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210 ESSEX STREET - BUILDING JACKET�� iia �ss� ,- x `s%� � ''i .. . .�.,. �� _ � �® �Fk UPC 10330 �Ng (Vo. 153L HASTINGS, NN co STREET PERMIT Citp of balem inner Office of Inopector of �3uilbingo .%ermissron rs Siere,6y yiuen to .iU\Y! k-l -F \ , h 1 T"1 h(i, I Kill to occupy for 1`.<. r i .1 r C_ t 1 �-�i 1>t t.- purposes in front ofeslale %. 1 G 1 Znld oeel.fse / s f .7Sii's permil rs liniledlo ,t ti r rf 1 20- —1 i. su6'ecl to I e � provisions of llse ordizances andslalules m rekbon to cSlreels andlSe 7nspec(ron and Gonslruclion of✓3urldnys rn tFie Gily of cSalem. l7irec%ol Pu6�'c c$e�wce✓ .lnspec/or o`.'�vi�dnys c59nalure o`.�(ppGaan/ 09/01/2017 14:51 7819339918 ARCH PAINTING INC PAGE 01/03 pD� Effective Date: seotemtoer 5th, 2017 Western Surety Company LICENSE AND PERMIT BOND KNOW ALL PERSONS BY THESE PRESENTS: Bond No. 63335527 That we, Arch Paint'nq Inc of Woburn , State of Massachusetts ,as Principal, and WESTERN SURETY COMPANY, a corporation duly licensed to do surety business in the State of Massachusetts as Surety, are held and firmly bound unto the Town of Salem ,State of Massachusetts , as Obligee,in the penal sumof One Thousand and 00/100 DOLLARS ($1,000.00 ), lawful money of the United States, to be paid to the Obligee, for which payment well and truly to be made, we bind ourselves and our legal representatives, firmly by these presents. THE CONDITION OF THE ABOVE OBLIGATION IS SUCH, That whereas, the Principal has,been licensed Street City of Salem by the Obligee. NOW THEREFORE, if the Principal shall faithfully perform the duties and in all things comply with the laws and ordinances, including all amendments thereto, pertaining to the license or permit applied for, then this obligation to be void, otherwise to remain in full force and effect until September 5th 1 2018 , unless renewed by Continuation Certificate- This bond may be terminated at any time by the Surety upon Bending notice in writing, by First Claes U.S.Mail, to the Obligee and to the Principal at the address last known to the Surety, and at the expiration ofthir aIV "Ways from the mailing of said notice, this bond shall ipso facto terminate and the Surety sh 11 apo ,, sieved from any liability for any acts or omissions of the Principal subsequent to said .ry' . d�yd �he number of years this bond shall continue in force, the number of claims mads a tCk b6nr8the number of premiums which shall be payable or paid, the Surety's total limit of 1 1? shall not be Irulative from year to year or period to period,and in no event shall the Surety's total hbty laiga§ bxceed the amount Bet forth above. Any revision of the bond amount shall not be c11Ul iye. -�f p�Y1�.�� Datert t"zs 1st day of September 2017 a � Asch Painting Inc Principal Principal WESTE SURE COMPANY By r� Paul T.Br t,Vice President: Form 532-12-2015 09/01/2017 14:51 7819339918 ARCH PAINTING INC PAGE 02/03 - ACKNOWLEDGMENT OF SURETY STATE OF SOUTH DAKOTA (Corporate Officer) COUNTY OF MINNFHAHA ss On this 1st dayof September 2017 ,before me,the undersigned officer, personally appeared Paul T- Bru f_tat,who acknowledged himself to be the aforesaid officer of WESTERN SURETY COMPANY, a corporation,and that he as such officer,being authorized so to do,executed the foregoing instrument for the purposes therein,contained, by signing the name of the corporation by himself as such officer. IN WITNESS WHEREOF,I have hereunto set my hand and official seal. . {4444asgabbNMNNNNNNNNY4Nh{ f M. BENT i er/ NOTARY PUBLIC ' SOUTH DAKOTA sEAI Notary public—South Dakota +M440.¢w4bNNNNNNNhNb4000N{ My Commission Expires March 2, 2020 ACKNOWLEDGMENT OF PRINCIPAL STATE OF (Individual or Partners) � ss .. COUNTY OF On this day of ,befora me personally appeared known to me to be the individual_described in and who executed the foregoing instrument and acknowledged to me that—he—executed the same. My commission expires Notary Public . ACKNOWLEDGMENT OF PRINCIPAL STATE OF , (Corporate Officer) COUNTY OF j as On this day of ) - - ,before me personally appeared who acknowledged himself/herself to be the of ,at corporation,and that he/she as sucb officer being authorized so to do, executed the foregoing instrument for the purposes therein contained by signing the name of the corporation by himself/hereelf as such officer. My commission expires Notary Public E 1 O p L @ ti Z o � � a 0 ca w c° 09/01/2017 14:51 7819339918 ARCH PAINTING INC PAGE 03/03 Western Surety Company POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That WESTERN SURETY COMPANY,a corporation organized and existing under the laws of the State of South Dakota,and authorized and licensed to do business in the States of Alabama,Alaska, Arizona, Arkansas, Caldornia, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland,Massachusetts, Michigan,Minnesota, Mississippi.Missouri, Montana,Nebraska,Nevada,New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon. Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, Wyoming, and the United States of America,does hereby make,constitute and appoint Paul T. Sruflat of Sioux Falls , State ofSn,rth Daggta ,its regularly elected _ vice P ardent - as Attomey-in-Fact,with full power and authority hereby conferred upon him to sign,execute, acknowledge and deliver for and on its behalf as Surety and as ifs act and deed,the following bond: One Str t city Qf Salem bond with bond number 63335927 for Pain Inc as Principal In the penalty amount not to exceed: $ 1-000.00 Western Surety Company further certifies that the following Is a true and exact copy of Section 7 of me bylaws of Vmstem Surety Company duly adopted and now in force,to-wit: section 7. All bonds, policies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the corporate name of the Company by the President,Secretary, any Assistant Secretary,Treasurer,or any Vxe President,or by such other officers as the board of Directors may authorize. The President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys-in-Fact or agents who shall have authority to issue bonds,policies,or undertakings in the name of the Company. The corporate seat is not necessary for the validity of any bonds,policies,undertakings,Powers of Attorney or other obligations of the corporation. The signature of any such officer and the corporate seal may ba printed by facsbnila. In Witness Whereof, the said WESTERN SURETY COMPANY has caused these presents to be executed by its with the corporate seal affixed this 7 st: day of September__, 2017 ATTEST �.,�//�p WESTE N URETXICOMPANY —� 8y Paul TfBwfiat.Vies President L.Nelson,Assistant Secretary si ric'airrrr�.,;vfr STATE OF SOUTH DAKOTA "?,`may'•,, �� ,Ytirs ' fw ss COUNTY OFMINNEHAHA j esp`'""'ql' On this 1st day ofSeptember 2017 before me,a Notary Public,personally appeared Paul T. Hru£1at and L. Nelson who,being by me duly swum,acknowledged that they signed the above Power of Attorney as Vice President and Assistant Secretary, respectively,of the said WESTERN SURETY COMPANY, and acknowledged said instrument to be the voluntary act and deed of said Corporation. 4wwwwwwwrrrrrrrrrrr..wrww `a J. MOHR r fj — MNOTARY PUBLIC SEAL ; L/ SOUTH DAKOTA 3V Notary Public 4wr�abrrrwrrrrrrrrrrrrwww f• Ny COr[anla$xOn Expires June 23, 2021 To validate bond authenticity,go to www.enasnrety cam >Owner/Obligee Services>Validate Bond Coverage. Farm F1979-1-2016 l r Certificate No: 204-13 Building Permit Ni 204-13 Commonwealth of Massachusetts City of Salem Building Electrical Mechanical Permits This is to Certify that the BUSINESS located at ----------------------------------------------------- Dwelling Type 210 ESSEX STREETin the CITY OF SALEM -----------------------------------------------------------------°- --- - Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY 210 ESSEX STREET SALEM FIVE BANK 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 Nov 13,2012 -- GeoTMS®2012 Des Lauders Municipal Solutions,Inc. ------------------------------------------------------------------------------- 210 ESSEX STREET 204-13 Gam�.. # , 10867r,; t COMMONWEALTH OF MASSACHUSETTS Map k #µ° CITY OF SALEM Block Lot: Category RENOVATIONS ; y� �lrl�� �Peimlt# , �_` 204-13') BUILDING Protect#��`.