290 ESSEX - ONE SEWALL ST - YMCA - BUILDING PERMIT APP - *J
:3
The Commonwealth of Massachusetts
Department of Public Safely
\11t1 I F. d.•� \Lt..aahu.vll.SLtte Bwlding Coale 1,•80 C.\IRi.1too•%en I E.hlwn !
\y\11 City of Salem
Building Permit Application for any Building other than a l-or 2-Fimily Dwelling
I This Srcnun For Uhinal L1sr Unlvl
Budding Permit Number Date Applied: Budding In..vpector
SECTION I: LOCATION(Please indicate Block a and Lot s for locations for which a street address is not available)
474 e Salem
\o.and Street Citi, /Town Zip Code .Name of Budding id•Ip)'hcahlr)
SECTION 2:PROPOSED WORK
If New Construction check here Cl ur check all that apply in the two rows below
Existing Budding Repair❑ Alteratiun Addition❑ Demulition )W (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Cknipancy Cl Other ❑ Speedy:
Are building plans and/ur construction documents being supplied as part of this permitapplication? Ye. RI I ❑
.m Independent Structural Engineering Peer Review required? Yes ❑ No fr
Brief Description of Proposed Work:
w1..e I ss w ;+P rra tett
R.sd •neaaf dime a.4- YMM ratiL.ae
SECTION 3:COMPLETE THIS SECTION 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 Use Group(s): f•
Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34:
SECTION 4:BUILDING HEIGHT AND AREA '
Existing Proposed
Nu.of Flours/Stories(include basement levels)4,Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Alsembiy A•1 ❑ A-2r ❑ A-2nc❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational Of
F: Facto F-1 ❑ F2❑ H: Hi Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
1: Institutional 1-1 ❑ 1.2 ❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2 Cl R-3❑ R-4❑ _
S: Storage SI ❑ S2 ❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
I IAO 18 IIAO 118C3 - 111A 111110 1 IV ❑ 1 VA ❑ V8 10
SECTION 7: SITE INFORMATION (refer to 780 CSIR I 11.0 for details on each item) _
(Vater Supply: , Flood Zone Information: Sewage Disposal:� Trench Permit:
(Debris Removal:
I'ubLi® ChccA 1t uu bi.ly PL.J Lt•nr InJlrelr mumcll+.d(X A french will not he Licrmcd lila
Pit% ❑ ,tr ridenb(e Zone:_ or'In life.%Item ❑ regw«•d ®ur trench �.r.)•cafe.
permit 1.enrlu.rtl C1
Railroad right-of-way: Hazards to Air Navigation: \I\ 1 h-t.•n, i . unun-i. n R.. ,•+
\.•I tIrip tuts r.Thin,urporl el•)•inaih.era' 11 then 11'1111 0""1 c-I.,I'
t l •n•%nl u. Ilwl.I ❑ I lrI❑ -r\n❑ lot \I. ❑
SECTION A:CONTENT OF CER"FIFICA fE OF OCCUPANCY
I .hl1�m .•I I � Jv . .___ L-c l.t,.i gv,i r,i%o i t I,ni ne lion. l to ups Il l •'e.I leer l l • t _ __
IJ.Irl lhr l•whbnq.�nn.un.tit�l•n,{Ilse?l .iv,n s)•rridl�I l leu 1,1 l u,nl__
�p
f
SECTION 9: PROPERTY OWNER AUTHORIZATION
N'.iniv and Addrr.,u1 Vr,,pa•rtsOwner
N,unr 11'rutl No and ilrcel Clh, (ut,n _ .(F.—_•�,.
I'ru)+erlr ON,tier Contact Intorno tum:
(illy (eiephune Not. Ibuanr..) (rlephunr Nu. (cell) r-m,ul.lddrc..
