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99 WASHINGTON ST - BUILDING INSPECTION The Commonwealth of Massachli'sd1sO. a� 5ti Department of Public Safety Massachusetts State BuildingCode(780CMR Alk SEP 2.2 P " Building Permit Application for any Building other than a One°or vvo-Pamtly Dw .1141 1 ( (Chis Section For Official Use Only) 1� Building Permit Number: Date Applied: Building Official: 1_ SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) �1Gt rlttaav7 6l Scl2yv, l _ No.and Street City /Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of NIA State Code used If New Construction check here❑or check all that apply in the tworows below Icxisting Building❑ Repair❑ Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: _ Are building plans and/or construe hon 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:. n�yIR.W l7Q,l(mrcv(rvVt, relocal e a ctly R__ 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 CIvIR 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.) j SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business E: Educational Q F: Factor F-1 ❑ F2❑ H: High Hazard H-1 ❑ 1-I-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1 ❑ 1-2❑ 1-3❑ I-4 Q 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) [A El IB ❑ IIA ❑ IIB 13— IIIA 13 11IB ❑ IV 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❑ Check if outside Flood Zone❑ I Indicate municipal ❑ A trench will not be Licensed Disposal Site❑ required❑ or trench or specify:_,._,_ Private❑ or indentify Zane:_ or on site system❑ permit is enclosed Q _ Railroad right-of-way: Hazards to Air Navigation: R4,l rst�xac C o mini.sign hi_ u.0 Pn,s s: Not Applicable❑ is Structure 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): _ TVpe of Construction:_—_ Occupant Load per Floor:.. Does the building contain an Sprinkler System?: Special Stipulations: --�Ac�l� �t_.�F-r�'� c�f�t,�>� � � • v . t t 30�t �{,t�} —.��.. SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of/Property-Owner J c �/� �I/I� �G.h'Cd] 5LLbNCN2.r 5G SCV 6�I NO( 0( U Name(Print) No.and Street City/Town Zip Property.Owner Contact Information: We-wq- qZ - G{�7GbiCj l�Yi�2�Y1 re�l2ttxt� (1171 Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable, the property owner hereby authorizes ydylei ohlie;VO( X35 Lvv+v+u ✓ Lvz1`I IV6? 0/9CJS Name StreetAddress City/Town State Zip to act on the property 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 buildin•is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control p Name (Re -strant) Telephone N e-mail ad i ess Registration Number yzz isf;e Ave �!0(p t."O.Z"Ite ,n $ � 0z714s Street Address Cily/Town State Zip Discipline xpvation Date 10.2 General Contractor tJ s Rev o vcJ--&1,1 /old C&�,,Az)-m !- G. Company Name ►Roic 4o 'i�->AcS:leo, CS- lm) Name of Person Respons le for Construction License No. and Type if Applicable yn Mys-l'c Ae 4A0 50),vuf-v- o A4A 0,7(4/r Street Address City/Town State Zip (of-4 -343- S75ro Telephone No. (business) Telephone No. cell e-mail address SECTION 11:4V0RI<EP. COMPENSA"PION 1NSLJRANCE AFFIDAVfr M.G.L.c.152.