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70-90 BOSTON ST - DEMO FLYNTANN B-16-921 C�sr� � sZ o8 The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Budding 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: Budding Official: _ 1 EC ION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) ,9 13057,7.1 e"r ai G�,�nnTA�1/ No.and Street City/Town Zip Code Name of Budding(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❑ 1 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 AM Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑ Brief Description of Proposed Work: SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY - Check here if an Existing Building Inv ligation 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 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-Z❑ Nightclub ❑ A-3 ❑ A4❑ 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 1-1 ❑ 1-2❑ 1-3❑ 14❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑ S: Storage S-I ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: _ SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA 111 [3 IIA ❑ IIB ❑ ILIA 13 IIIB ❑ 1 IV ❑ 1 VA r3 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❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site Cl required❑or trench or specify: Private 11 or indentify Zone: or on site system❑ permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: %[A I I I ru��.,mnn,tnn Re, ...._ ....._.._ Nut Applicable❑ Is Structure within airport approach area? - Is their review completed? or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑ r 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: 1 SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner ' Ar :¢ -7o-96' i3oS�0yiS% S'��eJs'1 ✓1 t/} d� 70 Name(Pri t) No.and Street City/Town Zip Property Owner Contact Information C17 a93 oC0117 Title Telephone No. (business) Telephone No. (cell) n e- it address If applicable,the property owner hereby authorizes ul fills //f &,57r`t57- s'. /-e'l'f" ai970 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 O 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 -Toseaj 4wc Aar— CS/0 qy/7 Name of Person Responsible for Construction License N6. and Type if Applicable //� �s r a� S S Alms-y fes- D/X170' Street Address City/Ton State Zip 979�O7EY1 978-2oV793j `7AUepa (le 30 o.uAh64-Ca Ni Telephone No. business Telephone No. cell e-mailaddress SECTION 11:W'OItKEliS'C;OM1iPI:NSA IION INSURANCE Af.Fit)AV,'fr 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 thisaffidavit will result in the denial of t ' suance of the building permit. Is a signed Affidavit submitted with this application? Yes';(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) S Note:Minimum fee=$ (contact municipality) 5. Mechanical Other $ 11 Enclose check payable to 6.Total Cos[ $ a— (contact municipality)and write check number here sECTI N 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 tion is true a ccurate t est of my knowledge and understanding. PI.ase r' sign name Title Telephone No. Date O S / r 3'�/ J�✓� 19 7 Street Address City/Town ,J State Zip Municipal Inspector to fill out this section upon application approval: Name ate CITY OF SALEM, MASSACHUSETTS BuumING DEP.'.RT.%tE1VT 130 WASHINGTON STREET, 3" FLOOR TEL (978) 745-9595 FAX(978) 740-9846 KINIBERI RY DRISCOLL THows ST.PwRRE MAYOR DIRECTOR OF PL ELIC PROPERTY/BL'II.DING CONMIISSIONER Demolition Permit Sign-Off (Supplement to permit application) hereby supply the following releases as part of the application for a permit to dernollish the structure located at 70 — 97B 53 0'1.1 S % Foelnrk FZ/ 4p-ppV _ _ _..-._ and shown on the Assessor's Maps of /� —as being on Map # Ir— Block # I Lot# CJS t� The 8'h Edition of the Massachusetts 'State Building Code, 780 CMR, states in part: "A permit to demolish or remove a building or structure shall not be issued until a release is obtained from the utilities, stating that their respective service connections and appurtenant equipment, such as meters and,egulators, have been removed or sealed and plugged in a safe manner." Utility to be Notified Notice Received b Date Received Gases Telephone. C;Z� 67 Electric RP a2�M �C C/ 'ate/s Public Utilities (Municipal) ad'�C I-lealth Department_ Fire Department Other - Other- j Demolition debris hauler: G j- o-m- o f� --7C._..— -.-_.. Location of licensed demolition debris landfill: W00 1 f}57—If Signature of Applicant A Date: _. Signature of Owner Date: This sheet must be returned to the Insp ctions Department along with a completed application for a permit, a site plan, and any other applicable information and fees: Demaperm.dm"� CITY C1F SALE , MAssAt� BULVejGl3XrAnMrrt W�S'm�'1,31°FiGOR UL(M)745.9595. ' FAXMW)7�9846 SIt��ERiZYDRLSCIC)Lt, MAYOR THMWSTJUM Construction Debris Disposal Afdavit (required for all demolition and,renovation work] in accordance with the sbkth edition of the State Building Code, 780 CMR, Section 111.5 Debris, and the provisions of MGL 00, S 5$; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properiy licensed waste deposit facility as defined by MGL c 111,S 150AL The debris will be transported by: C rM (name of hauler) The debris will be disposed of In: (AJOO'D 6L^4S 1_ U (75 cT-e7 . (name of facility) (address of facility) gnature of applicant Date �, 150 N The Commonwealth ofMassaehusetts Department oflndusttialAccidents 1 Congress Scree;Suite 100 Bostary MA 02114-2017 www.massgov/dia Workers'Compensation Insurance Affidavit.BufldesWComractersMeetridnnslPlumbers. TO BE PILED WITH THE PER TTING AUTHORITY. AUL"M In t rmatlo to Print b Nagle(BusmessttO.rrgamratimahatividaal): /� (CAM G/lU Lf/ Address: 30:5xol City/State/Zip: SA P/ M± 01 V0 Phone M Q Z 5�3 0 2 9-� Are you an employer?Check the appropriate box: Type of projed(required): 1.01 sm a employer with ` employees(ad1 MWmpart-mM).c 7. ❑New construction Yaiam asoloproprietwor putmuslupond boveaoarybyees working formein 8. ORemodeling - any capacity.[No workers'"comp fi sumove ruNital 3.0 1a m a bomeowaa doing all work myself[No wod¢ra'comp.rosmmee requued.)t -9. Q Demolition 4.0 1 am a bcmeowna and will be hiring cconactms to conduct all work an my property. Iwig; 10E]Building addition ... metre that all contractors ather have workers'compemmion insurance m are sole11.0 Electrical repairs or additions prgmetm with no e�loyem. . 