� , JS-20l3-000929':`L0 �7ILDI1�p7 PL^ Est. Cost $200,000.00 Fee Charged: $2 205.00 " � Balance Due:; $ 00 _ ; PERMISSIONIS:HEREBY GRANTED TO: '[Const. Class--,'.." >` Contractor: License: Expires: use GIIroup i., ''Y COMMODORE BUILDERS General Contractor-82243 Lot Size(sq 11ft) t —° Owner: SALEM FIVE zott alts Gained , s w'eti.Applicant: COMMODORE BUILDERS �U uts Lost" „� AT: 210 ESSEX STREET Dig Safe#. ' ISSUED ON: 10-Sep-2012 AMENDED ON. EXPIRES ON. 07-Mar-2013 TO PERFORM THE FOLLOWING WORK. RECONFIGURE INTERIOR WALLS AND NEW HVAC FOR SALEM FIVE BANK POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric 2,,,o f to0i� Gas Plumbing Building 141iergr-"At Underground: Underground: Excavation: Footings: Rough: 2✓?GC ,r Rough: Rough: Foundation: Final: "inal: Final: Rough Frame: �C7S Fireplace/Chimney: D.P.W. Fire Health Insulation: Meter: Oil: ` ���® . HouseN Smoke: Final: 7 {{{"' � O Water: Alarm: y� �GotiN-y- Assessor Treasury: OI/01/I j� . Sewer. Sprinklers: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATIO O ANY RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: i` BUILDING KFC-2013-000986 10-Sep-12 3299 $2,205.00 t, Call for Pathan to Occupy GcoTMS@ 2012 Des Lam let s Dtunicipal Solutions,Inc. VSpVE AD CITY OF SALEM Certificate No: 782-07 Building Permit No.: 782-07 Commonwealth of Massachusetts City of Salem Building Electrical Mechanical Permits This is to Certify that the BUSINESS located at Dwelling Type 0208 ESSEX STREETin the CITY OF SALEM -------------------------------------------------------------- Address TowrVCity Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY SALEM FIVE COMMUNI'T'Y ROOM 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 Jun 19,2007 ------------ - ---------------- - -- - - - GeoTMS®2007 Des Lauriers Municipal Solutions,Inc. ----------------------- ------------------ - -------------------------------------------------------- CITY OFSALEM BUILDING PERMIT 0208 ESSEX STREET 782-07 GIS#: 518 COMMONWEALTH OF MASSACHUSETTS Map: 35 Bloek: CI'T'Y OF SALEM (Lot 10205 li Category: REMODEL Permit# 782.07 BUILDING PERMIT P ject# JS-2007-001127 Est.Cost: 1$600,000.00 Fee Charged: 1$6,605.00 Balance Due: $.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: I Contractor: License: Expires Use Group: 1 COMMODORE BUILDERS Gen.ComructodCode IG-074439 0900/=004 LotLot Si�. 19165 Zoning: IB5 —Owner: SALEM FIVE- CENT SAVINGS BANK jUnitss Gained: Applicant: SALEM FIVE CENT SAVINGS BANK Units Lost AT. 0208 ESSEX STREET (Dig Safe i ISSUED ON: 09-Mar-2007 AMENDED ON. EXPIRES ON: 09-Sep-2007 TO PERFORM THE FOLLOWING WORK. INTERIOR RENOVATIONS TO SALEM FIVE BANK J.B. POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing Building Underground: Underground: Underground: Excavation: Service: Meter: /J �r[[ Footings: Rough: 3/(�Q'J Rough: Rough:OX.QpFJOG Y/2%A-7 Foundation: /J Final: f� /-3� ��aw inal: Final:P)(-!/Oe b/(/3/e'7 Rough Frau Q� Fireplar D.P.W. Fire Health Insulatim Meter: Oil: q J Final: House# o �p sv` - a., �, Tr v: Water: Alarm: OWL tti�C -LDp C.Q. Sewer. S nkt s: !- THIS PERMIT MAY BE REVOKED BY THE ITY OF SALEM UPON VIOLATIO RULES AND REGULATIONS. G� Signature: Fee'rype: Receipt No: Date Paid: Check No: snunuv: BUILDING REC-2007-001399 09-Mar-07 123ai SObui.uU 1 Call for Permit to Occupy Geo FNIS©2007 Des Lauriers Municipal Solutions,Inc. Certificate No: 782-07 Building Permit No.: 782-07 Commonwealth of Massachusetts City of Salem Building Electrical Mechanical Permits This is to Certify that the BUSINESS located at Dwelling Type 0208 ESSEX STREET in the CITY OF SALEM ----------------- - - -- ---------------- ----------------------------- --- - - - - ------------.- Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY SALEM FIVE COMMUNITY ROOM 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 Jun 19,2007 ------------------ ----- ---- ------ CeoTMS®2007 Des Lauriers Municipal Solutions,Inc. ------------------ - --------------------------------- ------------------------ r No.//� qy City of Salem Ward _ x APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT•Applicant to complete all items in sections:1, It, Ill, IV,and IX. /0 �SSk k $.7 ZONING �6 I. AT(LOCATION) DISTRICT LOCATION (NO.) (SMEET) OF BETWEEN AND BUILDING (CROSS STREET)) (CROSS LOTET ) SUBDIVISION LOT BLOCK SIZE II. TYPE AND COST OF BUILDING -All applicants complete Parts A -D A. TYPE OF IMPROVEMENT D. PROPOSED USE-FOR"DEMOLITION"USE MOST RECENT USE 1 ❑ New building Residential Nonresidential 2 ❑ Addition(If residential,enter number of new 12 ❑ One family 18 ❑ Amusement;recreational (rousing units added,if any,in part D, 13) 19 [:] Chruch,other religious 13 E] Two or more family-Enter number 3 gAfteration(See 2 above) of units....................................................... 20 ❑ Industrial 21 E] Parking garage 4 19Repair replacement 14 E] Transient hotel,motel,or dormitory- Enter number of units ........................... 22 E] Servicestation,repair garage 5 ❑ Wrecking IV multifamily residential,enter number 23 ❑ Hospital,institutional of units in building in Part D, 13) 15 ❑ Garage 24 JK Office,bank,professional 6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility 7 ❑ foundation only 26 ❑ School,library,other educational 17 ❑ Other-Specify 27 ❑ Stores,mercantile B.OWNERSHIP 28 ❑ Tanks,towers 8 rivate(individual,corporation,nonprofit 29 ❑ Other-Specify institution,etc.) 9 ❑ Public(Federal,Slate,or local government C.COST (Omit cents) Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing plant, machine shop,laundry building at hospital,elementary School,secondary School,college, parochial school,parking garage for department store,rental office building,office building 10. Cost of improvement ......................................................... $ at industrial plant.If use of existing building is being changed,enter proposed use. To be installed but not included in the above cost /}A/ a. Electrical........................................................................... ry b. Plumbing.......................................................................... ti D CH�NG� SrL- c. Heating,air Conditioning............................................. S 7 d 0 d. Other(elevator,etc.)............................... '7 11. TOTAL COST OF IMPROVEMENT $ /(/JQr 0 - �\ III. SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, complete Parts-E-�L;demolition, complete only Parts J&M,all others skip to IV E. PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL I. TYPE OF MECHANICAL 30 ❑ Masonry(wall bearing) 35 ❑ Gas 40 ❑ Public or private company Will there be central air 31 ❑ Wood frame 36 ❑ Oil 41 ❑ Private(septic tank,etc.) conditioning? 32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45 ❑ No 33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF WATER SUPPLY Will there by an elevator? 34 ❑ Other-Specify 39 E] Other-Specify 42 ❑ Public or private Company 46 ❑ Yes 47 ❑ No 43 ❑ Private(well,cistern) , J.DIMENSIONS M. DEMOLITION OF STRUCTURES: N 48. Number of stories . ...................... as. total square feetf floor area, all Boors,based o Has Approval from Historical Commission been received nexterior dimensions ......................................................................... for any structure over fifty(50)years? Yes_ No_ 50. Total land area,sq.It....................................................... Dig Safe Number K.NUMBER OF OFF-STREET PARKING SPACES Pest Control: 51. Enclosed ................................... 52. Outdoors...... HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED? Yes No L RESIDENTIAL BUILDINGS ONLY Water: 53. Enclosed ....._...................................................................... Electric: Gas: 54. Number of Full ................... Sewer: bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED Partial...................................... BEFORE A PERMIT CAN BE ISSUED. IV. COMPLETE THE FOLLOWING: Historic District? Yes_ No ✓ (If yes, please enclose documentation from Hist. Com.) Conservation Area? Yes_ No✓✓ (If yes, please enclose Order of Conditions) Has Fire Prevention approved and stamped plans or applications? Yes_ No ✓ Is property located in the S.R.A. district? Yes✓ No Comply with Zoning? Yes�L No_ (If no,enclose Board of Appeal decision) Is lot grandfathered? Yes_ No (If yes, submit documentation/if no,submit Board of Appeal decision) If new construction, has the proper Routing Slip been enclosed? Yes_ No AI�4 Is Architectural Access Board approval required? Yes_ No ✓ (If yes, submit documentation) Massachusetts State Contractor License# 0 1 1 1 3`/ Salem License# Pb 3 Home Improvement Contractor# 1,/.K Homeowners Exempt form (if applicable) Yes_ No CONSTRUCTION TO BE COMMENCED WITHIN SIX(6) MONTHS OF ISSUANCE OF BUILDING PERMIT If an extension is necessary, please submit CONSTRUCTION IS TO BE COMPLETED BY: y/t &Y in writing to the Inspector of Buildings. V. IDENTIFICATION - To be completed by all applicants Name Mailing address-Number,street,city,and state ZIP Code Tel.No. 1.Owneror I'" Fva ".,-%1 �/(1 FSS9X —sr Lessee S41L/11,1�4 , ti / )K 2. T. 5�s�1,. Ozd Gtbti -2- Contractor Builder's I I I Pi 2 i C.4 �I.vl �I License No. ///3 Y 3. f. Vfc CLCJVt(2 )1160 i.. . Architect or �7S-1 J Engineer �P� N$- avR2 $72�c/i.rtn-L. Tyr . 