65 CONGRESS STREET - BUILDING JACKET i
j 65 Congress St.
e .
i
Certificate Number: B-16.440 Permit Number: 8=16-440
Commonwealth of Massachusetts
City of Salem
This is to Certify that the .•...........................MFG Building located at
Bulk ng
Type
63- 67 CONGRESS STREET in the City of Salem
............................................... ................ .......
Address Tmn/City Name
IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY
Law Offices
65 Congress Street
SALEM RENEWAL & LAW OFFICES
This Permit is granted in conformity with the Statutes and Ordinances relating thereto,and
expires --------..._Not Ap_placable......... unless sooner suspended or revoked.
Expiration Date
Issued On: Wednesday, August 03, 2016
� 06�ONDtTq��
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VSQVE AD
CITY OF SALEM
Certificate Number: B-16.440 Permit Number: B-16440
Commonwealth of Massachusetts
City of Salem
This is to Certify that theMFG Building located at
........................................_.............................................. .. 1-_..._...........................................................
auNding Type
65- 6.. CONGRESS STREET n he City ofSalem
......__......-...... _ ... .......... ....................... ..-....................
Address Town/City Name
IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY
Salem Renewe!
67 Congress Street
SALEM RENEWAL &LAW OFFICES
This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and
expires ..............................N Applicable.............................. unless sooner suspended or revoked.
E*radm Date
Issued On: Wednesday, August 03, 2016
��6; '9�SlQ• �
w�wls
Divlrs �
C1V EMI
Commonwealth of Massachusetts ION
CitY of Salem ,
12e Washington Sl,3rd FloorSalem,MA 01970(978)7459595 x5641
Return card to Building Division for Certificate of Occupancy
PitNo. ;
FEEPERMIT TQ BUIrLD
4
FEE PAID: $352.00 ',,
DATE ISSUED: 5/12/2016
This certifies that SALEM RENEWAL, LLC
has permission to erect, alter, or demolish a building.65m,67.CONGRESS,,STREET Map/Lot: 340193-0
as follows: Other Building Permit I BUILD OUT SIX(6) OFFICES PER LANs INSTALL ONE (1) NEW
BATHROOM. NEW WINDOWS & DOOR PER PLAN ,
Contractor Name: David Pabich * -----------
DBA: SALEM RENEWAL LLC #
Contractor License No: CS-101745
5/12/2016 ;
Building Official Date
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official
may grant one or more extensions not to exceed six months each upon written request. !
All work authorized by this permit shall corifomt to the approved application and theapproved construction dotxafterrts for whkh,this permit hes been granted.
I
All constriction,alterations and changes of use of anylbuiklktg and structures shall be in compliance with 1 tzoning by-laws 8ttd codes.
I Imo ,
This permit shall be displayed'in.a location clearly visible from access street or road and shag be maintained open for lovbfictrispectiion for the entire duration of the
work until the completion of the same. , i °s ..
a
The Certificate of Occupancy will not be issued until atl applicable signatures by the Building and Fire Officials=ata provided on i�is,permg. �
s
HIC#: 'Persons contracting with unregistered contractors do not have access to tha.guaranty fund'(as set forth in MGL 042A),
Restrictions:
Building plans are to be available on site., s'
All Permit Cards are the property of the PROPERTY OWNER.
p Commonwealth of Massachusetts' '
ON of Salem
120 Washington St,3rd Floor Salem,MA 01970(978)745.9595 x5841
Y - Return card to Building Division for Certificate of Occupancy
1
Structure + CITY OF SALEM BUILDING PERMIT
J t
Excavation x :PERMIT TO BE POSTED IN THE WINDOW
Footing INSPECTION RECORD
Foundation -
Framing & e
Mechanical
t
Insulation INSPECTION: BY DATE
Chimney/Smoke Chamber
Final :
y
If Plumbin /Gas i
7f8 04
Rough:Plumbin i
Rough:Gas
Final .moi/ 66
"a ElectricaP
SenAce
Rough
Final
a Irant
�
p
Preli nary
MFina(
Health Department
Preliminary ;"
Final.