If ap)+hcublr, the pruprrtc oa+ner herabt•au Ihurl[rs
a Namr s r r ?tnrl .\dd rrss s Ci h•/(fnv "I"
Lip y
to ort. n Ih `-+fu ilNnt r' + f, in ill matters rM,ltllar,tr>`rvurk au1 �r rt ti ,•�L'w'�l
.k' L_ !J rt i� t ddln,:•gent I suu�t.,
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) No
(it budthn•u laws than 15,UIU cu.It.of rnclo.od s+acv and/or nut under Gm.lruclwn Cunlrol then check here O and k,i,Svinm 10 II
10.1 Registered Professional Responsible for Construction Control
�—
Na�nr(Registrant) Tele'phune No. to adB�ess Re istral�rttm Number
City/Town State Lip Discipline Eapirahun Date
10.2 General Contractor
Cu . trJ �._.. .aa$�a:+ro t�ra�r.•�+« +.sduuS ok�.It
►.voi
CumpanyNSRVF.'"
wiry haA1V ..;sap t-1em�, t►a.�n- b�..o
Name of Person Responsible fur Cunstructiun License No. and Type if Applicable
Street Address City/Town State zip
Telephone No.(business) Telephone No.(cell) e-mail address
SECTION 11:WORKERS' O ENSA I N INSURANCE AFFIDAVIT(M.G.' c.152. 25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
Is a signed Affidavit submitted with this a lication? Yes O No 0
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1. Building $ Building Permit Fre=Total Construction Cost x _(Insert here
2. EI trical 5 appropriate municipal(ac r)=5
3. Plumbing 5
a. Mechanical (HVAC) E Note:Minimum fee=E >nct municipality)
5. ,btechanical (Other) f 5 /f✓�+
Endure chuck payable to
fi. Total Cast 5 (contact munici alit )and write check num er here'
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
% vnlenng my name below, I herebv.utest under the pains and penalties of per(ury that all of the Infurmatiqin t;;ntalned ;n this
.tpphcahun la true ond.tccurale tit the best of ms• knowledgrand under.Lmdmg.
I'Irev'print .;nd gn n.une -r fulr .. — _ Y —
• fodcphone \\o;,; U.il
i.
l \lunicipal Inspector to fill out This section upon application approval:
t
INSPECTI NAL SERVICES
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2010 DEC 22 A 8: 5U
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GONSTRDOTION ENTRANCE
... .. .,
TEMPORARY ENCLOSURE,PM'p
TO MATCH STOREFRONTS I
TEMPORARYWOOD RAMP AND RAIUNGS-REQUEST 6"
REDUCTION IN RAW P WIDTH FOR ADEQUATE SIDEWALK WIDTH
-Temporary Access Plan-OPTION 2
MP 1/4 O
Note:Drawing scale may change when copied or taxed
SALEMYMCA WINTER STREET ARCHITECTS
290-292 Essex Street 12117110
Salem, MA 01970
0349001 TEMP - 2
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CONSTRUCTION EMRANCE
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TEMPORARY ENCLOSURE PM'p -.-.
TO MATCH STOREFOREFRONTSOME
TEMPORARYWOOD RAMP AND RAILINGS-PER
MAAB,REDUCES SIDEWALK WIDTH To 2'-10"
-Temporary Access Plan-OPTION 1
EEssex
may change when copied or faxed
MCAWINTER STREET ARCHITECTS
Street0 12/17/10
TEMP - 7
CITY OF SAMNIti AWSACHUSETTS
BUR MING DEPARTMEINT
l 120 WASHINGTON STROM r FLOOR
TEL.(978)745-9595
Kl\1BERL6Y DRISCOLFAX(978) 740-9846
[.
MAYOR THOMAS ST.10imm
DIRECTOR OF PUBLIC PROPERTY/8UIMtNG CO\il(iSSIpNiER
CONSTRUCTION CONTROL DOCUMENT
Projcct,ritle: YMCA i Salem Housing Authority Entry Swap Data: 21 Deeamber 2010
Project Location: 288-290 Essex Street ^
Scope of Project: Storekont re2ovn which restores the w ndow fine at the street internalizes the HC ramp
in a new Housing Authority lobby and provides access to the historic Ames Hall grand enteron Essex Street for ih�e YMCA
in accordance with SECTION 116.0.116,4.2 of the 6th edition of the Massachusetts State Building Code:
1, Mark Media Mass.Registration Number Req#7083
being a registered professional Engineer/Architect hereby CERTIFY diet have prepared or directly supervised
the preparation of all design plans,computations and specitieatioos concerning:
[ J EntireProject (X) Architectural [ J Structural [ J Mechanical
[ J Fire Protection [ J Electrical [ J Other(specify)
for the above named project and that to the best of my knowledge,such plana,computations and speciEcodons mcet
the applicable provisions of the Massachusetts State Building Code,all Acceptable engineering practices and all
applicable laws for the proposed project.
