The URL can be used to link to this page

0043 CHURCH STREET - BUILDING JACKET CITY OF SALEM PUBLIC PROPERTY DEPARTMENT Kl hllil�.lil.l?�,I. MA),01Z 120 WAShnNGION S'I'RPE-1 ♦ SA1,eM11,N1ASSAC1iUS1 1-1'S 01970 I, Ted.:978-745-9595♦ FAX:978-740-9846 APPLICATION FOR PLAN EXAMINATION AND BUILDING PERMIT ALL BUILDINGS EXCEPT ONE AND 2 FAMILY DWELLINGS 4 IMPORTANT:Applicants must complete all items on this page SITE INFORMATION _ Location Name - LyCevrn Res ra-vrvn E Building Property Address t43 Ch..�rch S-r smt¢rl Hg &Irl'-10 Located in: Conservation Area Y/N Historic district APPLICATION DATE Use Groups (check one) Group Homes R3_R4_ 40 Residential(3 or more Units) R2_ Type of improvement Residential(hotel/motel) RI_ (check one) Assembly(Theaters) Al_ New Building_ Assembly(restaurants&clubs) A2r_A2nc_ Addition Assembly(churches) At Alteration- Business B_ Repair/Replacement Educational E_ Demolition Factory(moderate hazard) FI_ Move/Relocate Factory(low hazard) F2_ Foundation Only High Hazard H_ Accessory Building Institutional(residential care) Il_ Institutional(incapacitated) I2_ Institutional (restrained) I3_ Mercantile M_ - Storage S1_Moderate Hazard Storage S2_Low Hazard OWNERSHIP INFORMATION(Please type or Print Clearly) OWNER Name Cr- e ys a Vteni LCA—�dl Address_ H v r-00 5 . Telephone Signature DESCRIPTION Oft WORK TO BE PER fORMED i t ESTIMATED CONSTRUCTION COST �G�� CITY OF Sa7L .M. NLkSSACHUSEM • BUILD]ING DEPARTNE[NT �_ 120 WASHINGTON STREET,3�FLOOR TEL (978) 745-9595 FA_.c(978) 740-9946 lOA{BRRt FY DRISCOLL MAYOR THONW ST.PIERRR DIRECCOR OF PCBLIC PROPERTY/BCIIAING 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: (name of hauler)n The debris will be disposed of in : (name of facility) t7 a�S Co rv,r�fr mk S� . ��n✓t te3cjj!�Z_ O t gUa (address of facility) signature of permit applicant date d�nt�tr.a« o CITY OF SALEM PUBLIC PROPERTY DEPARTMENT Mnrc.�ic 120 WnstuNG'roN S'rsecr*Sni.¢m,btnSsaCFNsens 01970 Tri,978-745-9595 ♦ E\x:978-740-9846 CONTRACTOR INFORMATION Name Co o ),S'nC Address `l(o SWCLMM,oT Ro Telephone-TRI — S9a-3135 � Construction Supervisor's Lic #C5 G t_180 S DO.V, GV-0 VV\' qX � Home Improvement Contractor# ARCHITECT/ENGINEER INFORMAT ON �' Name erne 5 '0 a V e r hl', d Address I f}6 >e STfL-eeT he r<.I a "0, Telephone Mass. Registration # PERMIT FEE CALCULATION 14160,qm Estimated Cost x $1151,000 +$5.00= COMMENTS The undersigned applicant does hereby attest that all information stated above is true to the best of my knowledge under the realties of perjury Signed - wrier) (agent) APPROVED BY: 1 DATE APPROVED: fo / 30 / © 1 JOyGQ ��P sP &,a /e / • t � I , CONSTRUCTION CONTROL AFFIDAVIT PROJECT LOCATION: 43 Church Street, Salem MA PROJECT NAME: Lyceum Bar and Grill NATURE OF PROJECT: Interior Renovation ARCHITECT: Siemasko+Verbridge, Inc. ADDRESS: 126 Dodge Street, Beverly, MA 01915 TELEPHONE: 978-927-3745 In accordance with Section 110 and 116.0 of the Massachusetts State Building Code, I, Thaddeus S Siemasko, Registration No. 6028, being a registered professional Architect,hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning, ARCHITECTURAL, for the above named project and that,to the best of my knowledge, such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all accepted engineering practices and applicable laws and ordinances for the proposed use and occupancy. I further certify that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 116.2. 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction contract documents as submitted for the building permit, and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for all code required controlled materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix G. Pursuant to Section 116.2.2, I shall submit monthly progress reports together with pertinent comments to the Town of Salem Building Department. - PACotntnemal,C1ue;MLycwm\04-Permitting and Zoning\construction Control Afdavit.doc Upon completion of the work, Architect, and/or Engineers, shall submit final affidavits as to the satisfactory completion and readiness of the project for occupancy. Signature Then personally appeared the above named Si ernmkAd made oath that the above statement by him is true. Beeff�oorre Me, � V✓'W 4� }; o. COSTIN �r �� Pli?lf x JE � xo C 3 CJMP/ "v.cA'T i OF: SGNt,K7SETT5 a �W MY Ocrnnjssio�cxri s Jz ..it,20t4 i � IAA � c�ayCi4 sari or 1 PnComrncrcial,CumnflLyceumA04-Permitting and Zonin^1ConsnvUion Conttol ARidnvitdoc GR5 N S The Commonwealth of Massachusetts Department of Public Safety `+�'I➢U Massachusetts State Building Code(780 CMR) B°eQ Building Permit Application for any Building other than a One-or Tw i w mg (This Section For Official Use Only) Building Permit Number: Date Applied: Bulldin Officii SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which.a street ad4kKs is not available) i 1 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❑ 1 Alteration 114 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix I) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Is an Independent Structural Engineering Peer Review required? Yes ❑ No Brief Description of Proposed Work: R Q All 01rredQ Q."g L_Ll O 9 12 f k 1JU l�-� Ql2r�nZs�4 ry,c2 �"/ tic � (.P�ALC 1 1.�X• 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.) 3 q,3"Lc> Total Area(sq.ft.)and Total Height(ft.) (OtSW 'a& SECTION 5:USE GROUP(Check as applicable) A: Assembly A-I❑ A-2 Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: Fli h Hazard H-1❑ H-2❑ H-3 ElH-4❑ H-5❑ lz L• Institutional 1-1❑ 1-2❑ 1-3❑ 14❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ RA❑ S: Storage S-1 ❑ S-2 Cl U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as a plicable) IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ig IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 781 CbIR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: A trench will not be Licensed Disposal Site❑ Public) D Check if outside Flood Zone K Indicate municipal required lAor trench or specify: Private❑ or indentify.Zone: -or on site system❑ permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: Un I_l o rf r .,n nn u v If} m ,_Gy) 1 r r cs: 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: 0:.0 4' /4 Does the building contain all Sprinkler System?: \1 Special Stiptdatiuns: tA�A' SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner 7Z 4A l VAt f q S94A ShV,� �out4a�Pr MA aJ93fJ Name(Print) No.and Street City/Town Zip Property Owner Contact Information- 0 WNIVIR qr1 -%81 - Sr _ ��S - -302'7 �tirt�P_�urn8r5 lac Ivvd',wvr� Title Telephone No.(business) Telephone No. (cell) a-mail address x If applicable, the property owner hereby authorizes[� /� ;� �� ^,B�a Gi't it,TAL..'JONA11tG+9(�"L p _ l�SUIVGM Ss1'QVi14 tNII V U JfLiAI/�?1 M/t— � Name Street Address City/Town State Zip to act on the property owners behalf, in all matters relative to work authorized by this budding permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If budding is less than 35,000 cu.R.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 Name(Registrant) Telephone No. e-mail address - Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor " CAS � �. Company Name mafbil P. 26Z- d . GS-vB9 ss� Ports�r. s>pewnor Name of Person Responsible for Construction License No. and Type if Applicable rll'a k.lA" U 1-1Viks00 Nh 0 0 / Street Address City/Town State Zip 161 -a- 500 of u41A few-far, Telephone No. business Telephone No. cell e-mail address SECTION 11:WORICFRYCONIPENSAI JOIN INSURANCE AFFIDAVIf M.G.L.c.152.§25C6 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 9No ❑ SECTION 12:.CONSTRUCTION.COSTS AND PERMIT FEE. Item Estimated Costs:(Labor my and Materials) Total Construction Cost(from Item 6) L Building $ Building Permit Fee=Total Construction Cost x (In%12 2. Electrical S appropriate municipal factor)=$ 3. Plumbing $ d.Mechanical (HVAC) $ Note:Mininmm fee=$ contact municipalit 5. Mechanical Other $ Enclose check payable to 6."rotal Cos[ I $ (contact municipality)and write check num er 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. Zoow cqwy Pro, P-J 04(,vtttier 7k-2qt - a 1313 Please print and sign name ii q TitleTelephone No, ate hS &,,kybut �1 . —(�v,,dtwh �� DG+4V&T-S,f ?&/ ®! L3 Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: Name Date The Commonwealth of Massachusetts PrntFormTij Department oflndustrialAccidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/ilia IV Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leidbly Name (Business/Organization/Individual):Construction Management&Builders,Inc. Address:75 Sylvan Street, Building C City/State/Zip:Danvers, MA 01923 Phone #.781-246-9400 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- " listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity, employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp.insurance.: required.] 5. We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.0 Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees, [No workers' 13.[1 Other comp: insurance required.] Any applicant that checks box Hl must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they mustprovide their workers'romp.policy number. lain air employer that is providing workers'compensation insurance for my employees. Below is tine policy and job site information. Insurance Company Name:Chubb Group of Insurance Cos Policy#or Self-ins.Lic.#:0044724157 Expiration Date:8/1/2013 Job Site Address: �a CWu(tw 5 i City/State/Zip: ,54Lbtl tMA- 019gQ 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 a inst the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations,of the W#for insurance coverage verification. I do hereby certify r : er the airs and enalties of er'ury that the information provided above is true and correct. Si nature: ...... .. Ai�a —..... .._._ _._..... _._...._ Date. . .. _� 10 2� Phone#:781-246-9 00 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. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: CITY OF Si1LZM) NWSACHUSETTS Bt:ILDL\,G DEPAR-MENT l 20 W.�SHINGTON STREET, 3iiO FLOOR TEL (978) 745-9595 F.LX(978) 740-9846 KI\iBF.liL.EY DRISCOLI. NL�YO t T�IOSt LS ST.PiERItB DIRECTOR OF PUBLIC PROPERTY/BCILDLI(G COSOIISSIONER 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 NIGL c 40, S 54; Building Permit At 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 tti1GL c l It, S 150A. The debris will be transported by: (name of lieu ur) The debris will be disposed of in (name of facility) ct�_b�. ,4rp,�- oi�yry (address of facility) signature of permit applicant kbrna;.J.0 43 CHURCH STREET 409-14 COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM GIS#: 1356 Map: B'Oek SIGN PERMIT Lot•., 0601; r. ." jPercmt Kr:Sign - �Category i' SIGN", FTZemut# 409 14 y PERMISSION IS HEREBY GRANTED TO: 'Pinlect# a �JS 2014=000916 *✓,;�, $5,060M, ,,`t Contractor: License: Expires: Fee Charged:$0 00 >' Concept Signs, Balance Due:$00 a w s Owner:: Tim Tumer of Fixtures: Applicant: Jim Turner �DigSafe#r AT. 43 CHURCH STREET �UseGroup `a LConstClass,, T; ISSUED ON: 19-Nov-2013 AMENDED ON. EXPIRES ON: 19-May-2014 TO PERFORM THE FOLLOWING WORK: SIGN PERMIT AS APPROVED FOR: TURNER'S SEAFOOD 0 'THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF 4TS RULES AND REGULATIONS. Signature: I "1 v CcoTNIS®?013 Des Lauriers Municipal Solutions,Inc. Y 1 I ► v� The Commonwealth of Massachusetts Department of Public Safety ' (((////�711 yl , �.:-, •y \la>w:dwrtt.tita_to Building Code(%8 �C 0 C\IR)tiemnth Edition \ City of Salem Building Permit Application for any Building other than a 1- or 2-Family Dwelling (This Section For Official Use Only) Building Permit Number: Date Applied: Building Inspector: SECTION 1: LOCATION (Please indicate Block M and Lot B for locations for which a street address is not available) 6 No.and Street City /Town Zip Code Nam of Building(it applicable) SECTION 2: PROPOSED WORK If New Construction check here❑or check all that apply in the two rows below - Existing Building Repair❑ Alteration ❑ Addition ❑ Demolition ®. (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ 1 1 Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No a- Is an Independent Structural Engineering Peer Review required? Yes ❑ No Brief Description of Proposed Work: r 2 SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Evaluation is enclosed (See 780 CMR 3402.0) Cl Existing Use Group(s): Proposed Use Group(s): r Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No, of Floors/Stories(include basement levels)&ArePro ( q. Total Area (sq. ft.)and Total Height(ft.) - SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2r ❑ A-2nc❑ A-3 ❑ A-4❑ A-5❑ f B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional 1-1 ❑ 1-2 ❑ 1-3 ❑ 1-4❑ M: Mercantile❑ R., Residential R-1❑ R-2 ❑ R-3❑ R-4❑ S: Storage S-1 ❑ S-2 ❑ U: Utility❑ 1 Special Use❑and please describe below: Special Use: - SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ 1 IV ❑ VA ❑ VB ❑ SECTION A-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 it uuhide Flood Zone❑ Indic,mte municipal ❑ A trench will not be Licensed Di*posal Site ❑ Z I' required O or trench or 1pecifv:I'll ❑ ,�� inden lilt une:_ ur on site sestem ❑ permit is enclosed ❑ Railroad right-of-way: Hazards to Air Navigation: VA I ( RC..... \nt Applicahle ❑ h Structure %,thin airport approaclm .ilea.' I> their lac iem� cunlpleted' r( 1'11.Cnt 10 Build ondn`C'd ❑ Yen ❑ ur.No❑ 1'e*Cl \o ❑ SECTION 8: CONTENT OF CERTIFICATE OF OCCUPANCY I_aiu%m ,,I ( udc: L,e Cruuplsl: - f%peuf Gin.truction: Llcaipant Lurid per I 1uor- 1)ue, the budding contain an Sprinkler Scatem'' Special Stipulations: . SECTION 9: PROPERTY OWNER AUTHORIZATION -Na�me and Address o'f`Property Owner 3 j (a Q_ 01970 Vreoro =c �F a,r-,� (/t d_a..ie.re4M Name (Print) No.and Street City/Town Zip Properly Owner Contact Information: � —2j�a Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable, the property owner herebv authorizes Name Street Address City/Town State Zip to act on the pro pert%lm ner's behalf;,in all matters relative to work,authorized by this buildin • permit a > ,licatiun. SECTION.10:CONSTRUCTION CONTROL(Please fill out Appendix 2) (If buildin•is less than 35OX)cu. it.Z)f endured s pace and/or nut under Construction Control then check here❑and ski i Sedion 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 COY �YV� =ter l.n ' Cum ny Name:nT �1�Lk Name of Person Responsible for Copstruct,up License No. and Type tf Ap licablee 70 Street Address 6 y/Town State Zip Tele hdne No.(business) Telephone No. (cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFF[DA VIT(M.G.L.c.152.§ 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 ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs: (Labor Item and Materials) Total Construction Cost(from Item 6) _$ �D G 1. Building $ 500 Building Permit Fee=Total Construction Cost x_(Insert here 2. Electrical $ appropriate municipal factor)=$ 3. Plumbing $ Note: Minimum fee=$ (contact municipality) 4. Mechanical (HVAC) $ 5. Mechanical (Other) $ I Enclose check payable to 6.Total Cost $ I (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. ' • .c�� C7'F-fi-oYt/c �i..�.el" Dili C�L✓'/4•n•� �-�. I'leaar print and sign 11.1111C� p Title Telephone No. I it 9 G i'�IA r c� - ry --` ~tale Zi ';If 'Ct :%ddress City/Ton'n Municipal Inspector to fill out this section upon application approval 0 \'ame Date CITY OF SALLM PUBLIC PROPRERTY ' DEPART'.VENT Construction Debris Disposal .-1111ida- it (rclluired air all dcmulition and I'CIlu%aIIon honk) In accurdance %%ith the sixth edition oft lie State Building Code, 7S0 CAIR section 1 115 Debris, and the provisions ul'.Iv1GL c 40, S 54; Building 1'ermil It is issued with the condition that the dchris resulting front this work shall he disposed of in it properly licensed haste disposal facility as defined by MGL c 111. S 150A. The debris will be transported by: I tome u)hauler) I he debris will be disposed ofin (n.une tit Nu uy) a-�S Z'OMWIQrYG(.31 S'� 1• ,IJrc„ ur lJl iI11V ""IJluic art p:n m .ipphl Jill 43 CHURCH STREET 207-10 COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM GIS# 1356 at. Map' 35 ilk Block: Lot— m 0601' SIGN PERMIT Pernat Sign Cate*or "' SIGN gory Per runt '207-10 " PERMISSION IS HEREBY GRANTED TO: Project# JS 2010-000297 Est Cost: $6,000.00 Contractor: License: Expires ' a ,. Groom Construction CONSTRUCTIO SUPERVISOR-06088 Fee Charged:$0.00 Balance Due:$ 00 Owner: SALEM CHURCH ST RLTY TR THE, HARRINGTON GEORGE F TR #of Fixtures Applicant: Groom Construction DigSafe# h AT. 43 CHURCH STREET UseGroup,y!l. ConstClass V; k ISSUED ON: 15-Sep 2009 AMENDED ON: EXPIRES ON. 15-Feb-2010 TO PERFORM THE FOLLOWING WORK: SIGN PERMIT AS APPROVED FOR(THE LYCEUM BAR&GRILL)jbh THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Data Paid: Check No: Amount: SIGN REC-2010-000355 15-Sep-09 x $0.00 GcoTMSID 2009 Des Lauriers Municipal Solutions,Inc. 7 The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Building Code(780 CMR) ® . Building Permit Application for any Building other than a One-or Two-Family Dwe lair' tg n (This Section For Official Use Only) Building Permit Number: Date Applied: Building Of t SECTION 1:LOCATION(Please indicate Block#anA Lot#for locations for which a street address is not avaf ble) r 01� 70 Vt� c. t- rn No.and Street City/Town Zip Code Name of Building(if applicai 'C SECTION 2:PROPOSED WORK cr rr'1 Edition of MA State Code used R New Construction check here❑or check all that apply in the two rows below Existing Building 13— Repair❑ 1 Alteration A--I Addition❑ j 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 A-�No ❑ Is an Independent Structural Engineerin Peer Revie required? Yes ❑ No CtY Brief Description of Proposed Work: Mt. �5 Lh 1 _ !1l 10 ft,N- - i Lc C 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 CJZ(J No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) 3 3 hf4scx) Total Area(sq.ft.)and Total Height(ft.) v Z� '3 (J� 3B 30,j-4j SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2 Nightclub ❑ A-3 [IA-4❑ A-5❑ B: Business ❑ E: Educational ElF: Facto F-1❑ F2❑ H: Hi h Hazard H-1❑ H-2 Cl H-3 ❑ H-4❑ H-5❑ I: Institutional I-1❑ I-2❑ I-3❑ I4❑ M: Mercantile❑ R: Residential R-111 R-2❑ R-3❑ R-4❑ S. Storage Sl ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB9" IV ❑ 1 VA VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Sup'pl}: Flood Zone Information: Sewage Disposal: Trench Permit. Debris Removal: Licensed Disposal Site Public L�l Check if outside Flood Zone Indicate municipal A trench will not be p Private❑ or indentify Zone: or on site system❑ requiredtrench or specify: permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable lK 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 t7 Use Group(s): 04 42-' Type of Construction: Occupant Load per Floor:/s - Z Z7 'go Does the building contain an Sprinkler System?: Special Stipulations: ��/�Tj- SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner s l i M Tcmaer 4 3 vn;.#17 8 -. 64cvice�1-e� M Pr-" 01730 Name(Print) No.and Street City/Town r Zip Property Owner Contact Information: D-U V r'- ° 8- 281-B535 9 6.3 S- 30 ,i rre� lu.fz¢�s- Sea�az4 Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes G!216 — 64s1at?Q 2"kq BjJq L 0411verc MA 0/ -23 tName Street Address rU City/Town 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.ft.of enclosed space and/or not under Construction Control then check here❑and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control t,"(e -r kar6-d- 6R--�- 323 Eyy1�- Dh�em;f, .cov- 9063 gfstmnt) Tele hone No. `� e-mail address Registration Number on (�fz^ PJ —�J4 �nS�»n � �Zla $l�ch;ka(— Street(Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor ['_ 1M11`s b TiIC- Company Name 3eL A N1 g�4hewrs CS- 435 G�96 Dame of Person Responsible for Construction License No. and Type if Applicable 975 S afic JU42 AP- F- 131id ✓q{e✓ Mo} 02-33.3 Street Address &ty N wn State Zip 8-5 -6t38C 9L_ - e86/� taFIkMd,5rDCr,bk4M .. cof" Telephone No.(business) Telephone No. cell v e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes 13 No O SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$3G0, cl 3o 1.Budding $ 13 00 Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ 4q 103 appropriate municipal factor)=$ 0.011. (.410 1 0) 3.Plumbing $ Z 5l Note:Minimum fee=$ 25 contact municipality)�ip6 4.Mechanical (HVAC) $ ( 5.Mechanical Other $ - Enclose check payable to CA S M 6.Total Cost $34D 1 (contact municipality)and write the 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 understand' g. , Ih _ VZJt'�h 9�i� �Q r Please riot and si n name Title Telephone No. Date �IS u I1/Q✓I k. �i r�;h,^ C a�yerlC Mfg 0l ,'� Street A dress City/Town tate Zip - Municipal Inspector to fill out this section upon application approval: 1 Name Date 1 � Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supen isor - License: CS-035696 JOEL A MATTHPyWS # �- 85SATUCKET AVE 5 E BRIDGEWATER MA OM �3� isw s Expiration Commissioner 02/03/2016 The Commonwealtli ofMassacliusetts Department of lndustrialAccidents Office of Investigations 9 I Congress Street,Suite 100 , Boston,MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information I Please Print Leeibly Name(Business/organization/lndividuaq: Construction Management & Builders, Inc. (cm&b, Inc.) Address: 75 Sylvan Street, Bldg C City/State/Zip: Danvers, MA 01923 Phone#: 781-246-9400 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp.insurance. t required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' com . right of exemption per MGL P 12.❑Roof repairs insurance required.]t c. 152,.§1(4),and we have no employees. [No workers' 13.❑Other comp. insurance required.] 'Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp:policy number. [am an employer drat is providing workers'compensation insurance for my employees. Below is the policy anti job site information. Insurance Company Name: Travelers Insurance Company Policy#or Self-ins.Lic.#: UB6E068394ACR Expiration Date: 811/15 Job Site Address: City/State/Zip: 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 ay against t e violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of t e DIA fKinsurance covers a verification. I do hereby certify rder t/ ains a pe to ' s of perjury that the Grformation provided a ove is true and correct. Sitznstore: - Date: IL Phone#: 781-246-940( 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.