B-17-370 - 0135-0139 BOSTON STREET - Building Permit A o iaf
The Commonwealth of Massachusetts
N_.
Department of Public Safety
Massachusetts State Building Code(780 CMR) .
Building Permit Application for any Building other than a One-or Two-Family Dwlinit
gy
Q (This Section For Official Use Only)
Building Permit Number: Date Applied: Building Official: t
SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available)
135-139 Boston Street,Salem,MA 01970 N
1--`— No.and Street City/Town Zip Code Name of Building(if applica i.
t SECTION 2:PROPOSED WORK
Edition of MA State Code used 8th 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 I] No ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No 0
Brief Description of Proposed Work:
Remodel existing building in new A&)King Bakery. New GWB Walls,doors and frames. New bakery equipment.
New electrical,hvac and plumbing distributions stems. e isting fire protection system. (zj,
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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❑ I-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:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ 1 IV ❑ 1 VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Watery 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®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[3 Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE_OF OCCUPANCY
Edition of Code: 8th Use Group(s): B Type of Construction: Occupant Load per Floor:
Does the building contain an Sprinkler System?: Yes Special Stipulations:
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SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Sigma Realty Trust 135 Boston Street Salem,MA 01970
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
Peter Copelas 978 317 5454
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
David Gorham,ExecuSpace Construction,140 Garfield Avenue Woburn,MA 01801
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❑and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control
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Name eamN gis nt t e-ma ad dreTele neN9 � Registration Number
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Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
ExecuSpace Construction
Company Name
David Gorham )CS 109469✓ x ,g'� t Z ci
Name of Person Responsible for Construction License No. and Type if Applicable
140 Garfield Avenue Woburn MA 01801
Street Address City/Town State Zip
781 938 9099 978 914 _ 4749 dgorham@execuspaceconstruction.com
Tefe 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[F] No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor,
and Materials) Total Construction Cost(from Item 6)_$
1.Building $ 246,475.00
Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ 40,180.00 appropriate municipal factor)_$
3.Plumbing $ 45,900.00
4.Mechanical (HVAC) $ 48,490.00 Note:Minimum fee=$ (contact municipality)
5.Mechanical Other $ Enclose check payable to
6.Total Cost $ 381,045 (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.
David Gorham Project Manager 978 _914 _ 4719 5/01/2017
Please print and sign name Title Telephone No. Date
ExecuSpace Construction,140 Garfield Avenue,Woburn,MA 01801
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval: '°`
Name Date
i
Initial Construction Control Document
d
To be submitted with the building permit application by a
_ , d Registered Design Professional
for work per the 8t" edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: JA kMoa4 bate:
Property Address:
Project: Check one or both as applicable: ❑ New construction Axisting Construction
Project description: J
I WV 1jVMA Registration Number: Expiration date: ,am a
FIE I
registerey esign professional, and I have prepared or directly supervised the preparation of all design plans,
computations and specifications concerning:
Architectural [ ] Structural [ ] Mechanical
/[ ] Fire Protection [ ] Electrical [ ] Other
for the above named project and that to the best of my knowledge, information, and belief such plans, computations and
specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted
engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary
professional services and be present on the construction site on a regular and periodic basis to:
1. Review,for conformance to this code and the design concept, shop drawings, samples and other submittals by the
contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable.
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 if the work is being performed in a manner consistent with the approved
construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent
comments, in a form acceptable to the building official.
Upon completion of the work, I shall submit t ial a`Fin onstr ction Control Document'.
t
Enter in the space to the right a"wet"or '0
electronic signature and seal: /
Phone number: CAI l/ (/(l Email:
Building Official Use-,Only
Building Official Name: Permit No.: Date:
Version 06 11 2013
Final Construction Control Document
{ To be submitted at completion of construction by a
d
d Registered Designs Professional
for work per the 8`h'edition of the
nM SVe�� ,
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Date: Permit No.
Property Address:
Project: Check one or both as applicable: 0 New construction isting Construction
Project description: -Al- � )A— 41V
two
1 MA Registration Number: Expiration date:D ,am a
mgislei-4 design prolessional, and l have prepared or directly supervised the preparation of all design plans,
Computations and specifications concerning:
Architectural [ ] Structural [ ] Mechanical
Fire Protection Electrical Other:
[ l [ l [ l
for the above named project. 1,or my designee, have performed the necessary professional services and was present at the
construction site on a regular and periodic basis. To the best of my knowledge, information,and belief the work
proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building
permit and that I or my designee:
1. Have reviewed,for conformance to this code and the design concept,shop drawings,samples and other submittals
by the contractor in accordance with the requirements of the construction documents.
2. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the
progress and quality of the work and to determine if the work was performed in a manner consistent with the
construction documents and,this code. .
Nothing in this document relieves the contr ibility regarding the provisions of 780 CMR 107.
Enter in the space to the right a"wet"or
electronic signature and seal:
Phone number: G (lep Email: 6:::A
Building Official Use Only
Building Official Name: Permit No.: Date:
Version 06 11 2013
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APPROVED
Subject t/)approval by any other
authorit,having jurisdiction.
C:T`_' of SALEM,MASS. O
FLTIE?v'xrPN ION BUREAU '�� U O
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PLANo IZ A..RRO`EO SOLELY FO IDENTIFICATION&
TYPE AND LOCAPON OE FIRE PRQTECTtCN DEVICES. O
ALL FIR2' :ROTECTMN' ^-rV10EE ".:_"liBJiCi TO
FtUi:.LTEST AND INSPECTION,FOR COMFLSTECO"I"PL" V
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