10, 12, 14, 16 CELESTIAL WAY, BLDG 18 - BUILDING PERMIT APP -tt- ( -1 to So
$2010M. $Z 2 (�
The Commonwealth of Massachusetts
Department of Public Safety
Massachusetts State Building Code(780 CMR) r��
�J Building Permit Application for any Building other than a One-or Two-Family Doing ; b
(This Section For Official Use Only):f+ ` "
cr f**
J Building PernvtNumber• Date Applied ' -' Banding Offical., "t e.r
SECTION 1:LOCATION(Please indicate Block#and Lot,#,foetocations for which a street address is not availAble) 7r,
Bldg 18 10 121416 Celestial Way Salem 01970 Sanctuary Condominiums JNo.and Street City/Town Zip Code Name of Building(i£applicableD'SECTION2PROPOSED�4YORK ,Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows*;low
Existing Building❑ Repair❑ 1 Alteration LI Addition❑ I Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:
Are buildingplans and or construction documents being supplied art of this permit application? Yes ❑ No C
P / gPP as P P PP
Is an Independent Structural Engineering Peer Review required? Yes ❑ No 19
Brief Description of Proposed Work: Remove and replace roofing Shingles
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(,): esl en a Proposed Use Group(s):
SECTION 4:BUILDING HEFGFIT.AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTIONS:USE GROUT'(Checkti`s a licdble)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ All❑ A-5❑ B: Business ❑ E: Educational ❑
-1❑ -1 -2 -3 ❑ -4❑ H-5❑F: Facto F
I: Institutional I-1 ❑ 1-2❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2❑Y R-3❑ R-4❑
S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTILIN,TY'VE(Check as a plicable); 1'
IA ❑ IB ❑ IIA ❑ IIB ❑ ILIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑
SECTION 7:SITE INFORMATION,(re£er to 780 111.6 for details oueach item),
Water Supply: Flood Zone Information: Sewage Disposal:
Trench Permit: Debris Removal:
Public❑ Check if outside Flood Zone❑ Indicate municipal❑
A trench will not be Licensed Disposal Site❑
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 R'mew 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:
•., * SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Sanctuary Condominiums Salem 01970
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
Charles Minasalli 25 Spaulding Rd Ste 17-2 Fremont NH 03044
Name Street Address City/Town State Zip
to act on the propertv owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix,!) - -
If buildingis less than 35,000 cu.ff of enclosed space and or not erider 6"uchon Contfol then check here Cltand skt Section 10.]
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 -
KTM Properties LLC
Company Name
Charles Minasallli 160139 HIC Exp. 6/25/16
Name of Person Responsible for Construction License No. and Type if Applicable
25 Spaulding Rd Ste 17-2 Fremont NH 03044
Street Address City/Town State Zip
603 895 0400 603 231 1677 tara@ktmproperties.com
Telephone No. business Tele hone No. cell e-mail address
SECTION 11:SVC7RKEItS'-CC)MFF,'VSATTON['VSUItANCE 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 15 No ❑
SECTION 12 CONSTR I CTION=COSTS AND PERMIT:FEE:
Item Estimated Costs: (Labor
and Materials) Total Construction Cost(from Item 6)_$ 20,000.00
1.Building $ 20,000.00 Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ - appropriate municipal factor)=$
3.Plumbing $ -
4.Mechanical (HVAC) $ - Note:Minimum fee=$ (contact municipality)
5.Mechanical Other $ - Endow check payable to
6.Total Cost $ 20,000.00 (contact municipality)and write check number here
SECTION 13:SIGNATI7RE OF BUILDING PERMIT APPLICANT,., `
By entering my namep; . o -below,I hereby attest under the ains and penalties of perjury that all the information contained in this
application is true a Id accur to t the bes of my knowledge and understanding.
N` President 60389895-0400 6/7/16
sa i
Please print an sign � e ar esina Title Telephone No. Date
25 Spaulding Rd 17-2 Fremont NH 03044
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval
'Name Date