246 ESSEX STREET - BUILDING JACKET a� � L"ss �x - �t— -
- - _ _._J
38_�Lra
SALEM STATE
t l ..
Iptt�A 2 - � ��C�FOP_p S
o STREET PERMIT
- Citp of balem
Office of Nopecior of jguilbingo
201
.permission is�Sierre6y#0en to
to occupy for i !..�'/�(�! ti�. V f. [ t , purposes
in ronf o eslale
f f ' z To"(
f + ofsi'di✓(e�m}aG� + ofslreel.
1 `3Sis permit is l}niledl
lo ; e ( C U pp .+ , sub ecllo I e
provisions of lSe ordinances'andslalules in"alion to c5ireels anGQ e.7nspeclian
andC'ionslruclion of Tuildn9s in I e Gi y of Salem.
` .Direr/ar o/'h6/ �. .�\ � - 9nrpaclor gf.`lJuildinya
Ii
cSiyna/'v i�:Xpp/rcan/.
. o
STREET PERMIT
Citp of *alem
®ffice of inspector of 3Jguilbings
cif e_mEll -j l h 20
.Permission is SiemSy given to On G�:
10 occupy for
infonlofeslale J74"D ea-
o`sidemaL(r, ofslreel. ,
`.l��ispermilisl}niledlo — 1/-A 20 IS su6'ecl10I e
provisions of lSre oroinancei andslalules in rdalion to c creels andlSie.9nspeclion
andGonslruction of Oarfdnys in ISie Gily of cSakm.,--
Direc/wol'.'fL6/ic cSernce, 9.rpee o�-.Aui/dn'y, `
C5,pi.Orap"(,rL I- 't aj
i
is
SF NE AGENTS COPY
Western Surety Company
CONTINUATION CERTIFICATE.
Western Surety Company hereby continues in force Bond No. 15044103 briefly
described as STREET OPENING CITY
,
fol- E-Z DISPOSAL SERVICE- INC.
as Principal,
in the sum of$ ONE THO SAND AND N0/100 Dollars, for the term beginning
September 18 2015 and ending September 18 , 2016 subject to all
the covenants and conditions of the original bond referred to above.
This continuation is issued upon the express condition that the liability of Western Surety Company
under said Bond and this and all continuations thereof shall not be cumulative and shall in no event exceed
the total sum above written.
V
Dated this 11 day of__54p1emhkx , 2015
WESTERN URETY COMPANY
By Paul T.Br at,Vice President
N,b '
. µ ,
tf� aY
THIS"Continuation Certificate" MUST BE FILED WITH THE ABOVE BOND.
Form 90-A-8-2012
LaMarche Associates
5 North Road, P.O. Box 250
Chelmsford, MA 01824
800-349-1525
Fax: 978-256-8590
January 21, 2016
Building Commissioner/Inspector of Buildings
SALEM, MA 01970
Board of Health/Board of Selectmen
SALEM, MA 01970
NOTICE OF CASUALTY LOSS TO BUILDING
UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 139 SECTION 3B
Claim has been made involving loss, damage or destruction of the property captioned below, which
may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6 to be
applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate,
please direct it to the attention of the writer and include a reference to the captioned insured,
location, policy number, date of loss, cause of loss and LA file number.
Insured: CHRISTIAN DAY
Loss Location: 246 ESSEX ST
SALEM, MA 01970
Policy Number: BOP5018920 12
Date of Loss: 01/18/2015
Cause of Loss: Physical Damage
LA File Number: MA-2-30892
On this date, I caused copies of this notice to be sent to the persons named above at the addresses
indicated above by first class mail.
Kris Kirkpatrick
Adjuster
LaMarche Assoclates,Inc-800-349-1525
Page 1 of 1
...... ... :..:.:.
