131 ESSEX STREET - 3 AND 4 CERT OF C O - BUILDING JACKET 74520 40°/d - P4
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The Commonweafth of Wassachusetts
(Department of ift6fic Safety
Board of Buififing ftulations andStandarcls
o°r Thomas G.Gatzunis,P.E.
OneAsh6urton Place, Wpom 1301 Commissioner
Deval L.Patrick Boston, Massachusetts 021.08-1618 Gary hairma,P.E.
Governor
G
Chairman
Timothy P.Murray Phone (617) 727-7532 'Fad(617)227-1754 Alexander MacLeod,R.A.
Lieutenant Governor � 727-0019
Vice Chairman
�/
Kevin M.Burke —— ` (617) 727 0019
Robert Antlerson
secretary
u wrw.massgov/dps Administrator
30-Dec-08
Mr./Mrs. McGrath
Building Commissioner
6'
120 Washington Street
Salem,MA. 01970 }4ypLlGa�[ , D c-"s LT
Docket Number 09-689 W 1—L`'t �
Property Address 131 Essex Street Salem,MA. 01970
Hearing Location 1380 Bay Street Taunton,MA. 02780
Hearing Date and Time 01-08-09 11;30 a.m.
Dear Mr./Mrs. McGrath
The appeal for the subject property has been scheduled to be heard on the hearing date and time and
location indicated above. A map is enclosed for your convenience.
The State Building Code Appeals Board requires your presence or that of your representative at its
hearing relative to the above case.
Please bring with you a copy of the record, including any plans, sketches, drawings,etc,that will help
to give the Appeals Board grounds to adjudicate this appeal. The State Building Code Appeals Board
hearings are held pursuant to 801 CMR 1.02 Informal Fair Hearing Rules.
NO POSTPONEMENTS OR REFUNDS WILL BE GRANTED. In order to reschedule an appeal
case,you must first withdraw the original case and file a new application. A new application fee will
be required.
Very truly yours,
THE STATE BUILDING CODE APPEALS BOARD
Patricia A.Barry 1
Coordinator
J
Directions to the Academy at Taunton
FROM THE NORTH:
From 1-95 South take 495 South (Exit 6A). Follow 495 South to Exit 9
(Bay Street). At the end of the ramp follow the signs for the Industrial
Park Road. You want to stay on Bay Street do not go into the Industrial
Park. You will go through several sets of lights (passing a BJ's, Ruby
Tuesdays, and Wendy's all on your left). The academy is about 1 1/4
miles from the exit. The sign is clearly marked 1380 Bay Street (you
will see a public safety trailer when you enter the parking area). Once
you have checked in with the security guard you will proceed to the 911
building — You will see the 911 sign on the side of the wall in back of the
building. Take a left to PARK anywhere in the circular lot.
FROM BOSTON: -
Take the Expressway (93 South) to Exit 4 / Route 24 South. Take 24
South to 495 North (Exit 14B). Take 495 North to Exit 9 (Bay Street)
At the end of the ramp follow the signs for the Industrial Park Road.
You want to stay on Bay Street do not go into the Industrial Park. You
will go through several sets of lights (passing a BJ's, Ruby Tuesdays,
and Wendy's all on your left). The academy is about 1 1/4 miles from
the exit. The sign is clearly marked 1380 Bay Street (you will see a
public safety trailer when you enter the parking area). Once you have
checked in with the security guard you will proceed to the 911 building —
You will see the 911 sign on the side of the wall in back of the building.
Take a left to PARK anywhere in the circular lot.
All visitors must stop at the main entrance and sign in and you will be
given directions where to park at the 911 Training Building. LOOK FOR
BUILDING "B" THAT IS WHERE THE BBRS APPEALS HEARINGS
WILL BE HELD. Handicap parking is available around the circle near
the building and the front entrance is at the circle via the handicap ramp.
Drivnig Directions from 1 Ashburton P1, Boston, MA to 1380 Bay St,Taunton, MA Page 2 of 2
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any loss or delay resulting from your use of MapQuest.Your use of MapQuest means you agree to our Terms.of Use
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Certificate No: 104-06 Building Permit No.: 104-06
Commonwealth of Massachusetts
City of Salem
Building Electrical Mechanical Permits
This is to Certify that the BUSINESS located at
Dwelling Type
0131 ESSEX STREET in the CITY OF SALEM
------------------------------ ---- - - - - ----- -- --- -- -- -------- ------------- ------- -- - -- - - - - - -----------------------
Address Town/City Name
IS HEREBY GRANTED A PERMANENT CERTIFICATE OF
OCCUPANCY
131 ESSEX STREET UNIT#3 STOREFRONT
This permit is granted in conformity with the Statutes and ordinances relating thereto, and
expires __ _____ ,unless sooner suspended or revoked.
Expiration Date
Issued On: Tue Jan 24,2006
GeoTMS®2009 Des Lauriers Municipal Solutions,Inc.
Certificate No: 104-06 Building Permit No.: 104-06
Commonwealth of Massachusetts
City of Salem
Building Electrical Mechanical Permits
This is to Certify that the BUSINESS located at
Dwelling Type
0131 ESSEX STREET in the CITY OF SALEM
------------------------------------------------------------------------------ -----------------------------------------------------------------------
Address Town/City Name
IS HEREBY GRANTED A PERMANENT CERTIFICATE OF
OCCUPANCY
131 ESSEX STREET UNIT#3 STOREFRONT
This permit is granted in conformity with the Statutes and ordinances relating thereto,and
expires --------------------------------------------
unless sooner suspended or revoked.
Expiration Date
---------------'__
Issued On: Tue Jan 24,2006
------------------------------------------------
GeoTMS®2009 Des Lauriers Municipal Solutions,Inc.
a
CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
KIMIiGRLBY DRISCOLL
MAYOR
720 WASr7ING9ON STREeT+ SALEM,1\'L\SSACI-IUSP:I-fS X1970
'rr.1.:978-745-9595 ♦ 11Ax:978-740-9846
October 9, 2008
Penny Van Dell
1 Schooner Road
Marblehead, Ma. 01945
RE: 131 Essex Street, Salem
Salem 13 Ghosts
Dear Ms. VanDell,
In the process of performing the Periodic Inspection at the Salem Thirteen Ghosts
storefront installation, on October 7, 2008 our Inspectors noticed that there is no fire-
suppression system in the above building. Further review of our records reveals that
the tenant improvement work creating the 13 Ghosts exhibit was not properly permitted
for its current use.
The current use of the space at the above address by the Salem 13 Ghosts installation is
governed by Section 413 of the State Building Code which spells out the requirements for
"Special Amusement Buildings". Section 413.4 of the code specifically requires that
special amusement buildings be protected with an automatic sprinkler system.
In order for to continue the present occupancy beyond November 1, 2008, a sprinkler
system must be installed in your property. Failure to install a sprinkler system will result
in revocation of the occupancy permit for that space.
If you feel you are aggrieved by this order, you may appeal it to the Board of Buildings ,Regulations
and Standards in Boston.
Sincerely,
Thomas E McGrath AIA
Assistant Building Inspector
c : File ire Prevention
L
PERIODIC INSPEMON REPORT
This form is to be completed each time a Periodic Inspection is made. At the claw
a new Certificate of Inspection is issued, a notation indicating that the fee has
been paid will be made to Application Foa prior to the new Certificate of Inspectic
being issued. Any changes since the last inspection are co be added to the file csr
of the premises.
Street 6 Kimber //3/ LL�csL ��S'//
Name of Premises �J�o/�(� tWo�s (9�oI142"ClorJe—
Y
Certificate to be issued to: ///puip2
Address 27
Owner of Record of Building }oiVAI'y //4y
Address /3/ '4/-'f-rex 61N/ll- , --6—
Purpose
Purpose for which premises are used
Changes since last Inspection (required on file csk* also)
1 .
2.
3.
4.
3.
Dace Order issued:
Order Issued To: Address
Dace Violations Corrected:
REY.AR[S:
I have chis day inspected the above premises, and the same conforms co the pertinent
requirements of the Massachusetts State Building Code and the rules and regulations
pursuant cherAtoo.
/D 48Z 7
tLil
a Building ficial
Certificate / Date Issued:
Date Expires:
�r
CITY OF SALENi, iL-1SSACHUSETTS
BumDL`IG DEPAATNMNT
130 W iSHINGTON STREET. r Ft.001
'PFI_ (978)745-9595
FAX(978) 710-9&%
KI\CBERIBY DR]SCOIS THOSNSST.PIEARB
MAYOR DMECTOR OF PUBLIC PROPERTY/BI:n"No CON
IJ�IONER
THE COM EONW$ALTF OF MASSACHUSETTS
CTTY OSALEM
per todic Inspecdom Renewal Nodes
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Commonwealth OfMassachusetts
City ofSalem Map: Block: Lot
35 0228-202
in Accordance With Massachusetts State Building Code 780 Cmr, Section 106. 5, Table 106
CERTIFICATE OF INSPECTION
is issued to Penny VanDell c/o Penny Vandell 1 Schooner Rd., Marblehead, Ma.01945
.........................................................................
..........................................
I Certify that I have InaDected the TENANT SPACE known as Spellbound's Ghostly Parlor
located at 0131 Essex Street Unit#1 in the City of Salem
The Means OfEgress Are SuMcient For The Following Number Of Persons:
BY STORY
Story Capacity Story Capacity
A-3 Assembly 1st.Floor 20
BY PLACE OF ASSEMBLY OR STRUCTURE
Place of Assembly or Structure Capacity Location Place of Assembly or Structure Capacity Location
22-08 10/11/2007 10/11/2008
Certificate Number Date Certificate Issued Date Certificate Expires Building Officin!
A COPY OF"PHIS CER7IF7CA7'E ML/ST BE POSTED IN CLEAR VIER'NEAR AI_L ENTRANCES
r
PERIODIC IMSPECTION REPORT
This form is to be cowpleted each tine a Periodic Inspeccion is made. At the tinea
a new Certificate of Inspection is issued, a notation indicating that the fee has
been paid will be made to Application Pore prior to the new Certificate of In"itti
being issued. Any changes since the last inspection are to be added to the file ea
of the praises.