Furthermore.I understand''and AGREE that I shall perform the necessary professional services and be present on
the construction site on a regular and periodic basis to determine that the work is proceeding In accordance with
documents approved b the building crmit n h the
Y b P and shall be responsible for the following as specllied in section
116.2.2:
1. Review of shop drawings,samples and other submittals of the contractor as required by tine construction
contract documents as submitted for the building permit,and approval for the conformance to the design
concept.
2. Review and approval of the quality control procedures for all Cade-required controlled materials,
3. Be present at intervals appropriate to tiro st
the progress and quality of the work and to age Of construction to become generally familiar with
determine,in general,if the work is being performed in
a mannan consistent with the construction documents,
I shall submit periodically, in a fort acceptable to the building official,a progress report together with pertinent
comments, Upon completion of the work,I site"submit to the building oit(cia iTre ort as to the
satisractory completion and readiness of the project for eedupeney. ,`—, .
Signature and Seal of registered professional;
th,
Jo. Ofl3
SALEM
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,r ' h4AS5
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Liberty The Ohio Casualty Insurance Company
MUtUdl. 9450 Seward Road,Fairfield,Ohio 45014
Bond# 5092400
BOND
KNOW ALL MEN BY THESE PRESENTS: That we
WJJ Planning&Construction,LLC
64 Haverhill Street Reading MA 01867
Street Address City State ZIP Code
(Full Name[top line]and Address[bottom line]of Principal)
(hereinafter called the Principal) as Principal, and , The Ohio Casualty Insurance Company with principal offices at Hamilton,
Ohio(hereinafter called the Surety)as Surety,are held and firmly bound unto
City of Salem
93 Washington Street Salem MA 01970 State ZIP Code
Street Address (Full Name[top lined and Address{bottom line]of Obligee)
(hereinafter called the Obligee),in the penal sum of
One Thousand (Dollars)$ 1,000.00
for the payment of which well and truly to made, we do hereby bind ourselves, our heirs. executors, administrators, successors and
assigns,jointly and severally,firmly by these presents.
WHEREAS,the Principal has made or is about to make application to the Obligee for a Permit for
Sidewalk Permit-Temporary Wall/Handicap Ramp-290 Essex Street,Salem,MA 01970
for a term beginning on and ending on*
(*strike out if license or permit is for an indefinite term)
NOW,THEREFORE,if the Principal shall indemnify the Obligee against any loss directly arising by reason of failure of said Principal to
comply with the laws or ordinances under which said license or permit is granted, or any ]awful rules or regulations pertaining thereto,
then this obligation shall be void;otherwise to remain in full force and effect.
PROVIDED,HOWEVER,AND UPON THE FOLLOWING EXPRESS CONDITIONS:
1. This bond shall be and remain in full force during the term of said license or permit unless canceled in accordance with paragraph 2
below; but if said license or permit was issued for a specific term, and is renewed for one or more specific terms, this bond will be
extended to cover such additional term(s) upon the execution by the Surety of a Continuation Certificate, provided such certificate is
acceptable to the Obligee. In no event , however, shall the liability of the Surety be cumulative from year to year or from period to
period,nor exceed the penal sum written in this first paragraph of this bond.
2. The Surety shhll have the right to terminate its liability by notifying the Obligec in writing ten(10)days in advance of its intention to
do so.
SIGNED,SEALED AND DATED December 9th,2010
WJJ Planning&Construction,LLC
By:
Principal
T io Casual I s r o pany
By:
Amand Morgan Attorney-in-Fact .
S-3853 License or Permit Bond (Unnumbered)
toe
Principal: WJJ Planning&Construction,LLC POWER OF ATTORNEY POA Number: 43-210
THE OHIO CASUALTY INSURANCE COMPANY
Obligee: City of Salem WEST AMERICAN INSURANCE COMPANY Bond Number: 5092400
Know All Men by These Presents: THE OHIO CASUALTY INSURANCE COMPANY,an Ohio Corporation,and WEST AMERICAN INSURANCE COMPANY,an
Indiana Corporation pursuant to the authority granted by Article III, Section 9 of the Code of Regulations and By-Laws of The Ohio Casualty Insurance Company and West
American Insurance Company do hereby nominate,constitute and appoint: John E.Mc Laughlin,Jr.,William B.Markhard,Nancy Mahoney or Amanda Morgan of Melrose,
Massachusetts its true and lawful agent(s)and attorney(s)-in-fact,to make,execute,seal and deliver for and on its behalf as surety,and as its act and deed any and all BONDS,
UNDERTAKINGS, and RECOGNIZANCES, not exceeding in any single instance ONE MILLION ($1,000,000.00) DOLLARS, excluding, however, any bond(s) or
undertaking(s)guaranteeing the payment of notes and interest thereon.
