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215 DERBY STREET - BUILDING JACKET I _ 215 DERBY STREET � k JAM .. V/s7zre �l�urtase c// � �'rLO/O7lpL 7/J�DO Deval L.Patrick Governor _ �t11/ y�p�O66O _ Thomas G.GatzuneP.E. Co . ej'114fi.E 1/_ L Commissionerr Timothy P.Murrayy ` . Lieutenant Governor' - �Qp- 6�j_ j_O66rj Thomas P.Hopkins Director Mary Eli Heffernan Secret - Secretary TO: Local Building Inspector Independent.Living Center Local Commission on Disability Complainant FROM: Architectural Access Board RE: -Seaport Cafe 215 Derby Street Salem DATE: 1111 mol 1 Enclosed please find a copy of the following material regarding the above location: _Application for Variance Decision of the Board Notice of Hearing Correspondence' -Letter of Meeting Stipulated Order First Notice Second Notice The purpose of this memo is to advise,you of action taken or to be taken by this Board. 1f you have any information which would assist the Board in this case, you may call this office, or you may submit your comments in writing to the above address. Thank you for your assistance. G7- _ d �y Ore lale Deval L.Patrick `^'OdON�, �L6d6""•'K'^' t%�'�r��6�0 - . . Governor CJI/ Thomas G.Gatzunis,P.E. _j'24R.Pi 1 L Commissioner Timothy P.Murray - Lieutenant Governor 9Ov 6y yp y �/-/L/-�66�j .Thomas P.Hopkins Director Mary Elizabeth Heffernan - / Secretary CaCljL6.91 ad& F G oPJ November 10, 2011 Lu Lu Gracious Realty Trust Docket Number C 10 082 4 Johns Avenue Middleton, MA 01949 RE: Seaport Cafe 215 Derby Street Salem Dear Sir/Madam: Upon information received by the Architectural Access Board; the facility referenced above has been reported to violate M.G.L. c. 22, § 13A and the Rules and Regulations (CMR 521) promulgated thereunder. Reported violations, include the following items: Section`. Reported violation: 7.2.2 c Service Counter Height: The"counter shall not exceed 36 inches above the finish floor. The complainant reports that the service window on the Union Street side measures forty-four (44) inches above the sidewalk: Under Massachusetts law, the Board is authorized to take legal action.against violators of it's regulations, including"but " not limited to, an application for a court order preventing the further use of an offending facility. The Board also has the authority to impose fines of up to $1,000.00 per day, per violation, for willful noncompliance with its regulations. You are"requested to notify this Board," in writing, of the steps you have taken or plan to take to comply with the current regulations. Please note the current sections may be different from the sections that are cited above. Unless the Board" receives such notification within 14 days of receipt of this letter, it will take necessary legal action to enforce its regulations as set forth above. If you have any questions, you may contact this office. cc: Local Building InspectorSincerely, Local Disability Commission Independent Living-Center" Donald Lang Complainant // Chairperson �• �, r Deval L.Patrick. Governor _ Thomas G.GatzuneP.E. e/w yB �f209LPi 7 /L"_O��O Commissioner Timothy P.Murray Lieutenant Goverror 97¢Qi Thomas P.Hopkins Director Mary Elizabeth Heffernan Secretary TO: Local Building Inspector Independent Living Center Local Commission on Disability Complainant. FROM: Architectural Access Board RE: Seaport Cafe - 215 Derby Street Salem DATE: 11/23/2011 Enclosed please find a copy of the following material regarding the above location: Application for Variance ecision of the Board _Notice of Hearing Correspondence _Letter of Meeting Stipulated Order First Notice Second Notice The purpose of this memo is to advise you of action taken or to betaken by this Board. If you have any information which would assist the Board in this case, you may call this office, or you may submit your comments in writing to the above address. Thank you for your assistance. i .� LULU GRACIOUS REALTY TRUST SHAWN E. & CLAIRE DONOVAN 4JOHNS;AVENUE, MIDDLETON,.MA 01949 November 18, 2011 RECE_I NE DEPARTMFNI; ; P; st '.^ SAFETY Derby Partners LLC; dba Seaport Cafd Gregory & Cynthia Shea NOV 2 1 2011 215 Derby Street Salem, Ma 01970 - —' ARCHITECTURAL ACCESS BOARD Dear Greg& Cindy: ' As promised, enclosed is a copy of the November 10, 2011 Commonwealth of Mass. Dept. of Public Safety violation letter. The violation is regarding the service counters. On Monday,I spoke with the state inspector, Mr. Mark Dempsey. Mr. Dempsey stated that several things need to happen in order to correct this violation. 1) Effective immediately, both service windows cannot be used until the violation has been corrected. 2) Both the window and counter cannot exceed 36 inches above the finished floor (sidewalk). It's OK to change only 1 window and keep the second window as is. 3) Once the violation has been corrected, a picture will need to be taken with a yardstick showing both the window and counter do not exceed the 36" height and sent to Mr. Dempsey. Please send.me,a copy of the picture and I will forward to Mr. Dempsey. Any questions, please give me a call at 978-774-2247. Thank You, Claire Donovan cc: Mr. Mark Dempsey, Commonwealth of Mass Dept. of Public Safety Architectural Access Board One Ashburton Place, Room 1310 Boston,Ma 02108-1618 CITY OF SALEM PUBLIC PROPERTY \ � DEPARTMENT RIN113HU-I?Y DRISCOLL MAYOR 120 WAS]uNGTON SI'Rf:Er♦ SALsnL N[ASSACI ICSITI'IS 01970 - 'Il�a.:978-74i 9595 FAX:978-740-9846 July 27, 2010 Mr Mark Dempsey Compliance Officer MAAB One Ashburton Place Room 1310 Boston, Ma 02108-1618 RE. 215 Derby Street Seaport Cafe Maab Docket CIO-082 Dear Mark Attached is the permit application and plans for the recent renovation at the above property. The plans called for a self-serve window to the sidewalk meeting the requirements for a transaction counter. Unfortunately, the actual constructed sill height of the window is approximately 41". The owner has been made aware of the violation and has applied for a building permit to rectify the situation. The width of the sidewalk at the window is a imately 6' and people queuing in a single line do not obstruct the sidewalk. Sinc r y, c rath, AI Assistant Building Inspector cc: file syso Deval L.Patrickomas G.Galzu his,P.E. Governor � 6»_'1�>'0660 0. 0mmissioner Timothy P.Murray '9 sv 6s�- ""aj .i mos P.Hopkins Lieutenant Governor Director Mary Elizabeth Heffernan COLdGd.f/ dd�lJ'd'/�/ . Secretary TO: Building Commissioner FROM: Mark E. Dempsey, Compliance Officer RE: Seaport Cafe 215 Derby Street Salem Docket No: C10 082 DATE: July 19, 2010 REQUEST FOR BUILDING PERMITS The Architectural Access Board has received a complaint on the above referenced premises. Before the complaint is processed, we would like to obtain copies of all the building permits since June of 1975. The Board needs the permits to determine whether or not we have jurisdiction under Section 3.3. You may use the space below or attach additional comments. Please return this memo with all the building permits within fourteen (14) days of receipt. ADDITIONAL COMMENTS: The permits need to show the value of the work performed. Building Official (Please print) Signature ,LII/�2I�d 01�IQ�IIIIS W H IV S 40 AZID ov aeose r E , V Certificate No: 712-10 Building Permit No.: 712-10 Commonwealth of Massachusetts City of Salem Building Electrical Mechanical Permits This is to Certify that the BUSINESS located at Dwelling Type 215 DERBY STREET in the CITY OF SALEM - - ------------- - ---- ------------------------ -- Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY OCCUPANCY PERMIT FOR THE SEAPORT CAFE jbh (INSIDE SEATING(70) (OUTSIDE SEATING (49) This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires unless sooner suspended or revoked. Expiration Date Issued On:Thu Jun 17,2010 ----------- -- GeoTMS®2010 Des Lauriers Municipal Solutions,Inc. ------------------------------------------------------------------------------- ,LIY��I�d �l�II�'IIIl S WR IVS dO A,LID � av anasn Ob 1(IrIO�� r7^'O --Z7Z7 f/„`7" 215 DERBY STREET y y 712-10 A COMMONWEAL'T'H OF MASSACHUSETTS GIS# 1289.., , p x7 t 34 $ioek t`! .x� b CITY OF SALEM Category:;' REMODEL, , ,i°l ° !; , . , ; BUILDING PERMIT Project#j ' ''aJS-2010-001049ir, •;;! Est Cost v;,. ' $29,400 00 Wv, Fee Charged:" '. $335.00 g Balance Duel, , $00 PERMISSION IS HEREBY GRANTED TO: Const. Class:: $ �'i M ' Contractor: License: Expires Use Group David Carnevale Lot Slze(sq ft) 4089 8484°h i( h +eu ad ,,: „,t ia,,,1�,,;9,�nE,,,,i;,,;Owner: Derby Partners, LLC Zomng t,,$t, _ BSle h ki t. Units Gained A,,4a;1101 ;°s.!! j!��f-App/leant: David Carnevale Units Lost:' .# ' .tw°.al. >u,n4x1 m T. 215 DERBY STREET Dig Safe#: "% "-'N taF FplhgA ISSUED ON: 22-Apr-2010 AMENDED ON: EXPIRES ON: 22-Sep-2010 TO PERFORM THE FOLLOWING WORK: RENOVATE EXISTING RESTAURANT AS PER PLANS jbh POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing Building Underground: Underground: Underground: Excavation: Service: Meter: Footings: " Rough: Q VIZ-71C ugh: Rouge 5 —2 I"�410 Foundation: Fi/nal: Final:&K�,11`1-Grl'!D!/ Final:00`/h�� Rough Framer G-sk fl / f Fireplace/Chimney: � D.P.W. Fire Health 1 IACLT, 7 Insulatian:�5rwrZ�l Meter: - Oil: J� i lily Final: , Iiuuscq Smoke: 7//yy� Treasury: Water: Alarm: t9�Gf fJ Assessor Sewer: Sprinklers: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ITS RULES AND REGULATIONS. uuu _ Signature: ® Fee Type: Receipt No: DSy Paid: - Check No: Amount: f BUILDING REC-2010-001222 22 'pr-I'0 3704 $335.00 }� An Im"COM 19 RM-MM Up ^ completioi, °` work, pWum UW Call for Permit to OCCUPY .� �7F�Gt 9-5�S4t tat ril GeoTMS®2010 Des Lauriers Municipal Solutions,Inc. cel r Tammanaa talt4 of ASOOROlp SM0 CITY OF SALEM In accordance with the Massachusetts State Building Code, Section 108. 15, this CERTIFICATE OF INSPECTION DERBY FISH & LOBSTER is issued to ]� 1 //��Yy ��l ss�pthat I have' inspected the premises known as DERBY FISH A LOBSTER located at 0215 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 gF%7K 7yK1rlC7i7K7i7K 14r7pR1K7C %p7KXSf{7yK7K % %'Xqq��*p'�1i1C7KX Capacity Story- Ca.F�cJ�7F 7C1C1K16'�7C7F��fG'3�76 Capacity Story Ca�1�.F7it%XSx7CS�%�7F��'X1G BY PLACE OF ASSEMBLY OR STRUCTURE Place of Assembly - Place of Assembly or Structure Capacity Location or Structure Capacity Location RESTAURANT 56 IST FLOOR A-3 0138-1998 09/01/1998 09/01/1999 Certificate Number Date Certificate Issued Date Certificate Expires Building Offi al The building official shall be notified within ( 1 0) days of any changes in the above information. C0.