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23 ENDICOTT STREET - BUILDING JACKET 232.Endicott Street S°raea� No. 153L-2 HASTINGS. MN LOS ANGELES-CHICAGO-LOGAN.OH MCG REGOR,TX-LOCUST GROVE.GA U.S.A. n P j m � I � I (� C25 � I I c .z Ute } 1 1 2 2f1 Gl9RD4YC I �fl PA�KAssbci T S i I. !I I �EASoby S'QI j PABODY, MA 01960 I � ^•�(;� � �;1 S `sic-�, ` - I I 1 I 'Pi i j , i �_ � t .-,� � n i ' I I I i � I I � t"?A bI'44R �AR�ASSOOIAT;ESd jai 1 -- i t E 40by' PEABODY .01111 jlf 1 IV ICA n r 1,0 4 J NOTICE OF CITY ORDINANCE CITY OF SALEM SALEM CITY ORDINANCE Citation: -.. 1473 �co�flrfiR \ Date: 06/25/2014:] r `- Location: QL 23 ENDICOTT STREET Badge Number: Officer: MICHAEL LUTRZYKOWSKI Fine: 06/25/2014 $ 50 . 00 Violation: 06 VIOLATION OF STATE BUILDING CODE (SCO 12-1) Payments : Other: $ -50 . 00 Docket : Verdict : TOTAL DUE: 07/25/2014 $ 0 .00 ABATEMENT RECEIPT CITY OF SALEM MA-037-CO-2014-00-1473 CITY OF SALEM PARKING CLERK 07/25/2014 PO BOX 203 TOTAL DUE : 0 . 00 MILFORD,MA 01757 (508)473-9660 - ABATEMENT INFORMATION 50.00 LAGONAKIS,NONDAS 07/25/2014 $COMPLIED 9 BRIDGE STREET SALEM,MA 01970-0000 r T CITY OF SALEM, MASSACHUSETTS - INSPECTIONAL SERVICES DEPARTMENT THomAS ST.PIERRE INSPECITONAL SERVICES DIRECTOR /BUILDING COMMISSIONER KIMBERLEY DRISCOLL MAYOR 120 WASHINGTON STREET♦ SALEM,MASSACHUSETTS 01970 TEL:978-745-9595 FAx:978-740-9846 March 14, 2014 E-(Zff)UtuPtNZ_ LagonikasNondas HS AIL 0ZVIC6 Property Owner, Salem House of Pizza 3 11'{V4 23 Endicott Street Salem, MA 01970 Mr. Nondas, On February 4, 2014 the renovation project at"Salem House of Pizza" was inspected by the Building Department. The building permit (B- 2014-0584) was signed as complete with the provision that the new entrance would be made totally accessible as soon as the weather permitted. Any alterations to an existing building that require a Building Permit are governed by CMR 521 (Architectural Access Board). The Salem Building Department requires that you submit a plan to make the new entrance accessible, and to adjust accessible parking if needed, in order to be compliant with CMR 521. O The plan for this work must be submitted to the Building Department by March 21, 2014. O The work must be completed and the entrance completely accessible by April 4, 2014. Thank you for your cooperation. Respectfully, Harry Wagg Assistant Building Inspector 978-619-5643 hwagg@Salem.com FAILURE TO RESOLVE THE ISSUES CITED ABOVE WILL BE CONSTRUED AS NON-COMPLIANCE. AND MAV RESULT IN THE ISSUANCE OF MUNICIPAL TICKETS AND FINES AS WELL AS THE FILING OF CRIMINAL COMPLAINTS IN DISTRICT COURT. YOU HAVE THE RIGHT TO APPEAL TO THE MASSACHUSETTS BOARD OF BUILDING REGULATIONS AND STANDARDS(BBRS) AT ONE ASHBURTON PLACE/BOSTON/MA. cc. Shar ali Shar, John Karavolas, file CITY OF SALEM, MASSACHUSETTS INSPECTIONAL SERVICES DEPARTMENT THOMAS ST.PIERRE INSPECTIONAL SERVICES DIRECTOR /BUILDING COMMISSIONER KI W ERLEY DRISCOLL MAYOR 120 WASHINGTON STREET♦ SALEM,MASSACHUSETTS 01970 TEL:978-745-9595 ♦ FAx:978-740-9846 March 14, 2014 Shar ali Shar Business Owner, Salem House of Pizza 3 Putnam Gardens #30 Cambridge, MA 02139 Shar ali Shar, On February 4, 2014 the renovation project at "Salem House of Pizza" was inspected by the Building Department. The building