100 DERBY ST - BUILDING JACKET RECEIVED
iSPECTIONAL SERVICES
The Commonwealth 9p �v� ell:s26
W
Department of Pntff�Massachusetts State Budding Code(790 CMR)
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Onl
Building Permit Number: Date.Applied: Building_Official:
SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available)
i 100 Dt z , , -Si-
No.
y
„S. and Street "-1 City/Town Zip Code Name of Building(if applicable)
SECTION 2•PROPOSED WORK
Edition of MA State Code used_ - If New Construction check here❑or check all that apply in the two rows below
Existing Building Repair❑ 1 Alteration ❑ 1 Addition❑ 1 Demolition O (Please fill out and submit Appendix 1)
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 ❑
Ism Independent Structural Engineering Peer Review required? Yes ❑ No ❑
Brief Description of Proposed Work: 6n Pie /tiTCL•o... F' 431•, af�.t, c�-ixr.i+-c.S
Sc+(Vl(f L-^CC7rC✓r
UPCr ( 7> xP y"cor— open G <u q—c�, -1.�o 'TdP
SrC�.,-, � rcPrc�rr.., ¢�v s� ram. F�r.r•� -ro crc�,.r� �-rc'�F cF�=cL-.
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) O
Existing Use Group(s): Proposed Use Group(s):
SECTION4: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 a plicable) - - -
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-I❑ A-5❑ B. Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ -H-4❑ H-5❑
I: Institutional [-1❑ I-2❑ I-3❑ [-1❑ M.
Mercantile❑ R: Residential R-1❑ R-2 O R-3❑ R-4 Cl
S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6.CONSTRUCTION TYPE(Check m applicable)
IA IBO IIA ❑ 11B ❑ r I IIIA ❑ IUB ❑ 1 IV ❑ 1 VAO VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for detafls on each 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: NIA)I tistoric,C...mission lhevww._Pnki_s:
Not Applicable❑ Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ 1 Yes❑ or No❑ 1 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:
FO 1-- 01 N Do W S I N 5 71Z may'
,SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of.Prgperty',Oiv"1 j;UI :
flosftrle�P1 ;( sLve-k lob Derimy 5:7— Sci1em iHPt Gla�o
Name(Print) d :') �+ No.and Strre et.- City/Town Zip
r
Property Owner Contact Information:
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
Coy 141kj,rfr/ 10'S SStan¢toeD QP cotmew945 ih� rYL�s�
Name Street Address City/Town State Zip r
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). - -
if buildingis less than 35,000 cu.ft.of enclose dI space and/or not under Construction Control then check here 0 and ski Section 10.1 f
10.1 Registered Professional Responsible for Construction Control
eM
1
KA(AU STSy CA raj ime CC4 .
Name Re istrant Telepphone No. e-mail address Registration Number
(03 II��.ch�toCic> Ca(vrgLCir�Y fHh c QzcSFf
Street Address City/Town - State Zip Discipline Expiration Date
- 10.2 General Contractor-
IkC Gefut�� Co,.Trc�� TnL
Company Name
Name of Person Responsible for Construction License No. and Type if Applicable
(DS 1310L�<? .,Crr> rzo 6VL(�C�CD—'e ("iA-- 02-t_SY_
Street Address City/Town State Zip
��_STS g �'ac c�� Grxy Lu f}GGcr1CrR1 ConnraeTr'-`� I r1G (n'"�
Telephone No. business Telephone No. cell e-mail address
SECTION 11:ii'ORKEhS'(AMPF:NSA'IION WSUItAN(Ji AF67lJAV1"I' 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 O No ❑
SECTION 12.CONSTRUCTION COSTS AND PERMIT FEfi -" - --
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$
1. Building Building Permit Fee=Total Construction Cost x_(Insert here
2.Electrical $ I a,040 appropriate municipal factor)_$
3.Plumbing $ tf
d. Mechanical (RVAC) $ -7w� Note:Minimum fee=$ (contact municipality)
5.Mechanical Other $ Enclose check payable to
6.Total Cost $ (fI "5'2 (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By 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 le best of my knowledge.and understanding.
