Loading...
347 HIGHLAND AVE - BUILDING INSPECTION 2-©Q� Cv� ItS-1 � The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling n (This Section For Official Use Only) Building Permit Number: Date Applied: Building Official: SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) t 34 -7 H; alnl av\4 Bv2 SRICM, AAA, 0197 1 l04 aXG'4 Ayl'Motl C)6\6 No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Code used 2 012 I Fb C If New Construction check here❑or check all that apply in the two rows below Existing Building Repair❑ Alteration )Q I Addition IW I Demolition ❑ (Please fill out and submit Appendix 1) Change 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 ❑ Brief Description of Proposed Work: ( 5�6f V ex,& . V i o h +O eX'yS 1 n 4 bvi ivxw Vn4.w s— k' ivk '\ft-- EA7! ?s �iN(S ., Th}i��_ k{�LLkCT vm6ivta �p 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): f Proposed Use Group(s): -RPA 5 i v L5 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.) 13,320 V- 4"4" 19 134 11'— SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business E: Educational ❑ F: Facto F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1 ❑ I-2❑ 1-3❑ I4 ❑ 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 ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ I VA ❑ vl X. 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 0, Check if outside Flood Zone❑ Indicate municipal Ok A 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-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable. Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or Nom. Yes❑ No El SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code:1011 Use Group(s): A5S Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?:-e 5 Special Stipulations: /(o -- C.(7 tJ, ' �e- -rte p , v . Ericka Pasersky Assistant Project Manager �r00m epasersky0groomco.com Cell 617.721.7102 construction ` Tel 781.592.3135 Ext 247 17 Fax 781.593.1480 c ^ www.groomco.com www.groomener&.com 96 Swampscott Road Salem,MA 01970 build green Better Building Through Better Thinking SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner DovkaA Sl,4n;ro 317 H;�hlvhd Ave. 54\k%4A , MA 019-1 o Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Tfty r 151-636- O'i01 Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes Name Street Address City/Town State Zip to act on the l2roperty 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 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 GYoo1M Coy 5 C_�\ o,n Cc, Z ,.\ r . Company Name T1Aovt^o,s G ro oyv\ Name of Person Responsible for Construction License No. and Type if Applicable qb 5W4,Mg5C_ otV Roca Sa\�vn Mk ovvio Street Address City/Town State Zip 751-592-3135 X17 - R - 85 k o q r o c,v%x(Z !�roo vv\c o . c o vtn Telephone No. business Telephone No. cell a-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVrr 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? YesX, No O SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs: (Labor Item and Materials) Total Construction Cost(from Item 6)_$ �� ,C 1. Building $ :?b00000 Building Permit Fee=Total Construction Cost xvAert here 2.Electrical $ o S (3 00 appropriate municipal factor) _$ 3.Plumbing $ 0 0 U 0 4.Mechanical (HVAC) $ p Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ ©O Enclose check payable to 6.Total Cost $ ali and write check number here � o� 00'0 (contact municipality) 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 the best of my knowledge and understanding. �ow/aS errbon 1/'<S, c/eAF V -59Z 313 Please print and sign name Title Telephone No. Date r16 Swcwg12scQA1 '%Loaa1 Sadew" A. Ok470 Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: ` ^ /d/7/i Name Date Appendix 2 Construction Documents are required for-structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required for this. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. I Checklist for Construction Documents* Mark"x"where applicable No. Item Submitted Incomplete Not Required 1 Architectural 2 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing include local connections 9 Gas Natural,Propane,Medical or other 10 Surveyed Site Plan Utilities,Wetland,etc. 11 -Specifications 12 Structural Peer Review 13 Structural Tests&Inspections program x 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review 521 CMR 18 Workers Compensation Insurance K.. 19 Hazardous Material Mitigation Documentation yC 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction.Work started prior to approval may be subjected to triple the original permit fee. Registered Professional Contact Information ,)aknn 52n2<- q79 _ 020 _tahnws4QQrnse�crg(Gk�4 r Name(Registrant) Telephone No. e-mail add''dr^ness egistrafion Number 10 De6y 54u5Y�Z SQ�Rm MlS 0519?0 �. C 31 1761(. Street Address City/Town State Zip Discipline Expiration Date A,5 ael P4t6 awe In-0�- 609 7 91193 Name(Registrant) Telephone No. e-mail address Registration Number 140 SV�UQn 5Vreer �gY\yers �I A O1g23 1n �vra1 6 'vo 2016 Street Address Cit /Town State Zip Discipline Expiration Date Cmace- 141CYVACOLe.tng;K�• W72 Name(Registrant) Telephone No. e-mail address egistration Number ` II 16rZOAWay sqv vS MA, Olqo E O Zdl6 Street Address Cit / own State Zip Discipline Expiration Date Initial Construction Control Document To be submitted with the building permit application by a y Registered Design Professional for work per the 8' edition of the Massachusetts State Building Code, 780 CMR, Section 107.6.2 Project Title: NorthEast Animal Shelter-Building Addition Date: 9/30/2015 Property Address: 347 Highland Avenue, Salem, MA Project: Check(x)one or both as applicable: X New construction X Existing Construction Project description: Site improvements, approx.. 