86 WHARF ST - BUILDING INSPECTION _f'Ma"
The' Commonweifth o ssac h-' "usetts,
Department of Public Safety
0\1assachusetts'State Building Code(780 CMR) Seventh Edition
City of SaleWi--
Building Permit Application for any Building other than a 1-or 2-Family Dwelling
(This Section For Official Use Only)
Building Permit Number: Date Applied: —I/AVC8 Building Inspector:
SEC7L'ION 1: LOCATION (Please indicate Block# and Lot# for locations for which a street address is not available)
42Z. \A/I�ACNr !!;V SA,\4-_$1V\ Ao%A, N1%c:;Co1m-A -s-TA"ao"
No. and Street Cit), /Town Zip Code Name of Building (if applicable)
SECTION 2: PROPOSED WORK
IfN�wConstructio�'che�k here[].or,check all that apply io the- tw' �,rows below,,,-
-'
Existing Building 0 Repair,P I Alteration.i( J.Al cfiticm 0 1 Demolition 13,(Please fill gut and submit Appendix 1)
Change of Use 0 Change Of Occupancy 0 Other 0 Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes N' No 0
Is an Independent Structural Engineering Peer Review required? Yes 0 No 0
Brief Descript��fZp=k:
Aoo^6&_\6Z 'Q4nC2S
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) 0
Existing Use Group(s): Proposed Use Group(s):
Existing Hazard Index 780 CMR 34: 1 Proposed Hazard Index 780 CMR 34: 1
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.) -AN Rlss cc) 1\12MO
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2r 0 A-2nc 0 A-3 0 A4 0 A-5 0 1 B: Business 13 E: Educational 0
F: Factory F•l 0 F2 0 H: Hi h Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0
1: Institutional 1-1 0 1-2 0 1-3 0 1-4 0 M: Mercantile 0 R; Residential R-10 R-2 0 R-3 0 R-4 0
S: Storage S-1 0 S-20 U: utility 0 Special Use 0 and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE (Check as applicable)
—
[A 0 111 0 IIA 0 IIB 0 IIIA 0 11111 0 IV VO JVAO VB 13
SECTION 7:SITE INFORMATION (refer to 780 CMR 111.0 for details on each item)
P' Trench Permit:' Debris Removal:
WaterSu ply: Flood Zo 0 Information: Sewage'Disposal:
'e _"tc
Public&r Check If outside Flood Zone 0 Indicate municipal 0 A trench %vi.11 not 11 Licensed Disposal Site
C] required Oor French orspecif%
Pmateo or incluntik,Z)rIc: -or on site',v,tc
m
permit is enclosed El
Railroad right-of-way: Hazards to Air Navigation: \IA I fi'torit llrtlt �:
Not Applic.ible 0, Is StrUCtUIC e,1(1111airport appioacharea' I.,their iecLeWC0II1pjetej?
,)r Cnnsent to IQIild enclosed 0 Yes 0 or No 0 Yes 0 \o 0
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code:— Use Group(s): — TN peof Construction: — Occupant Load per Floor:
DOel the building contain an Sprinkler S.c sleni': —SpVC1,11 SLLPLIIItLons:
C/ St
�1 'k — 3715
SECTION 9: PROPERTY OWNER AUTHORIZATION
Na�je.end Address of PruperLu."vner v
t�C�\`f1'l 6 ` —16 � �F \r�fa/ \\\.\ell An�c O� 1
Name (Print) No.and Street City/Town Zip
Property 0%.tier Contact Information:
CkW-Y49- 2,11401 41-79
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 pro pert y owner's behalf, in all matters relative to work authorized by this bu ildin> permit a p plication.
SECTION'10:`CONSTRUCHON CONTROL(Please.fill out'Apgendix2) " '• [s;,�,�.Se,' ,.
(If building is less than 35,000 a;. ft.of enclosed space and/or not under Construction Control then check here O and skip ction 10.1)
10.1 Registered Professional Responsible for Construction Control
\ /Qe-\i..i \Ao-l\*_ otJr-3/Y-_*?q3 ,C- ,4A Ny
Name (Re�istrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline E irat n Date
10.2 General Contractor
Compalny Mame:
Name of Person Responsible for Construction License No and Type if Applicable
r
Street Address" q7�3/Y City/Town - State Zip
_ 3`�f3
Telephone No. (business) Telephone No. (cell) e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(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? Yes O No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs: (Labor
and Materials) Total Construction Cost(from Item 6) =$
1. Building $ Building Permit Fee=Total Construction Cost x (Insert here
2. Electrical $ appropriate municipal factor)=$
3. Plumbing $
4. Mechanical (HVAC) $ Note: Minimum fee=$ (contact municipality)
5. Mechanical (Other) $ Enclose check payable to
6. Total Cost $ (contact municipality)and write check number here
SECTION 13: SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below, 1 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 enders nding.