Street i Number
Name of Promises cS4�ean S /,3 (`.1SIS
Certificate to be issued to:
Address / S6,40"', "'e- AdOwner of of Record of Building
Address Sgiyt�
Purpose for which premises are used — 1IT6M 0/4
Changes since last Inspection (required on file card also)
L.
2.
].
G.
S.
Dace Order Issued:
Order Issued To: Address
Data Violations Corrected:
REr.ARxS:
I have chis day inspected the above premises, and the same conforms to the pertinent
requirements of the Massachusetts Scace Building Code and the rules and regulations
pursuant chertto.
/aXZ3 �e
Dsfa 1
Building tofficial
Cercificace / Date Issued:
n.r. r....___.
F
CITY OF SAIE2 4 MASSACHUSETTS
BL:IIDLNG DEPAR•IMEN-r
130 WASHINGTON STUET,3iO FLOOR
TEL (978) 745-9595
FAX(978)730-9846
KI\�FJtIBY DRISCOIl THO"ST.Pmm
MAYOR DMECTOR OF PUBLIC PROPERTY/Bt:QDQIG CO%MQSSIONI.1
THE COMMONWEALTH OF MASSACHUSETTS
CITY OF SALEM
perlodk Impwdoa Reamd Noda
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(Vam ch ab payable to CITY OF SALEM) S&UM MA 01970
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Commonwealth OfMassachusetts
City of Salem Map: Bock: Lot:
35 0228-202
in Accordance With Massachusetts State Building Code 780 Cmr, Section 106. 5, Table 106
CERTIFICATE OF INSPECTION
is issued to Salem's B Ghosts
I Certi I., ..................................................................................................................................................
I have Inspected the TENANT SPACE known as
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
located at 0131 Essex Street in the City of Salem
The Means OfEgress Are Sufficient For The Following Number Of Persons:
BY STORY
Story Capaciltv Story Capacity
A-3 Assembly !10 el
BY PLACE OF ASSEMBLY OR STRUCTURE
Place of Assembly or Structure Capacity Location Place of Assembly or Structure Capacity Location
29-08 10/24/2007 10/24/2008 /y
Certificate Number Date Certificate Issued Date Certificate Expires Building Official
`*A COPY OF THIS CERTIFICATE MUST BF_ POSTED IN CLEAR VIEW NEAR ALL ENTRANCES **
rj * t� --'t_ ' .fit a. �t �.--- .«�Ih-. ..y,-.k"' R,,,.z X.'�..»�."„ .�P •�x. ,. �„ 'x' �
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780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS
THE MASSACHUSETTS STATE BUILDING CODE
for storage, the stage and supporting structures 780 CMR 906.0. Where the special amusement
shall be of one-hour fireresistance rated building is temporary or mobile,the sprinkler water
construction. supply shall be of an approved temporary means. _
412.7 Standpipes: A wet standpipe system in Exception: An automatic sprinkler system is not
accordance with 780 CMR 914.0 shall be provided required where the total floor area of a temporary
and equipped with 1'h-inch hose connections on special amusement building is less than fr
each side of the stage. square feet a mfrom
) and the travel distance from
any point to an exit is less than 50 feet (15240
Exception: Where the building or area is mm).
equipped throughout with an automatic sprinkler
system, the hose connections that are supplied 413.5 System response: The activation of the
from the automatic sprinkler system shall have a automatic fire detection system within a single
water supply of not less than that required by protected area or the automatic sprinkler system
NFiPA 13 listed in Appendix A. shall automatically:
412.7.1 Hose and cabinet: The hose connections I. Cause illumination of the means of egress
/- with light of not less than one footcandle(10.76
shall be equipped with sufficient lengths of 11
inch hose to provide fire protection for the stage lux)at the walking surface level;
2. Stop any conflicting or confusing sounds and
area, such connections shall be equipped with an visual distractions; and
approved adjustable fog n=le and be mounted in 3 Activate an approved directional exit marking
a cabinet or a rack. that will become apparent in an emergency.
780 CMR 413.0 SPECIAL AMUSEMENT 413.5.1 Alarm: Activation of any single smoke
BUILDINGS detector, the automatic sprinkler system or any
413.1 General: Special amusement buildings shall other automatic fire detection device shall
comply with the requirements for buildings of the mediately sound an alarm at the building at a
appropriate assembly use group in addition to the constantly attended location from which
requirements of 780 CMR 413.0emergency action can be initiated including the
capability of manual initiation of requirements in
Exception:Buildings or portions thereof that are 780 CMR 413.5.
essentially open to the outside air, such as 413.5.2 Public address system: A public address
buildings without walls or without a roof and
arranged to prevent the accumulation of smoke in system, which is also permitted to serve as an
the building or structure are not required to alarm system, shall be provided and shall be
audible throughout the entire special amusement
comply with 780 CMR 413.0.
building.
