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15 BROADWAY - BUILDING JACKET 15 BROADWAY UPC 10333 9YLEQLG r llll No. 153L-3 HASTINGS,UN a i ' CITY OF SALEM, MA ,*WW§ BOARD OF APP RK 120 WASHINGTON STREET♦SALEM;MASSACHUSETTS 01970 MmBERLEY DR1ScoLL Tt E:978-745-9595* FAx:978-740-9846 MAYOR May 31, 2017 Decision City of Salem Board of Appeals A public hearing for all persons interested in the petition of BRIMP'I'S REALTY LLC seeking Special Permits per Sec. 3.3.2 Nonconforming Urex and Sec. 3.3.3 Nonconforming Structures to extend a non-conforming use and reconstruct a non-confomvng building. The petitioner is also requesting a Variance per Sec. 3.3.4 Variance Required and Sec. 4.1.1 Table of Dimensional Requirements of the Salem Zoning Ordinance, to allow the petitioner to change a non-conforming structure in such a manner as to increase an existing nonconformity and for relief from the rear and side yard setback requirements at the property of 15 BROADWAY (Map 32 Lot 55)(1 Zoning District) A public hearing on the above Petition was opened on May 17, 2017 pursuant to M.G.L Ch. 40A, § 11 and closed on that date with the following Salem Board of Appeals members present: Rebecca Curran (Chair), Tom Watkins,Mike Duffy,Jimmy Tsitsinos, and Paul Viccica (alternate). The petitioner is seeking a Special Permit per Sec. 3.3.2 Nonconforming Uses and Sec. 3.3.3 Nonconforming Structures to extend a non-conforming use and reconstruct a non-conforming building. The petitioner is also requesting a Variance per Sec. 3.3.4 Variance Required and Sec. 4.1.1 Table of Dimensional Requirements of the Salem Zoning Ordinance, to allow the petitioner to change a non-conforming structure in such a manner as to increase an existing nonconformity and for relief from the rear and side yard setback requirements. Statements of fact: 1. Attorney Scott Grover presented the petition on behalf of the applicant. 2. In the petition date-stamped April 25, 2017, the petitioner requested a Special Permit per Sec. 3.3.2 Nonconforming Uses and Sec. 3.3.3 Nonconforming Structures to extend a non-conforming use and reconstruct a non-conforming building. The petitioner is also requesting a Variance per Sec. 3.3.4 Variance Required and Sec. 4.1.1 Table of Dimensional Requirements of the Salem Zoning Ordinance,to allow the petitioner to change a non-conforming structure in such a manner as to increase an existing nonconformity and for relief from the rear and side yard setback requirements 3. The property is located in an Industrial Zoning District. 4. The petitioner currently operates a construction/carpentry business in addition to providing space for three (3) other contractors in the current building. 5. The existing building construction/carpentry businesses are non-conforming uses. The existing property is in poor condition and an underutilized property. The petitioner is proposing a new structure and associated paved parking to provide much needed indoor workshop and contractor spaces. i City of Salem Board of Appeals May 31,2017 Project: 15 Broadway Street Page 2 of 4 6. The petitioner is proposing to raze the existing building to construct a 3,360 +/- square foot one- story structure with a mezzanine level above. The proposed structure will be parallel to Broadway and include four (4) small contractor bays for workshop space and storage or office space. 7. The existing building is dimensionally non-conforming as to front yard, rear yard and side yard setbacks. The proposed new building does not increase the existing non-confom3ities with respect to the setbacks on the east side and rear yard setback. 8. The west side yard setback is a new non-conformity. The petitioner is proposing a side yard setback of eleven (11� feet where thirty(30D feet are required. 9. The existing lot is 10,000 square feet with required rear yard, side yard and front yard setbacks of 30' feet in the Industrial Zone. 10. The requested relief, if granted, would allow the petitioner to extend a non-conforming use and reconstruct a non-conforming building. A Variance per Sec. 3.3.4 Variance Required and Sec. 4.1.1 Table of Dimensional Requirements of the Salem Zoning Ordinance, would allow the petitioner to change a non-confomring structure in such a manner as to increase an existing nonconformity and for relief from the rear and side yard setback requirements. 11. The property abuts a plumbing business where the business owner also lives at the property. This is the only residential property on Broadway. There are many businesses on this street including machine shops, sea food processing plant, body shops and other commercial businesses in this neighborhood. 12. At the public hearing the petitioner presented a petition to the Board, five (5) members of the public spoke in favor of, and none (0) opposed the petition. The Salem Board of Appeals, after careful consideration of the evidence presented at the public hearing, and after thorough review of the petition, including the application narrative and plans, and the Petitioner's presentation and public testimony, makes the following findings that the proposed project meets the provisions of the City of Salem Zoning Ordinance: Findings for Special Permit: The Board finds that the proposed expansion of a non-conforming use is not substantially more detrimental than the existing non-conforming use.The Board also finds that the proposed expansion to alter a non-conforming structure is not substantially more detrimental than the existing non- conforming structure. 1. Social, economic and community needs are served by the proposal. 2. Traffic flow and safety,including parking and loading is adequate. 3. Adequacy of utilities and other public services will not be negatively impacted. 4. Impacts on the natural environment,including drainage will remain the same. 5. The proposal fits with the character of the neighborhood. 6. Potential fiscal impact including impact on City the tax base and employment is positive. City of Salem Board of Appeals May 31,2017 Project: 15 Broadway Street Page 3 of 4 Findings for Variance: 1. There are special conditions and circumstances that especially affect the land, building, or structure involved,generally not affecting other lands,buildings, and structures in the same district. 