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BUILDING JACKET ^\ The Conunonweahh of i\IaSSaChLISCUS I'c tl: t Board of 13utlding RCcul:uiuns Mud Standards %It'NR fl AL] I ) L. �ti1usSaChuSCUS State Building Code. 780 CNIR. 7'�' edition l '\li Qi� P. Record.huwrn •,� Building Permit Application To Construct. Repair. Rtnocate Or I)rmulish a i One- or Tun-Fmnilr DwelNn,�- _oos — 1 This Section For Official Use Only \(1 Building Permit Number: Applied : : Date --- \` Building C I unnstoneo Inspector of Buddines Dale V l\ SECTION I: SITE INFORMATION o�tPpirt �`dress: �O/ ,n , 1.2 :assessors M1lup & Parcel Numbers -- �FYFYYJ' 6 L�m Man I.I❑ is this an accepted street? yes_ no Mp Nunllter Pal'c Cl Number _ _ I 1 3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area Isy it) UitII 1.5 Building Setbacks(fq Side Yards - Rear Yard Front Yard I Required Provided Required Provided Required Pros idrd 1.6 Water Supply: (M.G.L c. 40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑ Public❑ Pri%ate❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner of of Record: �� u.vP . ----T— 'Name(Print)] Address for Service: "+ -7 eAj- &c5.7 o r q-1 S at Sa34,, -Signature I(Tc lipphone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) :\dditim ❑ Demolition ❑ 1 Accessory.Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': e SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: OMcial Use Only I- Item (Labor and Materials) I. Building $ p 1. Building Permit Fee: Indicate how fee is dr etemined: ❑ Standard City/Town Application Fee 2. Electrical S ❑Total Project Cost' (Item 6) x multiplier x 3. Plumbing S 2. Other Fees: $ 1. ,\Qerhaniral (HVAC) S List: 5. Mechanical (Fire S Total All Fees: S ---- Su . ression) i Check No. Check :\mount (',uh :\nnxun:----_- j b. rolal Project Cost: $ CXW 171 Paid In Full - ❑ Outstanding Baki nce Due__ SECTION 5: CONSTRUCTION SERVIC'F,S 5.1 Licensed Construction SuFSL) Liccns�e Numher hir:rwni l ae ;Vamr o(C'S I_ I lull=e�r _ Lie) CSL'I\pe Isee heluml \ddrry 1"> e Desch loaf l Unresincted nip ar 35.000 Cu. 11.1 R Resirwed 1&'_ Fannh D%Nelline l l I-Q. L'SL'v7-Q+� RC Rasidenual Roulinc l'u�rnn_ Trhphonc N'S Kesidcnual Nmdua .mil Siduie SF Rr,ideiui;d Solid Ftml Bono no 1 i llial In,I.Jlawm D Restdcntud Deawlnnnl 5.1 Regi'tered home Improvement Contractor (111C) 141CoU9 �� SP�VI[pS =nr- HIC C omp:ury Nmne ur HIC R,elstrant Name licglstruuun Nunlhcr . Address ) 7JI1-64A xp Fx w[iun Date Signature Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. § 25C(6)) Workers Compensation Insurance affidavit 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. . Signed Affidavit Attached'? Yes .......... ❑ No ........... ❑ - SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN . OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize L 1_ Y I�1T3ph f r z-Q to act on my behalf, in all rnanet:s relative to v k authorized by this building permit application. - 1-O-SignaturewnerJ Dale SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION 1, (`hrf�t2�.DhPr 7—r)r7—Q , as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and behalf. v — Print , � n IC �S eitatur"t wncuu_Auuion'zed Agent Date ISiened under the pains and l2enalties of u.er' 1 - NOTES: I. An Owner who obtains a building permit to do his/her own work, or an oscner who hires an unregistered contraenrr (not registered in the Home Improvement Contractor(HIC) Program), will not have access to.the at program or guaranty fund under M.G.L. c. 142A. Other important information on the 141C Program and Construction Supervisor Licensing(CSL) can be found in 780 CNIR Regulations I l0.R6 and 110.R5. respectively, ' When:substantial work is planned, provide the information below: Total floors area ISq. Ft.) (including garage• finished hasementIattics, decks or porch) Gross living area (Sq. Ft.) Habitable room count Number of fireplaces Number of bedroom, Number of h:lhronms Number of halt/halhs fvpe of healing system Number of decks/ porchcs ___---—__--- r 'Type of cooling s}'stem Enclo,ed Upen -,--- -- -- 1. "Total Project Squ:te Footage- may he substituted fitr 'Total Project Cost" DISPOSAL OF DEBRIS AFFIDAVIT In accordance with the provisions of M. G. L. c. 40, Sec. 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed facility as defined_by M. G. L. c. 111, Sec. 150a. The debris will be disposed at: Salem Transfer Station owned by Northside Carting - [ Signature of Pe Applicant 2 �2r"BT Christopher Zorzy Name of Permit Applicant A & A Services, Inc Firm Name 115 North Street. Salem MA 01970 Address, City, State, Zip Code CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT .,•.r.n ::�I \ Hart .a I ',L\±•�a 12: \C'A;1HNl,:.I's i 1!it f I • l.\I Workers' Compensation Insurance Allidayit: Builders/Contractors/Electrici Print Lei rs k r f i ant Information n r_` � Se:rvlC�St ��C bly \;Iltl� lnu,unv l h_:autau,m Inds;dual l: n T Address: W C'ity,Slate:'Zip: Sralrrr) Mj� blg7Q_ Phone #: lire you an employer? Check the appropriate box: Type of project (required): ❑ I I am a employer with 4. ❑ I am a general contractor and 1 6. New construction � ��._ elnpluyees (full and/or part-time).' have hired the sub-contractors ? ❑ Remodeling '.❑ I :un a sole proprietor or partner- listed on the attached sheet. *- ship and have no employees These sub-contractors have S. ❑ Demolition working fir me in any capacity. workers' comp. insurance. 9, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions iequired.] officers have exercised their right of exemption per MGL 11.0 Plumbing repairs.or additions t,❑ 1 am a homeowner doing all work b p p myself. [No workers' comp. C. 152, §1(3), and we have no 12.0 Roof repairs ,. r� insurance required.] ' employees. workers' 13,4Other WndtQ -_ comp. insurance required.] ovoy Jpplicant that cheeks box#1 must also till out the section below showing their workers'compensation policy information. t I lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Cum raUurs that ihel'k this hOY I11USt JllachCd an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. Ian; an employer that is providing workers'compensation insurance for my employees. Below is fire policy and job site information. Insurance Company Name: w— —Tr(A V e�cr,-fp Policy #or Self-ins. Lie. o.a74. H U Expiration Date: /� Sl — Job Site Address: Jn (n Pn �� / C J� City/State/Zip: � ll'/ _^ _ / ^ Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration da(e). Failure to secure cxxerage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of line up to S1.500.00 and;'or one-year imprisonment. as well as civil penalties in the firm of STOP WORK ORDER and a fine ,If'up in) S250.00 a Jay agaltlit the violator. Be advised that a copy of this statement may be forwarded to the Office of In\csti_;uinns of the DIA for insurance co\crage verification. /do hereby vertil- t der he pains nd penalties of perjury that the information provided above is true and correct. t1191!.I I II I !llficial use only. Do not write in this area, to be completed by city or town ojjiciaC City or Issuing .kuthority (circle one): I. Board of Ilcalth 2. Building Department 3. Cih4fovvn Clerk J. Electrical Inspector 5. Plumbing Inspector 6. other Contact Person: --___---- --.— Phone #:— I Information and Instructions NIj ,.Ichuseus General I_ant,s chapter I rrywresall e lip[ON ers to prtrs ide hhorkcrs' annpensation for their enhployecs. Ihtrsuant to [Ills statute, an etNphorre is dc(nad as ".. cN ery person In the Serb ice of.uunher under❑nv contract of hire, ,•\pr css or implied. oral or hhI acn." . \n e ntp6rter is dclined as "an indite.dual, p,umership. as.Sottation, corporation or other Icgal entity, or any two or more of[he foregoing engaged in ajoint enterprise, and includme the Icgal representatihes of a deceased cnhployer, or the rcccih er or trustee of an indictdual, partnership, association or other legal ennty, employ ill,-,employees. f[owe%er the - w,%ncr of a dwelling house Ian ing not more than three apartments and o ho resides therein, or the oitupant of the dhN.•Iling house of;mother who employs persons to do maintenance, construction or repair cork on such dwelling house or on the _rounds or building appurtenant thereto shall not because of Such cnhploy ment be deemed to be an employer." \It il_ chapter I i2, ;25(-(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, %1(iL chapter. 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall curer into any contract fix the performance of public asork until acceptable eh idence 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 sub-contractors) name(s), address(es) 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 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 permMicense applications in any given year, need only submit one 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 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.c. a dog license or permit to burn leaves ctc.)said person is NOT required to complete this affidavit. The Officc of Investigations would like to thank you in advance fix your cooperation and should you have any questions, please do not hesitate to give us a call. fhe Departmcnt'.S address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE te•.tscd 2c,-u5 Fax # 617-727-7749 www.mass.gov/dia U-VALUES AND R-VALUES ( �i ENERGY STAR : Rv ,No„SrR.Es Harvey Manufactured PARTNER • Windows and Doors WHOLESALE PRICING u U-Values in accordance with NFRC-100 • Based on residential sizes U- and R-Values are subject to change without notice • Whole window values All Harvey vinyl windows with Low-E/Argon and all Majesty double hung windows with n Low-E/Krypton qualify for the ENERGY STAR®program throughout the U.S.* Isosoo, Clear Insulated Low-E* Low-E/Argon* VINYL WINDOWS U-Value R-Value U-Value R-Value U-Value R-Value Classic Double Huns (_ Mech_an 0.50 2.00 0.37 2.70 0.34 2.94 Classic Double Hung (Welded Sash) " 0.50 2.00 0.36 2.78 0.33 3.03 Classic Doub a ung (Welded Sas Frame) 0.49 2.04 0.33 3.03 Classic Acoustical Double Hung STC40 0.23 4.35 0.18 5.56 0.17 5.88 Signature Double Hung (Mechanical) 0.50 2.00 0.37 2.70 0.34 2.94 Signature Double Hung (Welded Sash) 0.50 2.00 0.37 2.70 0.34 2.94 Slimline Double Hung (Welded Sash) 0.51 1.96 0.38 2.63 0.34 2.94 _ SftIjDe Dotlt2le Hung (YVeided,Sash.& Frame)..._ . .0.50.-...- 2.00- _.A.38_-..2.53-. ..-_.-0.35.._.2,86 .- - Slimline.S ll ingle-Hung(Weed.Sash &-Frame) _ 9.50.--2 00 _ -0.38----283- - = 0.35--2.B6 -- - Vinyl Casement/Awning 0.47 2.13 0.34 2.94 0.31 3.23 Vinyl Casement/Awning and Thermal Panel 0.31 3.23 0.25 4.00 0.24 4.17 Vinyl Designer Shapes 0.49 2.04 0.34 2.94 0.$0 3.33 Vinyl Hopper 0.47 2.13 0.35 2.86 0.32 3.13 Vinyl Picture Window 0.46 2.17 0.31 3.23 0.28 3.57 Vinyl Welded Deadlite 0.50 2.00 0.34 2.94 0.31 3.23 Vinyl Roller - 2 Lite and 3 Lite 0.50 2.00 0.36 2.78 0.33 3.03 Clear Insulated Low-E* Low-E/Argon* VINYL NEW CONSTRUCTION WINDOWS(pg190-231) U-Value R-Value U-Value R-Value U-Value R-Value Vicon Double Hung (Welded Sash & Frame) 0.50 2.00 0.37 2.70 0.34 2.94 h Vicon Single Hung (Welded Sash & Frame) 0.50 2.00 0.37 2.70 0.34 2.94 Vicon Classic Double Hung(Welded Sash&Frame) 0.49 2.04 0.36 2.78 0.33 3.03 Vicon Casemewt/Awning 0.47 2.13 0.34 2.94 0.31 3.23 Vicon Picture Window 0.47 2.13 0.32 3.13 0.28 3.57 Vicon Designer Shapes 0.48 2.08 0.32 3.13 0.29 3.45 Temp.Clear Temp Low-E Temp.Argon PATIO DOOR (pg 257-260) U-Value R-Value U-Value R-Value U-Value R-Value Harvey Solid Vinyl Patio Door 0.49 2.04 0.40 2.50 0.37 2.70 Low-E/Argon* Low-E/Krypton* WOOD WINDOWS (pg261-270) U-Value R-Value U-Value R-Value Majesty Double Hung N/A N/A 0.35 2.90 Majesty Fixed Casement (PW) 0.37 2.70 N/A N/A Majesty Casement/Awning 0.42 2.38 N/A N/A Majesty Picture Window (DH) 0.34 2.94 N/A N/A 'The use of tempered Low-E glass may effect ENERGY STAR®qualification in your region. U- and R-Values are subject to change without notice. "- Not all products stocked at all locations. Call your local br^.nr_h for availabi;ity. Pricing and information are subject to change without notice& may vary from region to regic; . For current pricing, call your local branch or visit wnr.✓harveyind.com. Mective 3/17/03 256 �v: - Board of Building Regulatio s and Standards Construction Supervisor License License: CS 57733 - 9irf6d' 5126/1958 EYQfralian /26/2009 Tr# 13739 { 0a[J= 1D 1 0 1 CHRISTOPHERI -'•-� 115 NORTH ST •"" ', SALEM,MA 01970�s� Commissioner - . . . . - ... _ - _ _.. .�- ,A .. - �/�ee 70om�noaxu�e¢�/n �,.✓l+Lamac�iuoelA Board of Building Regulations and Standards - HOME IMPROVEMENT CONTRACTOR Registration: 101609 Expiration:, 8/26/2010 Tr# 267870 _Private Corporation A&A SERVICES,tNC- , Christopher Zo¢y:a 115 North Street — - Salem,MA 01970 Administrator Commonwealth of Massachusetts Division of Occupational Safety !aura M Marrm,Commissioner q;a Deleader-Contractor CHRISTOPHER ZORZY Eft.Date 04/09/08 Date 04/D8/09 DC0 ® //I�� . DC000440 Member of C.O.KES.T: j I Ir�II IIIII IIIu ulll l�Ilulu�I�PI�I�II�I WI { 80STONAENEW CITY OF S.U.EM PUBLIC PROPERTY DEPARTMENT 1/AYM 13D wA911NUM"S WAT•SAI M NAMCHL=M 01970 Ta-979-745.9S9S• FAs 9711-740.964 HOMEOWNER LICENSE EXEM"ION Please Print Date 7- os- Job Location d C eXl c ( 5� Z i 1-( L5>� e- �i vk(A O i a'7 6 Home Owner Address 5gme Home Owner Telephone a-7 591/ O V 96 Present Mailing Address 5A lh e tr 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 who.does not possess a license,provided that the owner acts as supervisor. DEFINMON 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 dwellin& 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 understands the City of Salem Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. U HOMEOWNERS SIGNATURE IC410 APPROVAL OF BUILDING INSPECTOR See other side for state code CrrY OF SALEM PUBLIC PROPRERTY DEPARTMIENT AtUs ls: Tu:IW464lM•/.%*IW46"4 r- Construcdo• Debris Dtsp"af Affidavit (reyuird far all deaudidos and smovad=worlt) In=Onbmg with du axth adid=o[dw Sum suddi*Codq,130 C IR soetios 111.5 Debris and dto pmvisions of N(CL a 40`S Sit 8uildiq Pumb• _ _ is issuM with the coodidos that the debris resulting It m this wads shall be disposed olin a prolowty Ueensed waste disposal &dUty as defined by moL a 111.S 15OA. rho debris will be transported by: laarae or ho�tM rhe,kbds will be disposed of in : .SwrFttn�Scc�� (2�- �l�/off eft — SECTION 5: CONSTRUCTION SERVICES ..I Licensed Construction Supervisor (CSL) G� 252 License Number Expiration Date Nantc o1'CSL- Holder List CSL Type(see below) lx� Address Type DescriptionFt Unrestricted lu to 35.000 Cu. Ft.) R Restricted 1&2 Family Dwellin Signature M Masonr y On RC Residential Rooting Covet in& Telephone WS Residential Window an Sidine SF Residential Solid Fuel 13urn1ne A>)ha11Ce Install:aiou D Residential Demolition 5.2 Registered home Improvement Contractor(HIC) HIC Company Name or HIC Registrant Name �j Registration Numher Address Expiration Date Signature Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE IFFIDAVIT (M.G.L. c. 152. § 25C(6)) Workers Compensation Insurance affidavit must be completed and submi ted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permi . Signed Affidavit Attached'? Yes .......... ❑ No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED HEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDIN PERMIT 1, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Dat SECTION 7b: OWNEW OR AUTHORIZED AG NT DECLARATION 1, , as C wner or Authorized Agent hereby declare that the statements and information on the foregoing application are true at d accurate, to the best of my knowledge and behalf. Print Name Signature of Owner or Authorized Agent Date (Signed under the 2ains and penalties of perjury) NOTES: I. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC) Program), ill not have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important info ation on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR R ulations 110.R6 :md 110.115, respectively. 2. When substantial work is planned, provide the information below: Total floors area(Sq. Ft.) (including •rage, finished base mendattics, decks or porch) Gross living area (Sq. Ft.) Ha abl roo ount Number of fireplaces Numbe edrooms Number of bathrooms Number o'halt/baths Type of heating system -Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage" may be substituted for "Toud Project Cost" ev �° yy The Commonwealth of Massachusetts >� ;r� Board of Building Regulations and Standards I OR �5 Massachusetts State Building Code. 780 CMR, 7"' edition h1UNIC II':�LI'I'Y l }}" USE Building Permit Application To Construct, Repair,,kerfevate Or Demolish a Rei ised bona[ One- or Tiro-Family Duelling 1. 