413.2 Special amusement building: A special
be
amusement building is any temporary,permanent or 4 stand Exit marking: "Exit" signs shall ed
mobile budding or portion thereof which is occupied directional
at required exit doorways. Approved
for amusement, entertainment or educational directional exit markings shall also be provided
purposes and which contains a device or system and shall include signs as required by other
CMR
which conveys passengers or provides a walkway are use. Where minors, mazes o other designs
along, around or over a course in any direction so are used that confound the means of egress paths,
arranged that the means of egress path is not readily approved low-level "exit" signs and directional
apparent due to visual or audio distractions or is path markings shall be provided and located not
intentionally confounded Orisnot readily available more than eight inches (203 mm) above the
walking surface and on or near the means o
due to the nature of the attraction or mode of
conveyance through the building or structure. egress path. Such markings shall become visible
when activated in accordance with 780 CMR
413.3 Fire detection: All special amusement 413.5,item 3.
buildings shall be equipped with an automatic fire 413.6 Interior finish: The interior finish shall be
detection system in accordance with 780 CMR Class I in accordance with 780 CMR 803.2.
918.0.
Exception:In areas where the ambient conditions 780 CMR 414.0 AIRPORT TRAFFIC
will cause a smoke detector to activate, an CONTROL TOWERS
approved alternative type of automatic detector 414.1 General: The provisions of 780 CMR 414.0
shall be installed. shall apply to airport traffic control towers not
4exceeding 1,500 square feet per floor occupied only
13.4 Automatic sprinklers: All special amusement -
buildings shall be equipped throughout with an for au traffic control, electrical and mechanical
aequipment rooms, radar and electronics rooms,
automatic sprinkler system in accordance with
78 780 CMR-Sixth Edition 2/7/97 (Effective 2/28/97)
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Page 1 of 1
Card 1 of 1
Location 131 ESSEX Property Account Parcel ID 35-0228-0
STREET Number
Old Parcel ID --
Current Property Mailing Address
Owner NOT AVAILABLE City
State
Address Zip
Zoning B5
Current Property Sales Information
Sale Date 3/15/1991 Legal 16770-581
Reference
Sale Price 320,000 Grantor 131 ESSEX STREET
Seller REALTY TRUST
_Current Propel Assessment
Card 1 Value
Year 2009 Building Value 787,200
Xtra Features Value 9,600
Land Area 0.361 acres Land Value 276,900
Total Value 1,073,700
Narrative Description
This property contains 0.361 acres of land mainly classified as Res. /
Comm. with a(n) Mixed Use style building, built about 1900 , having Brick
exterior and Tar+Gravel roof cover, with 8 unit(s), 24 total room(s), 8 total
bedroom (s), 8 total bath (s), 0 total half bath (s), 0 total 3/4 bath (s).
Legal Description
Property Images
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9ALLEM'S 13 GHOM
salemsl3ghosts.com
131 Essex Street 781-718-7856
Salem, MA 01970 Fax 781-631-5889
Mailing Address: c/o Penny VanDell, I Schooner Ridge, Marblehead, MA 01945
October 23, 2008
Thomas McGrath, Assistant Building Inspector
Re Letter of October 9, 2008
Dear Mr. McGrath,
The use of this space has not changed since permitting. I am referring your letter to the architect of record.
Your letter states that a sprinkler system must be installed by November 1, 2008. Is that the correct year?
Kindly send me the necessary information to appeal to the Board of Buildings, Regulations and Standards in
Boston: a mailing address, physical location and phone number.
Sincerely,
Penny VanDell
6 ° CITY OF SALEM
�� ,,' ' )! PUBLIC PROPERTY
���nnacp DEPARTMENT
KIMBIAW%Y DRISCOLL
MAYOR
120 WASHING I'ON S'IR6IiT+ $ALF.M,bIAS$ACIi U58i'rS 01970
1r.1:978-745-9595 ♦ FAX 978-740-9846
October 28, 2008
Penny Van Dell
1 Schooner Road
Marblehead, Ma. 01945
RE: 131 Essex Street, Salem
Salem 13 Ghosts
Dear Ms. VanDell,
Thank You for responding to my letter of October 9, 2008
I am aware that the use of the space has not changed since permitting. The permit may
have been issued in error or the information presented on the permit may not have been
entirely correct.
November 1, 2008 is the date that a sprinkler system must begin to be installed.
I have enclosed the application and filing instructions for an appeal to the BBRS.
