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B-20-578 - 0089 BRIDGE STREET - Building Permit The Commonwealth of Massachusetts Acl� C 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) No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of N1A State Code used If New Construction check here❑or check all that apply in the two rows below Existing Building❑ AI 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 ❑ NoIA Is an Independent Structural Engineern&Peer Review required? Yes ❑ No 1( Brief Description of Proposed Work: h,54,k, IC a,m,a-1 _. Elk) lokt� 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.) /'%Idr SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ _A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F: Factory F-1 ❑ F2❑ H: High Hazard H-1.❑ H-2❑ H-3 ❑ 1-1-4❑ H-5❑ I: Institutional 1-1 ❑ 1-2❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-1❑ 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 ❑ IV ❑ VA ❑ VB 44 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❑ required❑or trench or specify: Private❑ or indentify Zone:_ or on site system❑ 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 Yes❑ No ❑ SECTION 8:CONTENT OF CERTIVICATE OF OCCUPANCY Edition of Code:_ Use Group(s): Type of Construction: Occupant Load per Floor: _ Does the building contain an Sprinkler System?: . Special Stipulations: ,SUN 9 AM1 o29 JUN SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner V & U04- Z _JAVX ame(Print) No.and Street 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/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 building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here Q and skip Section 10.1 10.1 Registered 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 1Rp Co. - -( Z�c Company Name Name of Person Responsible for Construction License No. and Type if Applicable 7 3 f� �� .�� o Street Address City/Town State Zip Telephone 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 t issuance of the building permit. Is a signed Affidavit submitted with this application? Ye No 17 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 0 v 1.Budding $ ©v Building Permit Fee=Total Construction Cost xJ1 (Insert here 2.Electrical $ appropriate municipal factor) 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ PP (contact municipality) 5.Mechanical Other Is Enclose check payable to CIA 04-- S43G1 6.Total Cost I $ ��jd D v (contact municipality)and write ch ck 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 best of my knowledge and understanding. op �d� 4?-7` / _�sc� 6/ Zo�71 Please print and si Title Telephone No. Date Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: I i l ��, 6 Name Date The Commonwealth of Massachusetts Lfw Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.massgovldia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lelribly Name (Business/Organization/Individual): Address: City/State/Zip: � pt f z Phone#: /V el-VS(I S Are you an employer?Check the appropriate box: Type of project(required): 1.61 am a employer with 15- employees(full and/or part-time).* 7. ❑New construction 2.®I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.E]{am a homeowner doing all work myself.[No workers'comp.insurance required.]t []4.�I am a homeowner and will be hying contractors to conduct all work on my property. [will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole l l.❑Electrical repairs or additions proprietors with no employees. 12,0 Plumbing repairs or additions 5.F-1 1 am a general contractor and I have hired the sub-contactors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.r-J We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applwant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContrictors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an emtployer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: J w[fr5 Policy##or Self-ins.Lic.#:Ug --7_I'-I 1 Z 1 Expiration Date:C:)g'�?J 2 m Zo Job Site Address: (34� 5 F vA,L 2 City/State/Zip: � oil?7y Attach a copy of the workers compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation-punishable by a fine up to$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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb�eert# -, the its and penalties of perjury that the information provided above is true and correct Signatu_ Date: p —r— Phone Official use only. Do not write in this area,to be completed by city or town officiat City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: June 6, 2020 Salem City Hall 93 Washington Street Salem, MA 01970 RE:89 Bridge,Street Permit To Whom it May Concerns My name is Alycia Mack, I am the condominium board president for the 89. Bridge Street Condominium Trust. We as a condo.association authorize Joseph�Turnbell;'licensed contractor to secure a permit for construction of a new deck at our residence. If you have any questions or heed anything else.from me,-feel free to contact me-at'508-713-2,133: Sincerely, AlyciaJ. Mack r CITY OF SALEM MASSACHUSETTS BUILDING DEPARTMENT 98 WASHINGTON STREET,2ND FLOOR TEL: 978-745-9595 KIMBERLEY DRISCOLL - - --- 1 MAYOR THOMAS ST.PIERRE DIRECTOR OF PUBLIC PROPERTIES/BUILDING COMMISSIONER f Construction ..Debris Disposal Affidavit (required}'or 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: G/J Carting (name of hauler) T The debris will be disposed of in: i (name of facility) Revere, MA (address of facility) S' nature of applicant 6/19/2020 (today's date) �� j °vim x W 0 � F � � � � C� �' � �t c� s2 �� 3�� J M �� Stavroula Orfanos From: Joseph Turnbull <jurnbull@servprosalem.com> Sent: Monday,June 22, 2020 8:38 AM To: Stavroula Orfanos Subject: Re: 89 Bridge St 1