4.1 -S-066 1 hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application as his authorized agent and we agree to conform to all applicable laws of this jurisdiction. Si n ture of applica Address Appli ation date /o G Az/� F STONE A /1 S DO NOT WRITE BELOW THIS LINE VI. VALIDATION Building / FOR DEPARTMENT USE ONLY Permit number Buildinguse Group Permit issued 17 19 Fire Grading Building Permit Fee $ ZC Live Loading Certificate of Occupancy $ Approved by: Occupancy Load Drain Tile $ Plan Review Fee $ C TITLE NOTES AND Data - (For department use) G o 4- w PERMIT TO BE MAILED TO: DATE MAILED: / 1 Construction to be started by: Completed by: f VI ZONING PLAN EXAMINERS NOTES DISTRICT USE FRONT YARD SIDE YARD SIDE YARD REAR YARD NOTES SITE OR PLOT PLAN -For Applicant Use O N COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY - 9ip/f' OF ONE ASHBORTON PLACE �19 � fl MASSACHUSETTS BOSTON,MA 02108 P Ll C F N S L CAUTION EXPIRATION DATE CONSTR. SUPERVISOR .. EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST RESTRICTIONS ( THEFT. PUT RIGHT THUMB NONE I5 .7 06/30/1993 011134 o PRINT IN APPROPRIATE 9- NORMAN J SPRINGER M 014 MORGAN AV _ ST GORQ4 RP Il-P AT9�tSS # 013-22-8623 MEDFORD MA 0.?155 i {MUSTINCLUDEPHOTOI 1 ' r1 .. PHOTO musni NOV 08 1993ea ovN UNLYI FEE: 100.00 _ I / NO VALID UNTIL SIGNED LICENSEE ANOOFFICIALLY HEIGHT: SIAMPLD UN.GIONAfUREOf TIIECOMMISSIONER DOB: D.P.S. If— .S• \. 11 / 15/1929 THIS DOCUMENT MUST BE Y�—,nf•� aI « SIGN NAME INFULLADUVC SIGNATURE LINE �._. CARRIED ON THE PERSON OF IGNATUR FLICENSEE THF HOLDER WHEN EN' OTHERS-RIGHT THUMB PRINT GAGED IN THIS OCCUPATION tl A x,A �'J.� COMMISSIONERS a {� b d CITY OF SALEM 9' BUILDING LICENSE# 1423 This is to certif That- NormanJ. Springer - - - - 10 Plaza Ave. St Stone am Has been granted a license by the Building Inspector as a . General Contractors j Attest: March 30, 1994rd. .+�Gl� I Issued) nspect r " G COMMONWEALTH OF MASSACHUSETTS `l Er .. OF INDUSTRIAL.ACCIDENTS L e 600 WASHINGTON STREET -� BOSTON, MASSACHUSETTS 02111 games amooer. -�.ss one WORKERS' COMPENSATION INSURANCE AFFIDAVIT �otR -rl I—�Zf;/�� f /7�I/r3C r� otic: (l ice nser,perm tttee i with a principal place of business/residence at: (GrylStateiZip) do hereby certify, under the pains and penalties of perjury, that: JYI am an employer providing the following workers' compensation coverage for my employees working on this lob, l h�2i� YhuivgL ' C"7 7.207 673 Insurance Company Policy Number [ ] I am a sole proprietor and have no one working for me. I am a sole propricto eneral contraaor r homeowner (circle one) and have hired the contractors listed below who have the following workers compensation insurance policies: CtirZTArv :71 jWC%,7>?aa•J37i� zz Name of Contractor Insurance Companv/Policy Number Ri G1iFz1%!fR �1� kC!/f1L 7-6 A,,$ Crof-- 13.3'7;LQ7FC—A,A- 'Jame of Contractor insurance Companv/Policy Number �aySs r �i'N SIS/ L �o �L Tv� � YPGs3i�c*� Name of Contractor insurance Company/Policy Number [] I am a homeowner performing all the work myself. NOTE: Please be aware that while homeowoen who employ persons to do mlintenanec.construction or repair work no a dwelling of not more than three units in which the homeowner also resides or on the grounds appunenant thereto am not generally considered to be employers under the Workcn' Compensation Act(GL C. 152.sea. 1(5)), application by a homeowner for a license or permit mry evidence the legal status of an employer under the Workers' Compensation Act- understand ctunderstand that a copy of this statement will be forwarded to the Department of Industrial Accidents' Office of insurance for Coverage vcnnation and that fmiurc to secure coverage as recuircci under Section 25A of MGL 152 r3ss lead to the imposition o(cnminal penalties consisting of a Fine of up to 51500.00 and/or imprisonment of up to one year and civil penaities in the form Of Stop Work Order and a fine of S100.00 a day against me. Signed this '2 't7l( day of / 19 9 t� Licenseei Permiaec Licensor/Permiaor 04/06/94 07: 32 603 463 1082 A.GOSSELIHSTEEL PAGE 01 0 3/22/1994 THIS CERTIFICATE 19 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE LakeSidO Insurance Agency Inc. DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE ' 88 Stiles Road POLICIES BELOW. Salem, NH 03079 COMPANIES AFFORDING COVERAGE (603) 893-9450 coMRALY A ROYAL INSURANCE CO. ETtER COMPANY LETTFA P7 A GOBBELIN STEEL, INC. COMPANY LETTER C RFD *2 , 168 OLD CANDIA ROAD AUBURN, NH 03032 CQWAHY 0 LETTER LCEQTwTmk4y E 5. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION Of ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POMT ffprona POMV EXPIRATIONRA Or MOUPAKCE POLICY NUMBERDkTE (MMMO.ey) DATE R(MDO" OINERAL UAWAM GENERAL AGGREGATE i 2,OOO,Q00 COMMERCIAL OENERk LASLTY PSPII)4207 PRODUCTS-COWA3P AGO s 2 ,000,000 CLAIMS MADE X OCCUR, 01/09/94 01/09/95 PE ONAL A AOV MURI S 1, 000,000 OWNERS A CONTRACTOR'S PROT EACH oc'WRRENCE S 1, 000roolo RRE QWAGA 6111 $ . 50,000 IAEA kXPENSF IAO,are Parcae $ 50000 AUVQIIKR%M UAMMITY CA>A&WFO ANGLE ANY AUTO PSPI04207 Lw7 S 1,000,000 ALL OWNED AURN 01/09/94 01/09/95 BOO(,f wkjft t X SCHEDULED AUTOS X HIRED AUTOS 8004LY!HJURY H%1­10MED AUTOS (Pe,acct u WAGE LMB'WTY PFIZIPUIT' DAMAGE no"@ LIABILITY EACH rCC,. RENCE % 2,000p000 A X UMBREL,w FORM PLA$W89 01/09/94 01/09/95 ACIOPEOATe S 2, 000,000 OTHER THAN UMBRELLA FORM WORKIIA'A COMPEN"TION X STATUt(Ay LITS A AND WPCS312000 01/09/94 01/09/95 EACH ACCOEINI $ 500,000 DISEASE • FT Cf L(MII $ $00,000 VOLOYMAS'LLARAM EACH EMPLOYEE 6 500,000 OTHFA OWMPTION OF OMAAbONWLOCATION&YPiIGII WTZIAL(TVA9 Salem Five Cents Savings Bank Salem, NH HVAC Engineering INC. SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 17 Sterling Road EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO Billerica, MASsachusetts 01862 MAIL --2-q DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED 10 IHE LEFT, BUT FAILURE TO MAX SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS 00 REPRESENTATIVES. AUTHOR11120 RURIBIPAWE .12/18/03 15:08 $508 686 1515 MATERIAL INSTALL 001 Pbst-1t-brand fax transmittal memo 7671 sw peg"r lb 3�� From . OWL ��Qit6 vncnar �J Fait _'J �'-5'70WO PRcu1Q6 'CIRC-al.Y\i �?SiL�.c''�%�L $Rlooll\fG.1��V1E - sNob Na FKANF-r _. TtPIC6d.{-IM ASR FRAME pe.VN •� A.cri' {�P hl CF'M�^ MAWHO NY-BFR COMMONWEALTH OF MASSACHUSETTS JFSAIr:MENTOFINDUSTRIAL ACCIDENTS 600 WASHINGTON STREET fames : Canooei, BOSTON, MASSACHUSETTS 02111 ;o� ss,one, WORKERS' COMPENSATION INSURANCE AFFIDAVIT (licenseeiperminee) with a principal place of business/residence at: 35 (city/Sure/Zip) do hereby certify, under the pains and penalties of perjury, that: [ ) I am an empiover providing the following workers' compensation coverage for my employees working on this job. Insurance Company Policy Number [ lam a sole proprietor and have no one working for me. [ J I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation insurance policies: Name of Contractor Insurance Company/Policy Number ` Name ofiContrdctor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number [] I am a homeowner performing all the work myself. NOTE: Please be aware that while homeowners who employ persons to do maintenance,construction or repair work on a dwelling of not more than three units in which the homeowner also resides or on the gmunds appurtenant thereto are not generally considered to be employers under the Workers' Compensation Act(GL C 152.sect. 1(5)),application by a homeowner for a license t or permit may evidence the legal suras of an employer under the Workers' Compensation Act. I understand that a copy of this statement will be forwarded to the Department of Industrial Accidents'office of insurance for coverage verification and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties consisting of a fine of up to $1500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of S 100.00 a day against me. Signed this ( y day of /')gC Licensee/Permiaee Licensor/Permirtor 4 t r Nt>� City of Salem Ward J'F<twRc ve'Al' APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT-Applicant to complete all items in sections:1, It, III, IV,and/X. I. AT(LOCATION) a6+i 0 5 S e X ZONING DISTRICT LOCATION (NO.) (STREET) OF BETWEEN AND BUILDING (CROSSSTREET) (CROSS STREET) SUBDIVISION LOT BLOCK SIZE II. TYPE AND COST OF BUILDING -All applicants complete Parts A -D A. TYPE OF IMPROVEMENT D. PROPOSED USE-FOR'DEMOLITION"USE MOST RECENT USE 1 ❑ New building - Residential Nonresidential 2 ❑ Addition(It residential,enter number of new 12 ❑ One family 18 ❑ Amusement,recreational housing units added,it any,in part D,13) 19 ❑ Chruch,other religious 13 ❑ Two Or more family-Enter number 3 Alteration(See 2 above) of units....................................................... 