B-19-620 - 0331 BRIDGE STREET - Building Permit 1
Lid 31 Zgj
The Commonwealth of Massachusetts
i 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)
n Building Perrnit Number: Date Applied: . Building Official:
1^)V SECTION 1c LOCATION
I " a►
No.and Street City/Town Zip Code Name of Building(if applicable)
6' Assessors Map# Block#and/or Lot #
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❑ I 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 M No ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No Q
Brief Description of Proposed Work:
.•hr; 1
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here i1"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
RFacto
rs/Stories(include basement levels)&Area Per Floor(sq.ft.) l l Z S o 3 '2 0,1 o
(sq.ft.)and Total Height(ft)
SECTION 5:USE GROUP(Check as applicable)
ly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E. Educational ❑
F-1 ❑ F2❑ H: Hi Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
nal I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile❑ R: Residential R-1❑ R-2❑ R-3❑, R-4❑'S-1❑ S-2❑ U. Utility❑ Special Use❑and please describe below:
Special Use Description:
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 105.3 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
ub. jtl Check if outside Flood Zone I$ Indicate municipal A trench will not be Licensed Disposal Site❑
Private[] or indentify Zone: or on site system❑ required 12 or trench or specify: �• A L
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 It Yes No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
I
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Name(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 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.ft.of enclosed space and/or not under Construction Control then check here 0.
Otherwise provide construction control forms(see section 107 in the code as required.
uired.
10.1 Registered Professional Responsible for Construction Control(the rofessonal coordinatin document submittals)
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
1 2 General Contractor
A S c AP4J ,,
Company Name
Name of Person Responsible for Construction License No. and Type if.Applicable
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 the issuance of the building permit.
' Is a si- ed Affidavit submitted with this application? Yes O No 0
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.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 iri this
application is true and accurate to the best of my knowledge and understanding. r
Please print and sign name Title Telephone No. Date
Street Address City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval: A
Name Date
8�o G. rip • ;
CITY OF siusim, &LA sSACHUSE'ITS
f BlUnDL\G DEPART!-1&NT
120 WASHINGTON STREET, r FLOOR
TEL (978) 745-9595
�--' FAx 978 740-9846
KI.NiBERLE'Y DRISCOLL
MAYOR DIRECTOR
ST.PIERR6
DIRECTOR OF PUBLIC PROPERTY/au nLN- G co%o asSIONHR
Demolition Permit Sign-Off
(Supplement to permit application)
I,Stephen Lovely, hereby supply the following releases as part of the application for a
permit to demolish the structure located at 331 Bridge Street
and shown on the Assessor's Maps
of as being on Map # 26 Block # _ Lot # 0583
The sixth edition of the Massachusetts State Building Code, 780 CMR, states in part: "A
permit to demolish or remove a building or structure shall not be issued until a release is
obtained from the utilities, stating that their respective service connections and appurtenant
equipment, such as meters and regulators, have been removed or sealed and plugged in a safe
manner.
Utility to be Notified Notice Received by Date Received
(:was
N/A
NIA
fete hone.
IElectric Jason Benjamin Electric 4/25/2019
I.'ublic Utilities (Municipal)
1-Iealth Department
'ire Department
IOther -
LOther -
Demolition debris hauler: EZ DISPOSAL
Location of licensed Lynn, MA
demolition debris landfill:
Signature of Applicant Date: 11 ct
tiignature of Owner Date:
'This sheet must be returned to the Inspections Department along with a completed
application for a permit, a site plan, and any other applicable information and fees.
Demoperm.&L
Massachusetts Department of Environmental Protection
eDEP Transaction Copy
Here is the file you requested for your records.
To retain a copy of this file you must save and/or print.
Username: RLAVALLEE
Transaction ID: 1103272
Document: AQ 04-Asbestos Removal Notification Form ANF-001
Size of File: 231.73K
Status of Transaction: In Process
Date and Time Created: 5/1/2019:3:34:14 PM
Note: This file only includes forms that were part of your
transaction as of the date and time indicated above. If you need
a more current copy of your transaction, return to eDEP and
select to "Download a Copy" from the Current Submittals page.
L
Massachusetts Department of Environmental Protection
BWP AQ 04 (ANF-001)PreForm
Asbestos Notification Form
r This is a revision to an existing form.
Project ID for existing form to be revised:
r This job is being conducted under a Blanket Permit.
MassDEP assigned Blanket Authorization ID:
r This job is being conducted under allon Traditional Abatement Work Practice Permit.
