4B DEWEY DR - BUILDING INSPECTION (002) JACKET I
The Commonwealth of Massachusetts
Department of Public Safety
i ! :\I.ISS.trIMSHNSlatyBuilding;Qnle(780ClIt)
Building Permit Application for any Building other than a One-or'I'wo-Family Dwelling
v
` (Phis Section For Official Use C1nly)
Building Permit Number: _._ _ Dale Applied: Building OfflCiJI:
SECTION 1:LOC'A-1[ON(Please indicate Block N and Lot R for locations for which a street address is not available)
No.and Street City/Town Zip Code Nance of Building(it applicable)
SECTION 2:PROPOSED WORK
Pdition of MA Slate Code used If New Construction check here❑or check all that apply in the two rows below
Existinl; Building❑ Repai :Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
"Cliaitge of Use ❑ Ch,ulgeof OCcupanC,v ❑ 1 Other ❑ Specify:--___ _
Are building plans and/or construction tit wuntemts being supplied as part of this permit application? Yes ