �U �-
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval• "'
Name Date
I
Af
Mass
Boat achus�s_
artrnent
Lon.e�ctio ge9Pu atlons Of Public,S
8 �nSe: hixor and Stall
tls
� TpR
DAcfa
NvpR ti1A o,z
r
V �
r )'
OnL. l le Od
--�-`,` sione,ener
OS/1,r lot)
CITY OF SALEM, MASSAaiL SE TTS
BUILDING DEPARTMENT
S� 120 WASHNGTON STREET,3'DFLooR
TEL.(978)745-9595
FAX(978)740-9846
KIlvIBERLEYDRIS�LL
MAYOR THomm ST.PIERRE
DIRECTOR OF PUBLICPROPERTY/BUILDING CDWESSIOMR
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 00, 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:
�-
(name of hauler)
The debris will be disposed of in:
(name of facility)
�—-, k-
(address of facility)
nature of applicant
Date
tiF, ^< Commonwealth of Massachusetts
� s City of Salem
Inspectional Services
t 120 Washington St,3rd Floor Salem,MA 01970 Phone:(978)745-9595 x5641
=RECEIPT
Application For Building Permit (For Buildings other than a One- or Two-Family Dwelling)
� I `„, �' rr , f(This Sechdh for Offip(al Use Onl A � t" � _.
x 9a. u� 2.u: y) u S' -,
Pam'�.::{
PIN T6 15 539 _ `,',i` 0 gig Date Apphed:'6l1(2015 `{ „fi," "r° « {3MIN{n
si
t r:-,
,..:_ ,_,,.—.._. ,.,-.,..,.. ............ ___........... {-,:ate, . :�-
m SECTION 1:SITE LOCATION (Please indicate Block#and Lot#for locations for which a street address is"not available);(
40 WINTHROP STREET , Salem, MA
v is
. „ �-.. O : Y °{ { c,qaw
i.� 'd,1 t, ahva{Hi ::.
Are Building plans and/or construction documents being supplied as part of this permit application?: No
Is an Independent Structural Engineering Peer Review Required? Yes[-] No❑
Brief Description of Proposed work: RENOVATE THREE (3) BATHS &THREE (3) KITCHENS AND ADD THREE (3)
BATHROOMS.
SECTION 3 'COMPLETE,THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION'^ADDITION;OR CHANGE(Nlk
s „ USE OR OCCUPANCY(Check Here if an Existing Building Evaluation is enclosed (see 780 CMR 34)) 3 F
.u,b{ ,� Isu�.!i.[' . {` 11
ay.,v v. rd�,.,, +�
,...�,. .a4.... „..
Existing Use Group: Proposed Use Group:
, .r Q a , � SECTION 4:BUILDING HEIGHT AND AREA lH, - ry dyji;
Existing µ Proposed
No. of Floors/Stories (Include basement levels) &Area Per Floor(sq.ft.) 0 0.00 0 1 0.00
Total Area (sq. ft.) and Total Height (ft.) 0.00 0.00 0.00 0.00
'1119Nii, a 3 � t; a it i r„I+;i1$ rF t SECTION 5 USE GROUP {q:{r : {
Al
u9hCn,nn.{"I- { liSi r F d,pg m {xia c m i*u
Im
,. ,n- °�� a;..... «".s, ,,.,:,.8 .. -,., SECTION 6._..CONSTRUCTION
Multifamily 3+
�s each SECTION 7rSITE INFORMATION (refer,to 780 CMR 111.0 for details on each itemlP W.P. ��
Y tr:mM,dei2 'k-4,-rNtY(3NW ,W�.}:bhn.,).:.'- u ,ry{.,p544M13Mnn,
Water Supply: Flood Zone Information: Sewage nTrench Permit: Debris Removal:
Public Check if inside Flood Zone ❑ Munll not required ❑ Licensed Disposal Site ❑
or Identify Zone: enclosed ❑ or specify:
Railroad right-of-way: Hazards to Air Navigation: MA Historic comission Report Process:
Not applicable ❑ Is Structure within airport approach area9 is theirm review completed?