`^_!oNNt.1L= OF "_ASSACi:S -S _ a CITY OF SALE': 1PPLIC.;220 1 FOR C3IIFIGLTE 0= T-' SPEC:ZON ((4 --Fee :required S _/j7d Date ( ) No Fee Reouirea in accordance with the provisions of the N.assachusetts State Building Code. Sect: 108. 15. L herevy apply for a Certificate of Inspection for the below-named premises located at the following address: Street 6 Number 1 Name of Premises _ Purpose for which Premises isb'- License(s) or Permit(s) required for the premises by other Goveramental Ag�.+�+.e: Co wi License or Pet Acencv 92. CM t7 _r 2= CfT Cerrif:rate to be issued �- v m" Z v Address: IS C Owner of Record of Building: Address: �/ Name of Present Bolder of Cerrtficate: Name of Agenc. :_` any.. . 'gni ure r Person to wnam Lert_:icate s issued or hisiher authorized agent Lute //// �/ I'1q=UCTI0NS: Day tide phone i -A/ L6 7' 1. Make check payable to: The City of S-11- 2. Return this application with your check to: lnsnector of Buildings. Citv of Salem Buildine Deoarrment. One Sales Green. Salem. :1A. 01970_ PLEASE NOTE: 1. Application form with required fee must be submitted for each building or structure of part thereof to be certified- 2. Application S fee musc be received before the cert:Lficare will be issued. J. The building official shall be notified within ten (10) days of any cbaage in the above information. q. CER I= � ) 3�s / ?c =IM=0111 D=: - 1- T,OL -A %,ct zisl lo Cyj 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 S Number a SDe4L / Name of Premises Certificate to be issued to: Address _ 1 •�— Owner of Record of Building �✓� _CL �VI I rU�4 Address -- � I Purpose for which premises are used K� S t�/l '� k 1� Changes since (last InsDction (required on file card also) 1 . N C" 70VI �QIJ 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. )o - '�- - 9 5 valum EAQur-) Date Building Offici Certificate 9 ' 3 - g Date Issued: Date Expires: Recommended Next 114t Tommunwralt4 of ttuu r rn�ri#s Y b CITY/TOWN OF In accordance with the Massachusetts State Building Code, Section 108. 15, this J J CERTIFICATE OF / INSPECTION is issued to . . . . . . . . . .�.C�..�C. .u!. . . . . . . . . i . .('s. b.S.- � .r . . . . . . . .`. . . . . . . . . . . . . . . . . . . . . . . . . I (Unify that I have inspecteIdthe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .known located at. . . . . . . . .�. .5. . . . .1�e . Y . .�.1 . . . .in the. . . . . . . . . . . . .of. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . County of. . . . . . . . . . . . . . . . .Commonwealth of Massachusetts. The means of egress are sufficient for the following number of persons: BY STORY Story Capacity Story Capacity Story Capacity Story Capacity BY PLACE OF ASSEMBLY OR STRUCTURE Place of Assembly Place of Assembly or Structure Capacity Location or Structure Capacity Location 1sT Ft«��: . Certificate Number Hate Certificate Issued Date Certificate Expires Building Of icia The building official shall be notified within (10) days of any changes in the above information. i .. r ra w.-r's r s .. _.� . r- , - ,.. • ... v yr 5, al - _ p 1cf'arvvlar�+�,tx� Y < c 311 - N 6. I , l - -- ----- -- o%A5 Z<K1tv, � rol.ori r i2�"r .yl-q't I�a��" ,III Fzwl0r?Oft�Pei vo L WAPAi;fo�� _ -- - i i GoUNfUf�TO I j M ri Ij e: v f Y 5HI • 1 f c: � { i I i ' J ' - -- 6�y t — r1or'Zt�hr1G 4�' 1 ! r j _ AoV �1�wDi I ! tri , rI Jr � .: s151IL r. -HVaG aJax i 1 li � ',11- -:_: , It ^O: - ;e — i 1— - a GVrI�GW OeiaeLl — 1 <fsY1�j �1 j� `fir-w tll = _ I 1 1 Ilk s lig I I l si 1 ,;- • I�� I — -•—._,., _ 1� 1 - e { a Gd Subject to a val by any o auth ' y having J - • on. Cf5 Z o SALEM,1 7 :EVENTION AU r B PLAIN APP YED SOLELY FOR IDENTIFICATION TY c AfvD L TIOPI OF FIRE PROTECTION DEVICES. �-+7�T�777 �7'� �-v�7'+ LL-✓" / %V��1 :.ALL FIRE PROTECTION OEYICES ARE S'UNIECT TOA BERNER ARCHITECTS 1��HI l El.:�1 C` FINALTESTANDINSPECTION,FOR COMFLETECOMPLI, v e7 ANCE"9TH THE FIRE CODE. - 3 SCHOOL STREET MARBLEHEAD MASSACHUSETTS 01945 •° � i��'� C"i� ��e =% �, ��'. #�T�s �nit�3 M• M _ ooexx401 -r w am�C BhINMt �f � x-'`>TiPtit'c�=T - '- �a -�►- rT .�a 1DDIr1N�.�Wf'� Irxp - --- fi-- --- --- -- i Ir to r i f Hod I 4 f -- — ----- I O$q i O O p I - I BERNER ARCHITECTS E � � 3 SCHOOL STREET MARBLEHEAD MASSACHUSETTS 01945 MOAS X:V6 i I I I ►, j 'I II ,;�.,_ `� �; �� W �` 6 O v � � `� ��` - �. �. ,. c� �- " :> \ + �� \ cL. ,� ,'d O « ,` , , � � ` r"'- G- l y i �lil I (�r' i j M j -._ I' i � �. _- I i I i � .. . I I i -.. - �I FilllLuiNG UEPT CITY OF SALEM HEALTH DEPARTMENT MAY q 8 28 PSR '92 BOARD OF HEALTH Rr l `IES 9 North Street CITY OF SxLE1i, 9S S. ROBERT E- BLENKHORN Salem, Massachusetts 01970 HEALTH AGENT 508-741-1800 Jack Pelletier 23 Glendale Street Salem, MA 01970 Re: Proposed Food Establishment located at 215 Derby_Street, ,'Derby Fish & Lobster.^ Dear Mr. Pelletier: The Health Department, based on the April 16, 1992 Plan Review, issues the following comments in accordance with 105 CMR 590.000; State Sanitary Code, Chapter % "Minimum Sanitation Standards for Food Establishments". - The walls, wall coverings, ceilings of walk-in refrigeration units, food preparation areas, warewashing areas, and toilet rooms and their vestibules shall be smooth, nonabsorbent, and easily cleanable. "glassboard" or equivalent material. The concrete floor must be sealed. - All equipment and utensils to be constructed of stainless steel or an equivlaent smoothe easily cleanable material. Equipment to be installed with adequate space surrounding it to'allow for regular, effective cleaning. - Accessible wall-hung handwashing sink(s) with liquid soap and paper towel dispensers to be installed in each food preparation and warewashing area. sinks used for food preparation or for warewashing shall not be used for wahing of hands or for any other purpose. - In new establishments at least one (1) service sink or curbed cleaning facility with a floor drain shall be provided and used for the cleaning of mops or similar cleaning tools and foi the disposal of mopwater. Hand- washing or warewashing facilities or food preparation sinks shall not be used for this purpose under any circumstances. - Three compartment sink with drain board shall be installed in all new food establishments and in all establishments which were in existence prior to the effective date of these regulations, whenever such establishments undergo substantial renovation or transfer of ownership. Sink compartments shall be large enough to accomodate the immersion of most equipment and utensils, and each compartment of the sink shall be supplied with hot and cold running water. ' r ~ uw4 SALEM HEALTH DEPARTMENT 9 North Street Salem, MA 01970 The installation of exposed horizontal utility service lines and pipes on the floor is prohibited. Exposed utility service lines and pipes shall be installed in a way that does not obstruct or prevent cleaning of the walls, floors and ceilings. — All construction must also meet the code .requiremtns set forth by the Building, Fire, Electrical and any other pertinent municipal departments. — Submit the revised floor plan of the establisbment to this office for approval. The Health Department appreciates your cooperation in this matter. Contact this office to arrange compliance inspections throughout the construction process. If you have any questions, kindly contact this office. FORn THE BOARfD� OF HEALTH REPLY TO ROBERT E. BLENRHORN, C.H.O. WILLIAM T. BDRKE, III H.S. HEALTH AGENT SENIOR SANITARIAN RSB/sbm cc: Building Department Electrical Department Fire prevention - Licensing Department MAGNA CARTA ° M" N Es Form of Notice of Casualty Loss to Building Under Mass. General Laws Ch. 139, Sec.3B TO:Building Commissioner or Board of Health or Fire Department or Inspector of Buildings Board of Selectmen Arson Squad Town Hall Salem,MA 01970: RE: Insured: Derby Fish and Lobster Corp. Property Address 215 Derby Street, Salem,MA 01970 Policy No.: BF 023228 Loss of: Computers File or Claim No.: 16689 Claim has been made involving loss,damage or destruction to the above captioned property,which may either exceed $1,000.00 or cause Mass. Gen.Laws,Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139 Sec.3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured,location,policy number,date of loss and claim or file number. Debbie McIntyre General Adjuster On this date,I caused'copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Signature and date V 25 Braintree Hill Office Park, Suite 306 •Braintree,MA 02184 781-848-9200 • 800-225-5196 Fax 781-848-1146 • dmcintyre@mcarta.com I��UD a�13 LaTI apt CERTIFICATE ISSUED DATE May 25, 1993 y CITY OF SALEM 9 SALEM. MASSACHUSETTS 01970 BUILDING PERMIT [,m CERTIFICATE OF OCCUPANCY GATE 9� �t March-11, 93 PERMIT NO. 66-93 HI Pelletier APPLICANT ADDRESS iC� l�I� /��tp �T �I�MyO�.I ,Lr,[l��tq[I1SIR[ETI ICOM-•! LICCxSCI LY:ILWlfY ONS ri'A'1M/PMT UFIA1�1 - NUMBER OF PERMIT t0 (_) STORY OWELLING UNITS ' I1v1[ O[ IUI110V[M[xll x0. (PROPOSED Ylfl _ 2 De S.C�1ree W ZONING AT ILOCATIONI 215 Derby STZeet IKErQ ` 1 DISTRICT— (STREET I ISTRICT_(STREETI . BETWEEN LAND 'CROSS {i R[f it (CROSS Si PE[TI LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT, WIDE P., FT, LONG By FT. IN NEIGNT AND SxALL CONFORM IN CON57PUCTJON TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION °" $M.iZ:G ( PACIPYN(Y1' '1 ) M = 24 P32 SUUDING OFnCSAL , ieo EiTJi ay REMARKS: Mteracicros LQ u unused section of building, too mntLC%I<1S _handicap access CALL Fat ZMKT 710 OCCUPY 74455-995595 j� jR ry >f�fl A�IA�II$GO1 �01�ID119�N� AREA OR vOL UME Cd14!OG/RF F[[TI ��S P L obst:w Co. slpsi'9lsrwsAlA1n10PlIs�Ilsl7lbgt�l1�F)ljF/I �T of1�l�sIS S �f7110 tTsnlslllY OWNER �".! 