10 DERBY SQ - BUILDING INSPECTION (009) JACKET rsuperften
am rm.,7��p
Tab.
KEEPING YOU ORGANIZED
No. 10301
FAINIPM=
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woamum
Ga:TOt�AN®AT�EAD�!
REFRIG. 2 X 6 S S PREP -
TABLE
J// Prep r
SHEET
oRY
VINYL U
`FLOORING S OR 4
3 BAY SINK VESTIBULE W
N.I.C. F
%\
ax �
IREFRIG. v ai A R
(above STEAMER o 14_
I(above) ti� W Ao y
UFAS UP
56" X 60" (below) W a
n CLEAR FLOOR SERVER AREA TABLE
SPACE RAISED 8" + OR - 02 (REElF
Serving
NON-SLIP REMOVABLE
CASE FLOOR MATS OVER
GRI DE EXISTING
SHEET VINYL
HIGHFLOORING
SHELF I 4'-6„ ICE BIN o TEA DISPLAY
FOR IT/ w SHELF ABOVE
RADIO aCARAFES (BELOW
_ )
DRIP
a O SEALED WOOD COUNTER
z
TRAY O EW S ON WOOD BASE CABINETS
COU TER m
0 ti y
6'-0"
COFFEE A
O
STATION le
A A
01 0
Seating
RELOCATED HEATING ELEMENT. DETERMINE
CL. APPROX, LIN. FOOTAGE AVAILABLE IN
SEATING AREA. SUPPLEMENT AS REQUIRED
AT AVAILABLE WALLS TO REMAIN. COORD.
IN FIELD WITH OWNER'S FORCES
M
HTR HTR b
'Lz
MODIFY EXIST. JAMBS TO MAXIMIZE OP'G F
SIDEWALK IN EXIST,STOREFRONT. PROVIDE OFFSET
ADA HINGES TO OPTIMIZE OP'G. INSTALL
CLOSER AND LEVER HARDWARE FOR !r
ACCESSIBILITY ,
I Q
°r1
e( 32- 3zy4z—
NOT FOR CONSTRUCTION
10 DERBY SQUARE 851-09
COMMONWEALTH OF MASSACHUSETTS
CITY OF SALEM
GIS# : .3:2,.533
�,
Map: 35 , ,t f: .,,f
Bloek 1 G „2 .1.., r SIGN PERMIT
Lot: 0243v: Trp'
Pemut: . Slgnz -
Catego'ry: c SIGN:`., ,rt;� J,
Permit# 851-09 err € "' PERMISSION IS HEREBY GRANTED TO:
Project#',`_JS-2009-001533 it's
Esti Cost:> $1,100.00 1 k Contractor: License: Expires
Fee Charged:$0 00 ,��`�. '"'r µ , Concept Signs
Balance Due:$00 Ac Owner: Donna Lavoie
#of Fixtures' t "';'+, Applicant: Concept Signs
DlgSafe# ,;' ., AT: 10 DERBY SQUARE
UseGrouj`
ConstClass
ISSUED ON: 16-Jun-2009 AMENDED ON: EXPIRES ON: 16-Nov-2009
TO PERFORM THE FOLLOWING WORK:
SIGN PERMIT AS APPROVED FOR(LAVOIE STRATEGIC COMMUNICATIONS GROUP, INC.)jhb
THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF
ITS RULES AND REGULATIONS.
Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
SIGN REC-2009-001788 16-Jun-09 x $0.00
GcoTMS®2009 Des Landers Municipal Solutions,Inc.
x 'n, O1
PL-131 .1C f'ROI'I .IZ'1'1"
I'll\\ hIIIMI `.]Iltll I • ?••.II ',I.�I 'u�\ ;II �I :;•n 'I ii
tl I 't-4.'-1i Up')�,(♦'I'AA.'l.-'ry=.In
98 N.
APPLICATION FOR PLAN EXAMINATION AND
BUILDING PERMIT
ALL BUILDINGS EXCEPT ONE AND 2 FAMILY DWELLINGS
IAIPORTANT: A policanis must Complete all items nn this page
SITE IN'FORMA'TION
Location Name Building
Properly Address /� _
16 U G- .g Juit •, 14 lie
Located in: Conservati n Area Yo Historic district /Uo
APPLICATION DATE / 1/S• /0 9
Use Groups
(check one)
Group Homes 123 Ra_
Residential (3 or more Units) R2—
Type
2_Type of improvement Residential (hotel/motel) Rl _
(check one) Assembly(Theaters) A 1 _
New Building_ Assembly(restaurants & Clubs) A2r_A2nc_
Addition Assembly (churches) All —
Alteration
I _Alteration Loo'- Business B V
Repair/Replacement_ Educational E
Demolition_ Factory (moderate hazard) FI _ b
Move/Relocate Factory(low hazard) F2_ J�
Foundation Only High Hazard Ii_
Accessory Building Institutional (residential caieI 11
Institutional (incapacitated) 12 -•-" -
Institutional (restrained) 13
Mercantile M _
Stora'ze SI _Moderate ILiza]d `^
Stunt ee 52_I�Iw I laz:ud
OWNP,
INFORMATION(Please typr nr Print l'IearFc) / �
OWNER Name 1 —�— / Cmz ��TMM1T
Address /
Telephone 978- P 3 - 6,31 4
Signature
DI•:SCR 11'1,I0N OF y%OR17�- I'O KE PERFORMED
Tiya1. v �. C..��2.NewcJC hsa rjw 4tid 4lede+ n.vea
Tri11 ek-f
ljfr.r�C Oa Gx lNniev Wd �� 1»•1 Vtl� �IAOV S sT
PPA;Al
I•:Sl'I\I:\Il•:D CONtiI'RUC'1ION COSI'
5
CON'I'RAL'I Olt INF ICNIA I ION
Name Geovge N• �/ pest ,�
Address & S sExelaa»fie J4. L y Ahi
Telephone 7F1-S93 - 3 �� y
Construction Supervisor's Lir # C.L 8979 3
Home Improvement Contractor# I y8P 11
.%RCI(ITEC UENGINEER INFORAIAT1ON
Name
Address
Telephone
Mass. Registration #
PERMIT FEE CALCULATION
Estimated Cost x $11/$1,000 + $5.00=
CONINI1iNTS °
The undersigned applicant does hereby attest that all information stated above is true to the best of my knolvledge
under the penalties of perjury
Signed (owner (uscnt)
APPROVEDBY :
DATE APPROVED:
M
� � The Commonl{d�eBESti�f�l��s����etts �`
��' Deparhnent of Public Safety ���' J�� �7
�Y�, ` A9assachusettsStT(,�u'�qg��le�i'O�jv((�)I., � � ����N Ic, v
(
(r- Building Pemiit Application for any Bu d n o4}�er fian a One-or Two- amily Dwelling
_1� .(This Section Fur Official Use Onl )
�v 1
� 6uilding Permit Numbec Date ApPlied: BuilJing O((icial: -
SEC'CION 1:LOCATION(Please indicate 61ock k and Lot q for locations for which a street address is not available)
�
. , I 0�,1 5
� No.anJ SlriBt � City/Town Zip Code v Name of 6uilding(if upp�icable) .