CITY OF SALEM, MASSACHUSETTS
ELECTRICAL DEPARTMENT
I
44 LAFAYETTE STREET
T
I KIMBERLEY DRISCOLL TEL(978) 745-6300FAx(978) 745-4638
' MAYOR
MARK ROCHON
WIRE INSPECTOR FILE
COPY
I
JUNE 13, 2006
FIRST MAILING
TO: GARDNER ESTATES CONDOS
246 ESSEX STREET
SALEM, MA 01970
SUBJECT: RESIDENT COMPLAINT
DEAR CONDO ASSOCIATION:
j THIS OFFICE WAS NOTIFIED OF POSSIBLE ELECTRICAL HAZZARDS ON MAY
12, 2006 BY TELEPHONE. THE VERBAL COMPLAINT RECEIVED WAS THAT
THE WALLS WERE BUILT PERPENDICULAR TO ELECTRIC BASEBOARD IN
THE UNITS AND ON THE FIRST FLOOR A SHED ROOF IS LEAKING WATER
ON AN ELECTRICAL PANEL.
MAY 12, 2006 THE DOORS WERE TAGGED AND NO RETURN CALLS WERE
MADE TO THIS OFFICE.
PLEASE TAKE THE NECESSARY STEPS TO REPAIR THESE ELECTRICAL
HAZZARDS. THIS WORK SHALL BE DONE BY A LICENSED ELECTRICIAN
AND COORDINATED WITH THE BUILDING DEPARTMENT AT 120
WASHINGTON STREET. A PERMIT IS REQUIRED AND A FINAL INSPECTION
IS REQUIRED FROM THIS OFFICE.
SINCERELY,
MARK ROCHON
WIRE INSPECTOR
CC: FIRE PREVENTION FAX: 402
BUILDING DEPARTMENT: 846
HEALTH DEPARTMENT: 343
� ��� (1�mmm�nmrttl#f� of l�tt,��ttr�uttr
CITY OF SALEM
In accordance with the Massachusetts State Building Code, Section 108. 15, this
4s vs`
CERTIFICATE OF INSPECTION
is issued toy HARUTIUN DERhIE=N.JIAN
I Ttrfit13 that 1 have inspected the premises known as ARARAT SHOE REPAIR
located at 0246 ESSEX STREET in the city of Salem
County of Essex Commonwealth of Massachusetts. The means of egress are sufficient for the following
number of persons:
BYSTORY
Story Cha aacy6%�%76 Capacity Storys6%% %76t5G%s6A � Capacity
u�wx��xxxw�w �s�x�>i9� '���w�sxxs�sx ��C���
BY PLACE OF ASSEMBLY OR STRUCTURE
Place of Assembly - Place of Assembly
or Structure Capacity Location or Structure Capacity Location
BUSINESS 6 IST FLOOR
19`s\
�d
CHANGE OF USE
0019-1998 02/01/1598 OR OCCUPANCY
• Certificate Number Date Certificate Issued Date Certificate Expires uilt ing Official
The building official shall be notified within (10) days of any changes in the above information.
\ 1
••°-, _ � ap coraloNUEA1.TLI of MAssecHDSErrs `1
3, ems`:✓ 10 CITY OF SALEN
\9 APPLICATION FOR CERTIFICATE OF INSPECTION
Date (— Fee Required $
( ) No Fee Required
In accordance with the provisions of the Massachusetts State Building Code. Sectii
108. i5. I hereby apply for a Certificate of Inspection for the below—named premises
located at the following address:
lr N
dStreeett 6 QwDer (k
i QName of � Se9�r l� h hP D YYhAt)
w
C'$'�PurpMe gpt which Premises is used {{—T A I M��� 111Q/1 o
6 U N
2License(V7 or Permit(s) required for the premises by other Governmental Agencies:
J m o encu
— > License or Permit
CM Cn U
Certificate to be issued to: F„..b�ilii `)0✓YYLP 7�t /a i7
Address: a �/) ' S'{ SGI r i i')7Cy/ 9 76
L.owner of Record of Building: m Mo PERTY MCMI INC.-
1 Address: P,0 f30 ), 131 SW&HPSCOI'dtl019D7
Name of Present Holder of Certificate: I( "As kr)eIali2/7yOW
Name of Agent, if aay...
n C Oo ! / TITLE n{OGLti✓
Signature of Person to whom rtsficate
is issued or his/her authorized agent
9/ �j, ,
4/ DIate
INSTRUCTIONS: Day time phone
1. Make check payable to: The City of Salem of Salem
2. Return this application with your check to: Inspector of Buildings City
Building Department. one Salem Green. Salem. MA. 01970.
