7 DODGE STREET - BUILDING JACKET 7 DODGE STREET
9
'FILTiN(c 71Li'kNG �ipVE �fC"J'v �TCVL° i
fRY PAN FF Y YAN IFNOT_ ES
CJD
ND S"rRUGTL.RAL GNAHG�E� Ta PSE MADE,.
gArt :Ar3o F.w r - ] i Z NO EX'GRiOR GNAN cc S -� f
>INK el.
+JX _ FREEZER _._ —
COOLER COOLER � Fir,,�vF �AT�-���.At,C, 1vrT\v~� 'f'A'wLE.� .
y rN�TAt� YKeHL5rr- G A Fa 80API7 IN
Tl5P8H�£R Hp R DISH _ Kr(C.+'E` SE-RVtGE, V: ARS C P15N\VA5Nim((
® ROOM ® 51i V1q(5 ROOK,
- � •+�gFfZ}(A �� O IN5`ALL 'BAf':h� "'+1✓!?'iCn tH 'CJtHING IZ�ONi f1'�
®D?St VE W1HPO'WAHO FF-PL?-Zr-- 1V PhaS i h'. 2U�
s>�Pvk%E CAR *N-
107
ri
v _
I BaAfLa _ 10 ''eLDCX Off KI-rCf,4 D010K,
-LAwfliNv sHE!-F Your
f " INSTALI. COI.JH"C'ER� Ik`l G{^ ,
AFMA
t4 �R g DUIL.V PARTITtt3H 1H 6F-
II { ID FUILP F.ARTITIOH 1H V19}+WA5Hr- RUDr�I^—
FKEr2cFt WORK o0 11 }2E(„ARP�T 1�IHIHC� ROCt-? )*Z —I
AR �
i'iM1't; f^.g r'"2�tt63I F:F-.Ti
I3 7N: At_ PART.7tCN TO LAVA't'0T3'f tVft ,
W 1`f H 'DG'Cu?
CSE
j I SD �k1ftOY£f 14 IH5TAL1. HANDIe,,AT' ?A-NR+ M-- AHV i
r i En7t+. 0JM #'z.tt7kT34t±h
1 3 - ,5
13oC7Yh�A' rrlmA"?;� 1IAa #'Aaf?Of'
� GONr."TT<UG7��' "n ftl:.+tT"GF 1VAl;it�G ARf->� i
j' 00 $ II ALbitlD tp s Ya 7 M afs kHG7 f 7PSV
s9 INv FRF-EZER
Ll*Pt>~y o l� `1 tTL)
EAT4tf fes! 1 4� Qg,
r...
�t
r''`� ' OAF{ 1'A
I � t__.J 13 sreAh R
_ 8Rfi S!ytGS
tpoLERt, ',
RR,
k fift '(h�..KE, s iTN�EStG6tkNT-E.P.
LEGEND
r;'� RE,Fft k G^ERA?C R
"14 PULL ALARM HORN
STEAM /ftR HD HEAT Dr, w/ RATE OF RSSE
l_ 1 l_J TASK 7' SMOKE. M rEI TOR
+ 71 D
OL T 51D1^
IICF R �i
LWT � - r9kTz 1MF M6ER
!_,.-•f � Nr.><TER GONY:.YOT' Bv7'i LE GDOLEa � F`1.1)CSF; DRAIN
a oven llv
aDxx WCRK
nrz� Tae FIR APR 30 1985
.-- APPROVED
Cl
�. L7 Subject to approval by any other
G 45N authorityhaving'urisdiction.
C1_.1 BENGW r _ CITY oSALEM,MASS.
LJ AkE-DUr SIG' 1 { \ FIRE PREVENTION BUREAU
I
WINDOW
• / - .. !.,-+ " ^, ' TYPE AND LOCATION OF FIRE PROTEC ION
1?Q COAT RR✓I{ ." �` �,� �, •. 10 BE PLANS ARE APPROVED SOLELY FOR IU it
ALL FIRE PROTECTION DEVICES A7C -LO T 90 f,
R/iA++ _�PF!=Aia EaTlf 51'T `t i,Fin CC .•LE,ECO%,
tJPi.IOn F ANCE I!THT 'r
WAITIH(v AREA WILDIRGS
��o
5E . �RYKOFF
_1 l_ J �✓ `.�i �.� L— i trJf3EHGH
—1K-MRACi
I GUEL �5 MEXICAN RTSTAURA T
KEEf'£R
— - 7 DODGE Sr
- SALi�M _r'1A.
DATE. APRIL 29, M5 SCALE '/4"= 11--D%l
I
�l
��
4
1
aF y7� ������� .��.
/r
_�, _,�
7�.
.. .._-
i s �
...
,�
--- -
- ---.--_-.-- --- — .- - SV[l,S�INGt✓�c- ,OR"ctfcV,�'CtON
4
----- --- ----
._ ,,{ nr"nu.,y� �,^IER3Y4. v"♦ I 3' C�Af,�4�+"u��Cw� �� {I �i� ..
-
y I _ � x�rr � "r4 ✓i"� y .N'r t /� lr� � � t r� j�� /. d � F N 4 "'
O -.11� I i... - — _. ,.. - j lu� ; i& $3n, y. ,✓, p} F -i.,, , 1
_ LtQ1II' 'II� Ng A-go a :
E1I II 4t
II
11I'��II '{{1I1''11I1111
1�'
Slob
.�
I
rM
' 129 fa�6
7 -
I �
_ v
�-��- I- I:- ��'C w/Er.�E.Rt�ku6•tizUY
{.. -
/
YV II f 3 \
%9 chrTS -
�T'C•'? �A'ti�'C�"t7`t"Etc�'o17�'T�O,
�
I
2`E � � :.i I ,�,� ; s tio: � I _ 1 i � �c+'rxM �`6�+c� scavr � X�,E� ® --- �`� F=��C�CZ �c��-fL �`-i�ltc'cl�Xc�5 -C�-IEREc�a;•'\RrGp
0-1)
-�scs N
t �_r I
I 1 �`efs• _ �s,t�,m, -__ ,� —_ l �-C'N�,flcevPA�7e�{-c�o'C'��L CAt'�e tZ'Y t5 Zroo�'�R�S
1 a , v 2�S CMR��35 �SAtv\TA� (Ct�c�C�`'uIATC'CitJ$
I '
"tit )ro t3 d -E ro ! 1 -- - ✓XK �� < �U�K -- oCc�aE'F�h�C� C 200 g�Qc�lfR c�$TV.a`R+�tit[1C c
Tkk6
6 Nl�*NS of ww/ 3`-o PAt��C hARDWoR.C�ORS
.. - I 1 I �__-�'_. I OO 62- uP �+ U7� 1_
- - ��7P�L�� ': "LR .�EL,"T1� 2>ul ,V NCr� - �qL54EYr I -?�yA-7I'j') ` ., I�
L � : .� ` i :� I 65 I� U1 7 - 21-Co {3COF\AE\1C 5 1 SYSi�A,AS
- Er) ��� � ` bCOVP�NGKS alrt��lcl
7 97 4a 53 (J
- - �b PI)lull ��
�J` N $ tg )-TNc�Ci4ltpl
A05 at..L..�A i��t�EMrdri'S
12 $ T�oc - e�Ilj t,�, _ o� c�oMtacEss rVtG
t . �gt x a+ t is C+3 i �tx .. _04,v�j ' � _- 5a rob- 2L� uR
6e+c ct � tew�T
t� d.�5111 c Lt ''