;- SGCTION 2:PROPOSED WORK �
_(� Editiun of bIA Sfate Code used_ If New Constructiun check here O or check:ill that apply in [he Iwo rows bcluw
1`r'.1
� Existing Building Rep.iir Altcritiun ❑ Additiun❑ Demolitiun O (Plcase fill uut and submit Appendix I)
Change uf Use ❑ Chauge uf Ocuipancy ❑ Other ❑ Specify:
Are building plans and/or cunstructiun ducuments being supplied as part of this permi[application? Ycs ❑ Nu
Is an fndependen[Structurel Engineering Pecr Review required? � Ycs ❑ Nu 0�
6rief Descri tion of Propused Wurk:
�E h(�r C ��r��c� ��L`t �hc�N� : lu�N aui o ,c/
� � i - r i c.
,
SECT[ON 3:COMPLETE TFIIS SECI'ION IF EYISTING BUILDWG UNDERCOING RENOVATION,ADDITION,OR
CFIANGE IN USE OR OCCUPANCY .
Chcck here if an Existing Building Investigation and Evaluation is endos��i(See 7S0 CNIR 3i) ❑
Existing Use Cruup(s): ['roposed Use Croup(s): "i
SECTION 4:OUILDING HEICHT AND AREA I
Exis[ing Pruposed I
Nu.of Fluors/Storics(indud�basement Icvcls)&Arm Pcr Fluor(sq. f[.) ' �Q � 0�
Total Arca(sy. (t.):md Total Height(ft.) �,
SECT[ON 5:USE GROUP(Check as a plicable)
A: Assembly A-I❑ A-?❑ Nightclub ❑ A-3 ❑ A-1❑ A-5❑ �: Dusiness E: EducaHonal ❑
F: Facto F-t❑ F2❑ FI: Hi h Fluud H=l❑ H-2❑ H-3 ❑ H-�4❑ H-5❑
h Institutional 41 ❑ F2❑ f3❑ I•�!❑ hh MercanNle❑ R: Residential R-l❑ R-2❑ R-3❑ R-0❑
S: Storage S L❑ S2❑ U: Utility❑ Special Use O nnd plense describc beluw:
. Special Use: I
SECI'!ON 6:CONSTRUCCION'1'YPE(Check as a licable) - I
IA ❑ fll ❑ ❑A Q ❑6 ❑ IIL1 ❑ IfID ❑ IV ❑ VA ❑ VO �
. SECTION 7:SiTE INPORMATION(refer to 78U CbIR 111A for details on each item)
i S Trench Permit: Debris Removal:
Water Supp.y: [luod Zone Informa[ion: ewage DispasaL• �
Public❑ Check if uutside Fluad Zune❑ Indicate municipal❑
A trench will nut be Licensed Disvosal Site
reyuired�ur trench or specify:
Private❑ or indenlify Zune: nr un sitc syslem❑ v�rmit is enclosed 0 �
RailroaJ righ[•of-way: Iiazuds to Air Navigation: �I,�I I� � n C,�mn�� � n i ���•�.�i �.,.�•.<:
_.. .- --_ .,.... ...
Not Applicable❑ Is Stri�cture within airpurt appmach arcn? Is their review mmpleteJ?
or Cuuticnt to t3uild cnduscJ ❑ Ycs O ur No❑ Ycs❑ No ❑
; SECT[ON H:CO�TEN"T OF CERTIPICA'IE OF OCCUP,\NCY
[�litian uf Cu�lc: __Usc Group(s): Typc uf Cunstructinn: . Oecup�in[Lo,�d per Plnuc. .
❑nes Ihc builJiny,cunl�iin an tiprinklcrS}'+Icm?: .,_ Spccial Sliptdalionti: __,_
�Au..�,sr� g��
.
1�v-��I -�I I`f`� — c�-�.� "'�rz-EPa�; 6 r�c�c,
SECTION 9.� PROPERTY 04Wi ER AUTNORIZATION
N;ime�ind Address of Property Owner r
Eu►�M�c���ov��+ ro ,�E �rs -�-y ��Fw� �111� 4�9 0
Name(Print) No.nnd Street City/"Pown Zip
Roperty Ow�Jner Cuntact fn(ormation: �) . . r dCy� �y
lJ�l�l�/4'/` iiv"�' OQ�Lr..� _•_ �r ' �L�L I��9Yu URGU��.(�il
Tille Tclephone No.(business) "Cdcphone No. (ccll) e-m'� �JJress
(f�ipplicable,the property owner 6creby authorizes -
Nnme Street Address City/Town State Zip � �
to.�ct on the ro er owner's behalf, in all nmtters relative to work authorized b this buildin ennit a lication.
� SEC'CION 10:CON57RUCI'ION COMROL(Please fill out Appendix 2) � �
If builJin is Iess thnn 35,OW cu.ft.o(mclosed s ace and or not imder Construction Control�hen check here�d ski Sectimi 101
101 Re istered Pmfessionat Res onsible for Construcfion Control -
Name(Registrant) Telcphone Nu. e-mail address Regishation Number
Strcet Address City/Tuwn State Zip Discipline Expiratiun D.�te
10.2 General Contractor � � -
i �I��KS6n/ G �,U� �� C,B��QI��N i �y
� Cump�ny Name
/
' �JL ��4CKSo�✓ �-S�'t�5 ��7/ Ct1ivS7 �'u���tv'rso�
Name of Person Responsible fur Cunstructiun License Nu and'CyPe if APplic�ble
7 ����v � � �iD nc.r T��✓ �'-��9
Strcet Address � �ty/Town , State Zi�
-- �'Z-�'r� C�3 � --- .
Tcic hone No. business Tcle Iwne No. cell e-mnil addmss �
SECTIONll:l!'OItFEi:SCOAIPENSAI'IONWtiUH:\NCfS:1PPl1?;\Vfl' M.C.L.c.152. 25C6
A Workers'Compensation fnsurence Affidavit from the MA Deparhnent of Industri:il Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial uf the issuance of the building permi[.
Is a si ned Affidavit submitted wi[h this a IicaHon? Yes 0 No ❑
SECI'ION 32 CONSTRUCTION COSTS�W D PERMIT FEE�
��`i EstLnated Costs:(Labor .