§ 25C(6)) A Workers'Compensation Insurance Affidavit from the NLA 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 ❑ No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs: (Labor and Materials) Total Construction Cost(from Item 6)_$ 1. Building $ -/ 5 V0,CJ d Building Permit Fee=Total Construction Cost x (Insert here 2. Electrical $ N,", GO appropriate municipal factor)_$ 3. Plumbing $/y/. SvO.. (jU i. Mhanical (HVAC) $ Note:Minimum fee=$ (contact municil�ity-k 5. Mecechanical ((Other) $ Enclose check payable to 6.Total Cost $ 36,Ova QtJ (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 th ury Kn vlevi e and understanding. Please print and sign name Title Telephone No. Date Street Address City/Town \ State Zip Municipal Inspector to fill out this section upon application approval: Name Date Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 8u'edition of the UT Massachusetts State Building Code, 780 CMR, Section 107.6.2 Project Title: V\IQA �Odle) � O NtrlJ S Date: \\l2-\ \�O Property Address: Project: Check(x)one or both as applicable: [ ] New Construction[%Kxisting Construction Project description: k .7EW A0A<--W Dc;--w �� e U, > SkEr✓/ r�0 o4i)/tel tl/lS+ i 461 /1 rS c-x9/ I �L2&LpS C I—MGGc- MA Registration Number:?2� Expiration Date: / / ,am a registered design professional, and hereby certify that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: [ ] Entire Project [�-f Architectural [ ] Structural ( ]Mechanical [ ] Fire Protection [ ] Electrical [46ther:-)iJ(N'1S fl7- -!�UG 2' 6 l� 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. 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. 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 sub uilding official a`Final Construction Control Document'. ,ON S�F,RED AkLA,T Q`''JGsl S C. Fcr Enter in the space to the right a"wet"o Electronic signature and seal: . 3 y OMpN., Oy Phone number: qS4DF MpSSP� Email: 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. r _4 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. Checklist for Construction Documents* Mark"x'where applicable No. Item Submitted Incomplete Not Re uired 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 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review 521 CMR 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other S ec' 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 Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/TownyState -Zip Discipline Expiation Date a: Name(Registrant) Telephone No. '.�e-mail address Registration Number r. ., Street Address Ci Town ^State Zi Discipline Expiration Date Name(Registrant) Registration Number Telephone No. e-mail address Street Address Ci /Town State Zi Discipline Expiration Date { ,Gx;aaaasaapu�_ S7LZ4>dW'3l1IA83WOS i go""3AV olISAW ZZ4 QtlA'tSVO 01213801 1 3d 012i3808 lenpnlpul 4 LL6Z78/V .uo{;e3�dx I`. I� :ad61 - �9ZSL9k' :uot;er;sl38 k. GHolOVy NINoo'1N3W3Ao21dWi -"" uOnvjn%a3 ss UM �g sif},}Y.?aw"sooO loaaCU /lar�i�o�ori��jp�o a���r>omnnvonWdi -uv� �� T Massachusetts -Department of Public Safety Boardat8u41ding Regulations ardtartdards - C'.�hstracunn-�tj�c.�.x•�rr ,+`�'�V : 999 License. CS-108317 } ROBEItTO DASII VA 42'g ` STIC AVT #406 Sai11eM.4.{Q' 45;� / ,; #'. •` Expiration x o Mniss oner 03/31/2016 t" s r4t), \ The Commonwealth of Massachusetts Department of Industrial Accidents a I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information / /Please Print Legibly Business/Organization Name: Address: /3 If/n✓IS/ I�///-- vti� 14P City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Business Type(required): 1.❑ I am a employer with employees(full and/ 5. ❑Retail �,q or part-time).* 6. E]Restaurant/Bar/Eating Establishment 2.IIS1 I am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl.real estate,auto,etc.) ` employees working for me in any capacity. [No workers' comp. insurance required] S. E]Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152,§1(4),and we have 10.