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Niemitz Design Group NIEMITZ DESIGN GROUP, INC. ONE DESIGN CENTER PLACE °SUITE644 60STON ° MASSACHUSETTS 02210 617 345 °9323 FACSIMILE 617 330 •7980 EMAIL PETERN@NIEMITZ.COM RESTAURANT HOSPITALITY ENTERTAINMENT DATE: 9/30/14 PROJECT NAME: Turner's Seafood PROJECT LOCATION: 43 Church Street Salem,MA 01970 OWNER: Jim Turner In accordance with Section 107.0 of the Massachusetts State Building Code-Eighth Edition,we hereby certify that Niemitz Design Group,Inc.has prepared all Architectural design plans and specifications for the above referenced projects and that,to the best of our knowledge,information,and belief such plans and specifications meet the applicable provisions of the Massachusetts State Building Code,and all acceptable practices and applicable laws for the proposed use and occupancy. We further certify that a qualified professional in our employ shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved for the Building Permit and shall be responsible for the tasks as outlined under Section 116.2.2. Upon completion of the work,we shall submit a final report as to the satisfactory completion and readiness of the project for occupancy. This affidavit does not cover the documents prepared by others for the project,as this is the responsibility of other Massachusetts licensed professionals and the owners. Sincerely, 4 iassachusetts abn I License 9063 Subscribed and sworn before me on the 30"day of September 2014. Notary Public My commission expires \Ipc Zyt 2ol I MARY SACCO f Notary PUb is COMMONWEALTH OF MASSACHUSETTS My Comrflission Expires December 26,,2019. f 1 61 �uanC-� &Me, � A.1310 �M y Deval L.Patrick 2edi,", -O&do.4id..& 4MMV 1B1d Governor '0660 Thomas G.Gatzunis,P.E. Commissioner Andrea J.Cabral Secretary 61�>,�7-0665 Thomas P.Hopkins / Director e&e~.rxaQd�ov TO: Local Building Inspector Docket Number V 14 175 Local Disability Commission Independent Living Center FROM: ARCHITECTURAL ACCESS BOARD RE: Turner's Seafood at Lyceum Hall 43 Church Street Salem Date: 8/1/2014 Enclosed please find the following material regardingthe above location: _Application for Variance � /Decision of the Board _Notice of Hearing _Correspondence _Letter of Meeting The purpose of this memo is to advise you of action taken or to be taken by this Board. If you have any information which may assist the Board in reaching a decision in this case, you may call this office or you may submit comments in writing. ala Devai L.Patrick Governor Thomas G.Gatzunis,P.E. Andrea J.Cabral GZ- Commissioner Secretary r7"¢z 617"a�>=0665 Thomas P.Hopkins Director uucry.made.�ori/�e. . Docket Number V 14 175 NOTICE OF ACTION RE: Turner's Seafood at Lyceum Hall, 43 Church Street Salem 1. A request for a variance was filed with the Board by Elsiana Zhaka (Applicant)on July 7, 2014 The applicant has requested variances from the following sections of the 06 Rules and Regulations of the Board: , Section: Description: 28.1 Petitioner seeks a variance for the installation of a vertical wheelchair lift to the second floor function space. 25.1 Petitioner seeks a variance to not provide access at the Church Street entrance, based on the fact that a ramp entrance is provided to the space via the Cervoni Walkway (a wide pedestrian route along the east side of the buildina). 2. The application was heard by the Board as an incoming case on Monday, July 28, 2014 3. After reviewing all materials submitted to the Board, the Board voted as follows: GRANT the variance for the lack of access at the Church Street entrance (521 CMR 25.1), based on the following conditions: 1) the accessible entrance is open and unlocked during hours of operations; 2)directional signage is posted near the Church Street entrance door and along the path of travel, notifying patrons of the route to the accessible entrance to Turner's Seafood; 3)there is a policy in place regarding greeting (and a way to notify the staff, i.e. bell or camera system) of someone entering the restaurant through the rear accessible entrance; and 4)the existing directional signage is lowered to a compliant signage height of 60" to centerline of the sign (per 521 CMR 41.2). GRANT the variance for the use of a vertical wheelchair lift as a means of access to the second floor, on the condition that it complies with 521 CMR 28.12.2 and is readily available anytime that the second floor is in use. PLEASE NOTE.,All documentation(written and visual) verifying that the conditions of the variance have been met must be submitted to the AAB Office as soon as the required work is completed Any person aggrieved by the above decision may request an adjudicatory hearing before the Board within 30 days of receipt of this decision by filing the attached request for an adjudicatory hearing. If after 30 days, a request for an adjudicatory hearing is not received, the above decision becomes a final decision and the appeal process is through Superior Court. Date: August 1, 2014 , `WA kluo cc: Local Disability Commission Chairperson Local Building Inspector ARCHITECTURAL ACCESS BOARD Independent Living Center Commonwealth of Massachusetts Department of Public Safety Board of Elevator Regulations lug VARIANCE DECISION 1. In accordance with the provisions of Massachusetts General laws chapter 143,section 70(a)and Chapter 30A (State Administrative Procedures Act)—A hearing was held by the Board of Elevator Regulations in connection with the elevator(s)listed below. The decision of the Board follows. Date of issue: September 4, 2014 Elevator address: 43 Church Street,Salem, MA 01970 Elevator State ID Number: N/A Owner name: Jim Turner Owner address: 43 Church Street, Salem, MA 01970 Petitioner's name(if different than owner): Elsiana Zhaka Petitioner's address: 75 Sylvan Street,Building C, Danvers, MA 01923 Date of hearing: August 19, 2014 Decision: Denied ❑ Dismissed ❑ Granted ® with respect to the following code section(s)- Code: 524 CMR 535 ASME A37.1-1996 Part XX Rule 2000.7a Reason: to allow travel of 13' for a new wheel chair lift installation Applicable conditions): none In accordance with the provisions of MGL Chapter143, 70(b),within thirty days of receipt any decision or order of the Board of Elevator Regulations,any person(s)aggrieved thereby may file an appeal to the Board of Elevator Appeals established under Chapter 22,Section SSA of Massachusetts General Laws., This variance SHALL be posted in your elevator machine room By order of the Board of Elevator R gulation Chief Walt Zalenski,C ' man BER Variance Decision 11.2013 The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (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) H 3 do :,la'n SM4 600 MIS 0 )°170 Lc t-c e t v� 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 CRepair❑ 1 Alteration ❑ 1 Addition❑ 1 Demolition O (Please fill out and submit Appendix 1) Change of Use ❑ 1 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 Peer Review required? Yes ❑ No ❑ Brief D"�scription of PrgqPPosed c!e Pr-xNr- G 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 ❑ R Facto F-1❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H4❑ H-5❑ I: Institutional 1-1❑ 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) IAO Ill ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB 17 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 PC 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 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: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owne \, .n M.,crh SS sc(�Cyv-� , MA 0\9-70 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: 7 Title Telephone No.(business) Telephone No. (cell) ee-mail�address If llicable,the Aroperty owner hereby authorizes X 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) f 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 Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 102 General Contractor � r.�-►_ �c ns Cc� S Company Name 1�cM/A �(ITiy�� ( S CMG 1-1 eo It;- Name of Person Responsible for Constr"�u��qon License No. and Type if Applicable 9lo z 0.�4�S�c 11rJ1, �Fw► Street Address City/Town State Zip Telephone No.(business) Telephone No. cell e-mail address SECTION 11:WORKERS COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes❑ No 13 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ . uri 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 $ ,�r-trr7 _ (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. .•.ram <>w�nef �r1-��c"''� Please i t and sign n e Title Teleph a No. Date Street Address Ctty/ own State Zip vh C S Municipal Inspector to fill out this section upon application approval: l� N e Date io Appendix 1 For the demolition of structures the building permit applicant shall attest that utility and other service connections are properly addressed to ensure for public safety. Please fill in the information below and submit this appendix with the building permit application. The building permit applicant attests under the pains and penalties of perjury that the following is true and accurate. Property Location (Please indicate Block# and Lot #for locations for which a street address is not available) No. and Street City/Town Zip Name of Building(if applicable) For the above described property the following action was taken: Water Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Gas Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Electricity Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) 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 applUcable No. Item Submitted Incomplete Not Required 1 Architectural 2 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 1 Electrical 8 Plumbing include local connections 9 Gas Natural,propane,Medical or other 10 Surveyed Site Plan(Utilities,Wetland,etc. 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review 521 CMR 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other(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 Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zi Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Discipline Expiration Date Street Address City/Town State Zip The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Building Code (780 CMR) Building Permit Application to Construct,Repair,Renovate or Demolish any Building other than a One-or Two-Family Dwelling Code and Other Requirements for Building Permits The Department of Public Safety has issued these building permit application forms so that municipalities across the state can move toward use of a single permit form and consistent permit application process. The MA State Building Code specifies the requirements of building permits and the applicant is advised to review and be familiar with these requirements in order to avoid some of the common permit application problems.Likewise the applicant should be aware that some municipalities require that the owner confirm, even prior to acceptance of the building permit application, that no outstanding property taxes, water fees, etc.exist. Filing Instructions 1.Please contact the city or town where the work will be done to ensure that the city or town will accept this application form and if any additional information is required, and obtain the correct mailing address. After doing so, print the application, fill in completely and then submit to the local city or town where the work will be done. 2.All applications shall be considered complete and will be reviewed if construction documents, specifications, fee, and other materials that may be required as indicated in the Building Permit Application are included with the application. 3.Please include a check for the Building Permit fee. The fee may be calculated using the information to be supplied in section 12 of the Building Permit Application. The check is to be made payable to the local city or town where the work will be done. Page 1 of 1 Dave Groom From: George Harrington [gharrington@jonestrading.comj Sent: Thursday, November 01, 2012 5:25 PM To: Dave Groom; Dave Groom Cc: Peter Beaudoin Subject: Permit for 43 Church St in Salem, MA David, This email serves to notify the Salem Building Department that the owner of the building at 43 Church Street,Salem, MA, the "Salem Church Street Realty Trust", authorize you and any Groom Construction representatives that you may assign to represent you,to apply for a building permit for repairs of the roof of the building at 43 Church St. Please let me know if you or the building department need anything further to secure the necessary permit. Thank you, George George Harrington Trustee, Salem Church Street Realty Trust Cell: 978-973-5050 !DSPAM:363,5092e8aa243 571032865597! 11/2/2012 C_K Osl 59-L- 5q C10 1-v Commonwealth of Massachusetts Sheet Metal Permit _ Date: DAL Iw Permit# m c� 0 wo m --= y i � —m Estimated Job Cost: $ Permit Fee: $ o c� i zm Plans Submitted: YES NO Plans Reviewed: YES NO_ N D rn o b rn Business License# Applicant License # �a ,A CD C-) Business Information: Property Owner/Job Location Information: -0 rn ti Name: qv✓) -juj)��n Name:�.�,/(lfd' 1 `yf Street: -7 14EAt'y 6,2 Street: ui vwa ' City/Town: Q CAAVt`() - City/Town: ,544yy- m P5S- Telephone: 979 -1-11 Illy Telephone: 61-1 Photo I.D. required/ Copy of Photo I.D. attached: YES_ NO Staff Initial J-1 / Ilunl restricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family_ Multi-family_ Condo/Townhouses_ Other Commercial: Office Retail Industrial Educational Institutional Other X Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. Number of Stories: 2- Sheet metal work to be completed: New Work: Renovation:_✓/ HVAC _ Metal Watershed Roofing_ Kitchen Exhaust System Metal Chimney/Vents_ Air Balancing Provide detailed description of work to be done: .L,r.Sk�>1 �,f�chs� Goc�aU� pocta��'/1� CALLL EF-1 G Gl "1 - 10-7-- Fs4 8 '1 crxu.e-� 'z( '-I <-rnom R- P.0 . INSURANCE COVERAGE: I have a current liability Insurance policy or Its equivalent which meets the requirements of M.G.L.Ch. 112 Yes X No❑ If you have checked Yes,Indicate the type of coverage by checking the appropriate box below: A liability insurance policy X Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑,I hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and Installations performed under the permit Issued for this application will be In compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to Insulation installation: YES NO_ Progress Inspections Date Comments Final Inspection Date Comments Type of License: By Master Title ❑ Master-Restricted Cityrrown ❑Journeyperson Signature of Licensee Permit# ❑Joumeyperson-Restricted License Number: JCV& Fee$ ❑ Check at www.mass.gov/dpl Inspector Signature of Permit Approval The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 7 1W*LI � City/State/Zip: an k2 q T ieiZ3 Phone #: T76 11.1 1" Are you an employer? Check the appropriate box: Type of project(required): 1.4 I am a employer with 5D "4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors: 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. g Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp, insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp, insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box most attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they most provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. p �/- Insurance Company Name: AcIr` p-76t�- ✓e'y lo orf Policy#or Self-ins. Lic. #: O L OJ4 )e` D1 b I-Pol. Expiration Date: 1 I I 2Plly�/� Job Site Address: q 3 AV Xek 54- , City/State/Zip: I r,VV\ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct Signature: Date: J2,151j[`I Phone#. 10 e q Ul 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. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: i A��® CERTIFICATE OF LIABILITY INSURANCE DATOM113114 YY) THIS CERTIFICATE IS ISSUED ASIA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF I�SURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and Conditions of the pQl licy,certain policies may require an endorsement.A statement on this CertiBwte does not confer rights to the certificate holder In lieu of such endorsements . PRODUCER CONTACT Am Risk SeNces,Inc of Florida NAME: Aon Risk SeNeos,Inc of Florida 1001 Bddceli Say Drim,Suite#1100 A/C No Ext:800-743-8130 (FX No):800-522-7514 Miami,FLM131.4937 ADDRESS: ADP,COLCente Aon.com INSURERIS)AFFORDING COVERAGE NAIL# INSURER A:New HampsNm Ins Cc 23841 INSURED INSURERS: ADP ToIsSource CO Mi.Inc. 10200 Sunset Core - INSURER C: Miami,FL 33173 ALTERNATE EMPLOYER j INSURER D: Breen S Sullivan Mechanical SmAces Inc I: 7 Healy Q, INSURER E: Danvers,MA 01923 El INSURER F: COVERAGES j CERTIFICATE NUMBER:1854262 -REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLI I ES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED Oft V PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOWN ARE AS REQUESTED. INSP TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR MD MMIDD MMMD GENERA LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISE$ Eacmurrenca $ CLAIMS-MADE 0 OCCUR MEDEXP An one n $ PERSONALBADVINJURY $ I GENERAL AGGREGATE $ GENL AGGREGATE LIMITAPPUES PER PRODUCTS-COMP/OP AGG $ POLICY PROJECT 7 LOC $ AUTOMOBILE LIABILITY Ea accident $ ANY AUTO BODILVIWURV Par arson $ ALL OWNED SCHEDULED AUTOS AUTOS BODILVIWURV Per accident E NON-OWNED Ty HIREDAUTOS AUTOS j Per accitlenl $ $ UMBRELLADpB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEC I I RETENTION$ j WORK ERSCOMPENSATION X WC STATU- OTH- MDEMPLOYERS'LIABILITY Y/ TORY LIMITS ER A ANY PROPRIE-ORIPARTNERIEXECUTIVE WC 094184076 MA 7/1/2014 7/1/2015 E.L EACH ACCIDENT $ 2,000.000 OFFICER/MEMBER EXCLUDED? I_T"I N/A (Mandatory in NH) E.LDISEASE-EAEMPLOYEE $ 2,000,000 ff'.,d..vlm Z DESCRIPTION OF OPERATIONS belov ELDISEASE-POLICY LIMIT $ 2,000,000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule.R more space Is required) All worksite employees working for the above named c0ent conpany,mid underMP TOTAISOURCE,INC.'s pay1o11,are covered under the above stated puiiry. The above named diem Ism aft male employer under this policy. Jab Lorallon: Carewrdl Urgent Care nfi Andover Sl el Peabody,Street CERTIFICATE HOLDER CANCELLATION i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE j THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. j AUTHORIZED REPRESENTATIVE pgo11 evk eetvims, 41zc of oflotida j 01988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD I i A CERTIFICATE OF LIABILITY INSURANCE �2/1 il2° ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endoreemen s. CONTACT PRODUCER ME: Lau r@II DH1uC8 QUINCY INSURANCE AGENCY, INC. PHONE (781)431-9600 EPICFAX .(Tall aE1-9595 144 Gould Street E' L .ldeluca@quincyineurancH.net Spite 152 INSURE S AFFORDING COVERAGE NAIDY Needham MA 02494-2337 INSURERA:The Hanover Insurance Company INSURED umuRERB:F1reEnens Flund Insurance Co. Breen 6 Sullivan Mechanical Services Inc. IwsuRERc: 7 Healy Court INSURER D: INSURER E Danvers MA 01923 INSURE COVERAGES CERTIFICATE UMBER:CL13121 60 4448 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY.PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE.TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TypE OF INSURANCE POLICY NUMBER POLJDYEFF IMP LIMITS LTR GENERALUABILITY EACH OCCURRENCE E COMMERCIAL GENERAL LUIBILIN P MIS o uirtence E A CLAIMS-MADE OCCUR BN 9412470 02 12/22/2013 2/22/2014 MED E%P M pna san f PERSOWIL 8 ADV INJURY 8 GENERAL AGGREGATE E GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG E POLICY PRO- LOC AUTOM0" aLIABWTY COMBINED SINGLE LIMIT 1.00 000 ANY AUTO BODILY INJURY(Pu puaan) f 20 000 A ALL OWNED X. SCHEDULED Wt4 9799878 00 2/22/2013 2/22/2014 BODILY INJURY(Pu exBeno E AUTOS AUTOS 40,00 NON-OWNED PROPERTY DAMAGE E S 000 X HIRED AUTOS X plJT05 Madir� enlr E 5,00 UMBRELLA LWa OCCUR - EACH OCCURRENCE E 5,000,000 B ]{ EXCESS LIAR CLAIMS�.IADE AGGREGATE f S,OOO,DOO DEO R RETENTIONS U00031988784 2/22/2013 2/22'/2014 - E WORKERS COMPENSATION WD STATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOIM RIPARTNERIEXECUTIVE❑ N Ip E.L:EACH ACCIDENT E'' OFFICEREMBER EXCLUDEDT - (MandalvJInNH) E.L.DISEASE-EA EMPLOYE E N Yea.d"1=11 under - E.L DISEASE-POLICY LIMB E DESCRIPTION OF OPERATIONS hekNr DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Reach ACORD IM,AddiUwal Remuln Schsdub,H ma apace M ro ubad) Operations: Plumbing, Heating, Air Conditioning and Sprinkler Service and Installation. CERTIFICATE HOLDER - CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED RE SENTATNE • ` ... . . . Lau I ACORD 26(2010/05) 0 O CORPORATION. All rights reserved. IN8025(2moo51.m The ACORD name and logo are registered marks of ACORD • ��A �� T°rn 'T 1 u..., 1 r <., �:. � t �. r u �iti ` °� � Jt�.'� 6� ' ``' � Y ? 1�� M fi kUE,��` � '�0 E MA�`0785 1536�` ,.,��, f�L v�{� oo'n nrsov wddj�i as �!��tj-. �rf _ fJM `M, .E�4 ;��^,�A"Y�{�as�1k� �iE ��.5��. � • • - • • ts � Y �� . ��v C �`1 •. � � �: ya.e h": 7 h.CYS�'��i � Yf •�3 ��'�! 1 x wt y}f ,Y� �y� 3 � � ? ��yy�� S,EE ym��Y 4 A;gy^./g 5 SpY.1� E -s.a . ..� � '9'�'� #'iH' "'c'�d� tv��?!.!t7 ��i.'.�s°e<t°�f ?`��k�i ! r d� o- COMMONWEALTH OF MASSACHUSETTS 1 - T META O C S r `{ A BUSINESS 15S THE ABOVE LICENSE T M'... 3CtHN M BREEN 1 BREEN AND SULL AN MCHNEL SRVS 7 `�FiEALY` CT s a I3ANUER MA 41 3 004;ft " f 6 i i;6 08/N/14 2 9� 'Fold,Then Detach Along All Perforations , ' � ,V.f•If.WLF fW.4kk.