2. The literal enforcement of the provisions of the Ordinance would involve substantial hardship to the applicant as the required rear yard, side yard, and front yard setback requirements are thirty (30� feet, which severely restricts development on the site. 3. Desirable relief may be granted without substantial detriment to the public food, and without mollifying or substantially derogating from the intent of the district or the purpose of the ordinance. On the basis of the above statements of facts and findings, the Salem Board of Appeals voted five (5)in favor (Rebecca Curran (Chau), Tom Watkins, Mike Duffy,Jimmy Tsitsinos, and Paul Viccica (alternate)) and none (0) opposed, to grant a Special Permits per Sec. 3.3.2 Nonconforming Urex and Sec. 3.3.3 Nonwnfimming Structures to extend a non-conforming use and reconstruct a non-conforming building. The petitioner is also requesting a Variance per Sec. 3.3.4 Variance Required and Sec. 4.1.1 Table of Dimensional Requirements of the Salem Zoning Ordinance, to allow the petitioner to change a non-conforming structure in such a manner as to increase an existing nonconformity and for relief from the rear and side yard setback requirements, subject to the following terms,conditions and safeguards: Standard Conditions: 1. Petitioner shall comply with all city and state statues, ordinances, codes and regulations. 2. All construction shall be done as per the plans and dimensions submitted to and approved by the Building Commissioner. 3. All requirements of the Salem Fire Department relative to smoke and fire safety shall be strictly adhered to. 4. Petitioner shall obtain a building permit prior to beginning any construction. 5. Exterior finished of the new construction shall be in harmony with the existing structure. 6. A Certificate of Occupancy is to be obtained. 7. A Certificate of Inspection is to be obtained. 8. Petitioner is to obtain approval from any City Board or Commission having jurisdiction including,but not limited to the Planning Board. Special Conditions: 1. The petitioner shall construct the building along the existing non-conforming west side yard to increase the east side yard setback to fifteen (15) feet. 2. The curbcut shall meet the dimensional requirements of the Zoning Ordinance and be thirty (30') feet or less. 3. The petitioner shall pave the front parking area and driveway prior to a Certificate of Occupancy. 4. A fence shall be maintained all the way around the property. } City of Salem Board of Appeals May 31,2017 Project: 15 Broadway Street Page 4 of 4 5. There shall not be any outside storage of construction ®®materials. Rebecca Curran Chair ' Board of Appeals A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK .4ppea!from this detition,if any,shall be made pxrmaxt to Section 17 of the Massachusetts General Laws Chapter 40A, and.shall be filed ins 10 days of fling of this decision in the offm of the 0t,Clerk Pursuant to the Ma saebxmtu General Laws Chapter 40A, Section 11, the Vmianir or Speial Perm igranted herein shall not take eea until a copy of the decision beating the cvnt 6cate of the City Clerk has been filed with the Essex South Registry of Deens. CITY OF SALEM, MASSACHUSETTS ?� PUBLIC PROPERTY DEPARTMENT �q 120 WASHINGTON STREET, 3RD FLOOR B�MINB SALEM, MASSACHUSETTS 01970 STANLEY J. USOVICZ, JR. TELEPHONE: 978-745-9595 EXT. 380 MAYOR FAX: 978-740-9846 July 13, 2004 Chimneys by Brownie Inc. COPY 15 Broadway Street Salem, Ma. 01970 RE: Rooftop Sign Dear Owner: This Department received and investigated a complaint regarding a sign recently placed on the roof of your business. There are no permits for this sign. State Building Code 780 CMR, Section 110 requires a building permits for signs. Furthermore, City of Salem Ordinances 4-1 through 4-59 regulates all signs. You are directed to remove the rooftop sign immediately. After the sign is removed, you may apply to the Planning Department for the proper sign review process. If you have any questions, please contact me directly. Sincerely, r4tr-x'V )*Z� Thomas St. Pierre Acting Building Commissioner cc: Kate Sullivan, Mayors Office Councillor Veno PROPERTY LOCATION 0055 Suffix 0 No Alt No Direction/Street/Ci XTERIOR INF RMAT INTERI RINFORMATION !10428! 15 BROADWAY,SALEM Type Garage Avg HVFL:STND OWNERS 1 Sty Ht:1 -1 Story Prim Int Wal Minimum 'Owner 1:TANZELLA JILLIAN M (Liv)Units:1 Total: 11/05/0 Sec Int Wall: % 20 '.Street 1:61 JERSEY STREET -Foundation:Slab ,., �Partition:T :cal ,Twn/City:MARBLEHEAD ..- Frame:Wood Prim Floors:PNone x SVProv:MA Cnlry Own:OCC: Prime Wall:Vinyl Sec Floors: Postal:01945 ;Type: Sec Wall: %:,''Bsmnt Flr. 0,0 Roof Structs Shed '-'Bsmnt Gar: r`Date YIN- Result By: 'Name Roof Cover:Metal Electric:Typical Insulation: ,eL View/Desir. -Inl vs Ext: (1520) ....... _... _....- 70 76 Heat Fuel: :Item Cade Desci %-. Item Code Descri � Grade: verage + . Heat T.pe: z I INDUSTRIAL 100 U = Year Bit 1930 'Eff Yr Bit: If Heat Sys: o Jt zAllLUC: Alt%: %Heated:0 %AC: n -'Jurisdict '"'- fact:. 'Solar HW:NO Central Vac:NO Exmpt 08:27: -= Const Mod: %Com Wal +%Sprinkled DEPRECIATION Lump.Sum Adj: BATH FEATURES Location: "Phys Cond:average 40% Salem Full Bath iRatim Unit 11: "Functional: % A Bath: :Rafing: 20 s Floor: Economic: % =:"PareellD` " 3/4 Bath: L Ratin .%—Own; =S ectal: / 32 0055-0 A 3QBth Rating61111 LONG PERMITS CARO., 1 0} 1 TOTAL ASSESSED 106,500 Name: :> Override: / > ":;:Pat Acet 1/2 Bath: Rating: Mate- Number Descrip .: Amount C/O Last Visit Fed Code I:F:Dewrip c. m ?Comment IN PROCESS APPRAISAL SUMMARY =ToTotal 40% 10428 A HBthr Rating: UsCode lValue. Yard Items.'Q- Land Size Land Value. _ _Total Value ,:i OthrFix 401 2fi 400 2600 0230 77500 106500 CALC SUMMARY - - -- - - Code .�' Description.. „;Area-SO =Rate AV=Y Dnuepr Value. = Basic$/SQ:31.20 Kits: Rating: FFL First Floor 1520 28960 ��--- - -- -. 4402557--�= Srze Adj.:1.25 Const Adj.0.742654 �--Frpl: Rafing; - " Const AQ:.28.963 Total Card_ ` 26 400 2,600 0.230 77,500 106,500 VySFue: Rahn : Total Parcel 26400 2600 0230 77500 106,500 - Grade Factor:1.10 :Source:MarketAdjCostToialAssmntperSOunit /Card:7007 /Parcel.7007 REMODELING _ _ Print DatelTime - .Other Features:-4040 .._ Exterior 07/28/05 12:0024 - - - Neighborhood Inf 1 PREVIOUS ASSESSMENT Interior. Net Sketched Area: 1,520 7>�Total: Tac Yr Users,:Buildin Value Yard Items = '.Land Size Land Value`?. .Total Value Sotal Assessed: gdddions .;LUC Factor.1.00 2005 -401 26400 2,600 23 77500 106,500 106,500 Srze Ad 1520 Gross.Brea 1520 FinArea 1520 Adj Total:43983 r'Kitchen: 2004 401 241001 2,600 23'.. 75300- 102,000:• 102000 ,. Baths: No Und RMS" .BRS :=FL Sub .% Descnp J y--i0u' #� Depreciations 17593 SALES INFORMATION Plumbing: Area -usbl ,: ,Type Ten Depreciated Tot 26390 ` S`Grantor '°x- =Legal Ref `":T k Date = Nal Desc .1;;Sale Price, •V Tst?Verif°; Assoc PCL Value:: ` Electric: :u"^ Juns.factor JEFFERY BROS IN 16965.2 3/14/2001 Ponion-Asst 209000 No No Special Features:0 .s-Heating: .5072284 1/111900 .No No - kir, ,;Final Total:26400 -'General. -. � - ..:....... Code Description 'A-,Y/S-Oty": Size/Dim Oual Con Year" "Unit Price-,,D/S.Dep:wz LUC ,1 Fact:NB Fa ApprValue A,God JFact Ass'd Value COMMENTS Le al DeSerition 88 ,Fence-6 Y 1420 AV AV 1970 8.50T 264 401 IA 2,600 .2,600 FURNITURE STORAGE. More:IN I Total Yard Items: 2,6001 Total Special Featues: 'Fotal: 2,600 LAND SECTION Code, Description ' Fact Units r. -De th[PrUni,Unit Type ,Land Type Factor %Base Prim- Ad E NBC `N INFF N.Mod Infl 1 M%-> I02 %-&:%Infl3 %-df p aised *Aft Clas % Spec= J Fact r Use Value Notes 401 Ind.-Whs. 10017: Sq.Ft. Site 0'.. 