❑Manufacturing no employees. [No workers' comp. insurance required]* 11.❑Health Care 4.❑ We are a non-profit organization,staffed by volunteers, / with no employees. [No workers' comp. insurance req.] 12.�.Other ovt4-Er-1 &4, *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organizmion should check box#1. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name: Insurer's Address: City/State/Zip: Policy#or Self-ins.Lic.# Expiration Date: 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 Investigations of the DIA for insurance coverage verification. I do hereby cer ' ah nd penalties of perjury that the information provided above is true and correct. Si nature: nTh'o-, Date: / Z Z 116 Phone#: 5p/`0 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityrrown Clerk 4. Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#• www.inass.gov/dia t Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However,the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this.chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply your insurance company's name,address and phone number along with a certificate of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers' compensation insurance. If an LLC or LLP does have employees, a policy is required.Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary). A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSA-FE Fax# 617-727-7749 www.mass.gov/dia Forth Revised 02-23-15 0,3 HONEY DEW DONUTS- 99 WASHINGTON ST SALEM, MA CONSTRUCTION ESTIMATE ELECTRICAL.............--............................................................................$ 19,600.00 PLUMBER................................................................................................$ 17,500.00 CONSTRUCTION:painting wall etc...................................................$ 36,000.00 MISC..............................................................................................$5,700.00 TOTAL......................................................................................................$6 78,800.00 I �I3 IE Nr r. I� E X)V Donuts- Enjoy onutsEnjoy The Local Flavor Honey Dew Donuts 99 Washington Street Salem, MA HH Design Group Architects 1 Ticehurst Lane Marblehead, MA 01945 781 639 3493 June 20,2016 No. / Description Equipment 1 btu or elec. amp. 1 Sureshot dispgnser 120v/60/1 2 6' cup holder. 2 0 11' 0" 12' 0" 14' 6' T 61 Bunn Axiom 412 Twin 120V 6700w 27.9A 16.37". Bunn Coffee Grinder(39H1) 120v/60/19AAm . 5 Flavorshot 2 120v/60/1 ACFC-10 xP ngebwak 4 3 8 9 g� i 25 m ��TJING TIN a ® ®stdrain boar I rt ' 7 Bunn Ice coffee IC3120-208v119.5Amps o o FM 0 see specs !(.ase 6 0 office 20 90 i 138 621kPa w! 114 od Male flare fittin 8 Ice Coffee Container. 1 Freezer Dry storage 9 Hot ch000lateGB1 P-PC 120v 1.8kw15A.1/4"Mfwater 4 sEATINc 20/' N z 34 aff „ S2MG2 I Oh tV y� o 10 Ice ca uccinoMBLD 120V60/115A.1/4'Mfwater. ���t T C Area ; ase as ace ` '` 6 Tf Ice coffee container ,� Dark roast coffee container. Exi n9Twr o Floc,^ COM 3 Boas pro ss. hand sink s-w- 410- ssir " < dainw,trappnme y 23' O' p�ai a - taaRenmgaTin. rtaoRo Seabng14 BevAirSPE27B318h 115160117.9 amp. Laminal ,9SEATDNING O�? bagel . 