2008 \ This Section For Official Use Only \ ^ Building Permit Nuro": Date Applied: Signature: -2 - 0 Building Commissioner/ Inspector of Buildings Date SECTION l: SITE INFORMATION 1.1 Property Address: # 1.2 Assessors Map & Parcel Numbers 20 c� ,-r� Ass r ty I.la Is this an accepted street'? yes 1/no_ Map Numher Parcel Numher 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sy it) Frontage(it) 1.5 Building Setbacks (ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Prue ided i 1.6 Water Supply: (M.G.L c. 40, §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone'? Public" Private❑ Check if yes❑ Municipal M:On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP[ 2 Owner[of RecoTrd: I/ �Cf�QiA /y)n22isoJ �� fen� a/ Sfi o� iy Name(Print) Address for Service: 9-2t Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ 1 Existing Building 9' Owner-Occupied "�', Repairs(s) Cl Alteration(s)c1il' Addition El Demolition 10 Accessory Bldg. ❑ Number of Units I Other ❑ Specify: Brief DCSCrI Lion of Proposed Work': riV _S Fl JOr✓2 w�TX X w SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) L Building $ 414'oD I. Building Permit Fee: $ .) Indicate how fee is determined: XStandard City/Town Application Fee 2. Electrical $ 26?Jd- ❑Total Project Cost' (Item 6) x multiplier x 3. Plumbing $ tf00� 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical- (Fire $ Su ression) Total All Fees: $ Check No. Check Amount: Cash Amount: (i. Total Project Cost: $ 7��j , aid in Full 0 Outstanding Balance Due:_ L The Commonwealth of Ma tts _ Department of Public Sar*Ts§ A `1: 2 2 1 Massachusetts State Building Code(780 CMR) nt Building Permit Application for any Building other than a One-or Two-Family Dwelling J' (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) No.and Street City/Town Zip Code Name of Building(it applicable) 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❑ RepairX I Alteration P2r I Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ 1 Other ❑ Specify: 1 Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No A Is an Independent Structural Engineer in Peer Review required?// Yes ❑ No IRC Brief Description of Proposed Work: i��M,.�o t{,/ /'t rr 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.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-L❑ F2❑ I H: Hi h Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional 1-1❑ 1-2❑ 1-3❑ 14❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑ 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 ❑ 1 IV ❑ I 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❑ Indicate municipal❑ 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: NIA I hit",iC rommNsnn R. ww,I ru s l: Not Applicable❑ Is Structure within airport approach area? Is I h e I r review completed? or Consent to Build enclosed❑ 1 Yes❑ or No❑ 1 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: t a l 4 m P a e_t� SECTION 9: PROPERTY OWNER AUTHORIZATION Naar e and Addrre��of Property Owner /r /� ,. / //�/ /1 ZX 9i / r`7 r.L?�`ZPr7/ '> C . C/rl�C✓'-X-�`�� oL��-/�!%�/l v% C Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Title Telephone No.(business) Telephone No. (ce6) e-mail address if a Iicable,the property owner hereby authorizes�ne3 SSCc�i�71/� 51'' Y� �a ' � 4 O/F o Name Street Address City/ own State Zip to act on the property owner's behalf,in a6 matters relative to work authorized by this building permit application, SECTION.10:CONSTRUCTION CONTROL(Please fill out Appendix 2) f building is less than 35,000 cu.R:of enclosed space and/or or not under Construction Control then check here O 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 C JC1/�'IP�.S fro t�eis ��n.slt�.cfi✓,-� �� /3,5�//c> Company Name Q7 f r7 7 f- N.vne of Person Responsible for Construction License No. and Type if Applicable s S Cf-)PIA4 Sfi. Street Address City/town State Zip / �- 7uSS luU fL-? / 60re5hr0SC0n5_tiz (a 111)1r�: Telephone No. business Telephone No. cell e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AMDAM 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 No O SECTION 12:.CONSTRUCTION COSTS AND PERMIT FEE' Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1. Building $ U',, Building Permit Fee=Total Construction Cost x (Insert here 2. Electrical $ ,SCY>. appropriate municipal factor)_$ 3. Plumbing $ Ct)- d.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ s,j DO. `'s (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 per)ury that a6 of the information contained in this application is true amd accurate to the i hest of my kneivledge and understanding. Please print and sign name Title Telephone No. Date L 5— G��v 9 / 5 �� /y�,� Q G/o Street Address City Town State Zip rI, Municipal Inspector to fill out this section upon application approval: +7 4 Name Date Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-071792 Construction Supervisor FERNANDO S GOMES 6 KING ST " T 1q PEABODY MA 01960 < � �..nn Expiration: Commissioner 12/26/2017 - V/ee �(JorH�tto�rz[oeatG/a o�VlLa40ac�u[5e�b� Office of Consumer Affairs&Business Regulation I HOME IMPROVEMENT CONTRACTOR' Registration _ -135110 Type: Expiration 3!_112018 Partnership- GOMES BROTHERS'CONSTRUCTION CARLOS GOMES ei 55 CENTRAL ST. PEABODY, MA 01960Undersecretaryii The Commonwealth of Massachusetts UflDepartment of Industrial Accidents 1 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 Letibly Business/Organization Name: �n�yriit� ��rt GS Address: S � �� 7fYiq S City/State/Zip:4�_ O/`l o Phone#: OS S Are you an employer?Check the appropriate box: Business Type(required): 1.❑ I am a employer with employees(full and/ 5. ❑Retail or part-time).* 6. ❑Restaurant/Bar/Eating Establishment 2.V 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] 8. ❑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.] 1213 Other *Any applicant that checks box 41 most also fill culture 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 organization should check box NI. /am an employer that is providing workers'compensation insurancefor 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. l do hereby certify rider the pains and pena 'es oirperjury that the information provided above is true and correct. Sign Date:ature: v _ Phone#: 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.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia 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 a joint 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 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 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-MASSAFE Fax# 617-727-7749 www.mass.gov/dia Form Revised 02-23-15 Q''IYCFSALEM, IVIA.S'SAQ3L n B[aVue;l MPAanaorr uowesnomr,�� nL749.9995. , HY1nji, XL FAX 74i49F9 f MAYCK DMASSOMM DmmmxtcjpMMXJMMkW/BMMWaWfiWONU J - Construction Debris Disposa/Aff*V t (required forall demolition andrenovation work) In acaor*noe with the"edition of the State BuRAW Code, 7W CMIt SecMm M.5 oe M and the provWm of msL coo,S 54; 8utidlgg PermttA is issuedwkh the corr RUM that the debris nesul ft from this work shag be disposed of in a properly licensed waste deposit facility as deifned by MGL c ill,S 156A. The debris will be transported by: (name of hauler) The debris will be disposed of in: )*/o 77AIo4 5 f �� (name of fads ty) (address of fadiity) Signature of applicant /02 Date CITY OF SALEM, MASSACHUSETTS BUILDING INSPECTOR 120 WASHINGTON STREET, 3RD FLOOR SALEM, MASSACHUSETTS 01970 �OM� v��5 �OtJST'2Dcs�b� fiC7z�r�rvD C7 � Oerl�S Ventz�c� �i�� an�amGnZwm �urSt C/O The Gibraltar Management Co., Inc. P.O. Box 627 Beverly, MA 01915 (978) 922-2202 January 26, 2012 Re: 20 Central Street,Unit#216 Per our discussion regarding work to your unit: as long as proper permits and insurance are provided, the association is only concerned with aesthetic compliance. After speaking with the Board members, they do require a building permit for the window replacement. Thank you, '(Wd 1656, Robert M. Polansky, President The Gibraltar Management Co., Inc. 2 —33 911, 30"---.. — -211----I 9 WI 836L W3024B W2436B W1836 09L SB30B-1TIL DISH-IQ6818TR-D k _7-7777-- - f l( M,1TF38 4TF384REF309GREF-3096 qF38 CD LU Ce) Z 0) PNL1/4x4x8 0 CL OD CI) C) LL LU 3 It All dimensions -size designations Designed: 11/18/2016 This is an original design and must given are subject to verification on 20 ,�;TECMNO�6103 not be released or copied unless Printed: 12/1/2016 job site and adjustment to fit job applicable fee has been paid or job conditions. order placed. Bh Faircloth 11-18-16.kit All Drawing #: 1 I No Scale. I The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code,780 CMR SALEM 1/) Revised Mar 2011 If ' Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For OfficialXse Only Building Permit Number: I Date pplied: 44 nn:no Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Pro erty Address: #Z�4_ 1.2 Assessors Map&Parcel Numbers a� �� t strne� �Y L la Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(it) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP[ 2/Jl/drrM c,(9o�xc%' c 5�,Gem rn.e9 D/9.70 Name(Print) City,State, ao 2�� 7�l-S�SS<S�Yz No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK(check all that apply) New Construction❑ Rxisting Building❑ 1 Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ 'Accessory Bldg. ❑ 1 Number of Units Other ❑ Specify: Brief Description of Pro osed Work': /M�YV27/6e AaMOz�l.10`- ZM2 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I.Building $ a7 'OD 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ / /a ❑Paid in Full ❑ Outstanding Balance Due: SECTIONS: CONSTRUCTION SERVICES 5.1 Construction� Supervisor License(CSL) 5 l-7�� rl z 0� r S I P,4- Za Z l4 License Number Expiration D to Name of CSL HoldetT f G ,1 I OT41,� C�, List CSL Type(see below) No.and Street I `I'I 1 (� Type Description c/1 1 n M a O 1 q-1 0 U Unrestricted 2 Family s ir el ing cu.ft. 1 ' ' (� 1 V R Restricted 1&2 Family Dwelling Citylfown,State,Z4P M Masonr RC Roofing Covering WS Window and Siding A n SF Solid Fuel Burning Appliances p C - S I Insulation Tele hone mail address CUI J 11 D Demolition 5.2 Registered HomesRf Improvement Contractor(incHIC) Jo I (Poi fidHIC Registration Number t6I!xpiratiol Date 1117 Clompan Zy of UIC Reg' r tNrame //�� 77�I �/ n ^�r an Stre 1�0 Q—VISe V)CeS �S 7y/o y2,I Email address Can City/Town,Statd,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.152. § 25C(6)) Workers Compensation Insurance affidavit must be/completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuan a of the building permit. Signed Affidavit Attached? Yes .......... No...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING B,UIILDING PERMIT / ' I,as Owner of the subject property,hereby authorizerfi r lS�p/l Z z t to act on�my behalf,in all matters relative to workauthorized by this building permit application. to Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION 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. h nsf7 Print Owner's or Auth rized Agent's Name(Electroni ignature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass. ov/oca Information on the Construction Supervisor License can be found at www.nmass.9ov,4lps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of Massachusetts ;(',► Board of Building Regulations and Standards CITY i Massachusetts Stale Building Code, 780 CMR, 7ih edition OF SALEM 9 Revised January Building Permit Application To Construct,Repair, Renovate Or Demolish a 1. 1008 One-or Two-F 'v Dwelling This Secti For tticial On Building Permit Num ffer,, Da a I' Signature: vto., Building Commissionk7 Inspector of Buildings ate ' SECTION I:SIT NF RMATION I �P,(opryE' 1 1. 1 s 14O2 1.2 Assessors Map& Parcel Numbers 1.l a is this an accepted street?yes 1 no Map Number Parcel Number 1.3 Zoning Information: IA Property Dimensions: Zoning District Proposed Use Lot Area(sq It) Frontage(fl) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public❑ Private❑ Check ifyes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2 Owner'of Record: R(Z i V_• o2o C,Ft�MZM S N (Print) Address for Service: _ Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units_ Other XSpecif I Brief Description of Proposed Work': a Ov�M$ � i nt C 't12. Co I'S.i Ihl 6pbcIIJ PS iur_ ULI tvG P iCG SECTION d: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I. Building 1. Building Permit Fee:S Indicate how tee is determined: 2. Electrical S (�� ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ �?j CO 2. Other Fees: S 4. Mechanical (FIVAC) S � List:5. Mechanical (Fire S Su ression Total All Fees:$ Check No._Check Amount: Cash Amount:_ 6.Total Project Cost: S()k)6 QU ❑Paid in Full ❑Outstanding Balance Due: 1)3,0 D l SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) C_c g9),Lpe a a01a I.icense Number Expiration Date N' CUfC,y}d�, Ilolder ?, .r-� List CSL type(see below) _ 1 A10 i (," .t Description Zte U Unrestricted u to 35,000 Cu.Ft. R Restricted I&2 FamilyDwelling O_ I O M --Masonry Only RC Residential Rcofing Covering relephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition �2 �gte�stered Home�nprova gqt Cantr#ctpr(HIC g _J l.(� 4 r Iibrl f K lOdLltl�lTiNC I�� I C Com y Name CA Registration Number C' 1 kI a O IO Es nation Date Sign lure 'telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 25C(6)) Workers Compensation insurance affidavit 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. Signed Affidavit Attached? Yes .......... No...........O SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT i G R u F as Owner of the subject property hereby authorize r5 C0N$ fL(AC~l i o^t ( Zy P tN tU to act on my behalf,in all matters relative to work auth rized y this ti din rmit application. I, 7 Cs ^I/ 1), 1;01D Si+ alreofO er Dates SECTION 7b: O ERt OR AUTHORIZED AGENT DECLARATION 02,m� Tr �Y1Nt0 LAS S 4.uG+6N L ��'�aaOwner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. AFL Prim N LA - 1 _ arty 0 Signature OOwner rAuthorize Agent Date A�� (Signed under the pains and penalties of perjury) NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.116 and I IO.RS, respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq. Ft.) (including garage, finished basement/attics,decks or porch) Gross living area(Sq. Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. -Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY� M Massachusetts State Building Code, 780 CMR SdMar Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Only Building Permit Number: - Date A lied: Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION C 1 P,,troe�p ess: /I C-^` M M' 1.2 Assessors Map&Parcel Numbers I.1 aCIss this an accepted street?]'es__ no___ _ Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use lot Area(sq A) Frontage(it) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: Outside Flood Zone? Municipal ❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Rec rrd: i &2 , n N �. D/ ?�/-� ame(Print ! City,Stale,ZIP / l _ 7 V a�� q�� o �arr�arr►�a a i. No.and Street If Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ 1 .Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Descriptio of Pr pose ork- SECTION 4:ESTIMATED CONSTRUCTION COSTS _ Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ J 492 60 1. Building Permit Fee: $ _Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier _ x 3. Plumbing $ 2:. Other Fees: $. 