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395 ESSEX STREET - BUILDING JACKET �95'c��s�'�� caA� CITY OF SALEM, MASSACHUSETTS f� PUBLIC PROPERTY DEPARTMENT e_ 120 WASHINGTON STREET, 3RD FLOOR SALEM, MASSACHUSETTS 01 970 TELEPHONE: 978-745-9595 EXT. 380 M 0 FAX: 978-740-9846 KIMBERLEY DRISCOLL MAYOR November 1, 2007 To Whom it May Concern: RE 395 Essex Street: According to our records, it has been determined that the property located at 395 Essex Street is a legal grandfathered non-conforming 6 unit dwelling located in a Residential Two family zone R-2 This is to determine use only and in no way is meant to confirm or deny whether said property is in compliance with all building, plumbing, gas, electric, fire or health codes. Sinc e y, f ^'Jierre - Thomas St. Zoning Enforcement Officer Sep 12 2011 2: 05PM HP LRSERJET FAX 9784656607 p p. 1 may` No- The Commonwealth of Massachusetts I}p Department of Public Safety 1j�(1 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) - '&ullding Permit Number.. Date Applied: Buildmg Official: 5ECDoN3:LOCATION(Please indicate Block#and Lot 0 for locations for which a street address is not available): 5-,.t Ld-,t © ( ci 7U No.and Street City/Town Zip Code Name of Building(if applicable) SEtTION 1 PROPOSED-WORK .. .,. . ... Edition of MA State Code used_ If New Construction check here❑or check all that apply in the two rows below Existing Building,$ Repair Alteration ❑ Addition❑ Demolition ❑ (Please EilI out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ 1 Other ❑ Specify: Are building plans and/or construction documents being supplied as put of this permit application? Yes ❑ No N Is an Independent Structural Engineering Peer Rev�" + required? Yes ❑ No Ilk Brief Description of Proposed Work: lzG �Y�t'319 F /y?C 1-Sil r✓tj Ja i rt-� (�,ptp(r! t E t">}l 3 '1-44 5714 it-6 le, SECITON 3vCOM0LETE THIS,-SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDIPION;:OR -- CHANGE IN USE OR OCCUPANCY - - - - Check here if an Listing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA - Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION S:USE GROUP(Check as a livable) - A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4 ❑ A-5❑ B:'Business O E: Educational ❑ F: Facto F-1❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H4❑ H-5❑ 1: Institutional I-1❑ I-2❑ -I-3❑ I-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ Rif❑ S: Storage S-1❑ S-2❑ Uo Utility❑ Special Use❑and please describe below: Special Use: SECTION&'CONSTRUCTION TYPE(Check as applicable) IA ❑ 1B ❑ IIAO JIB ❑ IIIA ❑ 1HB ❑ IV ❑ 1 VA ❑ VB O SECTION 7:SITE INFORMATION(refer to 790'0MR 111.0 for details on each item). Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit I Debris Removal: Public Check if outside Flood Zone❑ Indicate munidpal`6d A trench will not be Licensed Disposal Site❑ Private❑ or indentify Zone:_ or on site system❑ required❑or trench or ecr,'ffyy permit is enclosed IFiLtLIaGQ Railroad rightrof-way: Hazards to Air Navigation: MA Uistoric Commission Review Process: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ 1 Yes O or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor. Does the building contain an Sprinkler System?: Special Stipulations: Sep 12 2011 2: 05PM HP LBSERJET FRx 9784656607 p. 2 l ( SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Aa rnleult-r 1.l'itt rV'LA pox / y3z) 0195 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Title Telephone No.(business) Telephone No. (cell) a-mail address If applicable,the property owner hereby authorizes Name Street Address- City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized this bull permit application. .$13CTION 10 CONSTRUCTION CONTROL(Please fill out Appendix 2) building is:less thzn-35,000 M.it of enelmed space and/or not under Construction Control then cheek here:O and Aci 'Section 10.1 .. 1k1 lle istered Professional Responsible for Construction Control Name(Registrant) Telephone No. a-mail address Registration Number Street Address City/Town state Zip Discipline Expiration Date 10-2 General Contractor - .. - ... . Company Name 155 8 q04 w C. C'& �5��2J ► �.cx i ccon ns Su�,er ri sc� Name of Person Responsible for Construction License No. and Type if Applicable l4-1 fet✓ST T7-• S,,4 -15Pi17, 04 ©le? z- Street Address City/Town Stare Zip gii&A6 03o-7 jig _ZZo_ 8 — vr�el. rimcir5n��comcros# tnet Telephone No. business Telephone No. cell e-mail address SECTION,11: FRS' MR 710 IfRANCB AFFIDAVIT M.G.L.c.153. 