122 DERBY ST - BUILDING JACKET . . �� � � c��. �z�sZ ����
� The Commonwealth ofMassachyse�C"TIONAL SERVIC $ c��oF
� Board of Building Regulations and Standards SALEM
Massachusetts State Building Code, 7$Q'CIyJ� I 4 . Revised Mar 2011
[d b MAN
Building Permit Applica[ion To Construct, Repair,Renovate Or Demo is�a3
One-or Two-Family Dwelling '
This Section For Official Use Only
� Building Perntit Number. Date Ap ed:-�
ti �A � 31�6 �
NBuilding Official(Print Name) Signature Date
.� SECTION 1: SITE INFORMATION
� 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
I i z� �� �, ��t.-<-�a
� l.la is this an accepted street?yes_ no Map Number Parcel Number ,
I 1.3 Zoning lotorma6on: . 1.4 Property Dimensions:
Zoning District Proposed Use Lo[Area(sq ft) Frontage(ft)
1.5 Building Setbacks(tt)
Fron[Yard Side Yards Rear Yard
Required Provided Requ'ved Provided Requved Provided
1.6 Water Supply:(M.G.L c.4Q§54) 1 J Flood Zone Intormatioo: 1.8 Sewage Disposal System:
Public Q' Private❑ Zone: _ Outside Flood Zone? Municipal fd'On site disposal system ❑
Check if yes�
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
f2 b.r.ra l� .ak,'nsl�pw No✓¢�i /4ndn�tv f??� O/ BN �
Name(Print) Ciry,S[ate,ZIP
/l9 A�-��-r+n F�v+nv�c 9?8 3(p� 'o7YS�
No.and Street Telephone Email Address
SECTiON 3:DESCRIPI'ION OF PIiOPOSED WORK�(check all that apply)
New Construction❑ Existing Building C9" Owner-Occupied ❑ Repairs(s) L9" Alteration(s) � Additio� ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
BriefDescriptionofProposed Work�: Qp / cn-/i'a✓i o-�' eyci-�.F- 'n� n�r� L�s �n � 'ao w.c//
n o � cc�i,s�!-�c � i'/. � �� r! .c ' �
-Y 1 1 � 2.r'l ' ti I Cl.( (✓ � �
' w o � ie c
SECTION 4:ESTIMATED CONSTRUCTION COSTS
T[em Estimated Costs: Official Use Only
Labor and Ma[erials �
1.Building $ 1 S UaU ,"' l. Building Permi[Fee:$ Indicate how fee is determined: .
i
2.Elecfrical g ❑Standard City/Town Application Fee
'`j.�000 ��tl ❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ � � 2. Other Fees: $ �
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Su ression Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ {'7+ D 6G ' `J . p paid in Full ❑Outstanding Balance Due:
'M tat��o �o t�.,�sv c.� 3 Ll S
SECTION 5: CONSTRUCTION SERVICES
51 Construcfion Supervisor License(CSL)
` Y3 '7
�'��-��^^ � 1 �hC �'1 License Number Expiratio Date
Name of CSL Holder � , /
' List CSL Type(see below) �/
7� �, N o✓-fh .Sfr-c.��
No.and Street Type DeScription
� U Unrestricted(Buildin s u to 35,000 cu ft.
. �✓t��YVl {� � 6� �7� R ResVicted 1&2 Famil Dwellin
City/I'own,Sta[e,ZIP M Maso �
RC Roo£n Coverin
WS Window and Sidin
� SF Solid Fuel Buming Appliances
T Insula[ion
Tele hone Email address D Demolition
5.2 Re�stered Home Improvemeot Contractor(HIC)
iJ.78�3 , �7
(.tJ �- c-� HIC Registration Number xpi tion Date
HIC Company Name or HIC Re strant Name
� .s�z nlnv-{ �S ✓ec_�' fi���nc�nfrr+cfar�) ve�iZO
No.an Stree[ Email address � y�i-f-
. St<h�-!1'Y)�� �� Ql� 7�
Ci /1'own,State;ZIP Tele hone
SECTION 6:WORKERS'COMPENSATION INS[JRANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6))
Workers Compensation Insurance affidavit must be wmpleted and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issua�ce of the building permit.
Signed�davit Attached? Yes ..........� No...........❑ -
SECTION 7a: OWNER AiJTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUII.,DING PERMIT
1,as Owuer of the subject property,hereby authorize G✓ 7/'n w. �v h cr�
to act on my behalf,in all matters relative to work authorized by this building pernut application.
R�6�r� /�r�'Li n S Yl v1 �.✓ �N �2C7/�
Print Owner's Name(Electromc Signaliue) Da[2��-
SECTTON 76: OWIV�ER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of pepury that all of the infortnation
contained in this application is trve and accurate to the best of my knowledge and understanding.