•W1::b11AW WkIVV -i': � . SHE .. WO ISSUES HE fOLLOWI � E ^ wcvw AVa1ASTER-UNSTRICTED s HESULL I VAN CH AL 7• HEAL � �Es A oi9z3-3�o� KK 1 / 186492 ' c L �. Pp c�'� 7S The Commonwealth of Massachusetts I Department of Public Safety 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 fficial: Or SECTION 1:LOCATION(Please'.indicate Block#and Lot#for locations for hi a of a 43 Sat,F^, "A DkKl o No.and Street City/Town Zip Code applicable) SECTION 2:PROPOSED WORK - Edition of MA State Code used If New Construction check here❑Veck all that apply in the two rows below Existing Building 0 Repair❑ Alteration I Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ 1 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 Peer Review required? /� Yes ❑ No Brief Description of Proposed Work: RC kioVA novJ br- 41 N-nAt G PX 2-;;TA-AA•hf-T- k 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): - -2 Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA - Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) '3 L/ 00 3 � Total Area(sq.ft.)and Total Height(k.) SU,'J 3(0 `IO,5i 35 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-1 ❑ 1720 1 H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1 ❑ 1-2❑ I-3❑ I-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑ S: Storage 5-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: ` SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA pI' IIB ❑ 1 IIIA ❑ IIIB % I 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 1 x A trench will not be Licensed Disposal Site�l Private El or indentify Zone: or on site system❑ required 7'1 or trench or specify: £ permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable thin airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or NoW Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY - Edition of Code:7B0 CAL Use Group(s):A-L Type of Construction: SY& Occupant Load per Floor:�ksEMGcr /Z� Does the building contain an Sprinkler System?: \ILS Special Stipulations: PIUT Z32� SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner -21VA TW41gQ, snarl]+- sjgyk C-1-ZjC,"—,C&t dAU4 01 3o Name(Print) No.and Street City/Town Zip Property Owner Contact In ©WNIVR CRL-JZL- SR 3s (0 -3q5_ 03 2? \ wt(d.aurntrs- 9d•wtlt Title Telephone No.(business) Telephone No. (cell) a- nail address If applicable,the property owner hereby authorizes C,Mkk ,TAL --S4W*VtJ(130l0,W '1554VVhVJ bT.—QInt.' ING C — 016)23 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.ft.of enclosed space and/or not under Construction Control then check here and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control � faLq (n. KARi�tEL Q-L-ms-- YLI }alert LJt>lewt�z.vot. QfJ63 Name(Registrant) Telephone No. e-ma address Registration Number 9 aLs1c,N r��R P1-6'14 ?,0s7yJ j114— 022AO AUib-rE.C,7%- Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Cann � b &k , Company Name(r p fU=w4 P, Kt&" RH CIS-081SS1 Cot4m. ),Rq-QVIS0Q Name of Person Responsible for Construction License No. and Type if Applicable `lea UAADM �Atio+J N 4 0305) Street Address +-� ' City/Town ff State Zip G3�� 7�L- -�1ID0 LID -�}` - q 1,6 lVld �6w Rm (? fMnJb�2 Lwt.ww Telephone No. business Telephone No. cell mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§ 25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 224,S S_ 1.Building $ Building Permit Fee=Total Construction Cost x^', (Insert here 2.Electrical $ appropriate municipal factor)_$�. (A 11/(< m) 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ 5.00 (contact municipality) 5.Mechanical Other $ Enclose check payable to G,: 9 SAA.EAV% OAA 6.Total Cost $ 22-4 I 595--01) (contact municipality)and write check number here 25513 SECTION 13:SIGNATURES 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. � ..lOup'{t{W GU&%'0 � —0 Y�oZEt,T n&Nr4GLR �-�& -Z (o- oploo h 2- 1 Please print and sign name Title Telephone No. ate '15 � a�i Str - gvultnlG C NVli_QS&AW /04 01 Z Street Address City/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 Required 1 Architectural 2 1 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) X 6 HVAC 7 Electrical 8 Plumbing include local connections 9 Gas(Natural,Propane,Medical or other 10 Surveyed Site Plan Utilities,Welland,etc. 11 Specifications 1K 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report X 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 Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zi Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Z1p Discipline Expiration Date 4 CITY OF S.UXUNI, N'LksSACHUSETTS BUILDING DEPARTMENT • F• 120 WASHLNGTON STREET, 3"'FLOOR fib! TEL_ (978) 745-9595 FAX(978) 740-9846 KI%{gFRi FY DRISCOLL MAYOR DIRECTOR ST.PIERRa DIRECTOR OF PUBLIC PROPERTY/BUU.DING COJLMISSIONER CONSTRUCTION CONTROL DOCUMENT Project"ritle: TvR.tsC.(Z S Date:'- /3 Project Location: 01970 Scope of Project: _ sue 2FueVu�`�oai 1n accordance with SECTION 116.0-116.4.2 of the 6th edition of the Massachusetts State Building Code : I Mass.Registration Number being a registered professional Engineer/Architect hereby CERTIFY that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [ ] Entire Project Architectural [ ] Structural [ ] Mechanical [ ] Fire Protection [ ] Electrical [ ] Other(specify) for the above named project and that to the best of my knowledge,such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the proposed project. Furthermore,I understand and AGREE that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved by the building permit and shall be responsible for the following as specified in section 1 16.2.2: 1. Review of shop drawings,samples and other submittals of the contractor as required by the construction contract documents as submitted for the building permit,and approval for the conformance to the design concept. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. I shall submit periodically, in a form acceptable to the building official,a progress report together with pertinent comments. Upon completion of the work,I shall submit to the building official a final report as to the satisfactory completion and readiness of the project for occupancy. Signature and Seal of registered professional: z CITY OF SOU EN131 1UNSSACHUSETTS BUILDING DEPARTMENT • P• 130 WASHINGTON STREET, 3w FLOOR TEL. (978) 745-9595 FAx(978) 740-9846 KIaIBERLEY DRISCOLL T MAYOR HoMAs ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDLNG CONWISSIONER SECONDARY CONSTRUCTION CONTROL DOCUMENT (for Professional Engineers/Architects responsible for only a portion of a controlled project) Project Title: Tt iL of -' &6—oeb Date:_12.1 G Project Location: I CRVACM .m'T. 25"Rtk.t7il, L4A 0151'70 �S Scope of Project: m&Ntz- aE4,MV&-qW#J In accordance with the sixth edition Massachusetts State Building Code,780 CMR SECTION 116.0: I _ Mass. Registration Number being a registered professional Engineer/Architect hereby CERTIFY that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: [ J Entire Project (� Architectural [ ] Structural [ ] Mechanical ( J Fire Protection [ ] Electrical [ ] Other(specify) for the above named project and that to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the proposed project. Furthermore, I understand and AGREE that I shall perform the necessary professional services to determine that the above mentioned portions of the work proceed in accordance with the documents approved for the building permit. Upon completion of the work, I shall submit a final report as to the satisfactory completion of the above mentioned portion of the work. Signature and Seal of registered professional: CITY OF SALE11rl, N'IASSACHUSETTS • BL'ILDLNG DEPARTMENT 130 WASHIDiGTON STREET, 3"FLOOR -0 TEL (978) 745-9595 FAx(978) 740-98" KI,,jBFRr F,Y DRISCOLL iLSAYOR THoNus ST.PtERRE DIRECTOR OF PUBLIC PROPERTY/BUMDTNG CONWISSIONER 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: gP T2�caU�S�o (name of hauler) The debris will be disposed of in �,ScrJ �12ANbS-�(Z �11kTt0�1 (name of facility) 300Cox9tj J, jD�oj, r�A olrl�� (address of facility) si&Mature o permit applicant 'l1Z/ i3 date dubrisafr.dix: The Commonwealth of Massachusetts �� { PrAnt`Forma Department oflndustrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Analicant Information Please Print Legibly Name (Business/Organization/Individual): Construction Management&Builders,Inc. Address:75 Sylvan Street, Building C City/State/Zip:Danvers, MA 01923 Phone #:781-246-9400 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 0 1 am a general contractor and I 6. ❑ New construction employees(full and/or part-time)."` have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8, ❑ Demolition workingfor me in an capacity. employees and have workers' Y9. ❑ Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LEI Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] •Any applicant that checks box#] must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Chubb Group of Insurance Cos Policy#or Self-ins.Lic. #:0044724157 Expiration Date:8/1/2013 Job Site Address: 1.3 coo-& }t1 S>Vizv,C City/State/Zip: 54LU. 1 Mk Qlff1) 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 a inst the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the W#for insurance coverage verification. I do hereby certify t er the pains and enalties ofpeoury that the in ormation provided above is true and correct. Signature: _ ___ ___ ;Date Phone#:781-246-9 00 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. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: AK R® CERTIFICATE OF LIABILITY INSURANCE OATE(MM/DDYVYY) 8/10/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER CO NCT -Ter AME: The Driscoll Agency, Inc. PHONE ac No: 81-681-6686 93 Longwater Circle E-MAIL P.O. Box 9120 ADDREss: n dri c ll Norwell MA 02061 INSURER B AFFORDING COVERAGE NAIL N INSURER A INSURED 6708 INSURER S;ChUbb Group of Insurance11111 Construction Management&Builders, Inc. INSURER C: i n' Fund Insurance dba C M&B INSURER D: 75 Sylvan St. Building C INSURER E: Danvers MA 01923 INSURER F COVERAGES CERTIFICATE NUMBER: 14302464 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN SR MD POLICY NUMBER MMIDDIYYYV MMIDDIYYYY LIMITS A GENERAL LIABILITY 1000025041 /112012 /1/2013 EACH OCCURRENCE $2,000,000 X DAMAGE TO RENT COMMERCIAL GENERAL LIABILITY PREMISES EseccurrEDence $300.000 CLAIMS-MADE IT]OCCUR MED EXP(Any one Person) $5,000 PERSONAL&ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GEML AGGR LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $4,000,000 POLIEGATE CY X PRO- LOC1ECT Per Proj/Per LOC Agg $25,000,000 A AUTOMOBILE LIABILITY SSIPCA08239612 /1/2012 /l/2013 Ea accident .1 000 000 I'XX ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ x AUTOS AUTOS HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ rl AUTOS Per accident A X UMBRELLA LIAR X OCCUR SISCCCLO1881612 /1/2012 /1/2013 EACH OCCURRENCE $4,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $4,000,000 OED I I RETENTION$ Excess $ B WORKERS COMPENSATION 0044724157 /1/2012 /l/2013 X WC STATU- x OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNEWEXECUTIVE E.L.EACH ACCIDENT $500.000 OFFICERIMEMBER EXCLUDED? � N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,tlescribe antler DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 C Excess Liability [HX00072199045 1/1/2012 /l/2013 20,000,000 20,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additlonal Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION30 days cant/10 days non pay SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATNE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Massachusetts-Department of Public Safety Board of Building Regulations and Standards Camtrunian Superri.or License:CS-0a955� ua nx r� MARTIN P FI.1Q![IAAY-- ' 76 WASONILD O Dag QDSON NIi g3a -I i vI Ex tion commissioner 71 ov2maia i it Construction Types - Definitions TYPE I-A--Fire Resistive Non-combustible (Commonly found in high-rise buildings and Group I occupancies). 3 Hr. Exterior Walls* 3 Hr. Structural Frame 2 Hr. Floor/Ceiling Assembly 1 Yz Hr. Roof Protection TYPE I-B--Fire Resistive Non-Combustible (Commonly found in mid-rise office & Group R buildings). 2 Hr. Exterior Walls* 2 Hr. Structural Frame 2 Hr. Ceiling/Floor Separation 1 Hr. Ceiling/Roof Assembly TYPE II-A--Protected Non-Combustible (Commonly found in newer school buildings). 1 Hr. Exterior Walls 1 Hr. Structural Frame 1 Hr. Floor/Ceiling/Roof Protection TYPE II-B--Unprotected Non-Combustible (Most common type of non-combustible construction used in commercial buildings). Building constructed of non-combustible materials but these materials have no fire resistance. TYPE III-A--Protected Combustible (Also known as "ordinary"construction with brick or block walls and a wooden roof or floor assembly which is 1 hour fire protected). 2 Hr. Exterior Walls* 1 Hr. Structural Frame 1 Hr. Floor/Ceiling/Roof Protection TYPE III-B--Unprotected Combustible (Also known as 'ordinary" construction; has brick or block walls with a wooden roof or floor assembly which is not protected against fire. These buildings are frequently found in "warehouse" districts of older cities.) 2 Hr. Exterior Walls* No fire resistance for structural frame, floors, ceilings, or roofs. TYPE IV--Heavy Timber (also known as "mill' construction; to qualify all wooden members must have a minimum nominal dimension of 8 inches.) 2 Hr. Exterior Walls* 1 Hr. Structural Frame or Heavy Timber Heavy Timber Floor/Ceiling/Roof Assemblies TYPE V-A--Protected Wood Frame (Commonly used in the construction of newer apartment buildings; there is no exposed wood visible.) 1 Hr. Exterior Walls 1 Hr. Structural Frame 1 Hr. Floor/Ceiling/Roof TYPE V-B--Unprotected Wood Frame (Examples of Type V-N construction are single family homes and garages. They often have exposed wood so there is no fire resistance.) • Note exceptions in the building code for fire resistance ratings of exterior walls and opening protection. � � q � i:' ~ The Commonwealth of Massachusetts ,�J' // , Y _ h-�I �V � � �� - , Department of Public Safety � � (� � �'`v,�-..•/ \�.i>..��hu.elh�tale Bwlding l:�dr 1:80 C\IR)tiirenlh Editn�n . . ' . � City of Salem �� Buildin Permit A lication for an Buildin other than a 1-or 2-Famil Dwel�in - (ihis Sactiun Fur Ufficia� Use Un iv) � � UuJding Permit�lumlxc ' . . D,rtr Applird: Budding InsF�ectur. - . SECTION 1: LOCATION IPleaae indicate Block N and Lot M for locatione for which a street addrcss ia not availa6le) 93 GF�uRc.l} ST SALEM n19�o:_ LYG.EUM No.and Strrel Ci[�• /T�nvn . ZiFi Qxie�e . �l.ime u1 Building lif apE,licablr) SECTION 2:PBOPOSED WORK . - - . � It Nrw Constructiun check hrre O ur check.ill that,pply in thr twu row�below . Esi.ling Building�8[ Repair❑ Alteratiun� Addi[ion❑ Demulitic�n O (Pleasr fill out and.ubmit Appendix I) � •�, ChangrufU>r ❑ ChangeufOccupancy ❑ Other ❑ Specify: � � Arr building plans and/ur cunstructiun documents bring�upplied as part of this prrmit application? Yes �( Nu ❑ ,t I,.in Indeprndent Struclural Enginrrring Prer Revirw requirrd? A . . � Yes ❑ .No�$ � �k5rii•f De�cripti�in uf('rup��+rd Wurk: rE(1�0�-Q Y ?'/�(� [Z - N�D�/.�Q G � LCI(Z'�/iV s ro (� rNSr,4LLEp �.G�n�— ro R�sr,dua.a�rr EurRiE< -�hs--�l Et'A-� �t3.'`'.41 ni (3p n< a-�c� f3RAf 1C�Tf_ i r.4rrts A.a '(�_$E�fj'D �uRIMG- 1.✓IHTER TO � �BLOGk � laL� FTS, 71�FY wtLL (3F_FuLLY OPER�I�4.E .�.�D �tILY MOVA-6L T'FI- �IiRIG v i�E E ' S � GM 2 tf. 80 G .- 707 a SECfION 3:COMPLETE THIS SECi[ON IF EXISTiNG BUILDING UNDERGOIN RENOVATION,ADDITION,OR � CHANGE IN USE OA OCCUPANCY � � - Check here if an Existing Building Evaluation is encloxd(See 780 CMR 3402.0) O -� �� • Existing Use Croup(s): � Proposed Use Group(s): � P 'cristing t{azard Index 760 CMR 34: - Proposed Haz�rd Index 780 CMR 34: SECTIOM4:BUILDING HEIGHT AIYD ARFA � - � Existing � � Propoxd � � �Ya of Flewrs/Srories(include basement levels)&Area Per Floor(sq.ftJ - . Total Area(�.ft)and Tytal Height(ft.). . � � � � SECI70N 5:USE GROUP(Check ae a ticable)- . A: Aeeembly A-1 ❑ A-2r A-2nc❑ A-3 ❑ A-0❑ A-5❑ B: Bueine�s ❑ E: Educational ❑ � F: Facto F-1 ❑ F2❑ H: Hi h Hazard H-1 ❑ H-2❑ H-3 O - H-4❑ H-5 O � .I: Inatitutionaf 1-1 ❑ 1-2 ❑ 1-i❑ I-1❑ M: Mercantile❑ � R: Reeidential R-1❑ R4❑ R-3�❑ R-d❑ � S: Stonge S-I ❑ 5-2 O U: Utility O Special Uae O and lease de.xribr beluw: 4pecial U..rl. � . . . � � � ' SECTION 6:CONSTRUCiION IYPE fCheck as a licable) � � � _ IA 0 IB.O IIA ❑ 1I8 O IIfA ❑ .IIIB.❑ IV O� VA ❑ VB ❑ � SECTION 7:SITE INPORMATION Irefer to 780 CMR 111A for detaile on each iteml I �W�ter$upply: Flood Zone InFormation: Sewage Disposal: Trench Pertnit: Debris Removal: Public❑ Chcik d oul.�dr F6�nd Lnnr❑ li�dicate mumcipal❑ :\ trench wdl nut he Liten.rd Ui.p.�sd tiitr❑ «•ywred O�ir trcnth ur.F,crd'c: � Prn�.uu❑ or indcntdr Zuna•:_ or un.dr.�•.trm ❑ F.rrmit �.��nd��.rd ❑ � Itailroad right-of-way: Hazards to Air Navigation: �1:� I h�b,n. c�..��i,.n�n It,��,�,. Pn•„�.., . \�d .\��•h:'.il�li•❑ � h�Iruilurc��tlinn.iirFq�rl.�ppn�dah orra' I.lhi•ir rc�ii�r rumF�lctrd.' . • ��r(��n.rnti��Hudd..•niL�.r.! ❑ '1r.O i�rSnO 1'i•.❑ \�n Q � . . j - � SECTIOY 8:CONTEtiT OF CERTIFfCAlE OF OCC(.'PANCY � � I.ddn�n��IC��.1r _..__ C.i•l:n�upi.r (�F.r��il-��n:truai��n: i1- - � . icuf,.int I��.id F•cr I�I�� ____ � 1)��o. thi•bwldu,�;:��niain.inCF,nnAl�•r}�.Irm'�. :pvai.Jjupulali��nv . i�l�,-l �o ��t h;�'C�ts �� c.�i <./_ . . . . . . . . . � SECTION9: PROPER"IYOWNERAUTHORIZATION . � N.ime and Addre..�� PruF,erlv U�vnrr � Salew� f�rl-awa+�d- Lcrp• 43 Gl.wrriln S�1-. SA.1 .w. Ot97D � .V,imrlPrinU � '(kGI�GCVm .'Vu..mdtilrert lih�/T�nvn � Li�i - PniF,irl�'lhcnrr<��rtt ut Inlurm tl�un: . �T3"dl'��2 F'F"Q'�yk�-�aY1 .Ar,o.�.'7�`'.�-.-:�� ---- -�1�a0:l�j��'S� CAh.c . xt J ro iidr Trlrphunr Vo.�buwnr�.) Trlrphunr N��. (crll) �r-mail addrvs. , 'NP�1}' If.ipF�licablr. �hr pruprrh�u�rnir hrrrby auth��rizrs � , . . � Xame titrerlAddrc.v Cit�'/T�na•n titalr Zif+ , �.i,irl on Ihr �ro nrl��.��vnrr'.behalf. m.ill maltrn rclali�'r lo wurk outhunzed bv this Uuildin • �rrmit a >>licatiun. � � SECitON 10:CONSTRUCTION CONTROL(Pleau fill out Appendix 2) . - 11(buildin�is Lti.Itun 3i.UW cu.ff.ad rnduv.d>>ace anJ/or n.�l und.r Cunslru.lion Cunlrol then cheek hrrc O and ski�5�.�.1iun IU.I I � I0.1 Re istered Pro(essionil Res oneible for Construction Control - rlk�ronFuc Srerti4sl��g�- 3�v�r f-I�ad�lsva(es;�h. _602� - Name(Ra�;istrant) Tri�unrNo. r-mail id`d�ss OIQ . �stration Numbe�� i 26 (�GDfrE s-r. v�.n�Y p«_ ►S �c I Strrrt Addreas City/Town titate Zip Dixipline - Expiration Date �i �10.2 Generil Contnclor - � 'I � Company Name: . �� - Namr of Prrwn Re.�msible fut Constrvction -License No. and Type if Applicable � 5lreet Address City/Town � - SWte Zip Tele hone fYo.(business) Tele hone No.(cell e-mail address - . SECTION 11:WORKERS'CObII'ENSAIION QVSURaNCE AFFIDAVI7(M.G.L.e.15L 25C(6H � � - A Wurkers'Compenution Insurance A(fidavit from the MA Department of Industrial Accidents must be completed and �, submitted with thu applicatioa Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a si ned Affidavit submit[ed with this a licationt Yee O No O SECTION 12:CONSTRUCI'ION COSTS AND PERMIT FEE . Estimated Costs:(Labor Item - and Materials) Tutal Construction Cost(from Item 6)_$ �B1`� � 1. Building � Building Permit Fee=_Total Construction Cost z_(Insert here 2. Electrical � S � � appropriate municipal factor)=5_�. 3. Plumbing S � � � 4.�Mechanical (HVAC) S Note:Minimum fee=5 (contact municipality) 5. Mechanical (Othrr) 5 Enclose check payable ro � � � 6.T�rtal Cust 5 ��UG17 (contad munici alit J and write check number hew SECTION 13:SIGNATURE OF BUILDINC PERMIT APPLICANT � Bv rnlrnn�my n,ime Uelnw,1 hercby attest under the pams.nd pen.iltir.uf perjury that.ill n(the infnrmation cuntained in this applicatiun is trur and accura[e to the be. f mY knowled�;eand underatandinh. - . �a�-r� �,� ��H �r��r 9� .2Z-� �� z Zo . I'Ira.c pnnl .md.i�;n n.imr iitlr � irlrphu \'� . U.uc I (Zb DODL-F ST. �Ef/E2LY M_� D ! � I �trvrt .1d.1rc.. . � C itv;'T�n��n . titatr � iF+ � � � \tunf.ipal Inspe.tor to lill out this srction upan�pplication approval• � �S / ' ' \amr � Uotr 'i� t • FINISH SCHEDULE PROJECT INFORMATION • 5, . CURTAW FABRIC � USE GROUP A-2 ASSEMBLY o CURTAIN ROD NUNc Faon+ v.i.v. - MANUFACTURER: KNOLL TEXTILES 4,100 TOTAL S.F. FIRST FLOOR CENNG MOUNTEO 5�" 5�" . � POSITBIONEDETO -� � NAME: UTMOST 2,358 SF. DINING AND BAR SPACE QEAR WWMN � � CAPITA� � STYLE NUMBER: K1325/10 EXISTING POSTED OCCUPANCY - 150 PEOPLE � / � � COLOR: TOMATO '� .@ EXIST. TO REMAW FLAME RESISTENCE: N 3 ....� / ADA RAMP � � o . � / o NFPA 701 TEST (2004) i � � � � � � oHRcuRtniH �� w o BACK ENTRY � , � ROD A60VE ' � ADA ACCESS �� _'� ..._� O .. � L?. b .. Fy � « aodusrne�E O HARDWARE SCHEDULE ° ` �; � � ` �",�� __� ' Q,' z o BACK ENTRY CURTAW � . _ 5 ""`"" �-° ' ON CURTAIN CURTAIN ROD AND BRACKETS �'—� I� �� L " U = o � ROD ABOVE u-- I�� O w iy �� HUNG FROM � . II �� "� B�_�• - . CEILWG p�o y � � RESTORATION HARDWARE EGRE55 PATH .� u l � -. ,..- v.�.F. '� � z ESTATE OIL-RUBBER BRONZE \I � I �� V II I �: IT � �� 1 3/4" RODS WITH END CAPS T' �� ` � �! ,� � CURTAIN ROD � � Z- � � � - � O � �TMeancK[R - - LARGE ROUND END BRACKETS � J �,� * � f= E-� � � � EXIT SIGN II I � �� : � 1�� _ _ ^' � � ' ` a_ :�.; °_:= x ; o � .. ��-��-�.�� --` _ _ _ � _ � F °' 0 3 EO EO � E EO U � � a° �` \ ,� �" ' n I ' FRONT ENTRY B1 �''t' vi � O EQ \EO � Q v � �� U b �BACK ENTRY PLAN �EGRESS PLAN E � � � � � s�.,� ,n-_ ,_o� � � _ x��E:�,nr_ r-u� N I `� �'�a P ADJUSTABLE � - °� �� '� � a�Y `om : u' � CURTAIN I y t'C a o ON CURTAIN ROD ABOVE � c � °1 0 u . , � <::� M C �C �� L � r �._6,. 4�� u N /'IENTRY/DINMG RM CURTAIN � � v O1 i �,n.-.�_p CLR � I � •� � Q� � . %. Q. EQ. � rn � I / . i to'-�' I I 'i� � � � v.LF. i �i�.� •'-I � . . eo eo. � i . � i UP � I /��i I � � � N1.0 6 I I � � � � � �..� 9 I � � I I � � (/\ CURTAIN ROD CURTAW EXIT SIGN I I � � I � �EL. IOO�—O�� a �' I I �/ /, ' LI � ^� � v� / / // ROD I � N � - � I I � � ADJUSTABLE/ � � rn � G� ADJUSTABLE � � � I � � � CURTAIN \ �� ..C� I o CURTAIN � � c� � I U I ON CURTAIN "� T - ON CURTAIN i � WAITING i RECEPTION i � Roo neovE BRACKET DETAIL '° � � RO� ABOVE � � . � � I y � ` EO � e0 / \ E � EO I I � I I I Z su�e i i/z' = Y_o• . I..1 /^ nn � m � � j �' � � il , ; Exir sicN il i , �,.0 5�, � � m % i / \ � i � � i � � � i � � I �\�L I I -- --� i EQ. EQ. � � m � � � O O � I � V .� Q I C�URTAIN BLE i . - - p— l �/1 N V1 � ON CURTAW � w ~ I � aoo neovE � � ^o `� CASING � o � � � /IENTRY/BAR CURTAINS 3 n � .�.n•�-�-o uP 6" END BRACKET DETAIL ` �ENTRY CURTAIN PLAN �E�. 99'—e" Exisr. 3 ��^� ,��'-,'-�- 1 scaic: i/o-- i'-a' � GRANITE STEP A 1 .O v�mane..i�.�. ��} • �.��r - "�; .ma � • ' * '�: �"' �;,� �y , , , t 3n "� .`�f _. t'..(� d . �.-. �-h� � , Y v d. „i�`' = s,'i��+' ~ ° �.�� F' 2 l / 4� � � � _ . , _ . . ' ,.� - ' ��5 � .� . , "... ,. . . . � .� . �� ..::..- � �� ,� . . . .. .. s � �� , �� ; . . �. �� ,� u� _.. � � f � �, .��. � _ _ �,�I;�� :' :� '.� --„ —. "_ .,e =�"� � _ �>-�• •' ; ru. _.� `—y �_ -"" . . _ . ,r.�. � s �;: � -- �. ; � _ _-_- -_- °' -, -,� --:�.' �� - j,. �.y _� � M _ r� �� — 4 J - , �"4� ' '� � _� � ,�:'. ti. � � � �� • _ ' ry ��.. S�i - �� , �� k .� 1 � 4 ' : � �� -��- � i a� � � � � �� A � , . t �� £ � �� _. � � �'_��i • . . . ` � ��d � ' P '_ '�I�.� .•~� ��+. %yn` r . • . �� M pg� � _ _ _' . .�„(;.. � _� ' _� _ _ - " ;'^Yms,�„A � �' . .,..�� l ��.,-..� ex�s-s.. :�:� � _ _. . .__ _- '-.. � � _ . . ._ _ _...