permit (B- 2014-0584) was signed as complete with the provision that the new entrance would be made totally accessible as soon as the weather permitted. Any alterations to an existing building (that require a Building Permit) are governed by CMR 521 (Architectural Access Board). The Salem Building Department requires that you submit a plan to make the new entrance accessible, and to adjust accessible parking if needed, in order to be compliant with CMR 521. O The plan for this work must be submitted to the Building Department by March 21, 2014. O The work must be completed and the entrance completely accessible by April 4, 2014. Thank you for your cooperation. Respectfully, Harry Wagg Assistant Building Inspector 978-619-5643 hwagg@Salem.com FAILURE TO RESOLVE THE ISSUES CITED ABOVE WILL BE CONSTRUED AS NON-COMPLIANCE. AND MAY RESULT IN THE ISSUANCE OF MUNICIPAL TICKETS AND FINES AS WELL AS THE FILING OF CRIMINAL COMPLAINTS IN DISTRICT COURT. YOU HAVE THE RIGHT TO APPEAL TO THE MASSACHUSETTS BOARD OF BUILDING REGULATIONS AND STANDARDS(BBRS) AT ONE ASHBURTON PLACE/BOSTON/MA. cc. Lagonikas Nondas,John Karavolas, file e� aT QTY OF SALEM, MASSACHUSETTS INSPECTIONAL SERVICES DEPARTMENT THOMAS ST.PIERRE INSPECTIONAL SERVICES DIRECTOR /BUILDING CONMSSIONER KIMBERLEY DRISCOLL MAYOR 120 WASI-UNGTON STREET♦ SALEM,MASSACHUSETIS 01970 TEL:978-745-9595 ♦FAx:978-740-9846 March 14, 2014 John Karavolas General Contractor, Salem House of Pizza 29 Abington Ave. Peabody MA. 01960 Mr. Karavolas, On February 4, 2014 the renovation project at "Salem House of Pizza" was inspected by the Building Department. The building permit (B- 2014-0584) was signed as complete with the provision that the new entrance would be made totally accessible as soon as the weather permitted. Any alterations to an existing building that require a Building Permit are governed by CMR 521 (Architectural Access Board). The Salem Building Department requires that you submit a plan to make the new entrance accessible, and to adjust accessible parking if needed, in order to be compliant with CMR 521. O The plan for this work must be submitted to the Building Department by March 21, 2014. O The work must be completed and the entrance completely accessible by April 4, 2014. Thank you for your cooperation. Respectfully, Harry Wagg Assistant Building Inspector 978-619-5643 hwagg@Salem.com FAILURE TO RESOLVE THE ISSUES CITED ABOVE WILL BE CONSTRUED AS NON-COMPLIANCE. AND MAY RESULT IN THE ISSUANCE OF MUNICIPAL TICKETS AND FINES AS WELL AS THE FILING OF CRIMINAL COMPLAINTS IN DISTRICT COURT. YOU HAVE THE RIGHT TO APPEAL TO THE MASSACHUSETTS BOARD OF BUILDING REGULATIONS AND STANDARDS(BBRS) AT ONE ASHBURTON PLACE/BOSTON/MA. cc. Lagonikas Nondas, Sahr ali Shar, file r4 cu.1 r �� CiLL/ ofSalem, Massachusetts Fire Department -4 t a i 48 Lafayette srrect Sa(em, Vassacfusetts01.9,'03695 'ire Prevention DavLd7✓ iuJy r Tel 978-i44-1235 'Bureau iAif rjax 978-745.4646 978-745-7777 9'8 476990 d',:n;lyi�isalern cnm Salem House of Pizza 23 Endicott Street Salem, MA 01970 ATTN: Owner/Manager MAINTENANCE,CLEANING, AND TESTING OF FIXED FIRE EXTINGUISHING SYSTEMS- MAINTENANCE,CLEANING OF HOOD AND DUCT SYSTEMS WHERE COOKING GREASE IS GENERATED................. The Salem Fire