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114 DERBY STREET - BUILDING JACKET i 114 DERBY STREET W CITY OF SALEM In accordance with the Massachusetts State Building Code, Section 108. 15, this 4tM Svsy` CERTIFICATE OF INSPECTION is issued { to HOUSE OF SEVEN GiAI:iLE":S SETTLE:MEN"f I ( trfifg that I have inspected the premises known as HOUSE OF SEVEN GABLES located at 1/711.4 DERBY STREET in the city of Salem County of Essex Commonwealth of Massachusetts. The means of egress are sufficient for the following number of persons: BY STORY Story Capacity Story CS%I Capacity X'.��G!G35'ISb�7K7i•;K•��7N��'f.� �7. �S�%',k�'d7,d���Z%� BY PLACE OF ASSEMBLY OR STRUCTURE Place of Assembly - Place of Assembly or Structure Capacity Location or Structure Capacity Location MRSI'sl Room 5L7i 16T FLOOR ARTS ft CRAFTS 12 BASEMENT EnYIrI GS 2ND FLOOR iZtc`37—:195)7 17.18/01. /1.997 N8/ib:L/1.9.38 _ Certificate Number . Date Certificate Issued Date Certificate Expires wilding Offic al The building official shall be notified within (10) clays of any changes in the above information. '} COMmONWEALTE OF MASSA=SETTS BUILDING DEPT. �z CITY OF SAL&'S ' APPLICATION FOR CERTIFICATE OF IYSPEjffIOf 914 AN 197 Date (N Fee RejftM#Ej1 7a'0-0 ) Noe'T e0FR8alsMckASS. In accordance with the provisions of the Massacausects State Building Cade. Section 108, 15, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street 6 Number 114 Name of Premises Purpose for which Premises is i0sed Community Service Center License(s) or Permits) required for the preaises by other G_ce--zntal enciea: License or Permit Anencv (2) Child Care License OFC Certificate to be issued to: House of the Seven Gables Settlement Association Address: 114 Derbv Street Owner of Record of Building: House of the Seven Gables Settlement Association Address: 54 Turner Street Salem, Ma. 01970 Name of Present Holder of Certificate: Name of Agent, if any.. . Jr=t- P. CowdP11 Settlement Director Signature of Pe n to waam Lertzficace TITLE is issued or his/her authorized agent 6/27/97 Date T_MEM CT 0-S: 'Day time phone i 745-5999 I. Make check payable to: The City of Salem 2. Return this application with your check to: Inspector of Buildinzs. Citv of Salem Buildinz Department. One Sales Green. Salem. MA. 01970. PLEASE NOTE: I. Application form with required fee must be submitted for each building or structure Of part thereof to be certified. 2. Application 6 fee must be received before the certificate will be issued. 3. The building official shall be notified within cep (10) days of any change in the above information.( p CERTIFICATE i �� / `� EXPIRATION DATE: PERIODIC INSPECTION REPORT , This form is to be completed each time a Periodic Inspection is made. At the time , a new Certificate of Inspection is issued, a notation indicating that the fee has been paid will be made to Application Form prior to the new Certificate of Inspection being issued. Any changes since the last inspection are to be added to the file card of the premises. Street b Number / '/� Jy v Name of Premises j��'�-4� { Certificate to be issued to: s- — Address Owner of Record of Building Address Purpose for which premises are used Changes since last Insp ction equired file card also) 1. /® 2. 3. 4. 5. Date Order Issued: Order Issued To: Address Date Violations Corrected: REMARKS: I have this day inspected the above premises, and the same conforms to the pertinent requirements of the Massachusetts State Building Code and the rules and regulations pursuant thereto. Dat Building Official p Date Issued: Certificate # Date Expires: �i� A 5� Recommended Neat Inspection: 4 r F77 QUIET ROOM TEEN'S AGTIVITY SPAGE TEEN 5 OFFICE OFFICE 3 ' HALL T ENDIRECTOR'S • < TOILET OFFICE 7 STORAGE STAIR I GYMNASIUM STAGE SHWR. STAFF ILEI 0200 STAFF GONFERENGE 8 LIBRARY STOR. SECOND FLOOR PLAN SETTLEMENT HOUSE 5ENIOR'5 AGTIVITY 5PAGE HALL HALL OFFIGE I ------------------------------------------ `BHIL 5 SENIOR'S KITGHEN -� ENTRY --------------------------------------- ILET FO FIGE _ I . I I O ® STORAGE 5TAFR I ENTRY HALL MAIN Al2EA 00 PRE-SGHOOL WOMEN'S ' OFFIGE TOILET I . OFFIGE 2 ----------------------------------- X---- O U TOILET FIRST FLOOR PLAN SETTLEMENT HOUSE //C/ f ti r 5TORAGE 0 0 CELL------------------------------------------------- Ai2 i i , i nn vu HALL ELF-r,. MEGH 0 o i ARTS d GRAFTS OIL TANK 0 o i i i 5TORA6E BOILER'ROOM 5TORAGE STORAGE I OIL TANK STORAGE MECH BASEMENT FLOOR PLAN SETTLEMENT HOUSE l/G/ ,�e���• X1'/7sL � Certificate No: 581-12 Building Permit No.: 581-12 Commonwealth of Massachusetts City of Salem Building Electrical Mechanical Permits This is to Certify that the SCHOOL located at - - -------- - - -------- Dwelling Type 114 DERBY STREET in the CITY OF SALEM -------- ----------------- -- ----------------------- Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY OCCUPANCY PERMIT FOR SALEM PREP SCHOOL This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires unless sooner suspended or revoked. Expiration Date ._. ------ - .._---------------______________---_.-----..----- Issued On: True Jan 3, 2012 -------- - ---------------------- ----------------------------------------------- GeoTMS®2012 Des Lauriers Municipal Solutions,Inc. ------------------------------------------------------------------------ ZIIATHad 19NIQZIIIS 1/%Tarlvs d0 AZID oa�ia� ad anasn J 114 DERBY STREET 581-12 GIs# 631 :r "' COMMONWEALTH OF MASSACHUSETTS Map: 41 Block: CITY OF SALEM Lot: 1Y 0014 a Category: rc., Handicap ramp ,, ! ' Perimt# °� 581712 ,jai;,r BUILDING PERMIT ProjectJS-2012-0014851 Est. Cost: • x$20,000.00 Fee Charged: -$225.00 % f, Balance Due:x $ oo - PERMISSION IS HEREBY GRANTED TO: Const. Class:r Contractor: License: Expires --:Use Group: ` 'ri1'".�_, NAPCQ INC. Lot Size(sq. ft.): 12587.0976 ' ffi '° Zoning: %" Owner., HOUSE OF SEVEN GABLES, SETTLEMENT ASSOCIATION Units`Gamed: 4.;= 'r' Applicant: NAPCO,INC. Units Lost- ost # i AT: 114 DERBY STREET Dig Safe#:':"k',: ,: AaiM ISSUED ON: 03-Jan-2012 AMENDED ON: EXPIRES ON: 03-Jun-2012 TO PERFORM THE FOLLOWING WORK: RECONSTRUCT HANDICAP RAMP TO MATCH EXISTING.BUILD 2ND HANDICAP SYSTEM IN PLACE OF EXISTING STAIRS jbh POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing Building Underground: Underground: Underground: Excavation: .A Service: Meter: Footings: Rough: Rough: Rough: Foundation: Final: Final: Final: Rough Frame: Fireplace/Chimney: D.P.W. Fire Health Insulation: Meter: Oil: Final: (louse# Smoke: Water: Alarm: - Assessor Treasury: Sewer: Sprinklers: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signa54evt` .*,.,- Fee Type: Receipt No: Date Paid: Check P6 Amount: BUILDING REC-2012-001653 03-Jan-12 3695 $22590 GeoTMS®2012 Des Lauriers Municipal Solutions,Inc. 13 . 13 r �h�ONDIT Salem Historical Commission 120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970 (978)619-5685 FAX(978)740-0404 CERTIFICATE OF APPROPRIATENESS It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving IE Reconstruction ❑ Alteration ❑ Demolition ❑ Painting ❑ Signage ❑ Other work as described below will be appropriate to the preservation of said Historic District, as per the requirements set forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: Derby Street Address of Property-11 n Derby Street Name of Record Owner: House of Seven Gables Settlement Association Description of Work Proposed: Replacement of windows on 1970s addition, as shown in the application elated 7/22/13. Windows will be Marvin 450 series vinyl or alurninum clad exterior in the color white. The lower six (6) windows will be 6/6. The three (3) awning windows will be 6-lite. The nauntins will be 9/16". New wood window trim to be painted putty color to match existing trim on main building. Approval of these replacement windows was made specific to this 1970's addition, and reflects the Conunission's case-by-case approach to renovations within the historic districts. Dated: August 12, 2013 SALEM HISTORICAL CCOOMMISSION 7� The homeowner has the option not to commence the work(unI t relates to resolving an outstanding violation). All work commenced nwst be completed within one year from this date unless otherwise indicated. THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessary permits or approvals) prior to commencing work. CITY OF SALEM, MASSACHUSETTS " fq' BOARD OF APPEAL \ � 120 WASHINGTON STREET♦SALEM,MASSACH RR93o P 12: 41 KIMSERLEY DR1scoLL "ISLE:978-745-9595 ♦ FAX:978-740-9 MAYOR I 1 CITY March 30, 2016 Decision City of Salem Board of Appeals Petition of 114 DERBY STREET NOMINEE TRUST, seeking a Variance for relief from the provisions of Sec. 3.3.4 and a Special Permit from Sec. 3.3.3 Nonconforming Structures of the Salem Zoning Ordinance to increase an existing non-conformity and alter a nonconforming structure for a substantially different purpose at the property of 114 Derby Street (Map 41 Lot 14)(BI Zoning District). A public hearing on the above Petition was opened on March 16, 2016 pursuant to M.G.L Ch. 40A, § l land closed on that date with the following Salem Board of Appeals members present: Rebecca Curran (Chair), Peter A. Copelas,Mike Duffy, Tom Watkins,Jimmy Tsitsmos. The petitioner is seeking a Variance for relief from the provisions of Sec. 3.3.4 of the Salem Zoning Ordinance to increase an existing non-conformity and a Special Permit from Sec. 3.3.3 Nonconforming Structures and alter a nonconforming structure for a substantially different purpose. Statements of fact: 1. In the petition date-stamped February 23,2016, the Petitioner requested a Variance for relief from the provisions of Sec. 3.3.4 and a Special Permit from Sec. 3.3.3 Nonconforming Structures of the Salem Zoning Ordinance to increase an existing non-conformity and alter a nonconforming structure for a substantially different purpose. 2. Attorney Grover presented the petition on behalf of the petitioner. 3. The subject property is located in a Bl Zoning District. 4. The petitioner proposes to renovate the existing building and the addition along Turner Street. 5. The property is dimensionally nonconforming with respect to lot coverage and side yard setback. The petitioner proposed to construct two (2) porches that will cause the lot coverage to increase from the existing 42% to 43%lot coverage and requested a Variance per Section 3.3.4 to allow an increase in an existing nonconformity. 6. The petitioner proposed to convert the existing building, currently owned and operated by the House of the Seven Gables Settlement Association, to six (6) residential dwelling units. The current use of the structure is an alternative high school. The petitioner has requested a special pennit per Section 3.3.3 to alter a nonconforming structure for a substantially different purpose. 7. The petitioner proposed nine (9) parking spaces, which meets the required number of parking spaces per the Zoning Ordinance. a6 1e� City of Salem Board of Appeals March 30,2016 Project: 114 Derby Street Page 3 of 3 On the basis of the above statements of facts and findings, the Salem Board of Appeals voted five (5) (Rebecca Curran (Chair),Peter A. Copelas,Mike Duffy,Tom Watkins,Jimmy Tsitsinos) in favor and none (0) opposed, to grant a Variance in accordance with the provisions of Sec. 3.3.4 and a Special Permit from Sec. 3.3.3. Nonconforming Structures of the Salem Zoning Ordinance to increase an existing non-conformity and alter a nonconforming structure for a substantially different purpose subject to the following terms, conditions and safeguards: 1. The Petitioner shall comply with all city and state statutes, ordinances, codes and regulations. 2. All construction shall be done as per the plans and dimensions submitted to and approved by the Building Commissioner 3. All requirements of the Salem Fire Department relative to smoke and fire safety shall be strictly adhered to. 4. Petitioner shall obtain a building permit prior to beginning any construction. 5. Exterior finishes of new construction shall be in harmony with the existing structure. 6. A Certificate of Occupancy shall be obtained. 7. A Certificate of Inspection is to be obtained. 8. Petitioner is to obtain approval from any City Board or Commission having jurisdiction including, but not limited to, the Planning Board. r. Rebecca Curran, Board of Appeals A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK Appeal fmm this deanon,if any, shall be made pursuant to Section 17 of the Massachusetts General Lacer Chapter 40A, and shall be filed within 20 days of fch'ng of this decision in the office of the Ciiy Clerk. Pursuant to the Massachusetts General Laws Chapter 40A, Section 11, the Variance or Special Permit granted herein shall not take effect until a ropy of the decision beating the artificate of the City Clerk has been filed with the Essex South Re of Deedf. ■ 114 Derb STrust 114 Derby St. , Salem , MA 01970 IN r Owner: Architect: ; �o� 114 Derby Street Nominee Trust Seger Architects, Inc. og gii n ` 114 Derby Street 10 Derby Square, Suite 3N Salem MA Salem, MA 01970 M .r Phone: 978-744-0208 t , s ✓ , , ' �,. . DRAWING INDEX PROJECT INFORMATION ► I 1 _ - SHEET DESCRIPTION COVER 2012 International Residential Building Code SITE PLAN — - LANDSCAPE PLAN PROJECT: 114 DERBY STREET CONDOMINIUMS LOCATION: 114 DERBY STREET, SALEM, MA W GARDENS/PERENNIALS . �� .. B �„" a ar's n,sMtnuziae FLOWERING TREES JURISDICTION ESSEX COUNTY �,' ``� "x��+. > r}� N"�"' ^`�'-fi" s SDs , a' �� ,4 SHADE TREES APPLICABLE CODES: 2012 IEBC W/ MA STATE 8TH EDITION ADMENOMENTS { r�"' `Sao A-1 EXISTING PHOTOS �- • mm�6ha,a Eufo Gnu< a-xx �� A-z EXISTING PHOTOS ZONING AND BUILDING DATA `.� 4 ' x ' A3 EXISTING ELEVATIONS 'J t; A-4 EXISTING ELEVATIONS ZONING DISTRICT: B-1, BUSINESS r.� � x � ^4 ,P' REQUIREMENTSREQUIRED .kart�wisPoa,asmP 6 ,, .atfa.a _ : EXISTING PROPOSED + ;m s axil+ a. ° r-+^ A-5 PROPOSED ELEVATIONS MIN. LOT SIZE 6,000 SF 11,947 SF NO CHANGE �E9�cA`� _ 4 A-6 PROPOSED ELEVATIONS MIN. LDT AREA D.U. — — — ` . `� �{, * 8T" / e, The Oardds ilax iH"v� y,�h `' tltre aof KwdM "^= �„R' i- A-7 PROPOSED ELEVATIONS MAX. LOT COVERAGE 40% 42% 43% o + *C, � j> ° • ` " A-6 DETAILS SIDE YARD 10' ON LINE, 11.0' NO CHANGE ��` '!k A-9 MATERIALS FRONT YARD 15' 6.3' NO CHANGE , ` * � e, ,9'e 'T. $ BACK YARD 30' 47.8' NO CHANGE �' 4,?? FRONTAGE 60' 231.37' NO CHANGE '� ', N� * ' )''s° YC OWe PND• l 'g di Trt'"' •f p OPEN SPACE — ` y H .ux,� *°° SCOPE OF WORK: CONVERT EXISTING SCHOOL TO 6 CONDOS. S TWO BEDROOM FLATS AND 1 TWO BEDROOM TOWNHOUSE Ab M SITE LOCATION � `40 +'(a 4•"()e� 8[aWai.pwMa� a'.,� -A' .y � ,$ -6' .rtk �`g � K d�.c. ,V Kha&ta Crt(R � � AWPR19 Gkvy a� Y 4 � t tAr ez.'.E i�m,Se+en,Gebka Date: 04.04.2016 Project # 15-053 Not For Construction Map 41 Lot 16 Map 41 Lot 30 N/F N/F Stockade Ann Adams Nickolds Mark Pattison Fence 20 Turner St. 11'4 Hardy St. / S75'34'06"E 102.12 101.51 101117 Ch OO 77.47 i 100.66 x19 T 100.50 'i ypica 1 1.76 �-0- 6" High Bit. 1I 1.76 Conc. Curb 'n 10 Tr e ;- 101 36� 10 T.B!R. 01.65 0j8 G ' 102.01 47.8 101.71 Tree Grass / I101.2 Lu T.B.RI PROPOSED Bit. Conc.o, Map 4/Lot 31 �I M° / -i- 102.19 PARKING � 101.22 (o � w "CONDO" D l 101,.73 + 15 Hardy St. `° 10 i-102 3iI 102.1 I I �Blf! an 101. 5 01.10 11.0' 7 �r; 1011 3 101 26 + 101 f! 100.66 J., 77,/ 1� 4" Fire Service 102.4 Q ! Proposed 1 0.5' Trash � -WCR 8" Bay on Enclosure ! 2nd Floor �1 Steel Fence & Snow Storage 1025'4', {—[��f -IIT- 100.51 Tree r; De W {? 6raWde Deck osedl ChoCR 11c) 102 23, , <<;_:,.�f' s-;-;r =r _ Il � 12.0' �"' 2"i Water w �— G• y= 100.43 �- Bit. Conc. - ;{ 1) Map 41 Lot 13 102 v -� GSG N/F ,n N #114 � In � h7 Robert Burkinshaw I 118 Derby St. `rte Ii Derby St. z �t SIII, Demo Planter a41 Lot 74 (See Landscape Plan 947 sq.ft. P17, ' 100.44 for scope of work in o.27 acres 1 !� Elec.(Underground) this area) -. Planter _ 101.21 -_ ✓ 1.''<;� _< < Q (1 1 N74 06'45"W 6-3', Y 101:37 80.70' 101.13 rou g ron ence 10,0.69 . + DERBY STREET CBO 0 0 WV D4 0 LEGEND 0 TMH OO SEWER MANHOLE GSG GAS SERVICE GATE UTILITY POLE ZONING DISTRICT - B1 -4b UTILITY POLE W/LIGHT O r FLAGPOLE REFERENCES: WCR WHEEL CHAIR RAMP 1) Deed Book 5413 Page 718 2) Deed Book 6937 Page 304 PROPERTY LINE --'a------ WOOD FENCE 3) Plan Book Plan 50 of PROPOSED CONTOUR_ 4) Plan #289 of 1928 — — 10 — - 5) Plan Book 422 Plan 29 6) "Bertram Home for Aged Men, Salem, MA, Dated December 1922" PLOT PLAN 114 DERBY STREET SALEM, MASSACHUSETTS Prepared By LeBlanc Survey Associates, Inc. `N wI161 Holten Street OF VERkki9, 1, Danvers, MA 01923 �. (978) 774-6012 LeBLANC N0. 33600 o March 30, 2016 Scale: 1 `20' his 9fGISTER�� 1� s�Ygt LAP HOR. SCALE IN FEET 0 20 50 100 3 / 31 / 16 Wood gate to match fence 10 Fothergillo gardenii, Trash storage 3 gallon - Ex. tree to remain; prune 1 Cercis canadensis, 3" ,•r '"- .; Luiriop spicata, l gal. caliper, ball and burlap Nepeto 'Walker's Low' ty Exmaple to be removed Ex. privet (prune) 6 Buxus 'Green Mountain' 36" tall sem` 1 Acer rubrum ' Red Sunet' 3 ' lawn � r caliper, ball and burlap Hemerocallis 'Happy Returns' 1 gal. . 3 Buxus" Blue'u e' 3 6 t o I'I'I _ ter ' r, ; � ( � 3 Acer 'Armstrong' 3" existing fence to remain at 1 Magnolia stellata, F T _ caliper, ball and burlap front elevation; relocated gate a` ' multi-stem 10' tall b&!5, �* 2 Pyrus calleryana 'Chanticleer' Paver pathway � 'r �' Asphalt paving 3 " caliper, ball and burlap Salvia "Snow Hill' 1 gal. A Sanguisorba 'Tonna ❑ � # x Few' � Precast concrete curb stop 5 Buxus 'Green Mountain' 36 " fall �f 1 gal. s# r �c, � " 3 .t Bulkhead epeta, Walker's ..- � Granite curb at ac Low 1al. �rpp� , 6' High wood fence 1gal. bulkhead, and g=spa"ces 7 Ilex glabra'Shamrock' fence 1 f; g �91Parkin " 11 Hemerocallis ' Happy Returns' 1 gal. INr15 s 1 36" tall " IF- ° Concrete path a u t % Ex.mople to be removed �;;. ° Paver courtyard , s: -.�-' rr>r,- Vinca groundcover $ '" ��j'. 6 Buxus 'Green Mountain' 36" tall " � I s Baltic ivy at fence rt s s 1 Amelanchier 'Autumn B.' " 6' High wood fence Hemerocallis ' Happy Returns' 1 gal, 8 ' tall multi-stem 7 Delaware Valley A ales- 1 Pyrus calleryana 'Chanticleer' + _ 2 Pyrus calleryana 'Chanticleer' 3 " caliper, ball and burlap a. wti 3 " caliper, ball and burlap New metal fence 16 Taxus 'Hicksii' 3 gallon 2 Cercis canadensis, 3 " t u r n e r s t re e t caliper, ball and burlap 1 Acer 'Armstrong', 3 " caliper, ball and burlap s0u,.se.-0' aal' r �jarchitects,ir,c s' a' o e' ia 114 DERBY STREET M ® LA 1 1 4 DERBY STREET NOMINEE TRUST L A N D S C A P E C O N C E P T g ■ E° �aeYA�+�.xu Ci .F kec ZPn'aN.°'�r .��AFib�.,. a ■BRlSM 1c.�.� �i �'k �t F ✓� a a -z - D ctl � s Al ,A&n R t n ': t 1 oa t h r/ fi Ye ¢ •Tj4 ' k "� {ry f Aa� �� +@' !Ps'ry'eN.MryKaaWi�+r+wpYw�•£ fi ■ k Wim_ � — ._ � ��. x ki � 4 QjjQf 5 fr ■ �V� S.y k � III iQ R ��a t '>•d`a q .M4ki� s`� ` '� � ��t '�l � 0'A� * �` t . 4y�e * �*�o-kt at ��4` ".�+T ■ gyp Ner �,µ � 94 �'1' �.a } ■ k M>� J �� XX�����,{ �yp�Y} yy �� l2 v. ll R 4 e. - , I r ppp v- Kkakp ,'x.'a 3 ab t 3 pl t -0`eh'� ■ "^'s~Yr]]±,m..d#P>M'1yY 3b�k0. 1¢Y �w- lax t .iz. 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SHINGLE — ROOF TO REMAIN 'g}+ d '� vs raTec ALUM. GUTTERS PROPOSED ASPHALT REPAIR EXIST. f+ - $' ,.�'�+i� ^' '� 2 & DOWNSPOUTS "'L— y,�e SHINGLES TO GUTTERS z` �\ � "=' ">- �=z '-�� -- MATCH E%IST. BLOC. REBUILD DORMER NEW PARAPET --- _ — COPING TYR. EXIST. MASONRY V ' RECESSES TO BE —-- — "' �'" � ICE & WATER CLEANED. TYP. _ r SHEILD. TYR PATCH. REPAIR & - � PAINT Exlsr. � PLATE ted. - x �, TOP T Ur� E p LINTELS, TYP. 'F � � � H NEW SIMULATED - " PROPOSED WINDOW t DIVIDED LITE y OPENINGS & WINDOWS F WINDOWS IN EXISTING - " ' OPENING. TVP. .Y BL MATCH ORIGINAL 2 ' ' BLDG. 100% CLEAN EXIST MASONRYFACADE 4, I"I P SECOND FLOOR cc PROPOSED CLAPBOARD o SiDING OVER AIR PRIME/PAINT-`i - VAPOR BARRIER, W L EXIST. PC CO 1PAINTED WOOD SOLID FENCE W PRIME/PAINT - PATIO ENCLOSURE Cn m EXIST. IRON . .- .. CL FENCE _. FIRST FLOOR � PRIME/PAINT LIGHT C-(2) AC UNITS PROPOSED METAL PROPOSED ROOF T f EXIST. PORTICO FIXTURE BEYOND FENCE M n Turner Street Elevation it y 0 y� O N U � S :"" •. EXIST. SHINGLE y �'ri•"�`"' _. ROOF TO REMAIN d REPAIR EXIST. GUTTERS & DOWNSPOUTS w~y NEW PARAPET = COPING TYP. RECESSED PANELS. - M PAINTED '- EXIST. MASONRY Y_ -- - RECESSES TO BE CLEANED. TW PROPOSED CLAPBOARD - . SIDING OVER AIR PATCH. REPAIR & PAINT EXIST. VAPOR BARRIER, PAINTED LINTELS. TW. PROPOSED WINDOW NEW SIMULATED O - DIVIDED LITE OPENINGS & WINDOWS IN EXISTING WINDOWS TO MATCH OPENING, TYR. ORIGINAL BLDG NO s&s,. 100%CLEAN EXIST. DIVIDED LITES) MASONRY FACADE S PRIME/PAINT SECOND FLOOR z i EXIST. PORTICO PROPOSED WOOD PORCH & BALCONY Q PROPOSED BALUSTRADE PRIME/PAINT TO MATCH EXIST. r EXIST. IRON 0.N FIRST FLOOR FENCE -Z� EXISTING PORCH REPLACE EXISTING NEW WOOD DOOR IN LIGHT FIXTURE EXISTING LOCATION, PAINTED REPAIR EXISTING STAIRS ,A nDerby Street Elevation Q Submittal Set 4/04/2016 EXIST. SHINGLE ROOF TO REMAIN t _ REPAIR EXIST. CUTTERS PROPOSED ASPHALT SHINGLES NEW MASONRY OPENING & - " r„ _ _ PRIME & PAINT TO MATCH E%IST. BLDG. WINDOWS TO MATCH ORIGINAL EXIST. LOUVER ICE & WATER SHEILO, TYP. BLDG. (NO DIVIDED LITES) NEW PARAPET _ COPING TYP EXIST. MASONRY = a -;---- RECESSES TO BE CLEANED, iVP. U u PATCH, REPAIR & Jz1rt PROPOSED CLAPBOARD— PAINT EXIST �- a _ * -a ^ Ti SIDING OVER AIR �x_ A � . �;' LINTELS, TVP VAPOR BARRIER. . p5 PAINTED NEW SIMU ATED V m DIVIDED LITE REPLACE EXIST '^' '" `� WINDOWS IN EXISTING W DOWNSPOUTS, , X OPENING. TYP. ' 100% CLEAN EXIST. h+ rn MASONRY FACADE WW U La W SECOND NEW WINDOW OPENINGPRIME/PAINT - A F & wlNpOwS ORIGINAL BLDG. (NO EXIST, PORTICO m DIVIDED uTES) '` PRIME/PAINT EXIST. IRON FIRST FLOOR n . ! ,E { 3 i FENCE COVERED RAMP & WINDOWS TO MATCH PORCH S& BALCONY TOBALUSTRADE REMOVE EXISTING NEW WINDOW OPENINGSOD NEW MATCH EXIST. ORIGINAL BLDG. (NO EXISTING PORCH v* DIVIDED LITES) n Courtyard Elevation c Y 0 y� O M U ` � EXIST. SHINGLE n ROOF BEYOND TO REMAIN C PROPOSED ASPHALT L SHINGLES TO MATCH EXIST BLDG s T NEW PARAPET 0 _ .:M �. E COPING Tw. ICE & WATER i' - .+^ 41.4 SHEILD. TVP , y �'N � Y _ rr �} A PROPOSED CLAPBOARD ALUM- GUTTERS ! "^`""''"'� t = '""e ''"W''" "A SIDING OVER AIR & DOWNSPOUTS - -+-fi'= - `'R VOR BARRIER. PAINTED u-- PROPOSED WNDOW r1 PROPOSED WINDOW jf _ OPENINGS & OPENINGS & WINDOWS TO MATCH WINDOWS TO MATCH ORIGINAL BLDG ; ORIGINAL BLDG (NO DIVIDED LITES) SECOND PROPOSED CLAPBOARD SIDING OVER AIR - PARKING AREA VAPOR BARRIER, PAINTED LIGHT FIXTURE PROPOS-0 WOOD - ti SOLID FENCE PATIO ENCLOSURE F �O FIRSTT i B1 EXISTING BULKHEAD (2) AC UNITS TO REMAIN BEYOND Rear Elevation Submittal Set 4/04/2016 PROPOSED ASPHALT SHINGLES TO MATCH EX15T. BLDG. �f ,t+ ICE & WATER F SHIELD, rvR70 _ z a ALUM_ GUTTERS & DOWNSPOUTS C SECON___.. _ F PROPOSED CLAPBOARD ~ SIDING OVER AIRW m VAPOR BARRIER. PAINTED a PROPOSED WNDOW OPENINGS & WNDOWS TO MATCH ORIGINAL BLDG ��++ FIRST FLOOR-� Fi EO DD STAIRS & LANDING ~ 1 STAIRS DING M •fel n North Courtyard Elevation c 0y fl � G T, 8 EXIST. SHINGLE ROOF BEYOND �� TO REMAIN (2) AC ROOF UNITS REPAIR EXIST GUTTERS & DOWNSPOUTS -- aw PATCH, REPAIR & PAINT EXIST. LINTELS, TYP. ' NEW SIMULATED DIVIDED LITE WINDOWS IN EXISTING OPENING, TYP. 100% CLEAN EXIST MASONRY FACADE �Q O W aF �O PROPOSED WOOD (2) AC UNITS STAIRS D EVOND South Courtyard Elevation Q Submittal Set 4/04/2016 f O MVM UNIT 2 v o STORAGE STORAGE H 8 W � a� �rurrr�rorr�rrprrnn x �� 0 w v c7 q 44 � m a w w � 0 0 UNIT 5 STORAGE [= _ UNIT 3 \ 4) a� STORAGE « UNIT 1 z N STORAGE A V A " � q UNIT 4 MECH. O a STORAGE , A N a UNIT 3 I I N Q 0 � i Z Q� r Basement Floor Plan r SCA '/'r II'' ° Basement Floor Plan Q Schematic Design Set, Not For Construction — 4/05/2016 O E UNIT 1 PORCH z 128 s.f. 1 F 5 F N81 Lz0CW BR MJL GARDEN z RJ 2 MBR UNIT 4 ENTRY v � UNIT .f _ �-- _ 1,345 s.f. J 0 3 ff— UNIT 1 PORCH ST DR B 0 AC Q 140 s.f. ' N 'r' u 0CD 0 AC w L 00 UIQ OJ —\ oo 00 00 DRI c� 00 MR 00 K K ILR K UNIT 6 (� O v � 5 z v ` UNIT 1 �� 1s7o s.f. �.. PARKING y c — 0 g 9 6 � J FOYW'1 O B o LJ y L _ JBR UNIT 6 ENTRE A O COURTYARD / 1,4 jLt r LLIBMBR AC UNIT 3 ENTRYLR ST. AC ISI — PATIO DO El — 0 �Q O �z UNIT 5 ENTRY -�y Ra TURNER STREET Q� n First Floor Plan 04 T SCALE: 3/3Y= 1'-� First Floor Plan Q Schematic Design Set, Not For Construction — 4/05/2016 - - J 7'M UNIT 6 ILR) � DECK `J O BR z E 127 s.f. UNIT 6 8 = 1,660 s.f. - - ----- ------- --- -- - B 0� j UNIT4 DR 1 00 - - I B 0 DECK LIB 0 q 270 s.f. w c -- 0 Lj 7[V1 O I _ BR O BR� v ILR K e w 14 O—J UNIT 41] 1,225 s.f. ® ® i — ® ® B ® ® r ROOF BR CJ v" a A — ---1 j BR B c`n O 0 a� or ❑� UNIT 3 UNIT 1,350 s.f. 1,460 s.f.KLR Igo Fes%' - y 'qC =- 00 K — �» BR �o i¢ Second Floor Plan o ;11F 3/3Y-fr T Second Floor Plan Q Schematic Design Set, Not For Construction — 4/05/2016 Certificate Number: B-16-863 Permit Number: B-16-863 Commonwealth of Massachusetts City of Salem This is to Certify that the ............................................................Multifamily 3+ Building located at Building Type ..........................................................................114 DERBY STREET in the Ci o. Salem ......................................................................................................................... ........................?y... ................................................................... Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY Unit #2 Turner Street HOUSE OF SEVEN GABLES This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires Not Applicable unless sooner suspended or revoked. Expiration Date Issued On: Thursday, January Janua 12 2017 Certificate Number: B-16-863 Permit Number: B-16-863 Commonwealth of Massachusetts City of Salem This is to Certify that the Multi amil 3+ Building located at ........................................................._� S .......................................................................................... Building Type ..........................................................................1.14 DERBY STREET in the Ci o Salem ......................................................................................................................... .........................y... ................................................................... Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY Unit 3- Derby Street HOUSE OF SEVEN GABLES This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires .Not Applicable unless sooner suspended or revoked. E)piration Date Issued On: Thursday, January 12, 2017 NORTON S. REMMER; P.E. CONSULTING ENGINEERS EIGHTEEN JOHN STREET PLACE •WORCESTER, MA 01609-2667 •(508) 756-2777 -FAX 1508) 756-3840 Michael Lutrzykowski,Public Property Assistant Inspectional Services,City of Salem 93 Washington Street Salem, MA 01970 May 2,2016 RE: 114 Derby Street Conversion of a Schoolhouse Building to Six Dwelling Units Dear Mr. Lutryzkowski I am writing at the request of Seger Architects,with reference to the proposed conversion of an existing two-story building,with a Basement, that was last used as a schoolhouse by the City of Salem, into 6 dwelling units located on two floors of the existing building and consisting of two single level units on the first floor,3 single level units on the second floor and a two level dwelling unit on the first and second floors. 