�. . � I I ,�,r�qranr...n.. � =r 8 � � �� E i % (. � � ._��vB4t'�C k� �. r '� r st� uy5 x s"+ � '6 � � � .`,��, S7Piwt�"`�.�� r 1 ��,. w �. � ,e .„f�£`'- .'a�ak.�v� ' ��. 't f ,. `�� E, � g ' � � i y: ,. � i f�: '�i?I . "a. � �.. . ��f � ��. qR t yPJ.. � �+1 ' ';'��5,� . fl � \ )// Y� tl�,. \ � '�� \ { � �� ` s{ I � � i �;� i � , 1 1 ' a '� � � �'� � ' t ; � ` , �r� , ,'�� ' ; : � , ; � . � ; � ��s a ;. ,,�"_ � -.'�' ,�, ..:, a, �±n x . ¢ r^e ��.il' #A.&�`�t�u"F' �� y R�t�' . a„ F r�: � r- � .�:.1 ,r �ir7.:�;ES* ' �L� �' �' _ . .. +�� dn��o��u«� �c��l�,,.,�,��. _ �.�� '�� J'� �� u�� I M � . ��o � , � � ,�5��' � �,� DEVAL L. PATRICK 1,�� STEPHEN D. COAN �� GOVERNOA ��' �"" - " ��e� ��77`5 $TATE FIRE MARSHAL ' ru.aoTxv P.Ntuaxnv �978) 567 3�00 �aa: (9�8) 567 3�2� �[tiona.as p. LEONnRo LT.GOVERNOR DEPUTI'STATE FIRE MARSHAL KEVIN M.BURKE � � _ SECRETARY MEMORAND UM TO: Heads of Fire Departments and Building Inspectors FROM: Stephen D. Coan and Tliomas Gatzunis, State Fire Marshal Commissioner DPS DATE: February 1, 2009 SUBJECT: Curtain Vestibules Due to energy conservation measures we are aware that "temporary" curtain vestibules are being created and installed within buildings. While current Massachusetts Regulations do not specifically prohibit these curtain vestibule systems, the guidance provided in this Memorandum should prove helpful. Curtain vestibules typically consist of a series of fabric curtains suspended from a metal piping/framing system and are used to create a temporary enclosure or vestibule around an entryway (inside or outside). The goal of this curtain vestibule system is to cut down cn the cold air entering an establislunent. In order to provide guidance to Fire and Building Officials on the installation of these� curtain vestibule systems, the following is provided: 1. A building permit must be obtained and building permit application construction documents sl�ould include and address: i. A plan of whzre the curtain vestibule is to be located. , ii. Details demonstrating that the required means of egress are not negatively impacted by the curtain vestibule system, including a determination that the occupant load and egress criteria are still met. c-'XRt�ma�rci.t�aGieee C-`�an�vtc�� • P�xaov.�oum q/l��iaCaoial ��anee . o�laaaacli,uaeCta C��vi�'n� P�ca,c�amui�..• �(��,ece o�lfie �Latv, �ke C?��C . } , � • . � iii. Details on the curtain, hangers, and support to ensure the "vestibule system" will remain securely in place or otherwise not hamper egress regardless of the crowd impact in an emergency situation. iv. Determination, coupled w/inspection verification, that exit pathways are not obstructed—i.e., the curtain is easily and predictably movable; that exit signage and emergency lighting are not masked or that any fire sprinkler heads are not masked by the curtain vestibule system or otherwise, that such masking of egress elements or fire sprinklers have been addressed in a revamped design and modification that is Building Code compliant_ 2. The curtains system must comply with 527 CMR 21 and Chapter 8 of 780 CMR, which both reference NFPA 701, Standard Methods of Fire Tests for Flame Propagation of Textiles and Films. The documentation showing compliance must be submitted to both the Fire and Building OfficiaL If the above criteria can't be met then a Building Permit should not be issued until compliance is demonsYrated. If a Building or Fire Official should encounter an existing curtain vestibule system, such system must comply with the guidance/criteria provided herein. In addition, a Building Permit is required to be issued by the Building Department. In the interim, before compliance is demonstrated, the removal of the curtain vestibule system is required, as an impediment to egress under either 780 CMR or 527 CMR and citation of such Building Code and/or Fire Code. Fire and Building officials are encouraged to work together in reviewing and inspecting this type of installation. ', If fire officials have any questions, or require assistance, please contact the Code Com liance & Enforcement Unit at 978 567-3375 or in westem Massachusetts az P � ) (413) 587-3181. Building Officials please contact your District State Inspector or the Department of Public Safety at 617-727-3200. � . KnollTextiles; Utmost Tomato . - �Page l,of 2 ,,� �t"it'��I��S Utmost Tomato K13251 Q . Utmost is made with 100%Treviro CS Pr��nzry o=_e: polyesCer, so i[ s inherently FR, aod can Upholstery , be used as upholstery or drapery. It coei:;ry or o��e�n�. comes in�15 stocked colors as well as 24 Germany� I� additional custom colors. co;;yr�s�,c inro: �� Additional Cobrs � KnollTex[iles(2009) �� Desfgner '. KnollTex[iles . ' Con:enL� Test:ng: . . - Trevira CS Polyester 100.0% pyYZenbeek�Published : 100,000 ' � �v�cin: 55 " Tensile Strength Weft : 169 e:e:;m per bnear yzrd: Tensile Strength Warp : 151 12.0 Ounces Seam Slippage WeR : 91 SB W^o��Gra6e�. B Seam.Sii a e War 99.8 SB Reoea:��mensons: Pp 9 P ' ' H: 0.0 Inches NFPA 701-2004 TM#1, as stocked : V: O.OInches Pass c..=-��o�...i.r.•�.,�� Liahtfastness 60 hrs : 45 � �4Z USD / $53 CAD (het e'�:e Ver I:nez�'vartl) . Availabie Colors Color.iendaion onfinz varies by computer manufacturer and modet..P9emo samples provide a more accurate repr�ese color and ter,ture. -� ��"�'_ - � `'" '�� .2�" �� . vtz'# 'a .,. � 'v �� ,, .'i"'-'. �.:+' .�° "' #� - , r,� +r. }��`aF-r; . •-•� ti ..:3 +�" '3''"' '�` 3 � p; � � >-+.��,�,� _�,'��° �. u ��a� �vi�`.�.::w '�~�$ 1 Cloud 2 eisque � 3 Feather 4 Shale .. 5 Fennel ■ , 6 Arbor 7 Quarry� 8 Breeze 9 elazer 10 7omato ■ ■ �, ii Sunset 12 Spice 13 Bark 14 Sugar Plum SS elack Related Products , http://www.knolltextiles.com/textiles/producY?produoHd=1325 � 11/4/2010 KnollTextiles:Utmost�Tomato Page 2 of 2 , . . ■ � Knoll Velvet Mohair Prima - UltraSuedeO Knol'Yexnles�3-S66-565-5853,oV,�oa } http;//wv.�v.knoll[exples.com/textiles/product?productld=1325 11/4/2010 The � 96-D Ailen Boulevard ��,,�� ' Farmingdale, New York 1�1735-5626 USA .�0�� 7e1. +1 (631) 293-8944 Fax+� (631)293-8956 - , e-mail: info@govmark.com �� Organization, Inc. . page 1 eceived:09/30/2008 Completed:l0l09/2008 Letter: WS rb P.O.#: OS-1218 Test Report#: 2-75564-5-RV ClienNs Fabric Name: Uhnost Part#K1325.Content 100%Trevira Polyester. Weight: ]4.5 o7/yd. Backing: N/A. Finish:N/A. Identification . Tested For: Andy Strick Key Test: NFPA 701-2004 TMNI RVRC 50 Knoll Inc. POBox157 Tel: I-(215)-679-1291 Ext: E Greenville,PA 18041 Fax: 1-(215)-679-1600 PC: O.SH TEST PERFORMED: NFPA 701 - Standard Methods of Fire Tests for Elame Propagation of Textiles and Fi1ms - 2009 Edition - Test Method N1 � PRODUCT CONFIGURATION: [x] Single Layer; [ j Malti Layer RESOLTS REPORTED: [x] Initially; [ ] After 3 dry cleanings; [ ] After 5 launderings @ 160°F RESULTS: Flame Projects - Above Top Afterflame' Flaming Drip Weight Loss Of Specimen Specimen # (seconds) (seconds) (peicent) (yes/no) "_"__"' __'______ _________ '__"_'__ _'_____' 1 0.0 1.0 7.5 NO 2 0.0 0.0 10.5 NO 3 0.0 0.0 9.5 NO � 9 0.0 1.0 5.0 NO 5 0.0 0.0 6.9 NO 6 � 0.0 0.0 9.2 - NO . 7 0.0 1.0 7.3 NO 8 0.0 1.0 10.3 NO � - 9 0.0 0.0 5.1 NO 10 0.0 , 1.0 8.1 NO _'______' __'__'_'_ � Mean: 0.5 Mean: 7.9 � STATISTICAL VALOES: SD = 2.0 3 SD = 5.9 Mean + 3 SD = 13.9 ABBREVIATIONS USED: SD = Standard deviation. � APPROXIMATE WEIGHT OF MATERIAL (as measured by Govmark) : 3B0 g/m' � PRECONDITIONING: [x] 0.5 hr @ 220°F (Standard) I ] 24 hrs @ 68±9^F (A1[ernate: Mateiial shrinks/distorts @ 220°F) CONVERSION FACTOR: g/m' = 28.35 x ,835 = oz/yd' � NOTE: 1. All specimens pzepared in the length direction. 2. See addendum for� individual specimen weights. �. REMARKS: None. � - (Page 1 of 3) The � � 96-D Allen Boulevard � Farmingdale,New York 11735-5626 USA � � �ovrn�ark Tel. +1 (631)2938944 Fax+t (631)293-8958 e-mail:info@govmark.com �� Organization, lnc. . Page2 Received:09/30/2008 Completed:10f09/2008 Letter: WS rb P.O.#: OS-1218 Test Repor[N: 2-75564-5-RV Client's � Fabric Name:Utmost. Part# K1325.Content: 100%Trevira Polyester. Weight: 14.5 oz/yd. Backing:N/A. Finish:N/A. Identificatioo Tested For: Andy Strick Key Tes[: NFPA 701-2004 TM#1 RVRC 50 Knoll lnc. PO Box 157 Tel: 1-(215)-679-1291 � Ext: ' E Greenville,PA 18041 Fax: 1-(215)-679-1600 FAILURE CRITERIA: As cited by NFPA 701 - 2009 Etlition Test Method� #1 (see Comments on page 3) � Weight Loss. (percent) I' elamin4 u=iP ---'-------'----------------------- After£lame (Mean) Mean Individual Specimen _"_{"_'_ _'_'__'____'_'__' '__________ ___"____'_____'___ Exceeds 2 seConds Exceeds 40$ Exceeds Mean + 3 SD CONCLOSION: Based on [he Results on page 1 antl the above Failure Czitezia cited by NFPA 701 - 2004 Edition Test Method A1, the item tested: [x] Passes; ( 1 Fails; O Requires testing of 10 additional specimens i.e�. only one individual specimen failure was noted REVISED FAILURE CRITERIA (see Comments on page 31 : I Weight Loss I' Flaming Drip ------------------------ Flame Height I A£te=flame � �Mean) Mean Ind. Spec. (Individual Specimen) - , _______"_ '_"'__'____'____ __'________ ___"'_____ '___'____'_____'____' �. * Exceeds 2 seconds Exceeds 40$ Exceeds 50$ Projects above top - of specimen CONCLUSION: Based on the Results on page 1 and the above Revised Failure Critezia, the item tested: �x] Passes; [ 7 Fails;[ J Requires testing o£ 10 addi[ional specimens i.e. only one individual specimen failure was noted • Afterflame is required to be recoided; however, the NFPA document does not factor it- into the Failure Criteria reporting zequirements. It should be noted that excessive afterflames (15 seconds or more) could be cause for rejection by local fire authorities pecfozming "match" field tests. CERTIFICATION: I certify that the above iesults were obtained afte= testing specimens in accordance with the procedures and equipment specified by NFPA 701 - 2009 Edition �Test Method kl with additional recording of flam�eig/��¢� _ . /��G^Q��/�- /J� P � ---'------------------------------ RV.11.26.08 AOTHORIZED SIGNATURE TxE GOVMARK ORGANizATION, iNC. /jb/7�(� (Page 2 of 3) ��, �'i�.�'��L��v o"7��si�� J The 96-D Allen Boulevard Farmingdale, New York 11735-5626 USA �:,�� Tel. +1 (631)293'-8944 Fax+� (631)293-8956 e-mail: info@govmark.com ■� Organization, Inc.• , Page 3 Received:09/30/2008 Completed:l0/09/2008 Letter: WS rb P.O.q: OS-1218 Test Report q: 2-75564-5-RV Client's Fabric Name: Utmost. Part# K1325.Content: 100%Trevira Polyester. Weight: I4.5 oz/yd. Backing:N/A. Finish:N/A. Identification Tested For: Andy StfiCk Key Test: NFPA 701-2004 TM#1 RVRC 50 Knol I Inc. POBox 157 Tel: I-(215)-679-1291 ExL• EGreemille, PA 18041 Fax: 1-(215)-679-I600 COMMENTS: The Govmark Org., Inc. has determined to establish failure criteria over and above the criteria spelled out in the NFPA documen[. The rationale for the "revised" criteria is as follows: Weight Loss - Individual Specimen Failure: � The NFPA 701 document, as written, provides for a statistical calculation which provides for retest and a potential failure if any individual value exceeds the mean by three standard deviations. Govmark is of the opinion that this cannot mathematically occur, i.e. no individual result is mathematically capable of � exceeding the mean plus th=ee standard deviations. Therefore, Govmark has � established 508 as the absolute number for individual specimen criteria. � Individual Specimen - Flame Projects Above Top of Specimen: ____'____________'_________'_"___"_'______"'__'__'__'__ I When NFPA int=oduced the weight loss criteria, this was hailed as a more objective measure of product pe=formance over previous editions, which relied on visual ; measurements of fire degradation. Unforeseen were those products which are ' composed of finishes over substantially non buzning substrates. Intense flaming . of the finishes occurs without substantially reducing the total weight of the � specimen that was tested. It is believed that similar behavior of the intensely � bu=ning surface finishes on products made from such material could result i❑ the ignition of nearby combustibles. (Page 3 of 3) The results contained in this report relate only to item(s)tested.The cest report shall not be reproduced,except in full,without written approval from The Govmark Organization, Inc. . _._..,.1�.....w � Tex4ile Tes4ing �� 553 76'"Street�Svron Center MI 49315 Phone:616.559.6123 Fax�616 559 6119 Report Number: 34064 . Date: 04-15-09 For the Account Of: Knoll Textiles 1235 Water Street Lubin Building East Greenville, PA 18041 Contact: Andy Strick Client's Identification: Utmost T�s4 P�u4oewoe¢➢: Recoa�nan�e�t9�Qiovs oca Yes4 Afle49oo�4ov De4eruroursimg @Po�fft�sis¢�e�ce¢o Flaseee o�NeaQicaBly Su�povted 4�tt8ao�s �eo� �dOms HP8eso0aa8don �.��'9 (ltG!)�s �un¢ee�e� k�y �9.563(941� TESY DATA � " Tes4 Resul4s: � . Af4erftame �uvning �ynition of Char Langfh SurPace Igni4ion Level 9 Specimen# (Seconds) Through 4o Co4¢on UNool (mm) Flash Edge (mm) Length 1 0.0 No � No 25 -0 2 0.0 No No 29 0 3 0.0 No No 29 0 4 � 0.0 No No 31 0 � � 5 0.0 No No 21 . 0 �,ey: a� Widih . 1 0.0 No No 31 0 2 0.0 No No 29 0 3 0.0 No No 52 0 - 4 � 0.0 No No 49 0 � 5 0.0 No No 25 0 Avg: 37.2 Approximate NVeigh4:3.61 g/m2 Tes¢ed: � Initially � ❑After exposure as per appendix 2 paragraph 2.2(if appropriate): _ ❑ After accelereted dry-cleaning(10 cycles) ❑ ARer accelerated laundering(10 cyGes) ❑ ARer accelereted water leaching (72 hours) ' � � .❑ ARer accelerated weathering: - ❑ Xenon Arc(100 hours) ❑ Carbon Arc 1 (360 hours)SET � Carbon Arc 2(100 hours) � - ACCEPYARCE CRITERIA L For any individual specimen: - � � a. Afterflame exceeds 5 seconds b. Bums through to any edge c. Igniles cotton wool - d. Surface flash exceeds 100 mm 2. Average Char Length exceeds 150 mm �� COWCLUSIOW Based on the above results and failure criteria,the item tested is: ' � Suitable ❑ Unsuitable � � ❑To be retested DISCUSSIOW The test procedure describes four potential ignAion levels. The produd is first pretested to the least severe ignition scenario (Level 1) to determine if sustained ignition occurs. If ignition does not occur, pretesting is continued at succeedingly higher levels until sustained ignftion does occur. Once the lowest level of sustained ignition is determined, a complete test of 10 specimens(5 warp and 5 fill) is conducted at the appropriate level. CERTIFICATION: I ce{tify that the above results were obtained after testing specimen in accordance with tFie procedures and � uipmen�cifi�d�b�the stand�rtl,�tated above. These resulls were obtained from an outside source. d _. o �Vl�� A�l �'I'/1g41% d U�� {7uW¢� Authorized Signature . . Page 1 of 1 F-11-A . � � Textile Testi�g �� 553 76�"Street� Bvron Center MI 49315 Phone:616.559.6123 Fax: 616.559.6119 ' Report Number:35775 Date: 7-9-2009 For the Account Of: Knoll Textiles 1235 Water Street East Greenville, PA 18041 Contact: Ethan Hong ClienYs Identification: K1325 Utmost TesQ�ev9orueoe� 58a,eae9acd Afle80ao� 06 YesB 4oe S�errP�ce �uPrn6ong C9uar�c9ePis4ecs of Bau6ldin� flfl�8eeoass �,SYR� �84-09 �D��a1Poeee�➢ TEST DATA Tes4 Specimen Flame Spread Smoke Developed Indeu Indez Reinforced Cement Board 0 0 Red Oak Flooring 100 � 100 K1325 Utmost 5 110 - � Specimen Da4a Time to Ignition � 00.07(min) Maximum Flame Spread 01.14(fl) Time to Maximum Flame Spread 00.45(min) ACCEPTAMCE CRITERIA �� qass Flame Spread Indett SmoKe Developmen4 62aQing � . 1 or A 0 - 25 0-450 maximum � 2 or B 26 - 75 0-450 maximum ' 3 or C 76 - 200 0-450 maximum COWCLl7S10Pd Based on the above Results and Acceptance Criteria,the item tested is: � . �Class 1 or A �Class 2 or B ❑Class 3 or C ❑Unrated DISCUSSIOFI � This test is certified for ASTM E84 by the Soulhern Building Code Congress International(SBCCI)as a testing laboratory for Fire and Materials testing, Evalualion Report Number TL-9606(Commercial Testing), and by the United States Department of Commerce, National Institute of Standards and Technology(NIS�,through the National Voluntary Laboratory Accreditation Program(NVLAP)for compliance with criteria set torth in NIST Handbook 7502001,�all requirements of ISO/IEC 17025:1999, and relevant requirements of ISO 9002:1994. � This report is provided for the exclusive use of the client to whom it is addressed. It may be used in its entirety to gain product acceptance from daily-constituted authorities. The test results presented in this report apply only to the samples tested and are not necessarily indicative of apparent identical or similar materials. The client provided sample selection and identification. A sampling plan, if described in ihe referenced test procedure,was not necessarily followetl. This report shall not be used under any circumstance - in advertising to the general public. In4roduc4ion This report is a presentation of results of a surface flammability test on ihe material referenced above, tested as submitted by the Gient. ' The test was conducted in accordance with the American Society for tes4 and Materials fire test response standard E84-09, Surface Burning Charaderistics of Buiiding Materials, sometimes referred to as the Steiner Tunnel lest. This test is applicable to exposed , suriaces such as walls and ceilings. The test is conducted with the specimen in the ceiling position withthe sudace lo be evaluated o r Th method which is similar to NFPA No.255 and UL No. 723 is an American Nationals . ex osed face down to the i nition s u ce. e , , P 9 . (ANSI) Standard and has been approved for use by agencies of the DepaAment of Defense for listing in the DoD Index oi Specifications and Standards. This standard is used to measure and tlescribe the response of materials, produds,or assemblies to heat and tlame under controlled conditions, bul does not by itself incorporate all Tactors required for fre-hazard or fire-risk assessment of materia�s, products, or assemblies under actual fire conditions: � a��e t nf7 . F-it-A . � � Textile Testing �� 553 76'"Street� Bvron Center MI 49315 Phone� 816 559�6123 Fax' 616 559 6119 Report Number: 35775 Date: 7-9-2009 The purpose of the test is to provide only the comparative measurements of surtace flame spread and smoke development of materials ,� with that of select grade red oak and reintorced cement board under specific fire exposure conditions. The test exposes a nominal 24- foot long by 20-inch wide lest specimen to a controlled airflow and flaming fire adjusted to spread ihe Flame along lhe entire length of a red oak specimen in 5.50 minutes. During the ten-minute test duration,flame spread over the specimen surface and density ot the resulting smoke are measured and recorded. Test results are calculated relative to red oak,which has an arbitrary reting of 100, and reinforced cement board,which has a rating of 0. The test results are expressed as Flame Spread Index and Smoke Developed Index. The Flame Spread Index is defined in ASTM E 176 as a number or classification indicating a comparative measure derived from observations made during ihe progress of the boundary of a zone of flame under defined test conditions. The Smoke Developed Index, a term specific to ASTM E-84,is defined as a number or classification indicating a comparative measure derived from smoke obscuration data colleded during the test for surface � burning characteristics. There is not necessarily a relationship between the two measurements. The method does not provide for measurement of heat iransmission through the surface tested,the effed of aggravated flame spread behavior of an assembly resulting from the proximity of combustible walls and ceilings, or classifying a material as noncombustible solely by means oT a Flame Spread Index. The zero reference and other parameters critical to furnace operation are verified on ihe day of the test by conducting a 10-minute test - using 1/4inch reinforced cement board. Periodic iests using NOFMA certified 23/32-inch seled grade red oak flooring provide data for the 100 reference. � Test Sample The test sample, seleded by the client was condifioned to equilibrium in an atmosphere with the temperature maintained at 71 +/-2°F and the relative humidity at 50+/-5 percent. For testing,two 12-foot lengths of the fabric were free laid over a 2-inch hexagonal wire mesh supported by 1/4-inch diameter steel rods spanning the ledges of the tunnel fumace at 24-inch intervals. This method of sample support is described in appendix X1 of the E-84 standard,Guide to Mounting Methods, Section X1.12.2 and X7.1.2.3. Tes4 Resul4s � The test results,calculated on the basis of observed flame propagation and the integrated area under the recorded smoke density curve,are presented below. The Flame Spread Index obtained in.E-84 is rounded to the nearest number divisible by five. Smoke Developed Indices are rounded lo the nearest number divisible by five unless the Index is greater than 200. In that wse,the Smoke Developed Index is rounded to ihe nearest 50 points. Flame spread and smoke development data are presented graphically in the computer printout at the end of this report. Clarifica4ion on Codes � � Code officials frequently use the Flame Spread Index and Smoke Developed Index values obtained by the ASTM E-84 test and � regulatory agencies in the acceptance of interior finish materials for various applications. The most widely accepted classification � system is descnbed in the National Fire Protection Association publication NFPA 107 Life Safety Code,where: SGndartl Classification System: - � qass Flame Soread Intlez Smoke Develooment Ratina � 1 or A 0 - 25 0-450 maximum 2 or B 26 - 75 0-450 mazimum 3 or C 76 - 200 0-450 maximum � . Class A, B and C corresponds to Type I, II, and III respectively in other codes such as SBCCI, BOCA,and ICBO. They do not prelude a malerial being otherwise classified by the authority of jurisdiction. � . The description of Ihe test procedure and specimen evaluated, as well as the observations and results obtained,contained herein are . true and accurete within the limits oi sound engineering practice. These test results were obtained from an outside source. A copy of. the original document is kept on file at Applied Textiles CERTIFICATION: I certity that the above results were obtained after testing specimen in accordance with the procedures and equipment specifi�d y ihe rtdard tated above. These results were obtained from an outside source. N� �� . Authorize ignaWre , � �-^^�� F-11-A ASTM E 8�TEST ��,Y�. I Client: Applied Textiles 'i Test Number: 4069-72&4 � AAaterial Tested: K1325 Utmost Date: July 29,2009 Test Results: � Time to Ignition = 00.07 minutes Maximum Flamespread Distance = 01.14 feet Time to Maximum Spread = 00.45 minutes Flame Spread Index = 5 � Smoke Developed Index = 110 � za ia is �a m iz � io C N � g 0 6 4 2 0 Tme,minutes � 100 90 80 � 70 � 60 c � 50 E � 40 m �' 30 20 10 0 Time,minutes � The - 9&D Allen Boulevard Farmingdale, NewYork 11735-5626 USA � �� Tel. +� (631)293-8944 Fax+1 (631)293-8956 �� e-mail: info@govmark.com Ora i i n zat on inc: �� 9 , Page I eceived:04/ISYL009 Completed:04/16/2009 Leqer:D rb P.O.k: 09-1134 Test Report#: 2-78212-0- Client's Fabric Name:Utmost. Part#: K1325. Content: 100%Trevira CS Polyester. Weight: 12 o7Jyd.Backing NlA.Finish:N/A. [dentification � Tested For: Andy Strick Key Test: NFPA 260 Cover Fabric(BLDG) 105 Knoll Inc. PO Box 157 Tel: 1{215}679-129I Ext: E Greenville,PA 18041 Fax: 1-(215)-679-1600 Category: NFPA 260 Fabzic � Specifier: Bldg. Codes PC: 4H /jd TEST PERFORMED: NFPA 260 Standazd Methods of Tests and Classification System for Cigarette Ignition Resistance of Components of Upholstered Fuenit�re; Cover Fabric Test � RESULTS: TEST RETEST (If Required) _"_______________"___'_' ____"__"'_"'__'_"_'___'__' Char Length - Char Length Ignition on Ve=tical Ignition On Veitical Specimen R (yes/no/SE) Panel (mm) (yes/no/SE) Panel (mm) - _____"'__ '____"__'_ _'___'__" __"__'____ ____'_____ 1 No 20 2 No 22 3 No 22 ABBREVIATZON WHICH MAY BE USED: SE: Indicates that the cigarette �self extinguished prior to burning its entire length. When this occurs, a '•retest" of that specimen is performed. REMARKS: None. � � CLASSIFICATION SYSTEM: � Class I - Foi each specimen: No obvious ignition; maximum chac length 45 mm (1.75'•) . (Zndicates propensity to resist cigarette ignition in conjunction with standard foam filling material.) � Class II - For any specimen: Obvious ignition; o= chaz length exceeding 95 mm (1.75") . � � (Indicates inabili[y to resist cigarette ignition in conjunction with standartl foam filling material.) CONCL(1SION: Based on the above Results and Classification System, the item tested is assigned a: ' fx1 Class I rating; [ ] Class II rating . • (Page 1 of 2) 96-D Allen Boulevard The Farmingdale, New York 11735-5626 USA � �� G��a� Tel.