PLEASE NOTE: or atructu
L. Application form with required fee must be submitted for each building
of part thereof to be certified.
2. .application 6 fee must be received before the certificate will be issued.
3. The building official shall be notified within ten (10) days of any change in the
above information.
THIS AREA FOR OFFICE USE ONLY
O� Qn
CERTIFICATE I ` r L � EXPIRATION DATE: a�
,Uv �dD
PERIODIC INSPECTION REPORT
This form is to be completed each time a Periodic Inspection is made. At the time
a new Certificate of Inspection is issued, a notation indicating that the fee has
been paid will be made to Application Form prior to the new Certificate of Inspection
being issued. Any changes since the last inspection are to be added to the file card
of the premises.
Street 6 Number / / 5 S C-' 7c� �5 / -'-r
Name of Premises /7 �" r? Y' >� OF*- /C e'e� '
Certificate to be Cissued to: /-1 ✓�,�a r r? 7 -54z' F
Address / ( 6S S ,$ I /FF r
Owner of Record of Building ✓t /11v9 c (
Address ✓ju X �� S W 'a / l /� 5 e
Purpose for which premises are used ,.5 h c E /'
Changes since last Inspection (required on file card also)
1.
2.
3.
4.
5.
Date Order Issued:
Order Issued To: Address
Date Violations Corrected:
REMARKS:
I have this day inspected the above premises, and the same conforms to the pertinent
requirements of the Massachusetts State Building Code and the rules and regulations
pursuant thereto.
� - / - �S—
Date ,Building Official
Certificate / I C� Date Issued:
Date Expires: I l r l
Recommended Next
Inspection:
� �i�r (�mnutnnznrttl� of �tt��ttr�t�p�t�
r
a CITY OF SALEM
In accordance with the Massachusetts State Building Code, Section 108. 15, this
CERTIFICATE OF INSPECTION
is issued to
�(ye•LifLJ that I have inspected the premises known as
in the city of Salem
located at
County of Essex Commonwealth of Massachusetts. The means of egress are sufficient for the follotoing
"s
dzi
number of Persons:
BYSTORY
Stor Capacity Story Capacity
Story Capacity Story Capacity Y
BY PLACE OF ASSEMBLY OR STRUCTURE
Place of Assembly Place of Assembly
city Location
or Structure Capacity Location
or Structure Capa
C' S 5
6 /s i
Building Official
Certificate Number Date Certificate Issued Date Certificate Expires
The building official shall be notified within (10) days of any changes in the above information.
What is the current use of the Building? units4
Material of Budding? if dwelling,how many
vviti the Building
Conform to Law? Asbestos?
Architect's Name ( 1
Address and Phone
Mechanies Name
Address and Pion aa$3 l�+tic Registration r 0 I q
�#yion SupervisorsLicense M �
Estimated Cost of Prof SAI-ma PermM Fee Calculation
permit Fee S� Estimated Cost X$I/S1000 Residential
Estknated Cost X S11/i1006 CommerGal —.-_An Additional$5.00 Is added a$an
Administra"charge.
Make sure that all fleids are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building permitnnto build to the above stated
specftad". signed under penalty of Perjury
Date
N
5 �
N
Ct
L �
� o
v96
0
7SXLE,t
PUBLIC PROPERTY
DEPARTME,�1T
k,.,GIERLEY o.MCO,.