1pLl [S 3.A/LCO{.Ca W SEE RE VE RiB31�IBORTR�Lq EcSF CERTIFICATE St., Saler, ADDRESS 1b Derby No. City of Salem Ward % �CLbNS. APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT-Applicant�to complete all items in sections:1, II, III, IV,and IX. I. AT(LOCATION) � ' � 1✓-e r b)L J+ ZONING DISTRICT LOCATION (NO.) TREETI OF BETWEEN 7e2-by 1!7 AND Bcke ')r+_ whaff`9 BUILDING (CROSS STREET) (CROSS LOTET ) SUBDIVISION LOT BLOCK SIZE II. TYPE AND COST OF BUILDING -All applicants complete Parts A -D A. TYPE OF IMPROVEMENT D. PROPOSED USE-FOR"DEMOLITION'USE MOST RECENT USE 1 ❑ New building Residential Nonresidential - 2 ❑ Addition(if residential,enter number of new 12 ❑ One family 18 ❑ Amusement,recreational housing units added,it any,in part D,13) 19 ❑ Chruch,other religious 13 ❑ Two or more family-Enter number 3 Alteration(See 2 above) of units ....................................................... 20 ❑ Industrial 21 ❑ Parking garage 4 ❑ Repair replacement 14 ❑ Transient hotel,motel,or dormitory- 22 ❑ Service station,repair garage Enter number of units ........................... 5 E] Wracking(1/multifamily residential,enter number 23 E] Hospital,institutional of units in building in Part D,13) 15 ❑ Garage 24 ❑ Office,bank,professional 6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility 7 ❑ Foundation only 26 E] School,library,other educational 17 Other-Specify ori 27 ❑ Stores,mercantile B.OWNERSHIP _ 28 ❑ Tanks,towers 8 K Private(individual,corporation,nonprofit 29 ❑ Other-Specify CCL '%� Oir' institution,etc.) he 1 9 ❑ Public(Federal,State,or local government d7 Uu�F nt C.COST (Omit cents) Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing plant, machine shop,laundry building at hospital,elementary school,secondary school,college, parochial school,parking garage for department store,rental office building,office building 10. Cost of improvement ......................................................... $ ;�5,Oct 6 at industrial plant If use of existing building is being changed,enter proposed use. To be installed but not included yJ�, �f(.� n in the above cost ¢8' 7/O»G�Tt� Oh 1141 IL C 5ec11 1D�" n� a. Electrical........................................................................... b. Plumbing.......................................................................... it In which 15 GL -F/-5h c. Heating,air conditioning............................................. 0 9 I The dciG17",a}1 oar a HG Acces . d. Other(elevator,etc.)..................................................... // 11. TOTAL COST OF IMPROVEMENT $ _2S,9:906 /Va'o SY r%A C�klta ' �(7c(T, P, s 121a all 01 r� III. SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, complete Parts E-L;demolition, complete only Parts J&M,all others skip to IV E. PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL 1. TYPE OF MECHANICAL 30 ❑ Masonry(wall bearing) 35 ❑ Gas 40 ❑ Public or private company Will there be central air 31 ❑ Wood frame 36 ❑ Oilconditioning? 41 ❑ Private(septic tank,etc.) 32 ❑ Structural steel 37 ❑ Electricity 44 El Yes 45 ❑ No 33 [:] Reinforced concrete 38 El coal H. TYPE OF WATER SUPPLY Will there by an elevator9 34 ❑ Other-Specify 39 ❑ Other-Specify 42 ❑ Public or private company 46 ❑ Yes 47 ❑ No 43 ❑ Private(well,cistern) J.DIMENSIONS 48. Number of stones .................... ......................... M. DEMOLITION OF STRUCTURES: 49. Total square feet of floor area, all floors,based on exterior . Has Approval from Historical Commission been receiv d dimensions ........................... nU -.F -.. ..... . ........ for any structure over fifty(50)years? Yes_ No 50. Total land area,sq.a .................... Dig Safe Number K.NUMBER OF OFF-STREET PARKING SPACES Pest Control: 51. Enclosed.................-........................................ ........... Sz. Outdoors HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?............................................................................. Yes No L RESIDENTIAL BUILDINGS ONLY Water: 53. Enclosed........................ ........................ Electric: , Gas: 54. Number of Full.................._..._.................. Sewer: bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED Penial.-----------"""""" BEFORE A PERMIT CAN BE ISSUED. IV. COMPLETE THE FOLLOWING: Historic District? Yes_ No-�K- (If yes,please enclose documentation from Hist. Com.) Conservation Area? Yes_ NO-</- (if yes, please enclose Order of Conditions) Has Fire Prevention approved and stamped plans or applications? YIl No_ Is property located in the S.R.A.district? Yes_ Nom Comply with Zoning? Yeses No_ (If no, enclose Board of Appeal decision) Is lot grandfathered? Yes_ Nom (If yes, submit documentationAf no,submit Board of Appeal decision) If new construction, has the proper Routing Slip been enclosed? Yes_ No_ Is Architectural Access Board approval required? Yes_ No_ (If yes,submit documentation) Massachusetts State Contractor License# Salem License# -M n Home Improvement Contractor# Homeowners Exempt form (if applicable) Yes_ No_ CONSTRUCTION TO BE COMMENCED WITHIN SIX(6) MONTHS OF ISSUANCE OF BUILDING PERMIT CONSTRUCTION IS TO BE COMPLETED BY: 6t 3 in writing to the Inspector of Buildings. V. IDENTIFICATION - To be completed by all applicants Name Mailing address-Number,street city,and state ZIP Code Tel.No. Qecb �,6r, aj a J Dea-b tt Owner or )J .ST 0/q 70 Zits-So CA, Lessee 4,p 6$�12Y N 2. )v'�-+h 5)vRc Mud-/++ ,z tS ��b 7 /N /% Of/$Rsa 'tAts Co 6a Contractor Guilder's License No. 3' Architect or �Y, er a-ch 'ect Schon i ,rb hsa� 6f Engineer I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application as his authorized agent and we agree to conform to all applicable laws of this jurisdiction. Signature of applicant / Address Applicatio date DO NOT WRITE BELOW THIS LINE VI. VALIDATION Building / /� q� FOR DEPARTMENT USE ONLY Permit number C�U� BuildingUse Group Permit issued 19Fire Grading Building Permit Fee $,N v Live Loading Certificate of Occupancy $ Approved by: Occupancy Load Drain Tile $ Plan Review Fee $ TITLE NOTES AND Data• (For department use) /g C L/ CAA PERMIT TO BE MAILED TO: DATE MAILED: Construction to be started by: Completed by: VI ZONING PLAN EXAMINERS NOTES DISTRICT USE FRONT YARD SIDE YARD SIDE YARD REAR YARD NOTES SITE OR PLOT PLAN •For Applicant Use I� W N �1� �Y. APPOINTMENT FOR FINASaeem Fite Department L' FtLce Prevent-Lon Bwceau APPOINTMENT FOR FINAL INSPECTION MUST BE 48 La MADE AT LEAST ONE WEEK 4ayette Skeet INSPECTION MUST BE Satem, Ma 01970 MADE AT LEAST ONE WEEK AHEAD----.--•-------' (50 8) 745-7777 AHEAD--_ 1' FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT In accordance w.cth the prov4_,5 on-6 04 the Ma."achu,6etta State Buttding Code and the Saeem F.vice Code, application tz hereby made 4o4 approvat o4 plan,6 and the t,6.614ance o4 a certt4dcate o4 approval 4or a bu.i.Edi,ng penm-i t by the SaP.em Ftce Department. (Re4. SectZon 113. 3, Mafia. State Stdg. Code) Job LocatCon: 1 Owner c /Ocupant: hV �15� t Lob57Er o EZec ., icaC ContAaator: �o � ar. bezl 7 ��r, FZke Supprea.6.Lon Cont4acto4: Stgnatwce o4 Appt.Zcant: �� Phone #: 7,5 - V 6oZ, Addre44 o4 1 City or a Appttcnt: Town: 5Cllelvi Approva.e date: Ce4t4.i,cate o4 approvat 46 hezeby granted, on approved ptanb on -6ubmittaQ o4 project deta.itb, by the SaCem Ftte Department. Alt plana ane approved 4ote2y 4or tdenti.4.icat.4on o4 type and Eocati.on 04 44- e protection devLce6 and equ.Lpment. At t plan,6 are .6ubject to approval. 04 any otheL a.wthonity having jutt4dLctlon. Upon eomptet4on, the applicant or enzta-t2er(-6) .6ha t requ"t an tnapeetion and/or te4t o4 the 4tAe protection devtcea and equipment. ( ** FOR ADDITIONAL REQUIREMENTS, SEE REVERSE SIDE ** ) New eon6truction. Propeaty Zocation ha.6 no eompllance with the prov-1.6Zon6 o4 Chaptez 148, Section 26 C/E, M.G. L. ,. reeati,ve to the tnata2ati.on o4 approved 4.i to atahm dev.ice6. The owner o4 thi-6 property L6 4equt4ed to obtain compliance a-6 a condition o4 obtatn,ing a Buttddng Permct. Property tocatLon -1.6 to compliance with the provt4ton6 o4 Chapter 148, Section 26 C/E, M.G. L. Expt4atl on date: / C) 3 ✓LOLw� L�LLi 1313 s.i natwce a4 �Giae Fee dice- under 7 - oo So. Ff - - 1 7� FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT In compliance with the provision of Section 113.5 of the Massachusetts State Building Code, and under guidelines agreed upon by the Salem Bldg. Inspector and the Salem Fire Chief, the applicant for a building permit shall obtain the Certificate of Approval (see reverse side) and stamped plan approval from the Salem Fire Prevention Bureau. Said application and approval is required before a building permit may be _J w issued. The Massachusetts State Building Code requires compliance approval of the Salem Fire Department, with reference to provisions of uz—. m w Articles 4 and 12 of the Building Code, the Salem Fire Code, Massachusetts o: � p 0 to General Laws, and 527 Code of Massachusetts Regulations. F The applicant shall submit this application with. three (3) sets of plans, w z i drawn in sufficient clarity, to obtain stamped approval of the Salem Fire g OP Q Department. This applies for all new construction, substantial z w w alterations, change of use and/or occupancy, and any other approvals a UU)i g = required by the Massachusetts General Laws, and the Salem Fire Code. a ? 