+� (831)293-8944 Fax+t (631)293-8956 e-mail: info@govmark.com ■� Organization, Inc. Page 2 Received:04/15/2009 Completed;04/16/2009 I,etter:D rb P.O.#: 09-1134 Test Hteport#: 2-78212-0- Client's Fabric Name:Utmost Part#: K 1325.Content: 100%Trevin CS Polyestec Weight: 12 ozJyd. Backing N/A. Finish:N/A. Identificatiou � � Tested For: Andy Strick 9Gey Test: NFPA 260 Cover Fabric(BLDG) I05 Knoll Inc. PO Box 157 'Q'e!: 1-(215)-679-1291 Ext: EGreenville,PA (8041 �ax: 1-(215)-679-1600 CODE INFORMATION: In accordance with — � (1) The 2006 Edition of the NFPA Life Safety Code 101, paragraph 10.3.2.1{1) ; and (2) The 2006 Edition of the International Fire Code, pazagraph 605.1.1.1, 805.2.1.1 and 805.3.1.1 Upholstezed furnituze components shall be Class I when tested in accordance � with NFPA 260, when used in: . Detention or correc[ional occupancy Health care occupancy � - � Residential board s care occupancy . - In certain situations an exception is made if the rooms or areas are sprinklered. CERTZFICATION: I ceitify that the above results were obtained after testing specimens in accordance with the procedures and equipment specified by NFPA 260. 'L��/_�'��e��_�___ '_""'___ AUTHORIZEO SIGNATURE � THE GOVMARK ORGANIZATION, INC./rb � � ll+i�. G4'�,�`�"}-�� C��=�5.�'��o (Page z of z� APR 2 2 20�9 The resul[s contained in this report relate only[o i�em(s)tested.The test report shall no[be reproduced,except in full,without written approval from The Govmark Organiza[ion, Inc. � � 96-D Allen Boulevard �`e The Farmingdale, New York 117355626 USA -�� Tel. +1 (631)293-8944 Fax+� (631)293-8956 rmail: info@govmark.com ■/ Organization, Inc. ' Page 1 Received:09/30/ZOOS Completed:l0/06/2008 Letler:W4 rb P.O.#:08-1218 Test Report N: 2-75564-4-RV ClienYs Fabric Name:Utrnost. Part#K1325.Content: ]00%Trevira Polyester. Weight: 14.5 o�Jyd. Backing:N/A.Finish:N/A. Identification � Tested For: Andy Strick Key'E'est: CAL I 17 Section E,Part 1 -Upholstery 50 Knoli lnc. Fabrics RVRC POBox 157 'H'el: I{215)-679-I291 Ext: E Greenville, PA 18041 Fax: 1-(215)-679-1600 . Flame Spread . Warp With Without Specimen (seconds) Nap Nap � ___'____ _'_'___"'_' ___'__' '___"_ 1 Face � DNI (x) ( � 2 Face DNI (x) ( ) � 3 Face DNI (xl ( ) 4 Back DNI �( ) (z} 5 Back DNI ( ) (x) � . Flame Spread Fill Specimen (seconds) , ___'____ ____'__"__' 6 Face DNZ (x) ( ) 7 Face DNI (x) ( ) 8 Back DNI , ( ) (x) 9 Back DNZ ( ) (x) 10 Back DNI ( )� (x) �, RequiremeMs: With nap - Minimum flame spread of any individual specimen shall not be less than 7 seconds. without Nap: Minimum flame spread of any individual specimen shall not be less than 3.5 seconds. . � [DNI = Did Not Ignite; therefore no recordable burning time (Flame Spread) . ] The � 96-D Allen Boulevard Farmingdale, New York 11735-5626 USA �� Tel.+1 (631)2938944 Fax+t (631)293-8956 .� � e-mail: info@govmark.com Organization, Inc.' page 2 eceived:09/30/2008 Completed:l0/06/2008 Letter: W4 rb P.O.#: 08-1218 Test Reportf7: 2-75564-4-RV Clieot's Fabric Name:Utrnost. Part# K1325.Content: 100%Trevira Potyester. Weighh 14.5 ozlyd. Backing:N/A. Finish:N/A. Identitication Tested For: Andy Strick Key Test: CAL 117 Section E,Part 1-Upholstery 50 Knotllna Fabrics RVRC POBox 157 Tel: 1{215}679-1291 Ext E Greemille,PA 18041 Fax: 1{215}679-1600 Page 2 of 2 Conclusion: The above results indicate compliance with the stated requirements. � I certify that the above results were obtained after testing specimens in accoxdance with the procedures and equipment specified by California Technical Bulletin 117 Section E, Pait I Upholstered Fabrics dated � January 1980. Testing Completed: 10/06/2008 �� AUthorized Signature /m� � THE GOVMARK ORGANIZATION, INC./jb TEST REPORT #: 2-75569-4-RV RV.11.26.08 V'�fd�< G�"�1�'i''�9�GL ��'��R� [GSA test report Pormat] . �The results contained in this report zelate only to item(s) tested. The test report shall not be reptoduced, except in full, without written appsoval fsom The Govmark Organization, Inc.J The results contained in this report relate only to item(s)tested.The cest report shall not be - reproduced,except in full,without written approval from The Govmazk Organization,Inc. � � The - 96-D Allen Boulevard Farmingdale, New York 11735-5626 USA • �: �� Tel. +� (631)293-8944 Fax+� (631)293-8956 e-mail: info@govmark.com ■� Organization, Inc: Page i Received:04/15/2009 Completed:04/19/2009 Letter:DI rb P.O.#: 09-1134 Test Report#: 2-78212-1- ClienNs Fabric Name: UtmosL Part#: K1325.Content: 100%Trevira CS Polyester.WeighC l2 oz/yd. Backing N/A. Finish:N/A. Identification Tested For: Andy St►ick Key Test: CFR 49 V 571302(FMVSS 302) 125 Knall Inc. PO Box 157 Tel: 1-(215)-679-1291 Exh E Greenville,PA 18041 Fax: 1-(215)-679-1600 ' PC: 29H /jd TEST PERFORMED: CFR Title 99 Chapter V Part 571.302 (FMVSS 302) - Flammability of Materials Used in � the Interior of Motox Vehicle Occupant Compartments SPECIFIER: D.O.T. � RESULTS: � (TS). (T) (D) Time [o Burning Time BUrn Distance Reach Beyond Beyond 38 mm BM 38 mm BM 3B mm BM Burn Rate Specimen # (seconds) (seconds) (mm) (mm/minute)� Code '___'__'__ ___'_____ "_'_____ __""_ '__"___"_ __'_ Length: 1 . 0 0 0 0 SE 2 0 0 0 0 SE . 3 0 0 0 0 SE 9 0 0 0 0 SE Width: 5 0 0 0 0 SE � 6 0 0 0 0 SE � 0 0 0 0 SE 8 0 0 0 0 SE ' • Indicates that bucning time beyond 38 mm exceeds 240 seconds; the test was terminated by the technician at time noted. The burn rate was calculatetl at the terminated distance. SPECIMEN HOLDER: [x] Standazd [ ] Modified, 10 mil wire spaced at 25 mm intervals across 51 mm width opening: [ j Test item was less �than 56 mm witle [ ] Specimen softens and bends at flaming end, which results in erratic burning METRIC CONVERSION: mm = 25.4 = inches � FAILURE CRITERIA: Burn Rate exceeds 102 mm pet minute foc any specimen. � CONCLUSION: Based on the above Results and Failure Criteria, the item tested: [x] Passes; [ ] Fails CERTIFICATION: I certify that the above results were obtained after testing specimens in accordance with the procedures and eq�uJipment specified by CFR Title 99 Chapter V Section 571.302 (FMVSS 302) . �C��/��___�__�'__�_�==_J��Z�_""`�___ - AUTHORI2ED SIGNATURE � THE GOVMARK ORGANIZATION, INC. /=b/ � !3`�i;r, f;1i.'. �c��i � >r:r: �t� � Page 1 of 2) .,� ��t= . .�.�e� � AP 2 2 20�4 The 96-D Allen Boulevard . Farmingdale,New York 11735-5626 USA �.,�A��r� � Tal.+1 (831)293-8944Fax+1 (631)293-8956 � e-mail:info@govmark.com u Organization,inc: Page 2 eceived:04/IS/2009 Completed:04/I9l2009 Letter:DI rb P.O.#: 09-I 134 Test Report It: 2-78212-1- Client's Fabric Nazne:Utmost.Part#: K1325.Content: 100%Trevira CS Polyester. Weight: 12 oz/yd.Backing N/A. Finish:N/A. fdentiflcation Tested For: Andy Strick IGey'd'es4: CFR 49 V 571.302 (FMVSS 302) 125 KnoO Inc. PO Box 357 � '➢'el: 1{215}679-1291 Ext: E Greenville,PA 18041 Fax: 1{215}679-1600 ABBREVIATION/CODE DEFINITIONS: DNZ - Does Not Ignite. Specimen does not support combustion during or after ignition. � . - DNO - Did Not Occur. SE - Self-Extinguishing. Specimen ignites but does not burn to the timing zone, which stazts at 38 mm. SE/NBR - Self-Extinguishinq/No Burn Rate. Specimen ignites; burning progresses � to the 38 uvn timing start line and extinguishes within 51 mm beyond [he start line. Time of burning after passing 38 mm is less than 60 seconds. SE/(B) - Self-Extinguishing/With a Burn Rate. Specimen ignites; burning progresses to the 38 mm timing start line and extinguishes within 51 mm beyond the start line. Time of burning after passing 38 mm is qreater than 60 seconds. Calculated burn rate is 51 mm per minute or less. B . - Specimen ignites. Burning progresses more than 51 mm beyond the 38 mm timing start line. Burn rate is calculated. REMARKS: None. Note: The original version of FMVSS 302 was expressed in English Units with a maximum burn rate of 9 inches per minute. When the U.S. �government converted the document to the metric system, they used 102 mm per minUte as the maximum burn cate, sather than the exact conversion (4"/minute x 25.4 = 101.6 aun/minute) . � (Page 2 of 2) � � The resula contained in this report relate only to item(s)tested.The test report shall not be � reproduced,except in full,without written approval from The Govmark Organi�ation,Inc. � � ;. � - Textile Testing „ 553 76'"Street �Bvron Center MI 49315 Phone: 616.559.6123 Faz:616.559.6179 Report Number: 34064 - Date:04-02-D9 � For the Account Of: Knoll Textiles 1235 Water Street Lubin Building East Greenville, PA 18041 Contact: Andy Strick Client's Identification: Utmost Test PerFormed IMO Resolution A.652�16)—Recommendation on �Bre Yest Procedures for Upholstered Furniture(Methods of Test for the Ignitability by Smoker's Materials of Upholstered Composites for Seating)—Section 8.3 TEST DATA � � - Progressive Smoldering Flaming (Yes/No) (Yes I No) , Initial Test � No � No TEST ITEM COMPOSITE Cover Fabric— � � � ClienTs cover fabric ❑ Standard cover fabric, 100%inherently Flame�retardant polyester fabric approximately 200 g/m� Filling Material— � �Standard filling material � � Non flame retardant flexible polyether foam,22 kglm'(1.4 Ibttt'� ❑ Flame retardant polyurethane foam, Code Red II 35,46.7 kg/m (2.9 Ib/H3) . ❑ Non flame retardant flexible polyether foam,22 kg/m3(1.4 Ib/ft3),wrapped with Uniguard fire blocking material - ❑ ClienPs filling material ACCEPTANCE CRITERIA � i � Progressive smoldering or flaming within one hour after start oi test CONCLUSION Based on the above results and failure criteria,the item tested: � Passes ❑ Fails . CERTIFICA710N: I ceAiy that the above results were obtained after testing specimen in accordance with the procedures and e�yipment specified by the standard stated above. These resutts were obtained from an outside source. � C�-�tsi✓o-�, `�YL`��_� Authorized Signature � Page t of 1 F-N-A 4 r� „J - Textile Testing , „ 553 7f;'"Str et B ron Center MI 49315 Phone: 616.559.6123 Fax:616.559.6119 Report Number: 34064 . - Date: 04-02-09 For the Account Of: Knoli Textiles 1235 Water Street Lubin Building East Greenville; PA 18041 Contact: Andy Strick ClienYs Identification: Utmostw/FR Test Performed IMO Resolution A.652(16)-Recommendation on Fire Test Procedures for Upholstered Furniture(Methods of Test for tfie Ignitability by Smoker's Materlais of Upholstered Composites for Seating�-Section 8.3 TEST DATA Flaming' Glowing' Smoking' Smoldering• (seconds) (seconds) (seconds) (seconds) Initial Test 0 0 0 0 - `Values are reported afler removal of bumer tube ignition source. � TEST ITEM COMPOSITE Cover Fabric— � � � ClienPs cover fabric ❑Standard cover fabric, 100%inherently flame retardant polyester fabric approximately 200 g/mZ Filling Material— - � Standard filling material � �Non flame retardant flezible polyelher foam,22 kg/m'(1.4 ib/ft3J � ❑Flame retardan[polyurethane foam, Code Red II 35,46.7 kg/m (2.91b/ft� � ❑ Non flame retardant flexible polyether foam, 22 kg/m;(1.4 Ib/ft�,wrapped with Uniguard fire blocking material ❑Clienl's filling material . ACCEPTANCE CRITERIA Fiaming,glowing, smoking or smoldering that exceeds 120 seconds CONCLUSION Based on the above resuRs and failure criteria,the Rem tested: � Passes ❑ Fails CERTIFICATION: I certiy that the above results were obtained aker testing specimen in accordance with the procedures and equjp��Jifi�.�yy Lli�anda:d s ed above. These results were oblained from an outside source. . l b�. Authorized Signature - Page 1 of 1 F-11-A Lto Commonwealth of Massachusetts 4 Sheet Metal Permit q Date: f I�D I i 3 Permit# 3oo— Estimated Job Cost: $ -1 voo r Permit Fee: $ Plans Submitted: YES_ NO_ Plans Reviewed: YES NO_ Business License # Applicant License # 1006 Business Information: Property Owner/Job Location Information: Name: " '`` " 'Gt„"J �j/v�_��l(u�h Name: �� 4�5 54Gfoo� Street: 7 Ht t� �^" Street: City/Town: 04h)\4 y fY)c, 6VkZ'� City/Town: Telephone: 9 7 6 -1-71 11 l H Telephone: 161 6 6 Z !3-10a Photo I.D. required/Copy of Photo I.D. attached: YES Z NO_ Staff Initial J-1 M-1-unrestricted lice J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family Multi-family_ Condo/Townhouses— Other Commercial: Office_ Retail_ Industrial/ Educational Institutional_ Other 1� Square Footage: under 10,000 sq. ft.I/al over 10,000 sq. fr._ Number of Stories: Sheet metal work to be completed: New Work: .Renovation: v HVAC v Metal Watershed Roofing_ Kitchen Exhaust System Metal Chimney/Vents_ Air Balancing Provide detailed description of work to be done: fiu �� urn �17S�a1n 41V 5j^ yv l bua 'Oncl.aili51 -Fw^ Gfo (Y\i;+ - gyp Gtr Uhl . GN- L I /0 o l P tit c . l s E)v; TU r�k on . I } Breen 4:7 Sullivan MECHANICAL SERVICES, INC. Heating•Ventilation•Air Conditioning•Sheet Metal•Refrigeration Controls•Automatic Sprinkler/Fire Protection•Plumbing -_ Eric Hersey,EEEonP Sales/Project Management Direct: 978-767-8487 7 Healy Court Main: 978-777-1114 Danvers,MA 01923 - _ Fax: 978-767-8488 www.breenandsullivan.com•Email:ehersey@breenandsullivan.com t INSURANCE COVERAGE: 1 I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes IyJ No❑ If you have checked Yes,indicate a type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box[],I hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit Issued for this application will be In compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO_ Progress Inspections Date Comments Final Inspection Date Comments Type of License: By 21 Master Title J 1 ❑ Master-Restricted Cltyrrown ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: 0 00 6 Fee$ ❑ Check at www.mass.gov/dpi Inspector Si nature of Permit Approval t The Commonwealth of Massachusetts dnFom Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, M4 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):BREEN AND SULLIVAN MECHANICAL SERVICES,INC. Address:7 HEiALY COURT City/State/Zip:DANVERS, MA 01923 Phone #:978-777-1114 Are you an employer?Check the appropriate box: ].�✓ I am a employer with 50 4. I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and havelpo employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers''comp, insurance comp. insurance.t 9. ❑ Building addition required.] 5. 0 We are a corporation and its 101-1 Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11-El Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL insurance required.] t c. 152, §1(4),and we have no 12.❑ Roof repairs employees. [No workers' 13.❑ Other comp, insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check thi's box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:THE HANOVER INSURANCE COMPANY Policy#or Self-ins.Lic. #:WHN 9769839 00 12/22/13 Expiration Date: Job Site Address: q 3 Okv*-� 5 t City/State/Zip: 5gt "� ty� �Y•- I i01 . U1 1D Attach a copy of the,workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as.required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ,fine up to$1,500.00 and/or one-year imprisonment, as well as-civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerd&under the pains and enalties of er'u that the.information provided above is true and correct. Signature: _ Date Phone 078 767-8508 — - 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.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: bp F A DATE(MMMONM) CERTIFICATE OF LIABILITY INSURANCE 12/19/2012 - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder le a .ADDITIONAL INSURED,the Policy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements, PRODUCER CONTACT NAME Lauren Deluca � QUINCY INSURANCE AGENCY, INC. HONE (781)431-9600 X .(TB1)431-Ps9s ig-.E.mi-deluca@quincyins=ance.net Gould Street AIL .ldeluca@quinayinsurance.net Suite 152 IN Needham SURERS APFORDINO COVERAGE NAIC# MA 02494-2337 INSURER A:The He INSURED over Insurance Company Breen 6 Sullivan Mechanical Services Inc. INSURER B:Risk Placement Ins. Service MA ' 7 Healy Court INSURER C: INSURER D: NSURER E: Danvers MA 01923 INSURER P: COVERAGES CERTIFICATE NUMBER:2013 Master REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION.OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. OR TR TYPE OF INSURANCE POLICY NUMBER POLICY fiFF POLICYEXP OENERAL LIABILITY LIMITS EACH OCCURRENCE j 1,000,000 X COMMERCIAL GENERAL LIABILITY A CLAIMS-MADE PR ISES Ea o nw 6 300,000 OCCUR IN 9797451 00 - 2/22/2012 2/22/2013 MED EXP A one redo $ 5,000 PERSONAL 4ADVlWURY B 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: lOC POLICY X PRO. PRODUCTS-COMPIOPAGG B 2,000,006 AUTOMOBILE LIABILITY S Ee aen 11000,000 A ANY AUTO BODILY INJURY(Pet person 20 000 Al ALL X SCHHO ULED WN 9799078 00 ) S 2/22/2012 2/22/2013 BODILY INJURY(per aecklent) § X HIRED AUTOS X NON-OWNED R DA G 40 000 -musteRdIall) $ 5 000 UMBRELLA UAII OCCUR McOical ft $ $ 000 (. X EXCESSUAB OCCUR CLAIMS-MADE EACH OCCURRENCE $ 5,000,000 AGGREGATE E 5,000,000 DED X RETENTION SU00031998784 12/22/2012 2/22/2013 $ A WORKERS COMPENSATION AND EMPLOYERe'LIABILITY YIN )[ VAC STATU- OTH- ANY PROPRIETORIPARTNEREXECUTIVE 11000,000 OFFICEWMEMBER EXCLUDED? NIA E.L.EACH ACCIDENT g (Mandatary In NH) 9769839 00 2/22/2012 2/22/2013 EA EMPLOYE S 1.00 0 000 Iryes Ee-eu be under E.L.DISEASE- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT § 11000,000 DEBCRPrONOFOPERATIONa ILOCATIONs IVEMCLEB (ASagh ACORD 101,Additional Remarks ScheduleI,It mom spade Is required) Operations: Plumbing, Heating, Air Conditioning and Sprinkler Service and Installatir CERTIFICATE HOLDER CANCELLATION --- "" SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Lauren Deluca/LLD ��,ujtyEiss V,G � ACORD 26(2010/06) O 1988.2010 ACORD CORPORATION. All rights reserved. INS025 potoos).o1 The ACORD name and logo are registered marks of ACORD ;' ;w�rn )�7sr f °a"Y;. S. y�.�fP3 T z�w m,K t. +r r�.» r �.,x+.e k..�f++.,`"l 9 'S e, t{y',.} i•*1r edk*.y, ,uG ary ^a'i p' zr � ' n5'" 3+4:;«} r C ks' 4 R PL }n t#""t"� N� ,� •i. Y a ..y a r re` SYd :x s k,y- Y .4�,-,:': �`Y v "�^' ,�"�`9M '?' y k' '� ,t c� � : l re5` .� {a Pf r'm «' x: � a^`�' 'm^N ..,kaU A` '. a Y r i d, '� 44 a n` t a$ (, i, � N^ ,sw" .•. s rsk ''4"s a� w) n`wn *.K¢ a ! a �:i 3 H ny Xk r f �`+ t n.. H eA} +,. r ,Y, .`s q ,ksu 5 Y' y's 4` #t r.• `2 r to v . ??�4 t '� Y -+� h l.;,d i, r e a,l xx nc H y d,• 1�2 Af i'�• ° t s s:.. ,,rx .�,�+*#„�' y,, _ { *, sY" �, Yli t- rk' f �i-. s"s t x d fr�t,�< 2'�c Y v�� 4A? vI„`x. `�"yYl3e: !a��,, K+?s a" rsx ram,',?,};. x a;d`r'�`y:wtr+» a�ta y Aye i' rf'` r4....4 £u' tix'r 5 t 'vc w :TrhM;:" *Ms, tr k :i'�z �k` �' exur�j •: 4F >�a? i;sm s� e.,m {` 53�_? R � 4 =tN "" t-ms `. [' h':� ?- p>t�i wM'�g z� iF,�, i ,#� 0.^^4kw '' sl, k rip ,ak,. '`3i� .�,}�•�YN'in � :i i ) '�'Yya � ,+' 3..a� ya.- '�� £. t N',� r i#' r^3�� }«"�a 3 6 F K d Y� � "`� rk i•'1'+"f "$fl2 tii:.,l �yF Y ..j r.4 k c`�.;., X = < >•TN�i uvx�h. x�*� �<sr'i 4�� r�,�t 3 ; ' 4k r• �:"f:: e, � ` 2. >t` z „ gg 4 - � � :� � �z�.�.a 3x .xe� �s3 ti x.5 :�5 4 f"�:`K.� •� co r'f" 3�$",k1e3- Y,rR,r +'a �;,_r } "'ti °'isw`-"T zY�a tf':� h"�3',#r. �'� r s� 'r1r `°'y'r'*k ,.c ,Cx4 � T F ^m?k., l" �'" Y .�4 ✓, _,{� � }'? #,�+ '� f' z �+ `4t r� r � .i b' k'" .e Yr �. d awe a a �� .��€�3 is w �+ a >� :,�'t 's r- '; k�I ^�F �� r �'k 'Y r+. i`�, s. 'x % �' ,.:+a'i� a;<,P��fv ,.^j ,bS� � � k&�, �'a�'v� �'><'?'ryk 'iyV, . �' „r {..;3+.rWtga s }y,+ki;. �avx G. `,t sa` r 'ktR.tp,'4�� ,yt �.G"`y' �y r "'S✓a�•e ��z<M.'. d• d s $:a s??4' F ,;. �A„aj a �_ '°, '>NJ � za k"� •;; + '-.nr>"> �. .>.-Yzn �, 1 :L�n-kak �tp�, k.,N;7 tksai} �x..:�"T��ry ..�s��"'�, w'�,'� yr.,a�' V'rT' 1�`*'"�f�`f "lv r"'� ^1., ,.? 3 't-e.. �. J. .,`3''"' .y.5.$�r` � r+'x,.r t�� 4 � .� ,,,e [�,rY.t ,{� � z' � �"'.q t � 'Y Fyn. �`,�a� ;. t- 'e}�x� �� ... %�'r s*.Ti•} �a� .,.a d �+��r x�y, a€y'v� ,r4} 'X .F, sth=9rt' x 'aS `;": *+''"�i5$ �a�'3`h » _,:fa•#"� �as,,.Y't� - y's 7yf:•`.'�" i`d�,P c* : ,.:4.t.„y a .s7��"` ' �^�t ''� ;: �"� NA ^' % ,�3 :�: •x�."3�,4`r .4'�s�" *�.. s .�,A'^rn.�• 'ry s fi i 1&k` G.-a^=dr R fs' �:e6v $ nr ;,RSkt ,rxf fax,'y`�r,�"��# s+hTf�' r.. �� ?r: � aa< a c� �� xi.. . ,»� .-.r2` '" "L3" •y„; � ...: t 5,•c. ^ � {..:�$"�'t + J:# y 4� � ra` ,,r'r `�" ,?,'4t�*^r C} k'' ". ry �"� s�5f eN .3 �� _-�+�" a � t�{"ga n x' ,w, �� t,..