25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a m ed Affidavit submitted with this application? Yes❑ No E3 SECfIO1V --:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ d Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ appropriate municipal factor)_$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minbnum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By enteringmy r ne below,I hereby attest under the pains and penalties of perjury that all of the information contained in this appl' �on is and accurate to the best of my knowledge and understanding. 1'Jir42�7Please print and sign name Title Tel Date Street Address City/Town state Municipal Inspector to fill'out thissectionupon application approval: - - � � Name tl V 61 Date ` `7 z '" H 2 4S� 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 Ys not available) 3'15 f>ALr-_H. MA 0�950 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 19'� Repair tr Alteration ❑ 1 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 tR' Is an Independent Structural Engineering Peer Review required? Yes ❑ No OP' ..Brief Description of Proposed Work: >Z 4 1 r P L c vtn/3 r / r s. I j' — w !1 -Z w n J9��+Yo O Wt S SECTION 3:COMPLETE THIS SECTION IF EXISTING.BUILDING UNDERGOING RENOVATION,ADDITION,.OR r •<" -�. CHANGE IN USE OR OCCUPANCY 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 - Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) ZO-00 Total Area(sq.ft.)and Total Height(ft.) ,3 Soo p 4. '• - SECTION 5:USE GROUP(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: Hi Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ 1: Institutional I-1❑ 1-2❑ I-3❑ I-4❑ M: Mercantile❑ R: Residential R-10 R-211 R-3❑ R-4 S: Storage Sl❑ S-2❑ U: Utility❑ S_vecial Use❑and please describe below: Special Use: SECTION.6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA O IIIB ❑ IV O 1 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 51" Check if outside Flood Zone V Indicate municipal V A trench will not be Licensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ required❑or trench or specify: permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable 01' Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No Er Yes❑ No • SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: sQss 4-0 CZ L LLl8 C f r SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner A ,llgf e r^w ,t_y in1u/v-1. ems; 136x /L/�-o .v[jPi Dfyso Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Y"av1< A� P�e_ 97�-- zoo - 4el?`Y Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the p,rppperty owner hereby authorizes (havl X1)--� l(� P-bX /tfSv &:!?-i -PC-T P-,1 rA © I `1 SO Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 0 and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control ` .0Aa-9- AubE:J_F_ 6t79' Vo- 4 3q 6 �s s� �acomceis+, t Cs-OS5725 Name Registrant Telephone No. a-mail address Registration Number O '�0X1'-�R'0 AA- 0Vg5D Cos' .Sv4 , tt I"a I 1 Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor 9_kQ&`S ISLAND, Uc— Company Name MA�lzk AUDE_1V_G N1G *; 155S`Io/CS-085'12-S Name of Person Responsible for Construction License No. and Type if Applicable FO 13OX kq,90 NFw9>J214P0Q� MA DASD Street Address City/Town State Zip j2L_L(o5 0 30-7 7$_IVD- 4 93 Lj r nctsis\and @C&(YI A,,t Tele hone No.(business) Telephone No. cell e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§25C(6))r.. A Workers Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of a'ssuance of the building permit. Is a signed Affidavit submitted with this application? Yes No O SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ 'Z 6 0 . Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ /, 0 0 6- r o appropriate municipal factor)_$ 3.Plumbing $ 006- 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ (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 a�pppllication is true and accurate to the best of my knowl and understanding. JM^V'1� UJ1 �tL � ySze- � �- � 70- c( �Jy Ple a print and sign name — Title Telephone No. Date UX /Y'S10 /t'"(0—t-v(S✓tYP0 tit 45D Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: 9 ' Name Date The Commonwealth of Massachusetts Department ofPublic Safety - Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One or Two Family Dwelling ..arf:. dt ,A„ „�'tu�;i't ;('ChisSecflonF'or Official Use.OnlY) ,"=..'" V"'.= `"!�_s' �xw,.' _a(-�. : Building Permit Number ." ,. Gu '1k `,Date Applied r` =,« ,-'`•`_'.-! ;Building Offictal illlr"'"'� 4 ?V�tp . � � ' a "'-'- ,nV`' SECTION 1-'LOCATION(Please indicate Block#and Lot#for locations for which a street address is npt available) .. 39 S lz 52:�-2e Sat.-r-t t, o c 9 -7 o No.and Street City/Town Zip Code Name of Building(if applicable) VVv,.°zIn SECTION 2:PROPOSED WORK, .rues 1 �.�'!