2 a Exception: Plans will not be required P for structural work when the proposed work to be performed under the building permit will not, in the opinion of the Building Inspector, require a plan to show the nature and character of the work to be performed. Notice: Plans are normally required for fire suppression systems, fire alarm systems, tank installations, and Fire Code ' - requirements. Under the provisions of Article 22 of the Massachusetts State Building Code, certain proposed projects may not require submission of plans or complete compliance with new construction requirements. In these cases, provisions of Article 22, Appendix T, and Tables applicable shall apply. This section shall not, however, supersede the provisions outlined in the Salem Fire Prevention Regulations, Chapter 148, MGL, or 527 Code of Massachusetts Regulations. All permits for fire code use and/or occupancy shall apply for- the entire structure; fire alarm and/or smoke detector installation shall apply to the entire structure based upon current requirements as per Laws and/or Codes, but the existing structure may comply with regulations applicable for existing structures. Notice: Sub-contractors may also be required to file individual applications for a Fire Department Certificate of' Approval for the area of their work. Such sub-contractors shall file an Application to Install with the Fire prevention Bureau prior to commencing any work for those areas applicable. j EOR F1NAL � �; MEN gE Form 81X (10/90) AppOWTMEW x BE A , APSPE SO4 M$SONE wE INSPECTION SS ONE WEEK 1MAOE PT L� -- "---� MpoE AT LEA` `� COMMONWEALTH OF MASSACHUSETTS E k DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET fames ; Camooeu BOSTON, MASSACHUSETTS 02111 -omm ssrone, WORKERS' COMPENSATION INSURANCE AFFIDAVIT 1, 1A O Ao-k/\ 2, &bA — (I icensee/permi tree) with a principal place of bususiness/residdence at: (City/State/Zip) do hereby certify, under the pains and penalties of perjury, that: [ ] 1 am an employer providing the following workers' compensation coverage for my employees working on this job. L� _ r � Insurance Company I Policy Number [ ] I am a sole proprietor and have no one working for me. [ ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation insurance policies: r�p MAnet Name of Contractor Insurance Company/Po 'cy Number l Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number (] I am a homeowner performing all the work myself. NOTE: Please he aware that while homeowners who employ persons to do maintenance,construction or repair work on a dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto arc not generally considered to be employers under the Workers' Compensation Act(GL C. 152,sect. 1(5)), application by a homeowner for a license or permit may evidence the legal status of an employer under the Workers' Compensation Act I understand that a copy of this statemenr will be forwarded to the Department of Industrial Accidents' Office of Insurance for coverage verification and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to $1500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of 5100.00 a day against me �'�,�//�� Signed this ��U� :`��/�i� %� day of 19 �`' Licensee/Permiaec Licensor/Permittor Ta J T�' Azza �-&a4AM o$""a'A' o ' >b ate: �>r michaei S. DuWrus tt!c�orn.aaw Cale ��ice J l Govemor JO/ tom; 02108 Kentaro Tsutsumt ' Chairman 6171 ^ 3:00 Charles J. Din—o Administrator M E M O R A N D U M TO: All Building DcpartmenwJtate Building inspectors FROM: Charles J. Dineno. Administrator DA7F— October 31. 1988 SUBJECT. MGi, cd0 SSA Added flr rSflA, 59 of the has n! 19117 The above•menuoned statute requires that debris resulting from the demolition. renovation. rehabf8tatfae or other alteration Of a budding or structure be disposed of in a Qroperty handed sand waste disposal facility as deftnea by MGL till. 5150A and that budding permits or licenses are to indicate the hscauoh of the farsury at which the said debns is to be disposed. THIS REQUIREMENT DOES NOT APPLY TO NEW CONSTRUCTION. Process and � to prcmde uniformity. we are attaching a copy of a form which y In order to ampUfy me ou can cubo reproduces and use s n n since the completed form will be attached to the office copy of bu6 Permits or luaus: or reproduce It on your IetierheML In casof municipal.commercial.industnai.or multiunit housing constructlon.the contractor may hot kaotr e the dumrler subcontractor at the time of the building permit appltcaluon. In such esus. the atucbedopp C b(an dant can be used. nen twopictcjaw i contained in the d have am q d mIssue of Please let us knowD which will be marled to wu is tha ou CM1km J city ofaiem, ia��ar�ju��tt� f3ublic �3rnncrtr 4:3enartmcnt r+,4 Swibinq 73enartmcni ant asurn Orren 745-a�°5 zzi. 320 William H. Munroe Director of Public Property lasocaor of Buiidinrts Zoruna Enforcement vfficcr In aaordancc "in the provisions of MGL c 40. S 54. a condition of Building Permit Number is that the debris resulting from this wort shall be dubosen of in a property licerisco solid waste dtsposat fantiry u dcflnm by MGL c 111. S 150A Tae debris will be duposm of in: r (Location of Facility) Signature of Permit Appuans �r/io/93 Date r . . 05 itp of Sztlern, C ttssttcl�u E##s Fire 11nWwnt lipubquarttre SALE4A>F9AS5. RLEEtA FIRE LAW AND CODE NOTICE .e dames CITY OF chid a , Date July 12, 1978 Craftsman - : 131 R Derby St:. ; 3 Salem, Mass. Ret 215 Derby Street Union St. G&rage :k =r Sirso Our records show that you have not complied with the provisions of the Salem Fare Code and Regulations made thereunder as follower ass' Failure to apply for plan approval of installation ofduct f©r x � t paint spray booth, located at 215 Derby Street, Salem, Mass. Permits are required from fire prevention bureau and building inspector " As a result of failure to comply, by filing the proper form or appearing by appointment at the Office of the Salem Fire Prevention " Bureau, to correct the above condition; yk ON OR BEFORE July 19, 1978 such furthur action as the law provides shall be taken by this office. Al Failure to comply may result in court action and/or revocation i of the Certificate of Occupancy for the structure requiring the ,sx compliance as set forth herein. Ws �, •, Per�ord r� C- t. avid J. oggiire Marshal Salem F re Prevent on Inspector °# ; CC, Building Inspector 'a $ file , M 3# ` hi X\M//X BX \,/�- -\�/X ERNER ARCHITECTS 3 SCHOOL STREET MARBLEHEAD MASSACHUSETTS 01945 617 631 8026 02 July 1992 Salem Building Department One Salem Green Salem Ma. 01970 ATT: David Harris RE: Pelletier Fish @ 215 Derby Street , Salem, Massachusetts CV The Work performed has been reviewed and found to be substantially complete and ready for occupancy. The following three items are noted deviations from the approved plans: 1) the creation of an enclosed room for the gas fired hot water heater with intake and exhaust ventiation. 2) the deletion of door number 1 & partition between the fish store and fish restaurant. 3) the deletion of door number 2 and the infill with lhr rated partition. I certify that to the best of the architect's knowledge, information, and belief the work conforms to documents approved for the building permit. Respectfully, 1� David R Berner AIA MEMBER OF THE BOSTON SOCIETY OF ARCHITECTS AMERICAN INSTITUTE OF ARCHITECTS 1 %��`°:� �m C�it� of �ttlem, �ttss�cl�usptts Public Propertg Department Nuilbing Department (One t3alem (5reen 508-7i5-9595 Lxt. 3d0 Leo E. Tremblay Director of Public Property Inspector of Building Zoning Enforcement Officer NOTICE Removal of Unsightly Conditions on Structures or Improvements Commonly Referred to as GRAFFITI YOUR ATTENTION IS HEREBY DIRECTED to the provisions of Chapter 2, Article XV et.seq. of the Municipal Code of the City of Salem, Massachusetts, on file in the office of the City Clerk on the first floor of City Hall . Pursuant to the provisions of said Chapter 2, Article XV, you are hereby notified that a certain unsightly condition exists on premises specifically described at the facade surrounding 214 Derby St. Salem, Massachusetts 01970, which injures neighboring property and the public health, safety, and welfare. You are therefore notified at once, and in any event within thirty (30) days from the date of this notice, to keep said property free therefrom. In the event you fail to complete such work within the time hereinabove mentioned, the undersigned shall cause the same to be removed and you will be responsible for the cost of removal of the condition from the property. Dated at Salem, Massachusetts this 15th day of August 1995. Director of Public Props ty ARCHITECT'S OWNER CT E A FIELD REPORT CONSULTANT Q � AIA DOCUMENT 07117�•• FIELD ❑ F� PROJECT: n:-,"q FI5a In'lkd. q—r FIELD REPORT NO: 7 CONTRACT: e2+5 0UyL6ti -2( 5hw+j ARCHITECT'S PROJECT NO: �I O DATE Cp'15"�Z TIME -3:pVQ04 WEATHER gU IN'l TEMP. RANGE EST. % OF COMPLETION 4707, CONFORMANCE WITH SCHEDULE (+, -) d I L WORK IN PROGRESS PRESENT AT SITE �G. Pq,�,in?rom �ItiKA G 1 �L. JI k'1 6,Vll H J vVAM 0&1r.J►xr 6v2unnoi S�'Sftrrri OBSERVATIONS �W LvAf&IL ua I N � cc �ilDewau� DU�i uP W10004^ pM PPM I Gu�nrcX� u&W q()x�fM l"1 w j A1t7"kwa�i o�J G6»r Pry W k" nr1�21*W 10*10W f 90r C)V" 7 l NhThN kV /fWA-iT-1 5f1�b 1�r1�rT1 ITEMS TO VERIFY INFORMATION OR ACTION REQUIRED ATTACHMENTS A-11%- n REPORT BY: I A00 (1-(�c�'►-No✓✓ AIA DOCUMENT 6711 • ARCHITECT'S FIELD REPORT • OCTOBER 1972 EDITION • AIAOO © 1972 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW, WASHINGTON, D.C. 20006 page Of pages 1 r ARCHITECT'S AO WNER o FIELD REPORT CONSULTANT ❑ 3lJI'Ju I'dt; OcPT AIA DOCUMENT 0711 FIELD ❑ PROJECT: �Y (�(7k (oxf-uor FIELD REPORWF)r r! 9 t Jt ii ii t 0 CONTRACT: Zl� �2PH 5f Gj�4f bn4 ARCHITECT'S PROJECT RtU� Gliy j' 111 '-r1� DATE �• ��•� �� TIME g. �.(� WEATHER TEMP. RANGE EST. % OF COMPLETION 7794 CONFORMANCE WITH SCHEDULE (+, -) O14- WORK LWORK IN PROGRESS PRESENT AT SITE `G, pL�mtyV ` )ur�f' l� A�l�1Nk`�DYI.� }L'Vl�•`'I��VI/l`,dAJ�� uenmi Iur�i9-!t� J�t.IJ �Eu�1eoG� ulrnl0au�7 OBSERVATIONS Dopa_ 6AM M P 5106 1 0 114dtA2 ITEMSTOVERIFY INFORMATION OR ACTION REQUIRED Pa*1f ! ll-&of //& hqr Aez' ATTACHMENTS REPORT BY: OLIO fl- b0LPW fid E� AIA DOCUMENT G711 • ARCHITECT'S FIELD REPORT • OCTOBER 1972 EDITION • AIA® © 1972 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW, WASHINGTON, D.C. 20006 page of pages ARCHITECT'S OWNEARCHITECT El A FIELD REPORT CONSULTANT ❑ AIA DOCUMENT 0717 FIELD ❑ PROJECT: FIELD REPORT NO: �7 CONTRACT: 12.16 ARCHITECT'S PROJECT NO: y''lo / DATE 6- 7;0 -'11, TIME 61: OQ A01 • WEATHER OVMtZt2T' TEMP. RANGE �5 O EST. % OF COMPLETION� CONFORMANCE WITH SCHEDULE (+, -) 0//-- WORK IN PROGRESS PRESENT AT SITE - "I N J n 0• foa- OBSERVATIONS1A)0M 9__/'1�klf)f)k ,�W JA) l!I i 3`' Gpy�> fZ (})WDIA&Y -..44J FdAw< .!T/�j L ( � 2 I Pww. Ny NC�L2 Govt OL�fI eiJ VOA-tj It lin urrt. On�-r� N 1 W A` *A-,l uG 11 f( 11 It AYxll,*fi(o a l oa-LA rr /A) 4 ,CJWW, 6 ,,, ITEMS TO VERIFY �j (j�jGj gQ�(�t.