20 ❑ industrial 21 El Parking garage 4 [:] Repair replacement 14 ❑ Transient hotel,motel,or dormitory- 22 [:] Service station,repair garage Enter number of units ........................... 5 ❑ Wracking(R multifamily residential,enter number 23 ❑ H pital,institutional of units in building in Part D, 13) 15 ❑ Garage 24 Oryice,bank,professional 6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility 7 ❑ Foundation only 26 ❑ School,library,other educational 17 ❑ Other-Specify 27 ❑ Stores,mercantile B.OWNFKHIP 28 ❑ Tanks,tovrers 8 rY'Private(individual,Corporation,nonprofit institution,etc.) 29 ❑ Other-Specify 9 ❑ Public(Federal,State,or local government C.COST (Omit Cents) Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing plant, machine shop,laundry building at hospital,elementary school,secondary school,College, parochial school,parking garage for department store,rental office building,office building 10. Cost of improvement ......................................................... $ 4rrQ at industrial plant.If use of existing building is being changed,enter proposed use. To be installed but not included in the above cost a. Electrical........................................................................... b. Plumbing.......................................................................... c. Heating,air Conditioning............................................. n d. Other(elevator.etc.)..........................................:............ 11. TOTAL COST OF IMPROVEMENT $ ' III. SELECTED CHARACTERISTICS OF BU DING -For new buildings and additions,complete Parts E-L;demolition, complete only Parts J& M,all others skip to IV E. PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL I. TYPE OF MECHANICAL 30 Masonry(wall bearing) 35 Gas 40 Public or privatecompany an l - ' ` ❑ 9) ❑ ❑ P P Y` -Will there be central air 31 ❑ Wood frame 36 ❑ conditioning?Oil q1 Private(septic tank,etc.) � 32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45 ❑ No 33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF WATER SUPPLY Will there by an elevator? 34 ❑ Other-Specify 39 ❑ Other-Specify 42 ❑ Public or private Company 46 ❑ Yes 47 ❑ No ` 43 ❑ Private(well,cistern) ,r J.DIMENSIONS M. DEMOLITION OF STRUCTURES: 48. Number of stories ............................................................ as. Total square feet of neexterior Has fl all floors,based o Has Approval from Historical Commission been received dimensions .......................-................................................ for any structure over fifty(50)years? Yes_ No 50. Total land area,sq.ft. ..................................................... Dig Safe Number K.NUMBER OF OFF-STREET PARKING SPACES Pest Control: 51. Enclosed ...................................... HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED? 52. Outdoors............................................................................. Yes No L RESIDENTIAL BUILDINGS ONLY Water: 53. Enclosed ....................................................:.._................... Electric: Gas: 54. Number of Full.................. Sewer: - bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED Partial..................................... BEFORE A PERMIT CAN BE ISSUED. IV. COMPLETE THE FOLLOWING: Historic District? Yes_ No (if yes, please enclose documentation from Hist. Com.) Conservation Area? Yes_ No✓ (If yes, please enclose Order of Conditions) Has Fire Prevention approved and stamped plans or applications? Yes—/ NO Is property located in the S.R.A. district? Yes ✓ NO Comply with Zoning? Yes_ No (If no,enclose Board of Appeal decision) Is lot grandfathered? Yes_ No (If yes,submit documentation/if no,submit Board of Appeal decision) If new construction, has the proper Routing Slip been enclosed? Yes-�o_ Is Architectural Access Board approval required? Yes_ No tt (If yes,submit documentation) Massachusetts State Contractor License# —P5/Gym Salem License # Home Improvement Contractor# Homeowners Exempt form (if applicable) Yes_ No CONSTRUCTION TO BE COMMENCED WITHIN SIX(6) MONTHS OF ISSUANCE OF BUILDING PERMIT If an extension is necessary, please submit CONSTRUCTION IS TO BE COMPLETED BY: /�2 �, in writing to the Inspector of Buildings. V. IDENTIFICATION - To be completed by all applicants Name Mailing address-Number,street,co,,and state ZIP Code Tel.No. Owner or S� E erYt 0/470 7YSS�55 Lessee z. 2to Ya LL- s D 0/ 2,40 - Q Contractor ��yy ) C.OUS `O• C. Builders � / [.._ License No. 61(. 3. It! I L4N,N n Architect or Engineer a l�SZ1uLS 1 hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application as his authorized agent and we agree to conform to all applicable laws of this jurisdiction. nat a of pplica Address Appl!xato date , / 6 O/P3p DO NOT WRITE BELOW THIS LINE VI. VALIDATION Building GJ FOR DEPARTMENT USE ONLY Permit number / Building Use Group Permit ispsued 19 /� Fire Grading Building Permit Fee $ rfS 0-0 Live Loading Certificate of Occupancy $ occupancy Load Approved by Drain Tile $ Plan Review Fee $ TITLV NOTES AND Data- (For department use) a PERMIT TO BE MAILED TO: DATE MAILED: t Construction to be started by: 2 y Completed by: VI ZONING PLAN EXAMINERS NOTES DISTRICT USE FRONT YARD SIDE YARD SIDE YARD REAR YARD NOTES SITE OR PLOT PLAN •For Applicant Use O N Nose City of Salem Wald n APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT-Applicant to complete all items in sections:1, 11, IN, IV,and IX. AT(LOCATION) ;,l io L-� S S L ZONING �Q LOCATION (NO.) (S19EU) DISTRICT OF BETWEEN AND BUILDING CROSSS REET%!q 4. (CROSSSTREET) LOT SUBDIVISION "} LOT BLOCK SIZE 11. TYPE AND COST OF BUILDING -All applicants complete Parts A -D A. TYPE OF IMPROVEMENT D. PROPOSED USE-FOR"DEMOLITION"USE MOST RECENT USE 1 ❑ New building Residential Nonresidential 2 ❑ Addition(tt residential,enter number of new 12 ❑ One family 18 ❑ Amusement,recreational housing units added,if any,in part D, 13) 19 E] Chruch,other religious 13 ❑ Two or more family-Enter number 3 ❑ Alteration(See 2 above) of units ....................................................... 20 ❑ Industrial 21 El Parking garage 4 E] Repair replacement ,:--,�..14 ❑ Transient hotel,motel,or dormitory- 22 ❑ Service station,repair garage5 ❑ Enter number of units ...........................Wrecking(It multifamily residential,enter number - 23 E] Hospital,institutional of units in building in Part D, 13) 15 ❑ Garage 24 ❑ Office,bank,professional 6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility 7 ❑ Foundation only 26 ❑ School,library,other educational 17 ElOther-Specify 27 ❑ Stores,mercantile B.OWNERSHIP s - 28 E] Tanks,towers 8 ❑ Private(individual,corporation,nonprofit institution,etc.) 29 ❑ Other-Specify 9 ❑ Public(Federal,State,or local government C.COST (Omit cents) Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing plant, machine shop,laundry building at hospital,elementary school,secondary school,college, �,-O parochial school,parking garage for department store,rental office building,office building 10. Cost of improvement ................................ $ at industrial plant If use of existing building is being changed,enter proposed-use12 . To be installed but not included in the above cost - aElectrical........................................................................... b. Plumbing.......................................................................... c. Heating,air conditioning............................................. rI d. Other(elevator.etc.)