H d5 LO 2s
8 Cosa — 7 �JoR ^�Tcc t��cs9�0 1/L�l- C -s!
,3CG)Ill =a
__ - - S�I�.��� J �-�r --- ----- -- - • � -- ` vnL --- � 1.� �,c�-r 5t 11JC�.tOR
_
FQE.SCRos �t!'��°7 v 10 -. �/ I - - - - -----i - -- - - - --- -
v�ct R vc6 tas s�wwN �T� SeUSNT/ -- — . --------
-
u 3 53°10_SQ,FT,-COY" STDFZ�
C7CCs.3eA1 JG`-Z , CApG�\-t
(�Cskc�oN I t �,tfi tooe.� 2T -t oTAL '`l E�crts C IWO-c� WLOIR = 144"
- -7 sq� \2
CA(� CANeG�rR � __ _ _
P r � �� � �P.�C;`� PSN M�`-C �a;
�hNtt�ct I vcce isg l of j � ---
a
c ye� '!� Ticehurst Lane `s
�- $ g
781.639
8d, A 01945 a'
C�-1Pt15(�G I cmcnrm � l5 �,
O ^ `r `.
sTl�G� �t�wticc*-ravrS? L5 SCS , 8
I
BOSTON,H® otis, Associate AIA
S
ARCHITECTS
— 745 - o t 3q
KEY :
)� NeW DP.YWP.LL• PARTITION:
_ _ = WXLIL TO FSE REMOVED
NoTU
AV
N C
REMove Ex16T• >.m _
r
Q _ II 5T 5TL. P11,111,0 - m< t %�
. -O I rRovlPc d INSTALL R-B- =E1 �O a Rm7
g
-0-1
w �jo r 11 cn pp
O_ I o0D I t 1 y CO
_581=-..AT-TF-`--RPX1 f p IC
-N.G• RCa7UIrAegEN7h _ 1 _
u n LANPIN NEw ErtP1oYEF I - - -
_P GQKPC170"F�
r
^I Rp f 11 t4'I`- w>,.1 r RESTRGt�h'1_ 30 � - wI,nM6_. 9rMfW_'(I:
�. e
1REMOVE SINK ¢ RELocATE I-dCIF NGAE55ARY)
"_ -
. QQ -� _C„ I ;' Oj1 I p z -.� TOILET=¢INST.c.�.-Gt�CsBAriS_.
L_LIALLS SIJ 'i'
tN♦:4!"FtCSrN .:.- -: .n f To ME.E H.C. 9EQI1I11EMEI'{'I'9.
New_voPx-SpINz: I 5E8 ATTA<-HP-P r7RWG_
._ AS 5F{oNN
E%IST.- Nooa1
REMOVE Lo,J w�" o _ f -
f —Normans
II I I
Z -O u
II KI-T. H-
FREtur TE5T6 F __
-_O , SUPPLICRS' DRAWiN6
-
I i LOW ua_ _ I d l Ty N C� AFAR From K-ITCHIs.N_ LAyouT) GAPP.GiT ( : __ 15 TA�I,I,S.__l�L/ Gui41 R5
_.. . i
_ II i'_o I$ (3AFZ SToo�S
I
1 6%IST NO0V -
I I '
vRovlo¢: Q I45TA"I- - �hl>✓w 3'-oPFt11N�+ .
N>✓w INSUL. e,.L.
W IN Pow - --- _ -
9
f Fcbruurya', 1989
1
ED
i
fSLack IJP EXT. of wlNDow �
w� PAIMTAOLE PLYwo�P i e (/?E'rmi� S2-E39
IN5VLATe- IN`ZTALL PtsT
WALL ON I TeKIOKZ OP $KI>T. )kLrIUVL eXI6TW6- wimm-w, - h
W IH Po WS v o wnw11 Pl.ovloR. 4 .,+ 0 MA
INSTs LL
r7G1T DooR 51 GN — 4«M OFM
DGtiR, To FSr- (2 GRADE PFIiR
N-�• ENTRY W I N T E R S T R E. E T A R C H I T u.. C 'iS
'4 1/' WINTER S-I REE"r SALEM MA.. II1470 'f EL. # (50 8) 'a�-7371
I
I �4
521 CNIR: ARCIII I J.I t'I:AL BARRIERS UUARU
SlLNO�RO � Z=6� WN. I STMITiIRD STMT 5'•0'
/ F• A e '_0
a
'o
a'-o' ww.
PLAN—TYPICAL, STALL A.
I I I II
-L [ 11111 1 lit
I I
. I I
fr I I
^,max • I I I I I
llv' I I I i i
I i I I
I I I I I S
III
I
II I II II
I I
I I I I
1 II
I J
I I
7�1 9
6'•Or wh. I 3�Oawn. I � '
SECTION — O
12/31/86 521 CMR - 56
° CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
KIMiERLEY DRISCOLL
MAYOR
120 WASHINGTON$'[BEET* SALEM,MASSACFI USE7TS 01970
TEL:978-745-9595 ♦ FAX:978-740-9846
June 9, 2008
City of Salem Licensing Board
David Shea, Chairman
RE: Dodge Street Bar & Grille
7 Dodge Street, Salem
Dear Mr. Shea
The owners of the above property have requested an increase in the allowed occupancy
and submitted an architect's as-built plan of the building. This department has reviewed
the plan and have agreed that an increase in occupancy to 181 persons would be code
conforming.
Si ce 1 ,
T omas E. McGrath AIA
Assistant Building Inspector/Local Inspector
C ile ayor's Office, Fire Prevention, Health Dept.,
SALEM POLICE DEPARTMENT
SALEM,MA 01970
January 7, 2008
Joseph Barbeau
Assistant Building Inspector
120 Washington Street
Salem,MA 01970
Joe,
I know that we spoke a couple of weeks ago concerning the Dodge Street Bar& Grille and I followed up
with a letter to you concerning Walgreen's and Starbucks. I am wondering if there is any progress to
add to the Community Impact Unit file for our Dodge Street, Dodge Street Court Project.