3.86 2,005 IA 77508 77,500 Total ALMA: .229959 ..Total SF/SK 10017.00 Parcel LUC:401 Ind:Whs. Prime NB Desc IND AVG Total: 77 508 Spl Credit .:Total: 77 500 =Mare:N Disclaimer:This Information is believed to be correct but is subject to change and is not warranteed. Database:AssessPro cmcintir 2006 DECOULOS & COMPANY ENVIRONMENTAL ENGINEERING&LAND PLANNING VIA FIRST CLASS MAIL Tuesday, October 03, 2006 j The Honorable Kimberly Driscoll The City of Salem 93 Washington Street Salem, MA 01970 RE: 15 Broadway, Salem;RTN 3-19954 Dear Mayor Driscoll: On behalf of Jeffery Bros, Inc, Decoulos & Company is pleased to inform the City of Salem of the completion of work related to the assessment and remediation of hazardous materials at the above referenced site. The work is summarized in a Response Action Outcome (RAO) pursuant to G.L. c.21E and 310 CMR 40.1000 that was submitted to the Massachusetts Department of Environmental Protection on September 15, 2006. On September 21, 2006, a Notice of Activity and Use Limitation (AUL) was also recorded at the South Essex Registry of Deeds in Book 26105, Page 193 to limit the use of the Site to commercial or industrial uses. A copy of the AUL is enclosed herewith. The AUL identifies certain activities and uses which are inconsistent with maintaining a condition of No Significant Risk at the property. The activity and use restrictions are designed to prevent exposure to residual petroleum concentrations remaining in the soil on the property at a depth of approximately two (2) to ten (10) feet below grade. The AUL identifies those activities and uses which are consistent with maintaining a condition of No Significant Risk and those obligations and conditions necessary to ensure that a condition of No Significant Risk continues to exist at the property for the foreseeable future. Copies of the RAO are available for download at www.decoulos.com/JefferyBros.htm . Hard copies are available upon email or fax request. Please feel free to contact us if you have any questions or concerns. Thank you. y yours, r Decoulos, PE, LSP decoulos.com cc: Joanne Scott, Health Agent, City of Salem Thomas St. Pierre, Building Commissioner, Zoning Enforcement Officer, City of Salem Carol A. Cole and Gary M. Cole, Sr. DEP Northeast Regional Office 185 ALEWIFE BROOK PARKWAY, CAMBRIDGE, MASSACHUSETTS 02138 TEL: 617.489.7795 FAX:877.842.9629 WWW.DE000LOS.COM 200I6I0I9I2I1I00I49`IIIIBIkII26I106lIIPIgIl193 Og121IY006 16:55:00 OTHER Pa 1113 NOTICE OF ACTIVITY AND USE LIMITATION G.L. c. 21E, § 6 and 310 CMR 40.0000 Disposal Site Name and Address: Beside Canal Street, 15 Broadway, Salem MassDEP Release Tracking Number: 3-19954 This Notice of Activity and Use Limitation("Notice") is made as of this 21 s`day of September, 2006, by the Jeffery Bros., Inc. and Jillian M. Tanzella Brown,together with their successors and assigns (collectively, "Owner"). This Notice is based upon Form 1075 developed by the Massachusetts Department of Environmental Protection ("MassDEP') and has been modified from its original format as presented in 310 CMR 40.1099. WITNESSETH: WHEREAS, Jeffery Bros., Inc. is the former owner in fee simple of that certain parcel of land located in Salem, Essex County, Massachusetts, with the buildings and improvements thereon ("Property"); WHEREAS, Jillian M. Brown is the current owner in fee simple of the Property with an address of 107 Broadway, Salem, MA 01970; WHEREAS, said parcel of land, which is more particularly bounded and described in Exhibit A, attached hereto and made a part hereof is subject to this Notice of Activity and Use Limitation. The deed for the Property is recorded with the Essex South Registry of Deeds (the"Registry") in Book 16965, Page 2 and the survey plan of the property originates from that plan recorded at the Registry at the end of Book 1438. WHEREAS,the entire Property is subject to this Notice of Activity and Use Limitation. The Property is more particularly bounded and described as shown on Exhibit B which is attached hereto and made a part hereof. WHEREAS, the Property comprises a portion of a Disposal Site as the result of a release of oil and/or hazardous material. Exhibit B is a sketch plan showing the Property which is subject to this Notice of Activity and Use Limitation; and Return to: James J. Decoulos Decoulos& Company 185 Alewife Brook Parkway Cambridge, MA 02138 WHEREAS, one or more response actions have been selected for the Disposal Site in accordance with G. L. c.21 E ("Chapter 21 E") and the Massachusetts Contingency Plan, 310 CMR 40.0000 (the "MCP"). Said response actions are based upon (a) the restriction of human access to and contact with oil or hazardous material in soil and (b) the restriction of certain activities occurring in, on, through, over or under the Property. The basis for such restrictions is set forth in an Activity and Use Limitation Opinion ("AUL Opinion" dated September 15, 2006,(which is attached hereto as Exhibit C and made a part hereof); NOW, THEREFORE, notice is hereby given that the activity and use limitations set forth in said AUL Opinion are as follows: 1. Permitted Activities and Uses Set Forth in the AUL Opinion. The AUL Opinion provides that a condition of No Significant Risk to health, safety, public welfare or the environment exists for any foreseeable period of time (pursuant to 310 CMR 40.0000) so long as any of the following activities and uses occur on the Property: (i) Commercial or industrial uses and activities associated therewith, including, but not limited to, pedestrian or vehicular traffic, landscaping, and routine maintenance of landscaped areas, which do not cause or result in the disturbance or the relocation of the existing building or the contaminated soil located at 2 to 10 feet below surface grade; (ii) Short-term (three months or less) underground utility or construction activities including, but not limited to, excavation(including emergency repair of underground utility lines), which are likely to disturb contaminated soil located at 2 to 10 feet below surface grade, provided that such activities are conducted in accordance with Obligations/Conditions (i) and (ii) in Section 3 of this Activity and Use Limitation Opinion ("Opinion'), the soil management procedures of the MCP cited at 310 CMR 40.0030, and all applicable worker health and safety practices pursuant to 310 CMR 40.0018; (iii) Activities and uses which are not identified in this Opinion as being inconsistent with maintaining a condition of No Significant Risk; and (iv) Such other activities and uses which, in the Opinion of an LSP, shall present no greater risk of harm to health, safety, public welfare, or the environment than the activities and uses set forth in this Paragraph. 