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Su ression) Total All Fees: $ 6.Total Project Cost: $ Check No. Check Amount: Cash Amount:__ ❑Paid in Full 0 Outstanding Balance Due: SECTION 5:.CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 6 -7 73 /3 wb r i h � Ic 7�T License Number Ez iration to e of CSL Hold 1115 0t/1 m List CSL Type(see below) o.and Street l�'� Type Description. Q ` 9 —10 U Unrestricted2 Family (Buildings u el ing cu. ft.) (�{��/ �• ,� � Y I( � I R Restricted 1&2 Famil Dwelling City/rown,State,ZIP M Masonry RC Roofing Covering WS Window and Siding (] ✓ ^n SF Solid Fuel Burning Appliances U�(�.P�� I Insulation Telephone ail address D Demolition 5.2 Registered Home Improvement Contractor(HIC) - I- C Regist(raOtion Number Ez iratio Dat I om any Nam o HIC e st, i d S[ e Email address City/Town,State,24P (/ Telephone SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issua a of the building permit. Signed Affidavit Attached? Yes ......... No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize _ yJ r_ to act on my behalf, in all matters relative to work authorized by this4bu,1g permit application. �— — r7o rU c inz/2& ® a Print Owner's Qoe(Electronic Signature) Difte SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION 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. �hro t OU r Z _ o I ; Print s or Aut o hzed Agents Name(El�oni�re) D� NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at wzvw.mass.eov/oca Information on the Construction Supervisor License can be found at www mass.t*ov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" The Commonwealth of Massachusetts Department of Public Safety yyQQ =s Massachusetts State Building Code(780 ) yi J Building Permit Application for any Building other than One-or amily wellin This S,ectibirFor„Official Use Only) Building Permit Number:' uilding0 SECTION 1:LOCATION (Please indicateAoi ck,#and Gat,#,for locations for a'street address. av able) 2O � Za/ rr �03 Sgl No.and Street City/Town Zip Code Name of Building(if applicable) SEC7T, „ ON 2:PR'OPOSED ZVORK Edition of NIA State Code used_ If New Construction check here❑ or check all that apply in the two rows below Existing Building❑ Repair❑ Alteration ❑ Addition❑ I Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ 1 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: .�8'OcyrE route //.o-/de /-✓ J.lfss<.es'r �qa �CMo✓n/ fi�.Gif/li(9✓ Ae-4 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.) Total Area(sq. ft.)and Total Height(ft.) SECTION S:USE GROUP'(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ I B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: Hi h Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5 ElI: Institutional 1-1 ❑ 1-2❑ 1-3❑ 1-4❑ 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(Checkers ap licable) IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ Hill 0 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❑ Indicate municipal❑ 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: AMA Historic CoMMIS5iOn Review Pnv:ess: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ 1 Yes❑ or No❑ 1 Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Cocle: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: SECTION 9: PROPERTY OWNER'AOTHORIZATION Name and Address of Property Owner Name(Print) No.and Street City/Town Zip Property Owner Contact Information: 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 property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10 CONSTRUCTION CONTROL(Pleas`e fill out A'ppendrx2)' If buitdiii is less than 35,000 cu.ft.of enclosed s ace and poi not under C6astruction,C66tr6l then check here'O'and'ski Section IO:I ` 10A Re 'stered'Professional Res"onsible for Construction Control- Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractors - - - Company Name Q `)io,Jen q�^ S, �uA do23 Q� Name of Person Responsible for Construction License No. and Type if Applicable A?_ fQ7.e rr2 4CZ-1r'ur7- '"I ozi�v Street Address City/Town State Zip Tele hone No. business Telephone No. cell e-mail address -� SEC rION,11:kVORKER.S'N COMPENSATfON INSUPANCE'AFPID.kVIT' 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❑ No ❑ SECTION',12:.CONSTRUCTION COSTS-AIVD 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 $ d. Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ ,/Q®®,a (contact municipality)and write check number here SECTION 13:SIGNATURE BUILDINGPERMITAPPLICANT,;, '; By entering my name below, I hereby attest under th&Kim and penalties of perjury that all of the information contained in this application is true and accurate to the best of my sv ge 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 The Commonwealth of Massachusetts q �< Board of Building Regulations and Standards CITY OF I I Massachusetts State Building Code, 780 CMR SALEM dMar l Revised Mar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a l One- or Two Family Dtivelling ly This Sectiori For Official Use Only' Building Permit Number; Date Applied`;. LU, nz 13 uilding Official(PrintName) gnat - . Date. SECTION 1: SITE INFORMATION 1.1 Property Address: �_ �Ot/ 1.2 Assessors Map& Parcel Numbers 20 C -,, r T 1.1 a Is this an accepted street? yes_ no Nlap Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L a 40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: / Zone: Outside Flood Z Public hY Private❑ — Municipal �'On site disposal system ❑ Check if yes SECTION!; PROPERTY OWNERSHIP"' 2.1 Owne rof-Record: F�lru� w, /Cyens� �� fe•� � lit - olR�o Name(Print) `� City,State,ZIP P,o Ce", / ( S/ �T 6l}-z5/ -IC7d No. and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK' (check all that apply) New Construction ❑ Existing Building Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg. Cl Number of Units_ Other ❑ Specify: Brief Description o Prop sed%Vorkz: , ep— , e 61� S ?-7 CG-4 j 1�Cl� h �X4i,t5 ryt 2— 4 4mb, f _ SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only,.; Labor and Materials 1. Building S 666 . 1. Building Permit Fee S ^ Indicate how fee is determined:, ❑ Standard.City%Town Application Fee a 2. Electrical S a06 _ .❑Total Project Cost',(Itern b)s multiplier x 3. Plumbing S 6 2. Other Fees: S 4. Mechanical (IIVAC) $ Listr 5. Mechanical (Fire $ Su> ression) Total All Fees: S Check No. Check Amount: Cash AITIOLU :. G. Total Project Cost: $ k666e ❑ Paid in Full ❑ Outstanding Balance Duc: a SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) -7 s 3 _Z6—(3 L -- �A o/"L" 7` ( J G W4 �- _ License Number Expiration Date Name of CSL I[older List CSL Type(see below) U---- .2 v- l3 206 f No. and Street Type Description U Unrestricted Buitdin s up to 35,000 cu. ft.) �VW-- R Restricted 1&2 Family Dwelling City/Town, State, ZIP II bfasonr RC —Rooring Covering v WS Window and Siding �7. SF Solid Fuel Burning Appliances 6-7 7�'"��"-7—� Z.� I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No. and Street Entail address City/Town, State, ZIP Tele hone SECTION 6: WORKERS' CONIPENSA'TION INSURANCE AFFIDAVIT(M.G.L c. 152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuanc of the building permit. Signed Affidavit Attached? Yes .......... No ...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property,hereby authorize to act on my behalf, in all platters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7h: OWNER' OR AUTHORIZED AGENT DECLARATION 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. Print Owner 1 or Authorized: .-ent's Name(Electronic Signature) Date NOTES: I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Houle Improvement Contractor(HIC) Program),will not have access to the arbitration program or guaranty fund under M.G.L. c. I42A. Other important information on the HIC Program can be found at %y% mass.eovi'oca Information on the Construction Supervisor License can be found at svww.ulass.eo�� dln 2. When substantial work is planned, provide the information below: Total floor area(sq. ft.)_ — _(including garage, finished basement/attics, decks or porch) Gross living area (sq. ft.) _ Habitable room count Number of fireplaces_ Number of bedrooms -- _ Number of bathrooms __ Number of half/baths rypc of heating system —_ Number of decks/porches - fypeofcooling System -----._-- Enclosed----.. .-_-_,---Open -- -3.. --1otaI Project Squ:uc Footage" may be sub_titutcd tor_ "Fotal Project Cost" _— --- -- ('K'301 l�.o The Commonwealth of Massachusetts LDepartment of Public Safety 1 Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (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) 0C e eh&a/ StL- �leA F /� O/4 �� o No.and Street City/Town Zip Code Name of B ilding(if applicable) 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 I Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ 1 Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Is an Independent Structural Engineering Pier Review required? f Yes ❑ NoA Brief Description of Proposed Work: KQD.'drf` �r�l'fP_l J�/�i�.le �P'/�'ll-zlnt-k1' �s�n�S S S � 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.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5 ❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ I H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ 1: Institutional I-1 ❑ I-2❑ I-3❑ I4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑ 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 ❑ ILIA ❑ IIM 0 1 IV ❑ 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❑ Check if outside Flood Zone❑ Indicate municipal❑ 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 Praess: 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): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: )I � 9 SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Lend/ �la� (�wcto�r1�n�cr�is � �-��fi_-el�cr/�ta�cz4et�.tf r� Name(Print) No.and Street 10-0 'a0Ci!y/T06V,5 Zip Property Owner Contact Information: QeV,QP AMA 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 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 building is less than 35,000 cu it of enclosed space and or not under Construction Control then check here❑and skip Section 10.1) 1 .1 Registered Professional Responsible for Construction Control Name(Registrant) No. e-mail address Registration Number Street Address City/Town State i line Expiration Date 10.2 General Contractor v— Company Name Name of Person Responsible for Construction License No. and Type if Applicable X4, /VVVt-Vieu✓ SiL << del- 611 40 Street Address City/Toy n State Zip �V-ff--J/�� Tele hone No.(business) Telephone No. cell e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCEAFFIDAVTT 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 No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT 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 $ f (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 the best of my knowledge and understanding. Please print and sign name Title Telephonrp Date �14eGt e �c Street Address City/Town Stare Z Municipal Inspector to fill out this section upon application approval: U Z4-�- Name D to CITY OF S.UI.E.NI, XWSACHUSETTS BUILDLNG DEPARTMENT P• 130 WASHNGTON STREET, 310 FLOOR raj TEL. (978) 745-9595 FAX(978) 740-9846 KI-,tBERL F-Y DRISCOLL MAYOR THomAS ST.Pwim DIRECTOR OF PUBLIC PROPERTY/BUUMLNG CONMaSSIONER 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: �'1tcPrlfY�ts6/1P% (narrK of hauler) �— The debris will be disposed of in s ley /r rytrf- scZedg-L Q v e (name of facility) (address of facility) `r signature of pe mit applicant date debris,fl'.il,x i CITY OF SM -M, N'UsSACHLSETTS • BUMI)ING DEPARTMENT 120 WASHINGTON STREET, 3'D FLOOR TM (978) 745-9595 FAX(978) 740-9M KINMERIBY DRISCOLL MAYOR THOMAS ST.P[ERRS DIRECTOR OF PUBLIC PROPERTY/BL'ILDLVG COM2%USSI0NER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Nn g,� Please Print Leeibly Name(Business:OrganizatioN y{lndividualy /'`t LPI�L% lG ,f IY ,0 - /r(!t JP (Q/�- Address: Ave- �� n City/State/Zip: Sa(2htf 1�14 6�,/QL<1 Phone #: Are on an employer?Cheek the appropriate box: Type of project(required): 1. 1 am a employer with 9 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).' have hired the subcontractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7• ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity, workers'comp.insurance. 9. ❑ Building addition [No workers'comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.) officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions myself.[No workers' comp. c. 152.§1(4),and we have no 12.0 Roof repairs insurance required.) t employees. [No workers' /� comp. insurance required.] 13.�Other Ae,00 - &kJar •Any applicant that checks box r I meal also fill out the section below showing their workers'mmlim mion policy information. r 1 tmreownen who submit this affidavit indicating they are doing all work and them hire outside cantmetors most submit a new andavit indicting seek =Contmctors that check this box meat attached an additional sheet showing the name of the sub-contractors and their wodera'romp.policy information, !am an employer that ls providing workers'compensadon Insurance far my employees. Below is the pollty and fob site injormatiam Insurance Company Name:. Policy#or Self-ins. Lic..#' C Gf� Z/� / Expiration Date: c� ! // .a t,h Job Site Address: oCl/ �fa��5 ( City/State/Zip: (P/kt. 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 ftnc up to S 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 S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations ordic DIA for insurance coverage verification. I do hereby cerrlfy under three p�aii+nnss and penaties of perfury that the h!formadon provided above is true and correct Signature: J'' ` 6�"�S/, [)are: phone#: /n 1 _cn ��-�R OJfcial use only. Do not write in this urea,to be cumpleted by city or town offli'iaL City or Town: Permit/License# Issuing Authority(circle one): 1. Huard of Ilealth 2.Building Department 3.Cityff own Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person. Phone#: Insured Copy Page 1 WORKERS COMPENSATION AND EMPLOYER'S LIABILITY INSURANCE POLICY INFORMATION PAGE MUTUAL COMPANY FEDERATED MUTUAL FROM MO Policy No. NEW 930331 'ARTICIPATING INSURANCE COMPANY • Prior Policy No. —�NONASSESSABLE POLICY Processing Office: INSURANCEv Account No. P.O. Box 328 343-429-7 NCCI Carrier Code: 16446 Owatonna, MN 550610-0328 HOME OFFICE: OWATONNA MINNESOTA 55060 Producer/Agent: Phone: 800-533-0472 ROBERT E HEVENER ITEM 1. NAMED INSURED AND ADDRESS: HURRAY MASONRY&MORE Entity Type Corporation FEIN 45-2439023 CORPORATION 10 REAR JEFFERSON AVE STE 1 SALEM MA 01971 See Extension of Information Page "Named Insured" Other workplaces not shown above:See Extension of Information Page "Other Workplaces of the Insured" ITEM 2. POLICY PERIOD: The policy period is from 07-31-2011 to 07-31-2012 12:01 A.M. Standard time, at the insured's mailing address. ITEM 3. COVERAGE: A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation law of the states listed here: MA B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $500,000 each accident Bodily Injury by Disease $500,000 policy limit Bodily Injury by Disease $500,000 each employee C. OTHER STATES INSURANCE: Part Three of the policy applies to states, if any, listed here: All slates except states designated in Item 3.A. and ND OH WA WY D. ENDORSEMENTS: This policy includes these endorsements and schedules: See Extension of Information Page "List of Endorsements" ITEM 4. PREMIUM: The premium for this policy will be determined by our Manual of Rules,Classifications, Rates, and Rating Plans. All information required below is subject to verification and change by audit to be made ANNUALLY. Prem.Basis Rate Estimated Loc. Name Code Fat Total Per$100 Annual No. No, No. Classification of Operations Ann.Remun. Remun. ,Premium See Extension of Information Page "Schedule of Operations" Minimum Premium Total Estimated Annual Premium $21,427 $550 Total State Surcharges $751 Total Estimated Cost $12,178 Deposit Amount $12,178 This Information Page, with "POLICY PROVISIONS", and attached endorsem` nts, if any, complete this policy. Authorized Representative and Dale Signed WC 00 00 01 A (04-92) WCF-1 A (10-00) Issue Date: 07-25-2011 (92L > �� Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration RealshaWn: 169898 Type. Cotporawn ExpiraBon: 8116=13 TV 215951 MURRARY MASONRY& MORE, CORPORA. BRENDAN MURRAY P.O. BOX 8454 SALEM, MA 01971 --Update Address and return card.Mark reason for change. SCA1 o zakw,rii Address Renewal Employment Last Cud c�4��paHrsnnwral�kculetr - Office of Cowper AfOdn&B■d Regnladea lAcease or registration valid for lodividul use only ME IMPROVEMENT CONTRACTOR before the espirstioo date. If found return to: h ration: 180898 Typo: OH&x of Consumer ABain and Business Regulation ration: 4116i2013.. copoalhn 10 Park Phra-Suite 5170 Boston,MA 02116 MU RY MASONRY d,MAbI�£,"C9RPORATION BRENDAN MURRAY-- 10 REAR JEFFERSON STREET S WIM,MA 01970 UedenemeLry Not valid without signature Safety Insurance BUSINESSOWNERS