114 Derby Street is an existing two-story building that was last used by the City of Salem as a school, Use Group E. The building is being converted to a total of 6 condominium dwelling Units for sale. Each unit on the second floor, units 4, 5 and 6,will have a single exit leading to a grade level exit. Each unit on the first floor,including the two-floor unit,unit 3,will have two exits to grade.The building willbe protected throughout by an NFPA 13R sprinkler system in accordance with 780 CMR Section 903.3.1.2. The dwelling units will be exempt from the requirements for emergency escape and rescue window facilities in accordance with 780 CMR 1029.1 where the building contains an NFPA 13R.sprinkler system. I understand thatthe building construction will be classified as.Type VB Construction with an allowable height of 2 stories above the Basement level and an allowable area of 7,000 s.f.for each floor and the Basement, in accordance with 780 CMR 506.4. i understand that the exit stairway enclosures will be rated as one hour rated enclosures with 1 hour rated,S label doors.A single means of egress from a dwelling unit is allowed in accordance with 780 CMR 1015,Table 1015.1,Exception 1,where the occupant load does not exceed 20 persons and 780 CMR 1021.1, Exception 4,.and Table 1021.2,which allows a single means of egress within a dwelling unit—Unit 3. The Basement level will also be protected by an NFPA 13R sprinkler system and divided into storage units serving the dwelling units on the 1'(and second floor levels.Each storage unit will have an access stairway from the unit and an exit at grade level with a travel distance of less than 75 feet,and an occupant load of less than 4,in accordance with 780 CMR Table 1021.2. r Michael Lutrzykowski,Public Property Assistant Inspectional Services,City of Salem RE: 114 Derby Street Conversion of a Schoolhouse Building to Six Dwelling Units May 2,2016 Page 2 The dwelling units on the.second floor of the building including 4,band 6,will each have'access-to a single:enclosed, I hour rated exit stairway with a maximum travel distance to the stairway enclosure entrance of less than 50 feet in accordance with 780 CMR Table.1021.2. Based on the above information and my understanding of the proposed construction, I believe that the design complies with the provisions of 780 CMR for the use of the building.for 6 dwelling units.with 2 single level dwelling. units on the first floor,3 single level dwelling units on the second floor and one two level unit with a first and second floor,and the applicable provisions of Section 1015.1,Table 1015.1 Exception 1,780 CMR 1021.1 Exception 4,and Table 1021.1,which allows a single means of egress for each unit on the second floor and the proposed egress arrangement for the Basement level storage areas. 4Resp' lly submitted, u " on S. Remmer,.P`.E. - I� -7 �� Salem Historical Commission 120 WASHINGTON STREET,SALEM, MASSACHUSETTS 01970 (978)619-5685 FAX(978)740-0404 CERTIFICATE OF APPROPRIATENESS It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving ❑ Reconstruction ✓ Alteration ❑ Demolition ✓ Painting ❑ Signage ❑ Other work as described below will be appropriate to the preservation of said Historic District, as per the requirements set forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: Derby Street Address of Property; 114 Derby Street Name of Record Owner: 114 Derby Street Nominee Trust Description of Work Proposed: Renovate existing building based on plans prepared by Seger Architects dated 4/4/16. Replacement of 1940's previous replacement wood window sashes by new aluminum-clad insulated wood windows is allowed by the Commission on this specific project only, and notes that this replacement is not of the building's original windows. Windows are to match existing dimensions and 9/9, 6/6 and 1/1 configuration. The building's 1983 rear addition to be painted Benjamin Moore "Shenandoah Taupe" and "Black Jack" as depicted on plans. Dated: April 27, 2016 SALEM HISTORICAL COMMISSION By: iA� ���-�c ✓'�w� lilrt�_ The homeowner has the option not to commence the work(unless it relates to resolving an outstanding violation). All work commenced must be completed within one year from this date unless otherwise indicated. THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessary permits or approvals)prior to commencing work. CITY OF SALEM ROUTING SLIP New Construction 6e✓ Certificate of Occupancy LOCATION /CtPeQfaar DATE �vl Sc zoo ASSESSORS DATE 70 I 93 Washington . j I CITY CLERK ATE 93 Washington PUBLIC SERVICES DATE �0 b 120 Washington St. WATER_ - DATE 120 Washington St. e L ' �VrJ�W+ CROSS CONNECTION DATE 5 Jefferson Ave PLANNING 0 DATE 120 Washington St. / CONSERVATIO TE 120 Washington St. ELECTRICALDATE 48 Lafayette FIRE PREVENTION DATE 29 Fort Avenue �7 HEALTH DATE 120 Washington St. BUILDING INSPECTOR DATE 120 Washington St. Commonwealth of Massachusetts ..; City of Salem .. 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5841 Return card to Building Division for Certificate of Occupancy - Permit NO. B-16-863 PERMIT TO BUILD 'FEE PAID: $1,034.00 DATE ISSUED: 8/12/2016 a This certifies that HOUSE OF SEVEN GABLES SETTLEMENT ASSOCIATION has permission to erect, alter,or demolish a building,. , 1.14 DERBY STREET _ Map/Lot: 410014-0 as follows: Other Building Permit f REMODEL EXISTING,SCHOOL AND MAKE INTO SIX (6) RESIDENTIAL HOUSING UNITS. NEW FRAMING, ELECTRICAL, PLUMBING, HVAC '\ Contractor Name: Joseph SKOMURSKI DBA: v SKOMURSKI DEVELOPMENT LLC Contractor License No: 078854 ell 8/12/2016 Building Official :r Date This permit shall be deemed abandoned and invalid unless the work authorized by this permit Is commenced within six?nonths 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 conform to 6e approved application-and the approved constructlbn documents for which this permit has been granted.., , All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. v G This permit shall be displayed in a location clearly visible from access street or road and shall be maintained openfor public inspection for the entire duration of the - work until the completion of the same. - Y The Certificate of Occupancy will not be issued until all applicable signatures by the Building.and Fire Officials ere provided on this permit, . H IC#: - 'Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). ` Restrictions: Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER. Certificate Number: 8-76.863 Permit Number: B.16-863 Commonwealth of Massachusetts City of Salem This is to Certify that the Multi anvil 3+ Building ..............f........ located at Building...............................g..................................................... Building Type 114 DERBYSTREET in the Ci o Salem ......................................................................................................................... h' Address ............................................:J..... ................................................................... Town/city Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY Unit D-1 HOUSE OF SEVEN GABLES This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires Not Applicable unless sooner suspended or revoked. Eviration Date Issued On: Thursday, January 12, 2017 Commonwealth of Massachusetts City of Salem i 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 Return card to Building Division for Certificate of Occupancy Permit No. 8-16-863 PERMIT TO BUILD FEE PAID: $1,034.00 DATE ISSUED: 8/12/2016 This certifies that HOU E OF SEVEN GABLES SETTLEMENT ASSOCIATION has permission to erect, al er, or demolish a building 114 DERBY STREET Map/Lot: 410014-0 as follows: Other Buil ling Permit REMODEL EXISTING SCHOOL AND MAKE INTO SIX (6) RESIDENTIAL HOUSING NITS. NEW FRAMING, ELECTRICAL, PLUMBING, HVAC Contractor Name: Joseph KOMURSKI DBA: SKOMURSKI D VELOPMENT LIC Contractor License No: 079 54 /fes 8/12/2016 Building Official Date This permit shall be deemed abandon d 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 o exceed six months each upon written request. I All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and change:.of use of any:building and structures shall be in compliance with the local zoning by-lavrs and codes. This permit shall be displayed in a locaticiin clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. I i The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. i HIC#: "Persons contracting with unregistered contractors do not have access to the guarantyfund"(as set forth in MGL c.142A). I Restrictions: Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER. Commonwealth of Massachusetts jL\ `~ �+ City of Salem 3 a 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 Return card to Building Division for Certificate of Occupancy kiksa Structure CITY OF SALEM BUILDING PERMIT PERMIT TO BE POSTED IN THE WINDOW Excavation ' ` Footing i INSPECTION RECORD i Foundation FraminW �L Mechanical Ji Insulation INSPECTION: BY DATE Chimney/Sm o e Ch lber jJ Final 3 II�tr�rlpi- v i p glumbing/GasA all Rough:Plu( �� Fill It (� _ /Kl l GSLi•"s` aA �/ �'" y Rough:Gas C Final $ - - Electrical Service „ Rough FinalSAW �'I � Oq� ' �� i V —] ��/ (N�►V Fire Department Preliminary Final /I�/ 4W� A/Ji2< � a/��� w tHealth Department 111W7J71� -273 Preliminary .2 rCj . 'iz4.4� G- Final I Certificate Number: B-16-863 Permit Number: B-16-863 Commonwealth of Massachusetts City of Salem This is to Certify that the Multifamily 3+ Building located at ----------------------------------------------------------------------- Building Type 114DERBYSTREETin the ------------- CityofSalem ----------------- Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY UNIT D2 HOUSE OF SEVEN GABLES This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires __.._._-._--Not Applicable -.unless sooner suspended or revoked. Expiration Date rA41� Issued On: Thursday, January 12, 2017 Certificate Number: B-16-863 Permit Number: B-16.863 Commonwealth of Massachusetts City of Salem This is to Certify that the M.ult.ifamily 3+. .....Building.. . .................................................... located at ........ . ... ... . ....... ................ . Building Type 114 DERBYSTREET in the Ci o_ Salem ................................................................................................................. .................................................................................................. Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY UNIT D3 HOUSE OF SEVEN GABLES This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires ...............................Not APPl!*k........_...__...._._......._ unless sooner suspended or revoked. E)piration Date CA4-1� Issued On: Thursday, January 12, 2017 co STREET PERMIT �RTa Citp of 6aremc Office of Intpettor of 3guilbingg C,,y Xalf, ,� � 20,J?l Jermission is 12'ere6y9iven to J J�F' —�J5 l�eM; ✓n lo occupyfor , M!�yt,(f�C �_pi purposes /� ~v infronl of eslale ( /-n" 1<�C/�",4 r%" a.t!lo l l � �tl - J � ofs�nlemaa,a. 1 ofslreel. .`7�rr's permit is Imiledlo /- '-C. +'�� � T 20 , su6 echo ISe provisions of 1Fre ordinances ano slalutes in refalron/o cSlreels ano"I e 9nspechon anti( onstructron of✓,3urldn9s in Ince C,yofcSafem. airec/or of/'�u61'c c$eroices v .9nspec%n of.'�uildn9,r i �,7 c$9na/ure of2ppl'can/ "� ' Certificate Number: B-16.863 Permit Number: B-16-863 Commonwealth of Massachusetts City of Salem This is to Certify that the .................................................... Multifamily 3+ Building located at Building Type 114 DERBYSTREET in the Ci .._o_ Salem ........................................................................................................................................ ............................................ f . . ................................................. Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY Unit T-1 HOUSE OF SEVEN GABLES This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires ...............................Not Applicable unless sooner suspended or revoked. Expiration Date Issued On: Thursday, January 12, 2017 Certificate Number: B-16-863 Permit Number: B-16.863 Commonwealth of Massachusetts City of Salem This is to Certify that the ...........................................................Multifamily 3+ Building located at Building Type .__...._.. 114 DERBYSTREET in the Cit o. Salem ............................................... .......................Address.............................................................................................. .........................................T. ..City Name ................................................. IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY Unit T-2 HOUSE OF SEVEN GABLES This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires ................................Not Applicable unless sooner suspended or revoked. E)piration Date Issued On: Thursday, January 12, 2017 Certificate Number: B-76-863 Permit Number: B-16-863 Commonwealth of Massachusetts City of Salem This is to Certify that the Multifamily 3+ Building located at ........................................................................................ Building Type 114 DERBYSTREET in the Ci o. Salem ........................................................................................................................................ ............................................. .f . . . ................................................. Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY Unit T-3 HOUSE OF SEVEN GABLES This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires Not Applicable unless sooner suspended or revoked. E)pirabon Date Issued On: Thursday, January 12, 2017 ` Commonwealth of Massachusetts P Citv of Salem I 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 - Return card to Building Division for Certificate of occupancy Structure CITY OF SALEM BUILDING ;PERMIT - 'Excavation PERMIT TO BE POSTED IN THE WINDOW, j Footing INSPECTION RECORD{{ Foundation .. ' fi Framincy l /r'+!M✓�� a r__....... �_.