2. Activities and Uses Inconsistent with the AUL Opinion. Activities and uses which are inconsistent with the objectives of this Notice, and which, if implemented at the Property, may result in a significant risk of harm to health, safety,public welfare or the environment or in a substantial hazard, are as follows: (i) Use of the portion of the property as a residence, school (with the exception of adult education),daycare, nursery, recreational area(such as a park or athletic fields),or any other use at which a child's presence is likely; (ii) Any activity including,but not limited to, excavation which is likely to disturb contaminated soil located at 2 to 10 feet below surface grade associated with underground utility or construction work, without prior development and implementation of a Soil Management Plan and a Health and Safety Plan in accordance with Obligations(1) and (ii) of Section 3 of the AUL; (iii) Any activity which involves the demolition or movement of the building on the Property from its current footprint as shown in Exhibit B; (iv) Any activity which is likely to disturb contaminated soil located at 2 to 10 feet below surface grade for a period of time greater than three months, unless such activity is first evaluated by an LSP who renders an Opinion stating that such activity is consistent with maintaining a condition of No Significant Risk and that such activity is conducted in accordance with Obligations (i) and (ii) of Section 3 of this AUL; and (v) Relocation of contaminated soil located at 2 to 10 feet below surface grade,unless such relocation is first evaluated by an LSP who renders an Opinion stating that such relocation is consistent with maintaining a condition of No Significant Risk. 3. Obligations and Conditions Set Forth in the AUL Opinion. If applicable, obligations or conditions to be undertaken or maintained at the Property to maintain a condition of No Significant Risk as set forth in the AUL Opinion shall include the following: (i) A Soil Management Plan must be prepared by a Licensed Site Professional (LSP)prior to the commencement of any activity which is likely to disturb contaminated soil located at 2 to 10 feet below surface grade. The Soil Management Plan should describe appropriate soil management characterization storage,transport and disposal procedures in accordance with the provisions of the MCP cited at 310 CMR 40.0030 et seq. Workers who may come in contact with the contaminated soil should be appropriately trained on the requirements of the Plan. and the Plan must remain available on-site throughout the course of the project; (ii) A Health and Safety Plan must be prepared and implemented prior to the commencement of any activity which may result in the disturbance of contaminated soil located at 2 to 10 feet below surface grade. The Health and Safety Plan should be prepared by a Certified Industrial Hygienist or other qualified individual appropriately trained in worker health and safety procedures and requirements.The Plan should specify the type of personal protection, engineering controls, and environmental monitoring necessary to prevent worker and other potential receptor exposures to contaminated soil through ingestion, dermal contact, and inhalation. Workers who may come in contact with the contaminated soil should be appropriately trained on the requirements of the Plan, and the Plan must remain available on-site throughout the course of the project; and (iii) The contaminated soil located at 2 to 10 feet below surface grade must remain at depth and may not be relocated, unless such activity is first evaluated by an LSP who renders an Opinion which states that such activity poses no greater risk of harm to health, safety, public welfare, or the environment and ensures that a condition of No Significant Risk is maintained. 4. Proposed Changes in Activities and Uses. Any proposed changes in activities and uses at the Property which may result in higher levels of exposure to oil or hazardous material than currently exist shall be evaluated by an LSP who shall render an Opinion, in accordance with 310 CMR 40.1080 et seq., as to whether the proposed changes will present a significant risk of harm to health, safety, public welfare or the environment. Any and all requirements set forth in the Opinion to meet the objective of this Notice shall be satisfied before any such activity or use is commenced. 5. Violation of a Response Action Outcome. The activities, uses or exposures upon which this Notice is based shall not change at any time to cause a significant risk of harm to health, safety,public welfare, or the environment or to create substantial hazards due to exposure to oil or hazardous material without the prior evaluation by an LSP in accordance with 310 CMR 40.1080 et seq., and without additional response actions, if necessary,to achieve or maintain a condition of No Significant Risk or to eliminate substantial hazards. If the activities, uses, or exposures upon which this Notice is based change without the prior evaluation and additional response actions determined to be necessary by an LSP in accordance with 310 CMR 40.1080 et seq.,the owner or operator of the Property subject to this Notice at the time that the activities, uses or exposures change, shall comply with the requirements set forth in 310 CMR 40.0020. 6. Incorporation Into Deeds,Mortgages, Leases, and Instruments of Transfer. This Notice shall be incorporated either in full or by reference into all deeds, easements, mortgages, leases, licenses, occupancy agreements or any other instrument of transfer, whereby an interest in or a right to use the Property or a portion thereof is conveyed. Owner hereby authorizes and consents to the filing and recordation or registration of this Notice,said Notice to become effective when executed under seal by the undersigned LSP, and recorded or registered with the appropriate Registry of Deeds and Land Registration Office. WITNESS the execution hereof under seal this 21"day of September, 2006. �ond G. esident Charles E. Jeffe re Jeffery Bros., Inc. Jeffery Bros., Inc. illian M. Brown The undersigned LSP hereby certifies that he executed the aforesaid Activity and Use Limitation attached hereto as Exhibit C and made a part hereof and that in his Opinion this Notice of Activity and Use Limitation is con iste with the terms set forth in said Activity and Use Limitation Opinion. Aries J. Decoulos, LSP COMMONWEALTH OF MASSACHUSETTS ESSEX, SS September 21, 2006 On this 21 St day of September, 2006, before me,the undersigned notary public, personally appeared the above-named Raymond G. Jeffery, Charles E. Jeffery, Jillian M. Brown and James J.Decoulos,and proved to me through satisfactory evidence of identification, which were Drivers' Licenses from the Commonwealth of Massachusetts, to be the persons whose names are signed on the preceding document, and acknowledged that they signed it voluntarily for its stated purpose. L (f .I <ix/t /// Notary Public My Commission Expires: SUa-.id A.