Si cer ly,
as E McGrath AIA
sist t Building Inspector
cc: File
STATE
`BUILDING CODE APPEALS BOARD
Service Notice
as for the
Appellant/Petitioner Y\-V\to f Ct/��.�'�� I an appeal filed with the State
Building Code Appeals Board on N U tJ t"'6'y 1' 20 (IF
HEREBY SWEAR UNDER THE PAINS AND PENALTIES OF PERJURY THAT IN ACCORDANCE WITH
THE PROCEDURES ADOPTED BY .THE STATE BOARD OF BUILDING REGULATIONS AND
STANDARDS AND SECTION 12.3.1 OF THE STATE BUILDING CODE, I SERVED OR CAUSED TO BE
SERVED, A COPY OF THIS APPEAL APPLICATION ON THE FOLLOWING PERSON(S) IN THE
FOLLOWING MANNER:
NAME AND ADDRESS OF METHOD OF DATE OF
PERSON OR AGENCY SERVED SERVICE SERVICE
-r- N crw o,,s h\ AT A U sx' S
1 S s
-68
sV1,A
2
a 3
Signa re:Appellant o efilfiioner
On the / T, Day of �`� 20 O PERSONALLY APPEARED
BEFORE ME THE ABOVE NAMED �hn V am
(rype or Print thelqarne of the Appellant)
AND ACKNOWLEDGED AND SWORE THE ABOVE STATEMENTS E.
IL
NOTARY PUBLIC ON tM( an8pi�
- _ 14 20ts
7
The Commonwealth ®f Massachusetts
Department of Public Safety
Board of Building Regulations and Standards
One Ashburton Place, Room 1301
Boston, Massachusetts 02108-1618
Phone (617) 727-7532
Fax (617) 227-1754
STATE BUILDING CODE APPEALS BOARD APPEAL APPLICATION FORM
DOCKET NUi44BER DATE
(State Use
The undersigned hereby.appeals to the State Board of Building Regulations and Standards from the decision of the
following person. (Please fill-in the name of the appropriate municipal or state building inspector or other authorit
Also,Also indicate if this is a request for a hearing de novo(new hearing)relative to a decision of a municipal app
board.) ,t
Building Official from the City/Town of: SA L E M
Board of Appeals from the City/Town of:
(Request for hearing de novo)
State Building Official: r ((U M,4 S ��t� (}R(37 R T- A
N .5 s v 93u ZNrsV�Ec-Tot
Other:
Please mark the appropriate box indicating the requested action to be considered by Appeals Board members.
t Variance ' Order � ) Direction
inEerpretation � �T'ailQie to Act � g Cather
� STATE USE ONLY ;
Check Number.
Rece'i'ved By - - -
Miis section must be completed or the application will be returned.).
Has the
building or structure been the subject of an appeal by this or any other appeals board previous to this filing?
No Yes ❑ if,yes,please indicate the date of the previous appeal,whether the matter was
heard before a local or state appeals board,the code section that was at issue,and the specifics of the decision
(i.e.a variance was granted\not granted).
4
Please take care to submit all unitten supporting documentation with this application to allow time for review.
However,Board members reserve the right to continue proceedings if such material warrant extensive review.
Please provide a brief description of the desired relief below_ Additional information ma-$,be attached if space is
not sufficient. All appropriate code sections that are subiect to appeal mast be identified in the description.
tt I�Gt C _ YK-t?i t
Please complete the following section completely and accurately.
Name of '�EV\w� «�� .�, 1 Representing.
Appellant:
i Scan t3 a h s �i d�e�
Address 1m CL r�, MA
For Service )
q Telephone7 ? 1 _ 7 9' _ 7 8 G Fax
Number: Number.
j3 1 sseY, S-r-
Address of
Subject Property ���� v ) 9 7 6
(if different from
service address):
What is appellant's connection to subject property? O W h e-,<"-
Siymature of Appetla Land\or Representative Please Print Name Legibly
Please return pplications I.
- Program Manager BoardofAppeals
Board-of Building leaslations azd
and Stands-One Ashburkon Place,Room 1301
Boston MA 021083618 3
5
Page 5 A brief description of the desired relief:
413.4 " Exception: An automatic sprinkler system is not required where the total floor
area of a temporary special amusement building is less than 1,000 square feet and
the travel distance from any point to an exit is less than 50 feet."
This building is temporary special amusement for October only. It is not a maze.
It is a walk-thru. The building is divided lengthwise. People walk down one side
and back the other.
The building is 2000 square feet, but the travel distance from any point to an exit
is only 43 feet. This is less than in some 1000 square foot buildings.
As an alternative to a sprinkler system, I would add more lit emergency exit signs,
fire extinguishers and emergency Iights so emergency exit signs and lights are seen from
every point.
I am retired with$893 a month in social security. I depend on the income from this
building for my retirement. To install a sprinkler system would be a hardship.
DESCRI '3TON C)r BUIr DINO'OR STRUCTURE RELATIVE TO TI4-E NIAS.SACY=USETTS
S)ATE BillTG C®DE I7ti1 EI3ITiOI�Ij (Urecl as appropriate)
Do not complete the entire table below for a One-or Two-Family Dwelling;complete only section entitled
"Description of the Proposed Work".
DESCRIPTION OF PROPOSED WORK(check at]applicable)
New Construction ❑ E<is N Building Repair(s) - Afteration(s) _ Addition
Accessory Bldg. DeoTi6on !-� Other i_ Specifyc
=' n
Brief Description of Proposed Work:
USE GROUP AND CONSTRUCTION TYPE
l
USE GROUP(Circle appropriate Use Group) CONSTRUCTIONTYPE G
A Assembly A-1 A-2 A-3 1A n.