�..� a....__. ,.... R I Mechanical - t Insulation INSPEC ION: # By t$ DATE Chimney/Smoke Chamber -� - Final Plumbing/Gas 07 Rough:Plumbing s Rough:Gas, Final ° .. . i W Electrical Service t _ Rough Final (/ Fire Department y%G •�• Q /,. Preliminary Final Health Department � �� � !'�,�nL -/f- � (,l/�✓,yaJ/-�� �� j 111117 Preliminary Final _ Comm'o wealth of Massachusetts- City of Salem I 120 Washington St,3rd Floor Salem,.MA 01970(978)745-9595 x5641 Return card to Building Division for Certificate of Occupancy 6Y` 'Permit No, 8-16.863 � PERMIT TO BUILD" FEE PAID: $1,034.00 DATE ISSUED: 8112120116 t This certifies that HOU E OF SEVEN GABLES SETTLEMENT ASSOCIATION has permission to erect, al er, or demolish a building_ ,,.114 DERBY_STREET, Map/Lot: 410.014-0 as follows: Other Buil Ing Permit , REMODEL EXISTING SCHOOL MAKE INTO SIX (6) RESIDENTIAL HOUSING l NITS. NEW FR�►MING, ELECTRICAL, PLUMBING, HVAC Contractor Name: Joseph KOMURSKI -- DBA: SKOMURSKI D VELOPMENT LIC Contractor License No: 079 54 8/12/2018 Building Official / t Date This permit shall be deemed abandon d and invalid unless the work authorized b this �` p y permit Is commenced within six months jfter issuance.The Building Official may gram one or more extensions not exceed six months each upon written request. _ All work authorized by this permit shall conform to the approved application and the approved construction documents for whichthis permit has been granted. , All construction,alterations and changes,of use of any-building and structures shall be in compliance with the local zoning by-laws and codes. _ x e This permit shall be displayed in a locati n clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the. - - work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. r _ .-" . . H IC#; t "Persons contracting with unregistered contractors do not have access to the guaranty fund'(as set forth In MGL c.142A). Restrictions: `I Building plans are to be available on site: All Permit Cards are the property of the.PROPERTY OWNER. f _ . r{ ` Commonwealth of Massachusetts, it 1 120 Washington St,3M Floor Salem,MA 01970(978)745-9595 x5641 Citv of Salem Return card to Building Division for Certificate of Occupancy 1 PERMIT TO BUI Permit No. B-16-863 FEE PAID: $1,034.00 ,LD . DATE ISSUED: 8/12/2016 ? This certifies that HOU E OF SEVEN GABLES SETTLEMENT ASSOCIATION has permission to erect, al er, or demolish a building_- ,.,1,14 DERBY.STREET ( Map/Lot: 410014-0 as follows: Other Buil Ing Permit REMODEL EXISTING SCHOOL AND MAKE INTO SIX (6) RESIDENTIAL HOUSING l NITS. NEW FRAMING, ELECTRICAL, PLUMBING, HVAC Contractor Name: Joseph KOMURSKI _ BT DBA: SKOMURSKI D VELOPMENT,LkC (' Contractor License No: 079 54 ' i 1 8/12/2016 1 . - Building Official / f Date This permit shall be deemedabandon and invalid unless the work authorized by this permit is commenced withins/xi rttonthsfter issuance.TheBuilding Official , may grant one or more extensions not to exceed sic months each upon written request. _ All work authorized by this permit shall conform onform'to the approved application and the approved construction documents for whichthis permit has been granted.All construction,alterations and..change:;of use of any:building and structures shall be in compliance with the local zoning bylaws and codes. . - pp 3 � This permit shall be displayed in alocatilit cleariy visible from access street or road and shall be maintained open for public inspe n for the entire duration of the work until the completion of the same. t The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials,are provided on this permit.. H IC#: - "Persons contracting with unregistered contractors do not have access to she guaranty fund"(as set forth in MGL c.142A). " Restrictions: Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER. r , Commonwealth of Massachusetts Citv of Salem i 720 Washington Sl,3rd Floor Salem,MA 01970(978)745-9595 x5841 Return card to Building Division for Certificate of Occupancy Structure CITY OF SALEM BUILDING PERMIT Excavation PERMIT TO BE POSTED IN TH . WINDOW Footing4 INSPECTION RECORD Foundation fIP Framl Mechanical ._•._ .,_ .�_ ..�__ . _-�,....,,,: I" .i Insulation INSPEC ION: i' BY DATE Chimney/Smoke Chamber Final /'"h'tl— � Plumbing/Gas 5 �� Rough:Plumbing Rough:Gas �/ .~ Final UAElectrical Service Rough , j Final (f#I4 Fire Department Preliminary Final _ /// ,t,��j. /,(� -",' ![•� /`/.� a. a .vv. Health Department7-1 rt_ Preliminary Final k o co cf= 10-7 Z 1;03 Glc ► 001 �� The Commonwealt of ssachusetts Department of Public Safety c(� Massachusetts State Budding Code(780 CMR) l\ Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Budding Permit Number: Date Applied: Building Official: ` SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) g0;uLlh SI S4 til 0(13.0 S¢-dlerhe c7" mouse, No.and Street City/Town Zip Code Name of Budding(if applicable) SECTION 2:PROPOSED WORK. _ 6 ,ty\II Edition of MA State Code used_ If New Construction check here❑or,check all that apply in the two rows below Existing Building Irl Repair❑ 1 Alteration fti( Addition❑ 1 Demolition ❑ (Please fill out mad submit Appendix 1) Change of Use ❑ 1 Change of Occupancy I Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes Mr No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑ Brief Description of Proposed Work: ( Mo Q S A rZ 0n R RAAdC� / 4 00i1n w per 4 G M — 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)&Area Per Floor(sq. R.) 000 *C0 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-i❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ -H-3 ❑ H- H-5[31: Institutional 1.1❑ 1-2❑ I-3❑ 14❑ M: Mercantile❑ R: Residential R-113 R_2 R-3 11R-4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 111 IIA ❑ IIB [3 IIIA ❑ 11113 IV.❑ 1 VA 13 VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Suppl}^ Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Licensed Disposal Site Public g Check if outside Flood Zone 'Indicate municipal A trench w" not be P required or trench or specify: Private❑ or indentify Zone: or on site system❑ permit is enclosed❑ Railroad right-of-wa Hazards to Air Navigation: kl'�i h t ric C.,mnni'si n it 'w i nx�+s: Not Applicable K Is Structure within airport aPpr ach area? Is the.ir revrc ona pleted. or Consent to Build enclosed❑ Yes❑ or No7 Yes I�o ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: CA-\t-.L—D LA P�s �, IN "A 5f TX SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Addre3lVf Property Owner Name(Print) No.and Street City/Town Zip Property Owner Contact Information: ,ja�e .SK0MV1,r h. sc>9 7 _3�1* J SKornr�ysk��GMA�( . caly`-- Title Telephone No.(business) Telephone No. (cell) e-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 budding permit application, SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) if budding is less than 35,000 cu.ft.of enclosed-space and/or not under Construction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Se S e / qZr_ k t ¢.tc+ _ -7f PvZyd Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor SKo PAWS 6:1 t2e,t,loprheA( Company Name yo�SOp�I S1rOMuyS�, GS = 07 `[SS � i� Name of Pers n Responsible for Construction License No. and Type if Applicable P.O. ft zoo`j t ;yAv«t, A4,4- 40 ( 17-,3 Street Address City/Town State Zip 508 qbZ_ 311Y_ J SkoMvpj,Ki �GN�s( . Gates. Telephone No. business Telephone No. cell e-mail address SECTION 11:WOR1:EIt5'COAIPGNSA'110N INSURANCE M-FiDikV['f 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 iadance of the building permit. Is a signed Affidavit submitted with this application? Yes Br No ❑ SECTION 12:.CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1. Building $ Go D' Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ 80,000 appropriate municipal factor)_$ 3. Plumbing $ 86, 006. d. hledumical (HVAC) $ 60,000 Note: Minimum fee=$ (contact municipality) 5. Mechanical Other $ Enclose check payable to 6.Total Cost $ yQ Old (contact mmnicipality)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 i3pp4cation is true and accurptet the best of my knowledge and understanding- SOF SOF f`L_ Ple, a rim and s' Onam - / O Title Telephone No.2 Date w �C� ghrh'*S acs 3 SirAddress /U-i— Yet57 "__r City/Town State Zip Municipal Inspector to fill out this section upon application approval: Name Date • '• 0 • • OA 940 • x 11 _ 109340 • . O . . OA 940 • x 1 1 _ 10 , 340 • 9� i • • 0 • • CA • 0 • • CA 740 • x 11 _ 8 . 140 - 0 • • CA 8 , 140 • + 1 , 034 • - 7 , 106 7 , 106 • G * ChYOFSALEA NASSAaREETP.' 0 BEKVMDl;rAJMWxr 120 W.temtr,MSTNEer,rFioaa ]131. 745-'7595. F�rPM740.9846 HII�ERIEYDRIS�.L MAYQR ?t3asST.P�tnE Drnacr+cat cFFU9JCRW1WtTT/BUMW4G00MWWQNMt Construction Debris Disposd Affidavit (required for all demolition and.renovation work) in accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debfis; and the provisions of MGL cW, S 54; Building Permit B is Issued with the condition that the debris resulting from this work shall be disposed of in a properiy licensed waste deposit facility as defined by MGL c 111,S 150A. The debris will be transported by: /New 67Af(G4j (name of hauler) The debris will be disposed of in: k, (name of facility) (address of facility) Signature of applicant Date The Commonwealth ofmassachuseds Depardnent ojlndushWAccidents I Congress Street,Suite l00 Boston,MA 02114-2017 wwwmassgov/dia Workers'Compensation Insurance Affidavit:Bunters/ContractorsMiectricians/Plombem TO BE FMM WITH TBE PERNnT NG AUTHORITY. Applicant Information Please Print I.eeibly Name(Business/Orgamzationaudividual): SM6fAVrS(C% 0eVA�opMe0! Address:_ -pO.Ae' 200 17 City/State/Zip: DSK t hNdc- ai9 Z3 Phone#: Are you an employer?Check Me appropriate box: I.O l�,n a employer with T�Vpe of project(required): eagnloyas(full amd/m par'time),• z I=a sok proprietor or partnership and have m 7. Ne/w construction my capacity-[No warkers'comp.imoraces mquami�Y�s x'eloma forme in 3.❑1 am a homeowner,doing all wad,myself[No worker'comp.insurance required.] t 9. L❑DCtn�OlitlOn 4.Q I am a homeowne and wr71 be biding contractors to conduct a0 work m my property. 1 will 10❑Badding addition ensure that all con"ams;either have workers'compenvatioa in..uce or am sole I LE J Electrical repairs or additions proprietors with m er�loyeo. s. lama 12.0 Plumbing repass or additions ❑]hese hers 6a I have hued the rob-conaagore Ind on rhe attached sheat. employee and have workers•came imsurenmi 13.Q Roofrepairs 6.Q we are a corporation and its offices have eretcised thekright ofexemption per MGL a 14.❑Other and webave m earployas.[No worker'cmap-:..,...s....requ'per *Any applicant that checks box#1 must also fill out the section below sbowba their workers'mWomtian policy irdematien. Homeowners who suhsuit this affidavit mdicat ng they=doing all wok and than hie out ide contrutm must submit a new a$rdavit indicetimg such ?Contractors that check this box must attached m additional shat showing the muse of the sub-canmages and state whether a act those entities bac eruployees. tftbe mb<mmacrors hm employn4 theY must provide their worker•cmnp.policyymmnber. I am an employer that is providing workers'compensation insurance fOr my employees. Below is the policy and job site injormarton Insurance Company Name: Policy#or Self-ins.Lia M Expiration Date: Job Site Address: ci$/StatdZip. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required trader MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year impnsirmn=4 as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. [ao hereby cert? radon the pains andp es !f, * 'that the mjormadon provided above is true and correct S' stare: 5 —Date: F 1 26/6 Ph a M OBSuaI use ty Do not write in ibis area,to be completed by city or town offlekl City or Town: Perlult/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,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 the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction 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 states that`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 any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have - employees,a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sore to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter 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 Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple pennittlicense applications in any given year,need only submit one affidavit indicating current policy information(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 that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia CITY OF SALEM ROUTING SLIP New Construction ��Ua Certificate of Occupancy J LOCATION 1`f/�Qa� DATE V vl Sc Z D� ASSESSORS DATE 93 Washington CITY CLERK ATE 93 Washington PUBLIC SERVICES 01 — DATE b 120 Washington St. WATER PATEGb 120 Washington St. o CROSS CONNECTION_`DATE 5 Jefferson Ave PLANNING ("_DATE f Z 0 lQ 120 Washington St. / CONSERVATIO TE J� l ,4s 120 Washington St. ELECTRICAL DATE �T�// 48 Lafayette FIRE PREVENTION DATE %- ;— L(n 29 Fort Avenue �7 J HEALTH � DATE L , ;'7 '/(J 120 Washington St. BUILDING INSPECTOR DATE `120 Washington St. l f - Commonwealth of Massachusetts , City of Salem 120 W nhington St,3rd Floor Salem,MA 01970(978)7459595 x5841 Return card to Building Division for Certificate of Occupancy - FEE PAI : $1 8-16-863 PERMIT TO B FEE PAID. $1,034.00 DATE ISSUED: 8/12/2016 This certifies that HOUSE OF SEVEN GABLES SETTLEMENT ASSOCIATION