Please print and sign name Title Telephone No. Date
(05 czc> CarCSQ f iR'
Street Address City/Town / State Zip l
Municipal Inspector to fill out this section upon application approval: J
Name(/ Date
30-0"
I
EXIST BEARING
15'-0' (V.LF.) - . WALL TO REMAIN -�^'cY(4
I
I
i
0 4
ALIGN WITH EXIST LALLY COLS v
IN BASEMEN[, FIELD VERIFY
EXISTING FOUNDATION SIZE
L
I � 45
i
NEW TWO 1Y X 11)S' LVL
BEAMS ON 3)f' X A"
I�j y VERSA-LAM COLS AT EACH
END. AC POST CAP
A L AT EACHPSON BEAM 0 COL CONN. ASK S�
EXIST FLOOR
S PRIOR FRMBNG TO REMAIN
T 2X10
w,
EXIST BEARING
WALL TO REMAIN
I
EXIST WOOD EXTERIOR
Ap WALLS (TYP)
SECOND FLOOR PLAN SHEA RESIDENCE
ALLAN W. DENNIS P.E. 100 DERBY ST.
8 WHEELER PLACE SCALE: 3/16' = 1'-O' SALEM, MA.
3 MARBLEHEAD, MA
781-718-2841.
2X6 COLLAR TIES AT EXIST 2X10 RAFTERS AT 24"
24' O.C. O.C. ADD ADDITIONAL 2X10 `
n
7'-0" ABOVE FINISH THE�EXISTIN F OAOBTAI J BETWEEN FLOOR 2XIO'AT 12" O.C. m
2X10 CEILING JOISTS THREE NEW TRIPLE 2X10 a
0 16" O.C. WITH TIES AT 6-0' O.C- m
SUBFLOOR TO ! m
REMAIN I 1. SIMPSON H2.5 HURRICANE TIES �0
- 3 0 FLR-ELEV _ _ _._ __
AT EACH RAFTER (TYP) a
[1� 3
2X4 0 16' O.0 STUDWALLS
EXIST BEARING - y SHEATH94G (1YP)
ep 4 WALL TO REMAIN{ !
2N0 FLR £LEV� ,
1
NEW TWO IW 11Yi LVL
BEAMS ON 5S" X
VERSA-LAM COLS AT EACH
n i END.
1ST FUR ELEV STORE /M \
EXIST
w EXIST
3Xi" A 1EXIST MAIN PAVEMENT
PIPE COL gEAy
NU m
g < ,i FIEID VERI I I CONCRETE SLAB
a
om9N FOOTRJG 51 � ' ON GRADE
W��95 t i
3 yJjim _
2'-6" I` �� SHEA RESIDENCE
a m n SOUARE 100 DERBY ST.
SALEM, MA.
SECTION A-A �— m
a
SCALE! 3/16" = 1'-0"
EIT�OF-S
PUBLIC PROPERTY
r DEPAIt'T24jE,�T
MAYaa
TEL 97a-745-gM♦FAX 97a•740.9W
AppLICATION FOR TRF REPAIR. RENOVATION CONSTRUCTION
DEMOLITION OR GRANGE O*USE OR OC('[rr, Cy FOR ANY QS �•
STRUC IR OR BUILDtNr
1.0 SITE INFORMATION
Location Name: Building;
PropertyrAddresa:--I(�('_-1�C.213y Sr • _ _Property Is located In a;Coneervadon Area YIN_A _H�ppAc DIaMd YM
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name: f 7-
v " -
Addreaa
S 7�
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN E7(ISIWQ BUILDINGS ONLY
Addition Existing
Renovation Number of Stories Renovated
Change in Use
New
Demolition
Existing
Approximate year of Area per floor(sf) Renovated
construction or renovation
Of existing building New
9dd Description of Proposed Work:
itEl��t/L
1 tt�rti,6 o w
C',tiL f ✓ZEt'C 4 Hi:
/ �c�o l� tc� 13 is i�t�t 13Ac/a�
Mail Permit to: —
c�uvl�y� .h/�. 01s60
What is the current use of the Building? 1i1eny Linda?�---
if dwelUng,ttow r
Material of Building? Asbestos? �O
Wit the guiding Conform to Law?