{t'� 6rJ �J XLH J('�f . #4WuV P�D AO 6e 1 D�� INFORMATION OR ACTION REQUIRED ATTACHMENTS REPORT BY: I// (L, yLqL- AL AIA DOCUMENT 6711 • ARCHITECT'S FIELD REPORT • OCTOBER 1972 EDITION - AIAO • O 1972 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW, WASHINGTON, D.C. 20006 page OI pages ARCHITECT'S OWNERARCHITa FIELD REPORT CONSULTANT ©'6"pqrLA r AIA DOCUMENT 0711 FIELD ❑ PROJECT: vev'4y ri5R 14A wr FIELD REPORT NO: CONTRACT: 2115 00-lbl-/ 5.r 5Au&m ARCHITECT'S PROJECT NO: DATE 4, 2Z. I TIME /;Z:010 WEATHER 50,t)A4 TEMP. RANGE 75' EST. % OF COMPLETION /D CONFORMANCE WITH SCHEDULE (+, -) OlL WORK IN PROGRESS PRESENT AT SITEf�.TIdL' fIeyky Q;opwh-( -2,IM oal'i Jriv kJruDu�,� OBSERVATIONS Y6W A 0• Pew Agrlph OAwA vot r Gof F>4kMa;2 I Qxrw Mr Q off)U4.0. a ) -tw gllhlel kMraly roLL kJlu) 6,Yazax1--1 W/%w &)ow V-�jm (P- 6w ,,t, 1uAtjw — kwmvP4 r—jr>,+f�rkw ITEMS TO VERIFY � l� f an, W ImoLy I J y) �jUect"&- INFORMATION OR ACTION REQUIRED ATTACHMENTS REPORT BY: II� AIA DOCUMENT G711 • ARCHITECT'S FIELD REPORT • OCTOBER 1972 EDITION • AIAOO © 1972 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW, WASHINGTON, D.C. 20006 page of pages ARCHITECT'S OWNET ARCHITECT O FIELD REPORT CONSULTANT r3�W9 Rif AIA DOCUMENT 0711 FIELD ❑ PROJECT: Vo-by fl5k wwwr FIELD REPORT NO: -rN21agr- CONTRACT:: '2.1--) ejHL&O ARCHITECT'S PROJECT NO: q 116) y DATE 4 - q2-- TIME 'f;30AWI. WEATHER JUNN'� TEMP. RANGE 50° EST. % OF COMPLETION -26J6 CONFORMANCE WITH SCHEDULE (+, —) L)14-- WORK /G_WORK IN PROGRESS PRESENT AT SITE �/„ �U.fLTIW�-�K. i,hy�.JLAn7✓� p<w�rJc, CaBeL�aP��.a�►�7 OBSERVATIONS u,vOen.G �i� PlOiuhT�1�I�9�r�P�+s►7-�! �! f�T� 3 G unk I N9�r„t fli►� 7t7 JOKO ITEMS TO VERIFY INFORMATION OR ACTION REQUIRED ATTACHMENTS REPORT BY: 'S/h�(��1 ►�1��i41�1 AIA DOCUMENT 6711 • ARCHITECT'S FIELD REPORT OCTOBER 1972 EDITION AIAO • © 1972 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW, WASHINGTON, D.C. 20006 page of pages ARCHITECT'S OWNER ARCHITECT ❑❑ FIELD REPORT CONSULTANT ��- AIA DOCUMENT 0711 FIELD ❑ PROJECT: av6-( k-jt{ mA(LKAqFIELD REPORT NO: K2, CONTRACT:-2�6J DjWl-�f 5,A ,2M ARCHITECT'S PROJECT NO: CT11 O DATE 3 •21.1 Z TIME 9;50AW1 WEATHER TEMP. RANGE �5V CO EST. % OF COMPLETION � ;/�b CONFORMANCE WITH SCHEDULE (+, -) b IL WORK IN PROGRESS PRESENT AT SITE . Pct Lerli -L, 4owtAolo 77 Bt��-nk1L' --rP*X4flur7 Vo-r- vvl 6vAr'rrl- OBSERVATIONS 1076 6,&M P&6r,5 oN 0090A411., W AM" bl t2th-� - I u`?PL<xan%J!� PL crcog n2 (Okra ITEMS TO VERIFY Q ►mssoow nJ rrwhren Akw �'/q`� Give _fVjga r - o A- K1rpt INFORMATION OR ACTION REQUIRED ATTACHMENTS REPORT BY: OAVIO (LD ff2,N L— •AIA DOCUMENT G711 • ARCHITECT'S FIELD REPORT • OCTOBER 1972 EDITION • AIA® © 1972 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW, WASHINGTON, D.C.20006 page 01 pages ARCHITECT'S AO WNER � FIELD REPORT CONSULTANT ❑ AIA DOCUMENT 0711 FIELD ❑ {3M5 DEOr PROJECT: 2ep-$1( n-70 "4cr_ FIELD REPORT NO: oNc CONTRACT: 1217 15-"Y `5rT 151hC " ARCHITECT'S PROJECT NO: 8110 DATE X3. 1 Co. 1Z, TIME 41D WEATHER 1570K)0*y TEMP. RANGE Z j -5y EST. % OF COMPLETIONQ 7e, CONFORMANCE WITH SCHEDULE (+, -) 0-1/- WORK .1GWORK IN PROGRESS PRESENT AT SITE K.pru,aae K Jµowe TiP+�.x[t1U�, f*'L- W�iil? 1°1P11ut� 103 PF �iS 5'C�1w� UNC-_�if1wnh� �W w 61 W� OBSERVATIONS Du txllrI94 A 0, G40V4 w1V pv7r&u /A) ar�ir�OG i�iy�S 5l u�ut PGy �o Fran g y�irtny Goza�ic�Tc.ro ITEMS TO VERIFY INFORMATION OR ACTION REQUIRED (,A) ! ATTACHMENTS ,/� REPORT BY: AV l� n ?;)taL. 1 W_ 74rlA, AIA DOCUMENT G711 • ARCHITECT'S FIELD REPORT • OCTOBER 1972 EDITION • AIAO © 1972 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW, WASHINGTON, D.C.20006 page of pages l I 215 DERBY STREET 41-10 GIs# 1289 4, COMMONWEALTH OF MASSACHUSETTS Map e .. 34 - Block. , °I° CITY OF SALEM Lot 0427:: Category `4 nn' REPAIRREPLACEVi, Perini# ,� 4110 BUILDING PERMIT Project# 4,,-4 JS-2010-000041 Est. Cost: - ' $3,500.00 Fee Charged: ' $49.00 ;r Balance Due:n $.00 PERMISSION IS HEREBY GRANTED TO: Const.!Clas`s:�� `+�� +-Contractor: License: Expires Bradford Construction,Leon W.Bradford Lot Size(sq ft.) 4089.8484 Zoning BS r ; rx? Owner: LU LU GRACIOUS REALTY TRUST,DONOVAN SHAWN E TR Units Gained: a ,,Applicant: Bradford Construction,Leon W.Bradford Units Lost.' AT: 215 DERBY STREET Dig Safe#i ISSUED ON: 16-Jul-2009 AMENDED ON: EXPIRES ON: 16-Dec-2009 TO PERFORM THE FOLLOWING WORK REMOVE PETITION WALLS,FOOD BAR AND REPLACE FLOOR TILES WHERE NEEDED jhb POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing Building Underground: Underground: Underground: Excavation: Service: Meter: Footings: Rough: Rough: Rough: Foundation: Final: Final: Final: Rough Frame: Fireplace/Chimney: D.P.W. Fire Health Insulation: Meter: Oil: Final: House 4 Smoke: Treasury: Water: Alarm: Assessor Sewer: - Sprinklers: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: BUILDING REC-2010-000053 16-Jul-09 Cash $49.00 GeoTMS®2010 Des Lauriers Municipal Solutions,Inc. IlY � C/) o � z 1 i o — o - I i I� D CO i j j Ai II _ o a Fl 0 m x_ V / z _ Z Cn a �7 3 r' D 0_J 0 xz - m n c 4 rrl r z v z 1 fel 3 �' S OD z � Z C, M D — D m CD d N O f rn C7 � IT � �' xm w D — D w z z m D O � � zz 0 0 z 0 I z 0 i II i _ L I i II i �� DEER HILL ARCHITECTS , LLC ELEWATI I 1 PROPOSED NEW ACCESSIBLE SERVICE WINDOW --- SEAPORT CAFE 40 LOWELL STREET, SUITE 23, PEABODY, MA N 215 DERBY STREET, SALEM, MA TELEPHONE (978)-5328660 FAX (97$)-532-3130 © Deer Hlll Architects LLC Thdse drawings are proprleiary and may,not be reproduced without written pernlsslon I � _� � , � .. ' The Commonwealth of Massachusetts ;, \' �y ,� Department of Publit Sa(ely . ` �`„�� . \Ia.�iahu.elln�lalrtluJdmtil��dr1:21�C�IRl�rvrnthEdilum 11 c�ry ar s.i�m �� Buildin Permit A licalion for an Buildln othe�fhan a 1- or 2-Famil Dwellin 1�hin 5rctiun F��r Vlfiaal Uv lh+Iv) liudding Prrm��Numbrr. Qur Applird: Bwlding In.prctur: SECTION l: LOCA ION IPleax indfote BI«k� �nd Lol I (or I«atiom(or which s atnet addm�is not avail� le! � .�I I � G � � _ G X��..ind ti�rrrl CiN• /io�vn Zip Gk1r � Namr uf Bud mg Gi.ipplia�blr) SECTION S:PIlOPOSED WORK If Nrw Can.uuc��un chrck hrrc�ur chrck all that apply in thr�wu ruwy brluw � E.hting Building O Rrpair Altrratiun O Additiun O Drmulitiun O (Pira�r fill uut.ind.ubmit ApprndiM 1) Chnngr u(U�r O Changr uf Occupancy 0 Othrr O Specify: Are building planv.ind/ur mnvtructiun ducumrnb bring supplied a�part u(this prrmit applicatiun? Yry Nu O I+an Inde�endrnt Slruclural EnKinrrrinK Prrr Revirw rryuirrdT Yrs O No O Bric(Drvcripliun of Prupoxatl Wurk: . ,Q1c �[ o4L' L.h-ti s SECiION 3:COMPLEIE THIS SECf10N IF EXISTING BUILDtNG UNDERGOtNG RENOVATiON,ADDITION,OR CHANG8IN USE OR OCCUPANCY Check here i(an Existins Buildlns Evaluatlon is encloned(See 7B0 CMR 3402.0) O � Exiyting Use GrouP(s): Proposed Use Croup(s): t Existing Ha�ard (nde:780 CMR 34: Proposed Harard Index 780 CMR 34: SECTION 4:BUILDING HEIGHT AND AREA � Exieting Proposed � Nu.of Fliwn/Storiry(include baarment levrls)Q�Area Prr Floor(sq. ft.) Total Arra(sq. ft.)and Tutal Height(ft.) SECTION!s USE CROUP ICheek a�a lieable) A: AaNmbl A-t O A-2r O A-2nc O A-3 O A4� A-5 O B: Budneu O E: Educatlonal � F: Facto F-1 ❑ F2� Hr HI Haza�d H-1 O H-2 O H-3 O H-4 O H-5 O 1: InstituHonal I-1 O I•2 O t-3 O 1-�O M: M�aantlle� R: ResidenNa/ R-lO R•2� R-3 O R-i O S: Stora • SI O S2 ❑ U: UNlitr O- _ '_. Special Us�O and Irasr drncriba beluw: SE,rcial U+C: . - SECTION 6:CONSTRUCTION 7YPE(Check u a Itcabl�l IA p IB O ItA O 118 O IIIA O IIIB O IV O VA O VB � SECTION 7:SITE INFORMATION Irefer to 780 C�1R I11.0 tor detail�on tach iteml 1V�ter Supplr: Flaod Zone Infartnation: Sewagt Disposal: Trench PertniM. Debris Removal: Pubba❑ � l�hc.k rt uut.i�le fL��J Lunc O InJit.�lr mumap.il O '\ trrnch wdl nnl br Licen.ral Di.�+��.d�itr O rcyuued O ur trenrh �a .�•.tid�•: I'n��et.❑ ��r indcnld�� Znnr: ur un.rtr.c.trm O �.rrmit h enrlu.ral O R�ilro+drighho(•war: Ha:ardstoAir.Wvigation: �I�� II�.��n. t „��..,,�,�R.•��.�„ I'.�.�,�.. \��1 \�•��ha.iblv 0 I.�Irwlure��ilhm air�.url aF��•rn.ich.vr.�' I. Ihe�r rr�ivw Cnm�•IclvJ.' ,�r l��n.onl h� Itud.l cndi��avl ❑ 1.•.O ur Xu❑ 1'a'�❑ \n ❑ � � SEC`iION B:CONTEVTOF CERTIFICA fE OF (KCUPANCY I ,lili�m ��ll�,�dv. _ l�rl:r��u�•l.r f�E�e��ll��n.lruaw�n: lkcu�•.�nlLu.idF�crll�n�r � I��r. lh�•l�inl.Ln�;:nni.un.�ntiF�nnAler��.lcm': ��•vai.J ?li��ul.ilian.: SECTION 9: PROPER7Y OWNER AUTHORIZATION Vame and � Jdrran��1 Nrnpeyy�V��•�n�r ,/�G�ie �)' /" i��/.s �,�i v�,l�° . . .V.�mr IPnntl .Vo. .�nd 5tr.�rl l ih�/ f�nvn L�� 1'ru�s•rlv lhvnrr(�unlarl INurm.�Uun: . � Tillr , Trlr��huorNu. lbu.inrn.l TrlrphunrN��. IcrIU r-mad.�d.�n�v I(a�•phr.�blr. Ihr��ru��rrl�•u�.�ner hrrrby aulhuncry .\amr �tr•rol AJdrr�v - litv/Tuwn 5t.�lr LiE, lu.ut un �hr vu v rtc ��cnrr'.brh.ilf. m.JI meltrrx n•I.�u��r tu wurk awhun[r.1 bv thi.buddin �rrm�f.� � +lir.�tiun. � SECTION 10:CONSTRUCTION CONTROL IPteas�fill ou1 Appendi�2) (I(t•uddin ia l.�dun)S.Uuu:u.te.rf an.�u�e.d s rce anJ/ar n.��unJ.r l'.�n.iru.iiun Gmin�l ihen chec4 her�O.�nJ.W &chun IU.II 10.1 Re iattrcd Pm(es�lo�al Rea o�sible (or Conslnution Conlroi � �.4 v,�� ( `rv.E��v /9�c • �'�9��— �/l�d.S' N.imr�(Rrgistra�q� � �r� Trirphanr Nu. rm.ul.iddrrxy Rrgialration Numbrr ��-� /"�l i.c.�• c. V T r� �rw� �.�. G�i9>v . 5trrrt Addrrst City/Tuwn . titate Zip Discipline Erpirelion Datr 10.2 Cenenl Contnctor ' //1J//i`d _,,,��,e.t� �/A � CumF{'any Namr: /D� �� C . C. J - Namr u(Prwn Rrwpmsibir fur Cunylructiun License No. and Type if Applicable � � Slreet Addrea . City/Towe ' State � Zip Trle honr Nu.(business) Tele hone No. cell Pmail address � � SECitON 11:w V (M.G.L a IS2 2SC(6)) A Workrn'Comprnnation Ineurann Affidavit from the MA Department of Industrial Accidenb must be mmpleted and +ubmittrd with this applicatfon. Failure to provide Ihis affidavit will result in the denial of the issuance of the building permit. le a ei ned A(fidavit submitted with thfe a Iicallon7 Ye�O� No O SEC170N 12:CONSTRUCfION COSTS AND PERMI'f FEE Item � Estimated Custe:(l.abor . and Materials) Tutal Construction Cost(from Item 6)=f � �� 1. Buildin S 8uilding Permit Fee�Total Cunstruction Cost z_Qnsert here 2. Eleetrical f appropriate mun�cipal fa tor)=f . J. Plumbin f 4. Mechanical (HVAC) f Notr. Minimum fee�S�(mntact municipality) 5. Mrchanical (Othrr) S Enclow chrck payable to 6. T��tal Cuat f (contact munici alit )and write chrck numbrr hrrr SECTION 17:SICNATURE OF BUILDINC PERMIT APPLICANT IIY rnlrn y n,�mr �rl��w. I hrrrby aur.t unalrr Ihr p.nnw and prn.dtir+�d prqury Ihat all uf thr informaliun cun6anrJ in thin � .iF.plicaU� i. Irur�� 1 curotr h� Ihr br�l�H my knuwlra tir�nd un '6r+t.indinK. v�,�/ �.� � �,� .- 7��'�� 19i•.�.0 F�nnt � •� • .�mr / . fiflr �ulcph�mr\'��. Uaie e �'l G I �trvcl .