B-19-1173 - 0029 BENGAL LANE - Building Permit I ♦ . A
i
6C)p
The Commonwealth"of Massach '
Department of Public Safe
i�
Massachusetts State Building Code(780 CMR)
Q9 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:
I SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available)
Zt? a I Lm s w /44- 0 l ` v L
1 No.and Strkle City/Town Zip Code Name of Building(if applicable)
SECTION 2:PROPOSED WORK.
Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below
Existing Building❑ Repair❑ Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑
Brief Description of Proposed Work:
lap,
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): 4 + 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❑ 1-2❑ 1-3❑ 14 D M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑
S: Storage S-1 ❑ S-2❑ U: Utility O Special Use D and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ 1 VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Trench Permit: Debris Removal:
Water Supply: Flood Zone Information: Sewage Disposal: Licensed Disposal Site❑
Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be p
required D or trench or specify:
Private❑ or indentify Zone: or on site system❑
� permit is enclosed❑ t
Railroad right-of-way: Hazards to Air Navigation: , ., . oric C1m iksion Review;�
Not Applicable D Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes D 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 1
Name and Address'of•Property Owner
rA
Name(Piint)',•, +=� C
q j j . , ,No.and Stre City/Town Zip
Property Owner Contact Information:
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
Name Street Address City/To n State 1 ,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 outAppendix,2)
[f buddiii .is less than35,000.cu.ft.of enclosed space and/or,not under Construction Control then check here O and ski Section 10.1 r
10.1 Re istered 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
Com any
Name
10 1, f
Mune of Person Responsible for Construction Lic a No. and Type if Applicable
Street Address Ci /Town State Zi
_ 7�� ode - f P �
-- -�� + Ir fi�hdt-���✓IKJ@ d Icd hI
Telephone No. business - Telephone No. cell e-mail address
SECTION 11:tVC1RKF:RS`C:ObIPEti5A'11(?i\INSURANCf?AFFl VI'r M.G.L:.'c;152.§25C 6
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes 13 No 13
SECTION 12:.CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$
1.Building $ C] Building Permit Fee=Total Construction Cost x—(Insert here
2.Electrical $ appropriate municipal factor)_$
3. Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5. Mechanical (Other) $ Enclose check payable to
6.Total Cost $ (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this
application is true and accurate to t est f my k wledge and understanding.
Please print and sign name Titl Telephone I No. Date
LA)
Street Address City own State Zip
Nlunicipal Inspector to fill out this section upon application approval::
Name Date
I
I
• J
Z`4
CITY OF S.ULENI, NLkSSACHUSMS
BuUMLNG DEPART%ILNT
`1 120 WASHINGTON STREET,32D FLOOR
TEL (978)745-9595
FAX(978) 740-9846
KIitBFRIEY DRISCOLL
MAYOR THOMAS ST.PIERRB
DIRECTOR OF PUBLIC PROPERTY/BL'1LDIING COMMSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leeibly
(1
Name(Busin,ssiOrganizatioNlndividual): � l �ll y� ��(�a LL C
Address: 7 y yl um V yylQ o
1
City/State/Zip: t d �q Phone#:
i
Are you an employer?Check the appropriate box: Type of project(required):
1. am a employer with_ 3 4. ❑ 1 am a general contractor and 1 6. ❑New construction
Pemployees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. q. Building addition
[No workers'comp. insurance 5• ❑ We are a corporation and its
required.] officers have exercised their 10.❑Electrical repairs or additions
3.[] 1 am a homeowner doing all work right of exemption per MCL I I.❑Plumbing repairs or additions
myself.[No workers'comp. c. 152,§1(4),and we have no 12.0 Roof repairs V'21P(��P
insurance required.]t employees.[No workers' 13. Other LA IhAw
comp. insurance required.]
