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84 DERBY STREET - BUILDING JACKET SuperTab® ablFoldws 90%Larger Label Area •*""° iii SM EAE KEEPING YOU ORGANIZED Na.low vuwwww "Istm GET 0RGMMD AT SMMAD.COM WI;ImCV=0uww wnwsr 84 DERBY STREET 1082-12 GIs# 907 COMMONWEALTH OF MASSACHUSETTS M4P 2 41 r xk Bio�k „ t, r '� CITY OF SALEM ]Lot*",-,", `0064-3011 4Categ617y m ', RENOVATIONS el it 1082 12 M p. BUILDING PERMIT Project# JS-2012-003074,,, 3 _ 'Est Cost: $6,000A0 FF, Charged:�".� $71',00 ° t 0.^-. : - . IBalancebue:: $.00.'&_q I, PERMISSION IS HEREBY GRANTED TO: Const. Class:„ k -'„;w .” Contractor: License: Expires: Use Group Ryan Macione CONSTBUCTIO SUPERVISOR- 101474 T �4oln,ng: sq..fr) 3400 ' ,�'p ..'iOwner: Ryan Macione Zoning. B1 _,;; ` Un1ts Ga App ileant: Ryan Macione Units Lost ; a s AT: 84 DERBY STREET Dig Safe# _ s ISSUED ON: 29-Jun-2012 AMENDED ON. EXPIRES ON. 29-Nov-2012 TO PERFORM THE FOLLOWING WORK: -- — - - - - W COMMERCIAL UNIT FIT-OUT CEILING,FLOORS WINDOW LIGHTING AND COUNTERS jbh POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing Building linderground: Underground:. Underground: Excavation: Service: Meter:_ - Footings: - Rough:6" /' IC T' Rough: Roughm dd j/" � Foundation: . ..._ Final: r _ Final: Fina `Irl/'( /1 --p/- Rough Frame: Fireplace/Chimney: D. '.W. Fire Health _ Insulation: Meter: Oil: RFinal: House k �- Smoke: Treasury: -- Water: Alarm: Assessor Sewer:' Sprinklers: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signatur Fee Type: Receipt No: Date Paid: Check o: Amount �? BUILDING tt,at;�: :+ .- REC-2012-003365 _ 29-Jun-12 1051 $71.00 ff,17n7TANT:OWNER OR CONTRAC OR^!UST A -'E FOR PERIODIC INSPECT Ions DUR:M1.G ' C, UCTION:SEE CURRENT:BUILDING CODE., C " 1 FOR LIST OF REQUIREDINSPEC,IGN'S.' ,. «., 'r ; s +r. 1- C,;__,'619-5641 TO_SCNEDuLE AN INSPECTVON , y GeoTMS©2012 Des Lauriers Municipal Solutions,Inc. -� Certificate No: 1082-12 Building Permit No.: 1082-12 Commonwealth of Massachusetts City of Salem Building Electrical Mechanical Permits This is to Certify that the BUSINESS located at Dwelling Type 34 DERBY STREETin the CITY OF SALEM Address -- ------ ... Town/C ---- - --itY Name-. ------ - i IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY OCCUPANCY PERMIT FOR(1) RETAIL UNIT This pernut is granted in conformity with the Statutes and ordinances relating thereto,and expires .__ ..... unless sooner suspended or revoked. Expiration Date Issued On: Fri Nov 16, 2012 72012 Des Lauriers Municipal Solutions,Inc. -- — --- — GaoTMS@ - -- - -- d The Commonwealth of Massachusetts Department of Public Safety U 0 \I 1 IS,lrhux'115 St.I lc I It l Idi nl,Cut lc(780 C\IR) Building Permit Application for any Building other than a One-ur Tivo-F,unily Dwelling ("Phis Section For Official Use OIIIV) Iuilding Permit Number Date Applied: Building Official: SFCnON L• LOCATION(Please indicate Block N and Lot p for locations for which a street address is not available) q-q- ? t" -- --- -�l`t - ---- ----- Nil. ,mdStreet CiIV /Imv11 /ip Code Name of Buildinf;(if SECTION 2: PROPOSED WORK Fdilion ul MA Stale Code osod___ - If NOV Cun.Slrttc tion chock here❑or check all That apply in the two nm:S holow-_-- liaislinf; fluildillpoltRepair❑ 1 Alteration ❑ ,\Jdilion ❑ Dumolilion ❑ (Please till outand submit:\ppenJtx 1) Change of Use ❑ Change of Occupunry ❑ Other Specify:-- a a' —�c it :CO3 ,\rebuilding plans and/ur ronslntction dt K'umenls bein sulied as art f thi it lii ? Yes NuIs mt Indpendcut Structural Engineering Peer Review required? Ycs Nu Brief Descri ttion of PrtqIusrd Work: �.rtQ�M JG(Q �I T_. Cjk0 ' CJ��`r _ fine SECTION 7:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVA"rION,ADUrrION,OR CHANGE IN USE OR OCCUPANCY Check here Ilan Existing Building Investigation and Evaluation is enclosed (See 780 CNIR.4) ❑ EciSling Use Gnmp(s): _ proposed Use GruuP(s):—__— ___._._ SECTION 4:BUILDING ((EIGHT AND AREA Existing Proposed Nu.of Flours/Stories(include basement levels)Se Area Per Fluor(sq. ft.) I'utal :\rea(sq. ft.)and Total Height(ft.) Iq S-p SECTION 5: USE GROUP(Check as a licable) .