31 BRIDGE ST - BUILDING INSPECTION �
•�: ',►^ The Commonwealth of Massachusetts
L• �� � Department oE Public Safety
�v-,.� .�1.u.,��hinelln Glalr BuJdin�Code(78�C��1R)4��enth Editiun
City of Salem
Buildin Permit A lication for an Buildin other than a 1- or 2-Famil Dwellin
�This tiectiun Fur Uf(ici.il Usr Onlv)
l3uilding Prrmit :VumUrr: Datr Apf+lied: Building InsF�rctur.
� SECTION l: LOCATION IPlease indicate Blotk N and Lof N for locatioro for which a street addrese is not available)
.,� 3 �� S � S e�^-� ai ��`�� ssl�..,. IJo�� c (.(,�
\u.and titrcrt Cih� /To�.�n Lip Cude Nart�buJ Buil ing(if.ippli�iblel��
... t v-.i
SECTION 2:PROPOSED WORK
If Nrw Constructiun chrck hrrr O ur chrck all that apply in thr twu ruws below
Existing Buildin Rrpair❑ Alteratiun O Additiun ❑ Drmulitiun ❑ (Plrase fill out and wbmit Appendix I)
ChnngeufUse O ChangeufOctupancy ❑ Othrr�Specify: Q.
• Are building plans and/ur construction ducument�bring supplird as part of Ihis permit npplicatiun? Yes No O
Is an Independent Structurol Enginrrring Peer Rr�vi�w requirc�? � � y� p N,�ivJ1 �
P P � q�1 liv. `J o'n U�C ('P mr�c�b�—.�`n.S:
Brief Descri tiun uf Pro osed Wurk: RO M da ,PX�
' c Ie/ �' I < / - c ' �"P n!
�, . �" , _� � + r �,-� ��s
SECI70N 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDI770N,OR
CHANGE IN USE OR OCCUPANCY
Check here it an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) O '
Existing Use GrouP�s)� - Proposed Use Group(s): -
Existing Havard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34:
SECTION 9: BUILDING HEiGHT AND AAEA �
Existing Proposed
Na uf Floors/Stories(indude basement levels)&Area Per Floor(sq.ft.) �
Total Area (sq. f[.)and TuWI Height(ftJ -i�+ ` n �
8
SECI70N 5: USE GROUP(Check as a licable)
A: Assembly A-1 ❑ A-2r ❑ A-2nc❑ A-3� A-4❑ A-5❑ B: Buainess ❑ E: Educational ❑
F: Facto F-1 O F2❑ H: Hi Hazard H-1 ❑ H-2 0 H-3 ❑ H-4❑ H-5❑
1: Institutional 1-I ❑ f-2 ❑ 1-3❑ f-4 O M: Mercantile O R: Residential R-1❑ R-2❑ R-3❑ R-S❑
S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use O and plra�e de�cribe beluw:
Special U�e:
SEC7'ION 6:CONSTRUCTION 7YPE(Check as a licable)
IA ❑ IB O IIA O fIB O IIIA O ❑IB ❑ IV ❑ VA ❑ VB�
SECTION 7:SITE INFORMATION frcfer to 780 CMR 111A for detaile on each item)
�Yater Supply: Flood Zone Infortnation: Sewage Disposal: Trench Pertnit: Debris Removal:
Publi� C hetk if uut.idr Fluud Lun Indic.rie municipal� �� trench will nut be Licrn.rd Di.p��cal tiite�
Pri��.ite❑ ��r indentilc Zunr:_ nr un.ite>e.trm ❑ reyuirrd O ur trench ur.pecil��:
' prrmit isencln.rd ❑
liailroad righf-o(•way: Hazard5 to Air Navigation: \I:\ I li.lori:�',�mmi..i��n Rr��i���� Pr„�o,.;
\�ut :\F.F�lirabl�:.�: 1.titrur�ure�ctlhin ,iirE+urt.��n�arh.irr,i' In lheir rr��ieo�cnm�,letrd.'