has permission to erect, alter, or demolish a building 114 DERBY STREET Map/Lot: 4100140 as follows: Other Building Permit REMODEL EXISTINGSCHOOL AND MAKE INTO SIX (6) RESIDENTIAL HOUSING UNITS. NEW FRAMING, ELECTRICAL,PLUMBING, HVAC `+ Contractor Name: Joseph SKOMURSKi _ DBA: SKOMURSKI DEVELOPMENT LLC Contractor.License No: 079854 f 8/12/2016 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 conform to the approved application and the approved constructon documents for which this permit has been granted. All construction,alterations and changes of use of anybulklirlg and structures shall be in compliance with the local zoning by-laws and codes. This perm shall be displayed in a location clearly visible from access street or road and shall be maintained open for pubfic Inspection for the entire duration of the work until the completion of the same. r The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. ` .. HIC#: "Persons contracting with unregistered contractors do not have access to the guarapty fund"(as set forth In MGL c.142A). Restrictions: Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER.. Commonwealth of Massachusetts � r City of Salem l� - 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 ° Return card to Building Division for Certificate of Occupancy Permit No. B-16-863 PERMIT TO BUILD FEE PAID: $1,034.00 DATE ISSUED: 8/12/2016 This certifies that HOUSE OF SEVEN GABLES SETTLEMENT ASSOCIATION has permission to erect, alter, or demolish a building,_ 114.DERBY,STREET- _ Map/Lot: 410014-0 as follows: Other Building Permit REMODEL EXISTING SCHOOL AND MAKE INTO SIX (6) RESIDENTIAL HOUSING UNITS. NEW FRAMING, ELECTRICAL, PLUMBING, HVAC'\ r Contractor Name: Joseph SKOMURSKI - '1 DBA: SKOMURSKI DEVELOPMENT LLC �- 1 Contractor License No: 079854 8/12/2016 Building Official ,r 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 conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. HIC#: •Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). { Restrictions: Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER. pNO`T° Commonwealth of Massachusetts r Citv of Salem a a m 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 .,'�,� Return card to Building Division for Certificate of Occupancy Structure CITY OF SALEM BUILDING PERMIT PERMIT TO BE POSTED IN THE WINDOW Excavation Footing INSPECTION RECORD Foundation Framing Mechanical T - Insulation INSPECTION: BY DATE Chimney/Smoke Chamber 1 Final flo Plumbing/Gas Rough:Plumbing Rough:Gas Final Electrical k Service Rough 1 I Final r Fire Department Preliminary Final % doHealth Department � Preliminary Final °�, Commonwealth of Massachusetts t ' City of Salem � Inspectional Services U�_ N M, RECEIPT 120 Washington St,3rd Floor Salem,MA 01970 Phone:(978)745-9595 X5641 Application For Building Permit (For Buildings other than a One- or Two-Family Dwelling) (This Section for Official Use Only) PIN: B-16.863 Date Applied: 8/3/2016 Building Official(Print name): SECTION 1: SITE LOCATION (Please indicate Block#and Lot#for locations for which a street address is not available) 114 DERBY STREET , Salem, MA SECTION 2: PROPOSED WORK Are Building plans and/or construction documents being supplied as part of this permit application?: No Is an Independent Structural Engineering Peer Review Required? Yeses No❑ Brief Description of Proposed work: REMODEL EXISTING SCHOOL AND MAKE INTO SIX (6) RESIDENTIAL HOUSING UNITS. NEW FRAMING, ELECTRICAL, PLUMBING, HVAC SECTION 3: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION, ADDITION,OR CHANGE IN USE OR OCCUPANCY(Check Here_if an Existing Building Evaluation is enclosed (see 780 CMR 34)) Existing Use Group: Proposed Use Group: SECTION 4: BUILDING HEIGHT AND AREA Existing Proposed No. of Floors/Stories(Include basement levels)&Area Per Floor(sq.ft.) 00.00 0 0.00 Total Area (sq. ft.)and Total Height(ft.) 0.00 0.00 0.00 0.00 SECTION 5: USE GROUP SECTION 6: CONSTRUCTION TYPE Multifamily 3+ 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 if inside Flood Zone Municipal will not required ❑ Licensed Disposal Site or or El Identify Zone: Is enclosed ❑ or specify: Railroad right-of-way: Hazards to Air Navigation: MA Historic commission Report Process: Is Structure within airport Not applicable p approach area? Is their review completed? or Constant to Build Enclosed ❑ Yes ❑ No 0 Yes ❑ No ❑ SECTION 8: CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Cade: Use Group(s): Type of Construction: Occupant Load per Floor Does the building contain a sprinkler system?:#Error Special Stipulations: SECTION 9: PROPERTY OWNER AUTHORIZATION THIS IS NOT A PERMIT N�oNmp� Commonwealth of Massachusetts 3 City of Salem a a 9 ! Inspectional Services RECEIPT 120 Washington St,3rd Floor Salem,MA 01970 Phone:(978)745-9595 x5641 - �-I HOUSE OF SEVEN GABLES SETTLEMENT 115 DERBY ST SALEM MA 01970 ASSOCIATION If applicable,the property owner hereby authorizes Joseph SKOMURSKI 107 BRADSTREET AVE/POB 2009 DANVERS MA 01923 To act on the property owner's behalf,in all matters relative to the work authorized by this building permit application. SECTION 10: CONSTRUCTION CONTROL(Please fill out Appendix 2) (If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then skip Section 10.1) 10.1 Registered Professional Responsible for Construction Control Name Phone Email Registration Number Address Discipline Expiration Date 10.2 General Contractor SKOMURSKI DEVELOPMENT LLC Company Name 079854 CONSTRUCTION SUPERVISOR Joseph SKOMURSKI License no. and License Type if Applicable Name of Person Responsible for Construction Address: 107 BRADSTREET AVE/ POB 2009 DANVERS MA 01923 Phone ( ) Email Address jskomurski@gmail.com SECTION 11: WORKER'S COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152§25C(6)) 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 SECTION 12: CONSTRUCTION COST AND PERMIT FEE Total Estimated Costs(Labor and Materials): $940000.00 Building Permit Fee: $1034.00 Enclose check payable to the City of Salem, Ck# 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 to the best of my knowledge and understanding. ( ) Please print and sign name Title Telephone Address: 107 BRADSTREET AVE/ POB 2009 DANVERS MA 01923 Date: 8/3/2016 Municipal Inspector to fill out this section upon application approval: 8/12/2016 Name Date THIS IS NOT A PERMIT Commonwealth of Massachusetts I City of Salem 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595x5641 �� I Return card to Building Division for Certificate of Occupancy Permit No. B-16-863 PERMIT TO B FEE PAID: $1,034.00 DATE ISSUED: 8/12/2016 This certifies that HOUSE OF SEVEN GABLES SETTLEMENT ASSOCIATION has permission to erect, alter, or demolish a building__ ..-1-14-DERBY STREET Map/Lot: 410014-0 as follows: Other Building Permit REMODEL EXISTING SCHOOL AND MAKE INTO SIX (6) RESIDENTIAL HOUSING UNITS. NEW FRAMING, ELECTRICAL, PLUMBING, HVAC Contractor Name: Joseph SKOMURSKI - - -- _ DBA: SKOMURSKI DEVELOPMENT LLC Contractor License No: 079854 + 8/12/2016 r Building OfficialDate 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 conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of anybuilding and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. FiIC#: 'Persons contracting with unregistered contractors do not have access to the guarantyfund'(asset forth in MGL c.142A). Restrictions: f/ Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER. Commonwealth of Massachusetts aCitv of Salem La a 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 Return card to Building Division for Certificate of Occupancy Structure CITY OF SALEM BUILDING PERMIT PERMIT TO BE POSTED IN THE WINDOW ' Excavation Footing INSPECTION RECORD Foundation Framing Mechanical Insulation INSPECTION: BY DATE Chimney/Smoke Chamber 1 Final +P',L Plumbing/Gas �• i 1 Rough:Plumbing f , Rough:Gas fit' I Final ElectricalLa `! Service Rough I Final j Fire Department (r Preliminary jr Final Health Department _ Preliminary Final pONaIT,� Commonwealth of Massachusetts 6 I City of Salem 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595x5641 t Return card to Building Division for Certificate of Occupancy \-- Permit No.$8 8-16-863 PERMIT TO B FEE PAID: $8,140.00 DATE ISSUED: 8/12/2016 This certifies that HOUSE OF SEVEN GABLES SETTLEMENT ASSOCIATION has permission to erect, alter, or demolish a building^1-14.DERBY.STREET� Map/Lot: 410014-0 as follows: Other Building Permit : REMODEL EXISTING SCHOOL AND MAKE INTO SIX (6) RESIDENTIAL HOUSING UNITS. NEW FRAMING, ELECTRICAL, PLUMBING, HVAC Contractor Name: Joseph SKOMURSKI - -- DBA: SKOMURSKI DEVELOPMENT LLC , Contractor License No: 079854 ' 8/12/2016 _ f 3 Building Official 1' 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. I All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. 1 } 4 This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. 1 J / The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials-are provided on this permit. HIC #: "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.1 42A). Restrictions: Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER. t Commonwealth of Massachusetts G .It� Sheet Metal Pei M RE' �51R-Vs;,t Date: 2 -50 101b NaVeQ2rlit s� llk t7 Estimated Job Cost: $ Permit Fee: $ V 1 Plans Submitted: YES_ NO_ Plans Reviewed: YES NO_ Business License# -3 S � Applicant License# Business Information: Property Owner/Job Location Information: Name; / �t��`� 2 n�C_ Name: _ �b Street: -( Je1�c�Q� �2 � Street: I t `-f City/Town: City/Town: Telephone: Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES NO Stafflai6al J-1 fp11 nrestricted license N 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_ u Commercial: Office Retail Industrial ' Educational Institutional_ Other_ Square Footage: under 10,000 sq. ft. over 10,000 sq. ft._ Number of Stories: t,.° Sheet metal work to be completed: New Work:f� Renovation: HVAC Metal Watershed Roofing_ Kitchen Exhaust System t Metal Chimney/Vents_ Air Balancing Provide detailed(description of work to be done: 4 INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes pf No Ye If you have checked s,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 ?I Owner ❑ Agent ❑ Signature of Owner or Owner's Agent -J' By checking this 1 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best f m nowledge 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, I' Duct inspection required prior to insulation installation:YES NO_ 2 k Progress Inspections Date Comments � T •P.e `Final Inspection Date Comments Type of License: By _ - Master Title ❑Master-Restricted Q a City(fown - ❑Joumeyperson Signature of Licensee Permit# ❑Joumeyperson-Restricted License Number: Fee$ - !. / Check at www.mass.govldpl #F Inspector Signature of Permit Approval r c Commonwealth of Massachusetts ^-{{ Sheet Metal Per"W NAL z'v.' .F: Date: A 2- 1 —05 IBIb NoNegit pA p: 2 p 1 Estimated Job Cost: $ t N, Permit Fee: $ Plans Submitted: YES— NO Plans Reviewed: YES_ NO Business License# (�u�j �j(p0�� Applicant License# r(t�` Business Information: Property Owner/Job Location Information: ` Name: 4 2 �;>DK =P )C_ Name: 24c c y Street: `-I 3e, Street: I ( `( _DQ(-+� G c� I City/Town: t ) l \ -vim 7--a n City/Town: S_ L2e�` Telephone: n - „�.� '� -V(/ Telephone: '6 q Photo I.D. required/Copy of Photo I.D.attached: YES NO Staff Initial ,. J-1 f-1 nrestricted license ilk J-2/M-2-restricted to dwellings 3-stories or less and commercial up to:10,000 sq.ft./2-stories or less r r .. Residential: 1-2 family— Multi-family Condo/Townhouses 5L Other R - Commercial: Office '' Retail Industrial Educational Institutional Other Square Footage: under I0,000'sq. ft. !!�L_ over 10,000 sq ft._ Number,of Stories: 'a heet metal work to be completed: New Work:y( , Renovation: HVAC Metal Watershed Roofing_ Kitchen Exhaust System_ Metal Chimney/Vents Air Balancing Provide detailed1 description of work to be done: 14 CAI ^ Fk�jC- 1S i ry _ ,o INSURANCE COVERAGE: I Have a current liabili insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes L1f' No❑ If you have checked Yes,indicate the type of coverage by checking the appropriate box below: 41 A liability insurance policy Other type of indemnity ❑ Bond ❑ 1,f 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 ❑ f_r Signature of Owner or Owner's Agent u `I By checking this b xxII hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best tSf m�lcnowiedge 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. aF Duct inspection required prior to insulation installation:YES_NO Pro¢ress Inspections Date Comments Final Inspection Date Comments Type of License; By ,. Master Title ❑Master-Restricted City/Town � - ❑Joumeyperson At Signature of Licensee Permh# y. ❑Joumeyperson-Restricted License Number: Fee$ . ❑ .. - - . Check at www.mass.tlovldpl J Inspector Signature of Permit Approval _ .. . �2 �5 �-�ctoo3 - ������s��►`�� �b- f � - `� °� � ; ,p�. � The Commonwealth of Mpg�}S�s�luiSelRs '� Deparhnent of Public�Nt�ty - � 4� Ivtassachusetts State Building Code(780 CMR) Building Permit ApplicaHon Eor any Building other than a One-or Two-Family Dwelling (This SecHon For Officiai Use Only)� � � Building Permit Number: Da[e Applied: �Build'uig Offici�l: SECTION 1:LOCATION(I'lease indicate Block k and Lot lf for locations for which a street address is nohavailable) �'�De� 4 sT S4le� or�i �a No.and Stree[ City/Town Zip Code Name of Building(if applicable) SECTION 2•PROPOSED W02K. � � Edition of MA S[�[e Code used_ [f New Construc[ion check here O or check all tha[apply in[he two rows below Existing Building Repair❑ AI[eration ❑ Addition❑ Demolition (Please fill out:vid submit Appendi�c 1) Change uf Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction docwnents being supplied�s part of this permit applic�tion? Yes [Jo 81 Is vi Inctependent Structural Engineering Peer Review reyuired? Yes ❑ No � Brief Description of Proposed Work: � Ma✓ w ! �� 2� rN� A'�s .rt'/�S � SECTION 3:COMPLETE TFIIS SECTIOIV 1F EXISTING BUILD[NG UNDERGOING RENOVATION,ADD[TION,OR CHANGE IN USE OR OCCUPANCY - � Check here if an ExisHng Building InvestigaHon and EvaluaHon is enclosed(See 7S0 CMR 3�k) � Existing Use Group(s): Proposed Use Group(s): SECIION 4:BUILDING HEIGHT AND AREA � Existing Propose�l No.of Ploors/Stories(induale basement levels)&Area Per Floor(sq. ft.) 3tlCi� � '�-'- �AS - Total Area(sy.ft.)and Total Height(ft.) " 3 S` ,3 S � SECT[ON 5:USE GROUP(Check as a plicable) . - A: Assembly A-1 � A-2❑ IVightclub ❑ A3 ❑ A-i❑ A-5❑ B: Business ❑ E: EducaHonal ❑ � F: Fazto F-L❑ F2❑ H: Hi h Hazud H-1❑ H-2❑ H$ ❑ H-�4❑ H-5❑ I: InstituHonal I-t❑ I-2❑ [-3❑ I-1 O M: Mercantile❑ R: Residential R-1❑ R-2❑ R-3❑ R-4❑ S: Storage Sl ❑ SQ❑ U: UHlity❑ Special Use O and please describe beluw: . Special Use: SECTION 6:CONSTRUCTION'CYPE(Check as ap licable) IA ❑ 160 IIA ❑ IIB ❑ IIIA ❑ ❑IB ❑ N ❑ VA ❑ VB ❑ SECTION 7:SITE INFORI�IATION(refer to 780 CMR 111A for details on each item) Water SupJply: Flood Zone InformaHon: Sewage Disposal: Trench Permit: Debris Removal: Public A trench wlll not be Licensed Disposal Site❑ 6p Check if outside Flood Zone [ndicate municipal reyuircd O ur[rench or specify: Private❑ or indentify Zone: oc on site system❑ �ermit is endosed❑ Railroad right-of-w�}a�. Hazards to Air Navigation: �J�\I lun.