-1]IONNE N Y ml A Public cotnuo!;;F. {q esus Comic�ion Expires CERTIFICATE OF INCUMBENCY Jeffery Bros, Inc. I hereby certify that I am the duly appointed and acting Clerk of Jeffery Bros, Inc., a domestic profit corporation in the Commonwealth of Massachusetts, and that as of the date hereof,the individuals named below are the duly appointed and acting officers of Jeffery Bros, Inc.,holding the offices set forth opposite their respective names. Raymond G. Jeffery,Jr. President Charles E. Jeffery Treasurer WITNESS the execution hereof under seal this 19'h day of September, 2006. hiJhy&_A�t 1z n 1. Bobbie M.Funrue, Clerk _ Jeffery Bros, Inc. COMMONWEALTH OF MASSACHUSETTS ESSEX, SS September 19,2006 On this 19u'day of September, 2006,before me,the undersigned notary public, personally appeared the above-named Bobbie M. Funrue, and proved to me through satisfactory evidence of identification,which was a Driver's License from the Commonwealth of Massachusetts,to be the person whose name is signed on this document, and acknowledged that she signed it voluntarily for its stated purpose. otary Public My Commission Expires: Ir r Notary Public C0nlnroMM Nh at Massaohusft My Commbsbn Vhrm dune 27,2009 EXHIBIT A (Description of Parcel of Land Containing Area Subject to AUL) The land in Salem, with the improvements thereon, bounded and described as set forth in a deed recorded at the Essex South Registry of Deeds in Book 16965, Page 2. Located on the easterly side of Broadway as shown on the plan attached hereto as Exhibit B. N N/F LAFAYETTE ASSOCIATES I / toO.DO i I � 1 1 1 I ONE STORY WOO 11 ' p BUILDING �1 070 O p h APPROXIMATE EDGE OF ASPHALT PAVEMENT C LI 0 s i 4 89.23 i N/F CAROL A. COLE AND GARY M. COLE, SR, flEFERENCES 1. PLAN OF LAND OF JAMES F. ALMY IN SO. SALEM SHOWING PACIFIC ST. AND MCINITY; BY C.A. PUTNAM. C.E.; DECEMBER, 1894; AND RECORDED AT THE ESSEX SOUTH REGISTRY OF DEEDS AT THE END OF BDOK 1438. 2. DEED FROM JEFFERY BROS.. INC. TO JILUAN M. TANZELLA AND CHRISTOPHER J. BRONN DATED MARCH 14. 2001 AND RECORDED AT THE ESSEX SOUTH REGISTRY P.' DEEDS IN BOOK 16955. PAGE 2. 3. STADIA FIELD SURVEY BY MICHAEL CONNORS AND JAMES J. DECOULOS ON APRIL 10. 2006. DECOULOS & COMPANY EXHIBIT B s w 6 25 ALEWFE BROOK Pr,cAKHMn M SKETCH PLAN ' WWW.DE000LOS.COM FOYE NO. 617.489.7795 15 BROADWAY, SALEM, MA B L EXHIBIT C ACTIVITY AND USE LIMITATION OPINION In accordance with the requirements of 310 CMR 40.1074,this Activity and Use Limitation Opinion has been prepared for a parcel of land formerly owned by the Jeffery Bros., Inc.. The property is defined in the deed recorded at the Essex South Registry of Deeds in Book 16965,Page 2(the"Site"). Site History The Site has been used entirely for commercial purposes. In the late nineteenth and early twentieth centuries,the area including and surrounding the Site was used for leather tanning operations. A commercial building is currently located on the northerly portion of the Site. [Note: The "MCP"is the Commonwealth of Massachusetts'code ofregtdations for the notification, assessment and cleanup of disposal sites where a release of oil or hazardous materials has occurred See 310 CMR 40.0000] Field investigations and soil removal actions have been conducted at the Site since 2000.The results of the investigations indicate that heavy metal concentrations exceed the MCP Method 1 S-1 Soil Standards in soil located at 2 to 10 feet below the surface in various portions of the Site. The metals of concern are arsenic. barium,cadmium,chromium, lead and mercury. Elevated metal concentrations have also been detected in groundwater samples collected from on-site monitoring wells. The groundwater contaminants are not considered a risk to human health, safety,welfare or the environment. [Note: The "MCP Method 1 Cleanup Standards"refer to numerical standards for chemical contaminants in soil and groundwater which are published in the MCP. The soil standards are broken into three soil categories:S-1,S-2, and S-3. The S-1 Soil Standards are the most strict, or lowest, numerical values since they were derived to be protective of a residential exposure scenario by considering a receptor's incidental ingestion and dermal contact exposures to.roil while gardening and playing. The S-2 and S-3 numerical standards are less strict and therefore higher, having been developed using passive recreational and construction-related exposure scenarios, respectively.] Reason for Activity and Use Limitation A Method 1 Risk Characterization was conducted to evaluate the risk posed by contamination remaining in soil at the Site. Using the Method 1 approach,concentrations of heavy metals remaining in soil were compared to the MCP Method 1 Soil Standards to determine if the Site poses a risk for current and future activities and uses. The Method 1 Risk Characterization concluded that the site poses No Significant Risk to health,safety, public welfare or the environment for current conditions of commercial use on the property because contaminant concentrations remaining in soil met the applicable Method 1, S-2 and S-3 Soil Standards for the Site. However,since concentrations of heavy metals in soil located beneath the current building and at 2 to 10 feet below surface grade on the Site exceeded their respective Method I S-I Standards.an unacceptable risk exists should future activities and uses of the Site result in unrestricted human exposure to the soil,such as those associated with a child's exposure through direct contact or ingestion. Therefore, in order to ensure that such exposures do not occur and that a condition of No Significant Risk be maintained for future activities and uses.an Activity and Use Limitation is required to restrict certain activities and uses of the Site. Permitted Activities and Uses (i) Commercial or industrial uses and activities associated therewith,including,but not limited to,pedestrian or vehicular traffic, landscaping, and routine maintenance of landscaped areas,which do not cause or result in the disturbance or the re- location of the existing building footprint or the contaminated soil located at 2 to 10 feet below surface grade; (ii) Short-term(three months or less)underground utility or construction activities including,but not limited to,excavation(including emergency repair of underground utility lines),which are likely to disturb contaminated soil located at 2 to 10 feet below surface grade,provided that such activities are conducted in accordance with Obligations/Conditions(i)and(ii)in Section 3 of this Activity and Use Limitation Opinion("Opinion"),the soil management procedures of the MCP cited at 310 CMR 40.0030.and all applicable worker health and safety practices pursuant to 310 CMR 40.0018; (iii) Activities and uses which are not identified in this Opinion as being inconsistent with maintaining a condition of No Significant Risk;and (iv) Such other activities and uses which in the Opinion of an LSP,shall present no greater risk of harm to health safety,public welfare,or the environment than the activities and uses set forth in this Paragraph. Activities