,�r l���n..•nl h� RuiIJ vnd�ncd ❑ Yr. � ur.\'�
1"r. 0 \n ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
lidrti��n ��� C���dr: l�.r(�n�upl.�: i��pc�H Cnn.IrurUun: l)ccuf•,�nl Luad per flnuc -
Unr. (hr lnuldin�;amLun an tiF,rinklcr ti��.trm.': Spoa.il SUpul,iliiin.�
� SECTION 9: PROPERTY OWNER AUTHORIZATION
N,ime and Addres..of Pruperlv O�vner
Namr lPrintl Nu.and titrurt Citp/Town LiP
PtuFief{�' )�.'nef Cont.�rt Inlurmdliun: ( '
/-C �ffcA� NtCpIc,U -= 3�- '�'� ' 'z' �
Titlr Trlrphunr:�lu. (bu>inrss) Trlephonr Nu. (crll) r-mail.iddres�
I(ap, �cablr. thr��ro,erN� ��wnerhrrebV.�uth��rizes ( M � � � �
��6t�r � d�d a���15�'- N. A„ao.,er � . . �S-1
Vamr 5tr.rt Addrrss Citv/T�nvn State Zip
tu acl��n thr +ru,rrt�'ownrr's brh.ilf, in.�II m.iUers nlati��e tu work authorizeal bv this buildin� �rrmit a � ilicatiun.
SECTION I0:CONSTRUC'TION CONTROL IPlease fill out Appendix 2)
(If buildin•is less Ihan)i.tM1U cu. ft of¢nilo..d s�a.e and/or nut undet Coro�tru.tiun G�nWI then cheek hrrc O and vki S�ction IU.I)
I0.1 Re istered Professional Res onsible for Const'uction Control
�qtMPS IJ. JI`'�� I� "Jr_O��_Z. 9`f � g i^ +�"t4�P.��r,i�(,4 � "t 3�6 '7
Name( rgis rant) • Tele ihone�vW� e-mail.iddre's R gist atiun Nymbrr
3� `� �G,��s LN. �. . {���.� I��b�e � � c� ' PrT Sti1�i/ZoK�
0
- Street Addrcs� City/Town State Zip Discipline Expiration Datr
10.2 General Contractor
� Gi h�l' ✓" �� °1v2I � �v�; �'r� ` a-✓• � a • -
Company Nam�e�+ C S � � g Cl � N o f e S�'C 1G�:�'�^$
(-�C`�_ 6' G�
Namr uf Perwn Res�y�y�sible f r Cu tructiun �/, 9��a�ense No. and Type�f Ap Iicabl�ZS/, 1
��i IJVcXsd.LC1. � �I/2, q�• �"` � _,��.•'
Street Address City/TT own— State Zip
6!7_3iZ_ 0�'2. � RE J�IOL � MSnI�• Go.N�_
Tele hone IVo.(business) Tele hone No.(cell) � �mail address
SEC770N 11:WORKERS'COIvII'ENSATION INSURANCE AFFIDAVIT (M.G.L.c.152. 25C(6))
A Workers'Cumpensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this applica[ion. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
Is a si ned Affidavit submitted with this a lication7 Yea No �
SECTION 12:CONSTRUC770N COSTS AND PERMIT FEE
. Item Estimated Costs: (Labor Total Construction Cost(from Item 6)_$
and Materials)
1. Building $ �'T� Building Permit Fee=Total Construction Cost x_(Insert here
2. Electrical $ 5 0 6U appropriate municipal factor)=3
3. Plumbin S 6 "U
� Note: Minimum fee=3 (contact m��icipalily)
4. Mechanical (HVAC) S ��,� /�
5. Mechanical (Other) $ Enclose check payable to��Y///` ��—
6. Total Cust S O 6�= (mntact munici ality)and write check number hem
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
Bv rnlrrin�my name beluw, I hrrrby attrst under the pains and pen.�lties uf prrjury that ali uf the infurm.tion amtainrd in Ihis
,iF��lication i+trur and accura[r tn lhe brs[ut mV knuwlydtieand understandinh. + '
C Q..q �Q�Ch � �V 1 F n 2P � � �.�.�' 1j17 _31Z _O17,� . �Z.C[.!d
� TiUe
I'le.�.r print .ind .ihn n.ime TrlcE�hunr Xn. U.ric
� a GG ds�xd�-� SF . /v� /�h.�{av�e� /✓i� o i ���.f
. � I tifr�•vt Addre.. Citt�iT�n�n Ptate Zifi
�tunicipal Inspector to fill out this section upon application approval:
.\ame I)ate
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"r CITY OF S.�1LE.`t, �L�SS.�CHL;SETTS
BI:RDLYG DEP.111'C�IE�iT
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, TEL (97� 7�5-9595
F.�x(97� 7iQ98�36
KJ�BERI.EY DRlSCOLL I?ioMAi ST.PIFilti
�Y�� Diaecroa oF r�euc rnove�rr/s�¢nac co�artssco`�
Wurkers' Compensatton Iosuranee AfTidrvit: Duilder�/Contracton/Electriclan�/Plumben
> i Iicant Infarm�tlo PI ri e
V�ITltlbusirn�a�.Orwn�tatio'rin�Lv�du:Jl: � -�'ilh� � fi/1 �a��..$ �:.("I ,a+--. Gjw Ghl
AJI�tCSf: � �06 � S�'�� � / V� �nNov�'� o ✓✓7/� d� b 'ls
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c��yism«z�P: rno�e w: � �7 � 1�. a, i Z�
Are yo�n emplsrp'Cseek�h�appropriatt boa: Typt of proJect(requlre�:
I�lam a¢mployc with��"-- s. Q I �n a�cneral cantrxtor aod 1
cmployca(full andlor pan-Gme).• have hired the wsconeracocn 6. ❑New conam�ctioo
- 2.O 1 am a sole proprietar nr pannu. listed on �he aKuhed�at, C 7. ❑Remaklins
:hip�J luve rn�employew T1fo�wbeonttaewn haw N. �Ikmolition
workin fw me in an ca oci �vorlcen'comp.inwraace,
t Y P �Y• 9. �Duildins additioa
(No workm'comp. insunnce S. � We aro�eorporsNan and io I O.Q Eloctrical repain or addi�ioru
raquireJ.] otTfun have exereiaed their
J.0 1 am a homeownrr doins alI wort� �Ith�o���p�an per MGL I I.Q Plumbin�repain a rdditions
myself.(\'o workers'comp. c. 132.41(4).uid we have no 12.0 Roof repairs
insunnce rcquircd.J t empbyeea. (No worYen' IJ.�Otha
comµ inwnnca requiied.J
'nny�pplicanl iAr cl�oc4 Eaa II muY alw fi4�uw iM raio�bclw�,fAorie�tAeit�rotce'cwnpm�Wn puliry inWrnudon
�I LMneu�vnee wM suhnil M's afll6ve indiain�ihry an Join�ill wat,vd tho hin wsid tenna�bn m�r�wAmU�rrw a1R�hvi1 indieriq wsk
{.,mra,ton�IW cMiek i�u Ea�mut anaclW an sld�iud dr�aAowin�J��mnv d�ly a�tpuesp�and tAey r,plon�'u�y.poliry isfom�euo�.
/u�w aw s minploye�rh�t bOnrid/nR worbn'rou��nra�lnw lntrnenjor nryry snrp/uy�es edow/i UY�ps/!ey aw/Jo�i!a
injarmu�iow� ' r ��
ImurrnceCompanyVame: � SL�w�G-P. Gd����n� �C ����Q. �
Policy M ur Sel(•ina. Lic. p: I lf C � 1 b Z�'b Eapirrtion Date• � �/� Z���
!ub Site AdJr¢u: �i � �f� �`1 iP S � City/Sn�e/Zip:� � I Y' �-"— �
,�ttacY a copr of th�worlun'comp�n��tb�poUey declantlo�pan(�howln�th�pollry sumb�r�a��tol o�daN}
Fuilure to�cure coverage u required unJer Section 23A of 1AGL e. 132 can Iqd to th�imposition of eriminal penalrin ofa
fine up to 51.500.00 and/or one-yeu impriaonmene,a�well as civil penrltio in�ha (orm uf a STOP WORK ORDER and� Hd
aPup�0 5?50.00�Juy��ins��hs violaror. Ik aJvi+ax!�hut a cupy uf this a�atem�n�may br furwarded to�he OIYce of
Invc>�iga�iuna�dUia OIA for insurance coveray�v.:rieicu�ion. �
/Jo h�rrbr en�i/'r m�Jir r i ui� ap/is ojprrJury rbat thi in�a�nroNow provided ubow is rrwe and tuntd
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"��� ��'KK °�^� ^ °^ JAMES D. SMITH,
^�� D��1G;1�i0G1°
� � EXTERIOR ELEVAiIONS; � � ARCHITECT, AIA p�N�
SCHEDUI.E .. ..ms*`:uwmw o
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�rdte'r
, �� CITY OF SALEM
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PUBLIC PROPRERTY
��`�',,,�% DEPAKTMENT
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\I `.1�at I'Q U'Ail II.VI::(�u S INFCT ��.11 I'\t. �1.\�iAl i Il :I I i�'����'
'fri:v-x.7�5:,;ys . I�.�x:,7aJ,a�iva6
Construction Debris Disposal Affidavit
(rcyuired lur�II dcmulition :mJ rcnuvatiun work)
In �ccurdmuc with th� sixth �dition of the S1ate Building CoJe, 780 CMR scction 11 1.5
Debris, anJ the provisiuns uf MGL c �0. S 54;
Duilding I'ermit t� . _ �s issued with the condition that tha debris resulting &om
�his work shall be disposed of in a proprrly licensed wnste disposal facility as dafined by MGL c
l 1 l. 5 150A.