� and Materinls) 'iutal Cunstruc[iun Cust(frum Item 6)_$ �Bf�s�
l. �uilding � 6uilJing Permi[Fee=Total Cunstruction Cust x ([nsert licre
2. Electrical 5 appropriate municipal factor =5 ��.
3. Plumbin 5
K Nute:blinimwn fee=5��/'L contact ntunici ilit
d. ��Icchanical (hIVAC) 5 P' Y)
� 5. blechanital Other . `� Lndose check p.ryable tu
6.Total Cust � Z� (contact municipality)and write check number here
SECTION 3:SIGYATURE OF 6UILDING PER1b11T APPLICANT
6y entering nry name below, f hereby attest unilcr the pains and pen�dties of perjury that all of the informntion containCd in tltis
' application is true and accurate m the bes[of my knowledge nnd understanding.
Plea+e priut and sign name TiNe Tclephune�lu. Date
Slrcet Addmss Cily/Town �State Zip
i�lunicipal Inspector to fill out this section upon application approval: _ 'i9"'"" ��ti ��
Name Datc
E_
a
Q-I-Y OF S,i:U-EM l�'WSACHUSETTS
BL'ILOwl; DEPIRTIE.\T
120 1X mNiaNGTON STREET, 3"'FLOOR
TFL (978) 745-9595
Rix (978) 740.-9846
KIStBERLF-Y DRISCOLL TNobw ST•PIERIts
` :MAYOR
DIRECTOR OF PUBLIC PROPERTY/BI:ILDIVG COSLtit(SS(OhiER
Workers' Colnpensation insurance Affidavit: Builders/Contractors/Eiectricians/Plumber9
Name l
City/State/Zip: Phone
Arc un employer'.' Check the appropriate box:
'Type of project (required):
1. I am a employer with
4. ❑ I am s general contractor and I
6. ❑New construction
etttployees (full antUor pan -time).•
2. ❑ 1 vn a sole proprictar or ptutnor-
have hired the subcontractors
listed on the attached sheet 1
�• ❑Remodeling
,hip and have no employees
These sub -contractors have8.
❑ Demolition
working for me in any capacity.
workers' comp. insurance.
19 ❑ Building addition
I No workers comp. insurance
5. ❑ We are a corporation and its
10.0 Electrical repairs or additions
resulted)
officers have exercised their
3. ❑ I am a homeowner doing all work
right of exemption per MGL
I I .❑ Plumbing repairs or additions
myself. (No workers' comp.
c. 152, § 1(4), and we have no
12.❑ Roof repairs
insurance required.) t
employees. (No workers'
13.0 Olhcr
.
comp. insumncereuuired.)
•Any applicant tlur chcrokr box II must also all out 1114 Section kdawshowina their workeni mmpimeni n pu,iq iniurmation.
' I lomeuwncv who submil this aln<Mvit indicating they am doing all work and then him outside contractors mint mhmil a new amdavil indiutina such.
mrwmn shut chssk this box mat attached an additional Acel showing she name of sub•avmratun and their wnnken'romp. pulley information.
l unr un employer that is provfdJnx tvorkert' coniparralon irtsurutace for my employees lielav is the pol/ry and job site
infurnmtion. p.� 7- �, / /�.
Insurance Conipany.Name:�Dt),Z E/�-1-__-TitlSUAI,t c -E /tr-,L
Policy it or Sclf-itis. Lic. d: __.._ Expiration
Job Site Adtkcss: City/State/Zip:
,\ttacb a copy of the worimis' compensutloo pulley declaratloa page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 2SA ol',L(GL c. 152 can lead to the imposition of criminal penalties of a
line tip to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of n STOP WORK ORDER and aline
of up to 5230.00 a day against the violator. Ile advised that a copy of this statement may be furwarded to the Of,ic° of
Investigations ofthe DIA for insurance coverage verification.
l du hereby certify under /it puhts and penohles of perjury lout the h furatulions provided ubuve is true and correct
Of ictal use only. Ou not write in thio area, to be cuunplet,,J by city ur fawn njjivioL
City at l'uva: Permldl.lcenseN__,._.___
Issuing Aulhurily (circle one):
I. Huard of llealth 2. Building Departuteut .i. ciiylfnnn Clerk 1. Electrical Inspector 5. Plumbing Inspector
b. Other ...-- -.....
Contact Person:._-----__--_- .--_-,-- Phone:r: _...
1
Salem
Redevelopment
Authority
Salem Redevelopment Authority Proposal
November 12, 2014
10 Derby Square, 0' Floor (Gregg Martin c/o Mazow I McCullough Attorneys at
Law): Discussion and vote on proposed replacement of windows
Decision
At its meeting on November 12, 2014, the SRA voted 5-0 to approve a Octobi
22, 2014 DRB recommendation to approve the replacement of windows at 10
Derby Square, 4`h Floor.
DRB Recommendation:
At its meeting on October 22, 2014, the Design Review Board voted unanimously to
recommend approval of the proposed replacement of windows on the fourth floor of
10 Derby Square, conditional upon all the dimension of the new windows' stiles and
rails be within a''/d' tolerance of the existing windows' dimensions.
Staff Comment:
The applicant field verified the dimensions of the existing windows, as well as
provided dimensions for the new windows. He noted the following:
Stiles and top rail: Old 2-1 4" - New 2-1/2"
Center rail: Old 1-9/16" - New 1-3/4"
Bottom rail: Old 2-3/4" - New 3"
Muntins: Old 1" - New 7/8"
Therefore, his proposed dimensions meet all tolerances.
Proposal for October 22 DRB Meeting
Within the enclosed documents, the applicant provides a coverletter detailing the
proposed process to replace 19 double -hung windows on the fourth floor of 10 Derby
Square. The applicant's representative notes that paint grade mahogany (sapele)
windows will be used to replace the existing pine windows, and will be painted the
same colors (shop -matched) as the existing windows. Further details are provided in
the coverletter.
Salem
Redevelopment
Authority
Also provided in this packet are photos detailing existing conditions, and drawings of
the proposed windows to be installed.
Staff Comment
The applicant's representative has noted that he will bring a sample of the window
that he intends to use for this proposed project.
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�� PUBLIC PROPERTY '
DEPAR'T�IE►�iT .} '�/-�
�;,..a�sr o.�ruu. C/�/�
V.�raa '� !" �
130 Wws�u�cm S17FhT���l,y,�,�aasti'rn 01970
Tfi 97L71i9S9S�Fs7e 97L7�9�
APPLICATION FOR TBE REpAIR. RENOVATION CONSTRUCTION��
DEMOLITION. OR CAANG� OF USE OR OCCUPAx[�y FOR ANY EXI3TING
STRUCTURE OR BiJILDIN
. 1.0 SITE INFORMATION � " � -
�acana, Namr �++� 3s= �
_ _._ . . Propertynddresc-- c��j�••s.� ; �vta�� ._
� L? 1�.� �Qv�'� �✓ _.
