B-17-651 - 0020 BATHING AVENUE - Building Permit zz -S
2c LoKt w, NtE:
The Commonwealth of Massachusetts
S 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)
� . tm k I SG 64
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
f Existing;Building❑ Repair❑ Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: o i
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No IL
Is an Independent Structural EngLineeripe Peer Feview required? Yes ❑ No
RUNBrief Description of Proposed Wor�kp:: � ~ G1 �' �. f�
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY ..
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed'
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional I-1❑ I-2❑ I-3❑ I4❑ M: Mercantile❑ R: Residential R-113 R-2❑ R-3❑ R4❑
S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ IIA ❑ IIB ❑ 7IIIA ❑ IIIB ❑ IV ❑7VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal:
Trench Permit: Debris Removal:
Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑
Private❑ or indentify Zone: or on site system❑ required 0 or trench or specify:permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: �I t tistori�:��ommission.Revivw Process:
Not Applicable❑ Is Structure within airport approach area? Is their review completed?
orConsent 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:
14 -7( Z\-i c. o � m tL-co TO 5o,�. (qL
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Name(Print) j No.and S eet City/Town Zip
Property Owner Contact Information:
--1a
Title ' Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
N<une 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:CONSTRUCTI.ON CONTROL,(Please fill out Appendix,2):
If bu ild ing is less than35,000 cu.ft:of enclosed space andi or.not under Construction Control then check here❑and skio Section 10.1
10.1 Re istered Professional Responsible for Construction.Control
(-,!l ,1•. -ftV9A-c 1 -233 _ S7 �\ c src�rKa4yc���.o. ic�Ssa�'L-
Name(Registrant) Telephone No. G ,afl')kress ��5� Registration Number
A.Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
Company Name
111 C4 CS -022 93
Name f Person Responsibl for Construction License No. and Type if Applicable
Street Address City/T w Late Zip
Telephone No. business Telephone No. cell e-mail address
SECTION 11:WOhK}RS'CO[�lI'li Vti 11'lOi� 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 thejpsuance of the building permit.
Is a signed Affidavit submitted with this application? Yes Cr No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE.
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$
1.Building $ 4,Cl s Building Permit Fee=Total Construction Cost x_(Insert here
2.Electrical $ appropriate municipal factor)_$
3.Plumbing $
1.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical Other $ Enclose check payable to
6.Total Cost $(�4 Ea-7j (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 m owledge.and understanding.
UJIcqm ,p,_rn. ca.I 70 233 _7 S I N -7/I I?
PI• •e print and sign nai e Title �Telephone�1o. Date
— S
Street Address C' )/Town State Zip
Municipal Inspector to fill out this section upon application approval: bv
Name Date
'I
I
CITY OF SALEM MASSACHUSETTS
DEPARTMENT OF PLANNING AND
COMMUNITY DEVELOPMENT
KIMBERLEY DRISCOLL 120 WASHINGTON STREET ♦ SALEM,MASSACHUSE17S 01970
MAYOR TELE:978-619-5685 ♦ FAR:978-740-0404
TOM DANIEL,AICP
DIRECTOR
SALEM HOUSING REHABILITATION LOAN PROGRAM
NOTICE.TO PROCEED
Date: July Yd, 2017
Case#: 17-01, 20 Loring Avenue, Unit 1, Salem
Contractor: Perry Brothers Construction, Inc.
Dear Bill:
You are hereby given authorization to proceed with renovations to 20 Loring Avenue,
Unit 1 in Salem, MA in accordance with the agreement dated May 30a', 2017. As stated in the
aforementioned agreement, work is to commence within thirty(30) days and be completed on
or before thirty(30)days subsequent to the date of this proceed order.
M,rc,aw
Thelma Naomi Isco
Housing Coordinator
This program does not discriminate on the basis of race, color, national origin,gender or gender identity, age,
religion,familial status, sexual orientation or disability. This program is funded through the United States ,
Department of Housing and Urban Development(HUD), utilizing HOME and Community Block Grant Funds
(CDBG).