�1l•,,�.� -�,,, ✓1 ��� y / � �, � �,
Print Owner's or Authorize AgenYs Name(Elechonic Signature) Dat�T e-
NOTES:
1. An Owner who obtains a building permi[to o is/her own work,or an owner who hires an unregistered confractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbi[ration
program or guaranry fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.eov/oca Information on the ConsWction Supervisor License can be found at www.mass.eov/dos
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basemenUattics,decks or porch)
Gross living area(sq.ft.) Habitable room count �
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches �
Type of cooling system Enclosed Open
3. "Total Projed Square Footage"may be substituted for"Total Project CosY'
�f�l�l._. '• G� � g -� 8"b`�~ (oO�s �
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.. . . . • . . .. � 'F '
DERBY STREET
� �¢�_��� li� 5 I D E W A L K z��_m�� �
�� I STORY � 2 STORY � . .
� EXIT EXISTING WINDOWS r �
" __i EXISTING WINDOWS
4 I\\\�
} Q DISPLAY TABLE
Q � EXI5TIN6
v Q DOOR EXISTIN6
TABLE
� - - -
� I �
� � � � � id,_5��
�
`� w � PROVIDE NEW PARTITION
� o] z � � EXISTIN6 HOOD
� O WITH RE-LOGATED
� z v I � EXISTING WINDOW UNITS TO REMAIN
O
a DISPLAY X �j I I �
� TABLE W � I z Q � I J , I - - ���.��qED A 2��,�..
JONN F
W v 3 � I Q � O EXISTING GANDY n � ��a �' ,
LL � � I I KETTLES TO REMAIN � ���1� °' � ,
Z tfl Z � � 6�'(�TJ, L 'i
I c. i
�p � � wm � II X � � PJ. G�.
� Q � I i � � O
� o � � I
� � � I
co�uMN I � � O SCOPE OF V�O� K
� I �
� �O � � l. RELOCATION OF EXISTING NON-BEARING WALL PARTITION.
� EXISTING GANDY � 2. RELOCATE EXISTING CASEWORK
FtDJ. STORAGE BAR SHOWGASE �� � EXISTING 3. PROVIDE NEW WALL CEILING FINISHES
EXISTIN6 � / TOILET ROOM
GASH 4. PROVIDE NEW CEILING/LIGHT FIXTURES
REGISTER I ' EXISTING
I I I SINK �\ �
exir OCCUPANCY LOAD = 20 PERSONS
EXISTIN6 I, I � ( TO SASEMENT EXIT
DOOR Q 'I �—b
. I I I EXISTING
, i DOOR SALES AREA = 535 SF.
1/30 = 17 OCCUPANTS
I KITCHEN = 30CCUPANTS
n FLOOR PLAN TOTAL = 200CCUPANTS
� SCALE: 1/4"=1'-0"
Zelloe + Weaver FLOOR PLAN
ARCHITECTS, LLC � JOB #: 16002
s9PARKST. Ye Olde Pepper Company SCALE: 1/4"=1'-0"
BEVERLY,MA 01915 � 122 D@fby Sff@2f DATE: O1.27.16 A� 7
978.921.6309T Salem, MA 01970 DWN BY: KL
978.921.6316 F �
CROSS REF.
NOTE: GG TO GONFIRM BEAM DIMENSION
� � EXISTING TIE-RODS AND BEARING PRIOR TO DEMOLITION
I I OF PARTITIONS.
I 3
� A-2
� � �
� �
— - - — — -- � ; - -� �
I RAFTER
i
I I
i �
_ TI — � — � � — I
I I � � �
I I J�GGTO VERIFY
I I � BEAM SIZE
RELOGATED I I � VyALL FRAMIN6
WALL � � �
II FLooR
EXISTING STEEL
II � POST
� �
I I REMOVE EXISTING
I I ; NON—BEARING PARTITION
� EXISTIN6 8X8
I I /
EXISTING i EXISTING WOOD � EXISTING STEEL TRU55 BEAM SIZE
GOLUMN BEAM POST To BE VERIFIED
i
i
EXISTIN6
WALL � EXISTIN6 GEILIN6 STEEL GOLUMN
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� �\S�EpED Aq�,�,i
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" NO.f91� "' �
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���� SECTION 3 DETAIL �a�, ,�,s��
�" SCALE: 1/4"=1'-0" SCALE: 1"=1'-0"
- 4�
Zelloe + Weaver SECTION & DETAIL
ARCHITECTS, LLC JOB #: 16002
59PARKST. Ye Olde Peppec Company SCALE: VARIES
BEVERLY,MA 01915 122 Derby Sireet DATE: 01.27.16 A�2
9�s.92t.63o9T Salem, MA 01970 DWN BY: KL
' 978.921.6316 F
CROSS REF.