`('u?e;Et,',-" ;�+r tt ,. iV Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Building A FRepair Ef I Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ 1 Change of Occupancy ❑ _ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Is an Independent Structural Engineering Peer Review required? Yes ❑ No V Brief Description of Proposed Work: V-M P^i v- t..- 'T—v5 f++ 17YI G.-- VA-- C'v eSECTION 3:.COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION'R.DDITION,OR''~;_ zr :. CHANGE IN USE OR OCCUPANCY:G ''. rZ '.�' %^'?ir n l��_(F �'"-�r'. `�w.F :"f«i,! Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) O Existing Use Group(s): Proposed Use Group(s): SECTION4'BUILDING HEIGHT:AND AREA'4" 0-,WV- Existing yProposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION S:USE GROUP(Check as applicable)h rF#a , A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ F B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1 ❑ I-2❑ 1-3❑ 14❑ M: Mercantile❑ R: Residential R-111 R-2❑ R-3❑ R-48L S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use ❑and please describe below: Special Use: 2; a „ . .i+ks• y i. . «_.._'� ;s SECTION 6:CONSTRUCTION TYPE(Check as applicable)' ':_k, Mtnifs,+F+w 'i 4+. IA Ill IIA ❑ IIBO IIIA0 IIIB ❑ IV ❑ 1 VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Licensed Disposal Site❑ Public� Check if outside Flood Zone❑ Indicate municipal N A trench will not be P required)l or trench or specify: 0ytVf-� Private El or indentify Zone: or on site system❑ permit is enclosed❑ P fir I S'Tr1�.N Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicablel?5 Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No 9f Yes❑ No ❑ 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?: /%10 Special Stipulations: SECTION9: PROPERTY OWNER AUTHORIZATION A _ �E€ siiFhilSii€ Name and Address of Property Owner Av0-'-et FAv...tc y Lt�, y iV�S ,— (rla�c t y $y /✓ . fs� r��rZ�� p �I�YSO Name(Print) No.and Street City/Town Zip Property Owner Contact Information: MAt2K Avkf)--"tip q-7k_ 2'70--L4$.?`l Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. �$ ` X v r, ' ( t SECTION 10 CONSTRUCTION CONTROL'(Please fill out Appendrk 2),!9 r iy .,. ... ._. . - _ a uv g "s I If liuddin is less than 35,000 eu Et.of exiclosed s ace and or riot under ConstrueBon.Control therrrheek"here❑acid ski10.1 ' `.1111 10.1 Registered Professional Resp onsible for m. _- ?'0mIs 0 k!',. Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date .10.2 General Contractor ,O "r`: 6 " F"^ �=;'f„eE....,.. :., m !., �'-n'u,tA.'IPkk ..rE�w�..r_" Company Name -_� -A CS $5-7Z5 KA G$L _//�•Vty�L f} t�t�¢ft # 1558clO — 1-IA +41G- Name of Person Responsible for Construction License No. and Type if Applicable 15d70 1 " a-0 Neu,y�l �y�tvr M 0195o Street Address City/Town State Zip Telephone No. business Tele hone No (cell e-mail address ' ".SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.Lt c.152.§25C 6 . MK;,!' A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes❑ No O kv i.„_SECTION 12:CONSTRUCTION COSTS AND PERMIT;FEE =,. �a Item Estimated Costs: (Labor and Materials) Total Construction Cost(from Item 6)_$ 3.SC1(9 1.Building $ 3 1.6 Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)=$ 2`T,.K O 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ 3 S OOP — (contact municipality)and write check number here $", ,_ SECTION13:,SIGNATUREOFBUILDINGPERMITAPPLICANTn ,c� ��`I'y ` i;I `r ,,,,y';F':: By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application i and acc ate to the best of my knowledge and understanding. v5 - � J PleaseQQppri�t and si`Q�n/naame �t Title _ Telephon o. Dat I�l� l l 4 V /"G L--! jj yL Street Address City/Town State av4 yF�ryi hIn' r� 4t i ei�, nrc4a � iFI�ff r R.vy#ti Municipal Inspector to� fill out this section upon application approval "') ..Name' .:*: v;; Daf "'t. u e /' � ::�� Cf"t';" C)1' Sr1i l Rat �C�I3fJC t.C)YJ 7t:R'l" I �Unl Rl.l�h'lll ICCOIJ. 1lYUF t 0`X''i$tOh 1)- aAtl l 14' 11.$�A t I I Q:I f JI'1„a 'In r.>?aS il,%iol.-��-v d )ti�ii APPLICATION FOR PLAN EXAMINATION AND BUILDING Pi RMTT ALL STRUCTURES EXCEPT I AND 2 FAMILY DWELLINGS OYIPORTAN-l': kpplicar.ls uruit cam let,all irev,'s on this pane �l SITE INFORMATION I Location Name Buiiding_P/�l Properly Address �S$ax _._. _ Located in: Conservation Area Y!N Historic disVic,... Use Groups (chock one) Residentiat(3 or more Units) R2 Type of improvement Residential(hotel/motel III (check.one) Assembly(churches) AIM New Building! Assembly(nightclubs etc) A2_ Addition Assembly(restaurants,recreation) .A3 Alteration Business B Repair/Replacement,- Educational L-- Lknto€ition_ Factory(nodcnte hazard) EI _ Move(Relocate Factory(low hazard) P2_ Foundation On High Hazard It Accessory Building Institutional(residential care) It-- Othcr(describe) Institutional (incapacinuccl) 12_ Institutional !restrained) 13 Mercantile NI_ Storage(modetute hazard) S 1 Storage flow hazard) S2_ ' OWNERSHIP ENIY)RMA"rION(Please type or Print Gleurly) II OWNER Naive At40-.