-4'� a i;� U ta. �� RrN�� a'' ,,,p ,d'x f Y�pn{�' k.a ,;,:•. S" .,r.,,,? T .>,, :r4 �,7'��'k :�xk`�d gp' ''"? ��- 3,hs: � .,t :,rt s "t "tk" X"'��;`'�'�k c •�"�a�'.��'�t � � x7 �� r` "'��» �y 4 fi.. a -, a' G. .. r ce " m., �• �r h e, tom.. - F .Sr .: sx t. ? s,.�.. .b.% a s m:x rk'r� -*y.@ .g `tf'xt t '! � � s s 'a:, » "a-t�i �i:v;5 /�`x(„v'r"� �"f"�y r'�e �L� �� kYa"z.'p°�•.1 "`N � '��.R`-Y ��.. '`#�k',`''e�^'�i '�:ti� a 34""' .�:.:;s� a..:d' d,: _ � rc.&^ s'{;'�#vA x ''�,7�TMa "76��r ns #v�, �x,,= �..,5 xn �2 k '>rt�5 a..�,� � f><^r At"^F�z•T '� .{... Yr rr�k 3*21;NT vr, a"s6 � S. x'm� vLr ,}^ cS 1 �` y.z k-.<� M e s �'.r .r,;;� t'K" ,`s''.. t�"?c 4�Zrb,�wr«'" re xct-a,,.. � n• ,�,.'�r' � �� »�„',c +.- -� �: n� `-, �.� x �-, k''k As„�'.,; i �..:z u �,3:,.;P - 'Y�,x�'*y,�"§+ rz�'"�` bA�� "5.•. � +e� �" ^r "4�&� ✓��,K':a:. ._ �a.:''�', �3,a �';'. ` ', ,, 6s.<N 2 ,3, r�,�,'�'`�. ,'h' -„�'�N-`":� ti`a. � � T t } �`� '3✓` }t }x Y."C ^�hil'A �y L`^, C>t. Y ,). q�+h. i)�a 1 .. 2 Y w ;j}�, � �5 `" � ✓ s+ .$ t_.,�.s '� ih,�`� n .x x i. -x t ""Y ,:4.,,4.,w '`� '� K.'1q�d"` � s ,,}."�`b.� �}�,,�t- wu �" .�t .d '°�::,n ,v s' ,� .�_ '�-.�,+ '�•.. �'{'�9y�4- ~ �_ r -u.-�t1K a ' 'Y�� fit' �t ,,t � �' �•.w �s�� k M1 l '..IYY," �'l .�" �}� ,�y.`rl � �. r-,vti :'�„�' c9 f`Y� ,..�5 � �� :2 N.� Y�. r�,',} v • "��kpi�;1' MI��Jrvv.l9�>�% iS�:' , �''_.'k�' y�a`"t�``,av�# •i':� "rR, 'i��5$�"�r�,f w'.. x _ -, 3. m. . -«I,.,- ., s �' L S' . , a a'"c � > `�.. � c a 7 ae,x-.,- _ ._-,.:F^:�?e. . :_., .. •z„.. : _ .�—._+:e,:p- �;;;o^ ,�"?�a: � 'sue{ ;gam. ,2-'3 ,r `^$'s "#"k'�.. �+�3 x'•f a; s ,�f f r,.� s,�z,xp�,'pys �„k,q, `..,a Fad r l`Y >fin ,�"-<tv C �' q�wsk�3Jx `" - • • • ••• • • •• • ':.��ry [ •a �"�e� .�."3y x`��' \�".aa&9.`-&s�`,.} ``•k X y,+ .�'W SNiE'fV,METAVL"WUk ' S�,�-``--- ,. � ;�� ; s �,�:..s. �. es^ r�.=, seraµ ar.n •e �5� tt�..- si°5' da.T•�` .. a*t��' �. '.3;"K# `� R� .�.c..`� s�'z" _'"":x' l9ax'' .�. �;?� Ta^�#s,?.2'e"'}," �+.Yi`.�-�} '�'. � � ... �x' � r .. r��.��'''�M�� ,-Mks' �� vr. WOES!- ME -8'..a,y `m rp �" '`�' ��'3:•' I EiA90YE LICENSE TO t� � S� t+, x-..�..."r' _.r g1 x -+,r,2 S' . . a. .�s -�;r'..;, ' `T-o:� k 1 4 w'�*•t+r�`+'.' M1 .tw.. M+� i�l �ce �� `� �"`�--�.�"2ir C# �-_ ��,'� Sva.�^-}.s^' .,Ysw-.�., l� ;w. '.�,r'� e�r£• ,y "�'t��',`��„z,' �y e��>�� a`w` `mrr`,t,�'�' Y�Ate+ tax ,tr-y,.yz ,n }r'+y4 a< �a 4 uy `• ..r 3 t 7 .r s T y. .-x 'w`{ a a Y c.w. @ F �rop: FR ..r*-sv.,F+ :Fa "''�r,i� .�•fk?,,x�' r�.✓xi��. *4k,`f,.�"` `xai' � '".,>' Y v�#��, �C :'"Y s �".F- '-�- x e': z; ,,."4..�� i3X �x ^�G _r �,n K �. '��t A } -_ Y +`�� t,-.:. '= i'� nj�t � )'•tT x'.aa. ,x.fGr� SL �{ i'4'�t"z �`7,c,'wY " _�a € °z:�.,�^' r"n'+, .",r,��u`�_" �' k.� � x ry�'!�"-aa �0 1'9�,3�D 0 0 0 .�� 1 4'p ' �• d„r- w'.,t ��, ��.-3� r� �sfy�3?-�`_ {.>�.fr �:' uu•*K.a'�-9?Pj'y`�' ��i �-� irr�u s��;:F, z,.g' -�'�' + �r AA N V ER 5�,-f„a ,r a.w M A'k• , .r 1 e:- � s= � -zv �i- i� e F a y e ::'a T, h. � �� Ar A,2'��k+tzS� t :}�? t +Y �,H"c fi .va.v r+-v.,-.,' P_._ dugs._':_§4' t "nA�":4"�W,. 4..- "x,L'K'.-•.� ry �w,b." ��Y d._„ "�:zp„ a. � Y'� ''Ya�'d�x '� ' i� '' �es.M�'feu, ��xu. " -i2'�`t _'�i`t"ia ^S&'tn�-k*sf �-L�' '.'F`"�r� ..._............ . .. ,... • •. • ';a,6 � 'lf,- �� .a 4�•�rsT`i w„�s+.kt,^»5 t.�"r5�„ s,. + '# »tY +!k'lG fr A 1 s / '}" 4y, n.R #>r # v k +£. .�'. � • `rim"��.,;.,� A ,n�f_' �� '_v"' ) �^'8 s � ¢a f � k 5, '•:r �4�.� � L. a" t r: `"'ctf �: sus'�r4�� Y � Y 'r''d+�+-t>'«4 d' r e '. t -a e t n�`'" x^�`�y �s`�"i.3 '�i � r'F 3y �k,�, J as K, x i ry ! 's�2 r ' 31:��e✓.Y .rt d,:ifp r'S=rS.`ST�,i2rz:`x+tY«Yr aW„u 4'; � a '�., :r..` a t t ',ti- k I`, a "� c y;�` � ;" .r s+. � +, �;. Y,r" ''�' S w 1'"e:. .e,p hK;: tf +.trr d 5 y9" e 1 u fir+' ,� f+'x }'�y= a**KKtt 'k'� >'z§.=- .*, � r.,y 4-a• -.'' r. c �a1 d-.:�"S� •" �`"rosy 'u�,-� � Ya''b,F,:.-.s f� � " " {h�a G i':N? a,l;..Y ,�.�.;w a F � ��,R y } .� :�:,t,e.,�'Y' �.:,-,hyr�xu �"�:r v+4i•r'�'a'KrmF�3R��,�".FS `',a:s+5rir� y„'��,..; �'#`. ,...�3v� ,r s:�:... �F �8r pt;,.. 's�' '>< �a� "#>°' � ��rr:�:`q'��t'F,`'a` ,' '"� ,'<" w :� ,t �,��T`k ,k 4 ec „k, y:.%tb xt a [ -_d, � frva rt✓i.:i,4,2 Ja'��'' '{u 8 e"�F`�rRd. cA` P,%�5:. � ... ,ate �m,. fi e��p �,yo."Yx',t �'`:%.� Tas x sad a 5 .l`4>`,.3 fnc$w, axiq} yn, :.,•c� �?'Y, 'u±d=.: ��-� ;�� -� z,..x' .m> s rTn x;2a ,.�;;�'7:�� .. "k � 4s �,• r-�'��. ^�: :t.,.- r�3'� a^�'•s"k'` 'y�.�u '?' .- rr ��^ �, ,� ,�x �,r�S � � 4�3.: �w't ; �w f; ;.. �'�' :t W`�xsv h .e'iaL.a'ka vR wt.b<F„t cAS sr,. ,..: E ,a�'ti`.... "� `�:�� ;:+. ��":: r'_a..� C# +�< .• '.�a*�yS.t'ss��s� .:f'1' S*"..a�x•5k�#'G sa '�'rM ',1; >r a.;.;i1sR ..b 'ya%' ar.r 4 : Y "+a nt Iva �..'}` � .,, � >r1_'�'wa h!'.p_�:e,��s•.`--r^++:y k,,:Y�. *-x(;y.. ..,. y �1. t �w:.x Yi yG? 'i:;V,�h� r t x v 4)t /� �.,xY� y '•. nv r�" p. r�t x` :,+,, t a :" d Hr,� i ,.. t 9 �r a ,r i S .+ s r x.s*-,: t ,; K w'x §'" x, rQ 5,- r t, e �" k�Y wtl• cY :w 1; ,e ute t >� "r, R w�` r x.„e ...d `.-r ✓F e >`i rt a s, i tn`i wt S" e :Y r +S r � T t "*} r e5.`-, �:aV 4+5,�dXr. i. �' "h�� R h! ,�a + .a f.� #•a5-: �vhd : "�1 ,+f ) } x k r 'aYY. v tik �, 1 Y:'.- � J4 k'413,r+ t- lx 4 el`Y 'f:" 4 S 6 ��41A•�4 1d. 4�'^k° k'ST1 ��. �r t �x�3��4 Y .�h .iY F '�+ % �fr�#'� Yi�j.v k{Y�Y a54"k*�`-0 , 3'' i� r'S'k5 =gaF�` '�'ry. }YY'�, It s ... � �u a x J Z n ;.t +z i r r - 3^=:'��""4 4 al fit;*.. ✓ .;t 1 Y%�.,:'za-e^.. ^r, wJ' a,s �-. M .tom"asJ ,b gka Y t t h9 .ta- ':+'r� ¢ - i k � y$rc-`%I s: ,,J.� 4 ;{ > ,S'rl s� is f � ':`j y"� Y ;.;! 3; iv 'rc=" 5x�;Y ft f k �d+• �k�tx4t r D „xs-?}d.c�"„'ri < 4 v h. a £^;:y t r fiP ,tx a t s 5 s :33� d'$ � - Nt >x•5 Etit i+ fr '+yv'S ��' 4�a4 �S< '^ � ,r, �yi�l 8!rp}�n 1.: «$rvYJTx t iAx.A 4� i � l ��' hYi�� G4� :fib y �i '� S t :}',3 e � Y +� > s } 4 �^c 7 T $ »i- t r �;lkn t &"}.✓:°"�'^,ra ^� t pti� *S� '•,{"fr �''�`w �t � �µ h "r�q 3.r�tR, s,r -i k a r c: r y f arh a �-'•1 <h s:, r. »,? '� a Y 'IJ rzdk"%i n xt h*v\' i i s Y s a a Yr k'Ye h.;' `.� �t '�% "rt � '�i* "I' t ;✓: a §. }i fS��kt r z # 'x €y 4�, ) n ,, s'a �'sl # r"� iY'? Sa riaX F k: >X r e +k 4 .+ +s' fa»w a $3'q°i`'r �4 k:6 ce f �&:s x .r xs A '#? S� t `:sY y i a 7 y Y 4,,,}rs:�y;,:�kYlt A-e E j f y`*." i F 7 x::, S'Yi'/ i :,. k h k� a 4� 1?Y SM1'� .ii.<n 1 'Y nYi- r`Tyr ? i j,lP� t„4 � 2 �+ I*�as i,y S fYa- 4 3 3 t i>•<,'+ b a F L�SY TA T. �, `t b�t'r��'� 41 Ca' YtS o^'.+ •5 rk � k P -n! t L Bt'u T�tYw F'� 4 R� f dlik tP� ( r' }� � YM1 4 �� 1" iCW`. 'C-:�'"{d'a f':S # � �Y .� ,� s Y a ,�. e '•�; YY, fr 1` s .e ;r4`,.;-L � -U ! '+r f >+ � 3 " i'r �' ti A su a - �x o % kk , SS.41EH,U ETT, r U [IRI S SLfCENRE �eDWI sFdDa9e fiYa;t1 � ,2- 11�11,11 t:anssY�inEsr�,'xmr�s¢ 1 fDM }S77 Mr I !;'GMUTHIHIER a, EUGENELA 10WE&,,,'.MA a " �LOWEL+L MAY` ,� ,z•. a r z '. 'G.OMMONWEACTH at - E -S � a a o •e a :v. .ao AS A N!ASTER-UNRESTRICTED ISSUES THE ABOVE LICENSE TO- EUGEHE L GAUTHIER JR 11r1 AlKEN AVC LOWELL MA 01859-1534 100G 11<28i13 79579h v ss3a �j �i GH�iLG� 5? t y,!G, Aot Construction Management&Buiders,Inc Elsiana Zhaka Manager of Integrated Design&Construction 75 Sylvan Street•Building C Danvers,MA 01923 ` , ` ezhakaQcmbteam.com t 781.246 9400•f. 781.246.9401 cell.617.407.5000 www.cmbteam.com - Consdlrcdon Management&Builders,Inc. July 7, 2014 Thomas St. Pierre Building Inspector City of Salem Inspectional Services, 120 Washington Street, Salem, MA 01970 RE: Architectural Access Board Application for Variance Amended on July 7, 2014 Dear Thomas, On June 27, 2014 your office received the application for variance on behalf of our clients Jim and Kathi Turner, owners of Turner's Seafood in Salem, MA requesting the installation of a wheelchair lift connecting the first and second floors. At the request of the Architectural Access Board we have included an amendment to the application asking permission to maintain the current conditions at the Church Street public entry and allow the use of the ramp at the courtyard as our accessible entry to the restaurant. Included in this letter you will find the additional documents to be included with the variance application. In addition we have also sent all the files electronically via email earlier today. Please do not hesitate to contact us should you have any questions. Best Regards, Elsiana Zhaka Manager of Integrated Design & Construction ezhaka@cmbteam.com t. 781.246.9400 Building Results... 75 Sylvan Street, Building C I Danvers, MA 01923 1 t. 781 246 - 9400 1 f. 781 246 - 9401 www.cmbteam.com Massachusetts Architectural Access Board Variance Application Amendment Question 7-Variance requested for the following: Section number 25.1- Church Street entrance not accessible due to 6" granite foundation step. Question 9- First built in 1831, the Lyceum building has historical significance as one of the country's oldest Lyceums and is best known for hosting Alexander Graham Bell's first live demonstration of the telephone in 1877. Since 1989 the building has operated as a bar and restaurant under two different owners. In an effort to improve business, the current owners remodeled the first floor of the restaurant during 2013 including adding a new bar, new accessible restrooms, and upgrading interior finishes. Due to demand, a year later the owners seek to upgrade the interior of the second floor and make it available to the public as function spaces. The goal of this remodeling project is to respect the architecture and history of the building while rejuvenating the interiors. The majority of the work focuses on improving access to the second floor, adding new accessible restrooms and updating finishes and lighting. The building has two public entrances, one located at Church Street along the North Elevation and a courtyard entrance off the Cervoni Walkway, a wide pedestrian route, along the east elevation. In 1989 the previous building owner was granted approval by the city of Salem to install an accessible entrance ramp at the courtyard entrance on adjacent town land. Again, in 2009 the previous owner was granted an AAB variance to use and upgrade the current accessible ramp off the courtyard entry in addition to installing a new 3'-0" wide door at the Church Street entrance. The restaurant has since operated with the courtyard entrance as the only accessible entrance without complaint. For this project,we have maintained the current condition of having the courtyard entrance serve as the accessible public entrance and considering the following: the current ramp meets all 521 CMR 2006 Requirements, and signage is provided on the southeast corner of the building to identify the entrance in an effort to attract customers from Cervoni Walk to the courtyard entry. There is no work proposed to the First Floor apart from installing a wheelchair lift to provide access to the second floor. F` Investigations to making the Church Street entrance accessible have proven to be both cost prohibitive as well as disruptive to business and above all to the preservation of the historic fagade for the reasons described below: — The buildings along Church Street all have original solid granite foundations, extending 6" above the current sidewalk grade, creating a step at the entrance. — There is no opportunity to install an accessible ramp at the exterior of the building given its location directly adjacent to the public sidewalk. Therefore, the only available option is to remove the existing granite curb and install an accessible ramp on the inside of the restaurant. Removing the granite curb is not keeping with our efforts to preserve the historic character of the building. Something else to note is that including a ramp at the building's interior would take up considerable waiting area space, would require demolishing the bar installed in 2013, and disrupt traffic flow between the dining room and bar area creating a congested hallway during peak business hours. The existing granite foundation supports not only the entry door structure but also extends under the adjacent structural brick walls on either side. Removing the granite would require an engineered shoring process known as "pinning" whereby the two story brick facade is temporarily supported by drilling through and installing a complex system of steel braces and beams.These beams would further require additional support by temporary columns and concrete footings. The adjacent sidewalk would have to be partially removed, excavated and replaced including any affected underground utilities in this area in order to remove the concrete block. In addition to the costs at the building exterior and sidewalk,the work requires extensive relocation of existing pipes, ductwork and equipment of the prep kitchen located directly below in the basement. ' Due to the reasons outlined above,the modifications required to make the Church Street entrance accessible are not feasible or practical. Incorporating this interior ramp into the building would render the entrance area non-functioning. Please refer to Exhibits A though G for additional information. We respectfully request the board's permission to maintain the current condition at the Church Street public entry and allow us to continue using the ramp at the courtyard as our accessible entry to the restaurant. r- . i e R r� Exhibit B—6"granite step integral to the foundation and supporting adjacent masonry walls 1:.11 77 A ILL, . IA 71 t `p: t r ° Q qG �t m �50- Wti'- c� Exhibit C—Signage mounted on the wall at Church Street clearly identify the accessible entry and attract customers from the Cervoni Way and to the courtyard entry. ©. A } v , d1,/� Exhibit D—Existing accessible ramp entrance m � Mus �' ,J � ..r � '9 li�� J � � Imo• Lk_, .. f'. 1�..... I - A _ a A yi 1 Limited space at this location not feasible e / r 7/2/2014 Page 1 • Construction Management&Builders,Inc. Turner's Seafood Entry Ramp Salem, MA cm&b Project#: 14100 CONSTRUCTION COST BREAKDOWN 7/2/2014 EXHIBIT G ITEM TRADE CONCEPTUAL BUDGET Division 1 General Conditions 01000 General Conditions $ 11,560 17000 Project Management& Supervision $ 45,215 Division 2 Site Construction 02220 Demolition $ 14,195 02350 Building Excavation $ 8,740 02820 Fencing $ 3,920 Division 3 Concrete 03050 Concrete Materials $ 7,020 Division 5 Metals 05120 Structural Steel $ 7,200 05510 Miscellaneous Metals $ 5,250 Division 6 Carpentry&General Labor 06020 Carpenter $ 15,520 06030 Job Cleanup&Laborer $ 13,200 06040 Final Job Cleaning $ 1,370 06050 Equipment Rentals $ 720 06400 Millwork&Architectural Woodwork $ 4,120 Division 7 Thermal& Moisture Protection 07100 Waterproofing&Dampproofing $ 1,200 07920 Sealants&Caulking $ 670 Division 8 Doors&Windows 08100 Doors,Frames&Hardware $ 3,081 Division 9 Finishes 09250 Drywall&Metal Framing $ 2,680 09640 Wood Flooring $ 4,530 09650 VCT&Resilient Flooring $ 1,500 09910 Painting $ 2,400 09960 Epoxy&Special Coatings $ 1,320 Division 01 Allowances $ - Building Results... 5 Sylvan Street, Building C I Danvers. MA 01923 t. 781 246 - 9400 I f. 781 246 - 940 www.cmbteam.com 71212014 'I Page 2 Construction Management&Builders,Inc. Turner's Seafood Entry Ramp Salem, MA cm&b Project #: 14100 CONSTRUCTION COST BREAKDOWN 7/2/2014 ITEM TRADE CONCEPTUAL BUDGET 01165 Relocate sprinkler piping in basement for new structural work $ 4,720 01165 Relocate plumbing work in basement for new structural work $ 4,720 01165 Relocate HVAC in basement for new structural work $ 4,720 01 165 Relocate electrical in basement for new structural work $ 4,720 01165 Relocate bar and equipment $ 35,000 01165 Parking space closure $ 1,920 Subtotal $ 211,211 Building Permit Fee Allowance $ 2,500 Insurance Fee $ 21,585 Total Construction Costs S 237,433 Building Results... 5 Sylvan Street, Building C Danvers, MA 01923 t. 781 246 - 9400 f. 781 246 - 940 www.cmbteam.com J Clarifications Turner's Seafood Entry Ramp 7/2/14 General conditions, project management and supervision costs are included for a period of 8 weeks. We have included open shop labor during normal working hours. Union or prevailing wage rates are not included. The following items have not been included: o Bonds o Builder's Risk insurance o Building permit fee o Inspection fees o Construction-related testing services o Police details o Fire watch details o Traffic details o Security guard services o Testing, removal, disposal or handling of hazardous materials o Removal or handling of unsuitable materials (Ledge, rock, organic, etc.) o Temporary utility consumption costs during construction o Winter conditions o Furniture, fixtures and equipment o Low voltage cabling or equipment plo Construction Management 8 Builders,Inc. Corstrwhan Management&Buibn bc. Turner's Seafood Entry Ramp Salem,MA cm&b Project#: 14100 CONCEPTUAL BUDGET 71212014 ITEM TRADE ITEM DESCRIPTION QTY UNT TRADE TOTAL 02220 Demolition MISCELLANEOUS: Cut down existing granite step/foundation wall M2CD Cut and remove existing flooring and structure Remove portion of sidewalk Remove door and entryway Sawcut and remove slab in basement for new columns $14,195.00 02350 Building Excavation Excavate and backfill to prep for sidewalk replacement l I CD Excavate and backfill for new footings 1 81 MD Haul spoils 1 LS $8,740.00 02820 Fencing Temporary fencing around work area 40 1 LF Temporary Jersey barriers at sidewalk closure Ji 80 1 LF $3,920.00 03000 Concrete Form and place sidewalk replacement 75 1 SF Infill at removed step/foundation wall 25 SF Add for short load of concrete 2 EA Place footings in basement 4 EA Patch slab in basement 2 MD Concrete pump 1 EA $7,020.00 05120 Structural Steel New columns for ramp/floor support- 4 1 EA $7,200.00 05510 Miscellaneous Metals Ramp railings 30 1 LF $5,250.00 Building Results... 75 Sylvan Street, Building C I Danvers, MA 01923 1 t. 761 246-9400 f. 781 246 - 9401 www.cmbtoam.com I!I C"I uctbn Mana9emeni 8 Bu kle s,Inc. Turner's Seafood Entry Ramp Salem,MA cm&b Project#: 14100 CONCEPTUAL BUDGET 7/212014 ITEM TRADE ITEM DESCRIPTION QTY UNT TRADE TOTAL DIVISION 6-CARPENTRY& GENERAL LABOR 06020 Carpenter Reframe new floor/ramp 1 881 SF Shoring of existing for structural modifications 11 LS Provide temporary partitions and fall protection 40 1 LF $15,520,00 06030 Job Cleanup& Laborer Provide laborer for protection and cleanup 8 WIC Protection and cleaning materials g li wlC $13,200.00 06040 Final Job Cleaning Provide detailed final cleaning at completion 1 41 MD Materials 1 I LS $1,370.00 06050 Equipment Rentals Fan rentals for negative air 1 81 wK $720.00 06400 Millwork& Architectural Woodwork PANELING: Rework entry 61 MD Materials I I LS $4,120.00 DIVISION 7-THERMAL&MOISTURE PROTECTION 07100 Waterproofing & Dampproofing Damproofing at removed step/foundation wall I I LS $1,200.00 Building Results... 75 Sylvan Street. Building C I Danvers, MA 01923 1 L. 781 246-9400 f. 781 246- 9401 www.cmbteam.com i WOUC110n Management 8 Builders,Inc. Turner's Seafood Entry Ramp _ Salem,MA cm&b Project#: 14100 CONCEPTUAL BUDGET 7/2/2014 ITEM TRADE ITEM DESCRIPTION QTY UNT TRADE TOTAL 07920 Sealants& Caulking Caulking and sealants 1 MD $670.00 DIVISION 8-DOORS & WINDOWS 08100 Doors,Frames& Hardware Furnish only: New entry door,frame and sidelight I LS Hardware l SET Sales Tax 1 625% $3,081.00 DIVISION 9-FINISHES 09250 GYPSUM Drywall Reframe entryway 1 41 MD $2,680.00 09640 Wood Flooring New wood flooring on ramp 1 881 SF Ramp skirt 30 1 LF Patch existing floor and refinish to match existing(3 coats) 3 CD $4,530.00 09650 VCT,Reslient& Carpet New entry mat 1 I EA $1,500.00 09910 Paint&Wallcoverings Touchup existing and affected area 1 41 MD $2,400.00 Building Results... 75 Sylvan Street, Building C I Danvers, MA 01923 I L. 781246- 9400 1 f. 781 246 - 9401 www.cmbteam.com Conch bn Management 8 Bwbers,bc. Turner's Seafood Entry Ramp Salem,MA cm&b Project#. 14100 CONCEPTUAL BUDGET 7/212014 ITEM TRADE ITEM DESCRIPTION QTY UNT TRADE TOTAL 09960 Epoxy& Special Coatings Patch epoxy Flooring in basement 88 SF $1,320.00 Building Results... 75 Sylvan.Street, Building C I Danvers. MA 01923 1 c. 781 246-9400 L 781 246-9401 www.cmbtoam.com 0 EXISTING APPRO✓ED COD cLY1aL1A IT DN Is HG EXCESS 4@ b • Q� RAMP / • - /'� n n H EZIr // A--I -� P.D.R z ; Niemi¢DES,G. ITC.wonEu nfu One Design Demer Place-en a BCSIDn,Afassacnusens oazTD R161OD-7983 ti — — PROS[ORA WINGS ARE17 ME N PROPERTY A M RE NOT NOT t 'MI.AND ARE ART NOW USED VP D /T N WHOLE EM DI PARD OFNDUI { IY I1/r \I1 IHC WRIrt[N LdISDR OF NIEYItI DECUR GiDUP. J _ BANNER ECK AND ALLY EXRAnoa TO L _ d cN¢cK AND VERIFY EYlsmw — UP SKIT DIEW BEFOIONSRE AND CONFTING i IN EXIT CONS CONSTRUCTIONANDyXCXSIAU OFANY NAh.GWO A DETALESIGN UCHANGES. )J I I I I I UP fly III I I I IITC O _ CM ppp 1 IUr� 1� E R it M B A R . J] x.1...1 LULU % v III �) /^ ` m Ona N MARKET ( Cc Lu K r / I' On ALLanW RED s WAIN PAmwdr ��, �� ( W MAIN _ J L FOR SERVICE 1 LASSO MA 4 RC-IT-- RT _ DIN I N 4 L -1 DRA5 CdLLT REgKES MRKET IrI =1 Q a 1' IPP INSTALLAT IXI REQUIRES EL NdT W OF AREA N .%KES N EGRESS AISLEWAT m Al �' Q q fX ST NG VE5TSULF SCREEN USED TO BELOW RECTRED AA CLEAR MINIMUM - B A R �y. PREVENT/&IFFER INFILTRATILN LT WTIXtlR AIR ON DINING 1 -) a IND_JR HVAC LOADS.ALTERING TWE EXISTING SCREEN TD ACCD50OATE TWE REWIRED RAMP AREA WWLD FURTWER REDUCE TWE MAIN FIRE Lu EGRESS A15LE BELW IS CLEARANCE '- w Tp• 60' I L- I _J ) N � InFN51CN5 �� $ / 9 RAMP INSTALLATION REWIRES J A J ELIMINATION OF DOSTIN5 POST STAND WITW CLEAR SPACE JLI REWIRED AT LANDING I I I I I I ENTRY I I .I I I I J _ _ - - - J L _ - - _ — J L — — — _ — J L _ — — _ — J L _ — _ — — J L — _ — _ — J RAMPELIMINATIW OF VESTIBULE INSTALLATION TLEFT REWIRE RAMP FROJRE5 FLIPPING OF T-O' EXISTING 6'GRANITE SLAB STEP BULE SCREEN A SWING EDE-CENTERING OF HISTORIC •REMOVAL OF SLAB STEP TO ACCESS RAMP SCALE:1/4'=1'-0- BANWETTE SEATING CIRCULATION!SPACE ENTRY iRONT TO PROVIDE CCMPLIANT REWIRES STRLCTURAL SWIXtING FOR fMRY N FIRE EGRf55 A15LEWAT ARE ALSYD DOOR PULL/PUSH CLEARANCE. DOOR, RAMP LANDING,!ADJACENT BRICK DWG TITLE NEGATIVELY AFFECTED A REDISED BELW -ENTRY BUGGY SETBACK MUST REMAIN AS FACADE.TIN IS ALTERATION ALSO REWIRES THE 4P CLEAR REQUIREMENT. DOOR MUST OWNS WT PER FIRE EGRESS CEILING AT THE BASEMENT PREP AREA BE FIRST CODE A SWING MAT NOT ENCROACH UMW LOWERED FOR TWE EXPENT OF TWE RAMP AREA PUBLIC SIDEWALK. FAT- AAFLOOR PLAN .ADA/MB CODE CCi1PLIANT RAMP W/ITr CNA.RAILINGSg yNN LOTTED DWG No. EXHIBIT F /�►-1 .11 A_ Certificate No:26=14 _ _Building Permit No.: 26-14 Commonwealth of Massachusetts City of Salem Building Electrical Mechanical Permits This is to Certify that the Restaurant located at - .