Prevention Bureau requires that all hood and dud systems are to be donned from the Cooking area(hood) in the kitchen. all the way to Ute extreme end of the duct, THIS QEANINQ WILL OCCUR ON A 29ARMRLX BASIS. A cenificate showing the name of the company,the person,end the date of the cleaning Mall be posted near the hood area. The certificate will indicate what work was performed, and will also Indicate areas not cleaned. ALL FIXED FIRE EXTINGUISHING SYSTEMS ARE TO BE TESTED AND CHECKED WJ& ANb"1 Y. THIS TEST WILL ALSO INCLUDE A TEST OF THE INTERIOR FIRE ALARM SYSTEM. The deaning company and the fixed extinguishing service company shall file within (5)five days after the work is Wormed, a report with the Salem Fire Prevention Bureau of all their activities relative to the above fisted systems. The repot shall also list any and all deficlances of the systems and the remedial action to be taken. Failure to adhere to this public safety requirement will rasull in the shutdown of the systems- Prior to resuming operations an inspection will be conducted by this office. Per Order, i-,'-LJ a „Acca;�an�_ ; Lt.Erkt Gd n M Date of Conveyance Fire Marshal FORM BIR (4/05) CC: file health Licensing Building 60 39Vd HOiVdSI0 Rdld W37VS L0t6grZ8L6 9b 80 900V6L/80 •: !_ CO.'^!ONWEAL;H OF !!1SSACIIUS= ' ��s a CITY OF SAL.Ea er APPLICATION FOR CERTIFI= OF INSPEC`T'ION Date /��Z�/9' ( Fee Required S ( ) No Fee Required In accordance with the provisions of the Massacbusecrs State Building Code. Seg 108. 15. T hereny apply for a Certificate of Inspection for the below-named premise: located ac the following address: 0C) r Strgec G Number d C3 C's Premises �J C`9 - � Putse for which Premises is used 7 w Limelb;e(s) or Permit(s) required for the prises by other Cavrrusinucai Agencies: Jr License or Permit Amencv f C�� A de®l� /, O �� Certificate to be issued to: Address: i 7X2 12 7-r S V Owner of Record of Building: Address: n' X&V -L-6 � i Name of Present Holder of Certificate: -Z Name of Agent. :f any. . . 0 ( ")1Vnarure of Person to woom Cert':-gate TITLE Ls issued or his/her authorized agent `Aw�lf(� /,J Date-} INSTRUCTIONS: Day time phone / 1. Make check payable to: The City of Salem 2- Return thin application with your check to: Inspector of Buildings. City of Salem Building Devartmenr. One Sales Green. Salem. MA. J1970. PTYA E NOSE: 1. Application form with required fee must be submitted for each building or srrnetur Of parr thereof to be certified. 2. Application & fee must be received before the certificate will be issued. J. The building official shall be norified within cen (10) days of any change in the above information. CMaii-ICATE I -17F, EXPIRATION DATE:-9-1- 97 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 & Number 3 C c h d / c c) ST ' (� Name of Premises 5-:n le UYl �� OT �J' / 2/Z 4' Certificate to be issued to: S [ Q -e Address SCt M / /� Owner of Record of Building No Q ( 6 6o no ( S Address r) 6r dl l Q 7- Purpose for which premises are used 1-cod /r(J Clza rg- Changes since last Inspection (required on file card also) 1. /' / o r�1Ca1 Q 0--a 2. Or 3. 4. 