Please print and eign name / Tide Telephone Date
y ,
Street Aidrev Cty/Tow'n ate Zip
l tr
Municipal Inspector to fill out this section upon application approval:
Nam Jato
a
CITY OF SALEM
� . PUBLIC PROPRERTY
ill, to
DEPARTMENT
,ivr.x'11' rxhl„II
12 W,NIII\C IONS IX LLI Is SMI.M. M.Iss.vt Intl i Is 3197:
I'IA. 071.715-9j95 • 1:IN Y711-74;.'r%16
Workers' Cumpensation Insurance \ffidal,it: Builders/Contractors/Electricians/Plumbers
knitincant Information l / ly` �+ Please Print LeCih
Vi11T1C llhnnK+Y I)r�]ntl.ninrVlnJl+Llual l: \ /'�'� �1�-'1/ C�ca�5\ C-co '
ltldtr.cs: �Q � aL.�MG3faLa �� r
City,Srare,%ip WF�/hi � it Thune '':
.%re 5au an employer:' Check the appropriate bus: Type urproject (required):
1. 0 1 ani a employer with 4 ❑ I :un a general coutraetor and 1 g, C1 New construction
-
cmployces(full antL'ur pert-time).• have hired the sub-cuntracturs
2. E3 .un a tole proprietor or partner. listed on rhe anachcd sheet. 7. El RtmoJeling
ship and-)lave no empluyl:es These sub-contractors have 8. ❑ Demolition
working for mein any capacity. workers' comp. Insurance. g, ❑ Building addition
I No workers'comp. insurance 5. ❑ We area corporation and its
I required) officers have cacrcised their 10.0 Electrical repairs or additions
5. ❑ 1 3n1 a homeuwncr doing all work right of exemption per NKiL 11.❑ Plumbing repairs or additions
myself.LNo workers'comp. C. 152, g 1(3),and we have no 12.❑ Ruuf rcpairi
insurance required.) r employees. (Ko workers' U.❑ Other
comp. insurance required.)
•
Nil, ,.I10 caol tba d=ks bo]of nius1:IIfY IIII oil the wcoun IKluw AtIvI la thva wurkus'cvmpenvrsiw)Iwlicy mtittnutiun.
' I lumeuwrwn whu tubmil this affidavil indic,una Mul,am Joint'411 work mW then hire o dude cuturmrun must suhmil a new arGJavil indiulsmi;arch.
-C,.ntrxuln that(hack rhN box MINI nlwilld.In aJaaiunal nrr-el.hawing tlw n:mN of the sub- ontrwlon and their workers'nxvp.policy mfurmanun
/our an employer that is pro viding rvorAer]'rmnpenvation/nrurnnce for my enrpluyecr. Belnly is rhe pu/icy and job site
inlunnuriun. t�
ERpiratwn Date:
),)b Site Address: gL W\AAtzf ST_SA�fM NSA CIIy:Slatu Zlp:
.\trach it copy of lite workers' curnpenxation policy declaration page(showing the policy number and expiration date).
Patluic to secure colerage as required under Scctiun 35A ul'>161. c. 152 can lead to the imposition of criminal penalties of a
Tina up n)51.500.00 and/ur une-year n)peisnnincnt, as wcli at civ d penalties in the form of a STOP WORK ORDER and a fine
of op to SI50 all it Jay against the violator. 1)e advi. :d [hot a copy of Jus mutcmeni may be forwarded to the Office of
Iry augau fns of 1lw DIA :or in,warce el scr.lge\ail is al:un.
I to hrrrby,, rrify under the pains and penahiev u/perjtrry that the in/uroradon provided ubuve i]true and correct.
r J/Jic'iu/
*0",Y*
Da not write iu this area, to he eunrp/rlyd by wily ur Iorvn uj/iciu/. I
( itv or I'nw'n: _ Pct miul.icvntc q
Issuing .whurity (cirri: nuc): i
I. nl,a d of Ileailh ?. Duddiuq Dcparuncnl 1. l:it).-fuwu Clerk J. Eleclrwal luspactor 5, Plu...bin q los pc U or
h. 011ier _
Conucl Purw e: .. _ Phone tl:
Information and Instructions
.\Lusachusetti General Laws chapter 152 requires all employers to provide workers' eompensauon ti)(their emptoyces.
i"tir"slant to rtis ,tatute,an rmpturee is defined as" .,ser) poison in the service of another under any cuntract of hire,
c%press or implied. oral or written."
\n:inplayer is defined as "an individual,partnership, .issociinou. corporation or other legal entity,or any two or snare
,r rhc toregomg engaged in a joint enoerprsc, and including the Icgaf representatives of a deceased employer, or the
receiver or trustee of.an nidividual,pantucrship,association or other legal entity,employing employees. However the
owner ofa dwelling house having not more than three apartments and who resides therein, or the occupant of the
,Iwc(ling house of another who employe persons to do maintenance,construction or repair work on such dwelling house,
or .at the,roun&%or budding appurtenant thereto shall not becaust of such employment be deemed to be an employer."