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_ EI'V'�D
� � The Commonwealth''�`iQ��c usetts ��
. �4� Department of Public Safety
A4assachusct�sStiteBuilJin�(��OC�1RP � 3Z
Building Permit ApplicaHon for any Building other than a One-or Two-Family Dwelling
.(fhis SecHon Fur Official Use Onl )
OBuilJing Pcrmit Nmnber. Date Applied: Building O(fitial:
� SECTION 1:LOCA770N(Please indiate 61ock M and Lot q for lowHona for which a akeef addresa is not available)
�- C�S Ca�C�e�sT S'[- �4L+Ewl M e1- D/°�
t No.and Street City/Town Zip Code Name of Building(i(applicable) .
n SECTiON 2 PROPOSED WORK �
`y Edition of MA State Cude used_ If New Cunstruction ch�v-k here O or check all that a I m the two rows below
PPY �
� Existing BuilJing'� Rep.ir O Altcr:ition O Additiun❑ Demulition O (Ple.ue fill out and submit AppendLr I)
� Ch�nge of Use O Chonge uf Occupanry ❑ Other ❑ Specify:
I��—� Am building plans and/or constructiun d�uments being suppli�4i as part of this p¢rmit application? Ycs 8� No ❑
Is an IndependentStructural Engim�ering Peer Review reyuired? Yes O No 0"
Brief Description of Propuscrl Work: � �- (� O�F' P 4t1� S � L
1 t�eti.� rba r�t e,cor-i w�� w iN fla..�S r aoae_ PaR.- r��
SECTION 3:COhiPLETE TN[S SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANCE IN USE OR OCCUPANCY
Ch�ek here if an ExisNng Building Investigallon and EvaluaHon is enclused(See 780 CMR 31) O
Existing Use Croup(s): Proposal Use Group(s):
� SECTION 9:BUILDING HEIGHT AND AREA
. . . � Exlsting Proposrd
IVo.af Fluurs/Sturies(include basemenf levels)&Area Per Floor(sq.ft.) � md � '3�O�p
Tutal Arca(x�.ft.)anJ Total Heigh[((t.) � �
SECIION 5:USE GROUP(Check ae a lieable)
A: Assembly A-1❑ A-2 O Nightclub ❑ A-3 ❑ A-1 O rl-5❑ B: Bueiness E: EJucaHonal ❑
F: Facro F-1 O F2❑ � H: Hi h Huud H-t O. H-2 O H-3 O H-•{❑ H-5 O
1: InstituHona! 1-1❑ 1-2 O 13 O 1-1 O M: MercanNle� R: Residential R-t❑ R-2❑ R-3❑ R-4❑
S: Storoge Sl O - S2❑ U: Utility❑ Spect,il Use 0 and Iease Aestribe bcluw: �
. - S�Yiai Use:
. SECTION 6:CONSTRUC[ION 7'YPE(Cheek as a Ifcable) � -
[A ❑ 10 O IL\ ❑ IIB O IIL1 ❑ IIIB ❑ IV ❑ VA O VO ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each ifem)
Water Supply: Flood Zone Information: Sewage Disposal:
Trenth Permlt Debris Removal:
A hench will nut be Lice�us�d Dispucal5i[e❑
Public❑ Ch�tk i(uuLiele Floo:l Zune� ImlicaF�:nuaicip:�l❑ reyuired 0 or trenth ur specify:
Private❑ or indentify Zune: ur on site sysMm❑ v�rmit is endoseJ 0
2ailro�J rightof-way: Huards to Air Navigation: �I.\I1:_tn�i.G�n�n,�.sl�m Itr._i����._I'r�k��_..:
Nut Applinble❑ Is Structure wilhin airpurt appro.ch area? Is U�eir review completeJ?
or Cunsent to BuJJ cnclostvl❑ Ycs� nr No❑ � . Yes❑ Nu ❑
SEC7ION 8:CONTENT OF CERTffICATE OF OCCUPANCY
[dilion ul CuJn: Usc Gruup(s): Type of Conslruction: (krnpant LnaJ Fur Fluur:
U�ks thc builJing cunt.�in an Sprinklcr Sys�cm?:_ Special Slipiddfiuns: _
�i '1 Fs �'1 -I � �L Zlt e,
(`r1 r�- � �,�. � �l 1 ll
� _ _ I
J
SECTION'k PROPER7Y OWNER AU'CHORIZA"f10N '' �
Name and AdJmss of Property Owner �
U4V In��� u-�' 8�.�1� �`tL.e'�'� N1 k 0l9� �
Name(Print) � No.anJ Street � City/Town Zip
Properiy Owner Cuntact(ii(onnation:� ;' � :
. ...
Tille Telephone No.(businessj Tclephone No. (cell) e•maJ address
� If applicable,the property owner hereby authorius
N:une Street Address City/Town State - Zip
to act on[he ro er ownels lxhalf, in all matters relative lo work authorized b this buildin ermit a lication.
