Loading...
17 BOSTON ST - BPA-11-563 1ST FLOOR WINDOWS The Commonwealth of Massachusetts Department of Public Safety \Ia".rchmelh Stme Budding Code(•-30 C\IR)h•renlh Edm,in City of Salem Building Permit Application for iny Building other than a 1-or 2-Family Dwelling I rhrs"s tion For Official Use Only) Budding Penrnt.Number: Date Applied: Budding Inspector I SECTI 1: LOCATION IPlease indicate Block s and Lot s for locations for which a street address is not available) .No,.1h strict Cr s' /Town Zip Code Name of Building(d applicable) SECTION 2:PROPOSED WORK If New Construction check here O or check all that apply in the two rows below --- -Er;rctingBudding - -Repnir -AItrraliun-04Addi{µin-❑ �lmvlitiun-[7�FJrasr-fill-oot-and-subm+t-Appen.lix� Change of Use ClChange of Occupancy ❑ Other fy7pecify: t s •a Are budding plans and/or construction documents being supplied as pan of this permit applicatiun? Yes ❑ No [,.in Independent Structural Engicering Peer Review required? Yes ❑ No Q-�_ Brief Description of Proposed Work: . r) i n S_'r�.rs a7.Re4n& Ne7 w59 I T' SECTION 3:COMPI ETF THIS SE ION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) ❑ Existing Use Group(s): Proposed Uw Group(s): r Existing Hazard Index 780CMR 34: Proposed Hazard Index 780 CMR 34: SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed Nu.of Flours/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft-)and Total Height(ft.) SECTION 5:USE GROUP(Check as app Iicable) A: Assembly A•1 O A•2r O A-2nc❑ A-3 ❑ A-0❑ A-5❑ B: Business ❑ E. Eduotional ❑ F: Facto F-I O F20 H: High Huard- -1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ 1: Institutional I.1 ❑ 1-2 O 1.3❑ 1.4❑ M: Mercantile❑ R: Residential R-10 R-2 ❑ R-3❑ R-40 S: Storage SI O S-2❑ U: Utility❑ Special Use❑and pleas,e describe below: Special Use. SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA O IIB ❑ IIIA O 1118 O IV O VA ❑ VB ❑ SECTION 7: SITE INFORMATION freferto 780 C`fR 111.0 for detailson each item) i hater Supply: Flood Zone Information: Sewage Disposal: Trench Permit: ' Debris Itentovil: P1,01w❑ C'heck d,ml'i'lePL+a \trench will not be Liccmed Dnp,..•.I due Cl Lnnr❑ In.hctte mumcipal❑ I'nvele❑ or indenotc Zone:_ err..n.rte,c,rem O required 0,.r trench .-r.1`calc. ! permit n enclo,c l ❑ Rail road right-of-way: Hazirds to Air.Navigation: 111 than..,, r ..,,,n„-... „I '\nl \I•pL.able❑ L ruu.lwe t.nhut aup,.ri eppur.rch arra' L Iltert ret Teo onnl.l.uJ• ",.cnl h- Iltol old.t.cJ❑ I 5c.❑ ,•r\o0 lr.❑ \„ ❑ —� SECTICxVB:CON TENT OF CFRTIFICA fE OF UCCL'PANCY I .lilnm dl • .Ie . ._._ L`c l.,•,ul`nr __ ftpv •I lnJrm lnn .___ lliitil`Jn11 n.r.I )cr li ,,, __. .__.. ___. ' Ili y. 1Yl`IIIIJII [unLl,rt.In�p(Inkit'I}t�Icm' _ >I•rn.rl�upualom� _____.___,_______ SECTION 9: PROPERTY OWNER AUTHORIZA rION --1 \'.t ne.utJ \ Idn•n.ul rut crta l)av nrr res{un Sf �_ �.�► /'�i9 b/ 4170 i � \,one ll'nnU .\'o.,uxl tilrcrl lila; town Li1 � a I'n tpvrh lhuwrConlaO lnlurmahu 4(tJr►e� �ol� . d�rG 835 �J7g `, pv d-e., / 73__ (elle Telephone No.(busmr>n) Telephune.Vo /� If., • •bcdblr, the nt• (cell) .,.I'I, V V p I erlc'uw ner hereb,'aulhuntrs Seat 6AM/"Jin z r��oh��{ Sfo/W-4,,r, hal oti fr�J Vame Mrvo Addrenn Citvi Town State Zip w as on the ro•ertc ow nrr behalf, m.dl routers rvlau%e to work aulhun,ed by ,hi.building• 'rrmn.t + dtc,rtuu,. SECTION 10:CONSTRUCTION CONTROL IPlease fill out Appendix 2) 11t buddm•Is laes than 1i,11W cu.N.ut rnduxJ s mca•enJ/or nut under Cwnauwt3on Coutrul tham check here❑and.kt•`,t,... Ill 1) 10.1 Re istered Professional Responsible for Construction Control —:V:rtir�(Ra�,i-.Trrnt) rep unr u. a-mat a rens Registration Number 5Vrrt Address City/Town State Lip Discipline Ezpirahun Date F l Contractor�©loame:�� DAL) � c ��3yoH-L I t)son Re.�p,gsiblr or Cunstructiun j License No. and Type it A plicableI✓,l ✓ �ss City/Town Stat qr�� .- E `f �k s��7f r ,�6 o.(business) Telephone No.(cell) / e-mail address SECTION It:WORKERTCONIPENSATION U45URANCE 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 i ante of the building permit. Is a signed Affidavit submitted with this application? - Yee E'l No O SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) F ruction Cost(from Item 6)_$ 1. Building E it Fee=Total Cunstructiun Cost x (Insert here 2. Electrical 5 propriate municipal!actor)=5 y - 1. Mechanical (HVAC) S imum fee=5 (c nt�yb,n unicip/alliity) S. Mechanical (Opayable to / l.66. Total Cast E 00, co alit )and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT Nc entering my name below, I herebv attest under the pains and pen.NNen d perjury that all of the Infurmation o rntained in this .Ipplica Non is true anal accurate to the bent ut my knoavledgeand underntnndmti. - S� i�rr►�/1rye% I'I • .c f nm .Ind •ir;n nano=• Ttdr U,uc ...���i Ao✓1C .�� �Irf�ht Ana• \ �Itrrt 1JJrv— _ (Tn : Lncn r Municipal Inspector to till Out this section upon application Jpproval: \,uneyc