\.IJn•.. � 1 � . Clh�i Tuw'n rt i�� \ 4� i �luni.ip�l Insprdur to fill out this seation upon�pplicolion approval: \'a mr I>a ir . i , - - ;_ _ _ t f ,. , , � ��;1}r ; � � � 0 � /; � ` �� : � � i ' � �� i � — L � . , � _ --- � I� � �,s ,'; � � � ��- �' '; � - . � , � i � i � , � �' ��' � i �� CR � _ � � . ,� ; f, _ i ': _.. , i �� . . . . . . : . ... � �:.. �� .-.. . � , . �, . . . �\ L � ♦ � � if. I � • � i '_._ I _ ._.__ . . , C_ I _ � '� i . . � �" _ _ , ' � � 1 . � � ; _ �� - ' , � � ' � - ' , � ---- . ', � f�— � j I �;' � " i I � i �i = � �i . � ` � � � � �i �j � ! � ;. � ' �i � Ij I I, �! 4 � � �I� . �' _ . � � • 5 _ ;, _ '�- � � . ; � I� ,: p � ; ,� � c � . ; I' - -- ' 4 : 4 ; � ; i, 1 I; ; P ii i I i � ij ' . ! 1 ' ' Ii -- � � I i � • . . . ._. _ `� + : � � � _ � PROPOSED RENOVA710N OF 7HE SEAPORT CAFE � O �,�o� . ,p�,Q ; , 215 DERBY STREET� SALEM� MASSACHUSETTS G� 0 ^,� � j � � � C = �°og o . I � �c ^�c- -`C ' �� r' DAVID F. JAQUITH ARCHITECTS � ,�`�'a�j ,,a''� ' � 81 RAILROAD AVENUE� ROWLEY� MA99ACHUSETTS 07989 O - I jaquitharch iteds@mac.com __ ; ; , • . ,�EpED Aqc� . . �' . . :, • , � � � �ra rl�`O DAVID F. '� JA�UITH n No.2853 .� ' s Rowley, MA $� ��M a r►ti��ct� 8 20f0 �L& �fc11�Y 2�0 -- , , -- -- N W j— " Q Um U W ' , F � o oF 2 � � W o, W V � Q N. � w � � � N � d � W m a a � F Q = f � _ �, g 1 ; � -� � ° � ; i i Z W � a ..LL i � � ..I ^ E ! �N� ts 1- Q Q i � Q N `7 W A � .. E . ' . - . � -- - ---.__- -` .---.__ 0 F LL' Q � : � � —_. —_� � --- - --..�� . a "` -- ---...__ .___.---__---- �� _ _.—... ___ . ---- � ---- '_ .�_:.__._._. ..._. ._...- --- _._. Z W � _ . . - ' w � � w . , _. - �_ _._'_ .. .. ._. . ._ _ _. _ . __._ . _ .____ _. ____._ . _ _ . _ _____ � � � .�. F - �,y�(�'. _ _ �� _ . � I � � �' Q� •rc � � . L�). W o0 - __��l✓��/---1G � _. _' --. _ _ ; ; j Q m -� II ( N � ^ � I ��7G+s ViN y `I`� - .yI _. . _ � I ' u. -Y. '- _ — 7 , W �I - , � _... ' _ �. ;: .. N .. .� _ �_�. � _ ,, . 1 . - - - - I -.. • , I .�� :_� �'' . � - _ __ ; o, r . ; - � , - _ _ _ � — � :� -- _ __ � - --- �� _ _ _ , � . , � , - . � _ _ _ � - ___ . �__ _ �_�� _ ��_�� i-_� -._� �.__ �� --� _-____ _ _ _ � , , j , , J � ;-:__�. _. .. I--- - �-- _ _. - , --- _ _ . _ --1----��"- s � �� . �.�.-�-.�/a,T � D�l _ �- _�� , � � . �i- _ _�;- ►'�.o � _- -�: �w _� , , � �_.., >,►._;' _ The Commonwealth of Massachusetts �d• �,� � Department of Public Safety II /��._,.✓ \I.�.s�rhu.ell.til.ilr Buildinti C��dr 1:E3�C�IN)Serrnth Editiuo � I U City of Salem ' '^I Buildin Permit A lication for an Buildin other than a 1-or 2-Famil Dwellin � �ihi+4ctiun Fur Utficial U.�r Onlv) Uuilding Permrt Numbrr. Detr ApplieKl: 't- Building In,Exctur. � SECTION 1:LOCATION IPleaee indieate Block N and Lot N for�ocafiona for wh' h a etrce address is nof available) / t! C o� ��. X��.and tilrrr�—' � /T�nvn Zip G�dr Namr uf Building(if applicablr) SECTION 2:PROPOSED WORK If Nrw Cumtructiun chrck hrre�ur check all that ap�ly in thr twu rows beluw � E.iisting Building❑ Rrpair❑ Altrratiun��, Addition❑ Drmuliliun O (Plrasr fill uut and submit Apprndix 1) < - — . Changrnf Use O - � Changr uf Occupancy O Othrr O Specify: Are building pl.ins and/or corutructiun d�xumrnls bring supplied as part uf thia permit application? Yea Nu ❑ Is an Independrnt Structural Engineering Peer Revi w required? Ves ❑ Nu O Brief Drscriptiun uf Proposctl Wurk: � nJ C SEC710N 3:COMPLETE THIS SECTION IF EXISTING BUICDING UNDERGO[NG RENOVATION,ADDI770N,OR CHANGE IN USE OR OCCUPANCY Check here if an E:ieting Building Evaluation is enclosed($ee 780 CMR 3402.0) O � Exisling Use Croup(s): Proposed Use Group(s): Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Fluors/Storira(include basement levels)&Area Per Floor(sq. ft.) � � � 7-��T Tutal Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as a Ucable) A: Aesembly A-1 ❑ A-2r A-2nc O A-3 O A-4� A•5 O B: Hueinees � E: Educatlonal ❑ F: Facto F-1 � F2 O H: Hi Hazard H-1 O H-2❑ H-3 � H-4❑ H-5❑ I: lnstifutional I-1 O I•2 O I-3❑ 1-i❑ M: Mereantile❑ R: Residential R-1❑ R-2 O R3❑ R-4 O S: Stonge SI ❑ $-Z O U: Utility❑ Speeial Uee O and Irasrde�cribe beluw: Spedal Usr: SECTION b:CONSTRUCI'ION IYPE(Check ai a Hcablel IA ❑ IB O IIA O IIB O . IIIA p � IIIB O IV� VA O VB O SECfION 7:SITE INFORMATION Irefer ta 780 C�1R I17.0 for details on each iteml Water Su I Flood Zone Information: Sewage Disposal: Trench Pertnif: Debria Removal: PP Y� Pul�Gc"� � Chcck il��ut.ida•fluud L�mi�❑ Indicalr mumciF+al'� �1 trcnch w I nnt br L�crn.rd Di.pu.,d�itr� r.�ywred�irlrench ur.f•eril��:� � . I'nv,iti❑ �inndvnlil��Zunr: � ur�m.�tr.��.trm0 �,rrmili>endu.r.10 Railroadrighbof•way: HuardstoAirNovigNion: �L� IIi.i��n, t�,�innii..i�mK�•�� I'n,�r..: \��d :\F��liialdc� I.�Iruiturc�crthm..iirf+urt,iE+Em�,ich.irr.�.' Inlhiirrrcic�cCnmE,lk'Ivd.' ��rl'��n.cnf��HuJdanih�vd ❑ 1b.0 ur.Vi�� 1'r.❑ \�n'�. SEC'I ION 8:CONTENT OF CERTIFICA fE OF OCCUPANCY li.ii�i,�n�� (',�dr: L�.rc;r��,, ,�. : ' _ � 1 ��pe��l G�ndnicliun: - OR k.upenl Lu,id F•i•r Ilu��r: I L�r��hv bmldui�;rnn�,un.in tiF,nnAl.�r?c.k•in^ �_}F,rael tilipulaliun.� . f"�/J !+'Y;?b�/� � ' SECTION 9: PROPER'IY OWNER AUTHORIZATION I'I Van�an./,A.(dre>s��1 Pn�F�crtv O�vnrr�� / �{/ � � � Pe"L " `!1 �_ S-/!9� Nf (��I'i71 ,�;��. Nam 'nntl � .Vu..ind titr��rl l'il��/�uwn Lip I' i�irt� thvr�er�(1'�� tart lurmalu�rya„� 3��''�/� - - G� �PC.C` CdMCcS�• �le� (1 �� Tid Trlrphunr Vu. Ibusmrs.) Trlrphunr Nu. Icrll) r-m.nl.iddn�.+ � If a�+�+lir.iblr, ihr pruprrh�o�vn.r hrrcby.�ulhunzr+ � Vamr 5trurt Addre�+ Citv/Tuwn tit.itr Zip I�i acl��n lhe +ru nr�c u�rnrr's behalf, in.dl m.ilter.rclati��r 1u wurk aulhurard bv this buildin� �rrmit a i ilir.iliun. SECTION I0:CONSTRUCTION CONTROL(Pltase fill out Appendiz 21 �II buiWin•is lahs Ilun JS,U1N)iu.tt uf enduxd s+aee.inJ/or nut imdar G�roYru.lion Can WI Ihcn check hrrc O.ind ski Si+liun IU.I I 10.1 Re istered Pm(e�eional Res onsible for Construction Contml f�c,� �Grne� e. �_�✓ .�..5'^„ e��{17CG�' 2f�� Namr(Rrgistrent) ��—� Trlrphunr Nu. � rma�l ad rs� Rr islretiun Numbry L"L—�-�f7Ar� .iYl�i �"��A' �� G! `J'�1��1 ZO/ 51rrrt Addrcsy City/Tuwn tiW Zip Discipline Expiralion Datr 10.2 Ceneral Contnctor 4�t G�j}�✓c„ Company Name: � � Namr u(Prrwn �m.ible fu unstr tiu License No. and Type if Applicable �,, ��L- '',f �'J� 4 ��•� Street Address - � e1s �q� City/Town State Zip _ �-_ Tele hone No.(business) Tele hone No. cell) � rmail address SECCION 11:WORKERS'COhII'ENSATION INSURANCE APF1DAViT(M.G.L.e.152. 25C(6)) A Wurkers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be complrted and ,ubmitted with this applieation. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a si ned Affidavit submitted with this a lication7 Yes O No O SECTION 12 CONSTRUC[ION COSTS AND PERMIT FEE Item Estimated Custs:(Labur rY'L /�� and Materials) Total Construction Cost(from Item 6)=S �7 �-LJ. l. Building $ � 0 Building Permit Fee=Total Cunstruction Cost z_(Insert here 2:Electrical S 2_ appropriate municipal factor)=3 3. Piumbing E (7 �� 4. Mechanical (HVAC) S Note:Minimum fee=S (contact municipality) 5. Mechanical (Other) 5 �'�^� Enclose check payable to 6.Tutal Cust 5 � w (contact munici alrt )and write check number hem ' SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT Bv.entrrinK my name brluw, I hrrrby allrsl undrr thr pains and f�rnaltie.uf perjury thal all uf thr infurmatiun cuntainrd in Ihi+ .iF, ��liun i..trur.� d,�ccur. tr t��e brst�iF mV uwlcwi�;qah under.Li�. � / � ��7� (�� i�g � � �/ w� > > � -� `' - -- Ple.�..prinl.ind. m n.i � � r ,^ � Ir c � une Xu. 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ElIMI�� / rNo va ,� /0�,� � ' +2r i.fiyY�.oi1'j . _ _ _ __ __ _ _ _ __ __ _ -- _ . _ _ _— - -- -- _ __ _ ; —. _ _ _ — The Commonwealth of Massachusetts 43udd,nNumb Department of Public Safety \tas.echucll.Stale Budding Curie(78U CMR)Seventh Edi ionCity of Salem Buildin Permit A lication for an Buildin other than a 1- wellin (This 4ctiun Fur Official Use Only)er: Date Applied: Building Inspecto .ATION (Please indicate Block M and Lot# for locations for which a street address is not available) xrl, 4 06�z3City /Totvn Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK If New Construction check here❑or check all that a pply in Vie two rows below Existing Building❑ Repair❑ Alteration ❑ Addition❑ Demuk:cn (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ 1 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 ❑ • Brief Description of Proposed Work: rz oL Y _ z' 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 3402.0) ❑ ' Existing Use Groups) Proposed Use Group(s): Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: 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 a' a licable) A: Assembly A-1 ❑ A-2r A-2nc❑ A-3 ❑ A4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑. 1H: High Hazard H-1 ❑ H-2❑ . H-3 ❑ H-4❑ H-5❑ 1: Institutional 1-1 ❑ 1-2 ❑ 1-3❑ 1-4❑ 1 M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑ S: Storage S-1,❑ S-2❑ U: Utility❑ 1 Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA IB ❑ IIA ❑ 1180 IIIA ❑ IIIB IV ❑ VA VB ❑ SECTION 7:SITE INFORMATION (refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: PP Y� Public❑ Check if Outside Flood Zone❑ Indicate municipal ❑ A trench will not be Licensed Di.pusaI Site❑ required O or trench or.pecilc: I'ncate❑ or unientilc Zone: or on site�t stem ❑ permit is endorsed ❑ Railroad right-of-way: Hazards to Air Navigation: �L( IIi.I��nC(,n mn-w,)Itc, \nt Applicable❑ T }tructure,rillvn airport approadt an•,t:' I.Theo review onnplcled.' M l 1111.cnt l0 1411111 enClo.ed ❑ Yes❑ or No❑ 1'c•s ❑ \n ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY 1'..fiuon nl (-ode: L.r(�ruupl.l: rt pe of(:on>lrucuon: OCaip•tnl Load per Fluor: Uor1 the building o,wain.m Sprinkler St+lcm.': Special Stipulations: SECTION 9: PROPERTY OWNER AUTHORIZATION \, Name and Address of Properly Owner ( .A' Name(Print) No.and Street Cih'/Town Zip Property Owner Contact Information: Title Telephone No. (business) Telephone No. (cell) a.mad address If applicable, the property owner herebv authorizes Name Street Address City/Town State Zip to act on the pro+erh owner's behalf, in all matters relative to work authorized by this building permit a >plication. SECTION 10:CONSTRUCTION CONTROL (Please fill out Appendix 2) (It buildin•is less than 35,LX)U cu.ft.of enclosed s pace and/or not under Construction Control then check here O and skip Section IU.U 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 Company Name: LClrir 3M 00 •n.