or Constent to Build Enclosed El Yes
❑ No ❑ Yes ❑ No ❑
nsSECTION 8 CONTENT OF CERTIFICATE OF�OCCUPANCMIN! pt i {a -Mu
,.� „ui�€i!i i ,a�g:"
Edition of Code: Use Group(s) Type of Construction:
Occupant Load per Floor Does the building contain a sprinkler system?:#Error
Special Stipulations:
„ GRI" SECTION 9 PROPERTY OWNER AUTHORIZATION . F i�
rp}{ ,..k.,u.,..r.u0„ „m,,,,..a,,,.mas.n®,,,,, „-.., wuix ,..n., „{..a,.,s—mow k;' ti'$cxcs" ,�568 +
*+ntuwai�+�swex,n µmt n`Pt"'r['Yr�,`•,.mcs,�."il""�. �gt�tw,m. ._,�flf.�{{nu{�{mr .V;di Snit@ftflftblg
®vgifi:;Y,w 9 ' '3 i(" s'i;
„r M"p iHIS1S;NOTE"AiPERMIT�- � u{{„i� aiTs
Commonwealth of Massachusetts
City of Salem
Inspectional Services
,yppn;gi °°WS�d
;.; 120 Washington St,3rd Floor Salem,MA 01970 Phone:(978)745-9595 x5641
RECEIPT
BECKER-POTTER INVESTMENTS,INC 48 SCHOOL STREET SALEM MA 01970
(781) 389-8641
If applicable,the property owner hereby authorizes
ROBERT F.ROGERS 26 WILDWOOD RD DANVERS MA 01923
To act on the property owner's behalf,in all matters relative to the work authorized by this building permit application.
r! a• >t' ;, SECTION 10 CONSTRUCTION CONTROLf(Please Jill out Appendix 2)' " ' ' ` ',,I�?f'
(If building is less'ttian 35,600 cuv ft df enclosed space and/or not under Const7uc6on Control thenAklp Section 101) 'fir s -
a s„ '°3 rt 10 1Regtstered Prpfesslonal Responsible for Constru ct�ioCgntrol ,
Name Phone Email Registration Number
Address Discipline Expiration
Date
VNiMMUr
%„Ur0 wvx 2 General Cont actora ,..:.:, i k w� �; ail:'HE ,;. NO—
Company
Name
CS-085322 CONSTRUCTION SUPERVISOR
ROBERT F. ROGERS License no. and License Type if Applicable
Name of Person Responsible for Construction
Address: 26 WILDWOOD RD DANVERS MA 01923
Phone (617) 680-3358 Email Address bob3358@comcast.net
SECTION 11 WORKERS COMPENSATION INSURANCE AFFIDAVIT IM G L° . 152§25C(6)). * i 't _
A Worker's 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?False
ISECTION 12 CONSTRUCTION COST AND PERMIT FEEeu
OWN,
Oil
Total Estimated Costs(Labor and Materials): $107000.00 Building Permit Fee: $749.00
Enclose check payable to the City of Salem, Ck#
� _ 3EGTION 13 SIGNATURE OF BUILDING PERMI7IAPPLIGANT "Ike.'
,z#"crsx'k"RiE§FA :a. xu�a. xaxmif;r,3.i.nfa,iw Ntk'3ux� .rwu.:n .nso-.za:,:.,u:Xk:r-xwH am„aA ...�,li�)4 d4 'r°^ _
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate
to the best of my knowledge and understanding.
(617) 680-3358
Please print and sign name Title Telephone
Address: 26 WILDWOOD RD DANVERS MA 01923 Date: 6/1/2015
Mumcl al Ins ectorto fill out this section u on a bcati66 a royal ' ' ' ll
I
P P p PP pp , , , , 6l8/2015f
s ,%'` "i`}° 'Rr " �ai9n��u Y a ss i
W �i'F';`W"sl 'i iE i' T' iti'i i t�,7' !i
rs imn .',ts!�S�Ge®e .3 v E td� ,k!'�il�i�!='( Name:'mck l�l,..k�', i Date
LFu1, E'n 1 + r 1HFC8...w, Ct�ft� - exmmnnln� y nrm
PIREM HIS=iIS..N�TiAlPERMIT li!`;,M11