Prap�r�Y���8:�o�servatlon Are�YM Hbta�ic Dbbict YM
4.0 OWNERSHIP INFORMATION �
7.1 Own�r af Land '
Nams: �t n L y. „ o� ,�
Addrear. .� �"� 5 �J 1���5 S,�- y^c��' �y
� ' � � ' -1 �<�Ibv('
Telephonr
3.0 COMPLETE THI9 SECTION FOR WORK IN EXlS71�IL3 BUILDINGS ONLY
Additian ExiaGng L�
RenovaUon � Number of Stories Renovated
Change in Uss N�
Oemolitlon Existing
2�7� �
Approximate year o( Area per floor(s� Renovated Z"70C� �
construction or renovation
of existing buitding Ne��m
B6et Description af Proposed Work:
�'e c� � ���- Po-���
��I�, ��w ��-�t `� o�-.s
, s - - -
-- - ----Mail Pertnit to: _ �p�/ /7 — 7/ % � � 35 --- -
�w°�� CITY OF SALEM
�I��,;,i PUBLIC PROPRERTY
��;'"� DEPARTti1ENT
��_�
� :;�u:�x�.tv!��rcn��,i1. ,
\l:,l�<",K I2G IX�.�il ll�(�i JN$TREET ��.{LF\1. �i.\tii.1Ci/LiL I'l5 Ol`)/: �'
'CF�:v7&7�i-9i95 �F.+x:178�7+G98+6
Construction Debris Disposal Aftidavit ',
(reyuired for all demulition:wd renovstion work)
In accord:uicc wi[h the sixth edidon of the State Building Code, 7S0 CMR section i t 1.5
I Debris, and the provisions ofMGL c 40, S 54;
[3uilding Permit # _ ___._ is issued with the conditiun that the debris resulting&om
this work shali be disposed of in a properly liceiued waste disposal facility as defined by MGL c �
111,S 1SOA.
1'ha debris will bc transported by:
— - a� S � C�l��
(name uf hauler)
l'he dcbris will be disposed uf in :
.. ✓��
_ ��r�., S� _. _ CIA` ���
(nume uf tacility)
___�i„� S c-0�-}- �_ S� � � �'r'.��
i�dd •ss of Ftcil�tY) .
-- �.i,�:atw�e�>f p.:nt��ic app;ic:tnt
- ���� �d `7 ---
,.���
_ �:._....,.�
�
. � •..
,,,
Cri'Y OF SALEM
PUBLIC PROPRERTY
DEPARTMENT
�..�,r o.�«,.
��
uo w.►gmw-ror,snasr.sue,r,�o�,.arn oisro
'ib1:97l.7�Sss9S �Fex:s7tJ�69W
Worl�ers' Compea�ados Insnranc�At'Adavik gyp�ContrutoyEt
A�n�nt Informatio� p� ..v.�...r.an.ti.
xame� r_ �'1'19 v h1 (',v�ST /' d � �
A�[GSi: v � r
c,�yismwz;p: S r�,w �7�� �3�I � -3 I3 3�
M yo�u�vplsy�rT CLek tb aYProPrlab!on
1�I am�mqioyer rit6 4. Q I�m�ieoeeal oomacooe md I ���Ol���'
2.0 I�sob�lWt aod/ar p�R-Nme�� luw himd tlr� � ❑Ne�v cm�trnatae
Propriaoor a pumn� ILoed oe ths aquhed�heet= 7. ❑�deNni
ship�cd h�w ao amptoyQa Tha�wb.o�uaetas haw 8. ❑Demolitlm
wotlrin� far mt ia my eaaeity. woekan'eomp idaaaoo�.
INo w�a�eken'eom0.ion�nna 3. � We an�eapontloe�ad i0r 9. �����im
K4�� oakaes haw a�ereLed theEt 10.�Eixp�cal eapai�s a�ddidoer
3.� 1 am a homeownar doin��Il aoAt �iht otmcampdm Per M(3L 11.Q ptumbinf repaitt ar+d�
mysali[No w�kR.�comp, a u�4u+�.m aw h.v.m l:.p Roorrep.ie, .
��uued�f emP�cYeaa LNIo worfomr' 13.Q Other
' �R�oo��e�ed,�
��Y�ur e6eb bez�1 moM�Iw!m ar�M�«dal�br�hedy�1i�
HO�O�OO MIO N6dt I�Y�YY��M d0��I�Olk�I��q�p�m01t�Y�0/��
=emu.oeos�er e6.d��61.e�mi.re�ee.e...amdmd.eut�m.ee.o/m.�ue.ea.u.aem.ia�.orY�.•,�, � ,
/aw aw�wOfoy�s NimisOrovlCGj worb»'cowpnwafo�Gu�rowc�Ioi nq'�"'P�Y�a Bdmr 4 ab
lejo.wa/ora Polh aulJai�Ar
lneuranee Comp�ny Nune: ' ��'
po�iey M os selt-v,..Go.N:__l� C l'►' y!6'!S 7 S-$ �r�nue:_ �,�(�/ og
Job Site Addrea;����, _ �
—�� Ciry/SawZip: S � M �- Ol 9�6
AttuY s eopr of t6�worten'eompewtlo� otley deelaratlo�pap(j� ty�
Fsihue w xeure eoven�ar �� �°i Po�P eumMr�nd�:plratlo�daN}
fine up to S 1,500.00 aad/or a�� �Oo 23A ot MGL a 132 an lad to tht impoapo�of�����of�
Y unpriwnmen�a�weli u civil peeultiy in d�e[am of a STOP WORIC ORDER�od a Aa�
ot up w S2S0.00 s daY a�ainK�vio4ta. &advixd rhu�co of�6i�mmment ma
InvestiQadow o[�he DIA ta inwreocq ceven�vai uion, � Y�forwarded to the ORlee o[
/do/unb�e� nn dY� on rfrry t1�af th�ln
/arn�ado�Provldil abow b�rt an/co�td
_ �� `�
PhoneN� �f� � � � `�--- � I ��' /
0,(Jlclaf uu onl�t De aW wrtfi G�th4 are�to bi casPfitd bp�uP alow�o/JfelaL
Clty or Tows: Permlf/Ueee�M
1»ulof Authorlty(etreb one):
1. Bo�rd of He�lt� 2.BuUdln�Department 3.C(ryRow�qerk �t. BkctriW In�peetor S. ptumDln`Impeetor
6.Other
Contaet penoa: P�ooe M•
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OFFICE OFFICE/ WORK AREA
CONFERENCE
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NOTE: MODIFY EXISTING DUCTWORK, ; ' '
SPRINKLE'RS, LIGHTING AND SWITCHING NEW WVOOD/GLASS SfI� I
• PARTITfION AND DOORS !
AS REQUir2ED FOR NEW PARTITONS. � �
. . . ( T___________ ________ -_-_n R_____�!____ ___ „
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. . ., ___________�___ ______�_________ il ,µ-----'�---- _ .