Please feel free to contact me at Salem Police Department Headquarters 978-744-0171 X-218.
Bet regards,
Harry Rocheville
Sergeant
Community Impact Unit
Salem Police Department
SALEM POLICE DEPARTMENT
SALEM, MA 01970
January 7, 2008
Joseph Barbeau
Assistant Building Inspector
120 Washington Street
Salem, MA 01970
Joe,
I know that we spoke a couple of weeks ago concerning the Dodge Street Bar& Grille and I followed up
with a letter to you concerning Walgreen's and Starbucks. I am wondering if there is any progress to
add to the Community Impact Unit file for our Dodge Street, Dodge Street Court Project.
Please feel free to contact me at Salem Police Department Headquarters 978-744-0171 X-218.
Best regards,
Harry Rocheville
Sergeant -
Community Impact Unit
Salem Police Department
Cb
r
SALEM POLICE DEPARTMENT
SALEM, MA 01970 -
February 12, 2008
Joseph Barbeau
Assistant Building Inspector
120 Washington Street
Salem, MA 01970
Joe,
I sent you letters concerning 100 Broadway and the Dodge Street Court project. The
issue with 100 Broadway centers on a boat and an unregistered motor vehicle parked in
the backyard. The yard is also stacked with trash, lumber, and debris.
The Dodge Street Court project is on going. However,I have not heard back from you
concerning the dumpsters at the Dodge Street Bar& Grille, Walgreen's or Starbucks.
All three properties appear to be in violation of the city ordinance concerning"dumpsters.
Could you please up date me on these issues?-
st r�
4e:ry
Rocheville
Sergeant'
Community Impact Unit
Salem Police Department
Cc. Jason Silva Mayors Office
r
• y '
• r r
SALEM POLICE DEPARTMENT
SALEM, MA 01970
December 6, 2007 `
Joseph Barbeau
Assistant Building Inspector
93 Washington Street
Salem, MA 01970
Mr. Barbeau,
Thank you for your quick response to the dumpster issue at the Dodge Street Bar
& Grill. I would like to address another issue in the same area. Both Walgreen's and
Starbucks have dumpsters that abut a public way, both are in the public view. I believe
that the two businesses are also in violation of the city ordinance. Could you address
these violations as well? It would help the Community Impact Unit in its effort to
revitalize and clean up the area surrounding Dodge Street and Dodge Street Court.
Several of the property owners have been very receptive. The property owners have
removed graffiti, added motion sensor'spotlights to their property and posted areas, "No
Trespassing." We look forward to working with you in this endeavor.
Best regards,
Harry Rocheville
Sergeant
Community Impact Unit
Salem Police Department
CITY OF SALEM MASSACHUSETTS
DEPARTMENT OF PUBLIC SERVICES
120 WASHINGTON STREET, 4TH FLOOR
o'
SALEM, MASSACHUSETTS 01970 ,
BRUCE D. THIBODEAU, P.E.
DIRECTOR OF PUBLIC SERVICES/CITY ENGINEER
STANLEY J. USOVICZ, JR. TEL: 978-745-9595 EXT. 321
MAYOR FAX: 978-745-0349
November 26, 2003
Mr. Hiam Weizman
Peabody Block Reality
PO Box 44
Swampscott MA 01907
Re: Dodge Street Cafe— 7 Dodge Street, Salem, MA
Dear Mr. Weizman:
This letter serves to document the findings of the test pit dug by your contractor over the City's
existing 4-inch water main running up Dodge Street Court. As you should already be aware, we
have denied your request to tie a new 4-inch fire supply service into the existing 4-inch water
main, to service your building and tenant the Dodge Street Cafe.
The existing 4-inch cast iron water main is very old and dead-ends about halfway up Dodge
Street Court. Given the age of the pipe and the low service flow conditions, it is not surprising
that the main is heavily tuburculated. The remaining clear flow opening of the existing 4-inch
main ranges from approximately 1.5 to 2.5 inches in diameter. Based on the minimum flow
needed to service the building, in the event of a fire, and the natural progression of the existing
main to further deteriorate over time, it is unacceptable to install a new fire supply to the existing
4-inch water main. The amount of flow available to fight a fire would decrease over time and
the likelihood that a piece of tuburculation could break-off if and when fire flow demand is
activated greatly increases. Should tuburculate break free during a fire it is likely to clog the fire
suppression system and cause it to fail. Given the nature and purpose of installing the '
fire
service in the first place and even more importantly the current use of the building, namely a
bar/pub/nightclub establishment, it is truly unwise to even consider using the existing 4-inch
water main for a fire service connection.
The existing 4-inch main is too small of a diameter pipe to be cleaned and lined. That is the
reason the new 8-inch water main was installed recently by a commercial establishment located
further up Dodge Street Court.
In order for you to connect a new fire supply service to the City's water system you need to hire
a licensed MA Registered Civil Engineer to design a plan for the City's review and approval.
Your Engineer will need to investigate what your options are based on the City's existing water
I':VN,.&,W Dnd,e S,-Pod,e SI C.f.Gre senior 11170.1,Aoc
i
Mr. Hiam Weizman
November 26, 2003
PcWe 2 of 2
system and surrounding utility infrastructure, evaluate the costs and complexities of each option
and then submit to this department an engineered plan showing all existing conditions
(structures, utilities both above and below ground) and what work is being proposed. Copies
should also be sent to Capt. Bill Hudson of Fire Safety for their review. We would be more than
willing to talk with your engineer prior to a final plan proposal being submitted, to ease the plan
review process.
Once a plan has been approved you may hire a Licensed Drain Layer to install/construct what
has been approved BUT only after a Street Opening Permit has been obtain through this office
by a Licensed Drain Layer. Street Opening Permits are available by application from April 1" to
November I"or at other times in the case of an emergency or as approved by the Director of
Public Services.
We advise that your engineering work be done well in advance of seeking a Street Opening
Permit. Feel free to call me if you have any questions.
()As
Very truly yours,
I
ph . Nerden
stant City Engineer
ssistant Dir. of DPW
C: Bruce Thibodeau, City Eng & Dir. of DPS
Bill Merrill, Asst. Dir DPS
Tom St.Pierre, Bldg Inspector
Frank DiPaolo, Bldg Inspector
Capt Bill Hudson, Fire Safety
Mayor's Office
� " �II�e t�ummnnnrrttl#�r of tt�,�nx�t��e��
CITY OF SALEM
,.` In accordance with the Massachusetts State Building Code, Section 108. 15, this
CERTIFICATE OF INSPECTION
is issued
am to.} ` DODGE STREET BAR & (:rRILL._E
I {� rfltlj that I have inspected the premises known as DODGE STREET BAR & GRI:LL...
