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11 CHURCH ST - BUILDING INSPECTION (38) k goo C-r- The Commonwealth of Massachusetts VIM Department of Public Safety Massachusetts State Building Code(780 CNIR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (this Section For Official Use 0n1 ) Building Permit Number: Dnte Applied: Building Official: SECTION 1: LOCATION(Please indicate Block #and Lot#for locations for which a street address is not available) Xtem. mik niq 7 )utA No.and Street - City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of NIA State Code used_ If New Construction check here❑or check all that apply in the two rows below Existing Building Repairgj Alteration ❑ 1 Addition❑ Demolition ❑ (Please fill out and submit Appendix I) Change of-Use -❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Is an Independent Structural Engineering Peer Review required? Yes ❑ No Brief Description of Proposed Work: 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(s): Proposed Use Group(s): SECTION 4:BUILDING FIEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)h Area Per Floor(sq. ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION S:USE GROUP(Check as ap licable) it: Assembly A-I❑ A-2❑ Nightclub ❑ A-3 ❑ A-1❑ AS❑ 1 B: Business Cl E: Educational ❑ F: Facto F-1 ❑ F2❑ 1 FL• Hi h Hazard F1-I Cl H-2❑ H-3 ❑ H-4❑ HS❑ 1: Institutional I-1❑ 1-2❑ I-3❑ I-4❑ NI: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-I❑ S: Storage I U. Utility❑ I Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as a Iicable) fit ❑ IB ❑ ❑e\ ❑ If8 ❑ IIG>, ❑ f11B ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 GNIR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: French Permit: Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate numicipal❑ A trench will not be Licensed Disposal Site❑ Private Cl or indentify Zone: - or on site system❑ required ❑or trench or specify: permit is enclosed❑ Railroad right-of-way: hazards to Air Navigation: V-\I_j,.t 'w nnnj.v n I �nsp,_I'rwt,�,,v; Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build unclosed❑ Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Cade Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: ,tipecial Stipulations:_ . SECTI Ng: PROP ERTY OWN Ell AUTI[Olt IZATION Nnnne and Address of Pru erty Owner © ®' U�JV 1� 9iPNIA7S641STikA�/ , Y lJ �u�(Print) No.and Street City/Tows Lip N: �Pr1op�e`rty Owner Contact lnfonnatiufn�, �17 p�� �^�� ' -W� Wl�@ JIAl IFiG �h Title Telephone i'No. (business) Telephone No. (cell) e-mail address If applicable, the property owner hereby authorizes r 0—SW A)c �klr,� �' 0� ame Street Address City/Town Statteo Zip Zip to act on tiie property uwner's behalf,in all matters relative to work authorized by this building permit a2plication. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.It.of enclosed space and or not under Constriction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Maine(Registrant) " etc hone No. a-mad add b res Reg tstration on Number trcc r d lress i /Town State Zip D cipline Es ration Dale 10.2 General Contractor `cName of Person Resp ns' a or Construction License No. and Type if Applicable 1� Iw KVJ/r,� �V�t�rU,aAC —OV� ��Ci Town State Zip Street Address !�'1--�--� �. 1 W��- ��, t-N)tsCi,�h nd SFsI onw N� "fete (tone No. business Telephone No. cell -mail address SECTION 11:tvr:tr.�:ElzS COnIPri\5n ric?w wsur.:wclt:vrn,;tvrr M.G.L.c.152. 25C 6 A Workers'Compensation Insurance Affidavit from the b1A 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 O No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs:(Labor Item Estimated Materials) Total Construction Cost(from Item 6)=S 1. Building y M ii [Building Permit Fee=Total Construction Cost x_(Insert here 2. Electrical $ appropriate municipal factor)=$ 3 Plumbing $ Note: Miniuuun fee=$ (contact mull ality) I. Mechanical (l-WAC) $ /' 5. Mechanical Other $ Enclose check payable to �' G.Total Cost I $ (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I her 1by attest under the pains and penalties of perjury that all of the information contained in this application is true and accura •t the b f i y knowledge and understanding. 