wra
130w 5imer0 '•.W4HANA0&ShXM01970
TEL M745-9S"•FAm M710.9W
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
ITI DEMOLON, OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDi1N
1.0 SITE INFORMATION
Location Namc / L suilding:
Property Address
Sty l�rtm o I q
Property Is located In a:Conservation Ares Y/N Historlo 0 M
2.0 OWNERSHIP INFORMATION
2.1Ownera(Land ti e S�C[�7On
Name: } Il Y u-hi u n e r m'✓r) L OLNO
Address: I t o Lowe,t t 5t '# 8
�le 19 019la-
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN FnVMONLYNLY
Addition
Renovation Number of StChange in Use Demolition Approximate year of Area per floor construcction or renovationof existing building
Saef Description of Proposed Work:
.J
Mail Permit to: 2 T,u n wren t C1 ,J
-11 cos
Mtqa
I �{ Z
f
jj (Y�( 7C V5 Cz�N O L_TVZ -/,
. The Commonwealth of IVIRE"11
} Board of Building Rd"flFtlGiTh�d�� tGES CITY OF
M
Massachusetts State BuildingCode, 780 CMR Sd thir
Revised,Nor 10l I
Building Permit Application To ConstrM51% i henkCbMemolish a
One-or Tivo-Family Dwelling
This Section For Off¢rl Use Only
Building Permit Number: Date.Appiled,
Building Official(Print N.une). Signature, D to
SECTION I:SITE INFORNIATION'
1.1 Property�i 1.1 Assessors Map&Parcel Numbers
T I.I a Is this as acce tad street?yes no Map Number Parcel Number
1.1 Zoning information: 1.4 Property Dimensions:
"Coning District Proposed Use Lot Area(sq Ill Frontage(11)
1.5 Building Setbacks(ft)
Front Yard Side Yams Rear Yana
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zunei _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if es❑
i SECTION I: PROPERTY OWNERSHIP!'
2.1 Owne t Reco I, /
�me(Print) � o � ity`State, P)
No.and Street Telephone Email Address
r SECTION J: DESCRIPTION OF PROPOSED WORKS(check4 that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ 1 Number of Units Other ❑ Specify:
Brief ascription ropose k=:
SEdl N 4:ESTINIATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use,Only
Labor and Materials)
I. Building $ I. Building Permit Fee:$ Indicate how fee is determined:
2. Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cose(Item 6)x multiplier x
J. Plumbing $ P ether Fees: S
4.1tcchanical (FIVAC) S List:
5.Mechanical (Fire S
Su ressiun) "total All Fees:$
Check No. Check Aniount: Cash Amount:_
6. Total Project Cost: S ❑Paid in Fail 0 Outstanding Balance Due:
1
t
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) ^
License umber Espir• ion ate
I alp,
Name of CSL Holder List CSL'rype(see below) _
Type Description
No.;
U Unrestricted Bull ings ug to 35,000 cu. ItJ
R Restricted 1&2 Family Dwelling
Cilyll'uwn, tale,ZIP t
M IMasonry
RC Roolin Coverin
WS Window and Sidin
SF Solid Fuel Burning Appliances
1 lnsulalion
' Email address D Demolition
• Tcle hone
5.2 Registered Home[ tprovementQntract r(HIC)
�>= HIC Registration Number #pir otioniiate
1IIC Company Name or HIC Registrant Name
f No.and a Email address
Ito
City/Town,State ZIP Tele one
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e.151§25C(6))..
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the lsivancpofthe building permit.
Signed Affidavit Attached? Yes.......... No...........❑
SECTION 7a:OWNER AUTHORIZATION.TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR AP P E9 FOR BUILDING PERMIT'
I,as Owner of the subject property,hereby authorize
r
t t9 act on my behalf,in all matters relative to work authorized by this building permit applicati
t Print Owner's Natne(Electronic Signature) ate
+ SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By enteri my ame be w, I hereby attest under the pains and penalties of perjury that all of the information
containe in is t lic on ' rue and accurate to the best of my knowledge and understanding.