Located at 00+717 DODGE STREE=T in the city of Salem
County of Essex Commonwealth of Massachusetts. The means of egress are sufficient for the following
number of persons:
yy BY STORY y;
Story Cag*,*r Capacity Story Ca i chi 'y '�'�" 1�"� '� Capacity
9r'X x�6iL X.SG%7G$SL'K S6 X•7F 9'.7G� SS�9+%��9'+Sx'Xry'.lsY+`.$7•�X:2;`X'.l+
BY PLACE OF ASSEMBLY OR STRUCTURE
Place of Assembly Place of Assembly-
or Structure Capacity Location or Structure Capacity Location
DINING:', ROOM (SMFILL.) 30 1ST FLOOR DDUNG ROOM (MAIN) Sit IST FLOOR
• r
02 -t `-97 01 /Vi 1/ 19,311 01. /01/ 1.999
Certificate Number Date Certificate Issued Date Certificate Expires Building Official
The building official shall be notified within ( 10) days of any changes in the above information.
BUILDING DEPT.
^_ COM !ONHFAL= OF HSSSA=STS
DEC B
CITT OF SAL9 is AM 191
ES
APPLICATION FOR CERTIFICATE OF INSPIRTMVED
A pn CITY OF SALEM.MASS. �!
Date It •l,i ! ( U'S Fee Required s y4d,&-o
( ) No Fee Reouired
In accordance with the provisions of the Massachusetts State Building Code. 'Se,
108. 15. 1 herepy apply for a Certificate of Inspection for the below-named premise:
located ac the follcw;;igpng /qaJddress:
Streec S Number -7 oQo4--q-0--
Nae of Premises
4
Purpose for which Pre es is used rE5f"R�Jr
License(s) or Permit(s) required for the pr—ses by other GOver entai Agencies:
Licensp or Permit Agencv
Co �M,y ant �jcuAit, 544M �1a��� go /"CC
�Rp �i�2V�cC nAn /�� n ,�,M/ �'�/
Certificate to be issued to:�-Y/�1`T(Sfoup- Zn , hgAh ii S� Qltz,
.. Address- -7 I/V oZA� S ! S.'}'C�/'U
Owner of Record of Building: IWAJI9 'N QEHLTY '�AVST n
Address: P P r7X ZLY�,N,l.{M/H�
Nage of Present Holder of Certificate: D6Yr,6 -,; YJf,�� (772J1�
Nae of Agenc, if any. . .--,& lh��k--
Signature 6E Perso c wo Derr=-case TITLE
is issued or hislher nut orized agent 1(-2q-q7
Date C 2p
IN=UCTIONS• Day rime phone I
I. Make check payable to: The City of Salem
2. Return this application with your check to: Insnecror of Buildings. City of Salem
Building Department. One Saler Green. Salem. MA. 01970.
PLEASE NOTE:
I. Application form with required fee must be submitted for each building or strnetur
of part thereof to be terrified.
2. Application 6 fee must be received before the certificate will be issued.
J. The building official shall be notified within ten (10) days of any change in the
above information. L}
CE9--=1CATE t - U 4 s� =IRAnoN DATE: .I l I
n
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. y�1� eppppy/
Street 6 Number GY/ HCl,
Name of Premises 00 p
Certificate to be issued to:WW— � tiW�, 08,49 4c�¢G �
Address �� o/51X? i•��ax�� p
Owner of Record /off Building
Address C/• a��J�r v�//YG/!Z �p��
Purpose for which premises are use Changes since since last Inspection (required on file card also) 01
2. t
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 regulat}ons
pursuant thereto. I
QBE, /o , I9 9 -/ Aa��1-k
Date Building Official
Certificate -7ga Date Issued:
Date Expires:
Recommended Next
Inspection:
w
X#r Tomnwnwralt4 of fitttsnr4uotf#s
9 CITY OF SALEM
y y'' In accordance with the Massachusetts State Building Code, Section 108. 15, this
CERTIFICATE OF INSPECTION
is issued to DODGE STREET PAR R GULLS
1 Tgrfitq that I have inspected the premises known as DODGE STREET bFiR & GiRILI
located at 1210037 DODGE 51 BEET in the city of Salem
County of Essex Commonwealth of Massachusetts. The means of egress are sufficient for the following
number of persons:
BYSTORY
Story Ca A* 45V%7Lk7� X }}fj X Capacity Story C4,)f`ci X 7tt y Capacity
X11%}i7GX56 }b5k?56S 7L3GfAG % 6� Gl (7G"X4X
BY PLACE OF ASSEMBLY OR STRUCTURE
Place of Assembly Place of Assembly"
or Structure Capacity Location or Structure Capacity Location
Dlkl].NCi ROOM (GMt"ll._I....) 20 SETT FLOOR DINING ROOM (n9AINI) 54 S'1" t_OOR
t
1711 n7i t/ I 9C..38 01 /0t/ 1.999
Certificate Number Date Certificate Issued Date Certificate Expires Building Official
The building official shall be notified within (10) days of any changes in the above information.
uc
"�t3 -I �l - /� 25 �LgBw IoOZ1,
RFrFlvrn
h� The Commonwealth of Massachusett N SPEC TIONAL SERVICES
Department of Public Safety
Massachusetts State Building Code(780 CMR) 1 1114 OCT _1 P 2' 29 `
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 N and Lot It for locations for which a street address is not.available)
`7 004e s ,;;� ems,
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❑ Alteration ❑ 1 Addition❑ TD,,olition 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 Engmeerinf Peer Review required? Yes ❑ No ❑
Brief Description of Proposed Work: d/a✓r'to 6'♦' 9�
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❑ A-5❑ 1 B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ 1 H: Hi h Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5 El
L• Institutional I-1❑ 1-2❑ 1-3 El 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 ❑ r IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ 1 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❑
Private❑ or indentify Zone: or on site system required❑or trench or specify:
❑ permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: Nt\1-In1r rn Commi s,i a Kovie,, I r cv s:
Not Applicable❑ Is Structure within airport approach area? 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:
M , L,CT:> vo C..rD ►x 1T r-,P c.To\,P— to l 1 S
SECTION 9:.PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
,.. .
4 19-
Name(Print) No.and Street City/Town Zip
v, . 11OC
p Property Q,wner,antacglnforrnation:
:TI � G� tie ^j _ 6075_7a aa8�
Title I 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)
If buflding is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 0 and skip Section 101
10.1 Registered Professional Responsible for Construction Control
None(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town 'State Zip Discipline Expiration Date
10.2 General Contractor
`6_ - '
wl � ram
Company Name
PI�T2cc � DAL Gt `t'L , C� c»a3043 ��.sF S �s .r , 5� � �KP• ��av�/G
Name of Person Responsib for Construction / License No. and Type if Applicable
as 4 ., - e �' h vrJN M /I C)15d,-
Street Address ity/Town State Zip
7ol'63ly?-7 a7 76K94�FS9.30 m cG r-K-K,
Telephone No. business Telephone No. cell e-mail address
SECTION 11:AVORKIiRS'CONIl FNSA'I ION INSURANCt:AFFIDAVI"f M.G.L.c.152.9 25C 6
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed mid
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 O
- SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
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 municipality)
5. Mechanical Other $ Enclose check payable to 7
6.Total Cost $ g(70 v (contact municipality)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 know edge and understanding.