..................................................:... 11. TOTAL COST OF IMPROVEMENT $ '111. SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, complete Parts E-L;demolition, complete only Parts J& M, all others skip to IV . PRITYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL 1. TYPE OF MECHANICAL 30 Masonry(wall bearing) 35 ❑ Gas - 40 Public or private tympany 7Will there be central air 31 ❑ Wood frame 36 ❑ Oil 41 ❑ Private(septic tank,etc.) conditioning? 32 ❑ Structural steel 37 ❑ Electricity 44 ❑ Yes 45 ❑ No 33 Reinforced concrete 36 Coal H. TYPE OF WATER SUPPLY ❑ ❑ Will there by an elevatoR 34 ❑ Other-Specify 39 ❑ Other-Specify 42 ❑ Public or private company 46 ❑ Yes 47 ❑ No \ , - 43 ❑ Private(well,cistem) .. J.DIMENSIONS M. DEMOLITION OF STRUCTURES: , 48. Number of stades ............................................................ squ re floor 49. Total ors,based n exterior Has Approval from Historical Commission been received all floors,based o f exterior dimensions ......................................................................... for any structure over fifty(50)years? Yes_ No_ 50. Total land area,sq.It....................................................... Dig Safe Number K.NUMBER OF OFF-STREET PARKING SPACES Pest Control: 51. Enclosed ...................................... ........... HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED? 52. Outdoors............................................................................ Yes No L RESIDENTIAL BUILDINGS ONLY Water: 53. Enclosed ..................................... .......... - Electric: Gas: Full.- Sewer: 54. Number of bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED Partial...................................... BEFORE A PERMIT CAN BE ISSUED. IV. COMPLETE THE FOLLOWING: Historic District? Yes_ No (If yes, please enclose documentation from Hist. Com.) Conservation Area? Yes_ No_ (If yes, please enclose Order of Conditions) Has Fire Prevention approved and stamped plans or applications? Yes_ No_ Is property located in the S.R.A. district? Yes_ No Comply with Zoning? Yes No (If no,enclose Board of Appeal decision) Is lot grandfathered? Yes_ No (If yes,submit documentation/if no,submit Board of Appeal decision) If new construction, has the proper Routing Slip been enclosed? Yes_ No Is Architectural Access Board approval required? Yes_ No_ (If yes,submit documentation) Massachusetts State Contractor License# © LG g�.� Salem License # t 6 U10 Home Improvement Contractor# Homeowners Exempt form(if applicable) Yes_ No CONSTRUCTION TO BE COMMENCED WITHIN SIX(6) MONTHS OF ISSUANCE OF BUILDING PERMIT If an extension is necessary, please submit CONSTRUCTION IS TO BE COMPLETED BY: in writing to the Inspector of Buildings. -r V. IDENTIFICATION - To be completed by all applicants �+ Name Mailing address-Number,street,city,and state ZIP Code Tel.No. Owner or • ^ Lessee z. o o��3v a 3 - Contractor nn Builder's Q COM r. License No. 3. .. 1✓ l 6 1 O ZS 1!J iU Architect or Engineer yj 6 I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application as his authorized agent and we agree to conform to all applicable laws of this jurisdiction. Si tur f plicant Address Appl' do date a• a7 o3 oi�So DO NOT WRITE BELOW THIS LINE VI. VALIDATION Building �/� FOR DEPARTMENT USE ONLY Permit number / Building /�/ Jy�f�� Use Group Permit issued C-P 19 / v Fire Grading Building Permit Fee $ Z Jl� . D Live Loading Certificate of Occupancy $ Approved by: Occupancy Load Drain Tile $ Plan Review Fee $ —2_ TIT NOTES AND Data• (For department use) f e - (, / -5Co P o w o r o L LL C etL riz Pe x� 17Al 0 nU - G cJ - GtJ O 2 Jz L PERMIT TO BE MAILED TO: DATE MAILED: —� Construction to be started by: Completed by: VI ZONING PLAN EXAMINERS NOTES DISTRICT USE FRONT YARD SIDE YARD SIDE YARD REAR YARD NOTES SITE OR PLOT PLAN -For Applicant Use O N COMMONWEALTH OF MASSACHUSETTS ° DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET : Garnooen BOSTON, MASSACHUSETTS 02111 games om n:ssone WORKERS' COMPENSATION INSURANCE AFFIDAVIT 0V)gL L� (I icenseei perminee) with a principal place of business/residence at: �5 /�) vr2ox,) 20fi7--) 1�14IJ (CiryisswcIZip) do hereby terrify, under the pains and penalties of perjury, that: [ ] I am an employer providing the following workers' compensation coverage for my employees working on this job. Insurance Company Policy Number [ ] am a sole proprietor and have no one working for me. [ ] 1 am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation insurance policies: Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number [] I am a homeowner performing all the work myself. NOTE: Please be aware that while homeowners who employ persons to do maintenance.constmaion or repair work on a dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto an not generally considered to be employers under the Workers' Compensation Aa(GL C. 152.sea. 1(5)),application by a homeowner for a license or permit may evidence the legal sums of an employer under the Workers' Compensation Act. I understand that a copy of this statement will be forwarded to the Department of Industrial Accidents' Office of insurance for coverage verification and that failure to secure coverage as required under Section 25A of MGL 152=lead to the imposition of criminal penalties consisting of a fine of up to $1500.00 and/or imprisonment of up to one yew and civil penalties in the form of a Stop Work Order and a fine of$100.00 a day against me. p Si ned this day of —J)E Ce h'1 L I C 19 Licensee/Permiriee Licensor/Permittor V ' .E WUI CERTIFICATEISSUED' DATE Feb.18, 1994 CITY OF 9 s SALEM. MASS CHUSETTS 01970 - BUILDING. PERMIT' . •v4EDmrt CERTIFICATEOF OCCUPANCY DATE'' January' b 19 r'4 PERMIT NO. .x_94 APPLICANT R.A. .'oya _l CJ13tIUCFiJC1 ADDRESS H rDnH4 da-.,era111, z"253. 1 _ 1.0.1 (STPEET) (CONTWS-LICENSE- NUMBE OF PERMIT TO A£terat ions (_) STORY &2nk DWELLRING UNITS IT.PC OF.IMPROVEMENTI 'NO'. IPPOPOSEO USE) AT (LOCATION) 2I0. CS3e7: Strest Ward i ZONING - B-5 DISTRICT INO.) ISTREETI 2 l . ETWEEN - ANDS .B ICR DSS STREET) [CROSS STREET) SYBOIVISION - ' - LOT ' BLOCK 52E 1.�.. BUILDING I$ TO BE 'FT. W'OE Rrfi ," FT. LONG BY ' TIN NLOT E IG NT ANO'SNALLC.ONF OR NWIN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOU NDAT,ON REMARKS: Fa,❑6'V2..L" GI13: .J 7"i ILLS:-0i bank AREA 00. " MEMO C ! _ lip jr VOLUME C,:BIU SQUIRE PEETI M1E'E16R'Elbf!EI bR'/Ib�'EIO't•EIOl11bfllbO B E COSTED ON REMISES b�lblElb OWNER Sale'.)`-1 "Y'i fc Bang TO BE POSTED ON PREMISES ADDRESS 10 !S33ex Street Sal c u. :X335. SEE REVkEI§E%LDEiFLOR_r((DNpIi IONS OF CERTIFICATE BUILDING PERMIT JOB WEATHER CARO DATE - - - 79 PERMIT NO..— APPLICANT O..APPIICANi - ADDRESS IMO.) (STREET) (CONTR'S LICE MSE) J NUMBER OF PERMIT TO - C`'- (_V STORY --`7 o DWELLING UNITS (TYPE OF IMPROVEMENT) NO. IPROPOSED USE) !l�.;. ZONING ,) AT (LOCATION) DISTRICT (x0.1 (STREET) BETWEEN AND (CROS. STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK S1ZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION JO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) L.-...... ..... REMARKS: Cliff fu a= tiirii o Uccupy UREA ORp _.-. .._ PERMIT Sc VOLUME ESTIMATED COST $ FEE 'COBIGSOUARE FEET) - OWNER .;itt': €' G.1"k BUILDING DEPT. ADDRESS ' - - .s8 ' BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY 09 SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY. NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS OUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL. PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH). FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 � - 2 ;A)r BO O TH GAS INSPECTION APPROVALS FIRE DEPT. INSPECTING APPROVALS 1 1 /1 za / _l� Li OTHER CITY ENGINEER 2 '✓\X\/ 2 1 WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD INSPECTOR HAS APPROVED THE VARIOUS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE STAGES OF CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION. CENTENNIAL STRUCTURAL ENGINEERS, INC. 17 Garrison St. Boston, MA 02116 I i • O ♦ Iii - I (E) w14•A4R (r)wtgy�� . 1 H I --t----�.—_ vNrr.- ate- 11 " 11N1 7 wcr- i7,5cb 3 w I M �. H I i i I r O I I I I n LChACl Zr7 i i - - 4 ^� PIPE 6�t-CTyP� L•Brt�CE 2rQs I Nd1 - i I � DA'L'E BY DESCRIMON I �LE� wa ----.--.- ----- MA12 • Qb • 19QQ w I l LE)4r4 r8�i6 (E) '28LH Joisr Q • e ..lOGlri ® • • • �— I I f 8 Q • • , I Yo.