65 BOSTON ST - BPA-11-211 U7 INTERIOR REVISIONS TO FLOOR PLAN The Commonwealth of Massachusetts
�I \- . its Department of Public Safely -
4. . .% \LI..IdnnrBs}Idle Budding C...1e L-80 C}IR)Seventh Edlhun
City of Salem
Building Permit Application for any Building other than a I- or 2-Family Dwelling
I Phi,�rctwn For Official U4e Only)
Ihnlding Permit Number: Date Applied: A411LBudding In,pector:
SECTION 1: LOCATION (Please indicate Block s and Lot s for locations for which a street address is not available)
✓'V 7e'b4zaP• C°.Y•b 551+1� jv
.\o. and Street C uv /Tuavn Zip Code Name of Budding W dpphaable)
SECTION 2:PROPOSED WORK N
If New Construction check here Cl or check all that apply In the two rows below
- --- --- -Existiny,-Buddinti❑ epair❑- ttrriPiasn-0 iixm mulinun-O-(P-1ci r4+li�4ut-.and-submu-Append4x
Change of Use ❑ Changeuf Occupancy ❑ Other tT Specify:Addi44n"AA WCetla.on untF"I P eawa.tk�
Are budding plans andlur cuastractiun.documents being supplied as part of this permit applicatiun? Yes EY Nu ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No 93 1
Braicpt-Dare'rsLc nw•lo�nlQvua Work:-iL•�ow, eaxv-aleel -atL¢ca1io 6ncbus�(tre.t v lm+Vr—` v r OUn
Har4ron� 5blrn 0411-
Add elesLk-I'o V- 0TA.Ad dis wzk aaKld l evyyig y► a.!
p{�Re_nwve (�.`-4claesnt_ � �
a^eVaVU4- tlyi. 4rvof!A Aw IOCci vzsenA Lua44 ale-hyc+, Acid avAslxei-. I VirrYeA lneolPr•u�► A)Gt�1
�laof5 r\e'edeatl : Q
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
rExisting
ck here d an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) ❑
ting Use Group($): Proposed Use Group(s): r
"Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34:
SECTION 4:BUILDING HEIGHT AND AREA
_ Existing Proposed
No.of Flours/Storie$(include basement levels)&Area Per Floor(sq.ft.)
Total Area(.sq. ft.)and Total Height(ft.)
SECTIONS:USE GROUP(Check as applicable)
A: Assembly A-1 O A-2r ❑ A-2nc❑ A-3 ❑ A-4❑ A•5❑ B: Business ❑ E: Educational ❑
F: Facto F-I ❑ 12❑ H: Hi Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
1: Institutional`I•I ❑ f-I ❑ 1:i❑ •1.4❑ M: Mercantile❑ R: Re3iden0al R-10 R-2 ❑ R-3❑ R-4 ❑
S. Storage S-I ❑ 5-2 ❑ U: Utility❑ Special Use O and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as Applicable) -
IAO IB ❑ IIA ❑ lien I IIIA ❑ 11100 1 IV VA VB ❑
I SECTION 7: SITE INFORMATION (refer to 780 C\IR 111.0 for details on each item)
I ' Debris Removal:
m Water Supply: Flood Zone Inforation: Sewage Disposal:` French Permit:
• A trench wdl not he LicrmcJ Ui.p. �.il F,Iv ❑
Public❑ Chcd.rt,nd�Ida•1;, •-d Gnt.-❑ Indu.. municqaf❑
nalwreJ ❑or trench .a
natr .pcuta.
I' a ❑ ��r mdenlda Zone:_ ���nm.dr.a.tem❑ prrmd I.rna lugrd ❑a
Railroad it Hazards to Air Navigation: \I\ f b.e•.,, t ..,,,,, -..�rs• „•., f',. „
\rt \I•Idi..d•Ic❑ L 1, then bra ic.. c,.u.I•f.t"I i
..i l .•n•c It n011wI1I onJ,,,c.f❑ I )c•❑ -•r \u❑ 1 ❑ Cl
—�
� SECTION 8:CONTENT OF CF.RTIFIC.1 FE OF OCCUPANCY
I ,Ltnm .d ( ..,tr L-c l.nup�•� fa�•r�•r l ••n-Iru.li,�n t occupant l cr ll „n
16n�tltr i•tu 1,11."q., 'Itmo., nevi o k lcr?t-drnt' rpvoai�upuldbnn.