Pie 1 p�nt and signn1m� Title Telephone C No. Date
/9-V-F mina
L @ y ey�
Street Address Y City/Town State Zip
Municipal Inspector to fill out this section upon application approval:
Name - Date
CITY OF SALEINI, NIASSACHUSETTS
BUILDING DEPART%MNT
N 120 WASHINGTON STREET,r FLooa
°1 T .L. (978) 745-9595
FAX(978) 740-9846
KIN[B Rt RY DRISCOLL
MAYOR THObIAS ST.P[ERR&
DIRECTOR Of PUBLIC PROPERTY/BUILDING CONWISSIONER
Demolition Permit Sign-Off
(Supplement to permit application)
6? M hereby supply the following releases,as part of the
application for a permit to demolish the structure located at 7 o y -- -Sr�t--
and shown on the Assessor's Maps
of_ as being on Map # 1�" Block # Lot # ®//e o
The sixth edition of the Massachusetts State Building Code, 780 CMR, states in part: "A
permit to demolish or remove a building or structure shall not be issued until a release is
obtained from the utilities, stating that their respective service connections and appurtenant
equipment, such as teeters and regulators, have been removed or serried and plugged in a safe
manner."
Utility to be Notified Notice Received by Date Received
Gas
Telephone.
Electric
Public Utilities (Municipal
IFire Department —
Other -
Other -
Demolition debris hauler: fa ti, e_m5-� Q c poSw _ v
Location of licensed � 0r-yy-er—'TJ
�
demolition debris landfill: 0�1_(-�,
Signature of Applicant _ bate: 7 /.¢
Signature of Owner Date: !016 FI-
This sheet must be returned to the Inspections Department along with a completed
application for a permit, a site plan, and any other applicable information and fees.
Demap�rm.dcx.
Salem Historical Commission
120 WASHINGTON STREET,SALEM, MASSACHUSETTS 01970
(978)619-5685 FAX(978)740-0404
WAIVER OF THE DEMOLITION DELAY ORDINANCE
It is hereby certified that the Salem Historical Commission has waived the Demolition Delay Ordinance for the
proposed demolition as described below, as per the requirements set forth in the Historic District's Act (M.G.L.
Ch. 40C) and the Salem Historic Districts Ordinance.
Address of Property: 7 Dodge Street
Name of Record Owner: Dodge Area, LLC
Description of Demolition Work Proposed:
Demolition ofstructures.
i
i
Y
Dated: 08/26/13 SAL HISTORICAL COMMISSION
By.
THIS IS NOT A DEMOLITION 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.
nationalgrid
40 Sylvan Rd
Waltham MA 02451
September 29, 2014
Srdjan Milicevic
NASDI,LLC
1365 Main Street
Waltham MA 02451
RE: Service Removal for Building Demolition.
Dear Srdjan,
This letter is to confirm that,per your request,National Grid has removed the electrical
service and meters 05097332 and 05085630 from 7 Dodge Street, Salem MA on 9/25/14.
If you have any questions or need further assistance,please feel free to contact me at
(508)357-4522.
Sincerely,
Deborah Correa
Customer Fulfillment
Ph# 508-357-4522
Fax# 1-888-266-8094
deborah.correa@nationalgrid.com
nationalgrid
September 26,2014
To: Jim Gagnon
Re: 7 Dodge Street,Salem,MA
This letter is to notify you that after our investigation it has been determined that there is
no live gas @ 7 Dodge Street, Salem, MA
If you have any questions please feel free to contact me at 781-907-2931
(;�'a Ao�L�
Linda Gadourey
GAS CUSTOMER FULFILLMENT
National Grid
40 Sylvan Rd
Waltham, Ma 02451
781-907-2931
�a► Ctg of -S-zttlem, gassadjusettg
Hire Drputmrnt 31r0quartrrs GK4:F 602�-
PRE-DEMDLITION APPLICATION FOR PEPMT
.Gn accordance with the provisions of the Salem Fire Code, and Salem Fire Code,
and Salem Fire Prevention Regulation #29C made under the authority thereof; an
inspection is requested of the proposed structure to be demolished, and a permit
issued subject to the following rules or recommendations which shall be complied
with under provisions of the law.
Owner of Land C �j
Address of Project 7 -00cCie SS -
Inspection requested by:
Address of Applicant a d q k r l��^S� G,y,v /V G,I./7=
1. Per the Salem Fire Code this structure shall be demolished in a workmanlike 01,Fos
manner under provisions of the Mass. State Building Code and the permit issued by
the Salem Building Inspector for said demolition.
2. All debris from each day's activities shall be kept apart from the basic structure
and wet down at the end of each workday. No debris shall accumulate over twenty-four
(24) hours at the site, and no mmre than twenty (20) percent of any one day's debris,
at any time.
3. The use of City of Salem water shall be approved by the City of Salem water
Department or by use of a paid off-duty firefighter on watch.
4. The contractor shall have a current welding and cutting permit in effect. Use
of said welding and cutting equipment shall be subject to the Salem Fire Prevention
Bureau regulations. A paid off-duty firefighter fire watch may be required by the
authority having jurisdiction in cases where it is deemed necessary, because of
increased fire hazard.
Failure to perform the operations in an approved workmanlike manner, may be cause
for an ilntediate "around the clock" fire watch by a paid fire department detail.
This shall be taken into consideration by a?? contractors and shall serve as notice
Of this regVirement. An advance pa, ment shdl_ be recrLir--,d ;tiev. '--erred necessary
for. this fire watch.
licent, s'signature
Fora #29C (Rev. 9/77)
Oct 03 iCiIA2a Dennis Mastrolia 781 592 9513 p.2
Dennis tire Mennis
King, q1 PL%' Confral-
7eP,?7ile MY!Pe-VI Collif'01 Spech.Lvi',v
MAIN'OFFICE.A\D LABS
29 l.ocusiNfleel
4)wrl. Wel. 0,1!)f)4
Boston Lirr, llmiv.fl H obura A'etvt(p Peahnlr Lawrence L)"ituan
67 103N 592 M�3 J 9-29jfl 935 L)L40 33 7-5,V53 5 32- 4 4-3. &W-069- 251-0006
October 3, 2014 INVOICE # 2296
A Mr.
—dop e Street
ga-Fe—m,-MW.�
Services completed for RODENT control for the demolition.