A-4 A-5 18
B Business 2A ry
E Educational 2B
F Factory F-1 F-2 2C
H High Hazard 3A
I Institutional -1-1 1-2 1-3 3B
M Mercantile 4
R Residential R-1 R-2 R-3 5A
w S Storage 5-1 S-2 5B
4
U Utility Specify--
M
Ferif}cM Mixed Use Specify:
S Special Use Specify:
COMPLETE THIS SECTION IF EXLSITNG BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Proposed Use Group: - —
Existing Hazard Index(76(1 CMR 34): Proposed Hazard Index(/BO CMR 34):
BUILDING HEIGHT AND AREA
BUILDING AREA Existing(if applicable) Proposed
Number of Floors or stories include
basement levels
Floor Area per Floor(st) a
Total Area(sf)
Total Height(ft)
Are there unresolved issues with local zoning ordinances? Yes t.; or No ;x
If yes,please explain briefly why this zoning issue is not a factor in the appeal:
6
Crry
PUBLIC PROPFATY
,.N DF.1 - 1R1 i . l
APPLICA'PION FOR PLAN EXAMINATION AND BUILDING PERMIT
-ALESTRUCTURES EXCEPT I AND 2 FAMILY DWELLINGS
- —IMPORTANT:Applicants must complete all items on this page
n SITE INFORMATION -
C U Location Name New Emlk,d M a Building
Property Address ITa.d �., -Y ^s.�jo 6-f•
Map#
Located in: Conservation Area YIN Historic district YiN
V' Use Groups
(check one)
Residential(3 or more Units)" R2
Type of improvement Residential(hotel/motel RI
(check one) Assembly(churches) Al _
New Building_ Assembly(nightclubs etc) A2_
Addition Assembly(restaurants, recreation) A3_
Alteration Business B_ V
Repair/Replacement_ Educational E
Demolition ✓ Factory (moderate hazard) Fl
V 6(•✓ Mme/Relocate Factory(low hazard) F2
Foundation Only High Hazard If_ 4
Accessory Building_ Institutional (residential care) 11
Other(describe) Institutional (incapacitated) 12
Institutional(restrained) 13_
Mercantile M 1
" Storage(moderate hazard) S 1 _. V"
Storage(low,hazard) - S2_ ` y
OW N ERSI II P I N FORMATION(Please type or Print Clearly)
("�
OWNER Name V
Address
Telephone '1 iS' l _ w /8 7 9 J`0
D/ESC/RIP'VION/^OF WORK"1 O BE PERFORMED / s
1/Cwy/rtri a� O� �n/iR r�,r .I mVi� 6IL PSS tfI✓r! U
ESTUNIA I"ED CONSTRUCTION COST
CONTRACTOR INFORMATION / r f • i
Name 4'�i/ 9/ G�i �i Ile
Address.
Telephone 0 02 ,i5;
Construction Supervisor's Lic #
Home Improvement Contractor#
ARCHITECT/ENGINEER INFORMATION
Name
Address
Telephone
Mass. Registration #
PERMIT FEE CALCULATION
Residential est. cost x $7/$1,000 + $5.00 =
Y Commercial est. cost x $11/$1,000 +$5.00=
�v
COMMENTS _ 5
The undersigned does hereby attest that all information stated above is true to the best
Of my knowledge under the penalties of perjury
Signed
Date
r
. 4
X FFV;�
� r
>
CITY OF SALEM
PUBLIC PROPERTY DEPARTMENT
DENNIS M. ROSS
PLUMBING&GAS INSPECTOR
Tel.978-745-9595 Ext.5644
Fax 978-740-9846 120 Washington Street
t
� � 9
.: :.
4
a
('runnnmwraIIh of III,lass:)chuse(ts -- -- --- - - -
t I3narJ rd I3tuldinp RCL!t)IdllUr)s anJ SI•uldarJ. Ut
t !~ NlassacliusClts State I3uildinQ Code. 751E Comor)
(` I•'` I I sl
Building fermi) Applicmion To Ctn)suuct. Repair. R.nutate (h I)rrnuli.h
Onr- rrr ]'urr-/'rorrilr (hirllrrre
phis Sei bon Fur Oftii ial 1 hr (htly -------- -
HwIJu),_I Penn i Number --- Darr .\ppheJ:
SI_notwe
-- -- - --- -----
BwWwfGnmw,vnmv ln.lu.mr of nlllldm�\ Dale
SEA. I ION I: .SITE INFORNIA IION - --- --- .