NIGL chapter 152, §25C(6)also states that "every state or local licensing agency shall withhold the issuance or
renewal of u license nr permit to operate a business or to coostruct buildingi1a the communsv`ealih for any
applicant wlie has not produced acceptable evidence u!cumpllance with the insurance coverage required."
Additionally, NIGL chapter 152. §25C(7)antes"Neither the commonwealth nor anyof its political subdivisions shall
enter into any contract for the performance ut'pithlic work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority." ,
-applicants
Please rill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s)namc(s), addresses)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP) with no employees other than the
members or partners, are not required to carry 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 confinmatiun of insurance coverage. Also be stare to sign and date the affidavit. The aflidavit should
he ictunted to the city or town that the application for the permit or license is being requested, not the Ucpartment of
1 ndustrial 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.
('fly or Town Official$
Please he sure that the affidavit is complete and printed legibly. The Department has provided a space ut the bottom
of the affidavit for you to till out in the event the Office of Investigations his to contact you regarding the applicant.
PL:asc be sure to till-in the pcnnit/license number which will be used as 4 reference number. In addition,an applicant
that roust submit multiple pernitilicentic applications in any given year,need only submwonc affidavit indicating current
policy information(if necessary) and under"Job Site Address':the applicant should write "all locations in (city or
town)."A copy of the affidavit that has been officia)lystamped or marked by the city'or'iown may ba: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 hone owner or citizen is obtaining a license or permit not related to any business or commercial venture
I i.e. it dug license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
I lie i)(t ice of tuvesti,atiuns +wuld tine to drank you in advance fur your cooperation and should you hate:any questions,
please du not hesitate to give us a call.
ncc Ocpartmem's address, telephone and fax number
The Commonwealth of Massachusetts ,
Department of Industrial Accidents
OMce of Investigations
600 Washington Street
Boston, MA 02111
Tel. p 617-7274900 ext 406 or 1-877-MASSAFE
Fax M 617.727-7749
www.mass.gov/dia
CITY OF SALEM
y i..
PUBLIC PROPRERTY
DEPART'.MENT
1'; N.\,nnt..,IN>I:ert-r * SAI I \t. \L\.; i .
11 I '1'8 '4i vli f\S:'i�8 'a:'1,1•J�
Construction Debris Disposal Affidavit
(required lir all demolition and renovation work)
In accordance %%itIi the sixth edition of the State Building Code, 780 CMR section I I 1.5
Debris, and the provisions of'1vlGL c 40, S 54;
Building Permit It is issued with the condition that the debris resulting from
this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c
I11. S 150A.
I
The debris will be transported by:
Inane of hauler)
I he debris will be disposed of in
(name ul'Iacihty)
IadJress ul'larililvl
,Ignulurc of p:nurt applic nl
Z\ Ocj
,late
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k. EDf
CODE
D 'Cc
(780 CMR) MASSACHUSETTS STATE BUILDING CODE (7TH EDITION)
521 MASSACHUSETTS ARCHITECTURAL ACCESS CODE 2/23/96 � ' a
(248) UNIFORM STATE PLUMBING AND GAS CODE 8/9/96 -
Building Type 3B-Protected Sprinkled Restaurant Use / Assembly A2R Restaurant tL
1290 Total Square FeetkL
amcc
4-
Length
N +
Travel ABLE 1015.1 250 feet permitted with sprinklers
Length of Exit Egress R ) P P
Fire Alarm System Safety to remains as previously approved for existing occupancy. o l�',. L o +
Interior Finish Requirements (Table 803.5) Class C
Egress into Main Lobby
1 Means of Egress Main Entry of 57" Doors
1 Means of Egress via 48" Doorway (to 70" doors @ exit) 13-7YZ
105 inches Total @ 0.15 inches/person = 700 people.
Main Entry accommodates 320 people (more than 2 occupancy)
Secondary exit accomodates 380 people
Bar Occupancy
72 Seats u,
30 Standing (600 sf @ 5 sf/person) ~
102 Total _
Capacity per Toilet Fixtures (Located Approx. 100 feet away through lobby) Y
WOMEN: 4Toilets @ 1/30 = 120 Women, 4 Lavatories @ 1/200 = 800 Women Lss• s- c
J
't MEN: 2 Toilets + 2 Urinals = 4 Fixtures @ 1/50 = 200 Men, 4 Lavatories @ 1/200 = 800 Men
CY
Total Occupancy per Plumbing 240 People
_
:.. 42:v. .:rci
Existing total Restaurant Occupancy: EXIT
Dining rooms and Bar: 220 - I I
TO CORRIDOR
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BARa 0 .
26 SEATS TOTAL - J >0 ..
oco 6
0. co CO)
0 0
jLJLJ Lj L I LJLJ LOUNGE
46 SEATS TOTAL
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EXIT ��,�-
4�yfD AR F.
Occupancy Plan EgressPlan
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AT ISSUED -- --