DECLARATIONS AUTO • HOME • BUSINESSop:cy Period Safety Insurance Company BKA0010985 08/29/2011 08/29/2012 12.01 A.M.Standard Time at the dearnbad loratien :.i9 .. .._ .. .:. Transeonn -. ... .. ...:..... Renewal Declarations N9med`,hrsured slid IYflailttaa'::Addreas .. Agent .. BRENDAN P MURRAY A1MED INS AGENCY INC DSA MURRAY MASONRY PO BOX 449/106 NORTH ST. PO BOX 8454 SALEM MA 01970 SALEM MA 01971 Telephone: 978-745-8800 65435 Form of Business: INDIVIDUAL Type of Business: MASONRY DESCRIBED PREMISES LOC BLDG ADDRESS AUTOMATIC INCREASE 001 14 BRIGGS ST SALEM MA 01970 4% ROP LOC BLDG COVERAGE VALUATION DEDUCTIBLE LIMIT OF INSURANCE 001 001 Personal Property Replacement Cost $ 250 $ 3, 375 Deductible shown above applies per any one occurrence BUSINESS INCOME: Actual Loss Sustained Not Exceeding 12 Consecutive Months LIABILITY AND MEDICAL EXPENSES Except for Fire Legal Liability, each paid claim for the coverages listed reduces the amount of insurance we provide during the applicable annual period. Please refer to Paragraph D.4. of the Businessowners Liability Coverage Form. BUSINESS LIABILITY COVERAGE LIMITS OF INSURANCE Liability $ 1,00.0,000 Per Occurrence Medical Expenses $ lo,000 Per Person Fire Legal Liability $ 10o,o o o Any one Fire/Explosion ADDITIONAL COVERAGES Some property coverages are subject to deductibles specified in the policy forms. Optional Property Coverage Description Limits of Insurance LOC BLDG DESCRIBED COVERAGES 001 001 Contractors Tools - Blanket Basis $ 10, 000 001 001 Contractors Tools-Scheduled Basis $ 54, 000 001 001 Contractors Tools-Non-Owned Tools $ 25,000 Optional Liability Coverage Description Limits of Insurance Contractors-payroll $90, 000 CHANGE IN PREMIUM: $ TOTAL PREMIUM: $ 3, 095 MORTGAGEES/LOSS PAYEES/ADDITIONAL INSUREDS LOC BLDG TYPE POLICY INTERESTS 001 1 AT Owners, Lessees or Contract BP0450 C P BERRY HOMES 460 BOSTON ST #5 TOPSFIELD MA 01983 001 001 Loss Payee GE CAPITAL CORP PO BOX 35707 BILLINGS MT 59107 BPDEC2011 INSURED �02�/�- �D ��`�, �I ;� �� - � � 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 w ellin ('This Section For 'c' se Only) Building Peimit Number: Date Applied: Building Official: ' SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a s6reet address is not vailable) ' ��G No.and Street Ciry/Town Zip Code Name of BuIlding(if applicable) SECTION 2 PROPOSED WORK Edition of MA State Code used_ If New Construction check here 0 or check all that apply in the two rows below Existing BuIlding❑ Repair� Alteratlon ❑ Addidon❑ Demolidon O (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construc[ion documents being supplied as pazt of this pemut application? Yes �( No ❑ Is an Independent Structural Engineeiing Peer Review cequired? Yes ❑ No Brief DescriFtion of Prnposed Work:__ L�t. S / s c �'o fi' -c1Gtid S ttQfP � r: +� L" i.� � T e �� / SECTION 3:COMPLETE THIS SECTION IF EXISTING BUII.DING UNDERGOING RENOVATION,ADDTI'ION,OR CHANGE IN USE OR OCCUPANCY Check heie if an Existing Building Investigation and Evaluarion is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECI'ION 4:BUII.DING HEIGHT AND AREA Existing Proposed No.of Ftoors/Srories(indUde basement levels)&Area Per Floor(sq.ft.) � Total Area(sq.ft.)and Total Height(h.) ' SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A3 ❑ A4❑ A-5❑ B: Business ❑ E: Educafional ❑ F: Facto F-1 ❑ F2❑ H: Hi Hazazd H-1 ❑ H-2❑ H-3 ❑ H4❑ H-5❑ I: InsHtutional I-1 ❑ I-2❑ I-3❑ I-4❑ M: Mexrantile❑ R: Residential R-1❑ R-2❑ R-3❑ Rh❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use �and please describe below: Special Use: SECTION 6:CONSTRUCTION TYYE(C7ieck as a plicable) IA ❑ IBO IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VAD VB ❑ SECI'ION 7:SITE IlVFORMAI'ION(refer to 780 Q�fR 111A for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Pemuh. Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A��W�not be Licensed Disposal Site❑ Private❑ or indenti[y Zone: or on site system❑ ��d O or trench or specify: pezmit is enclosed❑ Railmad right-of-Way: I-Iezazds to AiT NavigaHOn: MA Historic Commission Review Process: Not Applicable m Is Struchue within airport appioach area? Is their review complMed? or Consent to Build eiulosed❑ Yes 0 or No❑ Yes❑ No ❑ SECTION 8:CONTIN'T OF CERTIFICATE OF OCCUPANCY Edifion of Code: Use Group(s): Type of Constructlon: Occupant Load per Flooz: Does the building contain an Sprinkler System?: Special Stipulations: � SECTION 9: PROPERTY OWNQt AUTHORIZATiON Name and Address,of Propeaty Owne / /� Cn�rrrL ��Az� ��i�.rr�✓i�.y G/a l9i /°R��.?-f ��°'�2i�T Cv ..r.✓G . Name(Print) No.and Street ��/��,�City/ own � Zi �i �x+�r�y9LT �� A.�i,7 /7A O/97a P Properiy Owirer Contact Information: ��r fd�n//,C✓' O'7�,+/�q ' � / Ne�TY .��'Z-jZ_� ZZOZ __,-,�`S��C� 9 �vC��✓.�9 f'. ca-i Ti e v Telephone No.(business) Telephone No. (cell) � e-mail address If applicable,the property owner hereby authorizes Name SheetAddress City/Town State Zip to act on the ro er owner's behalf,in all matters relaNve to work authorized b this buildin ermit a lication. SECTION 10:CONSTRUCTION CONTROL(Ptease fill out Appendix 2) (If buildin is less than%,000 cu.ft of enclosed s�ace and or not under Construction Control then check hae 0 end ski SecNon 101) 10.1 Re istemd Pmfessional Res onsible for Construction Control �1n q��Q—G��-7-{q. �ar. , iA.�� •1-S�L4w. �y�' '/�-' a�m7-e�(`Registranty T lept1,�one No. ' e-maIl a e ��p-.�� R/e�� str tion Number /� /I' ,, -�' [ /[�d`t��Ef S'f" �A.('el.vl-r � —1-L-L�-� /'1�l��'�5�12—L7�{-�-1�i Slxeet Address Ciry/Town State Zip Discipline Expiratio�5 Date 102 General Contractor lnur��v /�'lasc�Py 2- �e . Cd,F,�. Company Na r<«.� �� ia ��a� � Name of PAerson Responsible for Construction q� License No. and Type if Applicable �o� ril�fN'l�eu/ s� 'L.�{�i1/'!l� �v� �� QIS Street Address City/To�- State Zip ��d,3� 4�P_��89� 2.1.��tuMrri�2tu.�o.ir�ano�bre Tele hone No.(business Tele hone No.(cell e- ' address `�O�'9 SECTION 11:WORKERS'COMYENSATION INSURANCE AFFIDAVti' M.G.L.c.152.§25C 6 A Workers Compensation Insurance Affidavit hom 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 si ed Affidavit submitted with this a licadon? Yes � No ❑ SECTION 12:CONSTRUCITON COSTS AND PERMI'1' Item Estimated Cosks:(Iabox and MateriaLs) Total Construction Cost(from Item 6)_$ 1.Building $ g��g Permit Fee=Total Construcrion Cost x_(Insert hece 2.Elcctricai $ appropriate municipal factor)_$ 3.Plumbing $ 4.Mcrhanical (HVAC7 $ Note:Minimum fee=$ (contact municipaliry) 5.Mechanical (OFher) $ �� 6.Total Cost $ �a �� Enclose check payable to � � (contact municipality)and write check numbei here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLIC_ANT By entering my name below,I hereby attest under the pams and penaldes of perjury that all of the information contained in this application is true and accurate to the best oF my knowledge and understanding. t3r�e�st � h?c,co�ray �'6es��e� r� 4��1L�Ya /6 r i Please prin�j and sign name / Title �,.� s� Telephone No. Date .�' .3- � �r l EM � �"�'W _ �/�r� Street Address Ciry/Town State Zip R'ea �-� /'S 1�. � Municipal InspeMor to fili out this secdon upon application approval: Name Date ! Il - u .k m � � m A2 2"INSULATED PANEL �yy r„��.c{ - � � I � � � � . ao THRU WALL FLASHING �- � ��t i �„ � � � � 3�"METAL STUD.WALL . � SAL9l k V W �'` � w > , � �_ � � UNIT 308 t� � Q W � � � II A� 6"CHANNEL � Q � � ( U N I T `t O / HEADER Q � Q � ITYPICAL WALL CONSTRUCTION W � F A C E B R I C K STEEL ANGLE AT � � W Q 7"AIR SPACE W/MORTAR NET WINDOW HEAD @WEEPHOLELOCATIONS _ _ - - � '��'.'. = W � O BRICK TIES @ 16"O.C.VERT / '..:'.,'.�.,��,t.� Q U �[ � 2"METAL WSULATED PANEL WEEPS AT 24"O.C. � ��.� U N I T �O U e� w NEW 35/a"METAL WALL STUDS LL. Z TO BE MOVED 1 1/2"BACK ' ��'� � � FROM EXIST.LOCATION � � �.� _ (3"BACK FROM INSIDE FACE n � ~ � OF BRICK) o � J/�"GWB PTD. THROUGH WALL MOVE EXIST.METAL STUD FLASHING(SEE METAL � WALL 1}" BACK FROM EXIST. WR4P DETAIL) / �t��".��t��:�� LOCATION � ,1�.�.�.t��.'.��, '�, BRICK TIE 16"VERT. EXISTING WINDOW � NEW 2"INSULATED � � � � � � � � N METALPANEL WINDOW HEAD . � �. � . � � � � � 4 n _ i n ��O 2 3 - � -� O\Z l ��oa I Az THRU WALL FLASHWG Z �Wm W J � I WEEP HOLES AT � . Q p �� Q 24"O.C. J ��Q U ,. � O. ZCN " I � _ _ _ ` � EXISTING WINDOW ICE AND WATER SHIELD '� EXIST.STEEL STRUCTURE �� LAPPED OVER PANEL ""'� � . J�"RIGID INSULATION �~ � 0 SOFT THROUGH WALL EXISTING STRUCTURE �y �� U N I T .J O C J FLASHING(SEE METAL O N Z� WRAP DETAIL � � � � Yz"GWB PTD. BLOCKING i (if � � � 2 MOVE EXISTING METAL LIMIT OF WORK � � ~ � STUD WALL BACK 3"FROM '~ � Ci A1 INSIDE FACE OF BRICK � a � ,�,� I I � � NEW 2"INSULATED s i � � � METAL PANEL EXIST.3/e"STUD WALL ,0 � � W � I W/3J�"FG BATT � � a � I BRICK TIES 16"O.G VERT U N I T �O U W � (�U] � WALL SECTION 1"AIRSPACE owc No. � 1 3 1/2" 1'-0° EXIST.Yz"SHEATHING FLOOR DETAIL A� WINDOW SILL 1 „ — , „ A 1 ( <�. . � 2 3�� _ �'-0" 3 1 -0 .,� � � �, NEW 2"INSULATED � ��S � . �- METAL PANEL � ` � � � r Z � F m METALSTUDS w p!a1 TO BE MOVED 3"BACK REPLACE T' � � > FROM EXISTING BRICK EXIST BREAK METAL COPING RUBBER f�F{N �� • � = o N TO MATCH-REPLACEBLOCKING MEMBRANE-PATCH f � V Q AS REQUIRED � � MORTAR NET @ WEEPHOLE A S R E Q U I R E D ` Q � � LOCATIONS � 0 g � �� /� ��,.:. � EXIST.INSULATION Q W� Q � BRICK TIE 16"O.C.VERT. � � � � % . . a � W a THROUGH WALL = (,�} ¢ O SOFTFLASHING W � Uo� � U N IT 407 ❑c z ICE AND WATER SHIELD � � LAPPED OVER PANEL � �,� H AT HEAD AND BASE M . . .. . . . N �I O 0 � N \� ICE AND WATER SHIELD p �Z LAPPED OVER PANEL H AND BLOCKING Z V m O ¢ 1 J � �QCa7 1 �"RIGID INSULATION � �' Z� y � EXISTING STEEL STRUCTURE �" RIGID WSULATION � � .,..� EXISTING STEEL STRUCTURE 2"INSU�ATED PANEL ...y BLOCKING �i Q � � �� i Q � � � � N C� � a � � j � � � ~ �i •� � U � � UNIT 308 UNIT 407 � � � � a� o � "; w � c� rn DWG NO. FLOOR DETAIL - OPTION 3 PARAPET DETAIL - OPTION 3 A2 2 3�� = 1'-0�� 1 3�� = 1'-0�� y S '6 1 - 1 � � G �12s;� I- 7 ? Z� The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code,780 CMR SALEM dMar Revised Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: tDate Applied.; Building Official(Print Name) - �'`Si /rem Date, - SECTION 1:SITE INFORMATION 1.] Property Address: 1.2 Assessors Map&Parcel Numbers !�4 _ _Qrl1+ aO I 1.1 a Is this an accepted street?yes no Map Number Parcel Number -1.3 -Zoning Information:- ---`^ >";.= -"" = 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6-Water Supply:(M.G.L a 40,§54) 1.7 Flood Zone Information: 1-.8-Sewage Disposal System} Ef� Public 41 Private❑ Zone: _ Outside Flood Zone? Municipal On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP[ 2.1 Owner of Record: �me(Prin ry r�u + .Nci c 3Qs-- �_lt_,�r.-, MA _ <019�O. Na t) City,State,ZIP 1 ao t^_of,�C,C,a 5+ D C) ;)o J 9 )e, -5gy.87y5 No.and Street ' Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building Owner-Occupied 911 Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units_ I Other ❑ Specify: Brief DescriptionofPro{p�o�sed Work : �lois'1oc�.cy` yNi�CA'an _riImrni[. +'rva�cte... CarSi'h� IG1RM� 13rt/w[nt SGH.,t. 45e T I�SECTION4 ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I.Building $ 7 i(QU p U 1Building Permit Fee: $ ,L.Indicate how fee is determined: 2.Electrical g ❑ Standard Cny/Town Application Fee OQ '110 ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 0 0 2. Other Fees; $ 4.Mechanical (HVAC) $ List: 5,Mechanical (Fire $ Total All Fees:$ Su ression) j Check No. .Check Amount: Cash Amount: 6.Total Project Cost: $ 6 4 70 Q-d 0 Paid in Full 0 Outstanding Balance Due: O ' SECTION 5:.CONSTRUCTION SERVICES Y 5.1 Construction Supervisor License(CSL) Ls -Oaf Vp,A,p,r C'<:y,`d 4License Number? (Expiration Date Name of CSL Holder L, List CSL Type(see below) nl7�r a 1 CCAkQ.-c- &,,I . S+tL. a l� No.and Street / Type Description U Unrestricted(Buildings u2 to 35,000 cu.ft. Y J7 R Restricted 1&2 Family Dwelling tJ' City/Town,State,ZIP M Maso C VD Roofing Coverin .� S Window and Siding Solid Fuel Burning Appliances C Insulation Telephone Finalla ess Demolition 5.2 Registered Home Improvement Contractor(HIC) C-"� a�crr,� Un\1 156191 l -la Dat �.�c�-� Registration-NumberHIC _ _ _ <ExpiFatimon Date 'Z HIC Company NameJr HIC Registrant Name a Co \�cr �+ s}a . a P6+�bcQQr v S+ .Y1at� No.and Street cE - Taddre@sj t� Pam. cak�o .. Mfa _ 0191.0 47g-315 ��tC�S Ci /Town,State, IP Telephone V SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c.152..§25C(6)) T Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide pP this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... No...........❑ '.SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN _ .. .OWNER'S AGENT OR CONTRACTOR, APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize C O,t] U t nc4rL. N i Jh t t Q3A En�as-f 6sq s yv_ . to act on my behalf,in all matters relative to work authorized by this buildi g permit application. Print Own 's Name(Electronic Signature) C.Da—tel - - - SECTION 7b:OWNER' OR AUTHORIZED-AGENT DECLARATION-.. . 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. Print Owner's or Aulhori Agent's Name(Electronic Signature) CDate4 NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass. og v/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost" __-- 1 I n:a,�� Ix m� � r, +�� ,Y �,,� ; � � �� ____..._--- ,�...a �____ -_ /� ,�� I_ mj1n' � ♦ J T1, !� �cof st The Commonwealth of Mas"'Wettg A it: 9 Department of Public Safety (] ® Massachusetts State Building Code(780 CMR) �J Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) I� Building Permit Number: Date Applied: Building Official: I SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) I-� No.and Street City/Town Zip Code Name of Building(if applicable) 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 ❑ 1 Addifion❑ 1 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 J9 Is an Independent Structural Engineering Peer Review required? Yes ❑ No 'ef Description of Proposed Work: OR cZG(�1 X41 C.-) k.�El—�. 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.H.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ F B: Business ❑ E: Educational ❑ F: Facto F-1❑ F2❑ 1 H: High Hazard H-1❑ H-2❑ H-3 ❑ H4❑ H-5❑ 1: 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 O and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA IB 13 IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ 1 IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Debris Removal:i Permit:Water Supply: Flood Zone Information: Sewage Disposal: Trenchp Licensed Disposal Site Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Private❑ or indentify Zone: or on site system❑ required❑ e permit is enclosed❑trench or cify. 2 2 Railroad right-of-way: Hazards to Air Navigation: MA I-Iistoric Commission Review Process: 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): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: CJ`�infi�CL� r��:CL V Gz,nc?�CLI�vf l✓/iG�9J E, c� Paws C110 The Gibraltar Management Co., Inc. P.O. Box 627 Beverly, MA 01915 (978) 922-2202 October 4, 2016 City of Salem Building Department City Hall Salem, MA 01970 To Whom It May Concern: Please note that the condominium association located at 20 Centir.al Sweet;, Salem MA, Central Plaza Condominiums, has hired EB VVindows of Lynn, MA to replace the common area windows. A�nyyquestions can be addressed to me, R&P Robert M. Polansky, President The Gibraltar Management Co., Inc. Managing Agent for Central :Plaza Condominiums SECTION 9: PROPERTY OWNER AUTHORIZATION A e and Address of Property Owner Ibi-a lir e- k 6W ua� P��-, Name(Print) No.and Street City/Town Zip Property Owner Contact Information: 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 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) Of building 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 D YIP lo' - �f7 ",)inY) &I �q �a\m�(Regissttr�t) h Tel phone No. e-mail address Registration Number a n J 63 Street Address Ci irat'/Town State Zip Discipline Ex n Date 10.2 General Contractor . U-)l rwpkp —♦-dot (J� Company Name�� fow 6t ✓" - Name of Person Responsiblelfor Construction License No. and Type if Applicable Street Address Ci /Town State Zip Tele hone No. usiness Telephone No. celle-mail address SECTION 11:WORKERS'CObll'LNSATION INSURANCE AFFIDAVU 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❑ No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs:(Labor Item 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)/xa 5.Mechanical Other $ Enclose check payable to ��/ 6.Total Cost $,a3 C)CD (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 thFbqt of my knowl d understanding. ` Please print and si n name /// Title Telephone�NTo� D e qhs r <-fI-1�,.q ^ t Street Address Ty/Town State Zip Municipal Inspector to fill out this section upon application approval: 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. 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 Plumbin include local connections 9 Gas Natural,Propane,Medical or other 10 Surve ed 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(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 120nu,(rid l �r n+SH / ?�3 Name(Registrant) Telephone No. e-mail address r,.,��r1+ Registration Number 1� ri In- 0/905 5 a f 3 Street Address C' /Town State Zip. Discipline Expi tion ate Name(Registrant) Telephone No. e-mail address Registration Number Street Address Ci /Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address Ci /Town State Zi Discipline Expiration Date -ftiy"SIMIST-BEffLf��IND APPROVE{) $Y T�iE .MWFXTDB PWfl TP:A.PEANUT BEING GRANTED CITY OF SALEM Sf 2LNo. '� ' Date 3 3 O5 Is Property Located in Location of the Historic District? Yes_No Building/ Z o G£nrT � sT Is Property Located in v rk`4 Y v� the Conservation Area? Yak—No BUILDING PERMIT APPLICATION FOR: Permit to: (Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool, Repair/Replace, Other: /S4rh' PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS IN PROCESSING TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit to build according to the following specifications: Owner's Name Address & Phone 2 7 v0r3 CA0 63( &Z30 AmAkeeft Name F3Atr g1ICA P,annr� Y Address & Phone 232 S4nnMir sr 84ze,,khoz- (61?) 26y 2, 3 /0 Mechanics Name LA) P Nt I (�6 ' Address & Phone What is the purpose of building? Gnn�op S Material of building? 4rvcaerc + e5i cK If a dwelling,for how many families? Lm✓oo Nil building conform to law? Asbestos?_ Estimated costJ /S",60 City License• N �' State License# O&2 0 q e7 �rrrU Hone Isprovenent Lic. t 1-4 3 16 ' ' nature of Applicant SIGNED UNDER THE PENALTY OF PERJURY DESCRIPTION OF WORK TO BE DONE �a2aug P7`n/ !c7/d!/ @ c/osu �N�q�4& 1"7'qsTe2 f� arm i�ffsiadt 7u/5 7z) mijkt 41,41k MAIL PERMIT TO: 3z • No. 2 fv5 I APPLICATION FOR _ PERMIT TO � E t ,t LOCATION r t� �Pnfnc( PP 417,r �� PERMIT GRANTED APRO �D INSPECTOR CIP BUILDINGS t L ^ri a r o NEN r 31, n/ rQ m e m REUSE EXISTfNt� NEW 56, POCKET DOOR OSET DOOR NEW 56" POCKET DOOR n c • U N , 4 Q VANITY WITH 00 NNI'f,E" CORIAN TO - INTEGRAL 51NK ^ _ NEN HOT lb m d? _ -- ---- WATER Ff ------------ a reo .o u� un:ana u.w. rni 1poc oompany --- �-srn-onv-aiiu p. e 0.W.PWLPOT COMPANY P.O.80.174 MPSFMO,MA DIM �S P� 0 l i i y 8' i ? ¢ 14 r{ I fTl ` s ` SNf1TZ RESIDENCE MATZIDESIGN 20 GEN7RAL ST. - SALEI .MAo b EXISTING FLOOR PLAN i i a FROM :BOILDINGDEPRRTMENT FAX NO. :9787409B46 Jan. 24 2006 03:52PM PI via blrtlOMMrI 1/rLl14Y :r MOAMT Y1L.� /— (mw �e WdW e�M�r �00�e To"WW=QpWJWNm 7M urmmOlud W"epow im A wft a kW Swo"a to abwrw o�ere N1Aw Iw�rw♦Fh m 7 -� Anhh m's Nm Adams i Ph" . Machw s NsmA 0 wwrrbps}o. il, ..- or ,.. J. ........m as�tsO1 ■e twlMB�ler�s�rgl r�P�.—�.---- wowr�sssuw�nw+ _ ho�rrodae zz= aysioen+• N A u° • hommms INipwt 1i1!lrilAL4Y ' �iiCw�101/or YIOIrG TO it DOpt MAIL PONNT Tk f 3) f o0 •.` J \, Pd.�- fin \\ ! Imo\.. �•\O \ \ � V' v.nroentr.u�r.a Tr nb.e.ro a6w,e•o tl:r Pe;•— rC 66• NrvPM Out e6 Gwn FriCp•reli hi 6,nlll w p.. hom aalotlnp enlnnco Cow. aG-�'-tC-Y--iC' '1 ao---�L il- 9Ppocebetl unWrewnMllgM1lp li-�� >t�� ao•�T_ ,e• 'I�'—ao••-.��o'-�•I aa• tlova ln�torcwP enC Mel cbntrtl{nev) Tbo o enba Charbu h.n i6i5' 112.1.oam MCNbnW of 2.5 i y I trnmF _Y®mhp WJn®IIT MI[L1 - . � n I � : �M'nee$1 �• r • �ielR6 aa,aa /'� O trh,ea FLt q eqn bees PM wUI CWIingb hdpht6Srl2- cabin ttotb 1 hot F �• =n. to be M1ung.r At- too rarys ho,e l'a[I.6,d Y. .S b �ryM ronminCx•dtl. b .flb tore Iw eropsr epeNnp y 'E • ; enwerce a , ...... V.na•r v1.to h..pp1- i R ._ n• toboaom WWol wb net ebow tonY en 311e. Y _ I o t �aeoa mh ynr or Y i —X—''a- proper fit to•all, Ir fi"..... —�.. PT 1101 I b O I '. zsa• '. All dimensions atze designations given T' Is is an ongina esggn an most not igned: lOf24/05 are subject to verification an job site loom s 1 j be released or copied unless applicable Printed: 10/24/05 I and adjustment to fit job conditions. ice ties been paid or job order placed. a UrliptfaIItr r Al Oc .ldt p;..Wilt tl,l.n ---_—,--- 1 Drawing : l current floor plan �j Partition wall to be removed Liv�ti� cv✓✓� 8� C�a�� FROM :BUILDINGDEPARTMENT FAX NO. :9787409846 Jan. 24 2006 03:55PM P2 CITY OF SAdLICM, MASSACF US19TTs PUBLIC PROPIERTV p6PARTMIENT 120 WASHINOTON STREET, 3R0 PFLOOR SALEM. IMASSAGHUSET'fS 0197o 4TANLRY J. LISOVICZ, JR. TELEPHONE: 978-745-2025 EXT. SaO MAYOR FAX: 278-740.9846 In accordance with the Provisions of MGL c40 S 54. a condition of your Building Permit is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL Chapter III, S 150 A. The debris will be disposed of in: ..(Location of Facility)s h&O J eignature of Applican Date 0an-24-06 09: 57A P_01 ACTCRD CERTIFICATE OF LIABILITY INSURANCE OP ID Dj DAM IMMDWYYYY) MONTR01 Ol 24 06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dan Hurley Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Chestnut Green, Suite 24 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Seven Federal Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Danvers MA 01923-3620 Phone, 978-777-9394 Fax:978-777-3306 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A. Preferred Mutual 15024 N3UktH e: R.M. many Robertt M.M. Montmiminy DSA IN3UAE0.C. 11 Cleveland Street INSURER D INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUF ED NAMED ABOVCFOR THE POLICY VLHIOOINDICATED.NOTWITHSTANnWG ANY REOUIREMENT,TFRM OR CONUII ION OF ANY CONTRACT OR OTHER LOW RENT WITH RESPECT TO WHICH THIS ELK(IFICATE MAYBE ISSUED OR MAY PERTAIN,INC INSURANCE AFFORDED BY THE POLICIES DESCRIBED HLREI I Ij BUBJEGT FO ALL THE TERMS.EXCLUSIONS AND CONUI I IONS OF SUCH POLICIES.AGGREGATE I(NITS SHOWN MAY HAVE BEEN REDUCED BY PAIO CLAI 43. INSR -.. .. U �DCYBXPIRATIOli ...-__�. ._... . LTR TYPE OFINSURAMCE PODCY NUMBER PATE MMN DATE MMro LIMMTS GENERAL LIABKJTY EACH OCCURRF.NGF E 1000000 A X COMMERCIAL GENERAL LIABILITY CPP0110577052 10/22/05 10/22/06 PRE_MISE$I(F0nu0RCP) S$0000 _ CLAIMS MADE LX7OCCUR. MED EXP(Arya P-xm) .... .$5_000 .__ PERSONAL&AUY INJURY $1000000 GENERAL AGGREGATE E 2000000 GEN'L AGGR[OATF.I IMITAPPLIES PER.i PRODUCIS-UUMFUPAGG s2000000 X !POLICY JEC ! 1 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT j ANY AU IO TEA eivdenl) ALL GMINFD AUTOS BODILY INJURY S SCHEDULED AUTOS (Per Parsm) HIRED AUT05 BODILY INJURY NON- OWNED AUTOS (Per.'dem) PROPERTY DAMAGE .. E .. (Pere ,d.,d) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 5 ANYAUI'0 - OTHER THAN EA ACC S AUTO ONLY AGO S EXCESSIUYBRBLLA LIABILITY EACH OCCURRCNCF S OCCUR ! f CLAIMSMADE AGGRFGATE j DEDUCTIBLE E RETENTION E E WORKERS COMPENSATION AND EMPLOYEWLIABILITY TONT LIMITS FR ANY PROPRIPORIPARTN[RJFXECU I NE E.L.EACH ACCIDENT S OFFICIto, RAIETABER CXCLUOFO-� [� L DISEASE-EA EMPLOYE E I(yyBs,deccrib9 UtldeT _ SPFCWLPRUVISION5brAv E.L.DISEASE-POLICY LUIT S OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I IEXCLUS"S ADDED BY NOORBENENTJ gPgQwI PROYI&ON6 As per policy. CERTIFICATE HOLDER CANCELL ATION Cl Cy OF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE TIIMFUF,THE ISSUING INSURER WALL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL City Of Salem IMPOSE NO OBLIOATION OR LIABILITY OF ANY MIND UPON TH E IN SURER,ITS AGEN TS OR One Salem Green REPRESENTATIVES, Salem, MA 01970 AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) Daniel LT Hurley 0 ACORD CORPORATION 1989 CORD CERTIFICATE OF LIABILITY INS.URANCE., - 9>!�o 02 011 24/06' PRODUCER THIS CERTIFICATE IS ISSUED.AS A MATTER OF INFORMATION ONLY AND CONFERS.NO RR9.HT8 UPQN THE CERTIFICATE John J Walsh Ins Agency, Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P O Sox 4407 ALTER THE COVERAGE AFFORDED ey THE POLICIES,BELOW. ' , ' i�x Ytir �F , • Plioae. 08-745-3360 Pax:978-745-9557 INSURERS.AFFORD1NG COVERAGE,.,.,. NAIC A! . TiE, 11ARTk'ORLT .. . . ., ROY7,P MOL .. , INSURERC . ._ _ C1,evela}AAD3d' .i• r INSURER D' .. . a Salem Mh! 61970 .. rM6uRFRe COVERAGES THE POLI OFINSURANCE Lf=BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PDUCYPERIOD INDICATED.NDTVATHSTANDINO ANY REQUIREJAENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,711E INSLIRANCE AFFORDED BY THE POLICIE6 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND COMMONS.OF SUCH POLICIES.AGGREGATE LEXTS 51 O MAY HAVE BEEN Re=m BY PAID CLAJMG... . LTR bR TYPEOPINSURANCE FOLIDY NUMBER I DATE M' D0. Lmurs GENERAL LLA ILRY : F.AGH : S . ,L'MMAERCIAL 6,ENERAL LLAknY '.PREMISES OtiVPnaB7 : S . '1 CLAMMADE FX CUR I, MEDEXPIIA"pt%gMo S .. Y.� FERSONAI:$ADVINJURY S .. . i IERAt AGREGATE' 3 GEN;tAGGREGATE'LPdITAPPI.BESPER; PRODUCTS{COMIRMPAGIS b ,, 'f uey $GT .IOC :. AUTOMOWEUAMUTY .. . . x.! COMBINED SINME LIMIT . ANYAUTD I�amAeA01: 8 1 . ) QJ- xW AUTOS - {BODA:YSuIYRY ., �,CHEDULEDAUTOB ,dl AUTOS 06DILY1K.16kY IS .. 55NON-OWNEDAUTOS Fw ecc,6,daral. i .. FROPEiIw RANIAOR S . OARAaE LIABDJTY AUTO ONLY=EAACCmarr 3I q: 1 yWYAUTO - 07.1 R EAA06 $' 1 . AUTO ON ., AGG S I vEXG�SA.maeRELLA UABdRY EACH OCCUfBiENCE s OCCUR Q CLAB,)B(MADE AGGRE A : :5, EMPLOYERS'LNuBLIfY AND % TORY LUAftB ER.,, A ANY PROPRIETOWPAR-RIERIEXECUTNE 6860U8-0732C314 11/01/05 11/01/06 EL EACHACCIDHJT $100000 OFFICETVA1Rri8ER'IXCLUDFDT .EUDISE*mFA6A01LOYE. S' 00000- RMea dada mdw MLA FRommoNBeabw E�:D�Asi�-POLKYLBAIT S500000 DESDRIPTION OVOPERATION8ILOCATION$!VEHIIII EXCLUSIONS AQDERBYEN00RSEMENT I SPECUIL PROVISS)HS CERTIFICATE HOLDER CANCELLATION 0001003 SHOULD ANY OF THEABOVE DESCRIES POUCES NECANCELLED BEFORE THE E{RATION DATE THEREOF,THE MSIBNG INSURER WILL ENDEAVORTO MAIL 10''. DAYS'WMTTEN CITY OF SAl" NOTICE TO THE CFAMF14ATE HOLDER NAMED TO THE LOFT,BUT FAILURE TO DO 80 SHALL A'1TTAT. HT^^ DEPT. IMPOSE NO OBLIGATION OR LABILITY OF ANY HIND UPON THE SERIRER TTSAGENTSOR 1 SALPH GRIMN SAL= N& 01970 REGtrS99aYATNES AUTHORRED REPRESENTATIVE 'PlB3S� 13� �♦i�IICOnL� . ACORD 26 120 07/08j 41ACORD.CORPOPA11ON 1888 Wd 89.:0.L 900Z kZ Usr M69b1616:Xe3 3ONVUSNI HSIVM NHnr CITY OF SALEM, MASSACHUSETTS y * BUILDING DEPARTMENT 120 WASHINGTON STREET,312D FLOOR TEL. (978)745-9595 FAx(978)740-9846 KIMBERLEY DRISCOLL MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER March 19,2019 Central Plaza Condominiums CIO Gilbraltar Management P.O Box 627 Beverly Ma. 01915 Att.Rob Polansky Dear Mr.Polansky, This Department has been made aware of a dryer venting issue at Central Plaza. Specifically,the coin operated dryers are vented directly through the wall and into a five gallon pail. I have looked in the ICC mechanical code and have not found an approved venting system such as yours. You are directed to secure the services of a qualified sheet metal person to design and install a proper venting system. The Installation will need a building permit through this office. If you have any questions,please contact me directly. If you wish to Appeal this order,your Appeal is to the Board of Buildings, Regulations and Standards in Boston. Please let me know your plan as soon as possible. Sincerely, Thomas St.Pierre , ; � � " N111IT 1 '9/- O � � � � � '� � � � � . . � � �: � � �w� � � � ; _ � � � � � M � � . � � � � � � � � : /JI � � � � 6 C¢a �'/'e e� {"(y7, � � � � �� S � � Sk,'�e � (G f � � � �n � ?: � ��rmit G��ted � /5 � 3p_ � � � �� r �� , � � � � � c :� • � �pp vsd by: - � � 3 �^ � �. . � I ' � � � � ��`y � ' �� , � � " � 61 � � I � ` l .� � �\ � i � � � 2-. : � � � s g • � � � � � c � � � � o �,� � � �i xx - � � g � � gs � � � -► � \ � � � I`J � v � � � $ , � , � s � � . � s �� s , � . � I ' N ' � � � ' '�_ � � i �� • EITY�OF � PUBLIC PROPERTY DF.P�R'r��►v'r �...�� „�. ��o��.��„�o�n. t�:n�a.s.�...�s sn�,Hw AlP�.ICATION FO�'T� RT�.?AIH. 1t�N�VATiAN CnN�trrrrnrr_ DE.riOLITION�QR C�AIYGt O�U3S 01t OCC[Jl.Lt�CY. FOR�rtY E�a�rrx� . 1.�llTt INfOR11AT10N • . . �«auonNanre C�NP��D � �NTf�� Yd�+a --- - plopwlyAdd�N�c-o�D_��L-�T�fi`r�I`�LA2A- i ��1TE . ---- - - - �9 ) --.. _ SA��M � M/� �1��-a P�oar�l Is bea0�d N�Con�wMlon/bM YM_��Hwlarb Of�lpt YM L 10 OWNERSFIIr INFORMATION • • • 11Own�dLand D�• JOi�iCe Csnrac� , `1�-�i�9 Narn� Cc�rv(�,�kv `7�"rLuTP�L— Addr.s�; a� C�� ; ��A-z.'k , Su �T� ��1� SA-�Er-� , 1�/� b 1°�� TN�pF�rw q �g `{I - 1 CD O �.00OMPLET!THis SECTiON f01!WORK IN E�Wp BUILDINps ONLY Addwai Extsqrq y + i�wer ga�aye 'i R�novallon �/ Numb�r d 3toriea R�novat�d Chang� h Us� N� Danolitlan �y� I�/�� . al� y¢ars ( n co��on a ronovabon �s pv Aaor a R�novataa of existirq buildirq New I Brie!Deiaipdon of Proposed Work: Ren�vc�fi� oFcu� P�x.i��li�� f�e�c- 5-iz�y�� c'e�re�, in-fii Ccv� o�{'i��e� Icibore��-ix� ; �.�ncl ~h� C2-� a�e�-Iz>ry �ams , --- - - ---Mail Permit to: - - - .r ��'✓IIV � � �— . ; . L�J LS�V 0 G�1L� i ' , .. . . . . � 2��l4.0��0 , . ., . � � ��1�� cow�srutcv iora co.i�c. � RENOVATIONS TO CONRAD DENTAL � ��y,��.o�c. � ��,��. Pw cermy Bquare LIST OF DRAWINGS ��Ka,�'�'� 7E B 746 . � c.wu:auv��cr8 �� 1 �' � SoaO��m T-1 TITLE SHEET " , � �o c��oc��o�a��s�� A-1 LAYOUT - A-2 REFLECTED CEILING PLAN � ��go�n6 E-1 ELECTRICAL PLAN F-1 FURNITURE PLAN . : G`StEREO AR�h�rF . . 4,'�0��,��s a.699 c��, � No.5185� k � g gosro ,,, 1AA$ ,ti / /f?'q� H F P fiI � ` � ��.'iw'.�., u� s4 w OMw�ur Mi��eRao�d�in � q��uW�M,e�n eyqi O n�P ' �IYY�O��I� . .tr'ttOVED' ��—�y�� .i�i:c4;ta a�psoval by a>y c`,.'��,t r�tc�rit.hav:��jrsis?,ic'-�,ion. N0. DEBCWPf10N a,.� . � �Lm4) E' �('( y�g "fRA(�� F i !.� O_Sl1ElW!Yly�.1.y.? • „� �rn� mm�i�;3I'd'Fff33 EuJE:;i.�Bl � DRAw�BYP°0'oc°s° CHECKED BY:D.J.G. � v' _ , '.s. C0P14�1$4TBm8 � 6CALE:1/4"•1'-0" �� ' " DAT£91/OA07 �tqn c r�or pppRGYED OLE " '�LDEL li'rl,�',i1i(flN-C'F -.c�AP1D I!`r1,TIAN QF'FIES��.,�.°d C ... c�, OCIE�PLAR9 � � F f PRGTECTl9fd DEVI�S�.o "U�J ^T ip A. � i .�.i�' TARDINSPECTION,FORcoht��.Er�c^��-.;�- TITLESHEET , ;�,�,iTr;T�e=iP=coo�. � PERMIT SET � T-1 � ,. � '� �� 4 � 9 4 � � SeEeury 7A.0 9�0 - ---� - — - - - - — ----- — - � —�\— -- . . � � ��6��lIPC� NOTES� COBdSTPtCU�IOk CO.IfNC. � 1� BPSE - HW. 4'H7. � � ' N %Jpf 2. TR7M - HW. 3' � lV � 3� D�ORS - HW, STILE AND RAIL W GLPSS, PROVIDE SH�P DRPWINGS� ruR ouT wa�� as Qr�yP�NVQea�le, Oesc. REPUIRED TO ACCOM�DA7E � 4, FLO�R LARPET. � ��Amo�ecp�� PLUMBING RUN GLASS WALL 5� WALLS PT GWB� pqDe�yByip�� BACK TO CHASE Bdanp,ppm�e�dlpwtry01W0 � X-RAY SCREEN RECESSED � 6, CEILING PT GWB AN➢ ACL FIELD � �� 'e 'a � O�� CONFIRM HT, �.W8 awn:auvwmnman � ' � 7. GLASS ABOVE WALLS WD�D FRAME, m""'°01" Op2f8tOry 1 � NAruRa��iNisHT cciuN�, s��s Hw e. sTORa�E Roon To r+AVE nD�usTne�c � �� sHc�viN�, aRov�sroNs FOR uNnER � 20 C�m8�9 SQme�4 P6�� C�UNTER REFER AND AB�VE COUN7CR ��'S' ' p' MICROW. � , ? W� 3'� x 4-�� 9. PROVIDE UNDER COUNTER LIGH7ING, . AND 7ASK LIGHTS AT [7PEN COUNTER ��400�� _________________________ �o, ________ ____________________ I AREa SEE CEILING PLAN, ``_._____________________________ �� I 10. PLUMBING CHASES TO BE PROVIDED 8�-8�� Y ALONG FLdOR TD CHPSE WNLLS, NOT PLUMBING T❑ BE RUN UNDER SLAB IN �`StEREDAR�,�r� ��» I 3_4� I GARAGE BELOW. ��. a Qp� J, ��_3�� ST D WALL TO 6' A80VE fIN CIELiNG t�'� `g J' '7 C IL DATA WIRE Tp RUN BACK T❑ SERVER Y , 'No.51 5i , � CONFIRM WIRE TVPE /+ND DEVICE. �� g o � , � i ^ BO6TSN 1 I _ � Laboratory q ' � Operatory 2 -� y�"a�, o M � � - - - — � � Y � \ o %-RAY SCREEN RECESSED � �> a ...�.. ��'.w.....,....... �' w w:.�'�..o:."°�.:'�.:,: CLOSE7 DODR /� g '.w.,"°'^',`�..'"',m„e'",e,'m','o,";"^ AND PORTION OF U n�^�"'e^^"0°"a°�',�A� a EXISTING WALLS ;', i�--W00➢ PANE S �"'0t t0 BE REMOVED j'', i PROM FLOQ T� 6' I I aeovE Do R � � I ( � Derby S�u�ve i i ; ', � 3._o..x ,.-o Storage � ,o._ .. Mech. � ^� Lockers : ' � � � P� � �_8 �, � . (� _ ..� ._ _. . _M .. . / . _.I . . . _. . . A/ll � reo. oescwrrooH un� Toilet Hall Toilet 7< PLUMBING CHASE PIUMBING CHASE a DR�AWPVBY DO�� . � CH�ECOCED BV:D.J.O. I Coaa4o�9 5ta�8 � scn�:va°•ra^ DAY@ 97I07A7 LAYOUT PLAN �� L4YOUT PLAN PERMIT SET � A-� ��uV� � � REFLECTED CEILIN�i KEY � �o� A o c.