5. Date Order Issued: Order Issued To: Address Date Violations Corrected: REMARKS: `� o` CUAo 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. Date Building Offi 'al Certificate 9 d� - 9e'� Date Issued: p Date Expires: " 1` Recommended Next Inspection: / 4 -�; / M b CITY/TOWN OF In accordance with the Massachusetts State Building Code, Section 108. 15, this CERTIFICATE' 1 S.�OF INSPECTION is issued to � RALY . . . . . . . . . V.U. . . . . . . . . . .P� .C . 4.� . . . . . . . . . . . . . . . . . . . . . . . . . (1rer�ify that I have insp cted the. . . . . . . . . . . . . . . . . . . . . . . . . .known as. . . . . . . . . . . . . . . . . . . . . . . . . . . located at. . . . . . . . .�.9 . . . .�Zr.�. . . 1. C. b.W ..'.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 Structure1 : Capacity Location or Structure Capacity Location Res+o,L> ra 1 T ' door- i Certificate Number Date Certificate Issued Date Certificate Expires Building Offi lal The building official shall be notified within (10) days of any changes in the above information. Tammanwralt4 at 080fiar4us0b CITY OF SALEM In accordance with the Massachusetts State Building Code, Section 108. 15, this CERTIFICATE OF INSPECTION is issued to I (UrtitH that I have inspected the premises known os located at in the city of Salem County of Essex Commonwealth of Massachusetts. The means of egress arc sufficient for the following number of persons: BY STORY in lie"'A Story x. fVyCapacity Story Capacity BY PLACE OF ASSEMBLY OR STRUCTURE Place of Assembly Place of Assembly or Structure Capacity Location or Structure Capacity Location 16 Certificate Number Date Certificate Issued Date Certificate Expires Building 0 The building official shall be notified within (10) days of any changes in the above information. M ac ION'� N • Y� a6/M�+A.Sp(y�igts , iv s 1� t�� xt5,+r yrxe..Mx �:... p,w i p .� an-,. ��tr r'�.u' t P' ? '< ,: t -., r f�.5•�2 �'F 4V 't1 M t•�'':w Nt - t �. 3 k Sl +OM1 1.':- x G5S-� i i hr t �("r C 5 f R, r s ON 1L"r .n r 'sr 7y ! j �t. t r 1 , } •`ht ty,. A fi El ...':}T'! �� i. .dee Fwr 'V. i1fl« k '.-t k �( `• t "E 1 x4 �,t i V aN ," �jL'j4'.,y:� Y, k ��rrr 2 '� �fA 4 Y Ylad �eF $ t i"• Y Y ''jA� p 1 f r§ s. S S s, , rt'�"r BTt'YP$ i� gtrtrt i �>, sial,ay L° 1 trz } x kba? ` t , � � f�oimu�wututiatl� of l�Itt� rbu ��t' sS ,t+ trig o , riyr4w � nt� l CITY OF SALEM 3 fy,. d 14 4 Rt % rC f r N !Rx ie5j. •Y.✓ A f )F 4t A i yr fwl��. p? Sc �sdav'n .1 t} pp v ixa aLtk ctilh ._, cjA ,� a4 n + ,...;i( �.,Ka;,rt,F OR' a�O� a. _ #1 `., i : " �.tIn 'a,ccordanc;e ¢wtth;fthe ,Massachusetts S[ate': Duildtng Code;? rSection, 10815 't.� ." #y11 �w` .,�Q v :'k% rl'f�a�"'r{ a'S"• br��a' S�2�4 °'?l�1�� �t:y%� R kf v, '' `! r �;;' 1-:, ' .A°.k,s'.. � " . a r f l k „ eTr � "�� w� 1 '. o ty :: t .A C'E'RTfIFIC`.� T.E OF.;` `'IN' SPErCTIONr, � z; '' �rr ; µ s arl' I Y mit 1 + t �l � ..ire l( < f °bP '.3 / �'.i ,'•3 � �( q w a T• Y '' t t t� e ,,g,S ra: t w,t ', at>.s xt ,`uE rQF'.S�ZZ♦?r.'S"XNC, { F.:itr ' .,a > xt4 'ty "v,,: t. ^a i r %� &1 +y21$',men.;e,. s - yrt,# u ,.Id 4 „ .i r' + r a. t! :,."tu' ! + St �, isuissued to . G'ta ? 'j^A fv iP v'1 rvk :K✓ 4 k! T!. '(. S s YYY'.1( k T 9�Irk M F f 4 n a"9 1q MST Digi x 'Y µ.`t x n / I: r I v 1 „I 3� ', #^ a r � � t✓�t r �i f; .