5,000 sfbuilding addition and interior improvements. I, John A. Seger, MA Registration Number: 30105, Expiration date: 8/31/2016, am a registered design professional, and hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications concemin '. g . Entire Project X Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perforin the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being.performed in a manner consistent with the approved construction documents and this code. When required by the building official, I shall submit field/progress reports (see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'. Enter in the space to the right a"wet"or DAR electronic signature and seal: P' P p'.*.30106 ASA Phone number: 978-744-0208 Email:johnaseger@segerarchitects.comf j yl� Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen, provide a'description. Trial Version 10 09 2012 Initial Construction Control Document To be submitted with the building permit application by a UT* Registered Design Professional for work per the 8'edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title:Northeast Animal Shelter Date:9/29/2015 Property Address: 347 Highland Avenue, Salem,MA Project: Check(x) one or both as applicable: New construction X Existing Construction Project description:Site improvements,approx.. 5,000 sf building addition and interior improvements. I Charles E. Mace MA Registration Number: 46492 Expiration date: 6/30/2016,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': Architectural Structural Mechanical Fire Protection X Electrical X Other: Life Safety&Fire Alarm for the above named project and that to the best of my knowledge,information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent comments,in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a `Final Construction Control Document'. Enter in the space to the right a"wet"or electronic signature and seal: �jN°I Mqs--IV, dCHARLES E. Gm MACE ELECTRICAL v, Phone number: 781-23311808 Email: CMace@CSI-Engineers.comNo,46492 o x A9p 9FGtS SPE���� SSI E Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an'x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen, provide a description. Version 06 l l 2013 Initial Construction Control Document UlfTo be submitted with the building permit application by a Registered Design Professional for work per the 80' edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Northeast Animal Shelter—Building Addition Date:09/30/15 Property Address: 347 Highland Avenue, Salem,MA Project: Cheek(x)one or both as applicable: x New construction x Existing Construction Project description: Site improvements, approx.. 5,000 sf building addition and interior improvements I, Michael Perham,MA Registration Number:41143 Expiration date: 6/30/2016,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning'-. _ Architectural x Structural _Mechanical Fire Protection Electrical Other: Describe for the above named project and that to the best of my knowledge, information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code;(780 CMR);and accepted engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept,shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a`Final Construction Control Document'. `SNoF t4 Enter in the space to the right a'wet"or �E� of electronic signature and seal: I A P v M STHUCTUHAL cin No 41143 Phone number:978-646-0097 Email:mperham@mcbrie.com `F3si rJkt Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen, provide a description. Version 06 11 2013 The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.govldia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibiy Name(Business/OrganizationAndividuaq: Groom Construction Co. , Inc. Address: 96 Swampscott Road Salem, MA 781 -592-3135 City/State/Zip: Phone.#: Are you an employer?Check the appropriate box: Type of project(required)_ 1.® I am a employer with 7 5 4. ❑ I am a general contractor and I 6. New construction employees(full and/or part-ti nie).x have hired the subcontractors 2.❑ I am a sole pzoprietor or partner-_ listed on the attached sheet 7. Remodeling ship and have no employees These sub-contractors have 8• ❑Demolition working for me in any capacity. employees and have workers' 9. Building addition Em:yself. No workers'comp,insurance comp. insurance t equired] 5. ❑ We are a corporation and its ]0.❑Electrical repairs or additions am a homeowner doing all work officers have exercised their - 11.❑Plumbing repairs or additions [No workers'comp. right of exemption per MGL 12.❑Roof repairs surance requtired)t c. 152, §1(4),and we have no employees.[No workers' 13.0 Other comp, insurance required.) °Any applicant that checks box#I must also 611 out the section below showing their workers'winperuadon policy inforoation. - t Hortteowners who submit this affidavit indicating they ate doing all work and then him outside Witnictors must submit a new affidavit indicating such. 10outracmrs that check this box trust attached an additional sheet showing the name ofthe subeontnetors and state whetter or not those entitles have employees. If the sub-contractor;have errployves,they must provide their workers'corm.policy number. .ram an employer that is providing workers'compensation Insurance for my employees. Below is the policy and jab site information. Insurance Company Name, - Hanover Tn , an P -rnuipany I Policy#or Self ins. Lic.#: Expiration Dgte —.WHNA552476 3/10/16 - - 3u i lam r� ,� 61q-70Job Site Address; � '9 h � City/State/Zip: _ Q,[ P''i M � 61 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=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. Be advised that a copy of this statement may be forwarded to the Office of j Investigations of the DIA for insurance coverage verification I do hereby certifyunder and penalties of perjury that the information provided above is true and correct. j Signa ture• Date: Phone#: 7f/ S92 3/3 Offeeial use ony. o not write In this area,to a completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): ].Board of Health 2.Building Department 3.City/Pown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other I i Contact Person: Phone#: