B-19-207 - 0100 BOSTON STREET - Building Permit The Commonwealth of Massachusetts
Department of Public Safety
Massachusetts State Building Code(7$ +C�� _
Building Permit Application for any Building other than a�-6rft; oO:ani ly'Dwelling
Sectton.For Official Use.(This ., Y): ,
BuildmgPernut Number: Date Applied. Building Official.:
SECTION 1:LOCATION
;100 � rev s Sla t�h otg'T C-ml FNL r✓cd
N No.and Street City/Town Zip Code Name of Building(if applicable)
Assessors-Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
r Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below
Existing Building Ek Repair. Alteration ❑ Addition❑. Demolition ❑ (Please fill out and submit Appendix 2)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes E4 No ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No 0
�i Brief Description of Proposed Work: R F'.f oc j ,ram/- Fl e w M&- I FA A M r iV&
0 ATyr a,00•h, , d fear w, ra 1.L , fo nc4,,<<A16—
t�l
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 y
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business E[ 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❑ 1 R: Residential R-113 R-2❑ R-3❑ R-4❑
S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA [I IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ 1 VA ❑ VB ❑
1
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal:
Trench Permit. Debris Removal:
Public]S( Check if outside Flood Zone h. Indicate municipal� A trench will not be Licensed Disposal Site.Blrequired❑or trench or specify:Artr ikrT'�
Private❑ or indentify Zone: or on site system❑
permit is enclosed❑ ,en
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process. ,
Not Applicable Sk Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ or No R. Yes❑ No ig
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: .✓.o Special Stipulations:
Design Occupant Load per Floor and Assembly space:
C-..
SECTION 9: PROPERTY OWNER AUTHORIZATION
t
�( Name and Address of Property Owner
,` Ems/ GNIL.�e✓d AaCda� ljr® &o57-v1V r? SJ9 F—,tl Q1970 \
Name(Print) No.and Street City/Town Zip `
Property Owner Contact Information:
Fogf3 r D cmil-J05 a c3%tP -.2lD DO.Z
Title "rF virw t Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
Name Street Address City/Town State Zip
to apply for and 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 1)
If a building is less than 35,000 cu.ff.of enclosed space and/or not under Construction Control then check here 13
Otherwise prqvide construction control-forms see section 107 in the code as r` uired.
Al Registered Professional Responsible for Construction Control(the rofessonal coordinatin document submittals)
Grk45 -05-3,?M
Name(Registrant) Telephone No. e-mail address Registration Number
Y66 ,news- c>" DnWVeAS 01993 02122AZO/9
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
Company Name -
&iCt-(oLn-, � fir►kAS C 05-399
Name of Person Responsible for Construction License No. and Type if Applicable
QA,iyye2 S A# 0/9 2 3
Street Address City/Town State Zip
c%O (9-- t7 1012. - - L/1✓��F� 5r4 y&-Pq Nt f 16-&6,-4A6j•
Tele hone 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 ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$ 71.[L_
uilding $ Building Permit Fee=Total Construction Cost x_(Insert here
ectrical $ , tq p 0 appropriate municipal factor)=$
3. lumbing $ —d t:�)
4.Mechanical WAC) $ Note:Minimum fee=$ (contact municipality)
Mechanical (Other) $ Enclose check payable to
6.T I Cost $ Co/, (Q 0 O (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.
,IV G Kp1 oa S G1 K4 S SVQF—v1'S OA- 9 V-—6)Y.- -IA.?/49
Please print and sign name Title Telephone No. Date
Y 5-6 LocvsT S i DIwileft f �Ia O/9 d-3
Street Address City/Town State Zip Email Address
4
Municipal Inspector to fill out this section upon application approval:
Name Date
i
F
City of Salem Building Dept.
98 Washington Street
Salem, Mass 01970
1/14/2020
The purpose of this letter is to inform the building dept.that I Nicholas J.Gikas
Of 456 Locust Street, Danvers, Mass 01923 building permit CSL license holder#CS-053873.will no
longer be working at 100 Boston Street,Salem, Mass 01970 on permit#B-19-207 and wish to be
removed from the building permit at this address as of January the 14th, 2020.Thank you for your
attention this matter.
Sincerely, Nicholas J.Gikas
Nicholas J.Gikas
456 Locust Street
Danvers, Mass 01923
(978)210 2376