MassDEP assigned Non Traditional Work Practice Authorization ID:
r This job does not require the use of an asbestos contractor licensed by the MA Department of Labor Standards
because(please check one box below):
r. This job involves breaking,shearing or slicing of non-friable asbestos-containing material only(e.g.cement
shingles/panels,cement pipe,asphalt roofing or siding,vinyl floor tiles,etc.)in a manner that does not generate
asbestos dust or render the material friable,as allowed by the Department of Labor Standards(DLS)at 453 CMR
6.13(2)(a)5.All work must be done in compliance with the applicable regulations at 310 CMR 7.15;or
r. This job involves work on asbestos containing material that is classified by the Department of Labor Standards
(DLS)as a`Small-Scale Asbestos Project,' an`Asbestos-Associated Project',or an`Asbestos Response Action'
by qualified`in-house'personnel as allowed by the Department of Labor Standards(DLS)at 453 CMR 6.00,and
will be performed in accordance with all the requirements of 453 CMR 6.13 (1)(a),453 CMR 6.13(2)(a)1.and 3.,
and 453 CMR 6.14(1)(a),as applicable.All work must be done in compliance with the applicable regulations at
310 CMR 7.15.
1-4one of the above conditions apply,generate a new form.
Revised: 11/13/2013 Page 1 of 1
-- Massachusetts Department of Environmental Protection 100307432
► _ BWP AQ 04 (ANF-001) Asbestos Project#
Asbestos Notification Form
r- Project Revision
r Project Cancellation
A. Asbestos Abatement Description
1.Facility Location:
331-333 BRIDGE STREET 331-333 BRIDGE STREET
Instructions 1.All a.Name of Facility b.Street Address
section:3 of this form SALEM
must be completed in MA 01970 9787458274
order tc comply with c.City/rown d.State e.Zip Code f.Telephone
MassDESP notification STEPHEN LOVELY PROJECT MANAGER
requirernents of 310
CMR 7.15 and g.Facility Contact Person Name h.Facility Contact Person Title
Department of Labor Worksite Location: AUTO BODY SHOP,EXTERIOR WINDOW,ROOF
Standards(DLS)
notification i.Building Name,Wing,Floor,Room,etc.
requirements of 453 2. Is the facility occupied? r a.Yes l✓b.No
CMR 6.12
3. Is this a fee exempt notification (city,town, district, municipal housing authority, state facility, or
owner-occupied residential property of four units or less)? r a.Yes l✓. b.No
MassDEP Use Only
4.Blanket Permit Project Approval,if applicable:
Date Received Approval ID#
5.Non-Traditional Asbestos Abatement Work Practice Approval,
if applicable: Approval ID#
6.Asbestos Contractor:
ACM GROUP INC,DBAACM ENVIRONMENTAL 7 LE1MS LN
a.Name b.Address
EAST HAMPSTEAD NH 03826 6033000537
c.Citylrown d.State e.Zip Code f.Telephone
A0000964 h.Contract Type:l✓ 1.Written r 2.Verbal
g.DLS License#
7. FAUSTO D.SANTIAGO AS010394
a.Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification#
8 N/A
a.Name of Project Monitor b.DLS Certification#
9 SAFETY ENVIRONMENTAL CONSULTANTS AA000233
a.Name of Asbestos Analytical Lab b.DLS Certification#
10.
5/13/2019 5/15/2019
a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY)
7:00 AM-3:30 PM N/A
c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday
11.What type of project is this?
a.Demolition r b.Renovation r c.Repair r d.Other-Please Specify:
Revised: 11/13/2013 Page 1 of 4
Massachusetts Department of Environmental Protection
100307432
ell BWP AQ 04 (ANF-001) Asbestos Project#
• J
Asbestos Notification� Form� r Project Revision
r— Project Cancellation
A.Asbestos Abatement Description: (cont.)
12.Abatement procedures(check all that apply):
r a.Glove Bag r b.Encapsulation r c.Enclosure r d.Disposal Only r e.Cleanup
r f.Full Containment ry—O g.Other-Please Specify: EXTERIOR WORIQNG METHODS
13.Job is being conducted: r— a.Indoors r b.Outdoors
14 a.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or
encapsulated:
40 90
1.Linear Feet(Lin.Ft.) 2.Square Feet(Sq.Ft)
b.Boiler,Breaching,Duct, c.Transite Pipe
Tank Surface Coatings 1.Lin.Ft 2.Sq.Ft 1.Lin.Ft. 2.Sq.Ft
d.Pipe Insulation e.Transite Shingles
1.Lin.Ft 2.Sq.Ft 1.Lin.Ft 2.Sq.Ft
f.Spray-On Fireproofing g.Transite Panels
1.Lin.Ft 2.Sq.Ft 1.Lin.Ft 2.Sq.Ft
h.Cloths,Woven Fabrics i.Other-Please Specify:
1.Lin.Ft 2.Sq.Ft
j.Insulating Cement WNDW CAULIQNG,RF FLASHIN 40 90
1.Lin.Ft 2.Sq.Ft 1.Lin.Ft 2.Sq.Ft
15.Describe the decontamination system(s)to be used:
2 CHAMBER REMOTE DECON EQUIPPED WITH A 5 MICRON WATER FILTRATION SYSTEM FOR CLEAN WATER DISCHARGE
16.Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)
(g):
ALL MATERIAL WILL BE THOROUGHLY WET AND PLACED IN 2 LAYERS OF SIX MIL POLY ASBESTOS LABELED BAGS
FOR PROPER HANDLING&TRANSPORT TO AN EPA APPROVED LANDFILL
17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency:
a.Name of MassDEP Official b.Title of MassDEP Official
c.Date of Authorization(MM/DD/YYYY) d.Waiver#
e.Name of DLS Official f.Title of DLS Official
g.Date of Authorization(MM/DD/YYYY) h.Waiver#
18.Do prevailing wage rates as per M.G.L.c. 149, §26,27 or 27A—F apply to this r a.Yes r b.No
project?