1Nt2 6i� 13A4 Pleas• rint and sign me Title T•lephoi Date )i MA Street ddress 7 'city/Town n State Zip \lunicipal Inspector to fill out this section upon application approval: Name Date CITY OF S:V-Y-.) [, , L1SSACHliSETTS Y r BUILDING DEPARTMENT 120 WASHCVGTON STREET, 3ntl FLOOR ` TFL (978)745-9595 FA.e(978) 740-9846 KISIBERLEY DRISCOLl iris♦YOR. TH011AS ST.PtERRH DIRECTOR OF PUBLIC PROPERTY/BUILDL`IG COSL\IISSIO%ER Workers' Compensation Insurance Af9davit: Builders!Contractorq/Electricians/Plumbers Applicant information Please Print Legibly Natric(Businn>.Urganirati°rvindividual): T v lf ' C.. Address: City/State/Zip: &( ��fC �3K I Phone M: AKlonployces u an employer?Che k he ppropriate box: Type of project(required): am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑Now construction (full and/or part-time).* have hired the sub-contractors 2.Eli im a solo proprietor or partner- listed on the attached shcuL t 7Remodeling - ship and have no employees These subconttacton have y. C]Demolition working.for me in any capacity. workers'camp.insurance. 9. Building addition [No workers'comp.insurance 5. EI We.are a corporation and its required.) offieors have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.(No workers'comp. c. 152,41(4j,and we have no 12.❑ Roof repairs insurance required.)t employees.[No workers' comp:insurance requin:d.). 13.0 Other, •AI Lnvyn oapopfnam wihhaocsa alon below showing iheir waken'co rtw don poll y infrmatfam w ofi s this affidavit indicating ihsq in;doing all work and than hire uetsids contractors must submit a new aindavit indicating such :Co nuacton that chuck ihls bex meat actachod on addilfuad ahml showing the name of the sub-contraclare and theft workam'comp.pullry Information. l urn an employer/buNs provldinR workers'compensation Laurancefor my employeeo Below/s the Polley andJob sire lufurince n �r h I ^_ Insumncu Company Nafne; ,' �-�I'CIJ{'i�K /j Pnlicy U ur Self--ins!. Lic. N: v" St —A .12(0— 1© Expiration Date: I/� �t-� p��� lob Site Address: y I CuiC 4 � City/State/Zip.` FA I,/TJ s I vif( 00 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A ut'kIGL c. 152 can lead to the imposition of criminal penalties of a line up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to$730.00 day against file violator. Ile advised that a copy of this statement may but forwarded to the Milieu of Invcsligalions of a DlA fd 'nsurance coverage veriiculiun. Ida hereby a nr h uGrs J penalties of perjury rbut nine infurmulleir prapide ubu is irut and correct. Into• I� P t il• OJJiciu!w'e Duly. Du uor write ire Briar area,to be completed by city or town a fflrlaL i City of ro%vn: _._-_Perm itILIcense.4 N%ulnk Aulhurily(circle one): i. hoard of Ileallh 2. IluiIdIng ❑epartnimtt S.Cityi ruwn Clerk J. Electrical Impccfur i. Plumbing lnspector 6. 0ther Confact Person: CITY OF SALEM, N'LkSSACHUSETI'S BUILDING DEPAR-MENT P 120 WASHINGTON STREET,3" FLOOR TEL (978) 745-9595 FAx(978) 740-9846 K1ffiFRi FY DRISCOLL MAYOR THo.%wST.PtE n DIRECTOR OF PUBLIC PROPERTY/BUILDING CONLIIISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section 11 1.5 Debris, and the provisions of MGL c 40, S 54; Building Permit# is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. , The debris will be transported by: (name bf hauler) The debris will be disposed of in ` A I (name of facility) (address of facility) +,reofcant date dcbri>ut7.dx a Salem ffM Redevelopment Authority Salem Redevelopment Authority Decision October 9, 2013 11 Church Street(The Essex Condominium): Discussion and vote on proposed exterior soffit replacement SRA Decision At its meeting on October 9, 2013, the SRA voted to unanimously approve the September 24, 2013 DRB recommendation for the replacement of exterior soffit along and under the roofline of 11 Church Street (The Essex Condominium). The replacement material will be white PVC. This approval pertains to the work described in the scope of work dated September 11, 2013 and included in the proposal. The following condition applies: • The replacement must look in essence the same as the existing soffit currently appears. Design Review Board Recommendation On September 25, 2013 the DRB voted unanimously to approve the below referenced and enclosed proposal to replace the exterior wood soffit at 11 Church Street (The Essex Condominium) with PVC material. Staff Comment The DRB stressed the requirement for the replacement to look, in essence, the same as the existing soffit, in terms of appearance and style, despite a change in material. The applicant agreed that the replacement would, in fact, look the same as the current soffit. Proposal for September 25 DRB Meeting The applicant seeks to replace existing white/wood soffit, mouldings, dormer rake board, fascia boards, and replace them with white/PVC. The applicant has provided a cover sheet, scope of work, cut sheet, photos of existing conditions, and sample of materials.