-. Dwelling Type 43 CHURCH STREET in the CITY OF SALEM - .. .. -' ---- --- ----- ---"- - Town/City Name Address IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY TURNER'S SEAFOOD-SALEM, INC 43 CHURCH STREET I This permit is granted in conformity with the Statutes and ordinances relating thereto,and expires __ ___ ---- ..__-....-.. unless sooner suspended or revoked. Expiration Date Issued On: Fri Nov 15, 2013 I GeoTMi 2013 Des Landers Municipal Solutions,Inc. _ _.... i 43 CHURCH STREET 26-14 is# 1356 — ^ COMMONWEALTH OF MASSACHUSETTS Map: 35 -i CITY OF SALEM Block !Lot- 0601 < Category: RE? OVATIONS•" ': 7 Permit# - , ';=x 26-144'E. max' ; ` lJ ILDING PERMIT Project# '; JS-2014-000063 Ed.Cost ;.'' ':$224;545:001;* Fee Charged w? $2,475.06"; 1, '« PERMISSION IS HEREBY GRANTED TO: Const Class 't Contractor: License: Expires: Use Group.,-°' 'A '�'-"': Martin Flannery General Contractor-089551 Lot Slze(sq: fti):'4586.868 'j -- Owner: Jim Turner �Zomng = . B5 'Units Gained, - -iApplicant: Martin Flannery (Units Lost AT: 43 CHURCH STREET ISSUED ON 09-Jul-201 3 AMENDED ON: EXPIRES ON. 09-Nov-2013 TO PERFORM THE FOLLOWING WORK RENOVATION OF EXISTING RESTAURANT jbh POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing y /�(/ Building Underground: Underground: y Underground: �j[�/✓Ae Excavation: rt(�vl� g�Rgjy� Footings: Service: Meter: C/' %C ".J S/;Cj /Ir�.�/.`/��..s' til�.• „A j Rough. ��. JRougl `Q� t Foundation: ®45� dell I' 9t Final:/�/h/// Fina • Final ✓ Rough Fraine: Fireplace/Chimney: D.P.N. Fire Health Insulation: Meter: Oil: ' � ,(� d)!/I,{ I` 1\� 1^ Final: p/I . t ClouseN Smoke Asses f_ � O ` Treasury: C� Assessor Waley: , ( Final: Scorer: Sprinklers: 1` ' lsr� THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. 1. Signa Fee Type: Receipt No: Dale Paid: Check 'o: AmuunC BUILDING REC-2014-000069 09-Jul-13 75513 52,475,00 IMPORTANT:OWNER OR CONTRACTOR MUST ARRANCE FOR PERIOD;G INSPECTIONS DURINGA CONSTRUCTION.SEE CURRENT BUILDING CODE Call.for R. CHAPTER to copy CHAPTER t FOR LIST OF REQUIRED INSPECTIONS, CALL 978-619-5641 TO SCHEDULE AN INSPECTION GeoT�\ISO 2013 Des Lau'iers Municipal Solutions,Inc. Commonwealth of Massachusetts City of Salem ' 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 Return card to Building Division for Certificate of Occupancy Permit I:$3 B-14-1613 PERMIT T O BUILD FEE PAID: $3,750.00 DATE ISSUED: 10/9/2014 This certifies that TURNERS SEAFOOD REAL ESTATE LLC has permission to erect, alter, or demolish a building 43 CHURCH STREET Map/Lot: 350601-0 as follows: Renovation INSTALL SPRINKLER SYSTEM THROUGHOUT BUILDING. INCREASE ACCESSIBILITY TO THE SECOND FLOOR, UPDATE WARMING,KITCHEN, CREATE TWO (2) NEW, ACCESSIBLE BATHROOMS & UPDATE FINISHES TO THE SECOND FLOOR Contractor Name: C M & B, Inc DBA: Contractor License No: CS-089551 10/9/2014 Building Official Date 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. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shalt be displayed in a location clearly visible from accessstreet or road and shallbe maintained open for public inspection for the entire duration of the work until the completion of the same. - - The Certificate of Occupancy will not be issued until altappilcable signatures by the Building and Fire Officials are provided on this permit. H I C#: "Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). _ Restrictions: Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER. Commonwealth of Massachusetts City of Salem ! 120 Washington St,3rd Floor Salem,MA 01970(978)7453595 x5841 K Return card to Building Division for Certificate of Occupancy I rt Structure CITY OVSAL.EM BUILDING PERMIT Excavation PERMIT TO BE POSTED IN THE WINDOW Footing INSPECTION RECORD Foundation Framing II 4. �• 4+ t qV 'Mechanical�" Insulation INSPECTION: BY DATE Chimney/Smoke Chamber 'Final ' r"x Plum in /G s X04 epi r Rough:Plumbing Rough:Gas Final Electrical pp Service - FRough I� Final ,S//c- i Fire epartment Preliminary Final Y Heal Department Final Certificate Number: B-14-1613 Permit Number: B-14-1613 Commonwealth of Massachusetts City of Salem This is to Certify that the CommerCtal Building located at Building Type 43 CHURCH STREET in the City of Salem .............._...................... . Address Town/City Name IS HEREBY GRANTED A TEMPORARY CERTIFICATE OF OCCUPANCY Second Floor Function Room TURNER'S SEAFOOD This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires ...........Friday,,.Febru44ry__1-3,-2-01-5__..., unless sooner suspended or revoked. Expiration Date Issued On: Wednesday, January 14, 2015 �` •�ONtDIT'�9 9� w VSQVEAD C/ pp CITY OF SALEM Certificate Number: B-14-1613 Permit Number: B-14-1613 Commonwealth of Massachusetts City of Salem This is to Certify that the ......-.--......-... Commercial Building ln. located at ........... ........1.1.11.111111............................ Building Type 43 CHURCH STREET in the ............... ........................ ............. ........... ...... Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY Second Floor Function Room TURNER'S SEAFOOD This Permit is.granted in conformity with the Statutes and Ordinances relating thereto, and expires ...............................Not Applicable_ _....... ... unless sooner suspended or revoked. Expiration Date Issued On: Wednesday, January 14, 2015 Certificate Number: B-14-1613 Permit Number: B-14-1613 Commonwealth of Massachusetts City of Salem This is to Certify that the Commercial Building located at Building Type 43 CHURCH STREET in the City of Salem ....................................._..._........__......................................................................._..... ........................ Address Town/City Name IS HEREBY GRANTED A TEMPORARY CERTIFICATE OF OCCUPANCY Second Floor Function Room TURNER'S SEAFOOD This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires ,.,,,.,,,..,Fridgy,._February_--,. 2015.__,.. unless sooner suspended or revoked. Expiration Date A i Issued On: Wednesday, January 14, 2015 l/( - Certificate Number: B-14-1613 Permit Number: B-14-1613 Commonwealth of Massachusetts City of Salem This is to Certify that the Commercial Building located at Building Type 43 CHURCH STREET in the Cly of Salem ...._................_........................._............. .............................................................. ...... Address Town/City Name IS HEREBY GRANTED A TEMPORARY CERTIFICATE OF OCCUPANCY Second Floor Function Room TURNER'S SEAFOOD This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires ............Friday,_February._13. 2015., __. unless sooner suspended or revoked. Expiration Date AA t. Issued On: Wednesday, January 14, 2015 / • G�77--1 Q r Id Deval L.Patrick Governor �u7/ + Thomas G. mmP E issioner Timothy P.Murray �f'ROfLPi /7 y�Ly Lieutenant Governor aFQi Thomas P.Hopkins Director Kevin M.Burke / Secretary CLCL'Ca'.m¢dd- /ib . TO: Local Building Inspector Variance Number: pg 129 Local Disability Commission Independent Living Center FROM: ARCHITECTURAL ACCESS BOARD RE: Lyceum Bar & Grill 43 Church Street Salem Date: 8/1112009 Enclosed please find the following material regarding the above location: Application for Variance _Decision of the.Board _Notice of Hearing _Correspondence _Letter of Meeting The purpose of this memo is to advise you of action taken or to be taken by this Board. If you have any information which may assist the Board in reaching a decision in this case, you may call this office or you may submit comments in writing. Tit eM"v0*0- vcr914 HM40W� Dxtm� at T '�'� C SDocket Number t ° 1 v_-% A A"z" - 1 04.4 A�49Oza. P&aji Rte. 1310 Deval L.Patrick M.c md"- M 02108-161$ Thomas G.Gatzunis,P.E Govemor >��M.c 61��27-0660 / 1-$DO-82$7222 Commissioner Timothy r VY 611 �270011 Thomas P.Hopkins Lieutenantt Governor r - Director Kevin M.Burke617-77?-066Swww.mass.gov/rips Secretary APPLICATION FOR VARIANCE In accordance with M.G.L., Chapter 22, Section 13A, I hereby apply for modification of or substitution for the rules and regulations of the Architectural Access Board as they apply to the facility described below on the grounds that literal compliance with the Board's regulations is impracticable in my case. PLEASE ENCLOSE: 1) A filing fee of$50.00 (Check/Money Order) made payable to the Commonwealth of Massachusetts, four original copies of the application for variance and all supporting documentation, Le all plans in 11" x 17" format, photographs (all in color if submitted as such), etc. In addition, the complete package (including plans and photographs) must be submitted via one compact disc. 2) If you are a tenant seeking variances, a letter from the owner of the building is required, authorizing you to apply on behalf of he/she. 1. State the name and address of the owner of the building/facility: George Harrington and Robert Bramble Salem Church Street Realty Trust 43 Church Street, Salem, MA 01970 Tel: 978-745-7665 2. State the name and address or other identification of the building/facility: Lyceum Bar and Grill, 43 Church Street, Salem, MA 01970-3738 3. Describe the facility: (Number of floors, type of functions, use, etc.) Two story brick building plus basement which functions as a restaurant and bar catering to everyday dining as well as hosting private functions. The basement floor is limited to storage space with a small office and prep kitchen. 1 4. Total square footage of the building: 12,907 s.f. Basement is total 4,160 s.f., First Floor is 4,587 s.f., Second floor is 4,160 s.f. a. total square footage of tenant space (if applicable): Not Applicable. 5. Check the work performed or to be performed: _New Construction _Addition X Reconstruction, remodeling, alteration _Change of Use 6. Briefly describe the extent and nature of the work performed or to be performed: (Use additional sheets if necessary). The nature of this project is to refinish the interior of the first floor dining and bar spaces to improve business. The design intent is to highlight the existing architecture and history of the building. Major work is as follows: 1) Construct new, fully accessible men's and women's toilet rooms. 2) Remove existing Church Street entry vestibule to improve entry circulation and flow. 3) Extend existing bar top, modify existing back bar and construct new built-in back bar to match. 4) Construct new partial walls, ceilings, soffits and glass panels to define dining spaces. 5) Repaint interior walls and ceilings. 6) Replace all flooring with new wood, carpet and tile. 7) Replace existing light fixtures and add new light fixtures. 8) Modify existing mechanical system to improve air circulation. 7. State each section of the Architectural Access Board's regulations for which a variance is being requested: 7a. Check appropriate regulations: 1996 Regulations 2002 Regulations_X_2006 Regulations SECTION NUMBER LOCATION OR DESCRIPTION 25.1 Church Street entrance not accessible due to original 6" granite foundation step. 8. Is the building historically significant? _X_yes no. If no, go to number 9. 8a. If yes, check one of the following and indicate date of listing: National Historic Landmark Listed individually on the National Register of Historic Places Located in registered historic district Listed in the State Register of Historic Places Eligible for listing 8b. If you checked any of the above and your variance request is based upon the historical significance of the building, you must provide a letter of determination from the Massachusetts Historical Commission, 220 Morrissey Boulevard, Boston, MA 02125 9. For each variance requested, state in detail the reasons why compliance with the Board's regulations is impracticable. State the necessary cost of the work required to achieve -2- Compliance with the regulations. PLEASE NOTE THAT YOU SHOULD SUBMIT WRITTEN COST ESTIMATES AS WELL AS PLANS JUSTIFYING THE COST OF COMPLIANCE. Use additional sheets if necessary. Variance #1 521 CMR 25.1.1 First built in 1831, the Lyceum building has historical significance as one of the country's oldest Lyceum's and is best known for hosting Alexander Graham Bell's first live demonstration of the telephone in 1877 (Photo #4). The building has been operating as the Lyceum Bar and Grill under current ownership since 1989. In effort to improve business, the,owners seek to refinish the interior of the first floor public dining spaces which includes a bar dating back to 1935 (Photo #5, Exhibit#1, existing floor plan) The goal of this remodeling project is to respect the architecture and history of the building while rejuvenating the interior decor. The total project budget is $160,000. The majority of the work focuses on new accessible toilet rooms, interior finishes, and replacing light fixtures (Exhibit#2, proposed floor plan). The building has two public entrances, one located at Church Street along the North elevation (Photo #6) and a courtyard entrance off the Cervoni Walkway, a wide pedestrian route, along the east elevation (Photo #7 and #8). In 1989, the owner was granted approval by the City of Salem to install an accessible entrance ramp at the courtyard entrance on adjacent town land (Photo #9). The restaurant has since operated with the courtyard entrance as the only accessible entrance without complaint. For this project, we have maintained the current condition of having the courtyard entrance serve as the accessible public entrance and have taken the following steps to ensure it is up to current code and equivalent to the Church Street entrance. First, the existing ramp is being re-built to meet all 521 CMR 2006 requirements, including extending the landings at the top and bottom of the ramp, installing new handrails and resurfacing the ramp, (Exhibit#3 sheets A-C and cost estimate for ramp modifications). This work is currently under construction (the restaurant is closed). Second, new signage will be mounted on the southeast corner of the building to more clearly identify the entrance in effort to attract customers from the Cervoni Walk to the courtyard entry. Third, at the interior of the courtyard entrance, the existing staff prep area will be removed and replaced by a large coat closet, (refer to Exhibit #2 proposed floor plan). These steps will enhance the aesthetics of this entrance and improve its use for all patrons. At this time, the owner would like to include in the scope of work the installation of a new door at the Church Street entrance, (refer to Exhibit 2, and Exhibit 4 proposed exterior door). The existing double 2'-0" wide door is not code compliant, is awkward to use and does not reflect the new image of the restaurant. We understand that work to the Church Street entry would require us to modify it to become accessible. However, we have investigated making the entrance accessible and found it to be both cost prohibitive as well as disruptive to the preservation of the historic fagade for the reasons described below: As visible in photographs#6, as well as photos #10 and #11, the buildings along Church Street all have original solid granite foundations, extending 6" above the current sidewalk grade, creating a step at the entrance. There is no opportunity to install an accessible ramp at the exterior of the building since the building is situated directly adjacent to the public sidewalk. Therefore, the only option available is to remove the existing granite curb and install an accessible ramp on the inside of the restaurant as shown on the attached floor plan labeled, Exhibit #5: Compliance Option. 3 Removing the granite curb is not in keeping with our efforts and the efforts of the Salem Redevelopment Authority to preserve the historic character of the building. This building is located within the Downtown Salem National Register District (Exhibit #6; Historic District Map) and is considered an important part of the area's historic architectural fabric. Note also that this design takes up considerable waiting area space, preventing the install of any waiting room seating, and disrupts traffic flow between the dining room and bar area creating a congested hallway during peak business hours. Furthermore, the construction cost of Compliance Option is out of proportion to the cost of the project. The existing granite foundation supports not only the entry door structure but also extends under the adjacent structural brick walls on either side. Removing the granite would require an engineered shoring process known as 'pinning' whereby the two story brick facade is temporarily supported by drilling through and installing a complex system of steel braces and beams. These beams would also require additional supports by temporary columns and concrete footings. The adjacent sidewalk would have to be partially removed, excavated and replaced including any affected underground utilities in this area in order to remove the large granite block. In addition to the costs at the exterior of the building, the work requires extensive relocation of existing pipes, ductwork and equipment of the prep kitchen located directly below this area in the basement. The granite foundation is also part of the first floor framing support system and its removal would therefore require modifications to the first floor framing and temporary supports during construction. Due to the difficult structural conditions involved the work is estimated to cost $138,000 which is close to the total project cost. The construction estimate for this scope of work is attached, Exhibit #7: Lyceum ADA work cost estimate and accompanying letter. Due to the reasons outlined, the modifications required to make the Church Street entrance accessible are not feasible. We would propose to improve the current condition by replacing the existing Church Street door with a 3'-0" wide door. The 3'-0" wide door would meet the required clear opening dimensions of Section 26.5 and improve accessibility. For reasons of safety and convenience, we propose to recess the door an additional 1'-3" to allow the door to open 90 degrees without overhanging the public sidewalk. Refer to Exhibit#8; Proposed Entry Improvements. Note that the following modifications which improve accessibility are within the project budget and are currently under construction: fully accessible men's and women's toilet rooms, removing the existing vestibule which was difficult to maneuver within, and bringing the accessible courtyard entrance up to 2006 requirements, as well as to enhance this entry for all patrons Therefore, we respectfully seek the board's approval to allow replacement of the existing double 2'-0" wide front door at the Church Street entrance with a new 3'-0" wide single door. We also request permission to pull the new 3'-0" entry door an additional 1'-3" back from the sidewalk to prevent the door swing from extending beyond the face of the building. These two revisions would improve non-wheelchair accessibility of the entrance. We hope that the board will consider granting a variance for these modifications without requiring the entrance be made accessible because it is cost prohibitive and goes against efforts to preserve the historic qualities of the Church Street facade. -4- 10. Has a building permit been applied for? Yes Has a building permit been issued? Yes, excluding work involving Church Street door revisions. 10a. If a building permit has been issued, what date was it issued? July 6, 2009 10b. If work has been completed, state the date the building permit was issued for said work: 11. State the estimated cost of construction as stated on the above building permit: $160,000 1la. If a building permit has not been issued, state the anticipated construction cost: 12. Have any other building permits been issued within the past 36 months? No 12a. If yes, state the dates that permits were issued and the estimated cost of construction for each permit: 13. Has a certificate of occupancy been issued for the facility? Yes If yes, state the date: 1989 14. To the best of your knowledge, has a complaint ever been filed on this building relative to accessibility? yes —X—no 15. State the actual assessed valuation of the BUILDING ONLY, as recorded in the Assessor's Office of the municipality in which the building is located: $684,800 Is the assessment at 100%? Yes If not, what is the town's current assessment ratio? 16. State the phase of design or construction of the facility as of the date of this application: Demolition complete, construction started for approved work. 17. State the name and address of the architectural or engineering firm including the name of the individual architect or engineer responsible for preparing drawings of the'facility: Thaddeus S. Siemasko Siemasko + Verbridge 126 Dodge Street _5_ Beverly, MA 01915 Tel: 978-927-3745 18. State the name and address of the building inspector responsible for overseeing this project: Tom St. Pierre Building Commissioner, City of Salem 120 Washington St. Salem, MA 01970 Tel: 978-745-9595 Date:(o 0 9 Signa re of1wnerol authoriz d agent PLEASE PRINT: C,win e. Rzii r ns 2 Name 0 tt - — FCEs s2_G Address 1 DFPAR7MFNT nF Pl�M IG SAFETY 6I970 F,i'; 7 2009 City/Town State Zip Code A;;CSSS BOARD ( Telephone 6 m COURTYARD F I$EL. 99'-S" - _O m _ 0 0 Q o f ___ _ _ _ _ __ _ ___-- ___________ __---__-___--__----____ _ -_ ____-__________ ___ _ EL 100'-0' cri a .FUNCTION ROOM. ! PREP TABLE BACK RM DINING a. W.. O MEN- 0 z Q ------------------------------ ------------------------------- w � w a A A :ASV V A��\� A�• �V A AV ---lam ---- --- o _ AA `V� V� �v..• v vv �� vv vv v` \:Av yea KITGHEN m q 0 yA � ,A No 1560 ASA � AA AV Q e �p 8 °: m DINING i U - - BAR PUB DINING J - -WOMEN CLOSET ,' N > WAITING RECEPTION'S � v m EL. 100'-0" U ES U N 0 UP 6" - (2) 2'-0" X C-e" GRANITE STEP _ =' DOORS EL. 99'-6" CHURCH STREET EXHIBIT #I VARIANCE X1 . 1 . u Srm"Yk,.vr.e,m=.m.. m USE GROUP A-2 ASSEMBLY COURTYARD OCCUPANCY — 150 PEOPLE O NEW CONSTRUCTION MODIFY EXIST. RAMP TO BRING UP TO CODE INCLUDING EXTEND LANDING v, ALL AREAS EXCEPT KITCHEN o TO RECIEVE: .No COLUMNS FIRUT NEW FLOORING ) s AME O NEW WALL PAINT OR TILE REPAIR It PAINT CEILING OR __ NEW GWB HARD CIELING I, NEW LIGHT FIXTURES P-I l -1 ,' 146W C,..CLQ EOAT - FUNCTION ROOM" I _ CAFE DINING ` O m q OM t BRINGnEN ENEN'S ,! NEW INTERIOR `. __. 