SECTION 9: PROPERTY OWNER AUTHORIZA rION
'ulle mid Addre,ul 1'n�perly Owner
G216e-r
Vince II'nm) No. and ;Irvvt -
Prnl.vrle 0%,,1vr(•+mtarl Inlurmatlun: t
rifle rviephune Nu. (busmn ,) releph.me No. (cell) r m,nl.nlJrv..
If.Ipphiable, the pn+pert% uw ner hereby authorize.
\'amr ?tree(Addres City/To,xn State G)+
w ect nn the m+ 'a•rtc +n.ner;,behalf, in all matters relauce to+vu rk.iuthunzed by this buddin • +rrmrt.1 + hr.ihun.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
ill buddm•ie los than)i,(MUcu.tt.ul rnduxJ.+ore and/or nut under Con,ut,,I n Conlrul Then check here O.tnd.k+ +\•.tom Ill I)
;Reered Professional Res onsible for Construction Control
rrep unr u. a-mat a ress eglslraGun Number
Sess - City/Town State Lip Discipline Eaplrauun Date
10.2 General Contractor -
�evkni4 113,I�lru r .woex-�elr '
Company Name: -
�L- Ci q to � Cn
Name uf-Permtr, R"Wris�tbta for C n+tructiun License No. and Type if A (cable
1� QC%A � <.dy-ei�r l P_FleAkk i V lCa M' rh19l.S'
Street Address J City/Town State Zip
— — C 7?,Brio_MV,7
Tele hone No.(business) Tele hone No.(cell) e-mail address -
- SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDA VIT IM.G.L.e. 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 a lication7 Yee O No O
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(labor
and Materials) Total Construction Cost(from Item 6)
1, Building S Building Permit Fee=Total Cunstruction Cast x j(a�"(Insrrt here
2. Electrical 5
appropriate municipal(actor) =Ejlzia
3. Plumbing S -
1. Mechanical (HVAC) S .- Note:Minimum fee=S'S o0 (crosntact municipality)
5. Mechanical (Other) 5 Enclose check',. payable to Ci}-y pe 5 &I- eVl
6. Tntal Cost S (contact munici alit and write check number here
SECTION 13;SIGNATURE OF BUILDING P RMIT APPLICANT
k fR Hv ,ruvri ) name below, I hereby attest under the Vains and prn.tltrcs n(p gory that ell of the information .,mt.unrd in thi,
.Ipplirat m u t ue and acct it to the best-nf mY knowledge and undernlandm .
e �' Yl� 7Sy� DODO
iI'I c.i.a•.print +n.l ,gn n.0 Do &V r Ile �- rcleph+ina• \u I),i 4• —
at GF,
- � \lu nicipal blspector to till out this section upo application approva
\a nr 11j;`.1
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c
_ 9
BATHROOM
23.1'
a KITCHEN
w )R4- J
U
- Q
J
CLOSET CLOSET
o ) Ir _"
EXCLUSIVE
USE STUDY
fi UNIT 7co
I
DOWN
r
w
U
ZQ I
UNIT 7 a
AREA = 644 t S.F. w
L
LIVING ROOM
16.0'
S.
VROCTO
LE ATION = 111 .1 •
OSSING
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yK � f'Tfn �,l7WE/`
pp
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BATHROOM
w
BEDROOM
Lc_
a
J
W
W t,
Yf 4"j-TMAL
I 19.8,
UNIT r• - g�;�n
AREA 753 f S F.
DEN I w CL SET
LOSE
CL ET
CLOSET
rl)
w
BEDROOM
BEDROOM =
U
i
CRAWL CRAWL
SPACE SPACE ----
,' ' • • •
LEVATION = 120.9' ' ossiNG
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