� u n • • - I 45 cl I IDej �'� �v I aa�cw4 � ;/�/��•' GST ______ / — �'Aar�'cuG 'r 1 . � 71 r I xLf I I % BASE W DTN N� ------ i0? WGT:QF LJN IT aXQ I ( I A • r — W�w10 W$Y10 (E) MA50Hr2y WAIT ---- -- — tS' I : III ISI —34 I . W m I i I ,D — -- ' - w -O � I� ( I i ' I wltl�"CApE 61 `-I L 517ACE ✓ I I L. enACE I ' IZY9 . 1A I Orrlr +q —{----- I I n� Ioecr IJ i �%ISTING :{18LHOrj �otgTg +1•"'t""A, j!' i 'I �O -ibl2 -17@1uFo17CE0 � L�a^M4 �•rr'l I I LS AT CE4tII2-Of SPAN 00 ---- I ---- BLEVATION SECT1c,�N - 43- ra --- C- --- j--- _ •,{2 11t o Z I I I Hv CW7ACING G E N M OF [:DAME OWLy) SALEM SIVE CANT I SA LEM , KAA u.nr4r a x (20•0 _)� II s 1 '• C7 a -. at cINTErZ of ShArJ . �. _ INSTALLATIl OF VO2 Ni-W r T©C� Ut\I ITNO- _ 04 APP'D. s e 7� I r � T .7 r, ,- *DEPT. THIS D^.`.'."IIGS TO BE KEPT ^ r r+_' DING UILD ^ F BUILDINGS it r " OP-2002-0082 Building Permit No.: 406-2001 Commonwealth of Massachusetts City of Salem BUILDING,ELECTRICAL&MECHANICAL PERMITS DEPARTMENT This is to Certify that the BUSINESS located at ----------------------------------------------------- Dwelling Type 0208 ESSEX STREET in the CITY OF SALEM Address Tow n1Cit y Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY 1st Floor Salem Five Savings Bank This permit is granted in conformity with the Statutes and ordinances relating thereto,and expires unless sooner suspended or revoked. Expiration Date ------------------------ r --------- Issued On: Wed Mar 6,2002 ----------------- GeoTMS®2002 Des t.auters Municipal Solutions,Inc. ----------------------_------------------------------_---__---_--___----- ------------------------------------------------------------------------------ r i r 0208 ESSEX STREET 406-2001 cis# s1s,° COMMONWEALTH OF MASSACHUSETTS tock CITY OF SALEM Lot 0205' ermlt ` Buildirtg .`� , Category 47,No sidential:adBUILDING PERMIT 6Je6t#:. JS-2002,0808 Est,Cost:" s $20Q 060.00 dFee: a .; $2,005;00 PERMISSION IS HEREBY GRANTED TO: Co❑st �lass:,, Contractor. License: Use Group: Carr Enterprises General Contractor-Salem#1995 Lot Size(sq. t). 19165° ` . Owner: SALEM FIVE CENT SAVINGS BANK BS Applicant: Carr Enterprises Units Gainedb_ Units host: AT. 0208 ESSEX STREET ISSUED ON: 30-Nov-2001 EXPIRES ON. 30-Jun-2002 TO PERFORM THE FOLLOWING WORK: Renovations to 1st&3rd floors per plans submitted. F.R.D. POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings Underground: Service:act f� � Meter: Footings: Foundation. Rough: Rough: /��Q�G House# Rough Frame:OF Final: Final: 3- s:'-0)1- Fireplace/Chimney: V - Insulation: ;, Gas Fire Depar ent Board of Health ��`/ I Final: Rough: Oil: C� (/ Treasury: Final: Smoke Excavation: THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: BUILDING REC-2002-000866 14-Nov-01 5946 Q?r105.00 Call for Permit to Occupy GeoTMS®2001 Des Lauriers Municipal Solutions,Inc. %35 Citp of satem, fflaggarbugettg ar TE FILED August 28, 1995 Type: ■ New Expiration Date August 28 1999 ❑ Renewal, no change Number 95-218 ❑ Renewal with change In conformity with the provisions of Chapter one hundred and ten, Section five of the Massachusetts General Laws, as amended, the undersigned hereby declare(s) that a business is conducted under the title of: Interactiv Transaction Partners at 210 Essex_ St.__( Salem Five Bank ) typeofbusiness Fl-erarnnir hnma banking and bill payment by the following named person(s): (Include corporate name and title if corporate officer) Full Name Residence .Tnsenh R Brownsted 5400 Legacy Drive Managing Dir or Mailstop B1-1A-54 Plano . TX 75024 ------------ Sig res / 1 n ----------------------------------------------------- --------------- - ---------------------- ----------------------------------------------------- on Aifr*o2 19 `� •the above named persons) personally appeared before me and made an oath that the foregoing statement is true. -------------------------- -- ----------------- ---- ------------------ DAWN PARKER Notary Public f Notary Public.state of Texas (seal) Identification Presented My tommisuart Expires 8.01-99 Date Commission Expires "`"` State Tax I.D. # S.S. # 45/-70 - (5''1 (if available) _._._._._._._._._._._._._._._._._._._._._._._ _._._-------- ------ In accordance with therovision of Chapter 337 of the Acts of 1985 and Chapter 110, Section 5, of Mass. General Laws, businessPcertificates shall be in effect for four(4) years from the date of issue and shall be renewed each four years thereafter. A statement under oath must be filed with the town clerk upon discontinuing, retiring, or withdrawing from such business or partnership. Copies of such cerdficates shall be available at the address at which such business.is conducted and shall be furnished on request during regular business;hours to any person who has purchased goods or services from such business. Violations are subject to a fine of not more than three hundred dollars ($300.00) for each month during which such violation continues. Job Si CITY OF SALE III LD 1 N G 1. = SALEM, MASSACHUSE RM IT '�nnuad�' DATE 3/4/97 19 PERMITNO, 103-97 APPLICANT Carr Enterprises ADDRESS 2 Doulton Pl 1465 (NO.) (STREET) (CONTR'S LICENSE) CITY Peabody STATE MA ZIPCODE 01960 TEL NO. 535-6399 alterations Bank NUMBEROF PERMIT TO ( ) STORY DWELLING UNITS (TYPE OF IMPROVEMENTI NO. (PROPOSED USE) AT(LOCATION) /210 Es es x Sn, ZONING (NO.)-'-(STREET) ' --i DTRICT BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT.WIDE BY FT.LONG BY FT.IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: Install 4 partitions &tT(doors Qfor p)offices /�[as per plans submitted. AREA OR 'Call for i �ir�{�It to Vc cQy py PERMIT VOLUME ESTIMATED COST 9.000. FEE $ 59. (CUBIGSOUARE FEET) OWNER Salem 5 BUILDING DEPT. ADDRESS 210 Essex St. Salem, MA BY M.M.M. THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF.EITHER TEMPORARILY OR PERMANENTLY,ENCROACHMENTS loo ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION,STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THEDEPARTMENTOF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL INSPECTIONS APPROVED PLANS MUST BE RETAINED ON JOB AND THIS CARD KEPT WHERE APPLICABLE SEPARATE REQUIRED FOR ALL CONSTRUCTION WORK: POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A PERMITS ARE REQUIRED FOR 1.FOUNDATIONS OR FOOTINGS. ELECTRICAL,PLUMBING AND 2.PRIOR TO COVERING STRUCTURAL CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH BUILDING SHALL MECHANICAL INSTALLATIONS. MEMBERS(READY TO LATH). NOT BE OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 3.FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS BOARD OF HEALTH GAS INSPECTION APPROVALS FIRE DEPT,7ASPECTING APPROVALS 1 1 k1 OTHER CITY ENGINEER 2 2 ERTIFI T 0 0C �- / �-p rmit C' of Salem uildin De : WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS INSPECTIONS INDICATED ON THIS CARD INSPECTOR HAS APPROVED THE VARIOUS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED CAN BE ARRANGED FOR BY TELEPHONE STAGES OF CONSTRUCTION. qS NOTED ABOVE. OR WRITTEN NOTIFICATION. .EOML(T_ CERTIFICATE ISSUED CITY OF SALEM DATE Feb.1 S. 1994 A a SALEM, MASSACHUSETTS 01970.--. s. BUILDING PERMIT. ' - v4�R0rt _ -WOCCUPANCY CERTIFICATE . .. ^DATE"" JanU.3rT ' 6 19 941 PERMIT ND: I5-94 "'' APPLICANT'' - R.A. JDVdli. Construction ADDRESS t :1}'rO Ei cY fid"7er:,1>.i, HESS. ,I ISTREETI IC0rTR•5 LICENSE' 1 NUMBER. OF i. PERMIT TO ASterations f_) STORY } Bank - DWELLING UNITS - (TvPE O0. (PROPOSED USE) .AT flocrno«Iz 210: Esser_ Street `7 Ward 1 - <zoNINGB-S DISTRIDT ISTRCFiI c3 'Vr D y# ((( aET WEE/, KROSS STNEE'TI t ST REiiI USO 1V IS IONLOT �OT BLOCK 52E 1" . Tt BOI I�pING IS -0 BE FT, YWIDE P M ;T(L"d BY FT IN HEIGHT ANDSNAUL CONFOR M C0N$TR UEFION f 3 444tttth i. TO TV PE USE'GROLP BASEMENT WALLS OR FOUNDATION I I { } > ITTPE) I .} REMARKS. kED dfi 1DTS8' ?_O Df x.1IL'03.:01 bank r i AREA 09 i IMelfil VOLUME SIR C BIC SOUAVE+IEETI OWNER S.•A].elel F1V@ B8ny. s'P's�'s'nsrnoeno'r's�'venbai'ocflo'n RrrlEser'O�nsrnse�ElO TO BE POSTED ON PREMISES ADDRESS - 210 P:S9e'X dtT@@t .`?a LE%D.