��o svosa t�on,�,n.oae�o — — GWB CEILINGS � _ 2 % 4 LIGHT � � CUGHSHEERfJVIDE � �� C06�5TRtC OPd CO.IWC. '`� :': �., ', 2 x 2 LIGHi � � Y ' LIGHTS PROVIDE � na pera ory 1 �v�, ��, ��T sHEETs A � 'v EM � �� 2x2 AC7 RECESSED DOWN @ o��Y�C�9�8CQ8� ORC. �B O ; � LIGHTS PROv]DE C� @ ��ro�� Et� A EM�—EMERGENCV LIGHT � 6swo��eerov� LUT SHEEiS DESIGNATIDN �� :.��,` 8alepn,PAwnehuMqqbp 047870 OBA A O v��CP. AIR REGISTER INEWALE � �� ^•'-•I:pMYNICN(tipry �� OB ♦ � SUPPLY � °��0�� A REcis1ER � � 20 C�ua8�9 S¢r�4 PBm� Q� G�A55 CHANNEL T G ASS PqN LS ❑VER CEILING SPRONKLER � S UD WALL HEAD • �BP9mi�Q90916 .... . .. . ' ......... ._...... ............ . ' ........._ .....,,... ; . �� SINGLE FACE EXIi SIGN �� G OB OB OB ER � \S.� ED AR H�r •pera ory 2 SMOKE DEiECrOR O5 e�6 ��,5 � G� F�,� STU� WALL TO 6" ABOVE FIN CIELING • �� 9i. ,\ INDICATES NIGHT EM � No.5185 k � � ~ • � EMERGENCY FiXTURE 8 � : A ' 7$'O �Y�e � i�`: y Labor to O ��# �f1 � p� � NOTES: � HVAC a ...... A h� �_ � � � L EXTEND AND ADJUSi EXISTING g ...+e-- '4 � � O DUCTS Tp NEW CEILING REGISTER g ""�"M°'"•�"4"'" � LOCATIpNS, a "�°'"'"""''"�""�'��'"�'"°^'m � 5 2f d+.�r:.'""+.ss..':°'�a`�w'.� 0 .........:...........:......._........ ma..am...n....�.......�a...�ww.. �� CEI6INC HT g'-6° T�P 2. FILED LOCATE HVAC THERMOSTA7. ^O1 �'^°` 4� �� `�� 3, ADJUST AND BALANCE SVSTEM, �e�sy s��ro �A ; s St rage waPROLowER00oR�"aeTURNT'a,°RTo UN1T. ELECtRICA4 Mech. • �A OCIC@ 1. RUN NEW DATA W]RE CPTS FRaM NO CEILMG � �� ,� � ALL LOCA7IDNS HACK Tp SERVER IN �� MAIN OFPICE, A�C � '. LOCPT�IONSEFROMEE%IS�TING PPNEL � L�NFIRM PANE� SIZE 7� MEET NEW PaWER REOUIREMEN?S. � 3. PROVIDE HARDWIRED SM�KE RETURN REGISTER ➢ETECTORS AS NOTEO ON PLPN, qp. OE60RIPIqN DATF LOW ON WALL Hall Toilet 4, PR�VIDE NEW ILLUMINATE➢ E%IS7 F Toilet SIGNS AT N�TED. a PROJEGTPoO.W090 DRAWON BV:DCi 5. PROVIDE EMERGENCY LIGHT CHFCKEDBND.lCi. BALLAST F�R CEILING LIGHTS N�TED �.��IS�� s SCME1/b°•1'-0° AS EM (EMERGENCE� $ DAYE:97/07N7 6, FIELD LOCATE SWITCHING �y P�� REFLECTED CEILING PLAN OEVICES W,T� ��ENT. � CEILING PLAN PERMIT SET � A_2 ��, uV, � � � � NJLSO� 20 GnBeal stroa¢ POWER OUTLETS "`"°",P/A.09B70 � \ � DUPLE% RECEP7ACLE—MOUNT 18"&F.F UNLESS NOTED OTHERWISE � c7J M�PC� / — COPoSTRCU�ON CO.IPi4'.. � DUPLEx RECEPTACLE wITH GROUND FAULT WTERRUP7iDN—MOUNT � � loa 18" A.F.F, UN�E55 OTHERWISE NOTED p� � � ❑ T/D a TEL/DATA OUTLET O��JI�CP�9Q�CQ8, OP9�. �DER C T/D tI� � ��aretl @entl�peNchMochas YA GeoOY W u¢ro �� Ope�atOry 1 OffIC@ � x—RAY scReeN e.�aa�...me��o+e�o �:�ie iis� ❑ � �C� cr�ui:au�rrrcre i/D UNDE C UNDER C POWER FOR UNDERCOUNTER LIGHTS � s�o¢��o� � �0 Ca�a4a�B�Qr��4 P9�zei � uNOER c Q � PZeuo�v�tlons T/D 7�p __--,___,_,_,—_-___„___„_,. "__-_-__-__ __ __-___-__ � ------ - _ ---- - _=_-� -_- SWITCHES RfPA9 UNDER C T❑ UNDER C �°+�E �y�p " � ��',» T� 5 SINGLE PO�E SWITCH Q.4�G N�g J•6'p rIP 53 iHREE WA1' SWITCH � Q�v� `►� ,� No.5185 ,C UN➢ER C SP P INDICATES SWIICH WITH PILOT LIGHT (TYP) � . 8 W%( 905TON. �( UNDER C � �Jyj 6 Laboratory � Operatory 2 , F M T/D _ �:.�.'w,.:a..,"�.�..:ee` .��..��....�..s "°'r�m.��........� .m....�.e..m...� UNDER C O q�a�a.�'.Yrwa�•�d T� � ws.a... �� Mech. Storage Lockers a/c � ; T/D � N0. DEBCRIPIOON 0.171E < 3 PROJECT FOo.07090 � CH�CVCED BY:D.J.6. Ceeo4�ml$¢c�8 � scaF 1/4"•1'�' GAYE:97I07N7 LAYOUT PLAN �� ELECTRIC PLAN PERMIT SET � E-1 � c�OoOV � � Do � D � � �m'°�.o ei'n _ _// _ \ - - -- -- -- --- -- — --�---- — � � ��1��1P� � cowsr�acv�iono co.iwc. � �Operatory 1' � � ;�' ;---� , a�Y,�co-,saec�e, ea,c. L no.v,E�tu�e w ' j I � � LaMac�W Arohkaot�e o I � ° 0 8�kotm,mp�mo�u4NMi01B70 i � i i I .� �,�m y5�qp� 10 �e I I I I a �O F�AXL..�B 748 8478 o ; , � Office o ��:�� :_._._�� ,__J � 6 e„R —}- � Saa6Qe� � �m � 2�C�m4�9£Q��Q P0� e � �3 R ro r—� l 4. 10.. ' �I � ��P9m�4d�B98 _-_-_-_______-__-_--_____-,, l �``______________—_:,-__--:.____._—_- � . (�... I ��c,; O�' ' � r ---- �- - J .. �� /l . � SEREDAR� t �I �S H� i , _8.. � o Operatory 2 �`�A�aa15 J.6A�`�o�\ � O ---------- � , a < , g No.51 5 H j � -� sosro . W� I I �f` �.us \ � � Laboratory i - -- --- � �y'�'q s niw� I I -.. m P � Slae inal Shop Drawings for Layout i � �' � .- I _� I � _ ___._.__._'__i-� � ��v..�"` i� I A � I 'm .m �'�":�'a'n..�wW.w '.. I . I ...�a�. i � ��----0------J +- .. I a'-t0" �s�p SQa��re Mech. Storage �o Lockers - � �� „ �._8. � _ _ _..-- -- �-J-� -- _ -- - - -- - A�� -// - - n % � wo. oescwmw+ wm Hall Toilet Toilet a vnaec�rvao.o�oao � onnwao ed:o0 CH¢CBCED BN:D.J.p. Ceav4r�l S4ms�8 � scug:va°,r,a^ DATE:91Po7N7 aC�H��.P+W FU RN ITU RE PLAN � FURNITURE PLAN PERMIT SET � F-1 : 20 CENTRAL STREET 340-04 COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM GTS#: 10045 " IMap: 35 B'OCk SIGN PERMIT Lo - o24s lPermit: Sign -- Category: SIGN Permit# 340-04 PERMISSION IS HEREBY GRANTED TO: rFee: $20.00 JS-2004-0490 $488.00 Contractor: License: United Sign Company Owner: CULVER INSTRANCE INC Applicant: CULVER INSTRANCE INC AT: 20 CENTRAL STREET ISSUED ON: 09-Oct-2003 AMENDED ON. EXPIRES ON: 09-Oct-2003 TO PERFORM THE FOLLOWING WORK: PERMIT TO INSTALL SIGN T.J.S. t THIS PERMIT MAY BE REVOKED BY THE CITY-OF SALEM UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: SIGN REC-2004-000504 09-Sep-03 3069 $20.00 GeoTMS©2003 Des Landers Municipal Solutions,Inc. M ALI dl r r 'jPertntt Number_. G � °'�"T RMIT MUST BE OBTAINED BEFORE BEGINNING WORK ` , + ,�,�' APPLICATION MUSTBE SUBMITTED IN puPt,lt'ATF,ONE SET TO BD TO PLANBE ""' � � � DEPARTMENT,AND ONE SET BEARING TF#I1PPiLONALOP THE �, „, I A fly ', FILED VW TH THE ~Y" y„y�pe.{�rrect,Complete and Legible. Separate mp Locat!on,OwrlaMp and fblill tv Sign- s+. Emery App lication Requhed s Application for Permit to Erect a Sign o - _ Salem,Massachusetts TIRE B13¢.DWoG INSPECTOR: mow. ' •, sitiiraNde4stdhroi+dliidG�.ro laafRoesdaibMfEt)b� ZnatadlOFisn Na ��n M16 ,>,•.ave a� i1[ Y#07i`MFA �'�t- r�� V�F— C.Ul�y�le.��fV�� e me of Property ,/ Ft Name of Sign Owner UL 41LL �AElifr, Address f=� �AL S� Sf)t 004 f>tG�NI� MAD1g70 If Owner is a corporate body,name of responsible officer' S#m l� �CQ�VE ° Name of Licensed Sign Erector P 1titfi i �f "I I '0 -rive /� �URfICE///CL Address e3 3 "I 07 P P_- &ffjjYfM Salem License No. nn- theot Buitding: Ist Flo , je0U `PLC tKord Floor fZ S 20d£4tor - athFloor !1G_C BOA/DOS rn;x w5urface. to Rrt _Free Sm+dng Type of Sign. Iq .A other(specify) Height: Sign Materials /N y i6 72 II Sign Area C1n IZSF Sign Dimensions f 1 r m Sign Area SF Existing Signs: Surface: Sign Area SF Right Angles: �— Si Area SF s I,T Free Standing: t� �v/ Sign SF qp , Other: Sign Area NIO(yFi Signs to be Removed: Type__o_�________,_ Sign Area SF FT -��V FT Property Frontage: Building s' w Signature of owner i r tative WMn pf Owner's R St SfJ/tE ao 3 e� 7 --7 7S FT rF '.� ` Es6imamd Cos[ Telephone d ter WoAc f uRa. r pp� Signature of Property Owns IF d A4r H, APPROVA : . merdereofStreew Historical Commission tl9' ' Salem P ning Department Suped u LpUTION;LOCATION OF OTHER SIGNS AND BUILDING d'I• ' ��.' ON REVERSE SIDE PLEASE SHOW SIGN SaE. - Ir � FNTRa NfF _ � �• s-a Com ora+ a Massachusetts Salem 10 WaBtiliapton St 3M fxloor,$$iem.IyIA p1978 j9i!$}745-9595)c5641 t�$Wid�e Ftottsl osi g f*1islon for certlffoate of occupancy Pefsm.it"No.. FEE PA: $308.00 t TO BUILD DATE ISSUED: ' This'certifies.#ha#. RIC1WQ,1 Ff+ f-A SHIRLEY t>>t #.LR WHITE REV LIV TR has permission to erect; after, or"defnafish TREET Map/Lot: 350248-817 y as follows: Othsv YBuilf -",Permit k REBUILDING BRICK Ft4CpkDE. RE'WiTA E: ° o 01110 Contactor No o,:, 4 V, 777 Contractor tloense hFo•'.�3 -� � 7/12/2018 Date This .� vad a after issuance.The Building Officiai me one or mare exi�asions rut to exceest �F � All-work authorized kY this penmrt sha#Conform 1611W. end the approved construction d i permit has been granted. All,constructlort;siteratione,andchonges of use of on res shaltbe in compliance Nrith, the ioc d codes. This permitshaH be displac!in a locatk+nclearly vis,' or road and-shag be maintained We for the entire duration of the work until the completion of the same. . The Certificate of Occupancy wiU not be issuad.urA " ulla F r ;permit. H ' 189898 to ntY fund"(as set forth in MGL c.142A). Restrictions. r B puns afe f be.avaMllft,'on site. �'e#ltLt C� >8ie fPo�.°© the E1�tTY,OWNI R . Commonweatth of Massachusetts CitvO Salem 120 W ashingtw St,3rd Floor Salem,MA 01978(978)745-9595 x5641 Return card to Building Dlvfsion for certl lcata of Occupancy I. Structure CITE' O� SAL EM BUILDING PERMIT Excavation .PERMIT TO BE POSTED IN THE WINDOW I (P Footing INSPECTION RECORD Foundation Framing Mechanical „ } Insulation INSPECT": DATE Chimney/Smoke Chamber Final 7 y Plumbing/Gas a Rough:Plumbing ` Rough:-Gas Finala Electrical Service �� '�n Rough x t Final �. Fire Department - „x h Preliminary Final Health.Department Preliminary Final - � . � � �°� . , � � "'" �o ;'; 7 . , . . . r., i ;:- ; -� �� I � 3 t� � �� P�L,��£iM�iSfi�$Ef�- �£��M1fl�,'I OV£D 8Y i'+�IE � � i Il�?,�CJ�',PF�IOR ��fP��p s �?' �E1NG GRANTED � � i ��. { `C ;�y� ' ; �ITY OF S�LEM � „�' ;. � � {.:,,1 ' �' � ,..' �/ � `� � Q N0. 1qry-. ZOO'l � l�,� l� �� , DeIB —'�r^--- ; ��, f e �y �� . . t 'y •R�'`F21" �/� . ' W8� .� f } ' j\'��'cy. ..� , Zoning Distdd Is Property LoCated In Location of the Hiatoric Distdct? Yes_No_ Building% �..� r�i�� % Is P[opprly l0,ceted-i.n ihe Cunservatlon Area7 Yes No,_ ' BUILDING PERMIT APPUCATIO FOR: ' Permit to: (Circte whiehever apply) Roof, Reroof, install Siding, Construct Deck, Shed, Pool, RepaidReplace, Other: PLEASE FlLL OUT LEGIBLY& COMPLETELY TO AVOIp DELAYS IN PROCESSING TO THE INSP-ECTOR OF BUILDINGS: The undersigned hereby applies for a permit to build according to the following specifications: - Owner's Name •r �N•��`�� - - Address & Phone �1-0 C,�5TJ3Y191'L ��- (�1'��f" �� Architect's Name ,��`""'T _ ,�� '�� Address & Phone �D ��}�� ''�2- (�11�'IDba Mechanics Name -� Address & Phone ( 1 w►�t is me Purvo�ot b�uair�v t�� ('.dNM�ft('�c� Gt"AUI�DI1hlIV�1(�►�1 T��r . Matedal of bulldirig? ��m��_�I a dwelling,for how meny families? � ' WIII bWlding coMorm to law9 C'P � Asbestos7 1�0 Estlma}ed cost��T City Ucenae 8 State License a Ho�e Improvemnnt Lic. / i natu e of p icant 8lGNED UNDER THE PENALTY aF PERJURY DESCRIPTIpN OF WORK TO BE DONE �� ve��-1�10� �c�y�hr� �a��. cecu u� d�m �NtS►1�. c,�Nr��►a�c�t�,n,�l ar-- n!�`w C�u.r�, p�rn.��,ar� �Mh1�1'1��1�2 � - MAIL PERMIT TO: ��/I '��l �— /�a d 7``�✓ � �LC �� NO. l �ZC7 �� . _ __ ' - - - ,�: t=-; " `"t. � - � _ `',- tr �. . . k:. �• � � � ` 4, W . AP�LICATION FOR � �.: � '� � : �` PERMIT TO ' '� � - . �� _ .�, _ .. . t' - �: : �- � s� � " �. ,. „ - �, � ` � � � ` e - �- � � ' � r °� �" �r. `�i �n� ' . � � s . - J � �' � ��r ,�,�� s� �h1 . •�- � - €�. , - ^ �_ �. , . ., � . d/ �j LOCATf� � � ;� • :' � � � - ` �a ��;,� ��, µ � �n -- � - - o- Gt �,� ';� 5,��.� � .� � � - : PERMIT�, GRANTED �' ` �; � _ l � '�� / = �� y' gf �' ` � 4 . ,� �. s -� ;:: c, ., � :�:; : �a, � . ¢ ` . A ROV�D ` _ k , �, �;„ ' t / .y i � , f' ,� s'S:. � �f f � r� F` ` ... .- ' � . f'-� x '.c3 k � /?�'� . •+ , - . . � INSP T� Q�BUILDINGS� � �� _ ��.� � �� =" � �� €, r'�`` � L $ �_ � _... � z a } � :.s ,� � ; , . � � � � n. 6 _ . . . . � w i � � �'! iii _ � T �_.w � _ ' , .. ._ ' ..� ✓�+ t'i .. ' _, ' i� ..z . e4 .,�" _ . µ- , . C:� _ _ . �, ,_r: w. ee�. . �:, t�� _ . . R' : , _ �.. �i � - . _� . �' .� P �- �; . '� -' � . . . �"�" �r ' . . bW _. . �^ � . _ �. . . � _ �_ ' . t�; - . �. � - __. ,-' :' � � . . . , i . ' ' _ _ �Id �^�", f_'_ _ ' e . . . . i. . �.� y .. � . ' ' ` ary i�kr 1�r'� � J , - i � ' . .Y' ! ""� a.. . . . . � " . �c� � .- ��.": y.. � . . . � Y.:i � . . . ; . . :i" � ' . . _ . _ . �y . .. , . '�' � �. . �. , , . � " t`. . . _ ' '�. . . . .. :- , . ._. . . . '. .. . . '. Gw�n � � � R e � o c 1 a t e � ]UInd�BtrM 3aNm.MAONN � vre.�u.waa rwYeie�axiee G , ,'.. '___________i �Na MK�BASE�� O� �� i {�ft]NYE EM6f �� a . i GdMiEARI¢1V��( ' n I I i 9NA C!P RWB '`�� i rO OR f�ELO AtpN� . u � ,s--. 05��f i�ii `��1 ��_Ji�I MkOK PNI111pN �s-� N�N Pµ�iO�YAN . i� in+�Tracuioorrto `. i_. I-'_'�y i � �� REIqVE UJOR/FlIMIE `�� PELOVE PMif110N � �� S�4E Fdi IEl4E - r� LYPICIL/OOiTm � II IT_'_ ____�_______________JJ AELOVEPNiTMkI L ___ ___ ___ ________'_'_._______ ��IYP�N/OOTIm _ ___ ___ �RFAI�Vf IdLNN116 w GAPETMYESNE �I �Rf1MYE1RkWNCy. I j i . t � RFIpK DOONiRILE _ J I �1 SINE fCfl AEIH L___J I I II �� . 11 rVCt NA BISE 11 11 �I 11 �� Gundersen r.�,�°"`°f6T Associates It�BPSE ��T Offices f CPi IM&KE 20 Central Street Units 1 & 2 DEMOLITION PLAN sa�em, MA ,,4 „_� ,�n i i II . � ;. _ - � � � . � �--NE'lf GAPFTiH/SE � R6E1i PE iE . CA Wi W OR H P T P i / ��I �U Wi L 1 f A1'0 ND 5 � FlLL M PMtT . . . �r,wi ui�r _�_ - - ze�a^ S,�ERED ARp�y� . a ^ roq�i� � a�z s/. rr��tir�wotm �`a��F. 6UNpit� �'r . � T PNIT iFCM ill � � OOA TO 10"RF M/ � � 'Y� �I�I i�i'�o wo w i No 51� ' ; I N�� T S � y c ! , I ,.�, �_ ` FULI M PMi � �` � aae' . '� [�,:-'�y�j'��'�:_..� .. � ---rxw cmm�aasc� �-x�w cwacveuE-+ �� ... �Tll OF MN` �ubj,�cP,ta cS r�re��".'ra;,s�.�y c;".^er � authaxia�l:�`�':�y:�,s;a<:.;-.:�. I CI7':�off.��t t p t'�?iTM�. --r�N cwPcrre�� in�'DWr, -mn. rR;! ,,__ i «., r.y�,,,x�i �� T� l rFw7f•s�wi w. m�on aaze �Y� cnx«i t�rem / vu��irt ?IAR.AorA�otL D°9tF�1�r� �^,-y, _ . NFE AM6 : .+i:;'1 0, P...f , . '-..r r t ._. �� r x , � '- � F?P 46TF AP 7 . �s � { i q� �s � tta+. . . 4Nf'[Y� � �' . I�Ewh�PM1111mIS f0 eF JRL°IE'fK 5NU5 W/5/B"CNB BDiH'goEi � FLOOR PLAN �� M=, '-o° 4 e tm: Neurt�: Giecked: . 9cela� Cste: 7 MP.V 03 � Demolition Plan Floor Plan yI�, � _� A1 � � Guntlereen Pasocletee Olflcee.Selem.MA � _. _._ _'____._ . . ._._ . —___.__.. _ - � . . . __-,,,, _. __ __ .. __.. . . ... ... ._ __'_'_.- ._ _. . .. ..__ G . o �� ,�.�.., �.�.�� 9l&1M./11W FA%PRJIlB38B II' '� ; ...� ......, .. . < < � � ' a�fl � , _. . .; � r x : � � � . ; : . ..�. � w�x�.., . � Qo o � - �� [ f , .... . ._ �...�. __' � : : ,� . .� , . . . . ., ._. .... : <,.,,., _i �� . , �..:::� ':: . ..:. .. ,_,,_ , ..... ._ .. . _; i ._ ...�_.::"""_'"'"""_'_..._: ; �. : : i : : ...... ^ ,:., I,...' ,^:s. :�Y_i i i ............. � ,III . ... E, . i ,: . .;. , : Gundersen I W '; `.. . c.r , .. : . ._.......' :_.� Associates , ;, ,: . ; Offices E � Y T� ` ��'T , YT�' ` ., 20 Central Street Units 1 & 2 I � NEW DUPLEX RECEPTACLE ELECTRICAL DEVICE PLAN �- QUADRAPLEX RECEPTACLE Salem, MA �'4 "=� �-�tl P' NEW TELEPHONE RECEPTACLE 'I �- NEW DATA RECEPTACLE . i r r ' i _i�" 'i . . ___. � �- i.�..� _ "_ .�.r. .�.. __ - �� g �n ,-r�� '--I ell- �.--�� d B ' ' � ! B Ij ii' �I 9 , � � � : � � -�� o�,�� -� � � Qo � ; . � � o � ; , �j I � � I_� I ' � i I � � � I 1 1 � � I e��• I � . ' I I` ` I � I riax Fae n.m�r��e � � �_ _� ag.�E0.ED AR�y�`F 'ii I r� cor�eur�Tn� �.� ��E,6UN0 c� � � n i ----� •--- � , �r , �� , I '� I _I _I �h �N�vi 8 �^ M1 �� ,I c,FC1 '; �. P`S � � N i � ••• eoaao---� .�TH OF N' �„ . i N . . . � _J �y I I I u � � y�y� 1 I � 1� � -, � � � � � i n 0 i �� nq. �eAsbn tlBte ,;, L. I a e I ..1 .I� � '�--' 6 i �{ C i ___' f • ' ----� _ . . � .., .�._ FURNITURE PLAN �,4 N� �-0N b ra.: dFevm: c7ieci�etl: &Cela: tle[e' 7 MAY 03 ♦ Furniture Plan � A3 a��,.s��,� � _ ___ --_._,.�—.__ ._ _ _�___ _ _ GlQ1�E�'9e� � A � • o c I ■ t � • � ]tYnNBeMt Slwn��lAORA viex.+oaa rwcvie.n.wes � i i i .� j i---i� i i i i i i i i i � i i i i i i i i i � i i i � i i i i i � i i i i � i i i i i i i i i i i i i � i i � i � i � i i "L' 1"1"J 1 I I � I J 1__ I I � jj � i i i _ i iC''''?"'i'__� i i � i i [i_'r"'k'y_'�i i i �� ' .11 I I 1 I 1 I I 1 1 � � I � 1 I I 1 I I �J 1 I I I 1 1 I I 1 � I I 1 I I 1 I I + —+ 1 � � 1 �a a � y. � i .�} i� � � 1 i i i _i� i i `I i i i � i � i i i i i I i i i i i i � �1� l i i i i � i i i i .� � 1- I 1 1 I I I 1 �MOVE EXRt i � I 1 I I I I I I 1 I I I 1 I I I 1 f10 SOfFRI I I 1 I I 1 + I I I I I 1 1 I I I 1 I I I 1 I I I I 1 I I I I 1 1 I I I 1 1 I 1 I I I 1 1 1 I I I I I I 1 1 I 1 I I I I 1 I I I I I 1 I 1 � I -1 I I ! F _F ♦ -4 4 --I- -I _J _4 L 1 1 I I 1 1 1 I I I 1 1 I I 1 I I I ___ ___ ___ � � I I 1 1 � 1 I - 1 I I 1 I I I 1 1 1 I I 1 I 1 1 � . � � � � I I 1 I I 1 I I 1 I 1 I I 1 I I 1 1 __L__1__J___1___ ___�___r_ Y ___T___T___ _'Y._.� . �___1___ ___�___r.