The debris will be transported by: �
�< S �t� ��v�,�}�"-�v,
Inamc o[haulat)
I'he dcbris will be disposed uf'in :
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II � ����, CERTIFICATE OF LIABILITY INSURANCE „°��1��""�:�°"x""'
Paao�� (800)225-1865 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORINATON
FreA C.Ch�vch,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
41 We11mar�Street HOIDER. TFIIS CERTIFlCATE DOES NOT AMEND EXTEND OR .
Lowell,MA 01 M51 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
aoo-zu-i scs
INSURERS AFFORDING COVERAGE NAIC#
P1511NEO - INSURER A: Firsl Mc2Vry In611rance Com�lany
St.Migud ConsWc[ian,LL.0 INSURER B: �nsurance Company af State of PA
1000 Osgood Strce[
NarthAndover,.V1.4 01845 �NSURERG:
INSUHER D:
MSURER E:
COVERA6ES
hiE POLIGIES OF INSUFANCE LISTED BELOW NAVE BEEN�SSUED TOTHE INSUFlED NAMED ABOVE FOR THE POLIGV PERIOD INDIGATED.N07WITHSTANDING
ANV RE�UIREMENT,TERM OA CONDITION OF ANY GONTRACT pR OTHER DOGUMENT WITH RESPEGT TO WHIGH THIS GERTIFIGATE MAV BE ISSUED OR
MAV PERTAIN,7HE INSURANCE AFFORDED BV THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS ANO CONDITIONS OF SUCH
POLJCIES.AGGREGATE LIMRS SHOWN MAV HAVE BEEN REDIICED BV PAID CLAIMS.
iwsn oa roucvwur�aer+ coucr�cme roucvEwnnnnoN uuRs
GENEwnLtInBILrtY EAGHOCCURRENGE $1,000,000
X COMMERGIALGENERAIUABILITV PREMI E r 53���
CLAINSNADE �pGCUR MEDE%1'�Myoneper6on) EEACIpdCA
A FMMA�MM�1725 IIUSY1U119 iasrznin PERSONALBADVIN,IURY $ �,�,WU
GENERALAQGREGATE S 2���4�
- GEN'LAG6REGATELIMIT�PPLIESPER: PRO�UCTS-COMP/OPAGG $ z�•�
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OPFICEILMEPABERIXCLUDED? E.L.OISEASE-EAEMPLOVE 51•�•�
� ny�aesome unaer Lo0o,o0D
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O1XER
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CERTIFlCATE HOLDER CANCELLATION
City of Salem SNou�o.vrvoF me aeove oesc�neeu nauGEs eE GdcELLEo eEcoqErxe e.twxanax
UlI(Ittlg IpS(1QCIOI UA1E 1MEIIEOF.l!�155UQlG IM6UPEF VYILL EMOEPVOfl TO YAIL 3U DAYS WRRIEII
93 Washington Street MOTCE TO 1NE CEAfIFIGiE HOLDFA NRNEU TO T�LEFf,BUT FNIUPE TO 00 SO SHe��
Salem,MA 01970 OtPOSE NO OBIJ6ATdi OA LIA6ILRY OF ANY qNp UPpi THE W6UNEN,RS AGEMS OH
flFW1ESEMA11YE8.
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ACORD 25(2001/OB) ��;�„�q zd1� �tq U9-IU GL ffi WC ccas �ACORD CORPORATION 7988
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IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate halder in lieu of such endorsement�s).
It SUBROGATION IS WAIVED, subject to the terms and conditions af the policy, cer[ain policies may
require an endo�sement. A statement on this certificate does not confer rights to the cert�cate
holder in lieu of such endorsement(s).