\: Assernbly A-1 ❑ A-2❑ Nightclub ❑ :\-1 ❑ A-1 ❑ A-5❑ B: Business IP r:: Educational ❑ F: Facto F-1 ❑ 1:2❑ If: fli h flaz,ud 1-1-1 ❑ 1-1-2❑ 11-1 ❑ li-I❑ 11-5❑ 1: Institutional 1.1 ❑ 1-2❑ 1-1❑ I--!❑ \I: Mercantile❑ It: Residential R-10 R-'_❑ R-4 ❑ S: Storage 5-1 ❑ S-2❑ U: Utility❑ Special Use❑and pleasFI -10 below: Special Use SEC`I-ION 6:CONS("RUCTION TYPE(Check as applicable) IAA IB ❑ IIA ❑ IIB ❑ MA ❑ IIIB ❑ IV ❑ Vil ❑ SECTION 7:Sn'E INpOR,NI,\TION(referto780('Jilt 111.0 fur details on eacWaterSu I Flood Zone Information: Sewage Disposal: 7-rvnch Permit: chris Removal: PP Y'I'u blis Pl C'herk it outside lluutl /_anerl7� Indicate numicip,tl .\ (rcnch well nut be •d Ili.pusal Silr�I'mate❑ oriodvnlilS' /one: anm ate St Slrnt ❑ reyuired42or tronthok - __. period is me Iosvd ❑ IiailroaJ right-uf-way; iLizards to .\ir .,\'avigatiun: ..\:nl .\ppllt.rblr@ I IS�Irut hire tulbiu .nrport,ipprt•I,h arr,t.' I Is their I,,%ic,c witylrlyd' r l"on.rul N IIuJ,I rut lu.rtl ❑ 1 rS ❑ or N„� )rs❑ \'„ ❑ Sl(PION 8: ON I FN"1'OF CFR 1 IFI 'AI"li OF OCCUPANCY I doom of l,nlr C\r l;nnl q. n l u upmlt I u,id 1rr I I,n,r i I. Itfn�ut C:�narw liu � I. t,n . for buildinf wnLun ,m �Immkk r tit arm` �prrial �lipula uunv r 1 IOI(IZA'1 ION r, _SI_ I'1:Cl hV_6 1 R01'Ii R'ry OWN f:12 AU 1 -__ --- -- ----- nuc ,utd \JJress of I roped%Owner 2 can ALI- nc_- _-.� _ ... - -- ��(P /. : - 1�14'7p - City/town .. ------- /;p Name(Priul) No.and Street y/ Property Owner Contact Information: ride relvphone No. (business) rclephone No. (cell) a-mail address If applicable, the properly owner herebv authorizes --- Name ------ -------Street Address — -City/Town Stale Zip to act on the property owner's behalf, in all matters reLmive to work authorized by this I111ilding IMIlit a ,plication. SECTION t0:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 13,001)cu.ft.of enclosed space and or not under Construction Conlnpl then check here O and skip Section In.l it61 Registered Professional Responsible for Construction Control Name(Registrant) I'clephone No. e-mail address Registration Number titreet Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor 4r Ocr�/i(2— CumpaIlyyV•m,e �i� Mimic of Person Responsible for Construction License No. and Type if Applicable Street Address City/Town- State Zip Tate phone No.lbusi ness Telephone No. cell e-mail address - -- SECTION 11: t\c v:K,l K, t t'atrr n ,%\'I I M.G.L.c. 152.125C(6)) A Workers'Compensation Insurance Affidavit fro n the MA Department of Industrial Accidents must be completed and Submitted with this application. Failure h,provide this affidavit will result in the denial of the issuance of the building permit. Is a si pned Affidavit submitted with this application? Yes 0 No ❑ SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs:(Labor Item . and Materials) Total Construction Cost((tom Item 6) 'S_ 1. Bultcling 5 3000 Building Permit Fee-Total Construction Cost x_(htsert here '_. Electrical S iOtz appropriate municipal factor) .S I. I'lumbiny, S 1. Mechanical (I-IVAQ S a�� Note: Nlininnun fee'S__(amtac nuniripalin•) i. Nlctliaimal Other S payable h, -� lSnclose chock _ - it, 1'otal Cost and write check number _---_-- SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT IIt,rntvring my name below. I herebv attest under the pains and penalties of perjury that Al of the informal ion contained in this appIiiation is true and accurate to the best of n,v kno„Irdge.md understanding. I'Icase print and .i);u manic I(lie G lyjh fo Ua <Irrrl \.Idw,s - cal ,/ town / tale / /ip Municipal Inspector to fill out this section upon application approval: . _.. 5'."✓.."°"'. /.. ____ / ::\_ Ipal/