�q�"�n�n�7s�m,�ic � �� I r,.u__e: Nut Applicable CY Is S[ructure within airport ap oach area? Is thcir rcv�� completed? ur Cunsent to Build endosed❑ Ycs O ur No� Yes�No O SECTION 8:CONTENT OF CERTIF[CATE OF OCCUPANCY flditiun nf Code: Use Cruup(s): Type of Cnnstructiun: Octupant Load per Ploor: Does the 6uilJing cunt:iin an Sprinkler S}'stem?: Special Stipulations: 'l � l2 U'�.v�—r`YJ �t� 5 -- H�. w��-�. P ] u W�'O 'l �l"3 � '+ '�' ��SECTION 9: PROPERTY OWNER AUTHORIZATION ' Na�m/e and Fljddress uf Property O�vner ?�,,� /� ' ,� - I�Z �el-!Oy ���OMi{U4L�7 US� -�_ ('"!" ZlJG� �GN'���P, /�IT d� � 2� Name(Print) No..and SY eet City/Town Zip Prope ty Owner Cont�ct h.fomi�tion: � - 2 �02 �'Ko�„w,r� S68 _96Z_ 3Si� J SKcs Mu�.s/4` � G- � -�'- Title � Telephone No.(business) Telephone No. (cell) e-mail address � If applicable,the property owner hereby authorizes Nzvne Stree[Address City/Town State Zip to act on the ro er owner's behalf, in alt matters relative to work authorized b this buildin ermit a lication. � SECTION.10:CONSTRUCT'ION CONTROL(Please�fill out�Appendix 2j� , � . � � Tf buildin is less than 35,000 cu.ft of enclosed�s ace and-or not undee Construction Conhol then cheek here O and ski� Section 10.1 101 Re isfered�Professional Res onsible far ConstrucHori Control � - � � � �� - � � Name(Registrant) Tclephone No. e-mail address Registration Numbcr Strcet Address City/Town State Zip Discipline Expintion Date 10.2 General Contractor � n' � � � � � � � � - � � - � � ,S�o m�rt �� //2ve.(opn�Qa� Company Name �_Tve S�on,���i` G � —O � ��S-S`l� Name of PersFo7n Responsible fur Construction License Nu. and Type ff Applicable . �• 6- I�F`f �oG�j QGh�.�F'f /�— �l�Z3 Street Address City/Town S[ate Zip ___ S6� _1`'�Z_ 3S JSKoM��zs.�c� `a7 �hta�l- Cow�_ Tele hone No. business Tcle hone No. cell e-mvl address SECTION 11:6VOItI:ERS COA�IPENSi1190N IIVSUR:\NCfi APFIIA\Vff M.G.G:c.152 25C 6 � � A Workers'Compensation Insurance Affidavi[from the MA Deparhnent of Industrixil Accidents must be completed and submitted with this application. Failure to provide this affidavit will resul[in [he denial of the issuance of[he building permi[. Is a si ned Affidavit submitted wi[h [his a lication? Yes O No ❑ � � - SECTION 12:.COIVSTRUCTION COSTS AND�PERMIT FES�- �� � � � Item Estunated Costs:(Labor - and Materials) Total Cons[mctiun Cos[(from Item 6)_$ 1. 6uilding � Building Permi[Fee=Total Construction Cost x_(Insert here 2.Electrical $ appropriate municipal fac[or)_$ 3. Plumbing $ .. 4.hfechanicat (HVAC) $ Note:Minimum fee=$ (cont�ct municipality) 5. hfechanical Other � Enduse check payable to 6.Total Cost $ Z S d0C (contact municipality)and write check number here SECTION 13:SIGNA7"URE OF BUILDING PERMIT APPLICANT 6y entering my mm�e below,[hereby attest under Nie pains and penal[ies of perjury that alt of the information contained in this application is true and aaura[e to the best of my knowledge and understanding. / J��G� SfC��,,�r.f� ` pc�hz� 5GS_ 1.6Z 3F(� 7/6 /.6 c Pleue print and si n name TiNe Tclephone Nu. Date _o . � z� p9��1 �--- aisz-� Stree[ AdJre � � � _ City/Town State Zip L b�lunicipal lnspector to fill out this section upon application approval: � �'+' ' "1.�w� � ��/l Name Da[c � 114 DERBY STREET CONDOMINIUMS � 114 DERBY STREET, SALEM, MA GENERAL NOTES SYMBOLS DRAWING INDEX � -- -- ----._ __.-_-_- _____� �� ^�i r.�. � sx�'r oescAiarroN f��°' �� � I �. �a�.,nno.ueopo�r�wvn��Qemm�xe.e,pea �sm� �O oamw� > �' . ayM.eam.rmmr.ea�rmmr.w.�uwtm.em.e �� � „� . . . � ,'��I .n�e,wyae er u.vaa.e. I z ie u.em or w�nmm'myIe�u..w.w�w ee�mn�m.a !� . �amus�mu m � wn�vme COVFft i .. "�y. ,�. �\ bmav MU Me equYninh aI1M WNp u11WXY bHq �f 9FC�IRYEfY bllN Of � J" '+. � �r'�'�� �Y r"mtl"`°'^'^"'w�a'^"�"°�'"'a'�"•r G1 EXIS7ING CONDIiION 517E PUN i j��� � �y � �� ��� ff.�l i ii e ue mn�n u.aninn m a�.ob new mennb a>xamm w /i�mu rw�ax � 5 mx� !,, �1 .. . .. .\ /� � pe.m m w w�w.e n qqnt rn�ow. m ro�•vm'mr (� 'si¢r wsa � P2 SIIE LAYOIIT PUN ( �'� � ',�! � � �j�� i RmnMe 1M d'rin�W tlw�n mv b mYe p^Mm w�wF0 L`e `�'� � �. ry �[ �? euwnni lne m.o-siu a�a w.iw�w��b b r �venw iwii Arohi[xNral i i J J '� r1. `-+, � --.-���` ��°.on�m�,�ma.enm.,�n,i.nwu: L --� 'v° � . �j ' f 7 �m�� ���� D4A BASENENT�EMOLI110N PLANS I :�� 'S � -m"''� �� � ui.en p.wmd ey a.a.wa uenv eei�q�ae a�mm.m o-- vmra nvE 0 [nwwsan Dt.i FlRST FLOOR DEMOLI710N PLANS �� ✓d ve.mm w16q mda�mmm mtl rqehFina ewq rNn ol ou�muwuv mmp�rm. m.�..e o-:m.s�o-s�m FE� �� �-12 SECON�FLO�R DEMOLIiION PLANS � { � � � d�^^����"�^ u ^a^^^'�'°�°°^" 61.3 ELEVAiION �ENOLIlION NOiES I � j �i 3�ryy( =n* . � � : ,��.b�,��a��,�,n�.�,.�.�,�.�� PROJECT INFORMATION a,.a �E�Ano� oE�o��no� �o,�s } - 3 _ r ,�; ---, emmn�s uom,wr�r�m�ee emwnv em�arn�n�.m wury ; :� }' ""^- �� u,,,mr m mr�„��,ww,�a„m„�w,d/d....aw..y p-0.o PROJECT SPECIFlCA770N5 . _ � v�m��a mr wHa.b u�oimo..a m. m.mnnm m A-0.1 SCHE➢ULES. DETAILS&WALL 1YPE5 � �� .o� r . `� - U o � i.e.n.e��+a�.nee.e�e.awe n burmm,. m. � � a � t � Z 1� c' �a emm�+=k+aa/s�rm me u..mn a.en aw� iannom n�owev s�cc vuv.v. A-t.t 9ASEA4ENT PIAN � � �� �.rn q u r.qwwmv o/w ease�ecb m rom'n nqva a M��e�is sm��wm+�.m�ik�u,.u er�.+ univaz mcce ma imc�tt 11-t3 SECOND ROOR PLAN i .�� r y �f�-.. i �.'il� a ., � � Vj�o � E a+�.m•e om/er�e�m.n�a mw ro+e� zes mc./a nerz em mnori uioaars v�nnrz A-1.3 iHIRO ROOR PLAN �. ,`� � . l7 �.. _� i- � w av,ya m w wu�e.'enMue. w°������� A-21 ENLARGFD PLANS- STAIRS � { .�{ :� ��. . I i W � � m y, i �t j r. m q�.e«�e�s xm a..p�w pmss m�n io w�r,t.ioi.. ue siert�m�uc.0 moc A.22 ENLARGED PLANS- BAiHS �� � �� � . � 3 I �� . ��.: __�- -"-_- F j A m.�.+e��o�mwre.wm,uu,�wwm ar arcrrwsu:owiem-uv i � � . i r ma im m�wa m u.m.oi emino>�W+ � A2.9 ENLARGE�PLANS- KITCHENS I � , �� � � ._ -_ - ''"'�— , � _ �U � � ZONING AND BUI�DING DATA � � . . m � a me a..m�e�nu ree w�ry ai..�'.y.m mwuon w.��u A-9.1 EXIERIOR ELEVA710N5 _^ _��;�_-�=--' ""-` . . ' C) � N a e�a.a.aa n.<�ws�m w.wi m mr w�w�m w.,n. zoomc psm¢r. e-i,eusMs A-s2 E%lERIOR ELEVNPONS . . . � . . � Q-' Q vi r �curs uwien r�snxc namasn ` ,„,_:. . � fn m �- _-.^..- . PoSnP. �b vA mxvm NL a d�uT1 b Me ave' ' .__ . .' . 1, Q .� �����y�� WN.LOT 9� 8.�SF 11,M]4 ND GUNCE A•9.1 BIIILDING$ECIION$ � �, ; � T� 4�yj xx.wi exe.V o u. - - - p.5,� WpLL SEC➢ONS � � � . �. � � - s. r.w���w.m ea e.�.w.m�m.�n.a��m u.u.�or m�.mr.cc � �za nx �-...'-' ' . . . . � a _$ m �m�w�.a..mo..an��mro a..m�a m,�.w m„we so[nwo io• a uxE n.0 xo awK[ A�.t DETAILS �_....__ . . _.__._ . __._"_" _-�_.___- ' W °�"^m^^°°°`°"e"'^°` Flmui vnNo �s' a.3 xo aaxts A-]d BASEMENt Rff. CENNG PLANS ��- ����- �"��-�-��-'_'- � �� °��' � �o o.wim�rom u..mo�.n n u..a.wme�q�xei b i..w.e e.�a rtiW w' a�.e' xo au+c[ q_�,p FlRSi ROOR REF. CEILING PLANS fn �� °%. er u.vtl+tst me m�e.rer W b u..lv1 N.N in wMa �+.y iFplinCE 60' R31.3T ND fHM'GE m+naer�uee�i..an.n��we�..�au.� roExSP�CE - - - A-]3 SECONDFLOORREF. C�LINGPIANS Owner: Architect: r�mw x w q�wa aoiamr. '�� "•'"°^"�mPeie°"'r+� ��e���� '""'1°101°""PE '��"""vMi°� snucwrel 114 Derb Sireet Nominee Trust Se er Architects,Inc. o��..�.ma m.nen m8nad-�u�.e.nw. Y 9 rz m.g..�e�w�n s�oe m pam w�pr�m %wc w rAa�:mxvw*[nsiuc sswa m s mrus e iu e�ox¢u g� . NO 5& PROGRAM DF SntUCi. STS&INSPECTIONS 114 Derby Slreef 10 Deiby Square ��a�.u�.uT.ima or�imx m u.e.a;..,m�muw ruR��emmou�n*!+m i Tw�woru muwousE E2 BASENENT&FlRST F100R FRAMING PIAN Salem,MA 019�0 Salem,MA 019]0 ia s�a..nq�..m.�e eeeewm,ome.+u w���d�w�.+ 63 SECON�FLOOR FRAMING PLAN Phone:878-]db-0208 n v�.m.u�ae�aeimna ma a u.a�p,�nh w�+�e s-a CENNG ROOF FRAMING PLAN �w�w..M..mwm an..i.wm e w�.m.�. wn.ewurmm�mawta�x.o,r���.mro�o� . �,s.�,���„��.�,�,aw�.,��, tructura ngineer: aary nwnmu.m.��. Plum6ing•OeaipnBuiltl n rmani,�,n,w e���. ,�wai��>r m.�.w.m,m w.y ae McBne Engineers, LLC eooima.m u.av�i�w esan maso�.n m4�wmmim ni mr.on. me emexw mm urm.eemv eeury m.eam�se uyuv.n u,Y Meehenieal-Desl n Builtl 160 SyIV2fl S4¢EY °vW°•'m�•^^� Danvers,MA 01923 �e. �.a u.�,,,ew�eme�wnw�.eau.e�w.aa. m.w.m Oxtrical-Uui n9uiltl Phone:978846-0097 Feu:978-646-0087 5 v.+�.�ma n u.ar�.w�w r.�. �.�u. mw e�e�nc um o-e�am me aim ma m n . .nmy e ammmi.i. FirePntacNon•Deai nBuild Surveyor. a � n. ri.m'� om�+.+ee mx o���w.me ivy+�wie s^A�P Me V���wr�MY de JmFP Fireatnm� LsBlanc Survey Assoclates,Inc. E04 ELECiRICAL- IEGENO AN�NOIES Site Loeation Eo� ELECTRICAL- FIRE ALARN RISER �IAGRAM 161 Holten Street EL� ELECiRICAL- BASEMENT&15T FLOOR �anvers,MA Ui923 � Phona:978-774E012 � ` � o o � � Etd ELECTRICAL- 2N� de }R�Fl.00R ^ � x � �.�b � ;.,� � ts�°1�.�,�.p�;?�"�p y v� G",;� ;� 5�..t �.' R ` m L` .::4 � F`' y -t�+� ��� t � �'PdC+�eS t3 �"�i,�¢ x �r,�',�! � . � § �7 ��- Landscape Architect: �"-'.��.�* .;.„ p + 5�.�� �#r�,�+��,�`�sk�,��ad f�!� � r Michael D'Angelo . a a a �g �� v�� ����'� � ��`,j�`� P'i+'�'Ta ���t \,�.1 r �,��,�,...-�`�a . " MDLA � Q g � o � g F B4 H Street,#2 " S a:e� �s,. t a .'�F �b�.a y c�' � Fr ° �,,.��"� „ �i�y�` ,� �,�,�4ry�`S �� '�'"4,�,..��� x � . .. Boston, MA 02127 0 r � Phone:203-592-4788 ,�y � s ;x��,� ,w�.'.���"4 �� 14.�'t;+�' �;�,°�, , � �� kp y ``� - � Q w"�t5 �}�t� � 1 � C .�r�' .�"�5,c i' .'.� D � ;�t���Y��� ;L��t��y�a ° �A� i ���'�4v..: - Fti �"`' `. '.x ..�, U � W } ' 9 � k � � .�\ ..:� � � � ' ��i'y ��d� `� � � � _ �i i`'\,.-'" S i 4 � ��. �}- . � { in (A �° r � y, w � ��w. ��,�' �F� '� "� � �R.t�}, � �_ `�� ' � O o > +��, '! y,;:tl 1�'� b �� °s$�,��„"`',tw'� � , �,3�c�' . ,.�+` �'" � � -x,�„�, � O , ': y �„� s q� � �k � � 4 ,�„��. . � v V v' �n9� ,i �b �� w�..... � ,6Y+ '��' � �n d 4., � �. 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FIRST FLODR h � � :'' � _ �_ - _ _ _ -1 -�� .�T.�Y_' L� �:�t -s;.c:�r� - li�� 4 II __� r i4' �� I � O '�. � __ ." . -_ - ' _ _ ___ -- rf"ti i �i�� �x'':J. � i_ � p ' o II � I � _ _ _ �'_� - W Z � EL. 24.65' 1." ._. .'_ � _'- _ '__ ' ' �i __ ��',-,i "' �.� . _ ._ ._ _.. _._. _-- .- _- " _..._.:, ...._.,�,..�'-t..�t-, ,i,:.. Y.. _ '�� -'i;_{ .. i_ rr� � .� _ . . � B � � � _ _ _ � � 1 . � - " -- - - - - � o ;p:_ - - ---- --- - - - - r i -----1 - I � � � o RLINK W'v�ID fl.lYG�tt Iqb�E WX.iANE ���5 RAY6 S�M f ""ROWAR'°""' "" �EXISTING WEST ELEVATION "°1O"°0°"� WSRlC MCO PtltL11 Usca�e �/a"=r-o• "'°°"�` D-1.4 07125/2016-Pertnit Set 2bc��► $5r 7 �° The Commonwealth of MANT-setts Department of Public Safety q P 3: IU �'Massachusetts State Building Code(78l(��Rkil 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 1t and Lot#for locations for which a street address is not available) No.and Street City/Town Zip Code Name of Building(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 Building❑ Repair firlAlteration ❑ Addition❑ Demolition ❑ (Please ft It outand submit Appendix 1) Change.of Use ❑ Changeofoccupancy Cl 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 required? Yes ❑ No ❑ Brie Description of Proposed Work: e u.� L,v-%S�i0 51 Oord , W 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 CIvIR 34) ❑ Existing Use Group(s): IProposed Use Group(s): SECTION 4: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 ❑ A4 Cl A-5❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-I ❑ F2❑ EL• Fli h Hazard H-1 ❑ H-2❑ H-3 ❑ 1-14 Cl 1-I-5❑ 1: Institutional t-t ❑ 1-2❑ 1.3❑ I-4❑ 1 NI: Mercantile❑ li: Residential R-10 R-2❑ R-3❑ R-4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: \ SECTION 6:CONSTRUCTION TYPE(Check as a plicable) fA ❑ 11) 0 ` IIA ❑ 11013 IHA ❑ IIIB ❑ IV 1 VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Wader Supply: Flood Zone Information: Sewage Disposal: "French Permit: Debris Removal: Public❑ Cheek if outside Flood-Lune❑ A trench will not be Licensed Disposal Site❑Indicate municipal❑ required❑or trench or specify: Private❑ or indentify Zone or on site system❑ permit is enclosed❑ Railroad right-of-way: Flazanls to Air Navigation: \I\11i t u 1'nnmu 'ion ,i, Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed ❑ Yes❑ ar No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: OcnIpant Load per Ilnor: Does the build ing conlainan Sprinkler Systcm?: _ Special Stipulations: _ q� SECTION 9: PROPERTY OWNER AUTHORIZATION ^; Name and•Address ofiPrg'pjrty'Ow rer Name(Print) Na and StreetJ City/Town Zip d! it Q � Property Owner Contact,in r atio�i;21 SA Tille Telephone No.