1.1 Properh \ddress: I 1.2 ssessors Map A M & Parcel .Numbers - -- - - - .
J3)_3 r I31-6/ _�rsrr Sf __
I la Is this an accepled ,ireet te,_✓ n„ LJA
:\umhrr P.n.rl ..\umhii
1.3 Zoning Information: :rcj
erty Dimensions:
Zonmv Oi,i nct Proryr,ed Use s 11) ageIto
4 FrUI1WgC IIL
1.5 Building Setbacks (ft)
Fmot Y'arJ Side Yards
—.._L..___ Rear 1'wd
Rryuo.J PnrviJrJ Re unc.l —_�
4 Prm iJcd Rcyw rrJ Pi J.J I
_y
LG Walter Supply: 04 G_L r. .40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System[ -"-. I
Puhlic fH Pneate❑ Zone: _ Outside Flard Zone I
Check if yrs❑ ..\lumnpal Cron ,ne Jislrnal sN Irm ❑
SECTION 2: PROPERTY OWNERSHIP' 7
O 2•,� wner'of Record:
Ye�r VuxleU r�l SfGX St
Vumc lPnnti Addressor Service: --
I
Signmurr Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing B;BAg.
ding ❑ Owner-Occupied ❑ �Repaihrsjrj ❑ ANerarpm(s)Demolition ❑ ,4ccesxn'y ❑ I Number tit Units ❑ SpecJy
Brief 1Des"ripuun tit Proposed work' _— // IF II //r enw uera 131- 3 d,./ 13/-y----
GM* 1 R OF FNMr�rf k rf b� Cpa r./J
SECTION J: ESTINIATED CONSTRUCTION COSTS 1
hem - Estimated Costs: -�
Il.ahirr and Materials) Official Use Only j
I Building S 3s'o I. [3udJmg Perrnu Fee: S- (nJlcate ho" fee is JClrl minced r
'. Electncal S a� ❑ Standard City/Town :\pphcahon Fee
--a ❑ Total Project C,utr (Item G) N mulhpher
3. Plumbing S /V1�. Orhrr Fees: ---
J Mechanical ill\'AC'I S A14 I Luc I
Nlrch,mrr.J IFue1 -- ---- — ----
1u )trr s,nnu S JVA" f,,cil :\II Fres: 5 -
Check No ('heck .\rm nmt: ( ',i,h \neuni n rolal Project Coll w -- -------
�00O 3P.uJ In Full 0 Outstandm_, B'dan,c• Ihic
SECTION 5: CONSTRI. CHON SER% ICES
5. d C CSIA
I U-1-0-se ons ructi 11 Super,,isor -57
VI
lX)0
I'd I
Re,m,!QJ
It
()f1k
I-,I
It C J,real It oh,I C I. C,I I
S
l'-plit lit: li,7! Btwwl-, Nj'ch
lii•l.i ilia
.2 Registered [ionic Improl,cruent Contractor (I HC)
MC
Si gilat ale
Ir
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT t,.%I.G.L. c. 152. § 250( t)
Workers Compensation Insurance it I idav i I must be C,InIpleted .,lid uhnii[red H it In I h I, sppl lt:at It III
this affidavit will result in the denial of the Issuanceol the holding permit.
Signed Atfidasit Attached? Yes .....SECTION 7a: OWNER No . 0
AUTHORIZATION 110 BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT sLlhl�0 property hereby
as Owner of the
to
authorized by this building permit 'iPpIti:aIllin.
Dal
SECTION 7b: OWNER' 011 AIU 110RIZEDAGENT DECLARATION
as Owner or .\uthoi Ized agent hereby JeLlalc
best or my 1,1110%0c4ealld
that the starements and intormation in the toregoinu application .Ire true and accurate, to the
behalf.
Print ',.line
Date
SILIjujure of Owner or -ituillowed :Agent
15' In-d under tlit- It ,ns and Enaltles of CeDIIEL) NOTES
7— -- :—--- -- — I) his/her own %%oik. ,rano\kner who hues Jo UnlCl!'I'leled LI1lItIALtIII.
An O"rici who obtains a building Permit ('I d , I,) the mb111,111
Contractor (1-110 Pirtlyarn). will not base ac,:e
I not registered in the Home lnipro�emenl ( —
pr,�Lrannor guaranty fund under NI G L. c Other important intminition ,m the IIIC Pr,,gimn nd
le'lle,
(,,,nst,u,tw n Supervisor I-i,:enNLng jCS1.) I:,tn be tmind in 7SO CMR R"ulations-I io.R6 and 1 10 R5
lnrh
When ut,,lant"ll kk,)rk is planned. plotide the intormalwn het —
tint:luding garage, linished hj.ejljetlt/atjIis, &,:ks or jltll.h)
Tonal floors area I Sq Ft,I Habitable nwrn chum
iro,s hslng area ISq "r Number
It bedr,win,
Number ct tileplaces—__
NUmthcr It 11,,Whalh,
i N'llithcr III hathlo"ni's Nuitihel .I je,k`r 1)I,i,bc,
�I,e .,t heallilL .�,tejn 11,1,"Cd
pe t,TCM
r
]',,tal Proj", Square F,I,,f,lI-e 111,1% be 'Llb'"tuled I"
CITY OF.SALEM
}&�, PUBLIC PROPRERTY
DEPARTMENT
"I%�I it 12C WAN t11\t;HIl,SI:(LLI' • SAI1`N, MAYS.\tIII it'I II,u197C,
1 i,1: 978.713-95'6 • f s.x:978.74CC9846
Yorkers' Compensation Insurance :affidavit: Builders/Contractors/Electricians/Plumbers
\ ) )licant Information Please Print Le ibly
Nillnt: l0uett«s�1//�+r�8anvatinfall/ndrvduul l: /gyp U �Gr _
CIty1Slalc /Ill " /�D//^OS� � Mont
:it re s o rn cuyiloycr? Check the appropriate box: 'Type of project(required):
I. 1 ;till a employer with 4. ❑ I ;till a gcnural contractor and 1 6. ❑ New construction
c mpluyccs(full und;'ur part-time).' hove hired the sub-contractors 7. El Remodeling
listed on the anachcd sheet.
