124 BRIDGE ST - BUILDING PERMIT APP e 3
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^n inn INSPECI10NAL SERVVA! Commonwealth of Massachusetts 3i bE�» `X
Department of Public Safety j 1 -2-7 tc% i TA L,
n.'� Massachusetts State Building Code(780 CMR)
Zpi� R1°�etfilit pp cation for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only) .
Building Permit Number: ':Date Applied: .Building Official:
SECTION I:LOCATION(Please indicate Block#and-Lot#for locations for which a street address is not available)
24 6�`� C � Sek eNNN WI q-)b St- 1 M t\c Qxe,sl CL,., cl.�
No.and Street 6ty/Town Zip Code Name of Building(if applicable)
1 SECITON2'PROPOSED WORK
^^ Edition of MA State Code used_ If New Construction check here❑or check all that apply in the two rows below
11 J Existing Building❑ Repair)g( Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
1(I— Change of Use ❑ 1 Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No 19
Is an Independent Structural Engineering Peer Rettiew required? Yes ❑ No
Brief Description of Proposed Work_ s`f �'Q �- Y e
-:'SECTION.3:COMPLETE THIS SECTION IF MSTING 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).
A: Assembly A-1❑ A-2❑ Nightclub ❑ A3 ❑ A-4❑ A-5❑ r B: Business O E. Educational ❑
R Fa F-1❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H i❑ H-5❑
I: Institutional I-1❑ I-2❑ 1-3❑ I-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R3❑ R-4❑
S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IBO HA IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR111.0 for details on each item)
Water Supply:
1 Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
A trench will not be Licensed Disposal Site
Public❑ Check if outside Flood Zone❑ Indicate municipal❑Private❑ or indentify Zone: or on site system❑ required❑or trench or specify: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❑ Yes❑ No ❑
.. SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction Occupant Load per Floor:
Does the building contain an Sprinkler System?: Special Stipulations:
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SECTION PROPERTY OWNER AUTHORIZATION '
Name and Address/of Property Owner
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Name(Print) No.and Street Gty/Town Zip
Property Owner Contact Information:
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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 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)
building is less than 35,000 co:ft.of enclosed space and/or not under Construction Control:then check here❑and sld- Section 10.1
10.1 Registered Professional Responsible for Construction Control
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
102 General Contractor
_0}1
-f)Oc y. \oWenv Co.
Company Name
5t<v e_ L 6\, a,( yo
Name of Person Responsible for Construction License No. and Type if Applicable
3� Ess ?r, si . s�\�tart MA r ?�
Street �Address /�(-(� City/Town) State Zip -
jQ� =tJ0. 4LF yr.1 W AWE¢1 c • ^- 1 L
Tel hone No. usmess Telephone No. cell e-mail address
SECTION 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)_$
1.Budding $ Building Permit Fee=Total Construction Cost x_(Insert here
2.Electrical $ appropriate municipal factor)_$
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipali�
5.Mechanical Other $
Enclose check payable to
6.Total Cost $ '% 460,00 (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANTBy 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.
Kobel-� &b L�e_% GL v. .� t
P 01- 9 , r� y t Y�PSt C . 9-1,fi- ---74tt of cr )S
Please print and sign name Title Telephone No. Date
3)3 E5S9_A S`j . So:� r ,. MA vt`t?0
Street Address City/Town State Zip
.-Man icipal Inspector.to fill out this section upon application approval:
-Name- - Date
Commonwealth of Massachusetts '
a
City of Salem
'00 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641
` Return card to Building Division for Certificate of Occupancy -
Permit No. B-15-233 FEE PAID: $242.00 PERMIT TO BUILD
DATE ISSUED: 4/2/2015
This certifies that ST JOHNS UKRAINIAN CATHOLIC CHURCH
has permission to erect, alter, or demolish building,,,-,122.BRIDGE,STREET Map/Lot: 360032-0
as follows: Roofing STRIP & R ESHINGLE DOME
@ 124 BRIDGE ST
Contractor Name: AMERICAN STEEPLE!&TOWER CO.INC.
DBA:
Contractor License No:
4/2/2015
Building Official ,1 Date
This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official
may grant one or more extensions not to exceed six months each upon written request.
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of anyltbuilding and structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same.
The Certificate of Occupancy will not be issued until all
lapplicable signattires by the Building and Fire Officials)provided on this permit.
HIC#: 'Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A).
Restrictions:
Building plans are to be available on site.
All Permit Cards are the property of the PROPERTY OWNER.