- SFC770N 10:CON57'RUCftON CON77tOL(Pleaee E111 out Appendix 2)- �
If builJin is Iese thin 35,000 cu.ft.of enclosed s are and or not under Corotruction Control�hen check here O anJ ski SecNon]01
10.1 Re istered Profeasional Res onaible for ConstrucNon Conhol. �
N:mie(Regislmnt) Tclephone fVo. c mail address Registration Numbcr
Strcet Addmss � City/Town St�ite Zip Discip6ne Expirution D;�e
70.2 General Contracror � - - � � � �
5�u �D P�i u-P ��a�-w� P_�—N��... L.1.C_
_ Comp<iny Name
`I�Av�D Pc�t u-� C� - l o l �`f 5
Nnme of Person Responsible fur Cunstruction License Nu. and Type if Applicable
� (-�a�3o2J 1�W 1�-�-- c�Kl�'l � ���
Strcet Address � City/Town , State Zip .
_ ��`-�—'15 Sg
Tcle hone No. business Tcle hone No. cell e-mail addmse
SECTION 11:4YOFF:EI:S'CO[+IPENSA I'ION INtiUH:�.NCli APF1UAVfl' M.C.L.G.152 25C 6
A 4Vorkers'Compensalion insur.ince Affidavit from the MA Dep�rhnent of Industdal Accidents must be complet�kl and
submitted with�this applicnEioa Failure to provide this affidavit will result in the denial of the issuance of the budding permit.
Is a si ned Affidnvit submitted�vith Ihis a Iicallon? � Yen O No O
SECTION 12 CONSTRUCI'ION COSTS AND PERMIT FEE � -
Item Estimnted Costs:(Labur �� ��
anJ blaterials) Totil Cunstruction Cust((rom Rem 6)a S�_
L 6uilding g UJ� Building Permit Fee=Total Construction Cust x_(Insert here
2.Eleclrical S �'j o00 - appropriate municip�l facror)_$
:f.P�umbing 5 O� .
d. Mcchunical (HVAC� g p}�A Nute:Minimum(ee=T� (mntadmunicipality)
5. M1lerhanical Other � �6 Endose check a able tu
vr
6.Totil Cust � 3��$Oc7 (contact munici ali )and write check number here
SECI'ION 13:SIGNATURB OF BUILDING PERh(R APPLICANT
6y ei ering my .me beluw,I hcrcby attest under the pains and penalties uf perjury that all of the informatiun contain�tif in this
::pplic ' n ' rue.v�d accurate ro the best of my knowledge anJ understanJing. ' n^,.� q�� �Zn��
�Jtv�D P�c c.�l r�A�.t�Es�� ��r2s � �-��u
Ple� 'e rin[a sign mm�e Tille Tclep un Uu Date
�'.� �`'a��2.Ss S; S�t�-�-f-� ��-�.�
Slm�t Address Cily/'Pown State Zip
�limicipal Inspector to fill out this section upon application appravaL• �'�'�'"' d"9�-�' j � `�
Name Dale
c� � �
* The Commonwealth ofMossachusetts
v
' 1leparbnent oflndustrialAccidents
'� I Congress Street,Suite I00
Bostox,MA 02I14 2017
www.mass.gov/dia
�§`orkers'Compeasation Insurance�davit:Builders/Contractors/Electricians/Plambers.
TO BE FII.ED WITg TgE pEghIITTJ�G AUTHORITY. �
ApolicantInformation PleasePrint Le�blv
Name(Business�orgamTaeonaqdiviauel): �r� (�.!✓�l.��l�- 1,LL
Address:_ �5 CorJEy,��S ��
City/State/Zip:_S P1'�.�^'� M�-- Phone#: I / o ( � / 2 �
Ne�empbyerY Check Ne appropriate boi:
Type of project(required):
1. I mn a employer wiN � employees(full and/or part-time).• . 7. �NeW COnStfUChon
2.❑I am a sole proprie[or or parmersAip and have uo employxa working for me in � ,
�Y�Pa�h�It`to workers'comµ rosivance required.] 8. odeling
3.0 I am a homeowner doing nll work myselE[No workeis'comp.insivance required.]1 9. ❑Demolition
4.❑I am a homeownn and will be hiring contractors W co�uct all work on m o 10�Building addition
eos�ve Mat all wntracton eithu have workers'co Y� P�f'. I will
� pm{aiewls with no employees. �°Sation'a�sursnce pr�¢sole 11.Q E]CChjCy�7epgjTS or 8dditlOrts
5.❑I am a geneml contrsctor md I have bired ihe subco�ectmy 7iatyd on the attached sheet. IZ.❑P�Umbmg rePa175 Oi 8dditioas
7'hese sub-contrac[ors have employees nnd have workers'comp,int�vance.i 13.�Roof repairs
6.Q We are a mryorapon and(ty ufficers have exercised t6e'v right ofuemption per MGL c. �4•���
152,§I(4),and we have no employees.[No wohers'comp,insiusnce my�aed.�
'MY sPDlicant that checks box#]must elso Sll out tlre sectian beloa showin 16e'v worgas'
. 1 Homeownen who subrtrit t6is affidavit i�mtumg thry ere domg all work and thm 7tire oubide contractors must�ubmit a nnv a$davit indicating such.