Archtted's Name ( )
Address and Phonf ti s f t, f tv•�
Mechanies Name
Address and Phone h<< .� ►S /y�S7 6
se C� g 3 9 s 6 HIC Regbtration N
Constnicticn Suf>a(Visors License _-----
Of Projed S6 Fn/ c2o Pernit Fee Calculetkut
Estimates Co Permit Fee S 7" Estimated Cost X S7K1000 Residential
x'—
Estimated Cost X i111S1000 Commerola�--
- - An Additional$5.00 Is added as an
Administrative charge.
Make sure that all fields are properiy and legibly written to avoid delays in proce"ng.
The undersigned do"hereby apply for a Building Permit to build to the above stated
specifications. Signed under penalty of perjury
Date
'k ~
a
cb
-
Salem Historical Commission
120 WASHINGTON STREET,SALEM, MASSACHUSETTS 01970
(978)745-9595 EXT. 311 FAX(978)740-0404
CERTIFICATE OF NON-APPLICABILITY
It is hereby certified that the Salem Historical Commission has determined that the proposed:
❑ Construction ❑ Moving
�L Reconstruction ❑ Alteration
+L7 Demolition ❑ Painting
❑ Signage ❑ Other Work
as described below does not involve an exterior architectural feature or involves a feature covered by the
exemptions or limitations set forth in the Historic District's Act(M.G.L. Ch. 40C) and the Salem Historic
Districts Ordinance.
District: Derby-Street - ..
Address of Property: 100 Der
p ,y. , by Street
Name of Record Owner: Martine Shea
Description of Work Proposed:
Repair/replace clapboards and window sash and/or casings to replicate existing. Repainting house to replicate
existing. No changes in color, material, design, location or outward appearance. Non-applicable due to being
in kind maintenance/replacement.
Dated: May 8, 2007 SALEM HIS OMMISSION
By:
The homeowner has the option not to commence the work(unless it relates to resolving an outstanding
violation). All work commenced must be completed within one year from this date unless.otherwise indicated.
THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of
Buildings (or any other necessary permits or approvals) prior to commencing work.
Commonwealth of Massachusetts
60 Sheet Metal Permit TT
Date: c( � I b Permit # U
Estimated Job Cost: $ �� � , `— Permit Fee: $
`Q Plans Submitted: YES NO Plans Reviewed: YES NO
1 Business License # Sk C Applicant License # T—013c/& S Jeff eJCC�/L ti
P;�7 2 II <35 st�E�r fir ,
Business Information: Property Owner/Job Location Information:
Name: J-/W-74791u<�- Name: AC r9 r-AA�lCd( �d/1/T/7AC77�G
Street: � Tj cAt -,D,W / street: Jbb J7 "1 , 7-
City/Town: w City/Town:
Telephone: � 72� Telephone:
Photo I.D. required/ Copy of Photo I.D. attached: YES NO
s„rr om�::i
J-I NI4-I-unrestricted license
J-2 / M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. / 2-stories or less
Residential: 1-2 family /' Multi-family_ Condo/ Townhouses— Other—
Commercial: Office Retail Industrial Educational
Institutional Other
Square Footage: under 10,000 sq. ft. �/' over 10,000 sq. ft. _ Number of Stories:
Sheet metal work to be completed: New Work: Renovation: !� x
1IVAC v Metal Watershed Rooting _ Kitchen Exhaust System_ m
9 �
Metal Chinmey/ Vents Air Balancing_ N zC')
.a >
Provide detailed description of work to be done: CAM
rn
17'�ClJrA� QA)G (�1 14/ -rSOS4S-fi'l 1-0AWZ-WS-1 yC �rwl>-�
r�tiu>✓o � j� � I �
INSURANCE COVERAGE:
I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yelil� No❑
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement.
Check One Only
Owner Agent ❑
Signature of Owner or Owner's Agent
By checking this box[],1 hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and
accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit Issued for this application will be
in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Duct inspection required prior to insulation installation: YES NO
Progress Inspections
Date Comments
Final Inspection
Date 3 Comments
cn
Q-
V. Q Type of License:
By t-- ❑ Master
=Y
Title ❑ Master-Restricted
City/Town
❑Journeyperson Signature of Licensee
Permit#
❑Journeyperson-Restricted License Number:
Fee 3 ❑
Check at wavw.tnass.govld111
r
Inspector Signature of Permit Approval