+ a � u
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5 � REMOVE EXISTIt�6, �� i
WOOD/GLASS PARl1TtON
. WORK AREA �'�' OFFICE SERVER ROOM
; C(�NFERENCE
, et ;
� 5 EXISTINlG WOOD/GLASS
� � PARTITfION TO REMAIN
,
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��
LEGEND 7. V��. . r,, NEW 2ND FLOOR PILAN
-'------"""' PARTITION BE REMOVED
-------------- EXISTING WOOD/GLASS ���
EXISTING PARTITION TO REMAIN PARTITION TO BE REMOVED ��� 0 1 2 3 4 5 6 7 8 9 10 FT ��•F;ioVED � �� �
, ■.� � � � �
;,; s,:�;��t ta �:,.__.��i �,•�_���:-r
� NEW GLAZED P�IRTITION TO UNDERSIDE NEW WOOD/GLASS ��� °L�`�, '�"a'
OF DECK ABOVE:TO MATCH EXISTIN6 PARTITION TO MATCH ��� Z C�T� ��
� �'--J
� -
� EXISTING ��� +i F..�', _� y -----
EXISTING DOOR TO REMAIN PORTION OF EXSITING LOW ' � F E— _
PARTITION TO BE REMOVED ��? � REVISED LAYOUT FOR THE OFFICES OF: , r Fr= ' � =� ' ,' I
AS REQUIRED. �1i M tF. , c `��..::'i-��i T ��-._�o;,:�., r.c� � -�_
;;; � ATLANTIC TELE—NETWORK;, INC. �\_ hi� if, yl
F
"' 10 DERBY SQUARE SALEM MA Q�o��s yO qc'�
NEW WOOD/GLASS DOOR TO t, o m
MATCH EXISTWG �'� ;;; ° No.a,ao � y
- SECTION �'� DOUGLAS HOPPER ARCHITECT �; SALEM
� �
I 'I �i! 28A FEDERAL STREET SALEM MA ��%g� MA ' r� _
2ND FLOOR � `� �;; DATE: REVSIED 2/21/07 " �� �� � ` l�'1r�^Vl ��
� � S�v�Yu� X
.._......__...._.
�
�
NOTE: MODIFY EXIST�ING DUCTWORK, ;
SPRINKLERS, LIGHTI��G AND SWITCHING R�MovE KicHEN
: � AS REQUIRED FOR NE'W PARTITONS. Cd6 NETSES AND �----- r� ��r�
� �
. • � ' �� �.,,� J��e.�A-I N
S. PARRISH D. MINSTER � A. FIENBERG ; ,
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NEW DOOR
� NEW GLAZED ---- s ,,.�o�r� pZfLt'�''`
WITH GLASS, —
i ❑ OPENING, TYP. TYP. �Lf: Oex �
+ � V� ,j,� � , v�,��e� c�jo°n GG
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EXISTING fOPEN OFFICE � � ' '
SYSTEM- �MODIFY AS SHOWN
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------ ' ;�' M. PRIOR i;'
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NEW 3RD FLOOR PLAN
�—E�7EN� 3'-0" 3'-0" 0 1 2 3 4 5 6 7 8 9 10 FT
______________ PARTITION TO BE REMOVED '�—''`'I`�` " � � � �' � Z
� !.
EXISTING PARTITION TO REMAIN k
� �� NEW PARTITION TO UNDERSIDE OF DECK ABOVE. +i
3 5/8" METAL STUDS @ 16" OC. WITH SOUND o o �
INSULATION & 5/8" GWB EA. SIDE. d-
. � REVISED LAYOUT FOR THE OFFICES OF: �Eaeo n,s
Cy�
�x�s-r�Nc �ooR To REMaw ATLANTIC TELE-NETW(�RK, INC. QOG�s M°°�„� ,�
10 DERBY SQUARE SALEM MA � Na.a,�o
LEM � `
3R° F� o ` DOUGLAS HOPPER ARCHITEC�T �' �'A �
,:.
NEW WOOD/GLASS DOOR TO MATCH EXISTING ELEVATION OF TYPIC�AL SECTION 28A FEDERAL STREET SALEM MA y a
DOOR 8t SIDELIGHT DATE: REVISED 2/21/07
_ _— — - --- ---_ __ _ __ ----
35---
Commonwealth
3=Commonwealth of Massachusetts
Sheet Metal Permit
Date: O/2 Permit#
Estimated Job Cost: $_ '33 F)o Permit Fee: $ ,�'-O , &a
Plans Submitted: YESNO Plans Reviewed: YES_ NO_
Business License # J Applicant License# 2 (D�)S
Business Information: II Property Owner/Job Location Information:
Name: Mom N �12 r' �ti . Name: 44t%la6 1& 2;
Street: CCr " Street: 14 (P<'. 3
City/Town: L S S eky� City/Town: Jy Ze
Telephone: �7� -)61 y61 ' Telephone: 974-T2yy- 6F6o
Photo I.D. required/Copy of Photo I.D. attached: YES /V\ NO
Staff Initial
J-1M-I- nrestricted license
J-2 /M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less
Residential: 1-2 family Multi-family_ Condo/Townhouses Other_
Commercial: Office 7< Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. k over 10,000 sq. ft. _ Number of Stories:
Sheet metal work to be completed: New Work: Renovation: on Ir
HVAC Metal Watershed Roofing_ Kitchen Exhaust System_
Metal Chimney/Vents_ Air Balancing
Provide detailed description of work to be done:
2PPlcc ¢ 7//L. - bn y6o �- k.p /�I/AC u�i`�L erclC�'
/4FJ�11�QmP.r'l': l�v�� yibrad�o � i ! oA1A
INSURANCE COVERAGE:
I have a current liabilinsurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes IAi No❑
If you have checked Yes,indicate the type of coverage by checking the appropriate box below:
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owners Agent
By checking this box ,I hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and
accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be
in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Duct inspection required prior to insulation installation: YES NO
Progress Inspections
Date Comments
Final Inspection
Date Comments
Type of License:
By 1( Master
Title ' ` ��
El Master-Restricted
wn
Permit#it#
/J ❑iourneyperson Signature of Licensee
Per
Wuperso ricted 2(" 3 S
Fee$ License Number:
Check at www.mass.gov/dpi
Inspector Signature of Permit Approval
L !+i
The Commonwealth of Massachusetts
0.
