35 GREENWAY RD - BUILDING INSPECTION h
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The CommonWNfft=U8XMsetts
Department of Public Safety
Massachusetts Stj0jFr>fi ,ggodj71V 5
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only)
r� Building Permit Number: Date Applied: Building Official:
GYM SECTION 1:LOCATION (Please indicate Block#and Lot#for locations for which a street address is not available)
�S C�jnwc , act 5ae�-, r�r9�o
No.and Street City/Town Zip Code Name of Building(if applicable)
i 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 1-1
Demolition ❑ (Please fill out and submit Appendix
IChange 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 W
Brief Description of ProposedWork: DCINLe n " all neij Cklo/ a4iJ I' k+ t
vti l a l e er�t f1 /1 .k bh epA4, fyrc L
ti ec
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.) `z
Total Area (sq. ft.)and Total Height(ft.)
SECTIDN'5<. I GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑"- ❑ B: Business ❑ E: Educational ❑
P: Factor F=1 ❑ F2❑ H: High Hazard H-1 H-2❑ H-3 ❑ FI-4❑ H-5❑
1: Institutional 1-1 ❑ I-2❑ 1-3❑ I-4❑ M: Mercantile ❑ R: Residen ' R-10 R-2❑ R-3❑ R-4❑
S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑ an please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 11 IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV 13 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 w- Check if outside Flood Zone❑ Indicate municipal l9 A trench will not be Licensed Disposal Site ❑
Private❑ or indentify Zone: or on site system❑ required M or trench or specify:
permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: eta I-fistoric Commisioll 1 eeOew Pro�:u=s:
Not Applicable Is Stn:cture within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes ❑ 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:
40� ,�/EW��2r �2rx7`/Dq,i✓�tcs/o/9z3 14--Pr itaz
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SECTION 9: PROPERTY OWNER AUTHORIZATION
Na``ne and Add 5e�s of Properly Owner
Name(Print) No.and Street City/Town Zip
Property Owner Contact information: c t —
IS1 _�IA - Tmo - - �rttulaS,�,IncrNT.zy glNai7. atm
Title Telephone No. (business) Telephone No. (cell) e-mail address 1
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 building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
if building is less than 35,000 cu.ft.of enclosed s ace and/or not under Construction Control then check here 0 and sLip Section 10.1
10.1 Registered Professional Res onsible for Construction Control
Name (Registrant) Telephone No. e-mail address Registration Number
reef t\,id ress City/Town State Zip Discipline Expiration Date
10.2 G neral Contractor
Company Name
Name of Person Responsible for Construction License No. and Type if Applicable
Street Address City/Town State Zip
Telephone No. business Telephone No. cell e-mail address
SECTION 11:WORRHRS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.452.§ 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 0 No 0
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Estimated Costs:(Labor
Item ootD
and Materials) Total Construction Cost(from[tem 6)_$ ,�/
1. Building $ C10()0,00 Building Permit Fee=Total Construction Cost x (Insert here
2. Electrical $ 3000, 00 appropriate municipal factor)_$
3. Plumbing $
d, Mechanical (FIVAC) $ Note: Minimum fee=$ (contact municipality)
5. Mechanical (Other) $ Enclose check able to
6.Total Cost $ l OvC� payable
(contact municipality)and write check number here
SECTION 13: SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below, I hereb attest under the pains and penalties of perjury that all of the information contained in this
application is true and accurate to e best of my knowledge and understanding.
Pleas p it and sign name Title Telephone Date
`�� �rx�ehty �ilt�t 01915
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval:
Name Date
y QTY OF SALEM, MASSAG JUSE TTS
BUILDING DEPARTMENT
\ 120 WASHNGTONSTREET 3PORom
TEL. (978)745-9595
KINIBERLEYDRISCOLL FAX(978)740-9846
MAYOR T7-IOMAS ST.PIERRE
DIRECTOR OF PUBLICPROPERTy/BURDING COMMISSIONER
HOMEOWNER LICENSE EXEMPTION
PLEASE PRINT:
Dater�o /? \
Job Location ILA
Sgle-j y M4 0070
Home Owner Address it& Sci l 4i M,4 Q(q,7-6
Present Mailing Address— `/'-4-- 1906 4ei;y1,x1-y g � Qgrq(r,.; 014 Ol F9 3
The current exemption of"Homeowners"was extended to include owner-occupied dwellings of two
Units or less and to allow such homeowners to engage an individual for hire that does not possess a
license, provided that the owner acts as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or
is intended to be, a one-or two-family dwelling,attached or detached structures accessory to such use
and/or farm structures. A person who constructs more than one home in a two year period shall not be
considered a homeowner. Such"homeowner"shall submit to the Building Official, on a form acceptable
to the Building Official,that he/she be responsible for all such work performed under the Building
Permit.