12.Ej Pltmabing repairs or additions 5.E]I am s general connector and I law hired the subconaaetms listed''on the attached sheet. These sub ommucmmhaw employeass and have wedrm`comp.immmce t l3.[f Ramf repaint 6.0 We arc a corporation and its offims have examined do*right of exemption perMGLc. 14.Q Other 153,11(4),ad we have no eagrloyees.[No wmkcs'comp.mammon regrmed.) "Any applicant that checks boz#I met also fig oro the aeaionbeMwshowing thea vrorkas' policy iafmmeti®. t Nomeowners who sutra dais aaidmit indicating they are doing all work and than lira euuide contractors must submit a new affidavit indinating such tCmascmrs that check this bm must much an additional shed showing the—of the su"mameacam and state whaheror netthme aaftes have employees. Ifthe sub=omttaaton have employees,they must provide stew wodma'comp.policy teacher . I am an employer,rkat is pra oidlag workers'compensation insurance for my employees. Below is thepoliry andlob site baformadent. f 1 hmrrance Company Name: Policy#or Self-ins.�Lic.#: tiff('{� 5� �"!-- / L27 tcp don ate: j.� C) — Job Site Address:-7 © .� ` Z LyO / Citylstatemply-ely �4 17.71) Attach a copy of the workers'compensation p*Ncy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,625A is a criminal violation punishable by a fete up to$1,500.00 andior come-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do undertiie cad pamet les ofperlury that site information provided above Is tru e and correct P Oficial«se only? Do not write in ibis area,to be completed by e#y or town,%okkml City or Town: Permltti ieense# Issuing Authority(circle one): 1.Board of Health 2.building Department 3.City/Town Clark 4.Electrical Inspector 5.Plumbing Inspector 6.Other ConmM Person: Phone#: t� Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." . An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employes or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more then three apartments and who resides therehm,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurteaaut thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§250(6)also states that"every state or Meal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings In the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of Anis chapter have been presented to the contracting authority." j Applicants I Please fill out the workers'compensation affidavit coni iletely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have j employees,a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retuned to the city or town that the application for the penmt or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate lime. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of investigations has to contact you regarding the applicant. Please be sure to fill in the pemnit/license number which will be used as a reference number. In addition,an applicant that must subunit multiple pernutdicenso applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address the applicant sbould write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture j (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit i The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia r Commonwealth of Massachusetts 5 Citv of Salem 120 Washington St,3rd Floor Salem,MA 01970(976)745-9595 x5641 5 _ p Return card to Building Division for Certificate of Occupancy mltNo. ,5_,4„ _ PERMIT TO ' BUILD -EE'PAID: $30.00 )ATE ISSUED: 1/612016 This certifies that 139 GROVE STREET REALTY TRUST ROBERTO' has permission to erect, alter, or demolish a building._. 7042 BOSTON STREET Map/Lot: 150299-0 r as follows: Renovation. DISASSEMBLE WOOD PORTION OF BUILDING BY.HAND Contractor Name: DAVID PARE - �- DBA: A TO Z SERVICES t Contractor License No: 068505 9 1!612016 Bu if ' I Date This permitehall be.-deemed abandoned and invalid unless the work authorized by this permit is commenced within siz months after issuance.The Building Official may grant one or more extensions not to exceed six mbnths each upon written request. - •� - _ 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 anyrbuilding and structures shall be in compliance with the local zoning by-laws and codes. Thispermit 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. y - f � r The Certificate,of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials, re provided on this permit.' ` HIC#: ', " ' - "Persons.contrac6ng with unregisteretl contractors do not haveaccess to the guaranty fund"(asset forth in MGL c.142A). r Restrictions r' Building plans are to be available on site. 'All Permit Cards are the property of the PROPERTY OWNER. i Commonwealth of Massachusetts City of Salem m 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 I ' ` Return card to Building Division for Certificate of Occupancy Permit No. B-16-921 PERMIT TO B FEE PAID: $250.00 DATE ISSUED: 8/23/2016 This certifies that 139 GROVE STREET REALTY TRUST ROBERTO has permission to erect, alter, or demolish a building . , -70-92-BOSTON STREET Map/Lot: 150299-0 asfollows: Demolition DEMO BUILDING (see B-15-1411) Contractor Name: DAVID PARE DBA: A TO Z SERVICES r t Contractor License No: 058505 r 8/23/2016 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. • 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. 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. r The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. HIC#: "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). Restrictions: Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER. Commonwealth of Massachusetts I ' t" a Citv of Salem a 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 Return card to Building Division for Certificate of Occupancy Structure CITY OF SALEM BUILDING PERMIT Excavation PERMIT TO BE POSTED IN THE WINDOW ` Footing INSPECTION RECORD Foundation Framing Mechanical _, ~ Insulation INSPECTION: BY ` DATE Chimney/Smoke Chamber � Final 1 14 Plumbing/Gas Rough:Plumbing Rough:Gas i Final Electrical �4 Service Rough Final Fire Department Preliminary rr i Final t Health Department _ Preliminary Final