Revised: 11/13/2013 Page 2 of 4
. Massachusetts Department of Environmental Protection
100307432
BWP AQ 04 (ANF-001) �
�j Asbestos Project#
Asbestos Notification Form -
�4 r— Project Revision
r Project Cancellation
B. Facility Description
1.Current or prior use of facility: AUTO BODY SHOP
2.Is the facility owner-occupied residential with 4 units or less? r a.Yes r b.No
3 331 BRIDGE STREET,LLC 7 R MARCH ST
a.Facility Owner Name b.Address
SALEM MA 01970 9787458274
C.City/Town d.State e.Zip Code f.Telephone
4 STEPHEN LOVELY 7 R MARCH ST
a.Name of Facility Owner's On-Site Manager b.Address
SALEM MA 01970 9787458274
c.City/Town d.State e.Zip Code f.Telephone
5 SPENCER CONTRACTING 101 FOSTER ST
a.Name of General Contractor b.Address
PEABODY MA 01960 9787148000
c.City/Town d.State e.Zip Code f.Telephone
TRAVELERS INDEMNITY COMPANY
g.Contractor's Worker's Compensation Insurer
6HUB1K54890618 8/11/2019
h.Policy# i.Expiration Date(MM/DD/YYYY)
6.What is the size of this facility? 10000 1
a.Square Feet b.#of Floors
Note:Temporary C. Asbestos Transportation & Disposal
storage of Asbestos P P
contair_ing waste 1.Transporter of asbestos-containing waste material from site of generation:
material is only
allowed at the place r7o a.Directly to Landfill or r.— b.To Temporary Storage Location/Transfer Station
of business of a DLS
licensed Asbestos
contractor or a transfer SERVICE TRANSPORT GROUP 301 OXFORD VALLEY ROAD STE 803E
station that is c.Name of Transporter d.Address
permitted by
MassDF_P and YARDEY PA 09067 2673999411
operated in e.City/Town f.State g.Zip Code h.Telephone
compliance with Solid
Waste Regulations
310 CMR 19.000 2.If a temporary storage location/transfer station is used,list name of transporter of asbestos containing
waste material from temporary storage location/transfer station to final disposal site:
a.Name of Transporter b.Address
c.City/Town d.State e.Zip Code f.Telephone
Revised: 11/13/2013 Page 3 of 4
y 7 Massachusetts Department of Environmental Protection
BWP AQ 04 (ANF-001) 100307432
�. _ Asbestos Project#
� `` Asbestos Notification Form
1
�� r— Project Revision
r— Project Cancellation
C.Asbestos Transportation&Disposal: (cont.)
3.Name and address of temporary storage location/transfer station for the asbestos containing waste
material:
a.Temporary Storage Location Name b.Address
c.City/Town d.State e.Zip Code f.Telephone
4.Name and location of final disposal site(asbestos landfill):
MINERVAL LANDFILL MINERVAL LANDFILL
a.Final Disposal Site Name b.Final Disposal Site Owner Name
8955 MINERVA ROAD
c.Address
WAYNESBURG CH 44688 3308663435
d.City/Town e.State f.Zip Code g.Telephone
Note:Contractor must
sign this form for DLS
notification purposes D. Certification
ROBERTLAVALLEE ROBERTLAVALLEE
"I certify that I have personally 1.Name 2.Authorized Signature
examined the foregoing and am PRESIDENT 5/1/2019
familiar with the information
contained in this document and 3.Position/Title 4.Date(MM/DD/YYYY)
all attachments and that,based 6033191270 ACMGROUP,INC
on my inquiry of those 5.Telephone 6.Representing
individuals immediately 50ANORTHWESTERNDR UNIT#10 SALEM
responsible for obtaining the 7.Address 8.City/rown
information,I believe that the NH 03079
information is true,accurate,and
complete. I am aware that there 9.State 10.Zip Code
are significant penalties for
submitting false information,
including possible fines and
imprisonment.The undersigned
hereby states that I have read the
Commonwealth of
Massachusetts regulations
governing asbestos abatement
(453 CMR 6.00 promulgated by
the Department of Labor
Standards and 310 CMR 7.15
promulgated by the Department
of Environmental Protection),
and that I am aware that this
permit application or notification
shall not be deemed valid
unless payment of the
applicable fee is made."
Revised: 11/13/2013 Page 4 of 4