-'TTZ' L,Ivw6 Address f-0 . v vY e ✓ ✓�f ol �lJr Telephone 9 1 g _ Z-70 _y83y DESCRIPTION OF WORK TO BE PERFORMED /( } LS'IT'VIATED CONSTRUCTION COST _ Z 0 0 0 . t3a CONTRACTOR INFORMATION Name MAvK Address 18' HtS4 (tD. Newfiw-1 rA ot9ft Telephone 9 7 8• 2.'7a - Lf8 3 Construction Supervisor's Lie# C S 8 S Z s Home Improvement Contractor# / SS 8 9 0 ARCH ITECT/F,NGINEER INFORMATION / Name 1 Address Telephone Mass. Registration # PERMIT FEE CALCULATION Residential est. cost x $7/$1,000 + $5.00 = Commercial est. cost x $11/$1,000 + $5.00= COMMENTS a yD The undersigned does hereby attest that all information stated above is true to the best of my knowledge under the penalties of perjury Signed Date '-I- /t-o $ _ April 11, 2008 Mr. Thomas J. St. Pierre Inspectional Services Director City of Salem 120 Washington Street Salem, MA 01970 Dear Mr. St. Pierre, Enclosed you will find an application for a permit to renovate/repair apartment number 4 located at 395 Essex Street in Salem. Plumbing and electrical permits will be applied for by the appropriate contractors. No work will be done on the exterior of the unit and nothing will be done that will require any input/permits from the Historic Commission. I did not complete the financial portion of the permit application. Each town is different and I didn't want to make any particular assumption. We will pay any and all fees upon the issuance of a permit. Thank you for your prompt attention to this request. The tenant is moving out at the end of this month and we would like to commence work on May I". If you have any questions, feel free to call me at 978-270-4834 or you may email me at Mark56kcomcast.net Sin r y, Mark Audette r The Commonwealth of Massachuse :�v # Department of Public Safety 4" I �rfl iRt�l Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a Ord r m ng (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 is not available) �O 3 ii S 1Zs5-Cx TT SAL'r-wt 4011 7U No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Building Repair Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) ICI Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Is an Independent Structural Engineering Peer Review required? Yes ❑ No lg/ Brief Description of Proposed Work: �.1 U V''�l�— (�(i G►k✓t I4 /� ) J tM LJ i- t i SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed (See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) 3 3 Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5 ❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ 1 H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ 1: Institutional I-1 ❑ 1-2❑ 1-3 ❑ 1-4❑ 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 ❑ IIB ❑ IIIA ❑ IIIB ❑ 1 IV ❑ VA ❑ VB ❑ SECTION 7: SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Debris Removal: Permit: Water Supply: Flood Zone Information: Sewage Disposal: TrenchLicensed Dis osal Site❑ Public l� Check if outside Flood Zone Indicate municipal A trench will not be G Private❑ or indentify Zone: or on site system❑ required (�or trench or specify: 71'— O permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: NIA Historic Commission Review Process: Not Applicable� F Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No eo� Yes❑ No SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Avotjt 1F*Vti ,,v D4,r !Y$n IV�a.� P �vV Q 1 `j'50 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: , /ylRrs�, Au&Oa((e-- 017Y_ Z70 �l$ �`� r4e-t .t21 Pt"VI^A ca�zksr Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.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 Company Name yY,L/+.,',< Ar tti P A t e, C S O YS 7 2- s Name of Person Responsible for Construction License No. and Type if Applicable [3Drc /-!?-0 N6 P M o/aniSv Street Address City/Town State Zip 27o Y83Y MeA > r(mariO&-eCOMC&Si, 116 Telephone No. business Telephone No. cell e-mail address SECTION 11:WORKERS'COMPENSA'rIGN 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 th issuance of the building permit. Is a signed Affidavit submitted with this application Yes No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT F E Estimated Costs: (Labor Item and Materials) Total Construction Cost(from Item 6) _$ 17. U y 0 1.Building $ 77 d 0-0 v01 Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ OJ appropriate municipal factor) _$_14-1-n_. 