52 CHARTER ST - BUILDING PERMIT APP N��S T";The Dmmt nWaltV of Massachusetts
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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) - a :.n
^, Building Permit Number: Date.Applied: Building Official: "' m
SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not4ailald e)
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No.and Street City/Town Zip Code Name of Building(if applicable)r '-
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SECTION 2•PROPOSED WORK..
t Edition of MA State Code used_ If New Construction check here❑or check all that apply in the two ows below
Existing Building❑ Repair❑ 1 Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit AjpendiU)
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
I -166
s an Independent Structural Engineering Peer Review required? Yes ❑ No"L�
Brief Description of Proposed�Vork:
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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.)
Total Area(sq.ft.)and Total Height(ft.)
SECTIONS:USE GROUP(Checkas applicable) -
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 13A4 13A-5 13B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ - HH Hi h Hazazd H-1 13H-2 El -H-3 13 H4❑ H-5(3I: Institutional 1-1❑ I-2❑ 1-3❑ 14❑ 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 13 13 IIA 13 IIS ❑ IIIA ❑ 11111 IV ❑ 1 VA 13 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❑ Indicatemunicipal ElA 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-oE-way: Hazards to Air Navigation: ;y_\1li,tor_r,Cummk ion Kcoi�._,%_I�ru_c_s:
Not Applicable❑ Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ I Yes❑ or No❑ 1 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
Name(Print) and Street City/Town Zip
Property Owner Contact Infomrati
Title Telephone No.(business) Telephone No. (cell) a-mad address
If applicable,the property,owner hereby authorizes
-
Name Street Address City/Town State Zip
to act on the property owners behalf,in all matters relative to work authorized by this budding ennit a lication.
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 chick here O and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control
Name(Registrant) Telephone No. a-mad address Registration Number
Street Address City/Town - State Zip Discipline Expiration Date
- 10.2 General Contractor -
�'
Company Name
I-,-),"CAn`\CD
Name of Person Responsible for Construction �p License No. and Type if Applicable
Street
CAddress
�^y'r�j City/Town ( State Zip
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_ 9i3 %o V31 I (GU�i_ 721 fi_7/+Z
Telephone No. business Telephone No. cell e-mail address
SECTION 1:WORKE.RS'COMPENSA'110N INSURANC1i 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 13 No O
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 $
d.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5. Mechanical Other $ Enclose check payable to
6.Total Cost 1 $ ( b I (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"bostm moa geand understanding. ( _I
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Plea�ste print and sign name Title`\ Telephone No. Date
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval: t
Name ate
CITY OF SC]lEN1, TMASSACHUSETrS
BUILDING DEPAR-MWUNT
• 130 WASHINGTON STREET,31D FLOOR
TEL (978) 745-9595
FAX(978) 740-9846
KINIBERI.SY DRISCOLL
MAYOR DIRECTOR
ST.PIERR&
DIRECTOR OF PUBLIC PROPERTY/BUILDING COILNIISSIONER
Demolition Permit Sign-Off
(Supplement to permit application)
I,_M cue\ M,.,,c� �\ hereby supply the followingceases as part of the
application for a permit to demolish the structure located at 95Z �nar�e� S�
and shown on the Assessor's Maps
of_ as being on Map # Block # Lot#
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'Che-.�th 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 regulators, have been removed or sealed and plugged in a safe
manner.
Utility to be Notified 4: Notice Received b _Date Received
Gas ��� \ e \vl7Z-0 ZoNS
Telephone.
Electric
Public Vtilities�Municipal)
I 1-lealth Department 11 " 2a ' �S
Fire Department
Other-
Other-
Demolition debris hauler:
Location of licensed _
dernolition debris landfill:
Signature of ApplicafiFZ::�' Date: \\V;!
Signature of Owner Date: � �—
This sheet must be returned to the Inspections Department along with a completed
application for a permit, a site plan, and any other applicable information and fees:
Domoperm.dcx.
76 Ash `
Danvers Ma \✓/
Fax 978.8.750.6781
verizon
To: Peabody Essex Museum From: John DiMaggio
Fax: Pages:
Phone: Date: 11/20/2015
Re: CC:
❑Urgent 0 For Review ❑Please Comment ❑Please Reply ❑Please Recycle
• Comments:
To whom it may concern
Verizon facilities @ 50 Charter St., Salem Ma have been removed. Verizon has no
facilities or equipment in place at this location
John M DiMaggio
Verizon Team Leader
Salem Historical Commission
120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970
(978)619-5685 FAX(978)740-0404
WAIVER OF THE DEMOLITION DELAY ORDINANCE
It is hereby certified that the Salem Historical Commission has waived the Demolition Delay Ordinance for the
proposed demolition as described below, as per the requirements set forth in the Historic District's Act (M.G.L.
Ch. 40C) and the Salem Historic Districts Ordinance.
Address of Property: 52 Charter Street
Name of Record Owner: Peabody Essex Museum
Description of Demolition Work Proposed:
Demolition of the former boiler plan building.
Prior to demolition, the applicant will obtain all necessary state and federal permits.
Dated: t SALEM HISTORICAL COMMISSION
B :
Y
THIS IS NOT A DEMOLITION PERMIT. Please be sure to obtain the appropriate permits from the Inspector
of Buildings (or any other necessary permits or approvals)prior to commencing work.
nationalgrid
40 Sylvan Rd
Waltham MA 02451
November 18, 2015
RE: Service Removal for Building Demolition
Work Request number- 20250975
Dear Bob,
This letter is to confirm that, per your request, National Grid has removed the electrical
service to 161 Essex St. Salem MA. If you have any questions or need further assistance,
please feel free to contact me at (508)357-4515.
Sincerely,
14�—��
Customer Order Fulfillment
nationalgrid