282 DERBY - BUILDING INSPECTION -
r) The Commonwealth of Massachusetts
r / Department of Public Safety
I �' +,,.j \Ia.aachuaelb SLue Welding(bile I%80C\IR)!,v%vnihEaltthin -
City of Salem !
Building Permit Application for any Building other than a I. or 2-Family Dwelling
1 rhm 5v:ion For Offlcmi C,e c)nly)
Iludalmg Permit Numlxc Date Applied: Budding In..pvctur:
SECTION I: LOCA r10N(Please indicate Black r and Lae r for locations for which a street ad-dress is not+vail+blel
Nat. and Street .jC6L �,� (-It% /Tuaen 5&14A., Lip Coate J f 9..e, .Name ut Building(it.ipphcot'le)NI f '
SECTION is PROPOSED WORK
It New Cslrtstrurtion check here Our check all that apply in the twu ruws below
- " Etl.ting-Butlding O -�Repair(Z! iam (k•m
- Altrratiun-0 -Addit -O - uliiiurf-O-(('(vase{ill.wt-and-.ubmlt-Aypen+i>t4)
Cha nge of Use ❑ Change of Occupancy O Other O Specify: Ly - n c e, ' ----_
Are building plans and/ur constructiun documents being supplied-Is part of this permit application? Yes Cr Nu ❑
Is an Independent Structural Engineering Peer Review required? Yes O No ❑
Brief Description ut Proposed Work: / / p
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SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Evaluation is enclosed(See/au CMR 3402.0) O
Existing Use Croup(s): Proposed Use Croup(s): r
Existing Hazard Index 730 CMR 34: Proposed Hazard Index 780 CNIR 34:
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
Nu.of FlmrslStories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(.`tq. ft.)and Total Height(ft.)
SECTIONS:USE GROUP(Check as a licable)
A: AssemblyA-1 O A-2r O A-2nc0 A-3 O A4O A-50 B: Business ❑ E: Educational ❑
R. Facto F-I O F2 O N: HI Hazard H-1 ❑ H-2 O H-3 O H-4❑ H-5 O
1: Institutional I-1 O 1-2 O 1.3❑ 1-4❑ M: Mercantile O 1 R: Residential R-1 O R-2❑ R-3❑ R-4 O
S: a S-I O 5.7 ❑ U: Utility O Special Use O and lease JvwrIbe below:
Special L'sr: -
SECTION 6:CONSTRUCTION TYPE(Check as a licable)
IA ❑ IB ❑ IIA O IIB O IIIA ❑ IIIB O "IV O VA ❑ VB ❑
5ECTION 7:SITE INFORMATION Infer to 78O C.NIR I i I.0 fordetails on each item)
I
Water Si::;
ormation: Sewage Disposal: french remit: Uebris Remuv+l:
1'ubbi., InJlc.ltemunicipal O \ trench will not be Llcrn+eal Un ,�.tl}nr❑
t n,dr• re uired Our trench_ on• c.trrn ❑ I permit I.end "vi,i O,Itailro+J nghbuf w+y: Harsrds to Air Navigation: \14 II„t,.n. I ..,n,ru.......
• 'Y \il \ La dl•IrO
I. Irmlulc as ahm.urpnrl.Ippinarh dn'•I' 1.Iltcrt lca scat oanldcicJ' '
ail .•• •.nln Ilwld ciala w'al❑ I '1,-0 r.\u❑ 1a.•0 V. ❑
SECFIO.N&CON rENT OF CERTIFICA IE OF UCCLI-ANCY
' - ndrtn ha n l4
— a/i. _ )•v••Il„ ____ 'iup.un l .al lcr lL ,n
I t.„. ihr Duil,hi`q, nn.ln.tn �I`n n{,lor?a•A•nt'
F(�) Oox
SECTION 9: PROPERTY OWNER AUTHORIZA r1ON
Nan,a•.u,J .\.LIn•s.of I'r,rytvrtc lhvnrr
\.env tPnot) No_md Nrvel l'la, r"`en
I, ,p,rj% lAt nvr C ontact Information: -- — —
ride reiephone No.Ibustnes) relephone No. (cell)
If.tpphc.ible. the prnpertr Im ner hervbs'.,whoriz"
N.tme Tireet Address Gts•i Toten Stale lip
;o act ,m the prop,rt% ,.oner .behalf, m all molterc relattcv to ,work aulhorized by thus building �erm;t a + drr.mon.
SECTION to:CONSTRUCTION CONTROL(Please fill out Appendix 2)
111 l•uddm•n lo.thin 35,txa)iu.ft.ul.•nduvJ+mce andlur not uudvr l.nntrudmn Gn,lrul then check here❑ bon In 11
10..11 Re istered Professional Rrs onsible for Construction Control
U/y✓//� �ji Gp v/i ,{/ — —--
v--(met tit r rp unr u. r-mat -a rrss egutratiun Number
Strut Address City/Town State Lip Discipline Eapimttun Date
10.2 General Contractor
XCompany Name: AS6f' O
Name of Prrvtn Rrnp"Ir far Cunstructfun License No. and Type if Applicable
Tic'/lu /]S/vvd Lillo'n H1/q
Str _ ddress City/Town State Zip
r-t •;w0 /Do ) ,
Tele hone No.(business) Telephone No. cell e-mail address
SECTION 11:WORKERS'CO&WMSATION INSURANCEAFFIDAVIT(M.G.L.c. 152.J 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 O No O
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor Total Construction Cost(from Item 6)=f
and Materials)
1. Building f Building Permit Fee-Total Construction Cost x —(insert here
2. Electrical f appropriate municipal factor)=f
3. Plumbing f
Note:Minimum fee=f (contact municipality)
J. Mechanical (HVAC1 f
5. Mechanical (Other) f Enclosr check payable to
X 6. Total Cost f (contact munici alit )and write check number here
SECTION 11 SIGNATURE OF BUILDING PERMIT APPLICANT
He ,entering my name below.I hereby attest under the pains and pen,dnrs of perjury that all of the mform.m,,n cont.,mrd �n th;..
,I. plic.own is In,e,md accurate to the be,l of my knowledge and unders(and;ng.
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municipal Inspector to fill out this section upon application approval: __ `.�.i.�.J - -
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JAQUITH -- S Ai I A ,
!, No. 2853 �.
Rowley, MA
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JAGNo.2853
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O°4 SPEC And.
DAVID F.
JAQUITH
No. 2853 -
��< Rowley, MA
UJ/LU/Lull ll:JO rAA araa40/uuz LAY1L JAMUiln AM.nllnl10 W.1 VV1
Salem
EERedevelopment
Authority
Salem Redevelopment Authority Decision
January 14, 2011
282 Derby Street(new tenant space): Discussion and vote on proposed
handicap ramp
IRA Decisions
t their meeting on January 14, 2011, the SRA voted to approve the December
0, 2010 DRB recommendation below (including the two conditions), for the
ro osed handicap ramp at 282 Derby Street.
DRB Recommendation
At their special meeting on December 30, 2010, the DRB voted to recommend
approval of the handicap ramp at 282 Derby Street with the following conditions:
- The ramp shall extend west to the edge of the brick sidewalk and east to
the centerline of the expansion joint, as indicated on the 1/6/2011 drawing.
- The cobblestone around the nearby tree shall be flush with the raised
walkway and filled with crushed stone to prevent the tree from rotting.
Staff Comment
The applicant has revised the proposal to conform to the DRB conditions_
Proposal
The proposal, as presented in drawings revised January 6, 2011, is to construct a
ramp on the public sidewalk to make a new tenant space handicap accessible.
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n No.2853
Rowley, MA
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