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B-19-1088 - 0331-0333 BRIDGE STREET - Building Permit The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling 6 (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) 331-333 Bridge Street Salem 01970 No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Code used 9th If New Construction check here❑or check all that apply in the two rows below Existing Building❑x Repair❑ Alteration x Addition x❑ 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 ❑O No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No x❑ Brief Description of Proposed Work:De an construct Two(2) 2 unit buildings 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.) 1 1250 3 2040 Total Area(sq.ft.)and Total Height(ft.) 1250 32 8160 32 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 ❑ H-4❑ H-5❑ I:Institutional I-1 ❑1-2❑1-3❑1-4❑ M:Mercantile❑ R: Residential R-111 R-2❑x R-3❑R-4 S: Storage S-1❑ S-2❑ U:Utility❑ T Special Use❑and please describe below: Special Use: 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 111.0 for details on each item) Water ply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: bl' Check if outside Flood Zone Indicatemunicipal El A trench will not be Licensed Disposal Site❑ required0 or trench or specify:EZ Disposal Private❑ X❑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❑O Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No❑x Yes❑X No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code:9th Use Group(s): Type of Construction: Occupant Load per Floor: 4 Does the building contain an Sprinkler System?: Special Stipulations: 10t 2-, Nl,(-\1 tip Gc) Cq c l SECTION 9:PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner 331 Bridge Street, LLC 331 Bridge Street Salem 01970 Name(Print) No.and Street City/Town Zip Property Owner Contact Information:Stephen Lovely 978 -745 -8274 978-430 -8147 steghen®lovelylawgroup.com Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes Stephen Lovely 10 Federal Street Suite 411 Salem MA 01970 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❑and skip Section 10.1) 10.1 Registered Professional Responsible for Construction Control 5294 Ste hen Livermore 978 - 828- 4006 Registration Number Name(Registrant) Telephone No. e-mail address Architect 8/31/2019 Mason Street Salem MA 01970 Discipline Expiration Date Street Address City/Town State Zip 10.2 General Contractor Company Name Salem Sheet Metal &gor.L -082126 Name of Person Responsible for Construction License No.and Type if Applicable 6 Wenham Street Danvers MA 01923 Street Address City/Town State Zip 508 -509-7438 508 -509 -7438 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 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)_$460,000 1.Building $300,000 Building Permit Fee=Total Construction Cost x.11 (Insert here 2.Electrical $ 70,000 appropriate municipal factor)_$5,060.00. 3.Plumbing $ 80,000 4.Mechanical(HVAC) $ 15,000 Note:Minimum fee=$ (contact municipality) 5.Mechanical(Other) $ Enclose check payable to City of Salem 6.Total Cost $ 460,000 (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. Stephen Lovel w Manager V 978-745-8274 3/18/2019 Please print and sign name Title Telephone No. Date 10 Federal Street Suite 411 Salem MA 01970 Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: C�� s e Date Appendix 1 For the demolition of structures the building permit applicant shall attest that utility and other service connections are properly addressed to ensure for public safety. Please fill in the information below and submit this appendix with the building permit application.The building permit applicant attests under the pains and penalties of perjury that the following is true and accurate. Property Location(Please indicate Block # and Lot#for locations for which a street address is not available) 331 Bridge Street Salem 01970 No. and Street City/Town Zip Name of Building(if applicable) For the above described property the following action was taken: Water Shut Off? Yes [Q'No ❑ Provider notified and Release obtained? Yes ERNo ❑ Gas Shut Off? Yes CKlo ❑ Provider notified and Release obtained? Yes IrNo ❑ Electricity Shut Off?Yes 064o ❑ Provider notified and Release obtained? Yes EPI1 o ❑ Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) Appendix 2 Construction Documents are required for structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required for this. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents.This appendix is to be submitted with the building permit application. Checklist for Construction Documents' Mark"x"where applicable No. Item Submitted Incomplete Not Required 1 Architectural 2 Foundation 3 Structural ✓ 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing(include local connections) 9 Gas(Natural,Propane,Medical or other) 10 Surveyed Site Plan(Utilities,Wetland,etc.) 