and Uses Inconsistent with AUL Opinion (i) Use of the Site as a residence,school(with the exception of adult education),daycare, nursery,recreational area(such as a park or athletic fields),or any other use at which a child's presence is likely; (ii) Any activity on the Site including,but not limited to,excavation,which is likely to disturb contaminated soil located at 2 to 10 feet below surface grade associated with underground utility or construction work,without prior development and implementation of a Soil Management Plan and a Health and Safety Plan in accordance with Obligations(i)and (ii)of Section 3 of the AUL: (iii) Any activity on the Site which is likely to disturb contaminated soil located at 2 to 10 feet below surface grade for a period of time greater than three months,unless such activity is first evaluated by an LSP who renders an Opinion stating that such activity is consistent with maintaining a condition of No Significant Risk and that such activity is conducted in accordance with Obligations(i)and(ii)of Section 3 of this AUL;and (iv) Relocation of contaminated soil located at 2 to 10 feet below surface grade on the Site, unless such relocation is first evaluated by an LSP who renders an Opinion stating that such relocation is consistent with maintaining a condition of No Significant Risk. Obligations and Conditions (i) A Soil Management Plan must be prepared by a Licensed Site Professional("LSP")prior to the commencement of any activity which is likely to disturb contaminated soil located at 2 to 10 feet below surface grade on the Site. The Soil Management Plan should describe appropriate soil management,characterization, storage,transport and disposal procedures in accordance with the provisions of the MCP cited at 310 CMR 40.0030 et seq. Workers who may come in contact with the contaminated soil should be appropriately trained on the requirements of the Plan.and the Plan must remain available on-site throughout the course of the project; (ii) A Health and Safety Plan must be prepared and implemented prior to the commencement of any activity which may result in the disturbance of contaminated soil located at 2 to 10 feet below surface grade on the Site. The Health and Safety Plan should be prepared by a Certified Industrial Hygienist or other qualified individual appropriately trained in worker health and safety procedures and requirements. The Plan should specify the type personal protection,engineering controls,and environmental monitoring necessary to prevent worker and other potential receptor exposures to contaminated soil through ingestion,dermal contact,and inhalation. Workers who may come in contact with the contaminated soil should be appropriately trained on the requirements of the Plan,and the Plan must remain available on-site throughout the course of the project;and (iii) The contaminated soil located beneath the building and at 2 to 10 feet below surface grade on the Site must remain at depth and may not be relocated,unless such activity is first evaluated by an LSP who renders an Opinion which states that such activity poses no greater risk of harm to health,safety,public welfare.or the environment and ensures that a condition of No Significant Risk is maintained. A� J es J.Decoulos,Licensed Site Professional DATE: September 15.2006 Massachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BWSC113A ACTIVITY & USE LIMITATION (AUL) OPINION FORM Release Tracking Number Pursuant to 310 CMR 40.1056& 40.1070-40.1084(Subpart J) 3❑ - 19954 A. DISPOSAL SITE LOCATION: Beside Canal St 1. Disposal Site Name: 2. Street Address: 15 Broadway Salem 01970-0000 3. City/Town: 4. ZIP Code: B. THIS FORM IS BEING USED TO: (check one) 1. Provide the LSP Opinion for a Notice of Activity and Use Limitation,pursuant to 310 CMR 40.1074. 2. Provide the LSP Opinion for an Evaluation of Changes in Land Uses/Activities and/or Site Conditions after a Response ❑ Action Outcome Statement,pursuant to 310 CMR 40.1080. Include BWSC113A as an attachment to BWSC113. Section A and C do not need to be completed. ❑ 3. Provide the LSP Opinion for an Amended Notice of Activity and Use Limitation,pursuant to 310 CMR 40.1081(4). 4. Provide the LSP Opinion for a Partial Termination of a Notice of Activity and Use Limitation, pursuant to 310 CMR ❑ 40.1083(3). ❑ 5. Provide the LSP Opinion for a Termination of a Notice of Activity and Use Limitation,pursuant to 310 CMR 40.1083(1)(d). ❑ 6. Provide the LSP Opinion for a Grant of Environmental Restriction,pursuant to 310 CMR 40.1071. ❑ 7. Provide the LSP Opinion for an Amendment of a Grant of Environmental Restriction,pursuant to 310 CMR 40.1081(3). ❑ 8. Provide the LSP Opinion for a Partial Release of a Grant of Environmental Restriction,pursuant to 310 CMR 40.1083(2). ❑ 9. Provide the LSP Opinion for a Release of a Grant of Environmental Restriction,pursuant to 310 CMR 40.1083(1)(c). ❑ 10. Provide the LSP Opinion for a Confirmatory Activity and Use Limitation,pursuant to 310 CMR 40.1085(4). (Unless otherwise noted above, all sections of this form (BWSC113A) must be completely filled out, printed, stamped, signed with black ink and attached as an exhibit to the AUL Document to be recorded and/or registered with the Registry of Deeds and/or Land Registration Office.) C. AUL INFORMATION: 1. Is the address of the property subject to AUL different from the disposal site address listed above? a. No ❑ b. Yes If yes,then fill out address section below. 2. Street Address: 3. CityfTown: 4. ZIP Code: Revised:06/27/2003 Page 1 of 2 ILEIMassachusetts Department of Environmental Protection Bureau of Waste Site Cleanup BWSC113A ACTIVITY & USE LIMITATION (AUL) OPINION FORM Release Tracking Number Pursuant to 310 CMR 40.1056 8 40.1070-40.1084(Subpart J) F3] - 19954 D. LSP SIGNATURE AND STAMP: I attest under the pains and penalties of perjury that I have personally examined and am familiar with this transmittal form, including any and all documents accompanying this submittal. In my professional opinion and judgment based upon application of(i)the standard of care in 309 CMR 4.02(1),(ii)the applicable provisions of 309 CMR 4.02(2)and(3),and 309 CMR4.03(2),and (iii)the provisions of 309 CMR 4.03(3),to the best of my knowledge,informati on and belief, > if Section B indicates that a Notice of Activity and Use Limitation is being registered and/orrecorded,the Activity and Use Limitation that is the subject of this submittal(i)is being provided in accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000 and(ii)complies with 310 CMR 40.1074, > if Section B indicates that an Evaluation of Changes in Land Uses/Activities and/or Site Conditions after a Response Action Outcome Statementis being submitted,this evaluation was developed in accordance with the applicable provisions of M.G.L.c. 21E and 310 CMR 40.0000 and(ii)complies with 310 CMR 40.1080; > if Section B indicates that an Amended Notice of Activity and Use