__ _ _�_ � 1 � 1 1 I I 1 1 I I 1 1 i I 1 1 I I 1 I 1 i i i 1 1 I I 1 I 1 I I 1 I I I I I 1 1 1 I I 1 � �� 1 I I I I I I 1 1 I I 1 � � I 1 1 I I � ' � � I I 1 I I �Rf49YF E?19f CLG� 1 I I I 1 1 1 I 1 I I I i ae 6cw i � � � i i sysiu�nnirts 1 \i i i i i I r � 1 � i I i "F-'_+_'J'_'J__'1"_L'__l___I�ISFbILY91CMJ_1___1_'_L_"i"J"_I ' �"�'__i_" _"�'__F__,L�� "'+' ' � � � � I i I I I I I � j j j j I I I I 1 I I I I I I I � � I I 1 1 1 1 I I 1 � �� L_L__L_�1_ ' � 1 I 1 I I I I I 1 1 1 I I � I I 1 1 I I 1 I I - - ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' Gundersen I I I I 1 I I 1 I I I I I I I I 1 I I I 1 I I I � ��4_�+�� _�_�-__��_�� L��._�i �----�, �- ' ' ' ' � ' ' �----- Associates �----� �------� s ; � _ � ; _ ! ! ; ; � � � � ; � , --;-------;-- �=___==_, Offices , � , � „ � , , , , , , , i i i i i i i i � i i i "+"___"r" i i i i i � i i i i i i i i i i i i i i i i i � i i � i i i i i i i i i i � i i � i 20 Central Street Units 1 & 2 EXISTING/DEMO REFELCTED CEILING PLAN sa�em, MA �� p�'��p . 4 I I , . . . __ - .—__ �� • ON' .�r-i ar�., . -- � p � z•a�^ e�rY.• n ��• W a�-r6• s-M7 va: c�z7r � � arw ta • • • COMC CECK • • "______""'_'__ FO S`0• Y-0" S'-0' S'-0' FO E0 S'-0' E0� I 6 [o rv� n i i�, O�gSf.aEO AR��TF ..� + ¢ i i mncKer-r�ffr . m+ O O n� . Q'� ��.s Ofqy°f , E)A 0.E II � • MO LT� Sp �4' IL% 5 1 I� �'-0.� � ,� I v�n r � mincer-r ar i i � y��,� ��_ Cp�IGRm r a YET/l GG 8, �K .i_Y` I � rWNCOEq(� ¢ MA$$.� \ ,; . oor mw oor sa+ a'��' ' r�',. ��. �,v :: or � � � � � A(I7f Oi IAA'' : '�y.. � • aor a uars e 's_'r:` � � � rro. m.As�an dale LIGHT FIXTURE SCHEDULE O „��,��o REFLECTED CEILING PLAN � 5Y�`""�`��°""°� msw is xcx wrnrt nwssmrt p w�LL tca+ce vaawm er mMA LOCATpHS i0 AE OEiWINm LEAt0.flt AIIWEfiE IL1PECiNIRfCT I � ��4'oKFLONG�Wi5 FILOqESCflR �' FIGSIN6 510KE OEIFCLOA �4 �—� �—Q p FkSiM6 9'PoXtlEA IEIL � YEfNNt S4 SEREY SIIR RWIR4CEM1' � � PF10kli NOIME�UUEA WCIWOAIt pmnp. E1aSfNG iAE NNN NLL SiAiION 55-41T1QpV-EBB1M/WHf1E MRE W1a15 NORN.WO WM b rio: � Grawn: chxketl: � xale: tlele: 7 MAY W Demolition Reflected � Ceiling Plan ' Reflected ` Ceiling Plan g A2 � a GuMeraen Pseocletee OXices,Sekm,AM _...—�T--- __.__.. _. _._ r . . .. ... _. . . .. ._.T . ...._ . . . . ,.. .. . I , ..,_ . . _ . _ . _ I ..._.__ _ .__..._ I . . , �� ', . t � I` _ I ; II Ij , -- --- - � . ,_ _ . i � ( ��.�r-E3T # �{ - Zoc.>�-P � � � p,�r;,�F P �N �ti ,a ��n_,-nd '1�zUS i i l�l;:i?I�'id �-C7 C�67�1 'TP-�'-^ S'S D�T� IS5JE� 1 — it� _p3 � --- I i PEr MiT T� U PDf��'f�G V NlT"S t —t 2, 7 � � � � , _ _ . __ _ ._ __ _— -- �,._--,_. T,, _ ____ T I ��s%oO �'i//<�i"� 'O , .. :: , a : ' � �, . . _ __ _ _ _ � ` ' , ' �The Com'monwealtHrofMassachusett's �' `�'°°^= rY � F �� :� Department of Public Safety \ v- •'� . . \I,i..,�chu.etts tit.iFe Buildinh Cudr 1750 C�1R)k�enth Editiun � City of Salem ` aR• '�,c ,• ;..,: , - ' " , � Buildin Permit A lication for an Buildin other than a 1- or 2-Famil �.Dwell (Thi.tiectiun For Ufficial Use Oniv) Uuilding Permit Numbrr: .. ` " ' D.ite AF�E,lird: � � �BUilding Inspectur:'�" . � SECTION 1: LOCATION IPlease indicate Block M and Lot M for locations for which a street address is not avai a 1 , C , / o - Nu..ind titrrel � Cilv /T��rn Zip Cude N.ime uf Buildinti(if apE,licablr) a� �" SECTION 2: PROPOSED�WORK � � �' Yf i�lew Cunstnictiun chrck here O.ur check all thSt apply,in the��twu ruws beliiw F=��• ��. "..� '; ` Eai,ting Buildin� Repair❑ Alteratiu�� Additiun ❑� Demqlitiurt ❑ (f?Iease fill out and submit Appendix�l) . ChanKe uf Use O Chnnge uf Occupancy ❑ Othrr ❑ Specify: � � Are building plans and/ur cons[ructiun duaiments being supplied as p.rt uf lhis permit application? Yes ❑ i�'o ❑ � Is an Independenl Structural Enginrerin�Peer Review required? Yes ❑ Nu ❑ Brirf DescriP tiun f Prupokd Wurk: �.l'•� i �i./C • . CI��•.'�/� ` r! !C �,� X _ ` ^ ' '� , . . , , SECTIOIY 3:COMPLETE THIS SEGTIOIV IF.EXISTING BUILDING UNDERCOWG RENOVATION,�ADDITION;OR ;-^.� � CH�ANGE I!Y USE OR OCCUPANCY ' � -- . CbKck here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) p ' Existing Use Group(s): � Proposed Use Group(s): p . Exysting Haiard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: � � SECTION 4: BUILDING HEIGHT AND AREA . - Existing Proposed No. uf Floors/Stories(include basement levels)&Area Per Floor(sq. ft.) Total Area (sq. ft.)and Tutal Height(ft.) � � � SECI70N 5: USE GROUP(Check as applicable) '` • . A: Assembly A-1 ❑ A-2r ❑ A-2nc❑ A-3 ❑ A-4❑ A-5 0 B: Businesa ❑ E: Educational ❑ F: Facto F-1 O F2❑ H: Hi h Hazard H-1 ❑ H-2 ❑ H-3 ❑ H-4❑ H-5 O L• Institutional I-1 ❑ 1-2❑ I-3 ❑ f-4❑ M: Mercantile O R: Residential R-1❑ R-2 ❑ R-3❑ R-�1 ❑ `� S: Sforage S I ❑ S-2 ❑ U: Utility❑ Special Use O nnd please describe beluw: Special Use: . . .,. .. SECTION 6:CONSTRUCTION 7YPE(Check as applicable). � IA ❑ IBO IIA ❑ IIB ❑ IIIA ❑ 1118 ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE WFORMATIOIV (refer to 780 CMR 111.0 for details on each item) .;- . ,� . ." _ . .,,.. , . . ', �`, " .„' : .."..,De6ris,,Remoyal: ��, . Water Supply:•- Flood-Zone;lnfomiation: ' � "Sewage DisposaL•' ` � �-Trench Pertnit:�- _ . .,,.�,. . . _ , Publir❑ Check i(uuKide PI�„ai Znne O Indic,ite municipal O. '\ trench �vill nirt br Licrmrd Di.po.�il tiite❑ . Pric.ile❑ '�i��inden[il�� 2�ine:_ - ��run'.ite.t:.tem O, ruquired ��ir trench �.ir..F,ecilc: � � �p�rmit i.cnrh�<e.1 ❑ - ' ' . iRailroad right-of-waY: - , Hazards to Air.Vavigation: �i:� i n.i,,,;,l�,�nnni..i��n R,•n��o Pn�r�...; I :\��.^q :\F,F,hral.lc ❑ I.tilrurturc�cilhin.iir�+��rt apF,ru,�.h arr.i.' . � I. lhcu�rrcic�v cnmplcicd.' � ��r l��n.ciil tn Rinld cnd��.cd ❑ . /., Yc. ❑ nr.\'i� ❑ - 1'r< ❑ \n ❑ � � � SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY I� I?.iui��n ��I C��dc: l..e(�n�u�,�.�: (cf+c��I Cnn.trucG��n: l)eeuF,ant (��ad fecr Fl��uc I)��c. thr buil.iin�;r��nl,�in ao tiF�rinklcr ti��.tcin?: tiF.crial titiF ulati��n.: � lu.Ge Cj� G(�. O� M (� '� �D�JD Gt� POi'L��v /��Z�� SECTION 9: PROPERTY OWNER AUTHORIZATION V amc and Addrrs,�il Prupert��O�v�er � �a (.�4__/s,1� �t/`�I �t. 0�8�V - �A�/fL�M� PI$X.�I Ce��MNANdT "�� b i �ih'/iuwn L�P - Name(Prinq !�u. ,ind ti�reel Pru�,irh� l��cner Cary.xt Inlurm.iliun: . �9�Y'� �o4�rGlyd+4 IyR`�-_LOdD =_ Tide /�.�. Trlephune Nu. (business) Trlrphunr N��. (crll) e-mail addresz I(a �plic. blr, thr pruf�ert�� u��ner hereUy.iuehurizrs �art4i, Gr�f arx./ic �r •+•2.3, /�1g'� S� __S�a�r�ir/ M4', 0.2 80 xV.imr titreet Addrcss Cih�/Tuwn St.ite Zip tu.xt�m lhr �ru�rrh��wner's brhalt, in.ill m.�tten relati�'e to w��rk aulhurized bv this buildin� �ermit a > >licatiun. SECiION l0:CONSTRUCTION CONTROL IPlease fill out.Appendix 2) � .•. - � . ,�, , , (II buildin�is Iess lhan 35,U1N1 cu. fG uf enilos�d>>ace and/or nul under C.�nstn�ction Conlrul then check hrre 0 and ski i 5«tion�IU.U 10.1 Re istered Professianal Res onsible for Construction Control PY' Nn ,6! ad ��7' -� OOd .S%�b� � Namr(R, istrent) Te p�No. e-mail ad mss �,9 Registration Number � 7� .?o Ct.r��/ .s� /rt_�___ �, • Stree[ Address City/Tuwn SWte Zip Discipline Expiratiun Date 10.2 General Contractor /''�/TCI"' �a s �n�k,5�y�•;,�5,�,; :, . _ „ . P � / I �/ p �q � � Y Cum �n e�"�d �i•�/MirO `_•. � . . � '�� 17 '� f7✓� . ✓.. r,.. . '1, . . ' . .;s,. !� Name uf Person Res un,�bir for unstructiun License No. and Type�f Applicable Q �� .5�3 /Y�4'��! .f'� ��en6�is.rt t, az tr Ad ress -- City/Tow tate Z�P � • 0 8/ �ir�t��o � �P�n �tJe,� Tele hone No. (business) Tele hone No.(celi) � e-mail address � SECT[ON 11: WORKERS'COIvII'ENSATION INSURANCE AFFIDAVIT(M.G.L.c.152. 25C16)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Atcidents must be completed and - submitted with this appiication. Failure to provide this affidavit will result in the denial of the issuance of the building perm��. � [s a si ned Affidavit submitted with this a lication? YesJl� IVo O SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Cos[s: (I.abor � Item and Materials) Total Construction Cost(from Item 6) _$ 1. Building $ 0�b• Bui(ding Permit Fee=Total Construction Cost x_(Insert here 2. Hlectrical $ �PPropriate municipal factor)_$ 3. Plumbing $ IVote: Minimum fee=$ (contact municipality) x 4. Mechanical (HVAC) $ � � 5. Mechanical (Other) � Enclose check payable to 6.ToWI Cost $ DO�• (contact municipality)and write check number herr � SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT Bv enterinh my name beluw, I hrreby •ittest imder the pains and penaltie+uf perjury that all of the infurmatiun cuntained in this iF�plicatiun is trur and ocavate to the bes[ot my knowledge and understandin�. �r�w" �i�C DQNiAs,��c• f�/fiy�/ D%��,;'�e /�i+►s• 7l% �- o-rB� Plra.c print and .i};n n.ime ��,� � � Title . TcleE�hune Vu.� Date I __,�✓3 IYIA`n f� -��"�-�1� � � � tiVeet Ad.lress Citv;'Tuwn tit te ZiF� 1lunicipal Inspe.tor to fill out this section upon application approval: � "� 1 `� � \'a e . 1),it . , . .. . . . . . � . ' � . -i. . � � , � , � ;� ' , . � . ., , - � + � — ' � `. 1 \� � � t V �� w �1 � r r.rw.w� ' e+ � � � t,�. , g �.,� . — �-R• �►z c K. ( _ � *� PS- . � �_ , � AREA OF REPAIR � AREA OF REPAIR • �� f � �� ca. � � - � u�►- �. � _ �� • JI;, E5. R.�' i � • � �.4C �1 2�6,. 2 g t ' c�o• +�n+ � ., ._ �s'•a� —r _ , � �� . - - _� 't�o. c - '� � � � F � ' � � ��rt u�nr+� � t � � � � ' � � � � � � - � ; � � �. 40� � � � �K .a �ea��.rs �� , �� . � - e��sst � � 6.R. �K. UNIT-404 FLOOR PLAN UNIT 408 FLOOR PLAN �. , 3 SCALE: t/8"=1'-0° SCALE:1/8"=1'-0" y�'�` � n'i t�.:. ' F ..., ��.µ �`'y�•�1;. �n � ri'' H NOTE:THE WORK CONSISTS OF REMOVING THE EXISTING BRICK AND "� t� � � MEfAL STUD WALL PLUS THE EXISTING SLIDING DOOR AND REBUILDING ` �' "� J}� 3' ; �' THE WALL WITH NEW 20 GA METAL STUDS WITH DENS GLASS SHEATHING, WATERPROOFING AND BRICK ON THE EXTERIOR AND INSULATION AND GWB '>, :.. _,.. �;I>',%d ON THE INTERIOR AND INSTALLING A NEW SLIDING GLASS DOOR. '�a:.,;��S1 ^ur �'S"��`? �,_.,_...�;;� � `' A 1 20 Central Street Condominium Trust Units 404 and 408 Exterior Wall Repair GUNDERSEN ASSOCIATES, ARCHITECTS 20 Central Street • Salem Massachusetts 4 Sept 09 • LJCISTING ROOF REUSE DCISTING ROOFEDGE NEW BRICK EXISTING ROOF STRUCTURE STAINLESS STEEL BRICK TIES NEW 1/2" GWB - NEW 20 GA METAL STUDS AT 16" OC NEW DENS GLASS SHEATHING MEMBRANE WATERPROOFING NEW 3" RIGID INSULATION NEW BRICK NEW LCC FLASHWG WITH END DAMS LEAVE EVERY OTHER �;"""'"^�;^w. HEAD JOINT OPEN �g��p q�;�� ---- FOR WEEPS �� . J,f TF� �,��f c , �� t - , " }` TYPICAL WALL SECTION - ' .�--�� ,�r� os ,�ff` SCALE: 1 1/2"=1'-0" '+��r--r F'"' 20 Central Street Condominium Trust Units 404 and 408 Exterior Wall Repair GUNDERSEN ASSOCIATES, ARCHITECTS A2 20 Central Street • Salem Massachusetts 4 Sept 09 V�( � ' v �e� �_ � '____ - _ . 7C ..r..w. — j _ _ ' � __ - ^ _ •1 � -- _ g �►o. � � � . — P�R� *z � K ( �. #� �?- . � ...� , � AREA OF REPAIR . � AREA OF REPAIR • r� v� � �� L CiO. � � � - J y;, 6_ K.� 1 � • � 1Yt. �l ��o +�+ � ., ._ a"',a' —r _ . �� - ' - _� `�ta� c - � - - � � � F � - � + ��y�. atn NG � i ,� � � � � � ; � � � t� �- 4�� . �� L l9S6t.Pi �'�`� � �� . B90Bs�$ � : w,R. ��. UNIT�404 FLOOR PLAN UNIT 408 FLOOR PLAN �;��na ��t�S+;.� ,1u=c�� SCALE: 1/8"=1'-0" SCALE: 1/8"=1'_0" ��, �•�. ��.'�f�� t.,d �` � � NOTE:THE WORK CONSISTS OF REMOVING THE EXISTING BRICK AND e,� r � METAL STUD WALL PLUS THE EXISTING SLIDING DOOR AND REBUILDING � = ! THE WALL WITH NEW 20 GA METAL STUDS WITH DENS GLASS SHEATHING, F � WATERPROOFING AND BRICK ON THE EXTERIOR AND INSULATION AND GWB `�°Jfy ON THE INTERIOR AND INSTALLING A NEW SLIDING GLASS DOOR. Ty �F t.....:��d: r_.;:.�" 20 Central Street Condominium Trust Units 404 and 408 Exterior Wall Repair GUNDERSEN ASSOCIATES, ARCHITECTS /q 1 20 Central Street• Salem Massachusetts 4 Sept 09 • ^�(ISTING ROOF— REUSE EXISTING ROOFEDGE — NEW BRICK EXISTING ROOF STRUCTURE STAINLESS STEEL BRICK TIES NEW 1/2" GWB - - NEW 20 GA METAL STUDS AT 16" OC NEW DENS GLASS SHEATHING MEMBRANE WATERPROOFING NEW 3" RIGID INSULATION I NEW BRICK _ NEW LCC FLASHING WITH END DAMS ' LEAVE EVERY OTHER HEAD JOINT OPEN FOR WEEPS `SgE�� -- - ��F. GU,��f� F�� , h � o. TYPICAL WALL SECTION ��FS� ' ' � SCALE: 1 1/2"=1'-0" 9� H fiF S�HS�� '.��. �"+..,._-.ew+"` 20 Central Street Condominium Trust Units 404 and 408 Exterior Wall Repair GUNDERSEN ASSOCIATES, ARCHITECTS A2 20 Central Street • Salem Massachusetts 4 Sept 09 i -iL4 -Iro /'f10 City of Salem Sign Permit Application Worksheet RECEIVED 16-Sep-14 INSPECTIONAL SERVICES Salem Dental Arts t�1 20 Central Street .. .tpl� OCT '9 r is 21 Zoning(res/non-res) B5 Entrance Corridor(Y/N) N Lot frontage feet Building or tenant frontage 39feet #of businesses on site 1 Bldng dist from street center <100 feet Multiplier 1 uniq @Ftd Blade Sign maximum area permitted 39.00 sq ft total proposed sign area 26.29 sq ft sign 1 Building Sign length 207.90 inches height 10.13 inches' ' sign 2 front window decal length 42.00 inches height 20.00 inches sign 3 side window decal length 42.00 inches height 20.00 inches sign 4 length 0.00 inches height 0.00 inches sign 5 length 0.00 inches hei ht 0.00 inches m t maximum area permitted 0.00 sq It(per side) maximum#of signs permitted 0 signs maximum height permitted 0.00 It tall sign 1 proposed sign area 0.00 sq ft length 0.00 inches height 0.00 inches proposed sign height 0.00 ft(approx) sign 2 proposed sign area 0.00 sq It length 0.00 inches height 0.00 inches proposed sign height ft Application meets guidelines set forth in the Salem Sign Ordinance Yes Recommend approval Yes Approved by SRA and DRB. Permit Number APPLICATION FOR PERN4IT TO ERECT A SIGN s TIoTE:BUILDINGPERMITMUSTBE OBTAINEDBEFORESIGN'ISEREC1ED �jr ffi Location, Ownership and Detail Must Be Correct Complete, and Legible Salem. Massachusetts Date To the Building Inspector: The undersigned hereby applies for a permit to Erect, u Alter, u Repair a sign on the following described buildings: Street Address Zoning District 1 (� ()jq Urban Renewal Area u Entrance Corridor u Historic District u None 1111-711"MrOMENQ YOKO GLV fano- MIAY67. QMQ_ Telephone p) q" 341_ 1b O) I`f_4510-1101 t floor Df!RC& mill QmtIA Mara if ono Mu�+� I Alm t3rrtizi " floor Address ?p RJ1IVA1 Sf- t SLkiik ill Wc4A R W" 3 floor J Telephone q".N 1- 40 A floor E-mail tNA (LS,,LltlmdfAn Alarisvvlq 66W How many businesses are in the building? If corporate body, name —of res onsibteofficer covolapt &1186 Building linear feet Construction Sup's License No c Applicant's Space(if muifl-tenant) linear feet Address iby(d C 3t2 Saltlrel 10A 0141fi) Property linear feet Telephone 0� _ 5(b0•p Mail Sign Permit to E-mail cbhc 1 St n (d ghoo.Lim M Sign Owner u Sign Erector u Other: i Proposed.Signs (if more than three signs are proposed. attach additional sheets) I n 1 SI 2 SI 3 Surface Surfacela-Surface u Right Angle to Building u Right Angle to Building u Right Angle to Building u Free Standing - _Free Standing u Free Standing u Awning u Awning u Awning u Portable (A-Frame) a Portable(A-Frame) Portable(A-Frame) u Other(specify) a Other(specify) u Other(specify) Sig(;Ti l%0 LQN{ �I� I•i°a. Sign Materialrh i Sign Materials 17 10 Sign Dimensions I Sj�n DimenVV ippgis I Sign Dimensions ,I 20l.9" x 10.13 ZV' X,j 2- X Z .Sign Area I� Sign Area Sign Area s ft s ft sq ft Sign Height(if free standing) Sign Height(if free standing) Sign Height(if free standing) Y Estimated Cost of iV�t Work s 60 ,dPl G2-5 0 _ ing Signs Signatures Type Sign Area To Be Removed? ig Owne u Surface sq ft u yes u no u Right Angle to Building sq ft u yes u no u Free Standing sq ft L,yes u no Sign Owner's Authorized epee ntative u Awning sq ft u yes u no u Other(specify) sq ft' u yes u no r party O er r Internal Review Pt6nnin Community Di5velopment Department Historical Commission Approval Building Inspector Salem ® Redevelopment Authority Salem Redevelopment Authority Decision October 2, 2014 20 Central Street, Suite 111 (Salem Dental Arts): Discussion and vote on proposed signage SRA Decision At its meeting on October 2, 2014, the SRA voted 5-0 to approve a September 24, 2014 DRB recommendation to approve the installation of signage at 20 Central Street, Suite 111. DRB Recommendation At its meeting on September 24, 2014, the Design Review Board voted unanimously to recommend approval of the proposed signage at 20 Central Street, Suite 111 (Salem Dental Arts). The recommendation includes a comment (not a condition), that the applicant may remove the black outline around the window decal signage. Proposal for September 24 DRB Meeting The applicant proposes to erect three (3) signs: 1. An 18"x24' building sign in place of the previous sign, to be black metal backing, with smalts background, picture frame moulding, and raised guilded gold leaf letters. 