And the execution of such bonds or undertakings in pursuance of these presents,shall be as binding upon said Companies,as fully and amply,to all intents and purposes,as if
they had been duly executed and acknowledged by the regularly elected officers of the Companies at their administrative offices in Fairfield,Ohio,in their own proper persons.
The authority granted hereunder supersedes any previous authority heretofore granted the above named attorney(s)-in-fact.
In WITNESS WHEREOF,the undersigned officer of the said The Ohio Casualty Insurance Company and West American Insurance Company
has hereunto subscribed his name and affixed the Corporate Seal of each Company this 16th day of February,2010
�,;Y INSp pN 1451!
o•, SEAL is �••
J.Timothy D'Ertico Assistant Secretary
r• r
STATE OF OHIO,
COUNTY OF BUTLER
On this 16th day of February,2010 before the subscriber,a Notary Public of the State of Ohio,in and for the County of Butler,duly commissioned and qualified,came J.Timothy
D'Effico, Assistant Secretary of The Ohio Casualty Insurance Company and West American Insurance Company, to me personally known to be the individual and officer
described in,and who executed the preceding instrument,and he acknowledged the execution of the same,and being by me duly swom deposes and says that he is the officer of
the Companies aforesaid,and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies, and the said Corporate Seals and his signature as
officer were duly affixed and subscribed to the said instrument by the authority and direction ofthe said Corporations.
IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed my Official Seal at the City of Hamilton,State of Ohio,the day and year first above written.
ayNW401114116
�� `ylsiuvnw M.1�'�.cQzvS
Notary Public in and for County of Butler,State of Ohio
'3 My Commission expires August 17,2013
"'iNlmrop�QC?
This power of attorney is granted under and by authority of Article III,Section 9 of the Code of Regulations and By-Laws of The Ohio Casualty Insurance Company and West
American Insurance Company,extracts from which read:
Article III,Section 9. Appointment of Attomevs-in-Fact. The Chairman of the Board,the President,any Vice-President,the Secretary or any Assistant Secretary of the
corporation shall be and is hereby vested with full power and authority to appoint attorneys-in-fact for the purpose of signing the name of the corporation as surety to,and to
execute,attach the seal of the corporation to,acknowledge and deliver any and all bonds,recognizances,stipulations,undertakings or other instruments of suretyship and policies
of insurance to be given in favor of any individual,firm,corporation,partnership,limited liability company or other entity,or the official representative thereof,or to any county
or state,or any official board or boards of any county or state,or the United States of America or any agency thereof,or to any other political subdivision thereof
This instrument is signed and sealed as authorized by the following resolution adopted by the Boards of Directors of the Companies on October 21,2004:
RESOLVED,That the signature of any officer of the Company authorized under Article III,Section 9 of its Code of Regulations and By-laws and the Company seal
may be affixed by facsimile to any power of attorney or copy thereof issued on behalf of the Company to make,execute,seal and deliver for and on its behalf as surety any and all
bonds,undertakings or other written obligations in the nature thereof,to prescribe their respective duties and the respective limits of their authority; and to revoke any such
appointment. Such signatures and seal are hereby adopted by the Company as original signatures and seal and shall,with respect to any bond,undertaking or other written
obligations in the nature thereof to which it is attached,be valid and binding upon the Company with the same force and effect as though manually affixed.
CERTIFICATE
I,the undersigned Assistant Secretary of The Ohio Casualty Insurance Company,American Fire and Casualty Company and West American Insurance Company,do hereby
certify that the foregoing power of attorney,the referenced By-Laws of the Companies and the above resolution of their Boards of Directors are true and correct copies and are in
full forceandeffect on this date.
IN WITNESS WHEREOF,I have hereunto set my hand and the seals of the Companies this 9th day of December 2010
OFA
pN1ASU SEAL ,n moi.. �:( ,fMark E.Schmidt Assistant Secretary