Limitation or Amendment to a Grant of Environmental Restriction is being registered and/or recorded,the Activity and Use Limitation that is the subject of this submittal(i)is being provided in accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000 and(ii)complies with 40.1061; > if Section B indicates that a Termination ora Partial Termination of a Notice of Activity and Use Limitation,or a Release or Partial Release of Grant of Environmental Restriction is being registered and/or recorded,the Activity and Use Limitation that is the subject of this submittal(i)is being provided in accordance with the applicable provisions of M.G.L.c.21 E and 310 CMR 40.0000 and(ii)complies with 310 CMR 40.1083; > if Section B indicates that a Grant of Environmental Restriction is being registered and/or recorded,the Activity and Use Limitation that is the subject of this submittal(i)is being provided in accordance with the applicable provisions of M.G.L.c.2 1 E and 310 CMR 40.0000 and(ii)complies with 310 CMR 40.1071; > if Section B indicates that a confirmatory Activity and Use Limitation is being registered and/or recorded,the Activity and Use Limitation that is the subject of this submittal(i)is being provided in accordance with the applicable provisions of M.G.L.c.21E and 310 CMR 40.0000 and(ii)complies with 310 CMR 40.1085(4); 1 am aware that significant penalties may result,including,but not limited to,possible fines and imprisonment,if I submit information which I know to be false, inaccurate or materially incomplete. 1. LSP n: 9360 2. First Name: .lames 3. Last Name: Decoulos 4. Telephone: (617)489-7795 5. Ext: 6. FAX: 7. Signature: e. Date: 09/15/2006 mmlddlyyyy 9. LSP Stamp: ��S)i0FG�4� .S <° JAMES �Ga a J. �m a>T o,DEFQUI VAM Mi kc OS RFc Pr�C .: Xl22J Revised:061 7 '003 Page 2 of 2 OOUM�ONMIEALTR�OF MASSACMISEM DEEDS, DIST. SAlal,MASS A c� r Y0 0 � o Commonwealth of Massachusetts ,, City of Salem ' 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 Return card to Building Division for Certificate of Occupancy Permit No. B-17-1249 FEE PAID: $2,145.00 , PERMIT TO BUILD DATE ISSUED: 1/8/2018 This certifies that BRIMPTS REALTY, LLC has permission to erect, alter, or demolish a budding15BFAW. A1(* Map/Lot: 320055-0 as follows: Additions-Commercial ' �Sr� D PLANS SUBMITTED '` � ING, WOOD FRAME AS 4 Contractor Name: " ' - DAVID G. CLARKE ; DBA: ESSEX BUILDING COMPANYI Contractor License No: CS-015386 & w-,� 1/8/2018 Date This permit shall be deemed abandoned and invalid un"tom tii nths after issuance.The Building Official may grant one or more extensions not to exceed six m All work authorized by this permit shall conform to the n and the approved construction his permit has been granted. All construction,alterations and changes of use of any t>00higltd 4b"res shall be in compliance with the nd codes. This permit shall be displayed in a location clearly visa `'street or road and shall be maintained open n for the entire duration of the work until the completion of the same. The Certificate of Occupancy will not be issued until alit res by the Building and Fire Officials rmit,` HIC#: P ► fund"(as set forth in MGL 042A). Restrictions: ' ' r Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER. Commonwealth of Massachusetts Citv of Salem 1 Washington FI 1 20St,3rd Floor Salem,MA 01970(978)745-9595 x564 , Return card to Building Division for Certificate of Occupancy Structure CITY OF SALEM BUILDING PERMIT Excavation ^�-`J 0 PERMIT TO BE POSTED IN THE WINDOW � p Footing ) —,2q _12? INSPECTION RECORD + f Foundatij Framing Mechanical Insulation INSPECTION: x x. R ak Fir DATE Chimney/Smoke Chamber Final y z • y kF Plumbing/G s n •. 1; u Rough:Plum ir'tg Rough:Gas rs Final Electrical Service Rough Final ? 're ep ent Final Health Department Preliminary Final i ' 7 r , ` n ��.� �■ 3 • ,7 Ap x r✓ V # vi v .k x, "' *SPK w Fnsul �. ' vk y It v M a siwir+Y of r �..�'i .n ,a��•' t rs F Y k .f k ��iwi`+..w+.�r u' �saaac Aftt"Ino/Gas. ete�{ I^1 s y�Mai 9tV�GBOiJ n '40 � E ` f uir� � 1 i t xt 7y C Wl ,r.'e n��ry/ y ":Anal �lnal �: s MAP 33 LOT 1 1 106'f H I 15't I I � I I > NEW FOUNDATION rw coI o o w� tocn MAP 33 LOT 2 1 15't MAP 32 LOT 55 I AREA = 10,000 t S.F. -H I M ' I I , ' I I , ------ ----------------106------------- --- ---- BROADWAY OF INgSS� AS BUILT FOUNDATION PLAN 0 GAIL L. m 15 BROADWAY L) SMITH cn SALEM a N0.35043 0� PROPERTY OF OAF G/STERE° BRIMPT S REALTY, LLC I CERTIFY THAT THE BUILDINGS SS�"A"woS� HEREON ARE LOCATED ON SCALE 1" = 20' MARCH 16. 2018 THE GROUND AS SHOWN. NORTH SHORE SURVEY CORPORATION / 14 BROWN STREET — SALEM, MA DATE PROFESSIONAL LAND SURVEYOR 978-744-4800 #4406 Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 8a'edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Clarke Workshops Date: 12/12/18 Property Address: 15 Broadway Salem MA Project: Check one or both as applicable: X New construction ❑ Existing Construction Project description: Project is to replace existing workshop with new slab on grade workshop building on frost wall with wood framing and roof trusses. See sheets A1.1 and S1.1 for drawings I Thaddeus S Siemasko MA Registration Number: 6028 Expiration date: 8131119 ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [x] Architectural [ ] Structural [ ] Mechanical [ ] Fire Protection [ ] Electrical [ ] Other for the above named project and that to the best of my knowledge,information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept, shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. h<t<t_o aR�, Upon completion of the work,I shall submit to the building official a `Final Construction Con tr P ent . C, NO.60 Enter in the space to the right a"wet"or o BE E Y electronic signature and seal: z 'OF n1 PSS Phone number: 978-927-3745 Email: thad@svdesign.com Building official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 CITY OF SALEM ROUTING SLIP New Construction Certificate of Occupancy (� LOCATION j ) j34-.�Z. U,),4/DATE )a-a/- ASSESSORS a-a/-ASSESSORS DATEa- 93 Washington St. p�� CITY CLERK DATE 93 Washington St. ! PUBLIC SERVICES DATE Z! z 120 Washington St. WATER DATE z/ L! 120 Washington St. CROSS CONNECTIO DATE 5 Jefferson Ave PLANNING DATE 120 Washington St. CONSERVATION DATE 120 Washington St. ELECTRICAL DATE 48 Lafayette St. FIRE PREVENTION DATE 29 Fort Avenue HEALTH DATE 120 Washington St. BUILDING INSPECTOR DATE 120 Washington St. MAP 33 LOT 1 I ' �Tl 06'f I 15' , I I I I > NEW FOUNDATION w N I ooI O IO i O Cri i � O MAP 33 LOT 2 I 15'f t MAP 32 LOT 55 AREA = 10,000 f S.F. I 0 ------ ----------------106------------- --- ---- BROADWAY 10.�P3,Nri UF ,i1gS� °�� AS BUILT FOUNDATION PLAN GAIL L. R, SMITH 15 BROADWAY NO 35(M3 n- SALEM O�Fs G/.S T 0R ki S°ti�� iah PROPERTY OF I CERTIFY THAT THE BUILDINGS BRIMPTS REALTY, LLC HEREON ARE LOCATED ON SCALE 1" = 20' MARCH 16. 