- iKBBS. . - SEE RE�S�§Ef§LOEyFMr99t! TIM$ OF CERTIFICATE EITY-OFSALE _. PUBLIC PROPERTY DEPARTMENT KistaFN.EY DRISCOLL MAYOR t?0 WASHING ON h rXELi•SAIXAk M AhSACHLS&n-S 01970 1EL,978-745-959S*FA=97&7a0-98" APPLICATION FOR THE REPAIR, RENOVATION CONSTRUCTION. DEMOLITION. OR CHANGE OF USE OR OCCUPANCY, FOR ANY EXISTING STRUCTURE OR BUILDING _ 1.0 SITE INFORMATION Location Name: Z to jE7S&en T Building: Property Address: Property is located in a; Conservation Area Y/N M 0 Historic District Y/N 2.0 OWNERSHIP INFORMATION 2.1 Owner of Land _ Name: Address: Telephone: 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 (sQ Renovated construction or renovation of existing building New Brief Description of Proposed Work: �e✓� O d l G ��� S -- Mail Permit to: What is the current use of the Building? Material of Building? Kh171111e W o0 If dwelling, how many units? At A Will the Building Conform to Law? Asbestos? X Architect's Name be(- 4 5'oc" Address and Phone Mechanic's Name Address and Phone Construction Supervisors License# HIC Registration# Estimated Cost of Project Permit Fee Calculation Permit Fee$ 5­3 Estimated Cost X$71$1000 Residential Estimated Cost X$11/$1000 Commercial An Additional $5.00 is added as an Administrative charge. Make sure that all fields are properly 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 Z iz o7 xd 0 � N a s �. ) 9 0 � .. 1 ;ft a1 d � s ..� u N C6 u X0, The Commonwealth of Massachusetts �. Department of Public Safety Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number: Date.Applied: Building Official: SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address i alb Ess6K ST. S61,E0\ ¢11470 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 E Repair❑ Alteration 19 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ I Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes (M No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No.Q� Brief Description of Proposed Work: E O N F3.CARE = rt OR r oR WAt,t,S T N DEFILE SPACE. 1 tr" t Yo-N ri.�cr / m t r-w AVAC -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) 0 Existing Use Group(s): 'By5se rm Proposed Use Group(s): 1'!o]ZNGSS 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 ElA-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business 151 E: Educational El F: Factor F-1 ElF2❑ I H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1 ❑ I-2❑ I-3❑ I-4❑ M: Mercantile❑ - R: Residential R-10 R-2❑ R-3❑ R-4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA 0 IIB ,0 IIIA ❑ IIIB ❑ I IV 0 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 A trench will not be Licensed Disposal Site 4, Check if outside Flood Zone$I Indicate municipal.)?9 required 19 or trench or specify: CNARt-Es Private❑ or indentify Zone: or on site system❑ permit is enclosed❑ CsE x*E SEfLJSGE$ Railroad right-of-way: Hazazds to Air Navigation: F—Tjv�LA--I1fi,,,storicCommission Review Process: Not Applicable C& IsStructure within airport approach area? s their review completed? or Consent to Build enclosed❑ Yes❑ or No D Yes ❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF-OC-�UPANCY Edition of Code: Use Group(s): Type of Construction: - Occupant Load per Floor: Does the building contain an Sprinkler System?: Y Special Stipulations: 6 y3 9� SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner S,veM 5 $ANK alit EsSex Sr. SAIEr+ MA ia�o Name(Print) No.and Street City/Town Zip Property Owner Contact Information: An - 1-041- 1;61) Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable, the property owner hereby authorizes <Hwx, ACu�G 4,t2,-r 15D 0,9 oA L(S-9 Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) f building is less than 35,000 cu.ft of enclosed space and/or not under Construction Control then check here%and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor (AMMQrVP_e- 13o3�T/ERS Company Name GMucA A RSENAM-1 (15saau3 Name of Person Responsible for Construction License No. and Type if Applicable 8d PFX-ZD&£ s-r. P)Gu1wY MA 0ak5'6 Street Address City/Town State Zip 17-61N- 35,4P Telephone No. business Telephone No. cell e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT. M.G.L.c.152.§ 25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes 0 No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs: (Labor Item and Materials) Total Construction Cost(from Item 6)_$ I jmr 060.Oo 1.Building $ S— em Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ - appropriate municipal factor)=$j_(,5�6_ . 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ contact munici 'ty) 5.Mechanical Other $ ddB Enclose check payable to f 6.Total Cost $ aJQ (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 acc rate to the best of my knowledge and understanding. Q ��C� Plea ls�e print an i Wame s 7- /Ve)Title Telephone No. Date d � to 1 Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval:. Name Date The monwealth of Massachusetts Department of Public Safety Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (Phis Section For Official Use Only) Building Permit Number. Date Applied: Building Official.- SECTION L•LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) a/0 9ssIVX 5> -5r)tVn /M/'J 0470 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 O or check all that apply in the two rows below Existmg Building❑ Repair 0 Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ 1 Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes No ❑ Is an Independent Structural Engineering Peer Review required? Yes V No ❑ Brief Description of Proposed Work: 8VA70V& 5'�aGl/NG O.I.L�Rt-f� 4 r I30fTD1;1 of i5X/-MA)6 e�i>=A/71S A&W 7 MV(Ae; W17V NEW. UaAl CO,UD,�moUA6, 6YI6774)6 REgAR AJiGL Pg� WI29 990% &Q AND 60g1t-ry lUiTfi P sr Sx/ /911VX . AIW w/u Ao,c' 72EiA440RCIA)6 ei- AtJtiMes -M AtAms P,-t^46 rl 2/J41A* A„ PO4A1 ' G To 1,0161046 -VIMIrX 91'ZU% 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): I Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.fL) Total Area(sq.ft.)and Total Height(fL) 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: Factory F-1❑ F2❑ It Hi Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1❑ I-2❑ I-3❑ I-4❑ M. Mercantile❑ R. Residential R-10 R-2❑ R-3❑ R1I❑ S: Storage S-1❑ S,2❑ U: Utility❑ Special Use O and please describe below: Special Use SECTION&CONSTRUCTION TYPE(Check as applicable) IA IB ❑ HA IIB ❑ HA ❑ MO I WO VA ❑ VBO SECTION 7:SITE INFORMATION(refer to 780 CMR 11LO 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 trends or specify: permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes O or No❑ Yes❑ No ❑ SECTION&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: 92 Oakville Street - Office(781)581-7719 Lynn,MA 01905 Fax(781)581-7783 DANDREO BROTHERS GENERAL CONTRACTOR INDUSTRIAL•COMMERCIAL Steve Gorynski Cell 781-520-9308 Project Manager steveg@dandreo::om • SECTION'k PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner 154WIl 1-�1t4 (Eur _<Ax)l0&5 AID sr 54tW, MA 0Iq -70 Name(Print)Jo5;-6 ),1 Lok)Co No.and Street City/Town Zip Property Owner Contact Information: \)1 CC g2g,5 t QEW r 9 78--j;o - 56l o q10 - 915- 31 q 5 i4qo @ 54am ptc com Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes wtQ11AWt 1>A-0DV,9& qa oAKvlllt� 5r 1/Nu, MA o1go5 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 't application- SECTION 10.CONSTRUCTION CONTROL(Please fill out Appendix 2) building is less than 35,000 cu.ft of enclosed space and/or not trader Construction Control then check here U aid skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Al 7302o1��n� 2L yNq- SISG ahalrjerdi@clmlxrg,ca+1 35iJ53 Name(Registrant) Telephone No. e-mail address s ' on Nymber /00 Ge Ns Pd Mwi7lht�wl Mk oay9N ruc ara /<��n aiy Street Address City/Town State Zip Discipline Expiration Date 102 General Contractor jKA);P12Ey ;02oiWe-1z S CO11sTjac(cT/OAJ Company Name A.)166 t 410 DqA.)-00e0 Name of Person Responsible for Construction License No. and Type if Applicable q a MhevWC 57- I-IA)AI RA- 0 H05 Street Address City/Town State Zip 6/ -58/- 701 -6qy- 3-73& WJ DaNn(ZCV @ -PAAJ PIZe-o -cored Telephone No.(business) Telephone No. ceB e-mail address SECTION It,WORKERS'COMPENSATION INSURANCE AFFMAWr(M.G.L.a 152.§25C 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' ance of the building permit Is a signed Affidavit submitted with this application? Yes kr No O SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs:(Labor Item and Materials) Total Construction Cost(from Item 6) 1.Building $ /# Pero Building Permit Fee=Total Construction Cost x_(Insert here 2 Electrical $ appropriate municipal factor)=$45,t . 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 671I eiz:; 6.Total Cost $ A a0'D (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 knowledge and understanding. GJiII/10 A14dt-eo ©fu f 78 77/9 4 / Please print and sign name Title elepho a o. Date 9A 0AV19 V—' �s L v o os Street Address City/Town State i Municipal Inspector to fill out this section upon application approval• , N Date Appendix 2 Construction Documents are required for structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required for this. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where plicable No. Item Submitted Incomplete Not Required 1 Architectural 2 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 IIVAC 7 Electrical 8 1 Plumb" include local connections 9 Gas atural,Propane,Medical or other 10 Surveyed Site Plan(utilities,wetland,etc. 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Suivey/Inveshgation 16 1 Energv Conservation Report 17 Architectural Access Review 521 CMR 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other S 21 Other S 22 Other S *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction.Work started prior to approval may be subjected to triple the original permit lee- Registered Professional Contact Information i 9L/ 9n20J D/ 76i _yNy_ 515� aba/re'rt�l B 6i+t�YryGbt9 36053 Name(Registrant) Telephone No. e-mail address Registration Number !6o Grescr k� /Uerd g a Ba l9�[ /9 4 0 4 Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State zipDP Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zi Discipline Expiration Date CITY OF S U�&%4 '.L%'LXS&-kCHUSETTS 3 SUlWlNG DEP.inm.T 130'W.iSImYG'TONSTttES[,3'"Pt001t TEL(978)70S-959S FAX(978)740-99" KINME3LEY DRISCOLL MAYOR THOU"StPIEW DMECCOB OF Ill MX PROPERTY/8t.'R.DING CO1 Lkl=O.iER CONSTRUCTION CONTROL DOCUMENT Project Title: n-Alf421 FIVR Date: 20 ZO I z Project Location p � �A Scope of Project: _i e. [fin �r, f_�tiit� In accordance with SECTION 116.0-116A.2 of the 6th editions of die Massuhusem State Building Code: 1, FBI i K- 5 0 Mass.Registration Number 3501E3 Ding a registered p rofesaional Engineer/Architect bueby CERTIFY that I have prepared or directly supervised the preparation of all design plats,computations and specifications concerning: [ 1 Entire Project [ ) Architectural Structural ( ) Mechanical [ 7 Fire Protection ( ] Electrical [ l 01her(slectl'y) for the above named project and than to the best of my knowledge,such plans,computations and specifications meet the applicable provision of the Massachusetts State Building Code,all acceptable engineering practices and all applicable laws For the proposed project. Faithetmore,I understand and AGREE that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved by the building permit and shall be reapmsible for the following as specified in section 116.2.2: 1. Review of shop drawings,samples and other submittals of die contractor as required by the construction contract documents as submitted for the building permit,and approval for the conformance to the design concept. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present al intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the wok and to determine,in general,if the work is being performed in a manner consistent with the construction documents. 1 shall submit periodically,in a form acceptable to the building official,a progress report together with pertinent comments. Upon completion of the work,I shall submit to the building official a final r rt as to the satisfactory completion and readiness of the project for occupancy. Signature and Seat of registered professional: - 80ROJERDI StRl1CTURAt 110.35053 i y d A yn q� 1'_. t.Whin`•• l �.' y„� f�fa�I'.."{� "auk a�•iy-Y LD \P �&• dA \ , t-`;tat 6 tt$ u if r - f t) r IF .yP all [" d IS r RUC R PI G NEERS CONSULT04G ENGINEERS DM BERG CONSULTANTS, P.C. PRINCIPALS 100 crescent Road,Sufte lA Se"ING THE INDUSTRY SINCE 1963 Thomas G.Heger,PE,LEER AP Needham,MA Ali R.Borolerdl,PE,LEED AP 02494-1457 David A Berg,PE p 781 444-5156 Peterµ Shedlock f 781 444-5157 w.vw.dmbergcan ASSOCIATES William H.Barry,PE September 20,2012 Mr. Robert Dandreo Dandreo Construction 92 Oakville Street Lynn, MA 01905 RE: SALEM FIVE SALEM,MASSACHUSETTS Subject: Pedestrian Bridge Repair Dear Mr. Dandreo: We have reviewed the concrete repair procedure described in the following enclosure and found that in accordance with the Massachusetts State Building Code and sound engineering practice. We will visit the project site while the repair work is being performed to verify the assumed existing conditions. Furthermore, we will review the probable damage to the existing longitudinal bars and verify that the two continuous No. 5 bars specified in Step 3 of the suggested procedure will be sufficient to address the existing condition. If you have any questions or comments on the above, please do not hesitate to contact our office. Sincerely, DM BERG CONSULTANTS,P.C. ALI R. RO YY g BORQJERDI STRUCTURAL. Ali R. Borojerdi, P. ., LEED AP 4 NO.35053 Vice President �Ac 5O Enclosure AL E p:\proji2\100-199\12174\121741001.doc Design•Analysis•Forensic•Construction Administration•StnEtural Tests and Inspections Peer Reviews•Feasibility Studios•Histodcol Preservation.Building Envelope•Specialty e �'*- �:erc!! v g , ... f ,.'�— :: c �.,*:,-r ♦- �..,x x � � x�� rp�"" rs. �.--> Nz e.�.;'_ `� r �1�%i..� '�7F ���4.�� t.lWb si;r F•. � '®' �'��' f /r ' i ! +t �"�'"rs` 'Z +"�: �f f/ . � � � . ark � ♦ � S i J '� t I OF } .. - .Nei, All 4 s 0 208 ESSEX STREET 282-13 GIs# COMMONWEALTH OF MASSACHUSETTS Map =a '35 `;£ Block: CITY OF SALEM Category ,?`'M! REPAIR REPLACE 1Permit# j�282.13,v v,-i BUILDING PERMIT Project JS-2013 001187';=A.�; Est. Cost:`-,, $10,20000 RX9 Fee Charged: '$75.00 Balance Dne: ; $.00 :� PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Expires: IUse Group: 0' r `z Z! j `;It „Dandreo'Brothers General Contracting & Construction Control-35053 LotSize(sq`.fr) 19165A93�N Owner: SALEM FIVE CENT SAVINGS BANK Zoning 7;:=i.. B5 ,s :nA pm Units Gained `�,„F, '-�� ;Applicant: Dandreo Brothers General Contracting &Masonry LLC Units Lost:,v� zt, ', _:. AT: 208 ESSEX STREET Dig Safe ISSUED ON: 27-Sep-2012 AMENDED ON: EXPIRES ON: 27-Feb-2013 -TO PERFORM THE FOLLOWING WORK REMOVE SPALLING CONCRETE AT BOTTOM OF EXISTING BEAMS & REPLACE WITH NEW PLEASE SEE PERMIT APPLICATION FOR ADDITIONAL REPAIRS jbh POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing Building Underground: Underground: Underground: Excavation: Service: Meter: Footings: Rough: Rough: Rough: Foundation: Final: Final: Final: Rough Frame: Fireplace/Chimney: D.P.W. Fire Health Insulation: Meter: Oil: Final: House# Smoke: - Treasury: !NA' Alarm: Assessor Sewer: Sprinklers: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIO TION OF ANY OF ITS RULES AND REGULATIONS. Signature: u ` Fee Type: 1i7'PORTM4T. Receipt No: Date Paid: Check No: Amount: BUILDING CHA TERUOTION FORD SErE CIC UINSPR1. hRj,u f�07-Sep-12 12489 575.00 EN"BUIL CALL 978-619-564LIST OF REQUIRED IPD pG CODE 1 70 SCHEDULE AN'ISP CTIONS. IN'SECTION GeoTMS®2012 Des Lauriers Municipal Solutions,Inc. FINAL STRUCTURAL AFFIDAVIT To the Inspectional Services Commissioner: I certify that I, or my authorized representative, have inspected the work associated with Permit No. , dated , locus Salem Five Bridge Repair, 210 Essex Street, Salem, MA. Ward (on the dates used below or on at least 1 occasions during construction), and that to the best of my knowledge, information, and belief the structural work has been done in conformance with the permit and structural plans approved by the Inspectional Services Department (and as modified per November 16, 2012 field report for the unforeseen conditions) and with the applicable structural design provisions of the Massachusetts State Building Code, Eighth Edition, and other pertinent laws and ordinances Ali R. Boroierdi, P.E.. 35053 ENGINEER - MASS. REG. NO. ALI R. 9 BOROJERDI DM Berg Consultants. P.C. c STRUCTURAL COMPANY NO.35033 y 9 100 Crescent Road, Suite 1A. Needham, MA 02494-1457 / n ADDRESS (781)444-5156 PHONE Inspection Dates: November 16, 2012 On this 23 day of January, 2013, before me, the undersigned notary public, personally appeared_ Ali R. Borojerdi (name of document signer), proved to me through satisfactory evidence of identification, which was a valid MA Driver's License, to be the person whose name is signed on the preced r attached document in my presence. Official signature and seal of notary) AN�k PETER M. SHEDLOCK ( Notary Public My commission expires t-l6/G y, �M ] COMMONWEALTHOF MASSACHUSETTS My CommlTtlon ExplTea July 29. 2Q16 p94)roji2i100-199V2174\12174-final atf.dm