2.❑ 1 a nt a sole proprietor or partner-
-
Ship;cod have no employees These sub-contractors have S. ❑ Demolition
working for me in any capacity, workers' comp. Insurance 9. ❑ Building addition
No workers' cum . insurance 5. ❑ We are a corporation and its
[ P officers have exercised their to.❑ Electrical repairs or additions
I rcquircd.] plumbing repairs or additions
3.El ant a homeowner doing all work right of exemption per MCL I I.❑ plumbi 6 P'
myself. (No workers' comp. c. 152, ¢1(3),and we have no 12.0 Rouf repairs
insurance required.] t employees- LNo workers' 13.0 Other
comp. insurance required.)
•Am .itphcaus Ibut checks box III must alw till out the c,clio,twduw showing their wurkus'cumpenu ivn policy Inlirrrr new
' I brmalwnen who submit this affidavit indiuuny they are doing all work and then him outside cwurxtom most euhmis a new at'fdavit indiutmy loth.
d'on¢wwry Ihot dwck this box mass mtxhnl an additional nhcel.huwiny Ilia nano of the subtontrxtora and their wurkern'comp.policy mflu rnatiun.
/any till employer that is providing workers'runrpen.sadon insurance•for ury eutplayees. Below is the policy and jab.life
ittforuratiom
Imurancc Company Name: _. .._.._....
Pnlicv a or Self-ins. Lic. tG: . ...___ Expiration Date:
Job Site Address; City;Stateizip:
Altach n cupy,of the workers' compensation policy declaration page (showing; the policy number and expiration date).
);allure to ,ccurc coverage as required under Scctiun 25A uf.\IGL c. 152 can lead to the imposition of criminal penalties of a
tiny up to 51.500.00 and/or one-year imps ismtment,as well as civil lnnaltics in the form of a STOP WORK ORDER and a fine
Of till to 5250,00;t day aguinsl lilt violamr. Ile advi.acd that a copy of this statement may be forwarded to the 011ice of
Ins-�sm,uunu ul the DIA :or iniurtr" :overage sc,ilicaLon.
l do her, by c crtifp under the pt ' and pennhicx of yepaty th t the infunnulian pravfdcd ubus•e is true uoJ correct.
Official use otdy. no not n•rite in this area, to be completed by city or town official.
City or Town: --_ Pcrmit/Liccnsc 0._ ..
Issuing Aulhurilv (circle ono):
I. hoard of Ilcallh 2. Iuilding Dcpartincnt 3.l'il)r-(Doti Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact I'cnuu; _. _ one
Information and Instructions
.Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as"._every Pelson in the service of another under any connacrof hire,
express or implied. oral or written."
An employer is defined as"an individual, partnership, association,corporation or other legal entity, or any two or more
,it the t0rceoing engaged in a joint enterprise, and including the legal representatives of a deceased empluyer, or the
receiver or trustee of .or individual, paltnershlp, association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the.-rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
.%IGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
.additionally,-NIGL ehapter 152, 625C(7)states"Neither the commonwealth nor aAy of its poliiical subdivisions shall
enter into any contract for the perforntance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone nunber(s)along with their certificate(s)of
insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners, are not required to carry workers' compensation insurance. if an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and dale the alfidavit. The affidavit should
he returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line. -
City or Town Offlelab
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit fur you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to till in the pcnnitilicense number which will be used as a reference number. In addition, an applicant
that must submit multiple permitAicense applications in any given year,need only submit one affidavit indicating current
policy int'mmation (if necessary)and under"lob Site Address"the applicant should write "all locations in (city or
town)." % copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a Jug license or permit to bum leaves etc.)said person is NOT required to complete this affidavit.
I he t)liicc of Investigations %%uuld like to thank you in advance fur your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Deparnncnt's address, telephone and fax number
4
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax # 617-727-7749
www.mass.gov/dia
� f
CITY OF SALEM
PUBLIC PROPRERTY
DEPAR"I'MENT
Construction Debris Disposal Affidavit
(required fiur all demolition and renovation work)
In accordance N%ith the sixth edition of the State Building Code, 780 CMR section 1 1 1.5
Dcbris, and the provisions of MGL c 40, S 54;
Building Permit rl is issued with the condition that the debris resulting from
this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris
//will be hansported by:
. t`H✓I a,r0.`S
(name tit hauler)
I he debris will be disposed of in
(ZT SD fQfrs;k D
nn S (nameW tacihty))
3 /Z, woed Grrt•,C . realo&
(aJdress ut facilitvt
,ignatwe u >ennit applT leant