2018 THE GROUND AS SHOWN. _- NORTH SHORE SURVEY CORPORATION s (� 14 BROWN STREET — SALEM, MA DATE • PROFESSIONAL LAND SURVEYOR 978-744-4800 #4406 Certificate Number: B-17-1249 Permit Number: B-17-1249 Commonwealth of Massachusetts City of Salem This is to Certify that theInd "s Building............................................................. located at Building Type 1 S BROADWAY in the .....................................City of Salem............................................... ................................................................................................................................................................................................................... .... Address Town/City Name IS HEREBY GRANTED A TEMPORARY CERTIFICATE OF OCCUPANCY Unit 3 This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires S _ a O / 9 ... unless sooner suspended or revoked. Issued On: Friday, December 21, 2018 �� r - ^ � ,,. ^,� The Commonwealth of Massachusetts �• �� Department of Public Safety „/� �v.�,..� \t,�s.achu.clt.tilatr duddin�;Cudr 1780 C\IR)tir�•rnth Edili�m �� City of Salem � Buildin Permit A lication for an Buildin other than a 1-or 2-Famil Dwellin � �� (Thi,tirctiun Fur uf(ici.il Usr Only) — ^ Uuilding Prrmit Vumbrr: Date Applied: `1Z O � Building Insprctur: T T SECTION l: LOCATION IPlease indicate Block N and Lot M for locations for which a street address is not available) �� 13� t�r'.a�"J)6;r:a-` � — 1 .S��r C7/ � /o \'o. and titrrrt Cit�� /Tu�cn Lip Cude Nemr uf Building(if.ipfilicablr) SECTION 2: PROPOSED WORK If Nrw Construc[iun check hrre O ur check all that apply in thr twu ruws beluw Existing Buildin�,�l Repai� Altrritiun ❑ qdditiun❑ Demulitiun ❑ (Piea�e fill uut and+ubmit Apprndix I) ChangeufUse O ChangrofOccupancy O Othrr O $pecify: Arr building plans and/ur construction documents bring supplied as part uf this prrmit applicatiun? Ye+ � No ❑ Is an Independent Structural Hnginrrring Peer Rrview reyuired? Yrs O No ❑ Brief ecrip[iun uf Prupi�sed Wurk: � �C'G'� —�:��GF.�. iN.�i 6v !> �d�iv..�c ��.�' �c�aLZ> .u�.r� �-%l�.Jiwr Si797/�' s lNCiYYvv /� ' -� '/�"��)�f ' SECI70N 3:COMPLETE THIS SEC770N IF El(ISTING BUILDING UNDERGO[NG RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) O ' Existing Use Group(s): � Proposed Use Croup(s): p Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: SECTION 4: BUILDING HEIGHT AND ARFA Hxisting Proposed Na uf Floors/Stories(include basement levels)&Area Per Floor(sq. ff.) (f��./.�� Total Area (sq. ft.)and Total Height(ft.) /��?{j �S' SEC'i'ION 5:USE GROUP(Check ae a licable) A: Aseembly A-1 ❑ A-2r ❑ A-2nc❑ A-3 ❑- A-4❑ A-5 O B: Buainese ❑ E: Educational O � F: Facto F-1 O F2❑ H: Hi Hazard� H-] ❑ H-2 O. H-3 O H-4❑ H-5 O � 1: Institufional I-I ❑ I-2 ❑ 1_3❑ 1_q❑ M: Mercantile❑ R: Reaidential R-1❑ R-2 ❑ R-3 O R-4❑ S: Storage SI O S2❑ U: Utility O Special Use O and please de.xribe below: $pedal Usr: � . SECTION 6:CONSTRUCTION 7YPE(Check as a Ilcable) IAO IB ❑ IIA ❑ IIB ❑ IIIAO IIIBO IV ❑ VAO VBO SECTIOfY 7:SITE INFORMATION Irefer to 780 CNR 171.0 for detaile on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Pertnit: Debris Removal: .. Public❑ C heck i(uubide Flu��d L�mv❑ Indic.itr municif+al O :� trrnch will not he Licrnsrd Di.pu.al tiite❑ � I'ri��ate❑ ��r indentifa Zune:_ ur�m.ilr.c.�rm ❑ reyuirrd �ur trench ur.pecif��: � � prrmit isendu.rd ❑ Railroadright-of-way: HazardstoAirNavigation: �I,\ II�.u�rirt�,nnmi..i��nR��i�� Pn,��,.: .\��1 :\F�F�lir.iblc ❑ I.titrurtin'c�cilhin.urFy�rt,i�,�,ri�.uh.vr.i.' I.thi•ir rrciri�� cimiF•lcti•d.' ��r l�nn.cnt 1�� Rudd.•nd�ncd ❑ 1"r. O ur\'�� 1"r.❑ \'i� ❑ SECTION 8:CONTENT OF CERTIFICATE OF(KCUPANCV li�lili��n ��1(��q1r: ��e(�ruuFq�l: i� �e��l C�umlfuCUun: . F lkaiF�anl L��.td f•cr I�lu��r' I)��c. �hr l�uildin�;rnnt,iin.in tiF,rinkl.�r ti��.lrm.': }�.vaal titi��u�atiuns: �v�� f23 �A,u/75�yr�7 .� D`-ll/J'V'!�S�,�svr.-rY�-rj SECTION 9: PROPER'IY OWNER AUTHORIZATION � M1 � Nam�.tnd Addrrss ol P�uf�crly O�vnrr �a nl C�� #��t'-rs 2�a�r/�u . iz3 , f�E�estw_r S'� �q�'8v� �� Name lPrint) Nu. .ind tilrrrt r��>ir,�,�� z��, Prupertc l)��nrr C�ml.ut Inlurm.iti�m: 1,�� a �,� f p�,3 . � ��„�<,� �� G3`I .,�-�. 7�'r- .�-� Tille Telrph�+ne Nu. �businrss) Telrphonr Nu. (cell) e-mail.iddres. I(applir.iblr, Ihr pru•rrt�•��wnrr hrrrby euthurizrs +"I.e1n/FrG� — Namr � Strcet Addrrss Cih'/Tuwn St.ilr ZiE� _ tu art�m thr �ro+erh'��'nrr'�brhalF, in.ill mattrrs r.la�i.�e w wurk,iuthurized bv this buildin� �rrmit a >>lic.i[i�m. � SECTION I0:CONSTRUCf10N CONTROL IPlease fill out Appendix 2) (If buildin�i�lir.llwn.Ii.UW eu.ft of rnduvv!s uicc and/ur nut und�r Constru.tion Conwl then eh«k hrn O and ski Scctiun IU.U 10.1 Re istered ProEessional Res onsible for Construction Control D�,�e Gu�� `��i. G3`� 2G�o J i I b87 Nam (Re�istrant Telephune Nu. e-mail address � i Registration Numbrr �,►��e..J,�� Fw� w.�,�6� �'-i�- o,< � Strret Address City/T�i'wn 5 W t e Z i p D i s c i p l i n e E x p i r a tiun Datr i 10.2 Ceneral Contractor -GJcY�. O V 1 �IJ�i- �i/"��),� / t / — C�mp.nf)/No.17 C�4.t�i CI' �IJS W � �530.f� Namr u(Perwn Re,Exmsible fur�C,�trucliun ��6�Lic�eE�;o. and Type if Applicable I y3, 9 t��N.tiY — Street Address i City/Town State Zip ,..5(�Ci ��U�1i -- � Tele hone No.(business) Tele hone No. (cell) � rmail address SECTION 11:WORKERS'WWII'ENSATION QJSURANCE AFF[DAVii(M.G.L.c.152. 25C(6)) A Wurkers'Compen�ation 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 ned Affidavit submitted with this a lication7 Yee 0 No O SECTION 12:CONSTRUCI70N COSTS AND PERMIT FEE Estimated Costs: (Labor � Item and Materials) Total Construction Cost(from Item 6) _$.Z3 a�— 1. Bu�lding S /2.D 0 'J guilding Permit Fee=Total Cunstruction Cost x_(Insert here 2:Electrical S j�QD appropriate mu �cipal factor)_$ � 3. Plumbing $��fJ 4. Mechanical (HVAC) $ Note:Minimum fee�__��ontact municipality) 5. Mechanical (Other) � $:30a� Enclose check payable to 6. Total Cust S 'L� '(f' Q 2� � (contact munici ality)and write check number here I, SECTION 13:StGNATURE OF BUILDING PFRMIT APPLICANT Bv rMrrin�; my namr brluw, I hereby altrst undrr thr pains and penaltirs of per�ury that all uf the infurmatiun c�mtainrd in thi+ ,iE,plic.rtion i.trur,ind accur.i[e to lhe brst of my knuwled�r and undrrstandinti. Pl�a.r print end .i�;n n.ime iitlr Tclephunr.V��. Uate I tilrrcl Addre�. Citt�iTu�.�n ti Zif� � �tunicipal L�spe.tor to fill out this section upon appliotion appmvaL• Z U \�,1 e I)ale `L�j 2�• -,�25 "J . . _ . _, _.._ �,.: _ . r - ... ��.:_.,. � ..._��, . • . _:, _ _ _ __ �. � �.� _. .., , ' _ _ ,_ _ ___- -- - - e _ _ .:_ .._.._ ._�-� t� � . � u� O�cG-a� � p�w �S�+—�o,.� {� �osc_ �UX � ��/ ...�� i �,T �l.S`�tJ� . �`^_� ___ _ _ � , �- ---- - 3 . . � O � � '� .�� s�� 5�p� � � � �� , .�� S�'o2��E � � �'N B� Wokr,� s�P. � �� I �j , D� � , _ I- - ��-( - � �� _ _ . � �_-w=_ � _ �2.� �U�'�.►^'1 rvt�� ( ;�D,�� _ — Wq-%N.F fh.�M . . :�x—.� � _ _ . .. - - , ,. �oB ►5 .�ie��b w�-y s��►� THE ESSEX BUILDING COMPANY SHEEfNO. O� oF 25 Chestnut Street �Z Ig a MARBLEHEAD, MA 01945 CAICULATEDBV DATE (617) 639-2640 CHECKED BV DATE � SCALE � '