Pnn Owner or rlutho zc r gent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will nor have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
wtwv m iss eov:'oca Information on the Construction Supervisor License can be found at www•.mess.l+ov'Jns
2. When substantial work is planned,provide the information below:
'total fluor area(sq. ft.) ' (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open_
1. "Total Project Square Footage"may be substituted for"Total Project Cost"
The Commonwealth of Massachusetts
/ Department of Public Safety
Masoctmselts State Building Code(780 CMR)
Building Permit Application for any Building other than a One of Two F Dw
Section For Official Use
Building Pe;nitNumber: Date Applied But7dingC+ffkial:
SECTION L•LOCATION(Ykase indicate Block 0 and Lot•for locations for which a streA not available)
y
No.and Stream City/Town Zip Code Name of Building(if applicable)
SECTION 2:PROPOSED WORK
F-dibou of MA State Code used it If New cm%struction duck here El or check all that apply in the two rows below
Ebsting Building 0 Repair 0Alteration Addition O Demolition ❑ (Please fill out and submit Appendix 1) }
Gtange of Use O Change of Occupancy .[7 Other 3 Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ir No 0
'Ls an Independent Stmchnal Engineering Pea Review ? {{ Ye@ O N O
Bri best ription of Proposed Work:-f-1r4+ �gJ� ✓te all 6 i11 f (p Ca } t i1 f a i
--o
r
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION.ADDITION,OR
CHANGE IN USE OR OCY TTPANCY
Check here if an Existing Building investigation and Evaluation is enclosed(See 780 CMR 34) O
Existing Use Group(s): Proposed Use Group(s)-
SECTION 4•BUILDING HEIGHT AND AREA
ExiMang Proposed
No.of Roors/Staies(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft)-
SECTION b:USE GROUP Cheek as Ikable)
A- AssemblyA-1 O A-2❑ Nrghtclub ❑ A-3 ❑ A-4 O A5 O B: Baehaee ❑ E: Educational ❑
P. Factory F-1 O F2❑ I H: High Hazard H-1 O H 2❑ H3 O H l 0 H-5 O
I. rnetitational I-1 a 1-2 O I-3 O 14 0 1 M: Mercantile O R: Residential P-1O R-2 T] R3 W R 10
S: Storage S-1 O S2❑ IU: Utility❑ Special Use O arm please describe below:
Special Use:
SECTION be CONSTRUCTION TYPE(Cheek as litable)
lA - IB O IIA O no !] 1 MA 17 MR 17 j TV C3 1 VA O VB d
SECTION 7:SITE INFORMATION(refs to 780 CMR 1IL0 for details an each item)
-Trench Perm Debris Removal:
Water Snppp)r Hood Tone Information: image Disposal: A trench will not be Licensed Disposal Site O
Public tp Check if outside Flood Zone Indicate Municipalwired ld or trench or specify:
Private❑- or indentify Zone: or on site system O permit is enclosed❑
Railroad dgM'of Hazards to Air Navigation: MA Historic Commission Review Process
Not AppBcabie[9( Is ShWhue within airport area? is their review completed?
or consent to Build enclosed O Yes O or No Yes 0 No O
SECTION s:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code:��Use Gmup(s): Type of Conshvc r Occupant Load per Floor:
Does the building contain an Sprinkler System?: Special Stipulations:
i a
i
SECTION* PROPERTY OINNER AUTHORIZATION
Name and Address of Property Owner bp-i 1 2y6 EyseY I?-y � A Q1g7(Z
Name ) No.and SU t City/Town zip
Property Owner Contact Information:614, � ( `Ye�i K—I �i/�'t�1hQ(�e�D/1►
title,. Telephone No.(business) T No. (CA
If applicable,the property owner hereby authorizes
Name Street Address City/Town State Zip
to act on the property owner's behalf,in all matters relative to work authorized by this building application.
SECTION M CONSTRUCTION CONTROL(Please fill out Appendix?]
(if buik*m is less than 31A=ca.R of enclosed and rant vaderC.mniftuctionCmnol the0dw there 4d sUp Section 10.1
101 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 Gineral Contractor
C. 0, '16(
pony Name
/ ( ucIIgA<- 012 ) D6 — CAD
Name of Pehm Responsible[or on License No. and Type if A licable
t-1 1A/,, I t�rr � � a � �w1IM 147/�
Street Address City/Town State Zip
'OL-15q-41C 1A i G�(G(-F�( nP /�14IfA5t-I1e
Telephone No. Telephone No. cell e-mail address
SECTION M WOR IC SA O SIJRANCE AFF VIT G.L.c.152.§25C
A Workers'Compensatiwt 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 issuarwe of the building permit.
Is a ' Affidavit submitted with this application? Yes(� No O
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Estimated Item m Coals: Total Construction Cost(frost Item 6)
and Materials) Total
1.Building $ Building Pewit Fee=Total Construction Cost x_(Insert hem
Z Electrical $ appropriate municipal factor)_$
3.Plumbing $ Note:Minimum fee-$ (contact municipality)
4.Mechanical (HVA $
5.Mechanical Otter $ Enclose check payable to
6_Total Cost $ l/ (contact municipality)and write check number here
SECTIO 13-SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I hereby atteq under the pains and penalties of perjury that all of the information contained in this
application is true and acauate to fire beer krnowledge and understanding.
Please grant and n RA -Wee rite -, ,Telephone No. Date
a-r
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval
Name Date
I'lie Conunonsveallh uF bl;usachusclls
Board or Building Regulations and Standards CITY OF
Massachusetts State Building Code. 7SO(•MR �•\Ll:\I
Building Permit Application To C'onslruct, Repair. Renovate Or Demoli a
One-ur Tuw•Pirnnh•Dn eRin,tr
This Section For Ieial sc On1
Building Permit Number: -- Do Ap ' d:
Building( Ilicial(Print Niune) /
Dula
SECTIO 1:SIT IN AI ION
1.1 Property Addres • 1.2 it rs Slap Ss Parcel Numbers
I.la Is this an acce led street? es no Hp Number Parcel Numlrer
1.3 Zoning Information: 1.4 Properly Dimensions:
Cursing Disuicl I'ropuseJ lJse Lot Area(sy Ill Frontage(II)
1.3 Building Setbacks(R)
From Yard Side Yards _ Rau Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.I.c.40.§34) 1.7 Flood Zone Information: 1.1 Sewage Disposal System:
liiblic❑ Pricme O Zone: _ Outride Flood Zone?
Cheek if es❑ Munieipd❑ On site disposal s)stein O
SECTION2. PROPERTYOWNERSHIPs
2.1 Own o a ord:
Maine(Print) (lly,Staut '..1111
Nu.unJ Scree f ��•7 ��
fvlephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(Check all t at apply)
New Construction O Existing Building❑ Osvner•Occupied ❑ Repairs(s) Alteratlon(s) ❑ Addition O
Demolition ❑ Accessory Bldg.❑ Number of Units Other Specify:
Brief Description of Proposed \Vork-:
If
SECTION q: ESTI,M.NTED CO, STRUCTION COSTS
hens Estimated Costs:
I Lahur and.Materials) OMclal Use Only
I Building S I. Building Permit Fee: S Indicate how fee is determined:
12. I:'leclrical S ❑Standard City.-Twro Application Fee
1. I'luwhing S ❑Total Project Cosl'(Item 6)x multiplier
S. Other Fees: S-
J, \lac h.micul i1111('1 S List:
\ledt.micul iFire
`u++rcisionl S rotal .\IlFces: S
n Tuwl Prnject Cu+t S (he" No, _ ( heck
0 Paid in Full O Outstanding 11al,mce Due:
SECHONS: ('ONSI'RIT`PIONSERVI(TS
S.I ('unstru ti) Supenis leenset0l.) G7�� 7�"r
, lm ,I V
N,une111'l'SI IaLI Yam( Itit01. I\pclseclmlul+l.--. —.._
Na. .uIJ�tFeel - - 11 14veslridcJ I Iluddin Is li ul t{,II+II)nl. IL1
It Re,irmcJISMPJmil DTcllin
M \heal
KC Rlwlin Cu+erin
W'S N'indow.mJSidin
. SF Solid Ivd hominy,\pplianccs
I Inslluliun
Do
19n;u1 aJJruaa D Demolition
1'elc 111olic ef
*Nlrilll,/'-�S.2 Registered mpr s inel 1 @onMrlc or IJ11 U to
IIIC ' u u or IC Ir
l:lnall address
Ci own,State ZIP tole hone
SECTION tit WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L e. Il2. 25C(fi))
Workers Compensation Insurance affidavit must be complet d and submitted with this application. Failure to provide
this atlidavit will result in the denial of the Issuance of wilding permit.