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and
other applicable by-laws and regulations.
The undersigned "homeowner"certifies that he/she understand the City of Salem Building Department
minimum inspection procedures and requirements and that he/she will comply with such procedures
and requirements.
HOMEOWNER'SSIGNATUR
APPROVAL OF BUILDING INS CTOR
an OF SALEK MASSACHESE TP,
BEELEIMeDBPAMZMW f
uo WAama�travS7R>an,3DFiooe
DL PM7454M
PAX"70-Ma
BlI�ERiBYD�II,
MAYOR MIMUsSUUM
DnMcnmce+rtsuc /snIIMVa0IfiffMCMM
Construction Debris Disposa/AffydOW
(required for all demolition and,.renovation work)
In accordance with the sixth edition of the State Building Code, M CMR, Section 111.5 Debris,
and the provisions of MGL coo,S 54; Building Permit B is issued with the
condition that the debris resulting from this work shall be disposed of in a properly licensed
waste deposit facility as defined by MGL c 111,S 1WA.
The debris will be transported by.
(name of hauler)
The debris will be disposed of in:
(.UCcS�c IMGh�ticG�itiT
(name of facility)
W-o bmgdwe,,, iMtlllo5e M,4 pZ�7
(address of cility)
ignat r of applicant
Date
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• 18 of 22 Form MMP.LOC-'ROTAL'aarafsal softare bv alamole.fr<.-T.800•ALAMOOE
F4a�5'R Casa llo. � PaOee as of 22
Building Sketch
KUnuoneT James Wiliam vinara
PrweM Address 35 Czeemeay RE
City Salem COenlq Ease. We RM Zip Lode 01970
Ler-JuXke01 MSA NlWwv LLC
36
i
Bedroom Bath Kitchen
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edroo U) Living
Bedroom
36'
Not Drawn to Scale / Room Sizes Are Aproximate
Yea CalculaW nz Sunlmdry
Wl00 Yea n Celcu4tlnn oenih
Rst Floc 900 Sn R 35 R 36= 9a0
TM I LWNg 4ea(PnuMM): 900 Sy rt
Fon SKULOSKI•'TOTAL'atwaisaJ safhuan by a lamar,.irr..-I.800.AWAOOE
.l% ACase lla. Pores 19 at 22
MORTGAGE INSPECTION PLAN 16-06810
LOCATION.: 35GREENWAYROAD BOSTON
CITY, STATE: SALEM,MA
APPLICANT: DAWN SURVEY
CERTIFIED TO: MSA MORTGAGE,LLC r INC.
SCALE: I INCH-20 FEET R.O.BOX 290220
DATE: AUGUST 9,2016 CHARLESTOWN,MA 02129
T(617)242-1313;F(617)2424616
W W W.BOSTONSUR VEYINC.COM
55.00'
LOT 82
7,896 sf+/-
0
4'±
1 story
#35 '
6'±
r\
N
v
v_
1+
I
I
_ 56.00'
GREENWAY ROAD
i LOOD DETERMINATION REFERENCES
According to Federal Emergency Management Agency maps,the DEED: BK 12544 PG 582
innjor improvements on this property fall
in as am designated as PLAN: 3530-600 �p�SH F S.
COMMAITY PANEL N0.2 J3)01 C k7"4 G NOTE; To show an accurate scale this plan must be printed ��� CyG
EFFECTIVE DATE: on legalsiiodpeper(S.5"x14") o GEDGR E
-MIA " CO INS w
Thepermanent structures are approximately located on the ground as shown. They either conformed to the setback requirements No. 1784
of the local zoning ordinances in effect at the time of construction,or are exempt from violation enforcement action under
M.G.C..Tide V71,Chapter 40A,Swion 7,and that arc no encroachments of major improvements across property lines except as
show,,and noted hereon. (,9N S yOQ'
SURA
This is nor a boundnry or tick insuruneo survey.This plan should not be used for construction,recording purposes or verification
ofpmperty Rocs.
George C. Collins, PLS