Department of Public Safety
Massachusetts SEno Building Gude(7811 CMR)
'° Building Permit Application for any Building other than a One-or Two-Family Dwelling
(ThLs Section For Official Use Only)
Building Permit Number: Date Applied: _ Building Official: _
SECTION l:LOCATION(Please indicate Block k and Lot p for locations for which a street address is not available)
No.and Street City/Town Zip Code Mime of Building(if applicable)
SECTION 2:PROPOSED WORK
Edition of AIA State Curie used If New Construction check here❑or check all that apply in the two rotes below
li\kting Building❑ Repair❑ . Alteration Q--- AJJitiun❑ Dumulition ❑ (Please fill but and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/ur amslnlctiuu documents being supplied as part of this permit application? Yes ❑ No ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑
Brief Description of Proposed Work:_
p X13L 4--tac�r
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 3-t) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Flours/Stories(include basement levels)&Area Per Fluor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION S:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-i❑ 1 B: Business C3"- E: Educational ❑
F: Facto F-I ❑ F2❑ H: High Flazard H-1 ❑ H-2❑ FI-3 ❑ H-4❑ H-i❑
1: Institutional 1-1 ❑ 1-2❑ 1-3❑ 14❑ M: Mercantile❑ 7 R: Residential R-10 R-2❑ R-3❑ R4 ❑
S: Storage 5-1 ❑ S2❑ U: Utility❑ Special Use❑and please describe below:
Special Use
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
I,% E3 IB ❑ 11A0 IIB ❑ IIIA E3 IIIB ❑ IV ❑ VA 13 V13
SECTION 7:SITE INFORMATION(refer to 780 CNIR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: 'rrench Permit Debris Renmv at:
Public :1 trinih trill not be Licensed Disposal Site
@� Cheek if outside hood 7_une Indicate municipal
required❑or trench orsp ok
Priv.hlc❑ or indenlily Zone:_ unm site system ❑
e . permit Is enclosed Cl RGA _
Railroad right-of-way: llazirds to Air Navigation: hl t I Ir.i��.�� , , ..: s,
"'. :: .�, ,. I' ..,
Not Applicable❑ Is Struchne within airport approach,urea? Is their rry i,-%, completed'
or COnsent to Huild CnclOsed CI1 cs C1 or No❑ Yes❑ No ❑
SECTION 8:CON'TE'NT OF CE.RTIIICA I'E OF OCCUPANCY
F, itiun of Code: L'se Gnnlp(S): I\'pe of Construction: _. _ Occulmnt Load per I9uu r: .... .
Does the huilding c.m Ltin an Sprinkler System.': __._.-._-_tipec i,d Stipulations:
t
SECTION 9: PROPI(R'IY OWNER AU IT IORIZA-PION
Name and Address ut Pro rorty O%%ner
d.swx 1u < tot
Name riot) No.•nd Street City/Town 'Lip
Property Owner Contact Information:"Tille Telephone No. (business) Telephone No. (cell) e-mailaddress
If applicable, the properq,owner hereby authorizes /
11—.4 UNI• �u� S O LAV � � 52
Name Street Address City/" own State "Zip
to act on the pro ort owner's behalf, in all matters relative to work authorized bV this building iermit a p lication.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If building is less axon 33,oW cu.ft.of enclosed space and/or not under Construction Control then check here O and skip Section 111.1
10.1 Registered Professional Responsible for Construction Control
Name(licgi' rent 12 hone No. e-mail adds Registration Number
o.v�.. _4
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
L-sz,( r Vl\ 4n
Company Name
Name of Person Re.ponsible fo Construction License No. and Type if Applicable
-zal
Street Address t City/`Town Stat Zip
�01- M Cr-?o
Telephone No. business Telephone No. cell a-mail ada ress
SECTION 11: c(Wil i_NIA_I10\ hMAJIN UNCIAptli aw11, M.G.L.c.152.0 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,13--l�lo ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$_
I. Building $ Isla Building Permit Fee,-Total Construction Cost x (Insert here
_'. Electrical $ appropriate municipal factor)-S
3. Plumbing S
J. Mechanical (HVAC) S Note: %linfmmilt fee=3 (contact i annicl alit)')
i. Mechanical Other S Enclose check payable to _
t;.Total Cost (contact municipality)and write check number her
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
-
Bv entering illy mane below, I hereby attest under the pains and penalties of perjury that all of the information Contained in ill
application is true and accurate to the best of 1111' knowledge and understanding.
Please print and siy;n name ' ------
l-itle Talep hone o .ate
-- O- - -511 ------ -- -- -- ---- ! _ o. _D
tilnrt .-\ddres' C' yj Tolvn State Zi
Municipal inspector to fill out this section upon application approval:
Nano Date
CITY OF SALEM[
PUBLIC P
ROPRERTY
DEPARTMENT
.r.u:. ��r r:rala,•r r
\I ill yl
L: \trA HIrA1a U,�i1aCL•1' • inllW, M.t»di.i It QI rail Y7,^,
-i-�.-I'r.r. v7i:li'ii'rSeP�x v7M.NC•'rxM
itYurkers' Cumpenaatlon Insurunce"I it"';" Builders/CuntracturyElactrlclynyPlumben
't t )Meant Infirrmrflon
PI •4� P )nt le 'hl
�I:IIT1e I Iluu,wyr)raanvuinlvindrvuluall; i-•�� �
ill
City,.Slam Zip � t �\r� /[� d��jG � i'hone 0: >e ST3-6(336
' .\re)nu an vmployer7 Cheek the appruprlete box;
I
I I.❑ I;un a umpluyer Wilk 4, a;uncrol cnuUaetor and I 1 ype of prnJect(mlasired):
�•C3u11tpluyecs(lull Jnd/ur pint-time).y huve hired the.vuh•cumiractun 6. ❑NOW cultxlruchun
1.tm a tale prnprienir or pannut• listed on tha anachcd sheat. : y emodtlins
ship and have no ampluycw These sub contractors have
tviukins Air me in any capacity, workers'comp, mpuence. C] Demolirian
I No workers'comp. insurance J. ❑ We are a corparttinn and its 9. ❑Building addition
required.) mr kers have eWriisvd their 10.[]Electrical repairs or additions
1 ;1111 a homauirner Joins ill work INO work143111 afeaeniptioo par MOL
I LQ Plumbins npuirs Of additiadditionalself. workers'cutup. C. 132.¢!(4),and we have no
insurance required.) t cmPluyees. [No workers' 12.[]Ruul'relwira
cnmp. insurancenquind.J 13.1:3 Other•,;rpLcaaf tl,W"hch Oya ill map:Jw rill uw r
'Irwrnuuw M.y"llun t+low aww•ug nwir.wwlus"alnr,labl{yn Put roliurrliura
nM web.Wnbl glia affidavit inal"iline rMy iir doing WI work in41h4m AIN yWi14e Claelntbly mull.whnil a naw ilnaaril Inaliyine wpb•
't'•Mlrlilrrn IIIA 4r1"i'd this I>oa TIW Jlli"Ilae.rn iaalllwlyl.114wt�,Iwllla ray nanM Ot(N IYfAeNerattara ane IMe wYArlr'{pop.plllcy Intbrrnanrra
/urn an eiuployrr that/r prurid/nx lrorArra'ruinpenrnllon hirarnnre for my rtnp/uyrrq Br/ury/s rhe pu/1iy and/ul.rih
in�urvnu/uirL
Inwrauw Company Vmnr._�__
I'oliey 4 Of Suir•Ins. Lic.is: _ _ --
Expiration Date:
lob Sita�\ddnsv: �'
Clly'slate/Zip:
Attach it copy of the irorkars' eumpematl11n pnllcy deeluraHun puge Ishowlns the policy number and etplratlua date).