Signed Affidavit Attached? Yes.......... No•••.•••• (3
SECTION 7a:OW NER AUTHORIZATION TO BE COINPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
i,as Owner of the subject property,hereby authorize -
ti
to act on my behalf,in all matters relative to work authorized by this building permit application.
Dw
Print U+sncr's Nwne(1:1991 unto Stynalure)
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
By enteri ny name below, I hereby attest under th ains d penalties of perjury that all of the information
cotltaine in tht applicati 's true and accurate i e b m owledge and understanding.
G III � Dul
Ihinl llwner's ur:\uduvireJ,\dent'.+� 12
wnull, ecuul '•. I natural
Vons:
I. .\n Ossner who obtains a building permit to do It is own work,or an owner who hires an unregistered contractor
(nut registered in the Hume hnpruvenlent ConlmctorlHIC) Program),will no have access to the arbitration
program or guUN111) fund under M.G.L.c. la?.>.other important information an the HIC Program can be found at
„p,% ,II , ,•, I Information on the Construction Supervisor License can be found at—,,% W 1,; V\ -
u`1
\Then substantial work is planned•provide the III urination below:
total flour urea t iy. I).1 - ____.._I including g;uage• finished basement allies.Jocks or pordU
f labitable room count _ -. ..
)truss h%ing area l sq. IL I ._.... �uulher of bedrooms
Nunlberol'tirel,laces - -_ Guuberoflmll'haths
\unlher kit'hathroouls . . Nunlherol'Jceks porches
I\peat heating i)aen+ I'nela,eJ ..(\pen
� l 1 pe pt<Calnlg 5\tlelil
t. "I',dal Project \Ilnllrc I'aPIJQemlll I`e tllbilltlned li`r l'otal Project
Permit Number J kV y�
0 APPLICATI N P�E TO ERECT A SIGN
u + NOTE: BUILDING PERMIT MUST BE OBTAINED BEFORE SIGN IS ERECTED
jt Location, Ownership and Detail Must Be Correct, Complete, and Legible
Salem, Massachusetts �� y
Date
To the Building Inspector:
The undersigned hereby applies for a permit to ❑ Erect, ❑Alter, ❑ Repair a sign on the following described buildings:
Street Address Zoning District
C�V � SLX ❑ Urban Renewal Area ❑ Entrance Corridor
I ❑ Historic District ❑ None
s0-h(zri,��T Use of Building
Telephone -) _ Li a 1' floor
• •T a 2 floorRest D Tla
AddressQH(e 3` floor RQ D t o1
Telephone _ 0 4 floor
E-mail Chpnsuaii,5 Sol G How many businesses are in the building? 13
If a corporate body, name of responsible officer
Building .5 0 linear feet
Construction Sup's License No Applicant's Space(if multi-tenant)a Q linear feet
Address Property linear feet
Telephone Mail Sign Permit to
E-mail Xzjign Owner o Sign Erector ❑ Other:
1 Proposed Signs (If more than three signs are proposed, attach additional sheets)
Sign 1 Sign 2 Sign 3
❑ Surface ❑ Surface ❑ Surface
❑ Right Angle to Building ❑ Right Angle to Building ❑ Right Angle to Building
❑ Free Standing ❑ Free Standing ❑ Free Standing
❑Awning ❑Awning ❑Awning
)kPortable(A-Frame) ❑ Portable(A-Frame) ❑ Portable(A-Frame)
❑ Other(specify) ❑Other(specify) ❑ Other(specify)
Sign Materials 1)LAST IC, Sign Materials Sign Materials
Sign Dimensions y 4 Sig;.n Dimensions Sign Dimensions
2 ,
Sign Area Sign Area Sign Area
Jr.$ s ft s ft sq ft
Sign Height(if free standing) �} Sign Height(if free standing) Sign Height(if free standing)
Estimated Cost of Net Work
Existing Signs
Type Sign Area To Be Removed? Sign O er
a e sq ft ❑yes ❑ no
It
Angle to Building sq ft oyes ❑no
N F e$landing sq ft ❑yes ❑ no Sign Owne iz R resen
❑Awning sq ft o yes o no
;/Other(specify) -Ei . sq ft ❑yes ❑ no
Pro erty caner I
Internal Review
l
Planning&Community Development Department Historical Commission
Approval
�vg7rM
Building Inspector
08/24/10 rev
-t2Z� .