*Any applicant that chocks box#1 must also fill out the section below stowing their workers'compensuion policy information.
t 1&xneowncrs who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new aftidavit indicating such
=Comractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that Is providing workers'compensation insurance for my employees• Below Is the policy and Job site
information.
r-
Insurance Company dame:
Policy#or Self-ins.Lic.a#:_ S00 S"D D q — 20 17
+ Expiration Date: ` �ZU
Job Site Address: 2 / 16-e 11 GI I L/1 City/State/Zip: J An v /9 70
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. Jae advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ldo1he:rrhy;crTr"1Ty un the p ns andp a! s of perjury that the information provided ab ve is true and correct
Date: O
r
Official use only. Do not write in this area,to be completed by city or town oJreiat
City or Town: Permit/1.1cense# _
Issuing Aulhority(circle one): Y
1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#•
CITY OF SALEK MASSAaR SETIS
BIALUING DEPARTI►aw
120 WASNNGTON STREET,31D FLOOR
TEL(978)745-9595
FAX(978)740.9846
KB BERLEY DRISOOLL
MAYOR THCMAS STY]ERRE
DIRECTOR OF Pu]BLIC PROPERTY/BLIDDING 00MtuII&%0MR
Construction Debris Disposal Affidavit
(required for all demolition & renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR,Section 111.5 Debris,
and the provisions of MGL c40,S54;Building Permit# is issued with the
condition that the debris resulting from this work shall be disposed of in a properly licenses
waste deposit facility as defined by MGL c 111,S150A.
The debris will be transported by:
4�v kVj,,,2r
(name of hauler)
The debris will be disposed of in:
(name of facility)
(address of facility)
Signature o applic nt
(today's date)
r Sanctuary Condominium Trust
c% Crowninshield Management Corp.
18 Crowninshield Street
Peabody, MA 01960
(978)532-4800
June 24, 2019
Ms. Marsha Gerber
29 Bengal Lane
Salem, MA 01970
RE: Replacement Windows and/or Sliders—Sanctuary Condominiums
Dear Marsha,
Thank you for your inquiry regarding window/slider replacements at your unit. Please be
advised that the Board of Trustees for the Sanctuary Condominiums does not object to
the replacement of these windows and/or sliders so long as they match in appearance
from the existing, they must fit in the existing opening, molding size and glass size must
remain the same. They will not allow grids and they will not allow French doors.
We also require the permits be pulled in advance, and that a copy of the final approved
permit once completed is also submitted to our office. We also require that you hire only
a licensed contractor, with adequate insurance. Please be sure that new sliders are
properly flashed and that a pan is used to protect against leaks.
You will most likely need to show a copy of this letter to the Building Department in
order to obtain your permit.
Should you have any questions or require additional information, please feel free to call
me directly at(978)532-4800 ext#232.
Sincerely,
J'W
Jill Fama, CMCA
Regional Property Manager
Crowninshield Management Corp.
Managing Agent for the Sanctuary Condominiums
cc: File
ti
rr Page No of Pages
Insured Litehouse Services
License#95280 Litehouse Services 67 Monument Avenue.
H.I.C. # 142824 Home Repairs Made Easy Swampscott, MA 01907
t litehouseservices@gmail.com
-Bob-Pierce 781-864-5238
PROPOSAL SUBMITIED TO PHONE DATE
rs
STREET JOB NAME i
CITY,STATE AND ZIP ODE JOB LOCATION
APPROX.STARTING DATE JOB PHONE
We hereby submit specifications and estimates for:
�l n h
E Fropas here y to furnish nal and labor—complete incordance with above specifications,for the sum of:
60 ` dollars($
Payment to be made as follows:
1/3 down, 1/3 middle ofjob, 1/3 upon completion
All material is guaranteed to be as specked.All work to be completed in a workmanlike manner Authorize
according to standard practices.Any alteration or deviation from above specifications Involving Signature
extra costs in be executed only upon written orders,and will become an extra charge over and
above the estimate.
Note:This proposal may be
withdrawn by us if not accepted within days.
rrf Frapusal—The above prices,specifications and conditions are /I�
rofAcceptance;_
are hereby accepted.You are orized to do the work as specified.Payment Signature 4
outlined above.
/ Signature