29 WASHINGTON SQ NO - BUILDING INSPECTION 00 CITY OF SALEM
PUBLIC PROPERTY
DEPARTMENT
KIMBY.RLFY DRISCOLL
MAYOR
120 Wnsru\croN Snuffer* SALEM,MessncHuserrs 01970
TH.L:978-745-9595♦ PAs:978-740-9846
APPLICATION FOR PLAN EXAMINATION AND
BUILDING PERMIT
ALL BUILDINGS EXCEPT ONE AND 2 FAMILY DWELLINGS
IMPORTANT:Applicants must complete all items on this page
SITE INFORMATION
Location Name=toHN23*112TI2A014 1/60'SE Building
Property Address 29 W4ZT�l--rA45TAN it/0A2rtq
s,a LE ry/Area /LtA
Located in: NO Conservation Y/N YLTS Historic district
APPLICATION,DATE 520/09
Use Groups
(check one)
Group Homes R3_R4_
Residential(3 or more Units) R2_
Type of improvement Residential(hotel/motel) RI _
(check one) Assembly(Theaters) Al _
New Building_ Assembly(restaurants&clubs) A2r_A2nc_
Addition Assembly(churches) AI _
Alteration X Business B_
Repair/Replacement_ Educational E_
Demolition Factory (moderate hazard) Fl _
Move/Relocate Factory (low hazard) F2_
Foundation Only High Hazard H_
Accessory Building Institutional(residential care) Il _
Institutional(incapacitated) 12_
Institutional(restrained) 13
Mercantile M
Storage Sl _Moderate Hazard
Storage S2_Low Hazard
OWNERSHIP INFORMATION(Please type or Print Clearly)
OWNER Name ToHn/ $6'2r04M ,4oysc
Address 29 A14s-HaAewroA/ cS9 A/oL r# Soc�Y✓J NIA
Telephone 9178-744 - 1002
Signature
DESCRIPTION OF WORK TO BE PERFORMED
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ESTIMATED CONSTRUCTION COST 320 OL'� OQ
a
�►'�� Peter Beaudoin
s senior Vice President
�J pbeaudoin®groomco.com
tel:781.592.3135 ext. 206 fax:781.593.1480 cell:617-548-0820
96 Swampscott Road,Salem, MA 01970
www.groomco.ccm
CITY OF SALEM
r F PUBLIC PROPERTY
DEPARTMENT
KI\16ER1XN DR ISCOI.I.
MAYOR 120 WASHINGTON STREET♦ SA1-FMjNLe1SSAC1lUS=S 01970
TEL.:978-745-9595 PAx:978-740-9846
CONTRACTOR INFORMATION
Name GP-,00fy7 00/JSr2UC,7=OA1 G'p. F.—AIG.
Address 9e, �wAmase�rr I SALEh?i tviS4
Telephone 98 t - 592-3736
Construction Supervisor's Lic# 0¢03179
Home Improvement Contractor# WA
ARCHITECT/ENGINEER INFORMATION
Name *PsTMAW& k1ARD4E ' AecA37.Pc= , LLC-
Address 32 CVQVZC# !2'r0FET , SAtPn/� IWA
Telephone 978-'�744- 8982
Mass. Registration # 8749
PERMIT FEE CALCULATION
Estimated Cost x $11/$1,000 + $5.00= * 3152S- 00
COMMENTS
The undersigned applicant does hereby att st that all information stated above is true to the best of my knowledge
under the penalt' . pe 'u
Signed (owner) (agent)
APPROVED BY:
DATE APPROVED:
CITY OF S.0 E1Nl, N-L-kSSACHUSETTS
• BUII.DLNG DEPARTMENT
120 W..xsHiNGTON STREET, 3D'FLOOR
or TSL (978) 745-9595
FAX(978) 740-9846
1QSiBERLEY DRISCOLL
MAYOR THoNw ST.PiEltR8
DIRECTOR OF PUBLIC PROPERTY/fIC11DING CONDUSSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit# is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
Hezr-c - Z �z�nOSAL—
(name of hauler)
The debris will be disposed of in :
/QAMS Ie>=-VSz
(name of facility)
Z4s Cam�c eczoL �'rtaty>=T
L f-o✓n/, AIA o/9oZ
(address of facility)
y
signature of pefinit applicant
Sl Z0l 09
date
dear salUm
PITMAN &
WA,"LEY
ARCHITECTS LLC
CONSTRUCTION CONTROL AFFIDAVIT
14 May 2009
The John Bertram House Elevator
29 Washington Square North
Salem, Massachusetts 01970
I, Peter F. Pitman, affiliated with Pitman & Wardley, Architects LLC submit that 1, or a designated
representative, will perform the following professional services, as specified in 780 CMR,.
Massachusetts State Building Code, Section 116.2.2.
L Review for conformance to the design concept, shop drawings, samples, and other submittals,
which are submitted by the contractor in accordance with the requirements of the construction
documents.
2. Review and approve the quality control procedures for all code-required controlled materials.
3. To be present at intervals appropriate to the stage of construction, and 'complexity of the
project, to become generally' familiar with the progress and quality of the work, and determine
to the extent practical and possible the work is being performed in a manner consistent with
the construction documents.
Our observation'during site visits will not relieve the Contractor or its Subcontractors of their
responsibilities and obligations for quality control of the work, for any design work which is included
in their scope of services (i.e. design delegation), and for full compliance with the requirements of the
Construction Documents, applicable rules, regulations and building codes. Furthermore, the detection
of, or the failure to detect deficiencies or defects in the work during our site visits does not relieve the
Contractor or their Subcontractors of their responsibility to correct all deficiencies or defects, whether
detected or undetected, in all parts of the work, and to otherwise comply with all requirements of the
Construction Documents.
No.8748
�lior4
Peter F. Pitman, Architect
Massachusetts Registration-No. 8749
32-CHURCH ST
S A L E M
MASSACHUSETTS
0 1 9 7 0
978-744 - 8982
FAX 978-744-0400
n
Salem Historical Commission
120 WASH INGTON STREET. SALEM. MASSACHUSETTS 01970
(978)745-9595 EXT 311 FAX 1978) 740-040.1
CERTIFICATE OF APPROPRIATENESS
It is hereby certified that the Salem Historical Commission has determined that the proposed:
❑ Construction ❑ Moving
❑ Reconstruction Alteration
❑ Demolition ❑ Painting
❑ Signage ❑ Other work
as described below will be appropriate to the preservation of said Historic District, as per the requirements set
forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance.
District: Washington Square
Address of Property• ?o Washington Square
Name of Record Owner: John Bertram House, Inc.
Description of Work Proposed:
Demolition and reconstruction of existing masonry elevator shaft per Pitman & Wardley Architects'plans
received 7/17/08, including two shuttered blanked windows and two new wood, 6 over 6, trite divided light
windows with matching lentils, replacing existing over-sized, multiple pane windows. Headers to match other
windows on building..
Dated: August 21, 2008 SALEM HISTORICAL COMMISSION
By:
The homeowner has the option not to commence the work (unless it relates to resolving an outstanding
violation). All work commenced must be completed within one year from this date unless otherwise indicated.
H HS IS NOT A BUILDING 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.
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