� 'u a > r a Ja a'1 fk'' }C„ I'Y1p11I1 ts. , gs $Eiggrx 4 , SALEMtFIC)lIBE gFuPl7'Zq;- {� 1�.5 .: f;;17 Ir ss �tha't I have inspectea-It he premises known as: } ..,, f s kr F s i7M r«4l PA, x„64 t d } R+ `eb �ni v'e { s Y x'i&S" )�>t'f4 27+! "e. Le �., ,trfA S . I x 1 /t"h] h Ya'at i5 1 '' ap A 5 $. -. k y t v F• fr^ ugrL yt M. aNA GgTITB?f2EETimI' �% t s fL R '' ay , located atp g in the city of Salem 5 kuh )'I`�`i`,4 i ) vr `'ttm AyH'.'r`'�'I'as iS ;J,, t^ .'<E` r+ ) ''a1r-wr1" to- r..r'1a ° Ifs t ° . .p sn '�$ 1 o- # + # ¢.3 b ,. ^ '. Ice a �'.� .i'"i" s. I t, s. �,. fr C#oantyf of Ess x� Crimfionwealth�+of�4Massdchusetts;° The ,means of egress are sufficient for `: the tifollowingr a\yy-s µ 1 y F '+ xl .'f`'kLPa�4d�t + %lRii"'quLA r<tlfttiA�y>{ }�ISht. ,'$v fV is `k ] . I k f: d �s +�l `y; s ! num'b e r o f p e r s o n s 'E� T �+ , ,,� , 3 .r ,r w < sa, nr' i ti w "` 2 �` .r .yl: 'u re .pr s7 t �„ } :-r>•t`'�: dt�. `r 5"4' S.. a� t`'S�' ,4, 4kIFr BYSTORY " { t lite KrV w `v�t: at+` %tl1J114141UIi7K1K1p1K7K14Apk `g� i t� ; m<5N ,SYS %9GXSSK7C9.M17K*SG1N IV'. � �e $Foryr .ACep* *K 'X y X1` rCapacity+ a ; Story .I , Ca $ ? * S7tG 7� #7G4 W,ekCapacityjA"u It f,r•. �� 't « µ. A nyag �M1Y �'q' `�ti�k ,�• yyS , 7, {� }i s5 t„meg J} A 3” r h tX '�` 9 �'Y ,•. k r , �r k y 4 Yr , .i r "t d-. � S 4 ; t W. � i yra�ra 93 ''` r s4 x" rV f�T Y�*Lt t$ t ,`�,��+�y § , ✓ t I r4 tS.fir a r-•-' Y '.E Cr'y�� S � FK;j sE+A� x v 3r K l S n #� l '6 rtFyY J I A y� yy fi PLACE OF ASSEMBLY OR STRUCTURE ' fir ,}rod, k aK` 1?lace of,.Asasembly2 '''n` `s� £ a}N� "fr sl Place of Assembly 4 *s L r E rat rvt . 4. j"yi� rfStrc�k raCapactty�slyaLocatton' A or Structure, Capacity ° Location 41 SS r}„ N p�STI�CJRRNTky` ;" y t , AQP 3j4�T 16T FLOOR � y �y f{ "� GY -."°tv�T ,•._ ,$'$ R�' i ids' e ls`�, 3?'Y- � r : }r "' ..j ] � •+k 1 +1 r � 2a� { §, .gib. F , s:. rpn, 3' r P.d 1' ,'.nF2✓ �''r d . ... � �� Eyy t � �4 � / i r '" "r I.)�r"i. i "t 3` v� "` t '�M: "�.,r�"{'. ,i 4�,dq f,.jj. iFYy.��r'+} c �t �R ¢: ',�'V �. f ' st" t ^` ��"�t ��!Clz, f o- � r.. { is /����. /;�,,� ✓�, . 'S. CK 'i "`a,'' , eG, ,t.r:. Cert,"t�icate JJumber: w DatetCe,rtlfidake,l;.sued ` ':r: h DatefCert ficaie Expires i building Offic y4 , ri. 'I' ] '�t e: t ,'Wfr'•. Ye� ] Y J r `§4 t #.; t k ( : 7. r'4]3^7S:',� '2 �� '. P k d# .k"sx'�n .�'" r ' ', ��e 3�Tfi r�e a t -`� Y. +?1�,..'S`, ?♦C'a.,+f ty [` 2'?4; .,r:r r t .'kta, aysot . s i �5` , � � .il's�'>i IThe building offiti l shµll,�be�notffiAdtwithin:(10) d , f`.any changein the above information :.'aka � , �r k�Q' 1121 t y 4;s•N x "��5> 1{�f 1�; �k�' $$1 Yui °sw�ysy�(r'Y!tt� �L' j 3Q 'Y`F " # � r ,tA i, t'. e ', 1 ' e t, '.�i'f tF� cY� i t ,„r. ',� rt 2". x r t r } YD4 YY k, t "$':'� q' �.. 1• � 'b� �l �>f�..,.3.:h�J...,, .c..tJ�:.....",�..s.�'s�r..ivbc'w'J�.,..�,.. �.,w. Law Office of AWaAnastos LisaAnastos,Esq. email:lisa(aanastos-nappolaw-eom Telephone:978-557-0728 Facsimile: 978-685-1048 March 1.0,20)0 Thomas McGrath Assistant Building Inspector City of Salem Public Property Division 1.20 Washington St. Salem,MA 01970 Re: 23 Endicott,Street Dear Mr-McGrath: Thank you for meeting with me yesterday to discuss the inspection regulations.At that time we discussed the property stated above. Secifically,we discussed the trap door in the floor of the kitchen- Mr, Can Ngo,an cruployee of Salcm House of Pizm fell through the trap door on June 26,2009. As he fell,his back struck the friolator causing boiling oil to splash on to his back and resulting in 2nd degree bums,skin grafting and extended in-patient hospitializition- The Salem House of Pxz7^located at 23 Endicatt Street in Salem,MA,was due for its inspection March 5, 2010. 1 request that you inspect the trap door in light of Mr.Ngo's recent accident. Please contact me following your upcoming iuspeetion.I thank you im advance for your cooperation. Sincerely- ... ,�' sa A. Ana o CC:Richard H. Schwartz,Esq.34 Main St.Peabody,MA01960 800 turnpike St. Suite 3001 North Andover,MA 01845 Page 1 of 1 Thomas McGrath From: Thomas McGrath Sent: Thursday, March 11, 2010 5:14 PM To: 'lisa@anastos-nappolaw.com'. Subject: 23 Endicott Dear Ms. Anastos I have sent a reminder to the Salem House of Pizza that their certificate of inspection has expired. They need to pay a fee and request an inspection. When I do my inspection I will be sure to examine the trap door very carefully. Thank you for your concern Thomas McGrath Assistant Building Inspector City of Salem 978-745-9595 x5644 3/11/2010 r 7, What is the current use of the Building? Material of Building? If dwelling, how many units?� Will the Building Conform to Law? Asbestos? Architect's Name 1 Address and Phone Mechanic's Name - Address and Phone Construction Supervisors License 0 S yi—d—B HIC Registration# l! d 8d �'— Estimated Cost of Project Permit Fee Calculation permit Fes$ 1 7�-- Estimated Cost X S71i1000 Residential Estimated Cost X S'l11$1000 Commercial - An Additional $5.00 is added as an Administrative charge. Make sure that all fields are property and legibly written to avoid delays In processing. The undersigned does hereby apply for a Building Permit to build to the above stated specifications. Signed under penalty of perjury X Date NI yy Q O� a NU `_ 4 f EI` `�JF PUBLIC PROPERTY IN DEPARTMEINT Nwroa 130 WASMNG ON air•SALUK 4AMCHLsc� S 01970 TEL 979•74S-9S9S•FAX 978.740-"" APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION DEMOLMON, OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING STRUCTURE OR BUILDIN 1.0 SITE INFORMATION Location Name: /i I e M �/� r c a i L Building: Property Address: Property is located in a, Conservation Area Y/N Historic Dhtrlct Y/N 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land Name: — t`j c L L G Address: Q;. a J e s— Sarre .r wa. d i y -1,, Telephone: '7 S ?Y J 1 3.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY Addition Existing Renovation Number of Stories Renovated Change in Use New Demolition Existing Approximate year of Area per floor (sf) Renovated construction or renovation of existing building New Brief Description of Proposed Work: 2en,m,e. L't• rf�� l��F t �niT.t'�t 2ew /�SSo/L ��9f Mail Permit to: w t-7 The Commonwealth of Massachusetts Department ofpublic Safety t - ) Massachusetts State BuiUi lding Code(780 CMR) B pli<Oor any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number: Dale Applied: ding Official: SECTION 1:LOCATION(Please indicat Block k and Lot#for locations for which a sheet address rs of available Q t1 q No.and Street City/Town Zip Code me Builds if a li ible ,t SECTION 2:PROPOSED WORK' Edition of MA State Co used_ If New Construction check here❑or check all that apply in the two rows below Existing Building Repair❑ Alteration 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 Engineeriuqefr Review required? es ❑ No ❑ Brief Description Proposed Wor . AP G ar f e I 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)k Area Per Floor(sq. ft.) Total Area(sq. ft.)❑nd Total Height(ft.) G'x SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ 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 I-1 ❑ 1-2❑ I-3❑ 1-4❑ M: Mercantile IJ R: Residential R-10 R-2❑ R-3❑ R4❑ 5: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe belmv: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA Ill ❑ ❑A ❑ 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❑ required❑or trench or specify: Private❑ or indentify Zgne: or on site system❑ permit is enclosed❑ Railroad right-of-way: hazards to Air Navigation: \I;�„�_l i [n a C'nmmi si n K.. c" 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 Cady. - Use Group(s): Type of Construction: Occupant Load per Flom: Dues the building contain an Sprinkler System?: Special Stipulations: SECTION 9: PROPERTY OWNER AUTHORIZATION _ Nanic an I Address of Proper j�wner �p Ao 4f Plum Cy , {�C�1M 7-3 1pj " ©C �1 Name(Print) No.and Street City/Town Zip Property Owner Contac ifurn a ron: cownar j2zd_9)& 7�4- 001� Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf, in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2). If building is less than 35,000 cu.it.of enclosed space and/or not under Constmction Control then check here O and ski Section 10.1 10.1 Re istered Professional Resvonsible for Construction Control L I 9 9 S 31 --4�5 I wa, w•.. 3�`f9 , NmN is nt ! LLLLLL g I)n a e-mail i dr ee 1 ne o. r% �foO a isS r. ton Number Street Address City/Tow State Zip Discipline Expir ition Date 10.2 General Contractor )I -- - CoS1 l�ev,, Conn any Name n G S b�21 Name of Person Responsible for Construction Licer "NoI. and Type if Applicable D I 0 Star t Address City/ n State Zip ��� ue_ or Telephone No.(business) Telephone No, cell e-mail address SECTION 11:WORKF1,S'CONIFFNSAI[ON INSURANCE.AFFIDAV1'C M.G.L.C.152.§ 25C6 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 Mt rials) Total Construction Cost(from Item 6)_ 1.Budding $ Building Permit Fee=Total Construction Cost x_(Insert here 2. Electrical - $ appropriate municipal factor)_$ 3. Plumbing $ 1. Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5. Mechanical Other $ Enclose check payable able to 6.Total Cost $ I (contact municipality)and write check nunnber here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By ing my name bel `I hereby attest under the pains and penalties of perjury that all of the information contained in this ap licat n is ruu and: '€yu!nto t he best of knowledge and un rstanding. 91-�- Plea, not and sig ame C�rCJ "fille ©(Tj;OP6one No. Date Strcet •ss C ity/Town State '11pO UUZip Municipal Inspector to fill out this section upon application approval: Name Date j -�-- _ ; i CT — 11 i;_III L-V + I iIL GARDNER PARK ASSOCIATION By Jk Date --_- -___-\--S hIe1 e—.—t No. o. Professional Engineers 10 `it)( 11 Peabody Square Subject PEABODY,MA 01960 C 2 Lo'I Pt o d (978)531-4705L I;- I _— —-- _- _{--I i'- ! � .I - IIIIR — i�- .— _— - —_ � (J