(business) Telephone No. (cell) e-mail address If applicable, the property owner hereby authorizes L�1 A,\ Nat e Street Address-' City/ -own State Zip to act on the property owner's behalf, in all matters relative to work authorized by this building ennit a lication. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.ft.of enclosed space and or not under Constriction Control then check here❑and ski Section 10.1 10.1 Registered Professional Res onsible for Construction Control - �� ' S� Nanie Rc gistrant Telephone No. a-nail address �19�A R• 'strati n N tuber 7CJ Street Addres City/Town State Zip Discipline Expiration Date 10.2 General Contractor Company Name Lo-k ,s c 63c� 12 Name of Person Resp nsible F r Construction License No. and Type if Applicable S`4 �uhh MA d1 6 �Sttrreeet(Street AddressCity/Town 1f State Zip /T.-M1-30 /O r - c'O 1Ays$CA.CGh`1W�-" 0 'CCj ' Telephone No. business Telephone No. cell a-mail addrilss SECTION 11:4VORKF.RS'COA till::NSA IION INSURAN(T Ai 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 0---No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ I. Building Building Permit Fee-Total Construction Cost x_(Insert here 2.Electrical S appropriate municipal factor)_$ 3. Plumbing S d. Mechanic I (HVAC) S Note: �lininuun fee=$ (contact municipolity.1- 5. Mechanical Other $ Enclose check n nble to �/ ' 6 "0 P�Y� 6.Total Cost 5 Q (contact a nicipality)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 to the best of my knowledge and understanding. Pleas,e print and sign.'5r- nV A'^ 8A L h title , ^ Telephone NO. Date LFr-G/ y.1f-YS ti G In �/{�J1 f C?b/ Street Address_, dity/"rown ./� State Zip i rcipal Inspector to fill out this section a on application approval: Name Date a 4y A813 ITS ED m A m ❑o House of Seven Gables A-3 I ELEVATION Settlement House Porch SEGER ARCHUCTS,INC. 114 Derby Street Salem,MA 01907 10 DERBYSQUARE,SALEM,MA p:97V -o W t�77 1* to Ell o El il DERBY STREET J-M l y I gi --p unap n House of Seven Gables A-3 ELEVATION Settlement House Porch SEGER ARCHITECTS,INC. 114 Derby Street Salem,MA 01907 10 DERBY SQUARE,SALEM,MA ,97&7�M tM7W10 I , d, I • i 10 =k3} X 1 Xi ! rn ti z rn a � TF DERBY STREET ov��Co�bMpi h wl 9Rat411N6 CA�� .Salem Historical Commission 120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970 (978)619-5685 FAX(978)740-0404 CERTIFICATE OF APPROPRIATENESS It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving ❑O Reconstruction ❑ Alteration I] Demolition ❑ Painting ❑ Signage ❑ Other work as described below will be appropriate to the preservation of said Historic District, as per the requirements set forth in the Historic.Disttict's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: Derby Street Address of Property: 114 Derby gtreet Name of Record Owner: House of Seven Gables Settlement Association Description of Work Proposed: Demolition of existing deteriorated porch. Construct new I st floor porch:Design as shown in plans dated 611113. Decking to be relish brown composite. Columns to be Tuscan style to match the front portico.All wood painted buffcolor to match the front portico. Railing to be stained natural mahogany color. Lattice to be 2"square composite or wood painted bud Relocate gate entrance as shown in plans dated 611113. Option to construct a 2id story balustrade above porch: Design as shown in plans dated 7117113. Railing and balustrade design and colors to match the Ist floor porch with the addition ofpyranudal caps. Decking to be Duratek rolled decking. Option for railing near baseuaent stairs: Wood railing to match the balustrade design or iron railing to snatch the fence design. Dated: July 18, 2013 SALEM HISTORICAL COMMISSION The homeowner has the option not to commence the work(unless it relates to resolving an outstanding violation). All work commenced must be completed within one year from this date unless otherwise indicated. THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessary permits or approvals) prior to commencing work. 1711 The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code,780 CUR Sd EM Mar Revised Mar 2011 Building Permit Application To Construct, Repair,Renovate Oi Demolish a One-or Two-Family Dwelling This Section For OfflqjalU, se Only Building Permit Number: Dat Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 ProQerty Address: 12 Assessors Map&Parcel Numbers 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) _ Frontage(ft) 1.5 Building Setbacks(ft) - Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G-L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Ownerr of Reco24 � �S f q -76 Name(Print) " ity,State,ZIP ' o.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ Number of Units - I Other ❑ Specify: Bnyyf Description of Proposed Work': d 1 4an OVI'l "7 r9v7-- SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6.Total Project Cast: $ 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) I License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft. R Restricted 1&2 Family Dwelling CityfFown,State,ZIP \ M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) RIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address City/Town, State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) Workers Compensation Insurance affidavit 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. Signed Affidavit Attached? Yes ......... No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION 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. a `Prri t Owner's or Authorized Agent's Name(Electronic Signature) I I Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass. og v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basementlattics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of M assachusetts I� 1 UlfDepartment of Public Safety JJ M assachusells State Building Code(780 CM R) 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 indikateBlock#and Lot#for Iorations for which astreet address is not available) 114- bey-W Meek Stem OIA-4O SQIeM aw w1001 No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Code used_ If New Construction check here❑or check all that apply in thetwo rows below Existing Building❑ Repair Alteration ❑ Addition ❑ Demolition El (Pl�fill out and submit Appendix 1) Changeof Use ❑ Changeof Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes d No ❑ Isan Independent Structural Engineeqng Peer Review required? Yes ❑ No Brief Description of Proposed WorkArlSP � �f (X Y V1 Qi1L0.:t z� SECTION 3:COM PLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGEIN USEOROCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed (See 780CMR34) ❑ Existing UseGroup(s): Proposed UseGroup(s): SECTION 4: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(Checkasapplicable) A: AssemblyA-1 ❑ A-20 Nightclub ❑ A-3 ❑ A-40 A-50 1 B: Business ❑ E: Educational ❑ F: Factory F-111 F20 I H: High Hazard H-10 H-20 H-3 ❑ H-40 H-50 I: Institutional 1-1 ❑ 1-20 1-30 1-40 M: Mercantile❑ R: Residential R-10 R-20 R-30 R-40 S: Storage S1 ❑ S2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as appl ikable) IA ❑ IB Cl IIA ❑ 11B ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION (refer to 780 CM R 111.0for detailson each item) Water Supply: Flood Zone Information, Sewage Disposa������l:1111 Trench Permit Debris Removal: Publiz&P Check if outside Flood Zone Indicate municipa A trench ill not be Licensed Disposal Site❑ Private❑ or indentify Zone or on site system requir*c Zr trench r sp�fy: pewit is enclosed ❑ t�+ Railroad right-of-way: Hazardsto Air Navigation: MA Historiccommission Review Process: NotApplicable Is Structure within airport approach area? Isthar review OD plated? or Consent to Build eclosed ❑ Yes❑ or N 0�kl Yes❑ No SECTION 8:CONTENT OF CERTIFICATE OFOCCUPANCY Edition of Code: UseGroup(s): Type of Construction: Occupant Load per Floor: Doesthe building contain an Sprinkle System? Special Stipulations 1 SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner l�ems�c cbl De DF, --+ W►1 sc n St. OIYI Pw 019!10 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Sul L'uAfuyfAxx 570q0043 Title Telephone No.(business) Telephone No. (cell) e-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 building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 0 and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor C• ComVbny Name Nam of PersonResponsibl for Construction License No. and Typeif Applicable 10 Cplo 51krn ML niq-+o Street Address City/Town State Zip q3634 3C6(o _ 1'(bcXk'(fl'M')kti�lWm Q VP►'171x�,C)P 1 Telephone No.(business) Telephone No.(cell) TJ mail address SECTION 11:WORKERSCOM PEN SATION INWRAN CE AFFIDAVIT(M.G.L.c.15Z§25C(5)) A Workers-Compensation Insurance Affidavit from theMA Department of Industrial Accidents must bexnmpleted and submitted with this application. FaJlureto provide this affidavit will result in thedenial of theissuanceof thebuilding permit. Isa signed Affidavit submitted with this application? Yes[] No ❑ SECTION 12:CONSTRUCTION COSTSAND PERMIT FEE Item Estimated Costs.(Labor and Materials) Total Construction Cost(from Item 6)_$ i aaaco 1.Building $ Building Permit Fee=Total Construction Cost x_(Insert here 2. Electrical - $ a appropriate municipal factor)=$ 3. Plumbing $ Note: Minimum fee=$ ��(pmntadmunidpal� /`itfy) 4.Mechanical (HVAC) $ ,l ,,, 5.Mechanical (Other) $ Fltdose chedx payable to f t-y U)61 A 6.Total Cost $q I� � (contact municipality)and writedledc number here SECTION 13:SIGNATURE OFBUILDING PERM IT 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 istrue and accurate to the best of my knowledge and understanding. POl�ea plr Title Teleph In o. Date 51 e 41e A Street Address City/Town State ip M unici pal I nspector to fill out this secti on upon application approval: Name Dal The Commonwealth of Massachusetts Department of Public Safety h1 v .\lass,irluisrlls til.dc l4uiidinf(Cudr(781)C\IR) Jh Building Permit Application for any Building other than a One-or'1'wo-gm vet tog ('This Setlion For Official Use Only) Built iug l'ennit Nunabee Dale Applied: ""� L Bu ilding Official: SECTION 1: LOCA'I[ON(Please indicate Block 0 and Lot p for locations for which a street add r rs not available) IF - r m--4f--_3 --5t1p,4A- -- r - 'U---------"--" No. And Street City/Town Zip Cade Name of Building(if applicable) SECTION 2:PROPOSED WORK GJilion of MA State Code used— If New Construction cheek here❑or check all that apply in the two rows below � Emsling Building, I RepairZ I Alteration ❑ Addition❑ Demolition ❑ (Please till nut and submit Appcndis 1) Changvof Use ❑ ChangeufOrcupaniy ❑ C71Ber ❑ Specify.:_ Are building plans and/urconstrucliunthicumenls being suppliedas part of this pennitapplicatiun? Yes ❑ N NrrVG]r,,��[y,1 Is en Independent Slnachard Engineerin+ Peer Review required? - Yes ❑ --_ Brief Description of Proposed Work:_ stOflls.l/ .�i� lL (le-. GV' C-_�N_J � f _ IF �— — SECTION 3:CONI PLETETHIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check hero if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Groop(s): _._ Proposed Use SECTION 4: BUILDING IIEIGIIT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Fluor(sit. ft.) Total:\rod(sq. ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as a livable) ,\: Assembly A-I ❑ A-2❑ Nightclub ❑ AJ ❑ A-a ❑ A-i❑ B: Business ❑ E: Educational ❑ F: Facto F-I ❑ F2❑ if. Ili h Ha7md H-1 Cl H-2❑ I1-3 ❑ li-T❑ 1 i-3❑ I: Institutional 1-1 ❑ 1-2❑ 1-3❑ 1-4❑ 1\I: Mercantile❑ R: Residential R-10 R 2❑ R-1❑ R-4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑Fw Special Use❑and please describe below: Special Use SECTION 6:CONSTRUCTION RPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ III,\ ❑ IIIB ❑ IV ❑ VA \'ll ❑ SECTION 7:SITE INFOI1b1A'FION(refer to 780 CAIR 111.0 for details on each item) Water Supply: PImaJ Zone Information: Sewage Disposal: French Permit: Debris Remm aL• public Cl Check if outside Hood zone❑ Indicate loomipal❑ A t«'nClt will not be Licensed Disposal Site❑ Private❑ or wtIvntih Lone: or on site system ❑ reyuirvd ❑or lrendt or specify: .. _. _.. .. _- --- permit is cm lased❑ _ Railroad right-of-way: Ilazards to Air.Navigation: \1 , i J. Nut :\pl+lied+c❑ IS tilructurr within airport approach area.+ Is Iheir rev ivw aompleled? or Cvtsent to f4mld cnclo,ed Cl )vs❑ or No❑ I YC+❑ .N,, ❑ SECT ION 8:CON'I'F.NI'OF C-FRI'IFICA 1'F OI'OCCUPANCY lidiliun, I lode. Lso Cruup(s): 1\pool C,mslrwnow lk,up,mt Ln I'llwi 11""I It u•s lh, foil lint;i,vtain m�prinU+rtitHvm?: tip+r ial>lipul aligns. SEC"IION 9: I1ROPFR'I'Y OWNER AU'1'11ORIZAIlON _.\.mic and Address of Property O+v ner — -- Nm (I nnt) No.and Street Cit1'/Town Zip property Owner Contact Information: I ide _ —— relephune No.(business) Telephone No. (cell) a-mail address If applicable, the properly owner hereby authorizes --_ Name Street Address ----- City/Town State Zip to act on the properly owner's behalf,in all matters relative to work authorized by this building permit a r plication. .l SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) III, lkling is less than 35,Ihk1 cu.ft.of enclosed s pace and or not wider Construction Control then check here 0 ilildikip Section 10.1 V.1 Re istered Professional Responsible for Construction Control Nile(R t al ) Telu hone No. a-nla 1 addresT s Registmtiun Numbs 4 ( S efA ✓l MA• L aZ V6 /z Street Address Ca /Town State Zip Discipline Expiration Date 10.2 G- oral Contractor C O . scry c ,/ —f C Name of� n Rrm i l so c se for Construction License No. and Type if Applicable 4-4joi- 0 9OZ Street Address Ci /Town State Zip _ — ce�7 yd. /L j s foe _ Tde,hone No. business Telephone No. cell a-mail address SECTION 11:no wKi 1 s'+.(,mvl I n?