�-o'C �C J Name of Person Responsible.for Construction 'tense No. and Type if Applicable Street Address City/Town S a Zip Telephone No.(business) Telephone No. (cell) e-mail address ,,.SE +ION 11:WORKERS'COMPENSATION INS RANCE AFFIDAVIT(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 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ f. Building $ Building Permit Fee=Total Construction Cost x_(Insert here 2. Electrical $ appropriate mum.cipal factor)_$ _ 3. Plumbing $ 4. Mechanical (HVAC) $ Note:Minimum fee=$ 2 (contact municipality) 5. Mechanical (Other) $ Enclose check payable to 6.Total Cost $ (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below, I herebv attest under the pains and penalties of perjury that all of the information contained in this application is rue and c rate to h best of my knowledgeand understanding. - kS � case pr a and sign ame Telephone No Date titrce•t :\ddn•ss lih'i ncn ate zip Municipal Inspector to fill out this section upon application approval: Name Date D St(- 3z The Commonwealth of Massachusetts Y� " Department of Public Safety Massachusetts State Building Code(780 Building Permit Application for any Building other than O - - amil�.r D Ili g - (This Section For Official Use Only). Building Permit Number: Date Applied: SECTION 1:LOCATION(Please indicate Block#and Lot#for local' or wire eet address is not avails e 2 5— s5 No.and Street City/Town Zip Code Name of Building(ff 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 Buildm Repair❑ Alteratio Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ 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 ❑ Brief Description of Proposed Work: �PUlt— l �� cr-�(C^ t ZecL .F'i /J�--- 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.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 ❑ -A4-13 A-5❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: Hi h Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ 1: Institutional 1-1 ❑ I-2❑ I-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ HA ❑ 1111 ❑ ILIA ❑ IIIB ❑ I IV ❑ 1 VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ Private❑ or incdentify Zone: or on site system❑ required❑or trench or specify: permit is enclosed ❑ Railroad right-of-way: Hazards to Air Navigation: Yid I i,ur ra Cunwuticlpn,RCI iL 1 ro eis: Not Applicable❑ Is Structure within airport approach area? i Is their review completed? or Consent to Build enclosed ❑ Yes❑ or No❑ Yes❑ No ❑ 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: Ai1, � r SECTION 9: .PROPERTY OWNER AUTHORIZATION Na ie.nd Addres of Property Owner 74�s �,s1, unc( rint) No.andStreet City/Town Zip Property Owner Contact Infonnatiogi-,F Title Telephone No.(business) Telephone No. (cell) e-mail address If applicT� typg1 owner h reby authorizes Name Street Address Ci 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) If building 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 - 1 t � - 7EJ� xz� /37� �f Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor l - - - Come V 1 ,<4 Name of erson Responsible for Construction Li e se No. and Type if Applicable �5o Street Address City/Town State Zip 0(q&-V(�, &//� 06zy Telephone No. (business) Telephone No. cell e-mail address SECTION 11:6l URKF2S'CC)MPF.N5,4 fION INSURANCE AFF'IDAVl'i 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 budding permit. Is a signed Affidavit submitted with this application? Yes❑ No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT.FEE Estimated Costs:(Labor e'O Item and Materials) Total Construction Cost(from Item 6) 1. Building $ Building Permit Fee=Total Construction Cost x (Insert here 2. Electrical $ appropriate municipal factor)_$ _ 3. Plumbing $ 4. Mechanical (HVAC) $ Note: Minimum fee=$ (contact mumcr t ) 5. Mechanical Other $ Enclose check payable to 6.Total Cost $ (contact municipality)and write check number here SECTION 13:SI A E.OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest u er a a' an penalties of perjury that all of the information contained in this application is true and accurate to the best o ny kt o I ge a d understanding. S " �r��z� Please pr ,/d syl •ixn nase / Title jte Telephone No. Date Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: Name - Date The Commonwealth of Massachusetts o Department of Public Safety f Massachusetts State Building Code(780 CMR) 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#and Lot#for locations for which a street address is not available) Z4 Dl iF&4 -S4 67,46.4 MA 0/970 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 K Repair Alteration ❑ Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use— ❑ Change of Occupancy ❑ 1 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 Or Brief pescriptio of Proposed Work t1.£nAC'i AtJa U oAd-E W t Ailt-i-S /d/ d1" / 07o p•L RCoO� lao�(Lr�E� 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.ft) Total Area(sq.ft)and Total Height(ft) -SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 A ❑ Nightclub 0 A-3 ❑ A-4❑ A-5❑ B: Business E: Educational ❑ I- Fa F-1❑ F2❑ I H- High Hazard H-1❑ H 2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional 1-1❑ I-2❑ I-3❑ I-4❑ 1 M: Mercantile❑ IL Residential R-10 R-2❑ R-3❑ R-4❑ S: Storage 5-1 ❑ S-2❑ U- Utility❑ Special Use❑and please describe below: Special Use: " SECTION&CONSTRUCTION TYPE(Check as applicable)_ IA IB ❑ IIA ❑ 1I60 IIIA ❑ IIIBO IV ❑ VA VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Trench Permit: Debris Removal• Water Supply: Flood Zone Information: Sewage Disposal: Licensed Disposal Site M Public 1� Check if outside Flood Zone❑ Indicate municipal a trench will not be I required Q+or trench or specify: Private❑ or dentify Zone: or on site system❑ permit is enclosed❑ Railroad right—of—jay: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable Q& Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No Ql Yes❑ No Qa 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: Call - wtiPti eklcl" Dr SECTION R PROPERTY OWNER AUTHORIZATION e NM Address of Property Owner N Name(Print) No.and Street City/Town Zip Property Owner Contact Information: q �/ Title Telephone No.(business) Telephone No. (cell) e-mail address if applicable,the property owner hereby authorizes 'DEAA%J,J rBFlnnovJi� 3 .Tb"s A✓g K�A Name Street Address City/Town State Zip to act on the proper owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10.CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 ca.ft.of enclosed space and/or not under Construction Control then check here O and Slap Section 10.1 10.1 Registered Professional.Responsible for Construction Control GjF,wi5 6rClrwo,9t 791-381-3 13 1 hplm�asacb�C',,.tc s,1•;Vz* N egistrant) T 1 hone No. e-mail ad Registration Number )Atu1 at,v u�.aa�� 00 Street Address City/Town State Zip Discipline Expiration Date -10.2 General Contractor ZFlpoor Yrt 8"h(k J jd„J Ce. Company Name ` ^ es' 76�f3 Z �WNtJ 1tMDt/� tY Name of Person Responsible for Construction License No. and Type if Applicable 3 Sek�4 Aar W�:AX\9-64 0A - cY 4 Street Address City/Town State Zip q� _ -r_ Z, ►,3 3 b*V e 4w-js4c a nort�ctrsk-: �lc� Telephone No.(business) Telephone No. cell e-mail address SECTION 11:WORKERS COMPENSATION INSURANCE AFFIDAVIT 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 ak No ❑ SECTION 12•CONSTRUCTION COSTS AND PERMIT FEE • Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6) 1.Building $ Uv0^ —' Building Permit Fee=Total Construction Cast x_(Insert here 2.Electrical $ appropriate municipal factor)_$ /J�,. 3.Plumbing - $ ti�1 ),. 4.Mechanical (HVAC) $ Node:Minimum fee=$ /. (contact municip Nal lii �ty 5.Mechanical (Other) $ r0 O . r Enclose check payable to �•H d-F JA� ,""a' 6.Total Cost $ yts-OO (contact municipality)and write chbck 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=thet ��""��ge a/�nd understanding. �J (rr✓nIEC $T-3/ 8 i• Please print and sign name Tale elep one o. 3 D� I oh rt�c 4Ale Street Address City/Town S to Zip Municipal Inspector to fill out this section upon application approval• Name 'Date � 3�..� -'�b cw�u- -#� �s-� .. _ . = --. _ _._ - - - -- -- -- ---- -- ----- �� 'I'he Conunonwealth of i�(assachusetts \ t I�� Deparhnentuf Publi� Safety - S • j' .\I.i,�dr6u,v11rSLdciluilJm+,Cu�lv(,'4Ul'.\IR) �� •.,.'. IIuilJing Pcrmit Appliratiun For any UuilJing uthcr than a Onc-ur'I'wo-Family l)ivrlling � (Ihis Socliun Fur(�((iri,d Uac l)niv) \ HuilJin�;Pcnnit �Vumbrr: --, —_ __... U,ile:\pplicd: --------..---- IluildingOtficial: -- ------ itiLC'I'ION L• LOC.\1'IUN Q9..�s. inJieatu Illoik M,inJ Lut p fur Incatiuns(or which a,Ireaf.idJrcas is nuf availablc) � --- �/S_..��by. � �_-5�-1«- y-��-�-- �1�,�� os�T �� - - -- - - ----- ,\'u inJ titrrrf Cil� ;fu�rn ZiF�CuJc Vdmc uF 11uiIJm7�(if.y+E�lic,�blc) 5GCI'ION 2: I'RUPUSEU WUItK LJiliun nt.\I:\til,itv Cn�lr u+vd _ _ If Nc�v Cunslrurliun chvrA hi�re O ur rhrrk dll Ih.it eF��d1 in Ihr Iwu ruwti boluw �_' li>isiin�; lluildi�y;❑ RrF+air :Utcr,iliun ❑ :\JJili�m ❑ Ucni�dilion ❑ (Plii.vclill��utdndsubmit.lF,�,onJixl) Ch,in+;��ui l'�c ❑ Changc u(Orrup,mry . ❑ Othcr ❑ Sperily:.----,-.-. :\rc l�uil�ling plans dnd/�irrun.strurliun�LNwucnls bcing supplicd ds p.irt uf Ihis pi�rinit applir.rtiun? Ycs Nu p--/-- '-' Is an IndcycnJcnt Slrurtural Engincrring Pccr Rcview myuircd? Ycs ❑ �,V,u�Cp��,� . OrirF Dcucriptiun��i Prupa,cd lVurk:._...�1T..�n��> ^�sJ L/J//1J1�� (2�Q+p��./f� �-��.'7_ -.�il`7'�-fl - �_��/�_�<-t?6i�ih.l /��1i6 l��L /J�sL�-f-��- �—�r+y—�____.' SEC7'ION 3:COhll'LGPE�I"fflS SBCt'!ON IF EXISTIYG OUILDINC UNUIiRCOING RENOV,\'I'ION, �\UUfI'ION,OR CtL\NGE IN USE OR OCCUPANCY Chrik hcrr if on �xisting OuilJing investigatiun and EvaluaNun i.s cncloscd(Scu 7Y0 G\IR.41) ❑ G�islingUscGrouP(�): ---"_'_ _ PropuScdU.ticGfuu �s : I l 1-------- ---- + SECRON 4: BUICDINC IIF.ICfIT AND AREA fxisting PruF�nscd Nu. uf Flu��r.r/Slorics(indudc bascmcnt Icvcls)h :1rc,�Pcr Fluur(sy. It.) . fuLd:trvd(sy. It.).�nd fuLd Hcighf((t.) . tiECI'ION i: USE GROUP(Check as a Iicable) .\: :\sscmbly:\-1 ❑ .