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B-19-1084 - 0097 BAKERS ISLAND - Building Permit R CEIVEri r' M9 SEP 2 b A fi,, Q 1. Rf G`to 612-q j ZO f N LA The Commonwealth of Massachusetts +A tr-P a� Qj) Department of Public Safety Zc>r,�ypvj C�, 0 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 Bloch'#and Lot#for locations for which a street address is not available), 1,07 91 �At:-E0.5 D19\1y 1 No.and Street City/Town Zip Code Name of Building(if applicabl SECTION -PROPOSED WORK Edition of MA State Code used If New Construction check here Xor check all that apply in the two rows below Existing Building 0 Repair❑ Alteration ❑ Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ 1 Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes,X No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ NoX Brief Descrip 'on of Proposed Work: tj re�, knz yc ov dA w e-. V,,L, (Y.ro SECTION 3 COMPLETE THIS SE N 1F 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.) 3 'SECTION 5:USE GROUP(Check as a' licalle A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-1❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1❑ I-2❑ I-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION6:CONSTRUCTION TYPE(Check as a _ livable) IA ❑ IB ❑ HA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ JVA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 7811 CMR 111a1 for details on each item): Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit Debris Removal• Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ 11 Private�* or indentify Zone: or on sitetsYm❑ required❑or trench or specify: permit is enclosed❑ Railroad right-of-way: Hazards to Air dNavigation: MA Historic Commission Review Process: Not Applicable Is Structure within airport approach area? Is their review completed? R or Consent to Build enclosed❑ Yes❑ or No% Yes❑ No ❑ SECTION,&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: 1 eo T® motn -.�® , I SECTION 9:<PROPERTY-OWNER AUTHORIZATION Name and Address of Property Owner �5 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: 157 15 Title Telephone No.(business) Telephone No. (cell) e-mail add—resJ If applicable,the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If buildin is less than`35,000 cu.It of enclosed s "ace and/or not under Constnution Control then check here O and skip Section 10.1 10.1 R 'istered Professional Res onsible for.Construction-Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor ' - Company Name Name of Person Responsible for Construction License No. and Type if Applicable Street Address City/Town State Zip Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE'AFFIDAVIT M Gh 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' suance of the building permit. Is a signed Affidavit submitted with this application? Yesk No 0 SECTION 11 CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ GQQ- 010 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 $ ( `O'©.00 (contact municipality)and write check number here SECTION:1.3 SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest undT�ty pains and penalties of perjury that all of the information contained in this application is true and a the best of owledge and understanding. Ao-rn- 24L,.f c9wn2S 3�ti'�n -45n 1`f Please print and sign name Title Telephone No. Date Street Address City/Town State Zip P Municipal Inspector to fill out this section upon application approval Name Date GENERAL NOTES OWNER OF RECORD: AARON RATNER 3775 LEAN DRIVE.EMMAM PA 16049 DEED REFERENCE: BOOK 34443, PACE 235 PLAN REFERENCE: PLAN BOOK 25, PLAN 13 TAX MAP REFERENCE:PARCEL ID: 46-0007-0 - COORDINATES SHOWN ON PLAN ARE BASED ON MASS STATE GRID. IRON%N FOUND . 1,69, FLUSH W PAIN I HEREBY CERTIFY THAT THIS SKETCH IS BASED ON AN ACTUAL FIELD � \ - - SURVEY BY OTTE&DWYER,INC..LAND SURVEYORS ON 6127116 \5.23' \ THROUGH 8/8/I6. PROFESSIONAL LAND SURVEYOR 5(S FOR OTTE&OWYER,INC. IRON AN FOUND cRgtio 2 \ `USH IN PATH SURVEY SKETCH 5.39 nor LOT 97 GRAND VIEW AVENUE . STAKE AND\ 5 T \ � .46 BARS ISLAND TONES SE Ai BASE SA✓•.rM MASS. ®l7'2'1' N:302076.8 APPLE TREE !