All baiting stations are labeled and recorded.
All inclusi 175.00.
Thank you,
Dennis Mastrolia
CEO/ACE
781-592-0023.
Thank you,
Dennis Mastrolia
978-459-2950. Office
781-910-0313- Cell
DennisNiastrolia@verizoiimet
S Mastrolia 781 592 9513 p.1
Dens the Alleunis
The Krra,vjYcSY Cowroj
Termile oild Pest Car(irol S%��ciulis;s
'9 Lnctis(SIi'�c1
:iiu. 0!9(i-!
6o.slon kwo Lwiv l !i'nlrr sr V-II on PrsLodr l rnvr�nt-e DeJ.(mrrr
?b:-103N 59P-6023 d-59-2950 ti3i-/ FAD 332-56i3 53=-3-I.13 6&9-00- 25!-Opp(
October 3, 2014
Mr. Pat McGrath
7 Dodge Street
Salem, MA.
Services completed for RODENT control for the demolition.
All baiting stations are labeled and recorded.
Thank you,
Dennis Mastrolia
CEO;ACE
781-592-0023.
Thank you,
Dennis Mastrolia
978-459-2950. Office
791-910-0313. Cell
DennisMastrolia@verizon.net
McGrath Enterprises
28 Oakville St.
Lynn, Ma 01905
*781-598-2727
10/7/14
To whom it may concern;
McGrath Enterprises will be doing demolition on 7 Dodge St.
Salem, Ma and will be spraying water for dust control on 10/8/14.
Thank you,
Patrick J. McGrath
P.O. Box 512' Ault,MA 02045 ` TEv(781) 925.4882. FAX(781) 925-4803
OESTOSREMOVAL e�-OEMOLITION ff ENVIRONAPTALCONTRACTING a 6ENERAI4'ONTPACT'm�r
CLEARANCE LETTER
er Octob 22014-
.4 1
Mr.Jim Gagnon
120 Washington Street,Suite 202A'
"Salem,MA 01970
Job Site:
Former Dodge Street Grill
7 Dodge Street
Salem,MA 01970 i
Mr. Gagnon,
Hazardous Abatement Services,Inc.bas removed all asbestos containing materials,
PCB's and Mercury devices identified in the Al Spectrum Services Summary Tables
dated April 7,2014, G
The building is cleared for demolnton aE
If you have any further questions or concerns,please don't hesitate to call or email
Sincerely,
Jam s P: alters
erations Manager
AC000287. "- e
AS052895
Hazardous Abatement Services,Inc
POB 512 ,
Hull,MA 02045 .c
781-983-3939 cell
rr
7 n
i
ee
Commonwealth of Massachusetts tOD2042so
Asbestos Notification Form ANF-001
Asbestos Project#
-'} r Project Revision
r Project Cancellation
A. Asbestos Abatement Description
1..Facility_Location:
FORMER RESTAURANT- 70ODGESMM
-Nana of Facility Street Address
Instructions 1.Al SALEM MA 01970 817625W15
sections of this form Cdyno„m 3tata :Zip Coder Telerdnorte
must be completaotn JIMGAGNON MANAGER
order to complyvrith
MassDEP notification Faalhy CordPerson Name Facility Contact Person TAle
requirements of 310 Worksite Location: ATncAND.ROOF
CMR7.15and - .
Departrnem of Labor BuMrm Nana;Vft,Floor;Room,.etc.
Standards(DLS) 2. Is the facility occupied? r.Yas FNo
notification
requirements of 453
CMRSa2 3. Is this a fee exempt notification(city,town,district, municipal housing authority,state facility, or
owner-occupied residential property of four units or less)? F Yes F No
MasmDEP Use Only. 4.Blanket Permit A Project
] Approval,if applicable-
Data Received Approval ID3
5.Non-Traditional Asbestos.Abatement Work'Practice AppmvaL
2..Subrrdt final if applicable: Approval In#
Formic:
Commonwealth of 6.Asbestos Contractor.
Massachusetts HAZARDWSABATEMENTSFRVICES PO BOX512
Asbestos Program
P.O.Box 120087 Nerve Address
Boston,MA 02112- NULL MA 02045 7819254882
008T
Gityrrown Stato LP Code Telephone
AC000287 Contract Type: F Written F Verbal
DLS License S
7. JAMESAALTERS AS052M
Nam of Contractors CnSka SuperviwrfFommen DLSCedikaflonA _
S. EfMRONMENTALSAMPiJNGANDTESMNGLTO AA000132
Nacre of Project Monitor DLSCertka on8
9..EMARONMENTALSAMPLINGAND TESTING LTD AA000132
Name of Asbestos Analytical Lab - US Certification 6'
10. 8Ia2014 81122014
ProjectStart Data(MMfDD1YYYY) End Date(MWDD1YYY1)
`7-4M 7-
Wbrk Hours-Monday Thmugh,Friday Work Hours-Saturday&Sunday
11.. What type,of project is.this?
F-: Demolition r Renovation r-Repair r Other-Please Specify:
Revised:11113/2013 Page-I of 4
1 .
Commonwealth of Massachusetts (1 DDpDg2gD
Asbestos Notification Form ANF-001 Asbestos Project
r Project Revision
LL
r.Project Cancellation
A.Asbestos Abatement Desorption: (coat.):
12..Abatement procedures(check all that apply):
ror. Glove Bag r Encapsulation r- Enclosure -r-Disposal Only (— Cleanup r Full Containment
r Other-Please Specify: ROOF
11 Job is being.conducted: E"Indoors r, Outdoors
14.Total amonpt of each type of asbestos Comainiug materials(ACM)to be removed,enclosed,or
encapsulated:
375 45M
Linear Feet(Um.R.) Square Feet(Sq.FL)
Boiler,Bt'eachmg,Duct, Transite Pipe
'Tank Surface Coatings Un.Ft-- Sq.FL - Lin.Ft Sq.FL
Pipe Insulation -50 Transite Shingles
Lin,FL S4 R. Lin.FL Sq.Ft
Spray-On f ueXoofiug Transite Panels
Un.FL Sq.Ft - Lin.rL Sq.Ft
Cloths,Woven Fabrics Other--Please Specify:
Lin.R. Sq.Ft
Insulating Cement ROOHR/4SHING 325. 45M
Un.R. Sq.Ft - Lin.FL Sq.Ft
15.Describe the decontamination system(s)to be used:
GLOVE BAG METHODS AND DouaLE surf Wf WASH BUCKET
16.Describe the contamenzation/disposal methods to comply with 316 CMR 7:15 and 453 CMR 6.14(2)(g):
DOUBLEASBESTO.S BAGS,WET,GENERATOR LASELON OUTER BAG.ALSO BULK LOAD IN DOUBLE LINED ROLLOFF
UUMPSTER FOR.ROOF MATERIAL
17.For Emergency Asbestos Operations,the MassDEP and DLS officiaLs.who evaluated the emergency:
Name of MassOEP.Olficial Tde of MagDEP Officbt
Date of Authortzaticn'(MM/DDIYYYY) Waiver#
Nacre of DLS Official- Title of DLS Offidal
Date of Authorization(MWDDNYYY) Waiver#
18.Do prevailing wage rates as per M G.L.c.. 149,§26,27 or 27A F apply to this 1 yes r No
projecty.