1IRO_. � B _ ---- UP TO CODE - ---- PARTITIONS �__ _____ y --- ---- II O I� j NEW WALL 3'-O" DOOR 1L1 I IJ KITCHEN ----------------------------- ---- ¢ m. w ENLARGE WOMEN'S ROOM i BRING UP TO CODE v bA -� E NEW BUIBAR LOUNGE LT-IN ° i QDININGLL - N .. y - WOMEN ✓' (Vr1 r z I 0 + o NEW I° I Y•i NEW COAT OL CLOSETS El 14 V - TF-- W (GLASS C m PANELS U r G�'S WAITING L Ll N �� NEW v PANEL NEW G EXTEND BAR SEATING F-, N ADD DRINK RAIL PROPOSED NEW 3'-0" AT EXTERIOR WINDOWS _ =- DOOR - RECESSED -= PENDING APPROVAL BY AAB CHURCH STREET EXHIBIT 42 A1 . 1 VARIANCE 1m 2 Ztpr m N z (D-4-1 4 O1< m � A MOr D � 3r r SOD DTO u'7U Z ;q D Li m=D O � O m r m w mmx O O O-1z Oz7 O TOD y i N soO AI DmZ �- A O O q•_�• Oz I 1N =r iO Nr W m N N a m m 0 i Z +o oo= u m N Z O A �D3 T r Nm-4 n mm= Oro rp z m a` ZT CO O O A mm O AX_ mN x p 171 � y w Lyceum Bar & Grill 43 Church Street,Salem,MA Existing Ramp Plan Revisions a 0 Descriptio, Dmo By •Architecture < h� Scale: I/2"=1'-0" File Name: , •Interior Design • Siemasko + Verbridge •Landscape Architecture •Decorating Date:7/14/d9 Plot Date: . 126 Dodge St. Bever) ,MA 01915 svdesign.com t 978.927.3745 £978.927.6365 Drawn b :SL m Y N REMOVE ALL HANDRAILS 1 REPLACE u u EXTEND LEVEL LANDING W/ NEW HANDRAILS BOTH SIDES AT ENTRY DOOR 8" EXTEND I'-O" AT BOTTOM 8" TO ACHIEVE 2'-0" DIM SEE ELEVATION .2 o FROM LATCH SIDE OF DOOR , -0. l'-O° CONCRETE. BROOM FINISH- i NEW LEVEL LANDING AT BASE SLOPE MAX. 1:12 FROM GRADE TO +l" COcu NCRETE W/ BROOM FINISH CONCRETE RAMP W/ BROOM FINISH ..J I-� o N '3 DEMO TREE AND GRIND STUMP n FOR NEW LANDING < c ry < ELEV. O'-l" ELEV. O'-O" SLOP DEMO HANDRAIL m N P 2'-0" U -0" NN y Q u m � � a V � = P NEW HANDRAILS + o KEEP 1 1/2' CLEAR FROM FACE OF WALL < EXTEND 1'-0" TOP 1 BOTTOM SEE .ELEVATION > m • v N 0 1 � N EXHIBIT 3 SHEET B A 1 . 1 0 C O " � a O .-w z o s 'w a �i � o / II o m a / p NEW HANDRAILS, BOTH SIDES GALVANIZED ALUMINUM, PAINTED BLACK TOP RAIL 9 36" ABOVE GRADE/RAMP SURFACE n BOTTOM RAIL ® 18" ABOVE GRADE/RAMP SURFACE Q V e POST W/ OFFSET RAILS-- 1 1/2" CLEAR REQ. \ / END O 1 1/2"D POSTS \\y / RAIL a WALL 1 I/2" D RAILS = oma v V N m a POUR NEW P-O" LANDING CONCRETE W/ BROOM FINISH S-I v NEW RAMP SURFACE '-0 SLOPE 1:12 � .a I' Ht - _ - GRADE Q -O" 2'_0• 1'_0" REQ. NEW CONCRETE RAMP SURFACE NEW LANDING J V_4" dj �S-•.•li otlo LEVEL LANDING AT ENTRY DOOR t p 'o EXHIBIT 3 SHEET C A1 .2 tl Si<mvko a VeAn�c 0 F- m 0 -- - - - - - - - - - - - ' WONEN Vj) — — I - - I -- BUILT—IN I I � o I � o V U I / I I I I UP I I 0 e A 0 w REDUCES WIDTH OF ENTRY HALL TRAFFIC FLOW IMPAIRED U ^ DURING PEAK HOURS o WAITING 7 � 2 I I I I I I v e HALF WALL Q � I I n V EL. 100'-0" 1:12 v 4 E SLOPE Q EL. 99'-6" v 2 P u m zn ry T Li m v N o rr o 1.4 V1 " ELIMINATES WAITING AREA /�I O AND ANY WAITING SEATING / -1 NEW FRONT DOOR J SWINGS OUT ONTO . . . . . OFF CENTER DOOR SIDEWALK • • NO SYMMETRY AT . . . . . 68 S.F. OF BASMENT LEVEL ((%%�� CHURCH STREET FACADE t� EL. 99'-6" SPACE BELOW NEW RAMP V DISRUPTED AND UNUSABLE CHURCH STREET SIDEWALK EXHIBIT 5 2'-2 1/2" 9'-1 1/2" rn O N - - - - - - - - - - - - - I n N 0 z c x w 7 n = m o n r CO c 70 X M = cn A To n 0 D CD fn m m E IMil D M R rn O >< z 70 L� 9'-0 1/2" 6'-2" O rnIn N O ^70 D x � m � n in C11 m O Os - i V DO (P x 6-8" nm U DD N < E M D LP rn mM z 3'-0" M -j M X n7Uz npXOm ASw MEZAn �,' .,� y. m i N>Dmm ., W ANO 0 OMO o zIT -ZO--44D zOD DD< O P O 2 A A A Z O 0 Lyceum Bar & grill Proposed Entry Improvements Rev 43 Church Street,Salem,MA isions � a oe."r�ouo" oam By t .ArcIt, -re Scale:l/2"=1'-0" File Name: . •Interior Design Siemasko + Verbridge •Landscape Architecture•Decorating Date: Plot Date: . 126 Dodge St. Beverly,MA 01915 svdesign.com t978.927.3745 f978.927.6365 Drawn by:SL t Groom consri=iction Mr. George Harrington August 6, 2009 Lyceum Restaurant 43 Church Street Salem, MA. 01970 Proposal to remove and rebuild accessible ramp in rear of building. -Remove existing ramp. -Excavate and pour new concrete ramp as per Siemasko Verbridge plans. -Install new code compliant hand rails system. Paint grade galvanized. -Repair brick pavers. -Paint handrail. Total cost: $5,200. Note: Price does not include removal of tree which is owners responsibility. Respectfully submitted by: David Groom 96 Swampscott Road • Salem, MA 01970 • tel: 781.592.3135 • fax: 781.593.1480 www.groomco.com I ,zz -- 13 E \ -- 5Y,' LJ i - LYCEUM MENU PLAQUE �II CLEAR L- m _ GLASS /7 O 4 O I M Q r 3/9' MAHOGANY TRIM--, RIM NEW 3'-O" X C-8" 5/9' MAHOGANY TRIM MAHOGANY EXTERIOR DOOR FLAT PROFILE MAHOGANY INSET PANEL MATCH EXISTING EXTERIOR WINDOW PANELS FOR PROFILE EXHIBIT 4 Lyceum Bar & Grill 43 Church St,Salem,MA Proposed Front Door •Architecture Scale:12"=1'-0" File Name:. Siemasko + Verbridge •'LedDesign •Landsucc ape Architecture Data 7/1/09 Plot Datc:8/5/2009 •Decorating 126 Dodge St. Beverly,MA 01915 svdesign.com t978.927.3745 f 978.927.6365 Drown by:. project 4: Q mn,k V. d m t Now �iLr it�� +a^r5k�ah• f� M ��.. �.. . 61, NO r � x A I Il �; _ €tr,, ��..=��.` h' N�d' 'r '«JWJ° �,6 :�+•+�aAt+4� 1w+#'', n'`�" ";� �"" �.-0 �X. s. s,.,+.•'"" wr. <, �✓' :J�"e• ern" r �' r e�-; _ — r 'w n y, � � K 4� + PCMM Photo # 4 - Alexander Graham Bell Plaque Lyceum Hall In this building on February 12, 1877 Alexander Graham Bell Presented the first public demonstration of long distance telephone conversations. Following the demonstration the first news dispatch sent by telephone originated here and was recieved by the Boston Globe. It was published the following day. Varianrr Annliratinn T vranm Rar Rr r.rill 294 Oft K _ 1 ZOOM, M f •,4 t r., i 0 � � qil� � 1 1 : . lJ l , r _o .a � r oi Photo #6 Existing entrance off Church Street showing granite curb along and double T-0" wide doors \/arinnra 4nn1irn6nn 7 vranm Rnr R Crill y� . z -t — .rr- � 1 1 1 /• `� � �*��„�h'�� a�-Sia. , �,k..aJ A'_ �a� �� ;.:..- .-,,.✓ WillMEOWf 1� 3 Ji t 1 1 • • 1 1 1 30 Photo #9 Existing Ramp at Courtyard Entrance Vnrinnp� Annlientinn I wopiim Rnr 9, (.rill , . r � i 1' f. �� 1. .� 5611• F r 4 p' I r < n E lig JLJ iw I III h T• ,�� } n. � r � � - '• YFa 1 1 • 1 1 'u. i e •vJ I o a•�•r ••pop0., • t ••li174. ras•,��ioi0 1 •s IJP 0�3�4n i � ♦•r�rP/Mo�`�1YEry1�♦••�♦• .. �•iiy�i44� •�JJOio��i�°��i�Op• , •♦�• ♦♦♦ ♦J�O•♦ti•♦.. Qsir1,. ♦♦♦♦♦ f � 1 1 Lyceum Restaurant �cvn�onOPPF� Mr. George Harrington 43 Church Street Salem, MA. 01970 Dear Mr. Harrington, In response to your request for a cost estimate to redesign/reconstruct the Church Street entrance in order to meet AAB standards, I can offer you the following. The current entry door is set 6"- 7" above the adjacent sidewalk on solid granite that is integrated into/part of the original building foundation. The existing door unit sits directly on this block which also extends beyond the existing door opening on both sides i.e. under the structural brick wall. (Note: this is not a veneer brick wall) Removing this granite is a very complicated structural task requiring an engineered shoring process known as "pinning" whereby the two story brick fagade is temporarily supported by drilling through and installing, a complex system of steel braces/beams. These, in turn, are supported by temporary columns and concrete footings. It would then be necessary to somehow remove the large granite foundation block and infill it with a smaller block or concrete in order to make the threshold level with the sidewalk. We feel this would be best accomplished from outside the building as there is little space to do this from inside the finished basement. In order to remove and replace the granite block, the sidewalk would have to be removed, excavated and then replaced in the affected work area. The shoring must also be clear of the sidewalk during this process, which further complicates matters. Also note that there would be significant damage to the historic brick fagade during this process and I am uncertain of our ability to match the original brick. Another unknown is exactly what municipal utilities located under the sidewalk and possibly in our way. Finally, the first floor framing is tied into this area, requiring us to build temporary supports in the basement. There are major interior mechanical and electrical runs impeding our ability to operate in that area of the basement. We would have to disassemble the finished area and reroute these mechanicals which is a vexing problem given the limited space. Assuming this can be done then we then would reconstruct the actual interior floor frame in your vestibule to create the interior ramp. Again, there is a 10x10 main girder flanking both sides of the entry right where the ramp would have to be. Consequently, the ceiling height in the basement work area would have to be lowered by approximately 8"-18" or more and render the space below unusable. Assuming this can be done, and I have shared my concerns above, the total cost would be in the area of $138,000. and would take approximately 6 weeks to complete if we don't run into any major underground utility work. Kind regards, David Groom, Principal 96 Swampscott Road • Salem, MA 01970 •tel: 781.592.3135 • fax: 781.593.1480 www.groomco.com Lyceum ADA work cost estimate at front of building-Prepared By Groom Construction 84-09 I General Conditions Permit $ 1,400 Porta John 280 Site Trailer-Storage 600 Licensed Supervisor-full time as required 6 weeks 14,400 Project Manager Part time 4,800 Surveys-field engineering 2,500 Utility Bills 100 Final Cleaning 500 Structural Engineering Services 3,500 Trucking-hauling 2,500 Police Details-1 offcer(sidewalk blocked) Est.6 weeks 10,800 Non Reusables 700 Laborer/Fuel/Trucking/Parking/Phone Etc. 4,500 Subtotal $ 46,580 11 Sitework/Demolition Demolition $ 2,500 Concrete/Granite cutting 1,800 Shoring-Pinning using steel-thru wall 18,600 Sitework-excavation, prep,fill, rough grade 4,500 Repairs to sidewalk and curbing 2,400 Underground utilities Contingency Allowance 8,000 Subtotal $ 37,800 111 Concrete Footings(4 temps for shoring) $ 1,600 Footings for lowering Floor frame x4 $ 1,600 Concrete Pumping x2 1,500 2" rigid insulation and water proofing 300 Concrete Slab repairs in basement 600 Subtotal $ 5,600 IV Masonry Brick Repairs and Foundation alterations Allowance $ 4,800 Subtotal $ 4,800 V Metals . 4 lally columns-installed and welded 1,000 Subtotal $ 1,000 VI Carpentry Rough Labor $ 4,000 Rough Material 1,100 Finish Labor 1,200 Finish Materials 400 Subtotal $ 6,700 VII Thermal 8 Moisture Insulation-combo urethane and Fglass $ 250 Subtotal $ 250 Vlll Doors& Windows Remove and reset Door $ 300 Subtotal $ 300 IX Finishes Board/Plaster& Durock repairs $ 1,300 oak flloors repaired and stained-2nd floor 1,200 Painting-Interior Only touch-ups 800 Paint Exterior at doorway 200 Subtotal $ 3,500 X Specialties Grab rail for ramp $ 1,600 Subtotal $ 1,600 XI Equipment special $ - Subtotal $ - XV Plumbing/HVAC Plumbing-Labor&Mat. $ 3,800 Plumbing Fixtures Allowance - Reroute heat pipes 2,500 Relocation of ducting 3,700 Relocation of sprinkler piping 1,700 Subtotal $ 11,700 XVI Electrical Labor&Materials Allowance $ 2,900 Light fixtures none $ - Central Alarm (Burglar& Fire) Allowance 500 Subtotal $ 3,400 Total Costs $ 123,230 Overhead& Profit 12% 14,788 TOTAL BUDGET $ 138,018 4-Y4"0 LAG BOLTS, MIN. 3" LONG, 12" GUSSET PLATE BOTH SPACED AT 6" 0/C SIDES OF COLUMN, WELDED COL. TO COLUMN AND TOP PLATE EXIST. TOP PLATE EF CUSTOM Y2" STEEL U-SHAPED TO REMAIN HANGER WELDED TO NEW 6" COLUMN & TOP PLATE AND V YP 2" BOLTED TO EXISTING BEAM „ 2'-3"x4"xY2" TOP PLATE r WELDED TO COLUMN AND I EXIST. BEAM LAG BOLTED TO EXIST. TO REMAIN TOP PLATE 6"xY4"x8" FLAT FILLER-"<-CD 2--Y4"0 BOLTS I Y2" STEEL GUSSET PLATE, CENTERED ON STEEL COLUMN AND NEW HSS6x4x " COLUMN HANGER AND WELDED TO COLUMN 10" 4" AND BOTTOM OF STEEL HANGER A" FULL }6" LENGTH EXISTING BEAM TO NEW COLUMN CONNECTION SCALE: 3/4 = 1'-0" RECEIVED JUL 2 3 2009 GROOM CONSTRUCTION T Bri LLC EXISTING BEAM SUPPORT PREPARED FOR LYCEUM BAR & GRILL MR. DAVID GROOM S _ 43 CHURCH STREET Structural Design&Sales SALEM MA 96 CONSTRUCTION 160 SYLVAN STREET TEL. 978-646-0097 ' 96 SWAMPSCOTT ROAD 07/21/09 2nd FLOOR FAX 978-646-0087 McBRIE, LLC JOB #9-112 REVISED 07/23/09 DANVERS, MA 01923 WWW.MCBRiE.COM SALEM, MA 01970 �V S 2 r o tkarGER - 7Y� (NatrE�7a ,� C.S7A3d 5fai}O /N5T/t4��f1GRq� �X/5T/Nv #9"�� CEMI�I/ � ON 1,1AW i !lL A04eO U^/v iI!A143® 7D 614749-5 OF H64A.J hdL- /-`�4417MS 1 RIOR WINDOWS IN THIS OOM TO RECIEVE ADDITIONAL METAL MULLIONS TO MATCH EXIST. jC IQT REMOVE CORINTHIAN DECORATIV EXIST. TO REMAIN TOPS AT EXIST. COLUMNS ADA RAMP RE-FINISH DORIC x1gt, . x!0 2-ZXf©GB —AxT, u.�Atc S�f�L��1�+� CURTAIN t �� AaE�IPo'- 1 RECESS TRACK t3L0GKIibLUA/ II � � INTO FIN. CLG 1 1 1 1 s i / ,. 1 SIDE ~d4J 1 1 HEIGHT LL FULL HV/ ADDITIONAL �l�/ Q `'' G �.�Ar— �.r Z)we f 0 1 EXIST. i t �I /" / Y y-�l �% i -�Z,X/0�• i l2= 'R�,r 2ytlol�/b yp FUNCTION ROOM K� a �Cn�fi U-Au- n 2 -�j�tj � 4t. 509 S.F. JRX9 :b � E , I ADA S SEE Al EXISTING DOOR TO 5-' REMAIN, 180 DEGREE OPEN' CLR +� PTD. TRIM COLOR t APPLY ��Ae ,tt'N/J OF" "� it I`-O" t y� FROST FILM TO GLASS z.�(J�.� O WD. EXIST. TRIPLE DOORS TO REMAIN - i a l i PTD. TRIM COLOR t APPLY t l �p Q WE , ,I O t FROST FILM TO GLASS t I / V � Eansrsltry � I �/�IjZAL I I, (EDF FRAMW� i s t i 1b (LiMAH1 REMOVE 2 SIDE PANELS REPLACE W/ NEW WALL - - FGAC TOF - HOLD RE I � � � n I I II 11911 Deval L.Patrick '^� • OPlO�l6l� Thomas G.Gatzunis,P.E. Governor Q�/ ypCommissioner Timothy P.Murray e//Q[O'fEb q -y✓pGy Thomas P.Hopkins Lieutenant Governor Director Kevin M.Burke w .mass.gov/dps Secretary TO: Local Building Inspector Variance Number:09 129 Local Disability Commission Independent Living Center FROM: ARCHITECTURAL ACCESS BOARD RE: y m Bar & G 3 Church Street Salem Date: 8/20/2009 Enclosed please find the following material regarding the above location: _Application for Variance _Decision of the Board _Notice of Hearing /Correspondence _Letter of Meeting The purpose of this memo is to advise you of action taken or to be taken by this Board. If you have any information which may assist the Board in reaching a decision in this case, you may call this office or you may submit comments in writing. Siemasko+Verbridge -� Architecture Interior Design Landscape Architecture hk Decorating 126 Dodge Street Beverly, Massachusetts 01915 t:978.927.3745 f:978.927.6365 svdetign.00m Commonwealth of Massachusetts oFpgRT oF� �` Department of Public Safety qI/ Architectural Access Board c 2 One Ashburn Place, Rm 1310 h X009 Boston, MA 02108-1618 4�H176 RA(4C Att: Thomas Hopkins, Director SIS SCS, n Please accept this Addendum to the variance application submitted on August 7`h for the Lyceum Bar and Grill located at 43 Church Street in Salem, MA. The owner would like to incorporate with the following recommendations made by Jack Harris of the Salem Commission on Disability: Request#1: Portable ramp The Lyceum will purchase a portable ramp to be stored in close proximity to the Church Street entrance for emergency and/or requested use by patrons. Request#2: Push Plates at Courtyard Entry Door The Lyceum has included into the scope of work installing automatic push plate openers at the courtyard entrance for improved accessibility. This work includes installing an automatic door closer/opener, wiring the existing door and installing two push plates on either side of the door. Please find attached Revised Exhibit 3 Sheet B, showing the location of the push plates as well as a product specification sheet. Also, please find attached a site diagram page showing an aerial view of the building and a diagram of the building's exterior conditions regarding entry paths, vegetation and lighting. Please also refer to the previously submitted photographs, in particular numbers 3, 7, 8 and 9, for further site information. This page confirms that the courtyard entrance is located on an accessible, well lit path. I look forward to hearing the board's decision after the meeting on August 24`h. Thank you, Sharon Liff Y m r l7 .Nr E REMOVE ALL HANDRAILS t REPLACE �" y EXTEND LEVEL LANDING W/ NEW HANDRAILS BOTH SIDES f1i AT ENTRY DOOR 8" EXTEND 1'-0° AT BOTTOM a z 4 8" TO ACHIEVE 2'-0' DIM SEE ELEVATION 2 0 FROM LATCH SIDE OF DOOR w a CONCRETE. BROOM FINISH NEW LEVEL LANDING AT BASE SLOPE MAX. 1:12 FROM GRADE TO +7 � CONCRETE W/ BROOM FINISH CONCRETE RAMP W/ BROOM FINISH o � _II o vJi III = o DEMO TREE AND IIII N Q Q GRIND STUMP ; IIII 5'-O° 'D FOR NEW LANDING IIII O L ry --- 11 Q ELEV. 0'-1" E ma «" r ELEV. O'-O' �o SLOPE 1:12_ �'..� DEMO HANDRAIL IIII m v r°v o in ly y • • N 1-O• ry 2'-0^ IIII U 1'-O° E P $ m a /WIRE EXISTING DOOR FOR AUTOMATIC PUSH PLATE OPENERS PP - PUSH PLATE FOR AUTOMATIC NEW HANDRAILS DOOR OPENER KEEP 1 1/2° CLEAR FROM FACE OF WALL (2) TOTAL EXTEND I'-O' TOP t BOTTOM MANUF: MS SEDCO 2 SEE ELEV TION #59-WSS ( STAINLESS STEEL WITH BLUE) 4 1/2° SQUARE m U � o rel REVISED 8/19/09 EXHIBIT 3 SHEET B A L I Addendum #1 Lyceum Variance Application CS Push Plate Switch Specification 8/19/09 59 Series co 41/2" Square Push Plate Switches SENSORS&SWITCHES ' \ Product Name Fits single or 2-gang Electrical 59 Series Box or''��MS SEDCO#1015 4112"Square Push Plate Switches Surface`Mount Box UIX • Special Finishes: US3, US4; LT .ERATE Manufacturer US10, US106, US32 DOOR MS SEDCO • Radio Control\V,ersions 8701 Castle Park�Drive Available \! #59-H(Blue Powder Coat with White Paint India apoliO46256 Filled Legend) Phone:.(800) 842-2545 ClearP wwwmssedco.com PRESS ClearPathTmRadio Control Switches 0 TO 0 Product Description with HDRUm solveproblems caused OPERATE BASIC USE by interference and stray signals— DOOR The 59 Series push plate switches and are guaranteed to work where are designed to provide reliable others won't #59-P(Stainless Steel with Black Paint activation of any automatic door. Filled Legend) - DIMENSIONS The 59 Series features 4" square See Reverse face plates in either stainless [[[[ steel or blue powder coated alumi- APPLICABLE STANDARDS • S 9 num with etched and paint filled American National Standards To Op Ss legends. A 4 1/2" square formed Institute (ANSI) - Building Hard- DOOR stainless steel back plate elimi- ware Manufacturers Association nates possible wall damage from (BHMA) - ANSI/BHMA A156.10 & #59-HSS(Stainless Steel with Blue Paint A156.19. Fill ed Legend) standard use. Designed as a universal switch, APPROVALS the 59 Series fit single-gang or UL(Micro-Switch) 2-gang electrical boxes with no adapters necessary. A surface Installation mount box is also available. The 59 Series Switch is easy to install. #59-W(BluelPowder Coat with White Each unit is built utilizing heavy n auge stainless steel, aircraft Hardwired Applications: uality rivets and screws, durable Mount to a standard single or inishes and the most reliable 2-gang electrical box at the icroswitch in the industry. desired wall location. Remove the i face plate from the switch assem- echnical Data bly. Connect the necessary signal 4"x 4"All Active Face Plate wires to the appropriate switch 4 1/2"x 41/2" Formed contacts (COM & N.O. are stan- #59-WSS(Stainless Steel with Blue Paint Stainless Steel Back Plate dard).. Secure the switch assem- Filled Legend) — the electrical box and UL Listed Cherry Switch ;SPDT, Y Mom., 15 Amp @ 125V ACreattach the face plate. #59-Plain(Stainless Steel with No _{-'Rubber-"Bellows Increases \Legend) Weather Protection (included) 22006 8701 Castle Pack Drive 111111Indianapolis,Indiana 46256■Telephone:,(800)842-2545/(317)842-2545■Pax:(800)849-3387/(317)849-3387 —irnss :cedcoom custsvc@mssedco.com 59 Series 41/2" Square Push Plate Switches sEoco // �\ SENSORS&SWITCHES Installation(continued) repaired free of charge. After Technical Services Wireless Applications: three years, the unit will beXMS SEDCO's staff of factory Mou t*a ClearPathw/transmitter repaired for a nominal service trained sales and service person- and�surface mounting box in the charge. Limited warranty Is In nel\offer design assistance and desired location.f Program the67'lleu of—all other warranties, technical support. Local distribu- transmitter and connect the wire expressed`or iimmplied, Including tars are also available to assist in leads toShe_COM and N.O. switch any Implied warrantability of selecting appropriate devices for contacts. Attach the wall switch merchantability. No represents- specific uses and to provide onsite assembly to the surface box and tive or person Is authorized to installation. reattach the face plate. assume for MS SEDCO any other liability In connection with they BELLOWS DIAGRAM Custom Applications: sale of our products. All warran- The 59 Series Switches can be ties are limited to the duration of customized in a variety of ways. this written limited warranty. In Conn Virtually any legend can be placed no event shall MS SEDCO be INCLUDED on the face plate as well as liable for any special, Incidental, RubberB�ws custom colors or finishes. Contact consequential or other damage the factory for pricing. arising from any unclaimed �II1trI►n►I►ny�nr�nr►� breach of warranty as to Its prod- VWVVV—► Availability&Cost ucts or services. AVAILABILITY Available internationally from Maintenance Insert rubberon bellows manufacturer's authorized dist- MS SEDCO recommends that all over spring over switches for ributors; contact MS SEDCO for maintenance and adjustments be weather tight fit! ti o the location of nearest distributor. performed by an AAADM Certified Z Z Technician. COST Cost information on MS SEDCO MlcRo-SWITCH products is available from the DIMENSIONS manufacturer's authorized 41/2„ distributors. 5/8" Warranty MS SEDCO, Inc. guarantees this product to be free from manufac- turing defects for three years from ESS date of installation. Unless MS SEDCO is notified of the date of ® TO installation, the warranty will be in a OPERATE effect for three years from the date of shipment from our factory. BOOR If, during the first three years_this product fails to operate and as not been tampered with orN abused, the unit can be returned 3/4" prepaid to the factory and be f 22006 8701 Castle Pack Drive■Indianapolis,Indiana 46256■Telephone:(800)842-2545/(317)842-2545■In:(800)849-3387/(317)849-3387 w ..mssedco.com 0 custsvcgmssedco.com_ r"_� Aaaenaum 17 t Lyceum Variance Application l z. 8/19/09 � P• i^, t � r T � M4 1 1 �F1 {F P � h A S s Gttthrt'tF� tom �p�guC. o o rJ QLAC, Vill0 CD S I 10 i. 1 4 J UY 1 t @`��°pjz 1 1 Refer to photos 3,7,8 &9 C s