(G\ E:848936.4tl I `" PREPARED FOR �P�Q AARONBRATNER ` Y1�G\A Boa`� O�T�T�EiT&�DTTwrYTECx,INC. 4]� IROND CAP SET NB 3g J4. \ 1~�h00\R0� LAND SUR Y EYORS N:302071].91 t�6 S E.a9sozfi.Da ZA931 rxDr WWW.OT7EDWYER.COM IRON ROD DAVIDD 59 APPLETON STREET SAUGUS.MA 09706 N AND CAP SET I\` - pWYER JR. H P.O BOX 982 (781)233-8155 JR SCALE 1'=20' AUGUST 17,2016 20.56' Ne.4e79 � L 1h. ,,cA. �� \ S81'41'27�E p IRON ROD / AREA , ROD \. -1 y8 AND CAP SEMI AND CAP SET �\\ ,JN. 11963 11,. 2ts,f ^` v This map or plot is not valid without the seal and o� 0.25 cres z N �T \ signature o/the responsible surveyor. �• Z\ SEE PLAN W ` PLAN BODY 343.PLAN 4t m ` \ IRa4 ADD 11.15' FOUND b' ./ !�Q ` •� �.y ` 584'31'14'W ROD AND HELD OWN- IRON AND CAPROD SET ).'20_ -`IRON ROD 88.38' up 1, 589'a5'STW 101.30' - .''� 1ND 50'(DEED) 2.69' UP Gi I CALL) UP 0�3' j4^E 153.94'( 50.98' . IRZ1`1 ROD \ N84'31' 49.55 AND CAP SET N:3020655.89 IRON ROD IROIJ ROD E:849031.68 `\ AND CAP SET _ 53.41 AND CAP.SET H:3020640.89 C. 846878,64 /I D4 w R.P�ceRqe 16 b oy5 D m '^� jo CITY OF SM .M. INLkSSACHUSETTS BUILDING DEnitn NT ` 120 W'1SHINGTON STREET,3"�FLOOR TEL (978)745-9595 FA..t(978)740-9M Ki' mBERLEY DRISCOLL MAYOR T HON As ST.PW-M DIRECTOR OF PUBLIC PROPERTY/BUILDLNG CO%maSSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Tattle(Busim-ssiOrganization/individual): Aos eat, Q,, W S Address: 3H�3 City/State/Zip: Ply \J2:�'\ Phone 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 1 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.: ? Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. workers'comp.insurance. 9• 0 Building addition [No workers'comp,insurance 5. ❑ We are a corporation and its 10.[1 Electrical repairs or additions required.) officers have exercised their 3. 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp, C. 152,§i(4),and we have no 12.0 Roof repairs insurance required.)t employees.[No workers' 13.0 Other comp.insurance required.) *Any applicant that checks box i#I must also fill out the section below showing their workers'compensation policy information. t I lomeowners who submit this atfidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contra-tors that check this box must attached an a Witional sheet showing the name of the sub-contractors and their workers'comp.policy infonrut ion. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: 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 S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce uu er pains and penalt erjuty that the information provided above is true gird correct i an t re' Date: L Phone#: 3 ti�3 3-3 S/3 Official use only. Do not write in this area,to be completed by city or town ojficiaL City or Town: Permit/1.1cense# Issuing Authority(circle one): 1. Board of)Stealth 2.Building Department 3.Cityffown Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Cbntact Person: Phone#• e .� �Warcia Kirkpatrick .J To: David Greenbaum Subject: FW: Permit application Hi Dave: This is what I sent to Aaron and his response to it. Marcia From:Aaron Ratner<asratner@gmail.com> Sent:Tuesday, September 03, 2019 9:43 AM To: Marcia Kirkpatrick<MKirkpatrick@Salem.com> Subject: Re: Permit application Sounds good and thanks for the update.The toilet was listed on the division of professional licensure as an approved device.Accepted on 1/2/2013. For whatever that's worth. If I need to adjust it please let me know. Thank you very much for your time and assistance. Aaron On Sep 3, 2019, at 09:05, Marcia Kirkpatrick<MKirkpatrick@salem.com>wrote: Good morning. We have received your application, drawings&check for Lot 97 @ Bakers Island. At this time, it is under review by our Health Director, David Greenbaum, for Title V Compliance. As soon as we get a ruling we will let you know If we can proceed and approve the application. Marcia ) Clerk in Building Dept. 1