2. Two (2) 20"x42" window decals a. One on the front window to the left of the door b. One on a side window Staff Comment The applicant has 39 feet frontage, which in a typical commercial zone, would allow for 78 square feet of signage (double the linear frontage). In the urban renewal area, the Salem Redevelopment Authority may, and typically will limit signage to half of what would ordinarily be allowed in the underlying zone (in this case 39 sq/ft.). The applicant's total proposed signage is about 48 square feet. The DRB has the option of approving the size of the signage as proposed, or to reduce it further. (R(a,*)_ Commonwealth of Massachusetts City of Salem 120 W ashington St,3rd Floor Salem.MA 01970(978)745-9595 x5641 Return card to Building Division for Certificate of Occupancy Permit No. B-14-1640 FEE PAID: $0.00 PERMIT "1"0 BURILD DATE ISSUED: 10/15/2014 This certifies that SD PROPERTY MANAGEMENT, LLC has permission to erect, alter, or demolish a building,,_20-U1.11,CENTRAL STREET Map/Lot: 350248-817 asfollows: Signs SIGN PERMIT;AS APPROVED FOR:"SALEM DENTALARTS en- Ali a Contractor Name: &i� r z a ;` it All DBA: IF t� a Contractor License No: Tr a r r (I �. ii �. i 'I, 10/15/2014 Building Official `° Date zj att" This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official may grant one or more extensions not to exceed six months each upon written request p t= zip, - ,m. . � ,.�M.� .3r.' aI.SIP... i ^ All work authorized by this permit shall conform to the approved application and the approved construction documents for whic h this permit has been granted. NV All construction,alterations and changes of use of any budding and structures shall be in compliance with the local zoning by-laws and codes. .s.iw.,PI This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. r Ir viian 7 The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are'provided on thisbermit. II ri, HIC#: Persons contracting with unregistered contractors do not have access to the guaranty fund"(asset forth in MGL c.142A). Restrictions: 2i r K Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER. �L��wccr�E,r��rwD �novEo er�+E lug PpIO�t Taw AElwii cruNTEa CITY OF SALEM 6/21 /06 kPv0PUbL40"db 1daati0* Of 20 Central St to Hkaft G~ YM_No INLus4 1.ps"WirU"MIn asawmew "Am? Yak_Na_ BUILDING PEAWT APPLICATION FOR: (Cl *whMOM A" Roof. Rood. UIMM SWft CorltUW D" Shod. POOL, PAPOWPAPWANN Otlwr: "AAW FALL Mr LiRi KY i COMPLETELY TO AVOID DELAYS W PPIOCESWa TO THE INSPECTOR OF DJ LDJIJGL- hmby appMe for a pewA to bww aoow&q to ow I011owirp ONW&Name Central Plaza Condominium Trust Addraor& PhW* 20 Central St. Salem, MA f9781 744-1000 An 'a NWO Gundersen Associates - 00 Aditu&Ph&* 20 Central St. Salem, MA 1 978 1 Porter Engineering, Inc. LMPd1a OU NUN Addr.s a Phone 17 Wallis St. Peabody, MA 978-531� -0581 L 1Ar issoPWIPMd b~ Condominium MAM.l a 6~ Steel & Concrete r a arrrC,for now w�yr wui.a9,� 6AW4.WIM 16law? � Ea��1�000a1 $165, 783 .00 N A a1Y.UOMIY CS 025859 � �/�3/• � a.a I�a..a...c �/ Mr. I A SONAWWaf AppiMd NNED LNUR THE PENALTY DELiCR MMI OF 1M=TO BE DONE OF PE1LwRY New plumbing drains in Courtyard, waterproof condo decks, Paint balcony rails, change concrete steps to granite, replace corridor windows, caulk windows and repair masonry. HAIL PMff M.2L W sont�'en AD H= g t 4 -a j 0 a31PiVklO lV,63d ��f"72 7 Nouvo0l Ol AVOGd tlOJ wouvonan p. -ON BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number:=CS 025859 BirtKd' - 07/15/1.936 Expires ,O7/15/2007 Tr. no: 2001.0 �C• Re$tncted 5:00 ALFRED J DIMAMBRO',' 27 HOWARD RD MEDFORD, MA 02155� Commissioner f I CITY OR SALXNq MASSACHUSMMi PtJ8UG PMOPUMTV OgAAT119W 120 viumlMS10/1 1room, as* ft"a �� MA•SAC11Yf��'T�OIf70 TtLSPN"e 04-744-nft a►. 2a9 /As 972.746"" Ia a000[dasee with the pCOvidoaa of MM C40 S.% a ooadidon of yow HOMMS Pan* is dM the debdo rah S fto dda wart ShA be&p ma of is a p vpo dy licensed 50114 WUM d� ad&dMy as did by MM chapter IIZ,S ISO A. 7U debda will be disposed of ia: Graham Waste Servies Md=o(Fad ty) Cohassett, MA z 4,� ppikaae June 21 , 2006 7we Cofignoanp""ofMessechusdis Deportee*of Ixdvifd l Aauessa 6o wahb � Bostesti MA 02111 %nrA% r=VWAt Workers'Compwadon hmranee A®da tk BDOden/Contr etorw abidamdPtambers ADD1teaDt heA�malb Please trial Ltaft Name Porter Engineering, Inc. - AddM8w 17 Wallis Street Peabody, MA.. 01 9 6_0 Pk=* 978-53,1 -0581 Am yoo a• Cleelt tbti bass' � . .: :: '!p'°Pri'n 'rev dpntael Q��k 1.(A I ass a cmpk* r Witt• I sae a Rsiaat ossaacsor Mill d. 0 New oosadtaedosa esoloyau(fu asdke pamb=1• ban wAi dw odi adasaon 2.0 I sai s soiepsaprielor a prima- *[pail a tie sawbod abeat i 7. 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He advised that dtb affi*o m*be aabmW a dw DePUUMd of hsdastrid a�oyedi of i covaaps AW M pre dV der the a� The a�davit Amu Accidents 1hr aaa�madas being jr the paink or lioease it ad the be MMACd Aar dw cbv or MR do so. sevad�bm sqy qoW s dw lair cr ttyoa Antego�od to abs,i.a.ro>leas' >ombat)♦ Wbebw seiRtosmad oamepais should mta 8tdr pb ar Tows OMddt Alftw"is complete and panted k&bwbr- ip ions h mem has provided s space at the t Um plwo be sme that the a®oat is the evert the Office of Im�atiptions hat 10 contact you aPP plan this affidavit far you �,bQ which will be used a a reference nombe� v Ad"a aPP� please be sma to®ia the amwHceeasa >i Wm is my OeS Yar+need o*submit one at9devQ mdicadM surest pa mast submit u(ifa a p IONY)= ass aPP poNcy is as(if neeasarY)nerd Hader"Job Site Addraa"the ap44 b shouldwrite Ma nW be s to dw at town)"AaoPl��thea�davittYRbasb�eSo�s�ge4t�InwX d_.oab. . appuaat ere proottbse a valid aOdsys it as fild far&ws parries or ltcasa. A near a�davis isi vesture (Le dog S a home owner a bum WWI obftbftd paws is NOT required a e�idt AtUDit (Le a dog linage at pe®tt and should you have any 4aatbns. The Offs of lavatintn would Ire a d=k Yon is advasee for your cooperation please do me hesitsts a pva as a caY. The Depxtmest's addressg telaphase and fsr aambQ The Commonweahh of Massachusetts Department of Industrial Accidents Oda of Invesdpdoos 600 Washington Strut Boston.MA 02111 TeL #617-727-4900 eat 406 or 1-977-MASSAFE Fax#617-727-7749 Revised 5-26-05 www mass.govidia .. The Coinriloriwealth of Massachusetts ,, ,t _, , Department of Public Safety \la>stchuwlt%Siate Building Code G-SO C:XIR)Srvrnlh EdiIwn City of Salem Building Permit Application for iny Buildinil other than a I- or 2-Family Dwellin (rhis Srchun Fur Official Use Orely) Building Prrmtt Number: D.ttr Applied: a Bwlding Inspeetur. C SECTION l: LOCATION (Please indicate Block I and Lot 1 for locations for which a street address is not available) 2.o c.f fat -Sr. No. end Streit City /Town Zip Qtdr Name of Building(if applicable) SECTION 2.PROPOSED WORK e If New Conaructiun check here❑or check all that apply in the two rows below Existing Building❑ Repair Alteration ❑ 1 Addition O 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use O 1 Change of Occupancy ❑ 1 Other ❑ Specify: Am building plans and/ur construction documents bring supplied as part of this permit application? Yes W No O Is an Inde�endent Structural Engineering Peer Review required? Yes ❑ NuX Brief Description of Proposed Wurk: �latl .es /N eId/'J QA i e/dI'A'J 9 77 SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING"RENOV.KTION,ADDTTTON,OR : ° Y CHANGE IN USE OR OCCUPANCY ' A't Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) ❑ Existing Use Group(s): I Proposed Use Group(s): r Existing Hazard Index 780 CMR 34: 1 Proposed Hazard Index 780 CMR 34: SECTION 4.BUILDING HEIGHT AND AREA • Existing Proposed No.of Fkwn/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq. ft.)and Total Height(ft.) SECTION h USE GROUP(Check ak a IiraBle) A: AssemblyA-1 ❑ A-2r O A-2nc❑ A-3 ❑ A4❑ A-5❑ Be Business ❑ E: Educational O F: Facto F-I O F2❑ H: Hish Hazard H-1 ❑ H-2 O H-3 ❑ H4❑ H-5❑ 1: Institutional 1-1 ❑ 1-2 O 1-3 O 1.4❑ M: Mercantile❑ - R: Residential R-10 R-2❑ R-3 O R-4❑ S: Storage S-1 ❑ S-2 O U: Utility❑ Special Use❑and please describe below: Special Use; I . .. .. + SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA O 18 ❑ IIA ❑ Ilea IIIA ❑ IIIBO IV VA O Val SECTION 7:SITE INFORMATION (refer to 780 CMR 111.0 for details on each item) _+. Trench Permit: Debris Removal: P Water Supply:. . Flood Zone Information:.` , Swage Disposal: - • . - • I'tibhc❑ Check it outride Iq.s.J Zonv❑ Indicate municipal ❑ A trench tJdl-not be Liea•n,rd Die)v.,,d Site required❑or trench I'maiv O .Pr mdintih Zone: pr on site rt,,trm O permit t,en do,ad ❑ Railroad right-of-way: Hazards to Air..Navigation: \1 I I li.l..n. t . inno...nn It........ I'r.,.' \,.1 4pphcet,ly❑ 1, their rvuccc coml•lcled.' . r l nncnl b.Ilud.l vildo d ❑ 1-e,❑ nr .No O 1'e>❑ \\. O SECTION 8:CONTENT OF CERTIFICA rE OF OCCUPANCY I-dowii ,U GO,- L•c l;roupl.t. rt rvoi C.nt.tructo.n: Occupant Load per I lu. r I h,,-, III,budJu.p iont.un.m Sprinkler�u.Icm` �pvcial?hpula ttunv SECTION 9: PROPERTY OWNER AUTHORIZATION .Name and)let ul Properiv Owner J L C4 )le4 P.�i X9 tt9 o �'anTiw� sl .$7/�f .Name(Print) Nu. and Strtrt l'ih•/ruwn lap, . 1'rupt•rty lhvner 6,nlact Inlurmatnm: Title Telephune Nu. (bu.mr.s) relephunr Nu. (cell) v-mad addn�. Y If applicable, the pnq�erty „caner hereby authunzes ,� Name titrtYt Addrr,s Ci1y/Town Stale Zip to act un the •ru v rtv owner',behalf, m all matter.relative lu work.udhon[rd bv'this buddin ,ermat a , ahcatiun. SECTION 10-CONSTRUCTION CONTROL IPlease fill 06 Appendix 2) (If t•uddin is Its than 35.000 cu.It.of vnclawsl space and/or nut uncle(C.nvstructiun Conlnsl thin check hen O and Aup Stdwn 10.1) 10.1 Registered Professional Responsible for Construction Control Name(Registrant) Telephone No. email address , . Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2,General Contractor Company Name:- Post,A, �,0 is d11 o& - as .,02 raj-y .. , Name u(Person rs ansa e h Cunslructiu License No. and Type if plicable / r- �: �1er, s�«as�.,ri. i off./ Bo Sir t Address eAggmifiroorCity/Tow State Zi Ift AM We Telephone No.(business) Telephone No. cell e-mail address SECTION 11:w V (M.G.L c. IS2 2506)) 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 No O SECTION 12.CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs: (Labor and Materials) - Total Construction Cost(from Item 6)-f 1. Building f C'V• Building Permit Fee.Total Construction Cost x_(Insert here 2. Electrical f appropriate municipal factor)a f 3. Plumbing f 4. Mechanical (HVAC) f Note:Minimum fee.f (contact municipality) 5. Mechanical (Other) f Enelowe check payable to fi. Total Gist f O Zp Oe• (contact munici alit )and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT Hv entering my name below. I hrrrbv attest cinder the pains and penalties of perjury that all of the infurmatton con Luned in this applicauon i.. ante and accurate to the best y know IFe and understanding. I'Ieo�.e•�j ost.,/n�d,s.jgp n.tme rr, Ir r0k hune Xu. Dale Stret•1 Addrv" �imn . IJt Z,p Municipal Inspectur to fill out this section upon application approval: U \ame Da G101f�.rseln I MI ,mmm w,wuu pq pOF•lOPMI ® rMI 0 0 r Central Plaza • ® � Condominium _.. Trust I Unit 309 Brick Restoration -m� Fw EFASTELEVATION(CENTRAL STREET SIDE)- —� �. 0 Central Street Salem Massachusetts (\TYPICAL WALL SECTION Elevations e Al A GnuL 6uw.5akm.ucssxnu W e L G�dersm _�ueiw�q .mreuw • R�1MP r iw rw nwuuu[uun • •r hMI ry �' rn. ` Central Plaza 74-1 ® g Condominium Trust Unit 309 Brick Restoration maaw tY~_ F ) EAST ELEVATION(CENTRAL STREET SIDE) 20 Central Street # Salem s Massachusetts TYPIOA 6WALL SECTION Elevations a Al L_ Gu.ndersen n w.awm6u ® • ®AOF YOP Central Plaza a w� Jim I ® 9 Condominium _ Trust Unit 309 Brick Restoration � J EAST ELEVATION(CEMRAL STREET SIDEr ...owroa.oik°.io..a•oa�m 20 Central Street j Salem Massachusetts \TYPICAL WALL SECTION Elevations Al L . V W IdIarseIn M Central Plaza Condominium �L Trust Unit 309 Brick �- Restoration emw f EAST ELEVATION(CEMRAL STREET SIDED 20 Central Street Salem Massachusetts \TYPICAL WALL SECTION Elevations 6 Al The Commonwealth of Massachusetts r Department of Public Safety Massachusetts State Building Code(i811 Cb1R) Building Permit Application for any Building other than aOne-orTwo-Family Dwelling (This Section m For Official Use Only) Date A Iced Building Official: Building Permit Number: PP SECTION 1:LO TION Please indicate Bloc #and Lot#for locations for which a street address is not available) eo No.and Street C, / - .l t Name of Building(if applicable) SECTION 2:PROPOSF. WORK Edition of NIA Stale Code used If New Construction check here❑or check all that apply in the two rows below Existing Building❑ Repair Alteration ❑ 1 Addition❑ 1Demolition ❑ (Please fill out,and submit Appendix 1) Change of Use ❑ Change of Occupamy . ❑ Other ❑ Specif}': / Yes 0 No Are building plans and/or construction docunnents being su plied as port of this permit application? Yes [I No f9' Is an independent Structural Engineering Peer Revie„ry lQ d� Q� Brief Description of Proposed Work: -CJfC15 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 CbIR 34) ❑ Existing Use Gnmp(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Proposed Existing P No.of Floors/Stories(include basement levels)&Area Per Floor(sq. ft.) Total Area(sq. ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 [IA4❑ A-5❑ B: Business El E: Educational ❑ F: Facto F-1 ❑ F2❑ H: Hi h Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ R: Residential R-l❑ R-2❑ R-3❑ R-1❑ S Institutional I-1 ❑ I-2❑ 1-3❑ 1-4 Mercantile❑ Special Use❑and please describe below: : Storage Sl ❑ S-2❑ U:U: Utility❑ P Special Use: SECTION 6:CONSTRUCTION TYPE(Check as ap licable) IA ❑ Ill IIA ❑ IIB ❑ IIIA ❑ Hill IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Uebris Removal: Trench Permit: Water Supply: Flood Zone Information: Sewage Disposal: A trench will not be I.icensed Disposal Site❑ Public❑ Check if outside Flood Zone❑ Indicate municipal❑ required ❑or trench or specify; — Private❑ or indentif,Zone:._ or on site system ❑ permit is enclosed❑ Railroad right-of-way: [lizards to Air Navigation: -- -Not Applicable❑ Is Structure within airport approach area. Is their review utmplatcd? or Consent ht Build cnClaaal ❑ Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Curie: _Use Grouts 'I\pc of Construction: Onup,utt Load per Floor' I — Does the building contain an Sprinkler Systent7:._ Special Stipulations: _— --- SECTION 9: PROPERTY OWNER AUTHORIZATION N',un 7fte nd Ad t ess of Pro arty Owner Name(Print) No,am Street City/Town Zip — Property Owner Contact Information- Ime . -1 A If ip il If 1P he Telephone o. (business) Telephone No, (cell) e-m I adds ea pn c ncr h r Eby uulh riz Q' � S Name Street Address Ity/Town �ate Zip to act on the ro er owner's behalf,in all matters relative to work a--tud t this building permit j2lication. 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 skip Section 10.1 10.1 Re i ered Professional Res o 'ble for Construction Control G INilNa a c�(Regtstp"(\ -I ail addr�ylYsg� /e Registration Nun�Es I Street Addm+s City/Town State V'Zip 41;�p�1me Expiration Date 10.�2('I an _ 3 GG 0 rI � � onn C ...irony Name f�:I ie of Pecs/ t ln'= onstruction C License (N�o. and�T e if A 1�'`-I f 11 (��IJ�°/ 1hv+t_\ \U 1 ' \1'1 Ty 0 IM t • i Town p�i / LSy ,t �� 1 s c C �. Tele hone No, usiness Tele hone No. cell a-mail address SECTION 11: i-��t n t,lazti'cilnu L:NS1cnUA'h\SUi::ANCV:vl'I n,w'l r 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 si med Affidavit submitted with this application? Yes❑ No 0 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 3. Electrical $ appropriate municipal factor)_$ . Plumbing � $ +. Mechanical (HVAC) $ Note: Minimum fee=$ (col tact municipality) i. Mechanical Other $ Enclose check payable to 6.Total Cost $ (contact munici di and write check number here_p� ty) SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering illy name below, I hereby attest trader the pains and penalties of perjury that a of the information contained in this o �p Icatit t is true and accu rite to the bes of my knowledg-a ad undo 4rtanding. - ( 6 W /kla Please Aril of sign name Title e e a e1S3o.' Dille Street Addi1/1 City/Town Stale Zip"Y Municipal Inspector to fill out this section upon application approval: Name Date u\ I-