DISCLAIMER
The Cerbikate of �nsurance on the reverse side of this fortn does not constitute a contract behnreen
- the issuing insurer(s), autho�ized representative or producer, and the certificate holder, nor does it
aifirmatively or negatively amend, extend ar alter the caverage afforded by the policies listed thereon.
acoao ss�2ooiroa)
� :H:IS1Al'llll.11'lll- Vl'�IilfUlll'Ill 111 runuc �a�c�)
� Bourd of Buildin� Rc��;ul:Uions and SGmdrrd
Construction Supervisor License
License: CS 81897
Restricted to: 00
GREGORYJ NOLAN ^�: �
13 WOODLAND AVE
KINGSTON, MA 02364 � V/ �
,.-
�--L �s�`� Expiratbn: 10/23/2011
l ('ommi>sionrr T�'#: 8798
1 �i ✓� lJdmilnO�ItII/P,�ll�� ay✓!'GaddaC/u14¢l
��, —a�\ Board of Building Regulatiolis and Stendflrds
� HOMEIMPROVEMENTCONTRACTOR
Registretion: 154517
Expiration: 3/75/2011 Tr# 28264
,� Type: Individual
� GREGORY J. NOLAN
• GREGORY NOLAN
13 WOODLAND AVE. �p�,,,.,
.KINGSTON,MA 02364 Administrator
St. Miguel's Construction
,
99 Winthrop Ave.
Lawrence, Ma.01843
Telephone 508-509-9701 Fax 978-685-1264
REVISED:
Proposal Submitted to: JOB NAME& LOCATION
Fabio Donuts Inc Dunkin Donuts
31 Bridge Street 31 Bridge Street
Salem, Ma Salem, Ma
• TeL• 978-682-2382
#C-01
We hereby submit specifications and estimates for.
A Remodel current Image to a Dunkin' Donuts 2015 Image per Dunkin' Donuts
specifications according to Dunkin' Donuts blueprints. Specifications submitted by customer.
This agreement is made between, Salem Donuts, LLC and St Miguel's Construction.
Included in this contract are Pages 1 through 3.
This contract does not include millwork and equipment. Any work requested not
specified in this contact will be billed separately in addition to the price quoted below.
The tax on materials is included in the contact price.
We proposed to hereby to fabricate and furnish materials in accordance with the Dunkin'
Donuts specifications and blueprints supplied by customer, for the sum of: $ 45,000.00
Acceptance of Proposal the above prices specifications and conditions are satisfactory and
are hereby accepted by customer. St Miguel's Construction is hereby authorized to do the
work as specified herein. Payment will be made as outlined on the last page ofthis contract.
Authorized Signature
Authorized Signature
Date of Acceptance I � �3G l o �
Note this proposal may be terminated and withdrawn by us, unilaterally, within 10 days.
1
St. Miguel's Construction
99 Wintluop Ave.
Lawrence, Ma.01843
Telephone 508-509-9701 Fax 978-685-1264
DEMOLITION:
Total demolition according to blueprints.
EXTERIOR FINISH CONSTRUCTION
Paint exterior of building according to blueprint.
Supply and install steel door and frame to replace existing back door.
SALES AREA FINISH CONSTRUCTION
� Existing Floor tile to remain.
Prepare walls to receive wallpaper.
Supply and install laminate Formica on sales area walls.
Supply and install wall covering on donut case soffit and walls.
Supply and install Armstrong acoustical ceiling Second Look 11.
Supply and install stained maple wood sills around window frames.
Supply and install wall tile on all back bar walls.
*ST. MIQUEL'S IS NOT RESPONSIBLE FOR REMOVAL OR STORAGE OF
EQUIPMENT IN SALES AREA.
ELECTRICAL:
Existing Electrical to remain.
Supply and install all lighting in sales area according to blueprints.
Supply and Install all connections for equipment.
PLUMBING:
Supply and install all connections for equipment.
HOOD:
Supply and install one bagel toaster hood.
2
St. Miguel's Construction _
99 Winthrop Ave.
Lawrence, Ma.01843
Telephone 508-509-9701 Fax 978-685-1264
PAYMENT SCHEDULE
AT SIGNING OF CONTRACT $ 11,500.00 .
AT ROUGH ELECTRICAL AND PLUMBING $ 11,500.00
AT COMPLETION OF FLOOR AND WALLS $ 1],500.00
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AT COMPLETION OF PROJECT $ 11,500.00
TOTAL AMOUNT OF CONTRACT $ 45,000.00
Cost Breakdown:
Construction $ 35,000.00
Electrical $ 5,000.00
Plumbing $ 5,000.00
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FILE#: DO)9057A1 �� '
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DATE: 11,/23/09 � I
PC #: 3�07435 �
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C.M. B. GLYNN o
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