\�_'❑ Nighlrlub O :\-1 ❑ :\-1 ❑ :\-i❑ U: 13usiness ❑ G: fJucatinnal ❑ f: 1'vcto F-I ❑ 17❑ fl: Ili h flat.vd FI•I ❑ H-�❑ I1-1 ❑ I I-a O I-I-i O 1: Institidiunal I-i ❑ I•?O I,t❑ I-J ❑ :�I: \i¢rcantilc O K: 1(cviduntial li-I❑ R-'_❑ R,l❑ It-� ❑ ti: .titumqe SI ❑ SI❑ U: Utility❑ tipetial Use O,ind ple.isa Jc�rribc hvlu�v: SF�crial l'sa . tiF.CIION fi:CONS�I'IiUCfION I'YI'F. (Chcck ae a� li.abl.) I:\ p IIf ❑ I1,\ ❑ Illf O III,\ ❑ 11111 ❑ IV ❑ �':\ ❑ \'ll O __ _ tif:CTfUN 7:tif1�E 1VPUR�LV'ION(rc(et to;BU('�IR II�.tl fur d.t�ilr un each iteuQ IV.itrr tiupply: Iluud Coni In(umiatiun: ti.•wage Ui.poral: frcnch Pcnnit Ucbris Hcmuval: _--� I'uf�lir ❑ �6n A d ouUiJr Pln„J Luno O InJii,ilv umnicip,d❑ .\ Ircnrh icdl�nnl (,v I irvu.rd I�i.�,u.al �il�•� I'm elc❑ „r iuJ��niil�� /nno� _ . ��rnn �ite��.yvni O rryuirrd O nr trvnrh ��r.��rrilc� . _. ��rnnrt i.rn.I��.oJ ❑ � If.iilru.iJriGlibu(�w.�y: Il.varJslu.\ir.\.n'ig,�timv' � . . � , . I '-_"__ \—„1 .\��phr.ddr❑ I�<Iru�lurr��ilhin .ur�+ort.i��pn,,uhdrr�i' I I.Ihrurrvn��rny,lrtr�l ' �� rl��inrn� h� IludJrn�L�.r�IJ � 1r. O ��r\'��❑ - lr.❑ \�� ❑ � yf(�IIUN 9:l"U.V I I!.Vl'I IF1'Flt I'IIIC.\I�L•'l)G U('(�l,�l'.\.VC�Y : I �LW•n „Il-,�Jr l .rl;n�n��.l I��r��ll��n.innh„n ��u��.mll �•.i�l ��rrl�l��„�—_'__'_'_ "'' �� I��. �h�� DuilJuia��ni.un.in `��nnUorti�.lrni' ��r�i.�l�lq�ul.ilii�n. I - _ . ._ _ . . . . . . . . . I i__. _. _--. _._..----------.sr:ciiuu �a rucmrtrrYuwurit_�uru�,itrt,�nu��---------------.- \ � ui ui�l .\�IJrru ul I n��rr1Y U��ni� �� /o s .c�de�.qri,v�/ �q,��-ss /�s�9- -. . m/9zS . --,_. . . - - ---.. z� , - __ _.._- V ,�nd titrrc� Cily/I'uwn F v,nni (I'riu�) . I'n�p.•rly l)�rnvr G�niarl inturmaliun: � O-,s� '�' . _ / °o•�JC7- 78��_ ---- ------- .�.�------------ ----- --- ---- ��-m.�il,nldress � fillc frlrphunc Nu. (bu.�in�'�s) fclephonc Na (ecll) II epF,lireblv, �hv pn�pvr�}� o�vncr hrrcby,w�h��rims . � ___ -___—_— ...-----------._---- �--��------��---�-��----—----��---�—- ----�--------' ql,ilc /i i N,�m¢ titract A�I�Ircas City/fuwn - 4 lu a�t�m ihc E+n��crl uwncr's brhall, in all m,W�•es n�l.itivi�In u�urk,wihurizrd b � �his builJin n�rmit a ��ie.iliun. SECfIUN 10:CONS'fltUl'f(ON CON"fROL(Plcaaa fill out Appendiz?) If FuiiJin•iti Ics+tlian 1i.01N1 iu. ft uf i'nduscd s+att and ��r nuf un�lcr Cunstructiun Gmtrul Ihm�chrck herc O aid eki+Sr.liun 10.1 tU,t Ke�istend Prufeseional Res oneiblr for Cansfructlon Cuntrol 1'cic hunc Nu. c-ineil,iddress Regivtnrtiun Numbcr Namc(Rrgistrant) N � ti�rrct A.IJress City/�uwn Slal� Zip Uiscipline fi�pir,�tiun U.�te 101 Caneral Contrufor � . o , v � i3 A L. l3tiltiP ` �«�-- Qnn��aiiy N,�m¢ _""" � �� .a-�.� �'S G8�/�'�a� iVamc ut' Pc wn Rcepunsiblc h+r Cunsiru.liun Li.ciuc Nu. ,ind iypc if Applicablc D ��57T �-' s�i"� — — -�a > � tilrcat A�IiIf0.59 City/Tuwn State Zip � � ry�p��jJ�" l'`�'.C�//G�/nGCf� �irw�r 4�_ fclo �I�ac No. busi�— ��R'Ic�hunc N�� c-m��i��L - SECTION ll:�� r.�.ri:�,�< <�airrv,.�i p,� i•;�.�n;.��i� .�I i n.�,•,��i i M.G.L.e. t51 25C 6 ,a lVurkrrs'Cumpensation In}umne� AffiJ.rvit kum thc\IA Deparhnent�+f 6idu,trial Accidrnte must becumpkled,ind wbmiltcal with this,iF�pliaitiun. F,iilurc tu pravide this,�ffiJdvit will rc+ult in tho deni.il uf the Lysu.mce uf th¢binlJing pi�rmit. Iv a si�ned Aflidavit submittcd with this a� licatiun? Yes❑ No ❑ SECI'ION t2 CONSI'RUCTION CUSTS AND PERh1IT FEE - Estimalcd C��sls: (LeL�ur Rcul ,��i1 \I.ihrial�) futal Cunshudiun C��st(frum Itcm b) 'S_._---- 1. 17uil�ling 5 �7� Ouilding Pcrmit f�r�Tatal Cunslnietiun Cast r _(Inscrt hcrc '. kil•�'triral S ,�pprupri,�M municipal(adur) �5 . � Plumbinli y iunLiit nwni.i �.di1�• N��Ic: \linimum (ci� "S--( 4 ) I !. \Irrl��mir,d (l IV:1C) � � i. \�crli.uiii.d (lih��r y Lnrli�se nc�rk p,�}'al+lc lu . _ _ '___. .. ... - - In. I'��lal C��.t ti .�� (r��ntarl munirip,ilih') and +critc i ho:k numbrr hrm ___ _ I tiGC�I( N 1.1: tiiC;NAfURE UF UUILUINC; PLIi�I1T,\PI'LIC,\NT � 14v rutrrin�; iuc namc brlu�v. I lirrcbv aiti�H un.lar N�c ��,iins.u�d prnallic<of E�rr�ury' ihet all nf Ihv intonnati��n innt.unr�l in Ihis ' .��Edir.i�i�m i,Iruc.inJ a..ua�lr tu Ihc br.l ol im� I.m��IcJ��,niJ miJ��rstmding. i �o�C- C I�oT�o C1�� l��- '�AAr��- T'��'��D :��6 7Jo L - _ � ' . . /lI Illlc �rli� hi�no Vn I letc ! I'Ir.rvr ��rml an.l .�+;n n.inic / l � . Ci��, ��n �ii�r r ��irr��l \,I.Irr.. G{f�GO�-� {'�� I�iniii��.�lln.pc<turtnfilluulthiv..•itiunupiin .�ppli�.�tiun.�pprucal: . _ � .\,nur I lilr _ - _ - - - -_ - __ _ �/l3/� � ¢ � „ � M i 1 n U N ° � � v J �' " o =, : J o °° „ � mo mvs �` r X � WQa ^ 4 LL � � � � � � n i . .. . . . � W N a � W � I— ` — ; � �'n E V/ � � O a � � �/ ~ ° : Q I W M � �L � n � r 4 '^ � O J Vl � „ v m s Jwa _ = W Z . � � s : - � O = � . . . . . _...� _.. � � J W � � LLI � w � �- � r _ p � a x Y F U ! I � I 1 . . _" __. . ..� � . . . . . .. � . .� '_ - — � �_ — —_ —._-_ _ — _ . — _ _-- -- - --� _ -_ ---- = -- I- -- _. ____ _ 7__.- �-_- T � _ --- -- -- _ _- -1 - -- --- --1---- -- --- - --- --_ __ 1- 1 � �-- _� ! T- �--.. _ -[-_- - �-= .- . � EXISTING STATI(ONARY WINDOW -� EXISTING STATIONARY WINDOW _ — � . _ � � � - _. .._. _ . .. . . . . � Q L z -- -- - _ _ � - — u, U > � � - - ___ W L� W . L NEW GLIDING WINDOW . NEW GIIDING WINDOW J m _.....___ _ __._ .. _._ . ,. - ._. ... . --. _.--_- . — �-- -- � W - -- -�-- T v w � - --_._ Q �- w S'-3�� COUNTER ..... 3'-3 4• � Q Q z � 1 -- � __ � z }_ w ; o � � I--- � � � � - a0 � � W Q o O — �—� W � (n N ---� I � �-- ---. ---- ---. - � - --_ � __ _ - -- - 1_ � -1- - � �`- _ _ COIUNTER AT NEW WINDOWS TO 3E A MA:XIMUM OF 36" ABOVE SIDEWALK 4 � / O � EXISTING SERVIC.E WINDOW ELEVATION PROPOSED SER 'VICE WINDOW ELEVATION &� �� _ , -0 2 ,,, _ �'-o" _ . � 13 JULY 2012 I' = i'-0" AI _ _ _ _ _ _ __ __ ____ __ ___ __ , � 21 DERBY STREET 812-13 i COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM U GIS#: 1289, Map 34 Block. SIGN PERMIT Lot:, 0427 Permit Sign. Category: 'SIGN Permit# 812 13 PERMISSIONIS HEREBY GRANTED TO: Project# . ,;JS 2013 002575 Est:Cost: $0.00 - u Contractor: License: Expires: Fee Charged:$0.00 Designflow Graphics Balanee Due:S.00 ,,,.,,,, Owner: LU LU GRACIOUS REALTY TRUST,DONOVAN SHAWN E TR #of Fixtures: Applicant: Designflow Graphics DigSafe# AT: 215 DERBY STREET Use Group ConstClass I _. ISSUED ON: 01-May-2013 AMENDED ON: EXPIRES ON: 01-Oct-2013 TO PERFORM THE FOLLOWING WORK.- SIGN PERMIT(AS APPROVED FOR(BRODIE'S SEAPORT RESTAURANT)jbh THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Amount SIGN REC-2013-002788 01-May-13 x $0.00 r GcoTMS@ 2013 Des Lauriers Municipal Solutions,Inc. e f ,�. `,�: The Commonwealth of Massachusetts `\ +' Department of Public Safety .,�,,,✓'`+ ..\iassachusetts Stale Building Code(780 CMR)Seventh Edition City of Salem Building Permit Application for any Building other than a 1- or 2-Family Dwelling (This Section For Official Use Only) Building Permit Number: Date Applied: Building Inspector: SECTION 1: LOCATION (Please indicate Block# and Lot# for locations for which a street address is not available)c No. and Street City /Town Zip Code Name of Building(it applicable) SECTION 2:PROPOSED WORK If New Construction check here❑or check all that apply in the two rows below Existing Building❑ 1 Repair❑ Alteration ❑ Addition ❑ Demolition UU(Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ 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 Brief Description of Proposed work: R,°.m ne 9,r non, wu �� i 7o Ze .r a m e 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 3402.0) ❑ Existing Use Group(s): Proposed Use Group(s): 1' Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: 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.) '3 RF SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2r ❑ A-2nc❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4 ❑ H-5❑ 1: Institutional 1-1 ❑ 1-2 ❑ 1-3 ❑ 1-4❑ 1 M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4 ❑ S: Storage S-1 ❑ S-2 ❑ U: Utility❑ Special Use O and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE (Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION (refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal:' Trench Permit: Debris Removal: Public❑ Check if outside Flood Zone ❑ Indicate municipal ❑ A trench will not be Licensed Disposal Site ❑ required ❑or trench Or specifv:D +� Private ❑ or indentifv Zone: or on site system ❑ permit is enclosed ❑ Railroad right-of-way: Hazards to Air Navigation: MA I li.tori.Cotmni—i�,n Rrc irmv Not Applicable ElL<titructu re"ithin airpurtapproach area? I., their rem iekc completed? , r(onsent to Build enclosed ❑ : Ye, ❑ or No❑ Yes❑ .No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: L,e Group(.+1: Tcpe of Construction: Occupant Load per Floor: Doe, the building contain an Sprinkler System?: Special Stipulations: �1a.-) fa ��e✓ r 1 SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Ol 4/eD Name(Print) No. and Street CitY/Town zip Property Owner Contact Information: Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable, the property owner hereby authorizes Name Street Address City/Town Stale Zip to act on the pro perty owner's behalf, in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL (Please fill out Appendix 2) (If building is less than 35,000 cu.ft.of enclosed s pace and/or not under ConstrnetiOn Control then check here O and skip Section MI) 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 Company : �L � Nam�e,,,.,.� 40/y3 64-"R-e!SJ-1`IC-{ as, Name of Person Responsible for Construction License No. and Type if Applicable Street Address City/To n State Zip VI-s1193Ty qZ-1&2-3SW Telephone No. (business) Telephone No. (cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT (M.G.L.c.152.§ 25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes❑ No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs: (Labor and Materials) Total Construction Cost(from Item 6)_$3'S 0 1. Building $ Building Permit Fee=Total Construction Cost x (Insert here 2. Electrical $ appropriate municipal factor)_$ 3. Plumbing $ 4. Mechanical (HVAC) $ Note: Minimum fee=$ (contact municipality) 5. Mechanical (Other) $ Enclose check payable to 6.Total Cost S (contact municipality)and write check number here C9 O SECTION 13: SIGNATURE OF BUILDING PERMIT APPLICANT By enl kin y name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this applicati m is t nd accurate to the best of my knowledge and understanding. Please print and sign name Title Tele shone.No. Date street Address City/Town State Zi Municipal Inspector to fill out this section upon application approval: O Name Z Date