B-17-577 - 0162 BRIDGE STREET - Building Permit C t �2�
The Commonwealth of Massachusetts
Department of Public Safety _
Massachusetts State Building Code(780 CMR) c . `
Building Permit Application for any Building other than a One-or Two-Family&ellin
(This.Section For Official Use`Only)
Building Permit Number: Date Applied: Budding.Official:
SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not ava abler>
t No.and Street City/Town Zip Code Name of Building(if.applica ) E a
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 ❑ I Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes No ❑
Is an Independent Structural Engineerin Peer Review re wired? Yes ❑ No i
Brief Description of Proposed Work: XW 3 Sir O►1�rC)
PecNv- nnk Sin;rs C3� e� ►,o�ipf e��f7' , Reh,.��al �ron�r sa4,r�.
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)
RAssembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-I❑ A-5❑ B: Business ❑ E: Educational ❑
F-1❑ F2❑ H: Hi h Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
nal 1-1❑ I-2'❑ 1-3❑ 14❑ M: Mercantile❑ R: Residential R-1❑ R-2❑ R-3❑ R4❑
5-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ 1110 IIA ❑ 1I1113 IIIA ❑ 11111 ❑ IV 1 VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Debris Removal:
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Licensed Disposal Site❑
Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be p
Private❑ or indentify Zone: or on site system❑ required❑or trench or specify:permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: �;(,��._f..l,i ioric_�_�_ommissioa Revicti��_Procc s:
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 CERTIFICATE OF OCCUPANCY
Edition of Coale: Use Group(s): Type of Construction: Occupant Load per Floor:
Does the building contain an Sprinkler System?: Special Stipulations:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
��^'� b�.,1�erS 1Z I,�p� c9a'. �afnYPrSe rtiS. pl�j�3
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information: f/
Sot1h Cg►�� Cf- -580-
Title Telephone No.(business) Telep lone 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 Constrnction Control then check here and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control
G5-<2.q Sg�s
Name(Registrant) Telephone No. e-mail address Re,* tration Number
G'a, S� 5-,16-N r\5 cytc(76 C _V�a1 I $
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
3'C (�>Pl\e-4I jrg
Company Name
J O'P\*"\ C
Name of Person Responsible for Construction License No. and Type if Applicable
1 Z_ LI taD>✓t,3 1--)EZ.._. y,ems 01 t 23
Street Address City/Town State Zip
Tele phone No, business Telephone No. cell e-mail address
SECTION 11t`t1'c)RKE.ttS'Ccm1E'FNEiA"1'tON 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)=$
1. Building $ 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.Ntechanica1 Other $ Enclose check payable to
6.Total Cost $ cjr /— (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.
h ccil"re ,��! cwtrPr' 97 _SSG CiI9Lf
Pleikse print and si n name Title Telephone No. Date
13�� � �� �C lP►� �q Gf��ca
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval: /
Name Date
1
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THIRD LEVEL ADDITION 162 BRIDGE STRSALEM, MA. 01970
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2"x 6°07 1.5 O.C.WWI Framing
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OHN CAMIRE
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JUNE 22, 2017
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WEST°ELEVATION SECTION
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j 162 Building 160 Building I
match existing aso ialt i New 16.0'x 16.0'3rd
roof shingles as sh wn. b r Floor Addition and
roofed porch deck. i New Stairs to 3rd
' I i Floor Addition and
New 2-5'-0"x
Decks
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mat i existing cedar shingles Eo
sidi 3rd Floor siding as shown.
existing vinyi capbo rd
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—� 2nd Floor Pt wood, s
& railings pe t
MA SBC/IBC.
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16'0 52'a' 5'Cr' -8010.
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New Third Floor Addition & Existing Pore Stairs Reconstruction ApriI17.2017
NEW LEFT S! -FLEVATiON 160-162-13r dge Street HH•Design Group Architects �o®;, C.y f
Scale:.3/16'= 1'-U' Salem, MA 01970 1 Ticehurst Lane p
Marblehead, MA 01945 r
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781 639 3493 MA �`
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David M. 1-tali0tis,ASSOC,AIA of Igh
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