15 Undercounter frozen station 120v/60/113.3 amp. 47 bar Area m CSD 0' sac �� 5 ® W N ¢ Dards - St bon 28' sink floor mounted EMS 2016-12 a L ee acs 0 N 16 Boos coder 17 Crescent Curr iW1-650MAH 208-230/60113 vire � � � �' 0 dedicated nuetral 15Amp.,318 od copper supply, _r ;- i , . _ . I II Ill Vent ¢ r ¢ . �', 4" "n w/Ra - er 4"dran w/to nmer Trash 314" FPT. in ndent dram. �� O yp�ai tap r>errnalze Area o o 8 NLR49 s r in refri rator1151601117.5 amp. w F . �,� ,reRaz'F�rs ;-- 'tea restroc"' $, $„ sacs� r,en °�`® N 19 Boas 3 comp sink w/drainboards 3816204-21)18 0 `Ye Re .n ; � cc C') mi W/Fisher#13390 Pre Rinse faucet/hose. 3oi ( Finishing Exis ng Te azo Floor 3 01, 0 20 Belshaw EP18/24 Proofer#30120 220v50Am 18. 6„ , stab«, _ r 21 SS. Finishing Station o o rsink to n 4 0" _ CO o 22 Glazing Pan Racks 401A38 Front load Alum. Lob 47 9' 23 ME-1 Majestic electric convection oven 240VAC 10 60Hz, 50Amp. 12 hp. 2 speed fan 24 Coke display cooler 48115/60/17.5 ampin® 5 25 Norlake freezer 6 x1 0-c 220/50/13 phm. FLOOR PLAN 26 Mobile S.S. Glazina Cart bv Advance Tatco. & EQUIPMENT LAYOUT 27 BevAir refi rator UCR27A 3/8h 115160/15am . scale: 5110' = 1'-0" Q- Q o ra LL p - 2 c ani = rnci LEGEND: FIRE PROTECTION LEGEND: 9f ® smoke r� q=P emergency light r 1 Q carbon detector ® knox box 1� 1 tLJ JB GtS4 m fire hom light ED manual pull station 1' i r i i i ' N exit exit sign 1 1 1 i i 1 N o O ® fire extinguiser I! � � � � � � _ � lm 80 © general lighting exit d �p r s� C 0 Q fan 1 i ; ' , ® pendant lighting i ® 60 r r� recesseddied lighting gti i ® fl = ® ([� 11 l gf ® 'Y `N\ � exit Q electric ` 1� sub pnl. ��� NOTE: - Q , ` L to Sprinkler contractor to be licensed in Massachusetts \\ J CL o and provided plans by a fire protection engineer for f o c < 2 approval and installation for upgrading the existing exit CLI J co — ------- `. c _ sprinkler system. exit rn `, to N � A- rn � ` a) a) ch All Fre Protection system upgrades shown to existing existing addressabre Q addressable system. fire zone central panel. Z °�° C JB +r ELECTRICAL/CEILING PLAN T & WALL LAYOUT tv ce scale: 31(G' = T-9' Q o 0 LL p n cu c S aa) c = rntn Glass frosted Guard r77-7 7777 —77- 1 I OProvide grommet for 01p11 O o O O O data feed, K'flectrical. o V Stlinless steel Solid surface counter, brainless s eeI counter. indercount oat efriRerator Ice Caddy. 2411 1 2' 0', O C` N Coffee Counter POS Counter Coffee Counter °2 o on 5' O11 7' Or' 7' O11 4' 0„ : �� ° ° lc�r M Ch 31 011 I . Glass frosted Guard 1 Q �- yi P.es[ronm l(7 O11 V Nr L � U) Displa♦ Shehes Display Shelves 7101 _ Q O Q Solid nrface counter. - fll 7 vj k C' ca � �i 1 � ii� ii •� if i i 1 � ill t ��, t J M . CU 11 HONEY Fnu1 cod Lammatelt 31 11 ti-+ -co C't 0' F k C e le I ase 0 1"- (J .Q > 00 Coffee Counter POS Counter µ;H 1 �� `s;g„- Coffee Counter Z ~ o ` 1/2” Frosted Imo— 4' 0" 71011 — 71011 — 5' 01, --Mj 11 011 ` Glass Guard. 1 Laminate over 3/4 moisture resistant MDF. system. Stainless steel county r. Solid surface counter. POS v Compresion San Latch Lock. Faun,va nd Laminate0 _� >✓ 65 3/4" MDF panel— 31011 211011 d Q C \Y"ond French Cleo t. Adjustihle 1" \loisture. resistant Adjustible 1" Moisture resistant 17DF shelf w/ Laminated 3/4" \7DF A9DF shelf x'/Laminated 3/4" \1DP 2 16" nr. "' Panel,. COUNTER PLAN LAYOUTS ? pt. sill shot into slab. 1 Panels. Q 21 61' scale: 3/8" = 1'-0" m ca E 3' 4t1 21411 Z0.) E Coffee Counter POS Counter Cross Section Cross Section Scc A2. c. GhiDigit,) 1 CvII rapc gh,) 6 O Graphic Digital O Mcnv Board Mem,Board. `rJls 2, 11 N a 0 I Enjoy TI"12 I.00HI Flavor t. ster ov n a LEI— 00 ? ` 3141 � M Q �e %! (.ustoTrt Itt.. See A2. Sec A2. €las .dlsDla 101811 01 qp icrowa e. 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