=Contracmrs t4at check this box must atfeched m�additional aheet showing Ne oame of the aub-cpnpactors and ytate whethe m oot those entitia have
employees. If the sub=contractors have emp7oyeea,they muvt provide the'v urorken'comp.poliry nwnyer.
I am an employer,tha[is providing warkers'compensa[ion insurance jor my employees. Below rs the policy arsd job site
injormation. Q,.,, �
Insurance Company Nazne: c�C7G�`'�
Policy#or Self-ins.Lic.#: � Expiration Date:
JobSiteAddress:_ ��l WN(-aQES,S C5ty/State/Zip_�{�� �{�- 0��'�
Attach a copy of the workers'compensation policy declaratlon page(showing the policy oumber and ezpiration date).
Fail�¢e to secure coverage as req ' c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or ono-year impriso ,as well as civil alties in the form of a STOP WORK ORDER and a fine of up to$250.00 a -
day against the violator copy of this stat t may be forwazded to the Office of Investigations of the DIA for insurance
coverage verification.
I do he�eby certijy und e p ' - p¢R�i�orpef���,�y�the injormalion provided abov is tr e and correct
Si ahue: . ate: z �
Phonett: /�� q � ` I 1i�
O,S4cia!use only. Do rsot wrae in this areq to be comple[ed by city or town oJjicial
City or Town• PermiULicense#
Issuing Authority(circle one):
1.Board of Health 2.Building Depar[ment 3.City/Town Clerk 4.Electrical Inspecror 5.Plumbing Iaspector
6.Ot6er
Contact Person• Phone#•
I —
�
.
�
Information and Instructions `.
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
�Piasuant to Uvs statute,an employee is defined as"...every person in the service of anotha under any coatract ofhire,
express or implied,oral or written."
An employer is defined as"an individual,paztrierahip,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or tLe
receiver or trvstee of an individual,parinership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments end who resides therein,or the occupmmt of the
dwelling house of enother who employs persons to do maintenance,conshuction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also s[ates tha["every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for eny
applicant who 6as not produced acceptable evidence otcompliauce with t6e insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of ifs political subdivisions ahall
enter into any contract for the perfotmance of public work until acceptable evidence of compliance with the msurance
requ'vements of this chapter have been presented to[he contracting authoriry."
Applicants
Please 511 out the workers'compensation af5davit complMely,by checldng the boxes that apply to your situation and,if
necessary,supply sulrcontrac[or(s)name(s),address(es)and phone number(s)along with the'vi certificate(s)of
insurance. Limited Liability Com�anies(L.LG�or LimiteA Liability Parh�ers}dps(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation ins�vance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Depazhnent of Industrial
Acciden[s for-confimiation of insurance coverage. Also be sure to sign and date the a8idavit The afHdavi[should
be retumed to the city or town that the application for ihe pemtit or license is being requested,not the Depaztment of
Industrial Accidents. Should you have any questions regarding the law or if you aze requrzed to obtain a workers'
- compensation policy,please call the Department at the number listed below. Self-insured companies sl�ould rnter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Depaztrnent has provided a space at the bottom
of the afSdavit for you to fill out in the event the OfSce of Investigafions has to contact you regazding the applicant.
Please be sure to fill in the pemtit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permiUlicense applications in any given year,need only subtmt one affidavit indicating cwrent
- policy infoimation(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof tha[a valid affidavit is on file for future pemrits or licenses. A new affidavit must be fi11ed out each
yeaz.Where a home owner or citizen is obtaining a license or pemut not related to any business or cormnerciel ventiue
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete tlils affidavit.
The Department's address,telephone and fax number: � -� �
The Commonwealth of Massachusetts
Department of Indushial Accidents
1 Congress S�eet, Suite 100
Boston,MA 02 1 14-20 1 7
Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
l � BATHS TO REMAIN NEW 1 HOUR RATED TENANT DEMISING WALL 8�_�^ ��pEp,a
EXTEND TO DECK AND SEAL ALL VOIDS
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� III � WINDOW � � RATED TENANT DEMISING " � `
x � i - ' (�I WALL EXTEND TO DECK AND V � �
" i, � OO OO OO I SEAL ALL VOIDS �' v°�i a
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' ! O f fice WA�� � � O f fice � O ffice O ff i c e � r � 10z � i � � �
�\ �� OPENING I REMOVE DOORS I�� Tenant 1 � 6
6 d II � 1 � � 3
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� NEW WINDOWS IN � NEW WINDOWS I
�Q � REMOVE DOOR 3 i
� EXIST. LOCATIONS REPLACE �� W EXIST.
� � LOCATIONS I EXISTING CMU WA�L. 1 HOUR
N N W/WINDOW ' I RATED TENANT DEMISING
WALL EXTEND TO DECK AND a�
�n � Floor Plan - Proposed Office parkin , SE^� ^�� �°'°S I a v
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� WALL TYPES � O I o N �
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. ,iz� �WB �oa Exisr. � � u" o �
• 2 X 4 WOOD STUDS � 16" O.C. O FURNAC � °
� 3 1/2" SOUND ATTENUATION ' � 1 C Bat �
� -� � - � � � � BLANKETINSULATION
I �N07E: M.R. G.W.B. � BATHROOMS • 1/2" GWB I
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FIRE RAnNG BASED DN �STING CODES REMOVE OH DOORS I 4�-O �-6
GWBPARTITION UL RATING
I 7 NA NA REPLACE W/WINDOWS
NOTE: & DOOR (BY OWNER) D I
. s/e' rvPe 'x' c.w.e. ALL DOORS 3'-0" X 6'-8"
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• z x s sTuos � is� o.a (BY OWNER) � 103 i I
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.. ... . _ . ... . .:, ..
• BLANKET BATT INSULAiION �I Office
I . 5/8" TYPE 'X' G.W.B.
GWBPARTITION FlRE RATING BASED �N �SiING CO�ES II
i Z 'HR UL NA^nNG WALL KEY i �
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• 5/B" TYPE 'X' G.W.e.
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ExisT. a" cMu EXISTING R�z
. �2> 2 X 8 STUDS � EA SIDE � , ��
& ,6- o.�
• BLANKET BATT INSULA710N ----- DEMOLISHED Q�
• 5/8" TYPE �X' G.W.B.
� PROPOSED
INFILL PARTITION @ CMU WALL flRE RAIING UL RATING TESTING CODES !�
3 7HR NA ���������� DEMISING - a
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� EXIT SIGN � PROVIDE AND INSTALL STROBE FP �{/g I �
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� PROVIDE AN� INSTALL EXIT SIGN I
ExR E%IT SIGN: MANF. EMERGI-LITE �. PROVIDE AND INSTALL EMERGENCY LIGHi
� W-LXN-I-RC-C-120 I
� PROVIDE AND WSTALL HORN/STROBE m2 PROVIDE AND INSTALL PULL STATION ES
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� PROVIDE AND WSTALL FlRE EXiINGl11SHER � EXISTING SMOKE DETECTOR P � I
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NOTE: ALL LIGHTING, WIRING, SWITCHES LIFE SAFETY DEVICES, AND LOCATIONS SHALL 8E 1HE
RESPONSIBILITY OF THE ELECTRICAL CONTRACTOR AND BE APPROVED BY hiE SALEM FIRE DEPT. . I I G�
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Fi�x(978)7449&6
MAYOR 7�IaiSAsST.P�RRE
DDtSCI'�1R OPP[�LTCPR(�R7Y/BiAfDII�GO��R
Construction Debris Disposa/Affidavit
(required for all demolition and,.renovation workj
In acwrdance with the sixth edition of the State Buiiding C�e, 780 CMR,Section 131.5 Debris;
and the provisions of MGL rAO,S 54; Building Permit�f is issued with the
condition that the de6ris resuking from this work sha0 be disposed of in a properly licensed
waste deposit facility as defined by MGL c lii,S 150A.
The debris will be transported 6y: i
�Q�� ��� . � .
{name of hauler) ' _
The debris wiH be disposed of in: : ^
� 1
(name of facility)
�nvG ,
(address of facility) �
.� ._ , . ,_
Signature of applicant
6 z- I(o
—T Date �