I-adura w,ecura cwerJ3e as required under Scctiun 23d% ul'.NIGL c. 152 eau lead to me imposition or'eriroinal penalrieaofa
find up(.).it500.01)n 't'JA nJ/ui uoahe Vi unprisunmunt, Ja well 4.y civil pcnuhius in the conn Ora STOP%YORK ORDER and a rent
o/up ra i?SO.IM a Jay.r1iainet the vialantr Ile advi.ic•d that a copy of this statcmunl may be Iumirded to the 011ica ul'
lit\'�,�II�Jllrnb JI:IW UI,\ for ut.uru'ca arvcrJ3e terilicJUun.
/r/u/r,•rvhy i.114/3 arse/er rhe p,iinr rind prnn/f/et usfprr/trry shill r/u ili urrirul/on
l yrvrrJed ubuw it rear end eorrvrR
Ir1 j/&iu!sur ori/y, /)d irnl,vrirr in Nii.r arra, to Ar rueiplesed by airy of sownt a/111 iuL
(71v or fnwn: _
Ivvuing.lulhurity (circle nnu); Pcnnit/Licence t
I.
G. t1-ilvir 1 •rf 11"41111 1. Iluddiri" Ucp.0 tara•111 1 l:it 'f ' Lk a. ectricalnIterNr i,
f lumping Iniycclor
t'•rn 4c1 I'i non: _�_
I
Information and Instructions
I
is JrlineJ as"...ervi
very pec.+an m rhe sece of another un.ler any:unmet of hire,
�l,la;acltusctts lienaral laws chapter it le4wrcs all eanployep to provide wurkers' cmnpensatlon it)( heir culplayees.
1`uhulult to tins>141ulc, an ra,OJul'e1
,,press or implied. Jral or written." two or more
�a c,nplupar +JetincJ>a"an individual, partndmilip,assoeiauoo, :orpor3siun ur other legal entity,or my
em to to ,.m loyees. However the
t he i:,requulg nngagcd in a joint enterprise, and including he legal retiresmuatives of"I decease)employer,ur the
, fthe
ecelver Jr uuatee u1 .an IIIdIVIJual' p umenhlp,assoeuatios o other legal entity, D Y a D
to r+ons to Jo Inaintenunca,construction or repair work on such dwelling haute
Jwner :r a dwelling house having not mora than hree apartments and who resides therein,or he occupant e
,Isvcllang laouie,sf another whu amp Y• pa
or on the grounds Jr building appurtenant hereto shall not because of wch employment be JeemaJ to be an employer.
ance
�IGL chapar 152, �_SC(6) also states that"every state or local licensing agesey shag withholawdalth ld the Ise a ranor
he i:OM04
Ileacs with the Insurance coverage req
renewal of s license or pornfallaced
d operate a business or to ce mpusluet buildings Is tof c pc tic I subdivisions shall
Ipplkant who has not prod 5v
Acceptable(71 /--Neiitiher the commonwealth nor any
WJitiunully, -,IGL ehupter l5_, 5-
enter into any contract fof he perfomwnCd ul Picd t he contracting g aut�horityviJanca of outpli uaca w ith the insurance
rcquiramols of this chuptar have been P'
Applicants die boxes that upp1Y to your situation and,if
address(ns)and phone numb@f(s)aing with their cattincate(s)of
Plc:lsa illi out the workers' compensation alydavit completely,by checking with no employuas other than the
neccssury,supply sub-eontractar(s)namels),
insurance: Limited Liability Companies(LLC)or Limited Liability ParinerehiPe(LLP)
insurance or united are not required to carry workers' compensation imuronce. If as LLC or LLP door have
employeas.a policy is required. 8e advised that this affidavit In.y be submitted dto the Department of Industrial
permit o l011 0 is being requested, sof the L) Penmen of
Aecidenu for confirmation of iruurarteo coverage. Also be see to rlgp and Jule the ufpdsvlt. Tu slliulavit shoo
. e runlmed to the city or town that the upplieaton for he pa
he I.cttrial Accidents. Sr tow you have any quest
regarding the luw ur if you ora required to obtain u workers'
omptrialfifion policy,please call the Da nil qu s st the number listed below. Self-insured companies should enter their
xclf•inSurance license number on the appropriate lino.
(-try or Tows OMelsls
provided a space thea li bottom
pleallL
as affidavit crthat
ilia ilia ffid l nuesin the ev rs the Office Complete ;Ind primcd lof is estig�ony. The has to contact uyou regarding h the twm
I'I:ase be sura to till in'he ps;rmidlicmase nwubs:r which will be used as a fCPCfCrICC IlUlllber. In addition,
in is applicant
that must submit multiple pennitllicnse applications in any given year,nand only submit one
ait;atiu s ri ided (QiIY ret
the
policy information Iif necessary) and under"Job Site Addresss"l or marthe pkedliclbyi I>•uc til oretowo may be
provided
o (city ur
town)."A cJPY of the uffidavit That has bean officially sump'
applicant as proof that a valid affidavit is on file for future pmmits or Licenses. A now 4111davit must be hivetilled nut each
ennit not related to any business ur comltaarcial venture
ersutt is NOT required to complete this afrtdavit.
y e:lr. 1,','here o hu/na owner Jr citizen is obtaining a Itcensa or
I i.,., ,, Jug licen.4e Jr permit to burn leaves cte.)Mid P
I h: ,)ilia ui Inve tigatiunx wuuld like to thank you in advance for your cooperation anJ should you have any 41,101101's,
please Ju nut llcsitata to give us scall
rhe U:p:unrien" add"' telephone aThe Cornmonweaith of Massaehuse"
Department of Industrial Accidents
OMCS of tavadQadons
Epp Washington Street
Boston, MA 02111
f ei, p 617.127-1900 ext 406 or 1.877-MASSAFE
Fax M 617-727.7749
j ;.1f, www.mau.gov/dia
PN TAU.' NIEREO- Ply '1 ENTERED �C
ON wry. ELO.
VI
PANEL 8 ARF. PANEL E"A.F.F. -
0
U
ON cl -'EW (l WALL
-ADD LAYER OF
HKIMM E TO OW. AREA
ME OF WAIT.
( MATCH NEW WALL
M)
TD
P4MlELS 6ENTEREO
' ON WAW B.0.
tp PANEL S"A.F.F.
r
AMON wWft
® a o
-NEW 4'METAL SIUD WALL.
-PARTIAL NDlCIT(MATCH E IST'Oj
PAUE
AINTED NOMAWIE PANEL PLAL WIN AND NEDGHT,
02 WO BASF CLEAR COAT,
1111 WD TOP AND BOE IDEA CLEAR COAT,
X -HER 4"METAL STM WALL�JlrmT
PAR tTIAL IGHTR� E VC)L ((2) 4N8 ENTERETI!