1 flu LL' I ;L'
The Commanwte ,titTiCofiMa'ssachus_Its
=0) B
h rkh'drt Department of Public Safety
MassachusettsStatI(7 C=%R)uilding Permit Application for any Buil �L o-Family Dwelling
t (This Section For Official Use Only) _
' ^ Budding Permit Number: Date Applied: _Buddirig Official: -
U JgEdItion
ION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available)
3 S! 0zlf70 i
reet City/Town Zip Code Name of Building(if applicable)
SECTION 2:PROPOSED WORK..
f MA State Code used [f New Construction check here❑or check all that apply in the two rows belowilding❑ Repair Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No
Ism Independent Structural Engineering Peer Review required? Yes ❑ No
Brief Description of Proposed Work: c
79
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY -.
Check here if an Existing Building Invest' on and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): I Proposed Use Group(s):
SECTION 4:BUILDING HEI AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Ar er Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTIONS:USE CROUP(Check as applicable) - -
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional 1-1❑ 1-2❑ I-3❑ 14❑ M: Mercantile❑ - R., Residential R-10 R-2❑ R-3❑ R4❑
S: Storage S-1❑ S-2❑ U: Utility❑ Special Use O and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
i
IA IB ❑ IfA ❑ IIB ❑ illA ❑ 11 1V ❑ VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 C,AIR 111.0 for details on each item)
Trench Permit: Debris Removal:
Water Supply: Flood Zone Information: Sewage D' pasal: _
Public❑ Check if outside Flood Zone❑ Indicat umcipal❑ A trench will -be License)Disposal Site❑
Private❑ or indentify Zone: or Sewage
❑ required r trench or specify:
per is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: nL4 ifistoric Commi_,:.ion R ,w,,_i'nncss:
Not Applicable❑ Is Structure within airport appro area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Cole: Use Group(s): Type of Construction: Occupant Load per Floor:
Does the builJhig contain an Sprinkler System?: Special Stipulations:
M A t Co tJz-. t i ��
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address Pro erty Owner
� �' S%
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
2;7
Title Telephone No.(business) Telephone No. (cell) e-mail address
ff applicabl th'e.Perty o er here y authorizes
�y� S! 5,4��wf � 019�w
Name U Street Address City/Town State Zip
m act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) -
If building is less than 35,000 cu.ft.of enclosed space and/or/ not under Construction Control then check here O and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control -
Name(Registrant) Telephone No. e-mail address Registration Number//A,
Street Address City/Town State Zip Discipline Expiration Date
- 10.2 General Contractor
Company Name Z`G 5_4 d
&I �7.I1/ �e_ /Sa 5-7l7
Name of Person/ � r179b1M r Construction t .-License No. and Type if Applicable
LL f� ��°°��VV�L-- / /
Street Address City/Town State Zip
Telephone No. business Telephone No. cell a-mafl address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVI'f 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 17 No ❑
SECTION 12:.CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$
1.Building $ Building Permit Fee=Total Construction Cost x_(Insert here
2.Electrical $ appropriate municipal factor)_$
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$�contact munici lality)
5. Mechanical Other S Enclose check payable to J
6.Total Cost $ Zr�� (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 knowledgeand understanding.
/ 'norPlease pri t1 signfir r///`_T tlti lepho Date l�
Street Address /o /CityIT000wn// State Zip '
Municipal Inspector to fill out this section upon application approval: /
Name Date
bF� dc7'e � IL