Revised-. 1.1/13/2013 Page 2 of 4
Commonwealth of Massachusetts 1100204280 --�
L] Asbestos Notification Form ANF-001 Asbestos Project
F Project Revision
r; Project Cancellation
B.Facility Description
1.Current or prior use of facility:: RESTRURANT
LIS the facility'owner-occupied residential wiib 4 units or less? F Yes (J,.ATo t �
,3,:DODGE AREA LUC 17IVALOO STREET,SUITE 10D
Facility Owner Name Address
SOMERVLLE MA 02143 6176258315
City/Town - State Zip Code Telephone
4,JIMG,AGNON 17IVALOOSTREET.SUITE 100
Nacre of Facility Owner's On-Sits Manager. Address
SO,MERVILtE -MA 02143 61762583
cdyfrown State 74 Code Telephone
.5,WA WA
Name of General contractor Address
NIA MA 00000 0000000000
Cityrrown -Slata Zip Code Telephone
Note:Temporary' LIBERTYMIITUAL
storage of Asbestos
containing waste Contractors Workers Conponsation Insurer
matenal Is only WC5.31S-320002.024 2711/2015
allowed at the.place ,poTcy g - Eupiration Date(MMIDDTYYYY)
of business cis OLS.
licensed Asbestos 6.What is the size of this facility? '3000 2
contractor or a transfer
station that M
permitted by Square Feet 9 of Floors.
NauDEP and C.Asbestos-Transportation-& Disposal
operated in
compliance wen Solid
Wage Regulations 1.Transporter of asbestos-containing waste material from site of generation.
310 CMR 19.000
F Direcoy'to Landfill or r7 To Temporary.Storage Location/ Transfer Station
HAS,INC. POSS12.
Name ofTransponer - Address
HULL MA. -02045 7819254882
clyRbwn State Zip Code Telephone
2.If a temporary storage location/transfer station is used,list name of transporter of asbestos containing
waste Material from temporary storagelocalion/transfer station to final:disposal site:
Name of Transporter Address
city)Town - State no Code Telephone
Revised:1 111 3/201 3 Page 3 of 4
Commonwealth of Massachusetts
`a� oozo4zao _
Asbestos Notification Form.ANF-001 Asbestos Project#
C F Project Revision
(— Project Cancellation
non:wnaanor muse C.Asbestos Transportation&Dis sul: cont:
sign this tam for DLS p Po (cont)
notification purposes 3.Name and address of temporary storage location/hansfer station for the asbestos containing waste
material:
Temporary ShuageLacatlon Nacre Address
Cityrrovm State Zip Cade Telephone
4.Name and location of final disposal site(asbestos.landfill):
TURNKEY LANDFILL. WASTE MANAGEMENTOF NH
Final Disposal Site Naive Final Disposal Site Owner Nacre
90 ROCHESiER NECK ROAD
Address
ROCHESIER NH 03WS 6033030279
City/Tom Site Flo ode Telephene-
D.Certification.
"I:certify that I have personally.
examined the foregoing and am JIM WALTERS JIM WALTERS
familiar with the information Nam Authorized signature
contained in this document and MANAGER- _ 72WO14
all attachments and that,based. Fosiiian7Tdle Date(MM7DD/YYYVp
on my inquiry of those 78j9254882
individuals immediately HAS INC.
responsible for obtaining the Telephone_ - Representing
information,I believe that the POS512 HULL
information is hue,accurate,and Address Cay?own
complete.I am aware that there: M.A 02045
are significant penalties for " -
submitting false information, State Zip Cade
including possible fines and
'imprisonment.The undersigned
hereby states,under the
penalties of pedury,,that I'have
.read the.Commonwealth of
Massachusetts regulations
,governing asbestos abatement
(453'CMR8.00,promulgated by
the Department of Labor
Standards and 310.CMR 7.15
.promulgated,by the Department
of Environmental Protection),
and that I am aware that this
permit application or notification
shall not be deemed'valid
unless payment of the
applicable fee is,made.'
Revised: 11/132013 Page of 4
Massachusetts Department of Environmental Protection
eDEP Transaction Copy
Here is the file you requested for your records.
To retain a copy of this file you must save and/or print.
Username: DEMOMAN
Transaction ID: 692140
Document: AQ 06-Construction/Demolition Notification
Size of File: 218.94K
Status of Transaction: in Process
Date and Time Created: 1 0/712 01 4:10:31:09 AM
Note: This file only includes forms that were part of your
transaction as of the date and time indicated above. If you need
a more current copy of your transaction, return to eDEP and
select to "Download a Copy"from the Current Submittals page.
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention•Air Quality
BWP AQ 06
Notification Prior to Construction or Demolition
This is a revision to an existing form.
Project ID for existing form to be revised:
ri This job is being conducted under a Blanket Pemtit
MassDEP assigned Blanket Authorization ID: I -I
This job is being conducted under a Non Traditional Abatement Work Practice Permit.
MassDEP assigned Non Traditional Work Practice Authorization ID:
r None of the above conditions apply,generate a new form.
Revised: 11/13/2013 Page 1 of 1
Massachusetts Department of Environmental Protection
y Bureau of Waste Prevention•Air Quality
' B��'i AQ 06 100208964
Notification Prior to Construction or Demolition Asbestos Project Number#
A.Applicability
A Construction or Demolition operation of an industrial,commercial,or institutional building,or residential
building with 20 or more units is regulated by the Department of Environmental Protection(MassDEP),Bureau of j
Waste Prevention,Air Quality Division,under Regulations 310 CMR 7.09.Notification of Construction or
Demolition operations is required under 310 CMR 7.09(2)ten(10)working days prior to any work being
performed.The following information is required pursuant to 310 CMR 7.09.Is this a fee exempt notification(city,
town,district,municipal housing authority,state facility,owneroccupied residential property of four units or less)?
Is this a fee exempt notification(city,town,district,municipal housing authority,state facility,owner-occupied
residential property of four units or less)?