% ly,ul,n.wl\) I n w vl M.G.L.c.152.1 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 0 No 0 SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=S_ I. Building S Building Permit Fee-Total Construction Cost x_(Insert here 2. Electrical S appropriate municipal factor)=S 3, plumbing S 4. \loch,unical (HVAC) S Note: i\linin»un fee=S (contact municipality) 3. .\Icchanical Other S Enclose ilncck payable to _ _._.. — h. ro tat Cost S (cuntait numicipality)and write check number here _-- SECi 13:SIGNATURE OF BUILDING PERMIT APPLICANT -- -- 14v entering my name below. I herdw alest under the pains,md penalties of perjury (hat all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Please print and sign nenw Dille Idephone No. Dale <Ircct Address Citvi rown Slate Zip Municipal inspector to fill out this section upon application approval: _-- Name Dale i )Nut' to . t- 4t, A'£��MMB G1 Salem Historical Commission 120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970 (978)619-5685 FAX (978)740-0404 CERTIFICATE OF NON-APPLICABILITY It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving Reconstruction ❑ Alteration ❑ Demolition ❑ Painting ❑ Signage ❑ Other Work as described below does not involve an exterior architectural feature or involves a feature covered by the exemptions or limitations set forth in the Historic District's Act(M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District: McIntire Address of Property: 114 Derby Street Name of Record Owner: House of the Seven Gable- Settlement Association Description of Work Proposed: Repair and repoint brickwork to replicate existing, including mortar thickness, color and texture. Repair cement steps to replicate existing. No changes in color, material, design, location or outward ap1mar rnce. Non-applicable due to being in kind maintenance/replacement Dated: December 12, 2011 L S L COMMISSION By: The homeowner has the option not to commence the work (unless it relates to resolving an outstanding violation). All work commenced must be completed within one year from this (late unless otherwise indicated. THIS IS NO"r A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessary permits or approvals) prior to commencing work. The Commonwealth of Mass husetts Department of Public Safc NLIssai lul set is St.nc lie old inl;Cudr(L ticI Building Permit Application for any Building other than eorivo-Family Dwelling (-I his Section Fo Offici, Use CAaly) Building Permit Number: _ Dale Applied: LI Building O F�ial: SECTION 1: LOCATION(Please indicate Block III and Lit p for locations for which a street add s nut available) No.and Street City/Town — - Zip Code Name of Buildinl;(if.I pill icablc) SECTION 2:PROPOSED WORK Edition of NIA Slate Code used. If New Construction i heck here❑or check all that apply in the two rums below Existing Iuilding Repair❑ 1 :Vter•uion ❑ 1 Addition❑ Dmnulfliun ❑ (Please till out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other Specify: Are building plans and/or construe[it'll docunlen is being supplied as part of tit is permit application? Yes ❑ No " Is an Independent Structural Engineering Peer Review required? Yes ❑ No tv Bescri+tio I of Pro w'et [York:._ _SECTION 3:COMPLETE IIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here Ilan Existing Building Investigation and Evaluation is enclosed(See 780 CNIR.14) ❑ Existing Use Group(s): _._. Proposed Use Group(s): SECTION 4: BUILDING HEIGHT AND AREA Existing Proposed No.of Flours/Stories(include basement levels)dr 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 Cl A-1 ❑ A4❑ A-i❑ I B: Business ❑ E: Educational ❑ F: Facto F-I ❑ F2❑ FI: lli h Hazard H-1 ❑ H-2❑ FI-.3 ❑ li-4❑ li-5❑ I: Institutional 1-1 ❑ 1-2❑ I-1❑ 14❑ Nt: Niercantile❑ R: Residential R-10 R-2❑ R-3❑ R-I❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use SECTION 6:CONS"rRUCrION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ 1116 ❑ I IV ❑ 1 VA Cl V13 ❑ SECTION 7: SITE INFORM A'rION(refer to 780 CNIR 111.0 for details on each item) LVater Supply: Flood Zone Information: Sewage Disposal: Trench Permit Debris Removal: .Public❑ Chock it outside Flnod Zone❑ Indicate numiiil+al ❑ A trench will kill be Licensed Disposal Site❑ - required Cl or trench orspeciN. I'riv,uc❑ or indenlify Lunn or an site sysG'm ❑ per nit is enc losvd❑ .-.. Railroad right-of-way: Haiards to Air Navigation: 1. . .. .. Not Applicable❑ Is Stnli lull•tcithin airport apprn•li h an•a' Is their n•v ielr ronti+lclvd' or C onsont to Budd vnrlowd ❑ )es ❑ or No❑ I 11•s❑ No ❑ SECTION N:CON FEN OF CHITIFICATE OI'OCCUPANCY I!down of Coda. _. _ .,, Ise Group(.,): - _ I\pc of Cotl.,lnn Iron: ll,,updnl I "'Id pvr Iloor: Poe,the building conl.lin mSprinkler St,Wtn.': _ L;poc idl�til+ulalicns: _ _ . II - SIV!ION 9: PROPFR'I'Y OWNER AU'I'IIORIZA"IION iN uoc•anndd A%Idr•ss of l'nI'ro�pwQrhv'U%%i rr /) �,�(� w1� Must V_ —v"tLl'.(��^NlZKLs-1 _ C' _ _'_��_—LV"` o�-.._I Name(Print) No.and Street \{{ City'/Town Zip op [Illy Owne - III I formation: �'Pi rl Wt'lf � ��yI:ille - — relephone No.(business) Telephone No. (cell) c-mail address If,I apt able, the pr aperly 0%7'a r hereby authorizes be 5t, Name Street Address City/row, State Zip to art on the pro erty owner's behalf, in all natters relative to%vurk authorized by this building permit a p plication. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If buildin•is less than 15,0W cu.ft.of enckm•d s pace and or not under Construction Control then check here O and ski Section 10.1 10.1 Registered Professional Responsible for Construction Control Nance(Registrant) "Telephone No. a-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor NA o Con �� titL r 'ap6t Name ll` �� CS a13ao WY� r 2rV l Sor Name of P rson Itcsponsilb a for Construction License No. and Type if Applicable 1 Si �touceJ r f1 ©n o Street Address aCity/Town State Zip Q��0-00� — tloewavc-45� MOM I � Telephone No. business Telephone No. cell — e-mad address SECTION 11:Iccu:r.Id;;rr(mlrtvs.,\ru+NINhuf:.\.vrrA) 111 \VII 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. (s a signed Affidavit submitted with this a lication? Yes❑ No ❑ SECTION 12.CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs: (Labor and Materials) Total Construction Cost(from Item 6)=S L� 000 1. Building S Building Permit Fee-Total Construction Cost x_(Insert here 2. Electrical 5 appropriate municipal factor)-5 t. l'lunrbing $ I. \luxhanind (HV,\q 5 Note: \lininnnn fee=5 _(Contact municipality) i. .\IcChaniCal Other 5 Endow chtx'k payable to I,. Tulol Cost '+ D Do0 I (contact municipality)and %%rile check number here SECTION 13:SIGNATURE OF BUILDING IIE14NIlT APPLICANT ' By entering nay name below, I hereby eltc I w cr the pains and penalties of perjury that all of the information contained in this aplph% Ilion is tru I ul AL ir.le to the Ices of n ncledge• ad mderstandIng. Igo _— _ . - I't as. pri t.volts ln i •m e Tille 1 Iophone No bate ao - �1-� _�lo�_�es�- Vyli�-- ©�a3� �tr%ct Address Litt/rows State /tp Municipal Inspector to fill out this section upon application approval: I- -- ----- --Name ---- ._ 1%alc----- S , c(0 17, £ J 9�'C/AryNE�yJ� ,Salem historical Commission 120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970 (978)619-5685 FAX(978) 740-0404 CERTIFICATE OF NON-APPLICABILITY It is hereby Certified that the Salem Historical Connilissioir has determined that the proposed: I ❑ Construction ❑ Moving ❑ Reconstruction ❑ Alteration ❑ Demolition ❑ Painting ❑ Signage ❑ Other Work as described below does not involve an exterior architectural feature or involves a feature covered by the exemptions or limitations set forth in the Historic District's Act(M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District:_ Derbv Street Address of Property: 1 14 1)erhy Street Name of Record Owner:., House of the S v n Gables Assoc Description of Work Proposed: Rebid&hanclicap access rarnp in rear to replicate existing. No changes in color, Material, design, location or 0111 marl appectrance. Non-(tpplicable elite to being in kind mainlenanceh"eplarenrent. Dated: December 27 1)011 SA II T t A COMMISSION By: The homeowner has the option not to continence the work (unless it relates to resolving an outstanding violation). All work commenced must be completed within one year from this date Unless otherwise indicated. THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessary permits or approvals) prior to commencing work. Commonwealth of Massachusetts wt�`'tc�i u r Sheet w Metal Permit ��o Date: I z 1 ( J J Permit 1Ulb M1 21 A 10r 20 Estimated Job Cost: $ 9 �U Permit Fee: $ Plans Submitted: YES NO // Plans Reviewed: YES NO Business License# Applicant License# t Business Information: Property Owner/Job Location Information: Name: j �0(,�2� V C— Name: ����i t M>6a Street: Street: lJ Q-—b C City/Town: _1 City/Town: 51 q� Telephone: Telephone: z;-6'9 — 7 Photo I.D. required/Copy of Photo I.D. attached: YES A NO_ Stag Initial J- M-1- estricted 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 Y., Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. ')( over 10,000 sq. ft. _ Number of Stories: Z Sheet metal work to be completed: New Work: -/-/, Renovation: HVAC ( Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 YesV,,No❑ If you have checked Yes, indicate th 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 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 o y 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. P P P 9 P Duct inspection required prior to insulation installation: YES NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: BY Master o Title '1 1 El Master-Restricted Cityrrown ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: Fee$ / ❑ Check at www.mass.gov/dpl Inspector Signature of Permit Approval Commonwealth of Massachusetts LA Sheet Metal Perm7 `�a� E>,+1 ;yi,_ . d° Date: I 1 l 201b NONe?rlit#Q to 20 Estimated Job Cost: $ noD 1T. Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License# Applicant License# LBusiness Information: Property Owner/Job Location Information: f_ t Name: �� �� e �L Name: �, ) (-k D P_ t Street: Street: I f H FI)e_r k G City/Town: �c City/Town: Telephone: � n - fo,�j - // Telephone: b Photo I.D. required/Copy of Photo I.D. attached: YES NO Staff Initial J-1 /9 restricted 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 X\ Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: _2S. Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: ��`� ) INSURANCE COVERAGE: �� I have a current liabili insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes p,�' 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 box he I reby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best f m nowledge 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 r Final Inspection Date Comments Type of License: By Master -�- Title ❑ Master-Restricted City/rown ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: Fee$ ❑ Check at www.mass.gov/dpi Inspector Signature of Permit Approval Commonwealth of Massachusetts 3cr,�t Sheet Metal Permit /C} `Date: 1 (6 Pemvtjolb NOV 21 A flak 20 f1 Estimated Job Cost: $ 6U v Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License# 6Z{ �)C(�lc��� Applicant License# L ' Business Information: Property Owner/Job Location Information: Name: J �> �oGl2� LJC G f Name:JCt ����t o le2SV4 Street: '( ` l R, p Street: I I �-{ 0 e r� City/Town: _ City/Town: mac.. Telephone: ) Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES A NO— Staftloitial J- M-1- estricted 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 Y,_ Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. ')( over 10,000 sq. ft._ Number of Stories: 2 Sheet metal work to be completed: New Work: Renovation: HVAC_9Q Metal Watershed Roofing_ Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done:, 1 +qA-/ tl LESS n9. e Cl G7 " p Ke J INSURANCE COVERAGE: I have a current liabil insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 YesV,,hio❑w- If you have checked Yes,indicate 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 o y 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 Master jTNe ., El Master-Restricted. Citylrown - - ❑Joumeyperson -Signature of Licensee. Permit# x ❑Joumeyperson-Restricted n Fee$ License Number: Check at www.mass.Govidpl 'Inspector Signature of Permit Approval .. - - �` Commonwealth of Massachusetts Sheet Metal Permit „9 Date: z 1 ((o ( � ) Permit iolb MY 21 A ID 20 ail Estimated Job Cost: $ 9.f 0 CCU v Permit Fee: $ Plans Submitted: YES_ NOS-y_� Plans Reviewed: YES_ NO Business License# b _�{s� ab� Applicant License# Business Information: Property Owner/Job Location Information: t Name: 1r 7DC) �x> L Name:jce �����t 1NIA60-5y-1 Street: -1 �'P y�� t�fZ p Street: I I LI City/Town: City/Town: �f� Telephoner +/ / Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES NO Stairinitial J- M-1- estricted 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-V.- Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. ' ( over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC Metal Watershed Roofing_ Kitchen,Exhaust System Metal Chimney/Vents_ Air Balancing Provide detailed description of work to bedone: 1 l CQ/rz r-4-1 ��L 1 01C(cjc(t--c �¢GL Ij - J - s INSURANCE COVERAGE: I have a current liabili insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes[ ( o❑ If you have checked Yes.indicate th 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 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 k y 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 Master Title ❑Master-Restricted �...� Cityfrown ❑Joumeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: Fee$ ❑ Check at www.mass.govIdol Inspector Signature of Permit Approval _ '