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review(521 CMR) 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction.Work started prior to approval may be subjected to triple the original permit fee. Registered Professional Contact Information Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number I Street Address City/Town State Zip Discipline Expiration Date SALESHE-01 DKULICK ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) F0312(0/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#1780862 CONTACT NAME: HUB International New England PHONE FAX 600 Longgwater Drive IA/C,No,Ext):(781)792-3200 (AIC,No):(781)792-3400 Norwell,-MA 02061-9146 ADDRESS: INSURERS AFFORDING COVERAGE NAIC 0 INSURER A:Commerce Insurance Company 34764 INSURED INSURERB:TWin City Fire Insurance Company 29459 Salem Sheet Metal Inc.Roger Petit INSURER C: 89 Russell Street INSURER D: Peabody,MA 01960 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN RI A_ SUER POLICY EFF POLICY EXP L TYPE OF INSURANCE IN D POLICY NUMBER p LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ 1,000,000 CLAIMS-MADE FX OCCUR 8008030009967 10/29/2018 10/29/2019 PREMISES DAMAGE TORENTED 100,000 PREMISE Ea occurrence $ MED EXP(Any-one person $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Is A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident $ ANY AUTO BBLXBV 03/31/2018 03/31/2019 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY X ALITNOpSWN p BODILY INJURY Per accident $ X AUTOS ONLY X AeTOS ONLY PeOacEcidentDAMAGE $ $ A X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS UAB CLAIMS-MADE TBA 02/15/2019 02/15/2020 AGGREGATE $ 2,000,000 DED I X I RETENTION$ 10,000 $ B WORKERS COMPENSATION SEATUTE ERH AND EMPLOYERS'LIABILITY 08WECAA8678 07/07/2018 07/07/2019 500,000 ANY OFFICEWMEMBER EXCLUDED?ECUTIVE Y❑ N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Stephen LOVBI THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P y ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) {©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD n f CITY OF S. I. 2M. NN-WSACHLSETTS • BI:MDLNG DEPARTMENT t 120 W ASHI NGTON STREET,3-FLOOR TEL (978) 745-9595 FMX(978) 740-9846 KI'BERLEY DRISCOI-I. ST.PiERRb Li1t,YOR n-Io><l�►s DIRECTOR OF PUBLIC PROPERTY/BI:MDLNG CONMSSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print ' Name(Businc-&OrganizationA ndividual):RfIGER L.PETIT Address: 96 WENHAM STREET City/State/Zip: DANVERS,MA 01923 Phone #:508-509-7438 Are you an employer?Check the appropriate box: Type of project(required): I.X I am a employer with_4 4. ❑ I am a general contractor and I 6 ❑New construction employees(full and/or part-time).' have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. X Remodeling ship and have no employers These sub-contractors have & ❑Demolition working for me in any capacity. workers'comp.insurance. [No workers'comp.insurance 5• ❑ We are a corporation and its 4 Building addition required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no l2❑ Roof repairs in required.]t employees.[No workers' comp.insurance required.] 13.❑Other 'Any applicant that checks lox ill must also fill out the section below showing their workers'compensation policy information. t 114mwowntets who submit this affidavit indicating they are doing all work and that him outside com metots must submit a new affidavit indicating such. -Comm-tors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. l am air employer that h providing svorkers'compensation hrsurance for my employees. Below is the policy and fob site information. insurance Company Name:—Twin CITY FIRE INSURANCE Policy#or Self-ins.Lie.*_08WECA A8678 Expiration Date:2/15/2020 Job Site Address:331 13RIDGE TREET City/State/Zip: Salem,MA 01970 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 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 S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. do hereby certify under the pains and penatles of perjury that the info rnratlon provided above is true and correct 1 r 1p / Sienature: I`/9 P ��-- Datc: 5 ( _?6 r Phone X: Official use arty. Do nor write in this area,to be completed by city or town ofrciaL City or*'own: t ermittLicense# Issuing Authority(circle one): L hoard of Health 2.Building Department 3.City/town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: �l J • S'� 3 CITY OF SALEM ROUTING SLIP New Construction Certificate of Occupancy LOCATIONS 1t^e 1 DATE `a ASSESSORS DATE 93 Washington St. CITY CLERK DATE 93 Washington St. PUBLIC SERVICES DATE t L 120 Washington St. WATER . DATE �1 120 Washington St. CROSS CONNECTION DATE ( ° l ( q 5 Jefferson Ave PLANNING DATE 41 120 Washington St. CONSERVATION ATE 7/1 Ell 0) 120 Washington St. ELECTRICAL DATE_ -z , 48 Lafayette FIRE PREVENTION DATE !� _ 29 Fort Avenu HEALTH DATE 120 Washington St. BUILDING INSPECTOR DATE i 120.Washington St.