Yes r No
Type of Notification:
(j Revision of an Existing Form Q Cancellation of Project
Instructions: 1.Blanket Permit Project Approval,if applicable:
Approval ID#
1.All sections of this 2.Non-Traditional Asbestos Abatement Work Practice Approval,if applicable:
form must be
completed in order to Approval ID#
Deparmplytment
me the B. General Project Description
Department of � p
Environmental 1 Facility Information:
Protection
notification FORMER RESTAURANT 7 DODGE ST
requirements of 310
CMR 7.09. Name of facility Street Address
SA FM MA 019700000 6176258315
2.Submit Original Form To: Cityfrown State Zip Code Telephone
Commonwealth of JIM GAGNON MANAGER
Massachusetts Facility Contact Person Contact Person Tide
Asbestos Program 9787400006
P.O.Box 120087 jgagnonQrcg-Ilacom
Boston,MA Facility Contact Person Telephone Facility Contact Person Email
02112-0087
Facility Size:
3000 2
Square Feet Number of Floors
Was the facility built prior to 1980? r Yes ❑No
Describe the current or prior use of the facility:
RESTAURANT
Is the facility a residential facility? ❑Yes r No If yes,how many units?
2.Facility Owner:
DODGE AREA LLC 17IVALOO ST,SUITE 100
Facility Owner Name Address
SOMERVLLE MA 021430000 6176258315
CityfTown State Zip Code Telephone
JIM GAGNON 17 NALOO ST.SUITE 100
On-Site Manager/Owner Representative Address
Somerville MA 02143 6176258315
Cltyrrown State Zip Code Telephone
Revised:03/17/2014 Page 1 of 3
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention•Air Quality
BWP AQ 06 1100208954
Notification Prior to Construction or Demolition Asbestos Project Number#
8.General Project Description(continued)
3.General Contractor:
MCGRATH ENTERPRISES 28 OAKVILLE ST.
Name Address
LYNN MA 019050000 7815982727
City/Town State Zp Code Telephone
PATRICK J.MCGRATH 7818445630
General Contractors On•site Manager/Foreman Telephone
C. General Construction or Demolition Description
General 1.Construction or demolition contractor:
Statement:If
asbestos is found MCGRATH ENTERPRISES 28 OAKVILLE ST.
during a Construction Contractor Name Address
or Demolition
operation,all LYNN MA 019050000 7815982727
responsible parties City/rown State 'Sp Code Telephone
must comply with 310 PATRICK J.MCGRATH 7818445630
CUR 7.00,7.09,7.16,
and Chapter 21 E of Construction and Demolition On-site Manager Telephone
the General Laws of
the Commonwealth. 2.Licensed Contractor Supervisor:
This would include,
but would not bw PATRICK J.MCGRATH S40028832
limited to,filing an
asbestos removal Supervisor Name License Number
notification with the
Department and/or a 3.Is the entire facility to be demolished? r Yes ❑No
notice of
release/threat of release of a 4.Describe the area(s)to be demolished:
hazardous FULL CONTAINMENT
substance to the El
Department,if
applicable.
5.If this a construction project,describe the building(s)or addition(s)to be constructed:
MassDEP Use Only ALL METHODS WILL COMPLY '
Date Received
6.If this is a demolition or renovation project,were the structure(s)surveyed
for the presence of Asbestos-Containing Material(ACM)? FY_J Yes ❑No
7.Was asbestos containing material(ACM)found?
r Yes rNo
If a survey was conducted,who conducted the survey?
HAZARDOUS ABATEMENT SERVICES AS052895
Name Department of Labor Standards Certification Number
Revised:03/17/2014 Page 2 of 3
Massachusetts Department of Environmental Protection
t Bureau of Waste Prevention•Air Quality
BWP AQ 06 1100208954
Notification Prior to Construction or Demolition Asbestos Project Number#
C.General construction or Demolition Description(continued)
The Asbestos Abatement Notification Number for this 100201280
address is:
This project ❑ Construction r Demolition
is:
10/8/2014 10/15/2014
Project Start Date(MM/DONYYY) Project End Date(MM/DDNYYY)
8.For demolition and construction projects,indicate dust suppression techniques to be used
lJ Seeding r Wetting ❑ Covering ❑ Paving r Shrouding
r .Other-Specify: -
9.For Emergency Demolition Operations,who is the MassDEP official who evaluated the emergency?
NA
Name of MassDEP Official
NA
Title
10/812014 NA
Date of Authorization(MM/DDNYYY) MassDEP Waiver Number
D. Certification
"I certify that I have personally PATRICK J.MCGRATH
examined the foregoing and am Print Name
familiar with the information PATRICK J.MCGRATH
contained in this document and Authorized Signature
all attachments and that,based OMER
on my inquiry of those
individuals immediately PositioniMfie
responsible for obtaining the MCGPATHENTERPRISES
information,I believe that the Representing
information is true,accurate,and 10/7I2014
complete.I am aware that there Date(MMIDDNYYY)
are significant penalties for
submitting false information,
including possible fines and P.E.#
imprisonment.The undersigned
hereby states,under the
penalties of perjury,that I am
aware that this permit
application or notification shall
not be deemed valid unless
payment of the applicable fee is
made."
Revised:03/172014 Page of
• MassDEP Home I Contact I Pnvacy Policy
MassDEP's Online Filing System
UsemarnwDEMOMAN
Nickname:BUILDERMAN
My eDEP; Forms®{ My Profileliso Help! Notifications
Receipt 1
Forms Sianature Payment Receipt J
Summary/Receipt e
pnntreceipt,- Exit
Your submission is complete. Thank you for using DEP's online reporting
system.You can select"My eDEP"to see a list of your transactions.
DEP Transaction ID: 692140
Date and Time Submitted: 1017/201410:28:39 AM
Other Email :
DEP Transaction ID: 692140
Date and Time Submitted: 10/7/2014 10:28:39 AM
Other Email :
Form Name: AQ 06-Construction/Demolition Notification
Form Name: AQ 06- Construction/Demolition Notification
Payment Information
DEP code: 99548
Date: 10/7/2014 10:27:49 AM
Amount($): 100
Payment Detail: MCGRATH PATRICK—AccountType—AccountNumber
****8088 ConfirmationNumber:
MyeDEP
MassDEP Home Contact i Pnvacv Policy
MassDEP's Online Filing System ver.12.9.7.00 2014 MassDEP
r
• •� • MassDEP Home i Contact i Privacy Policy
MassDEP's Online Filing System
Ummame:DEMOMAN
My eDEPI Formsizi. My ProfiieRO HetpI Notifications Nickname:6UILDERMAN
Transaction Overl/1eW Trans#692140 ID#100208954 AQ 06-Construction/Demolition Notification
r
Forms Si nature Payment Submit
e —
Payment
print ,. Exit'
Payment Confirmation
Thank you.Your payment has been received.
Note:Payment received after 3:30pm will not be posted until the next business day.
MassOEP Home Contact ; Privacy Policy
MassDEP's Online Filing System ver.12.9.7.0®2014 MassDEP