4- -PAINTED NOMASOTE PANEL FULL WIN AND NEIDNT � PANEON ".CENIO.
�j
ON ROOM BOE @AW NO NOMASOTE ON ELEVATOR SIDE. PANEL B" A.F.F.
VAT BASE CLEAR COAT.
= INS W TOP AND SIDE TRIM CLEAR COAT.
i
Vk4
. 1 y.-
FS i1:
Li
PIANELS CENTERED (1) 4)B IIgIA�IE O®
ON WALL; B.a PANELS CENTERED OO
PANEL 8' A.F.F. ON WALL: MO.
4
PANEL 8"A.F.F.
a
N
U
Q O -'1USr0. WALL N
_ - ADD LAYER OF
ROMASOTE TO CONF. AREA
SIDE OF WALL.
- WD TRIM AND PAINT TO
MATCH NEW WALL
(4)4X8 HOMASOTE
PANELS CENTERED
ON WALL: 8.0,
Nto PANEL 8"A.F.F.N
.r
ALIGN w/E>OSYa
-103 Cl Q
- NEW 4'METAL SND WAIL
- PARTIAL HEIGHT(MATCH Emsrq
- 1/$"OWB EITHER SIDE.
- PAINTED HOMAS07E PANEL FILL WIDTH AND HEIGHT,
- 1)(1 WD BASE CLEAR COAT.
Jhm - 1X8 TO TOP AND SIDE TRW CLEAR COAT.
•Y - NEW 4"METAL SND WALL
I - 1/2VISIGHT PARSIDE EXSrO} 7) 4X8 HOMASOTE
Q" -.PAINTED HOMASOTE PANEL FULL NID1H AND HpCNT "� PANELS CENTERED
ON WALL4 B.O.
Jp ON ROOM SIDE ONLY: NO HOMASOTE ON ELEVATOR SIDE PANEL 8"A.F.F.
1X1 WO BASE CLEAR COAT.
- IXB WD TOP AND SIOE TRIM CLEAR COAT.
SCT
ASOMA
1
rr 1
���� � fL�1g1N16T�EfiLfi�IND AiPPROVEO f3Y ZNE
JdSPISM PGM MD A PROW AFMG GRANTED
CITY OF SALEM
blWlo� OYId4?� Ynw N'o ��i lacatim �f /0 /�Cr
Is Peoprq Loomed in
i wo Cmwnamon Awm9 Yo4_No_
BUILDING PE AIT APPLICATION FOR:
Permd t0:
Pole WWww apply) Roof. Retool. Irat" Skfh&, CondW Dak, Shod. Pool.
RepaigRepktaa. Ottwr: G� li�t__-- --
PLBASE RLL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS W PROCESSING
TO THE WSPECTOR OF BUILDINGS:
The urtdetaiprwd tw W applies for a permit to build accordN to Ow fokmvg
Owrwt's?done Nock N a I
Addrass A Photo 1t '� �-Y�ti Sg),. (9)n Y S- >/7/
Aft"s& Photo
Medwnics Nano -Lod a J M. )l os gw ll
Addrass A Phorw -190-900 k, St (>a A .f13-663 O
Lt vt j , at yoi
l �� w"M b pupoma a widYI�?
/ trmlmsd a T ��c k /.0 oo r a ar.rrp.for tow army wimm a7
vm tmrYdYq awoim b Imw9 T X10
Esimm sd ams _qtr ummro s N P4 atw uonw• 0 -321 "
Boas laptasommst
Lis. f /c7>Y'3
tjig TILE PENALTY
OR PERJURY
DESCRIPTION OF WORK TO BE DONE
u,� A'�,✓s�Tl� � S l S�^�c.>n e.� (MCS�-,r s�c�t �'i_
IN S W X I Inst
MAIL POW TO.=
No. OL�f-' .
APPLICATION FOR
PEMW TO
LOCATION
PERMIT GRANTED
N—S-PECTOR OF BUILDINGS
LL
\�
5 :.,,�. 1�5� � ! �� 1 O ��v �
�k � � I` ( Commonwealth of Massachusetts '
`' � Sheet Metal Permit
Date : /3 _ Permit#
Estimated Jab Cost: Pernrit Fee: $ S� � o0
Plans Submitted: YES NO ✓ Plans Reviewed: YES NO
Business License# �O S9 Applicant License#_ �.��''�'
Business Information: Property Owner/Job Location Information:
` ,
Name: /}�orrls' /7erp-�iitq d q«i�c, Name: fean d /Vovm �oner
Street: S6/f'l�`!'c:lae // /�cP� Sueet: /� 'De�b� J'g Gc,.;+ #�Z
City/Town: .1- P .5' tu r cl. y /�'J,A, City/Town: ,si�/a� i n'/�
Telephone: �'?8 � 3 5 6 � �13� � Telephone: �J YI �� � �o� 30 6 2 p o,�...
Photo I.D. required/Copy of Photo I.D. attached: YES� NO_
Building Type: y�/ � � � _
//!Qf✓ uniti,r a re,ri.�Pencz �— $H, i�P,,,s, a�ro has 2efa+ l
�' butiner�- orf'�ce.r
Residential: 1-2 family_ Multi-family Condo/Townhouses=
Commercial: Office ✓ Retail Industrial Fducational Institutional
Building Cubic Footage: under 35,000 cu. ft.� over 35,000 cu. ft._
Sheet metal work to be completed: New Work: _ Renovation: ✓
HVAC ✓ Metal Roofmg_ Kitchen Exhaust System_ Chimney/Vents_
Provide brief description of work to be done:
�eplace 6 ?o., roo F -t,�rr Nv,te w;-t�e
�X�tc t r� p � ace �,. e ,. d— .. .
I
INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes ® No ❑
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
A liability insurance policy ® Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws, and that my signature on this permit application waives this requirement.
Check One Only
Owner ❑ Agent ❑
Signature of Owner or Owner's Agent
By checking this boXp, i hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and
accurate to the best of my knowledge and that all sheet metal work and Installations performed under the permit issued for this application will be
in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Duct inspection required prior to insulation installation: YES _ NO
Date
Date
By.—
Title
City/Town
Permit #
Fee $ _
Inspector Signature of Permit Approval
Prolrress Inspections
Comments
Final Inspection
Comments
Type of License:
�1Ffaster
r
❑ Master -Restricted
❑Journeyperson Signature of Licensee
❑Joumeyperson-Restricted License Number: 38
❑ Check at www.mass.gov/dpl
MORRIS HEATING & AIR CONDITIONING INC
The City of Salem
Date Type Reference
8/19/2013 Bill 2013-127
8/19/2013
Original Amt. Balance Due Discount
50.00 50.00
Check Amount
13810
Payment
50.00
50.00
* TD Bank INC. 49 Jones, Jean & Norm:2013-127 Bryant RTU 50.00