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $ /'7 0&0 — (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 bQ of my kno edge and understanding. rat-r, AAocb a `/ 7V -5I - - q�3 2ru Y�3�I 7�-1 l se print and sign name Title Telephone No. Date P M: rvF-o /�19P �_ A oIgSo Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: Name Date �P��G� 3222 The Commonwealth of assac 4x etrCF. Department of Pu S �'L�f" Massachusetts State Buildin �d '60 EBR)FD 3 4 Building Permit Application for any Building other than a One-or Two-Family Dwelling t (This Section For Official Use Only) Building Permit Number: Date Applied: - I Building Official: iSECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) 315 C55'4' S :5 � -P-v%A 01 q -1 o 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'L9fRepair Mel 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 0Y Is an Independent Structural Engineering Peer Review required? Yes ❑ No V' Brief Description of Proposed Work: PIIt (1-sd �- r ? R07 fz,i-oa2 Ra�v P10—� K 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): (;i4 vK 1 t,)/ Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA -- Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) S00.0 3 S SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-1❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1❑ 1-2❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3 p' R4❑ S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: . SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ ILIA ❑ IIIB ❑ 1 IV ❑ 1 VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Suppi Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public Cf Check if outside Flood Zone❑ Indicate municipal e A trench will not be Licensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ required O or trench or specify: permit is enclosed❑ 9(L X cl p Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable LAY Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ i or No 5K Yes❑ No t/ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): (ri,.,,s- Type of Construction: 6674a-0 Occupant Load per F1oor: Does the building contain an Sprinkler System?:_ Special Stipulations: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner AaQ. TTc, is, NVK 395 (c-55-e7r sAL�wt 01q 70 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Mtkf .y, Au o e IIz 9 xr_ybS- o o - - (fit e • 2 I V tAy-,"Q S_T- Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes /y,,A nr, Au"Ti Pox 1K(To f-JPP i )A 0l9 S0 Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 0 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 hn A fL►G A LA 0A 11 e. Company Name 1 V� ✓'tom �Q ati �� I I e ?r 1 2 S CS Name of Person Responsible for Construction License No. and Type if Applicable Rox /4 $6 Ng P% M d 6ci Sp Street Address City/Town State Zip 91t1Ljv5 - 0 �6 '7 N►nL .lLtvwl i.4x 9 t.+ST .Kt Telephone No.(business) Telephone No. cell e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§25C 6 A Workers Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ S 0610 1.Building $ s !�Q Building Permit Fee=Total Construction Cost x .0�(Insert here - 2.Electrical $ appropriate municipal factor)_$?,<,00 3.Plumbing $ -i-5,00 aar `"% 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ 1 (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. f 1n A tZKc A tx o-e,e, Tycr_.�rc-C_ Please print and sign name Title Telephone No. Date (� x 14 r4D N i3%x-y po� M o r gsa Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: Name Date Commonwealth of Massachusetts f f City of Salem 1 " - 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 IFReturn card to Building Division for Certificate of Occupancy Pet rmi No. B-2012-0269 FEE PAID: $49.00 PERMIT TO BUILD DATE ISSUED: 9/27/2011 This certifies that MARK AUDETTE/Rings Island LLC has permission to erect, alter, or demolish a building` ,395 ESSEX STREET Map/Lot: 250201-0 as follows: REPAIR/REPLACE RE-ROOF EXISTING (3) TAB ROOF WITH (3) TAB SHINGLES jbh i Contractor Name: _ 4 DBA: Contractor License No: i 9/27/2011 k Building Official / Date This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official may grant one or more extensions not to exceed six months each upon written request. t All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any.-building and structures shall be in compliance with the local zoning by-laws and codes. , t This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officialsare provided on this permit. HIC#: "Persons contracting with unregistered contractors do not have access to the guaranty fund"(asset forth in MGL c.142A). Restrictions: Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER.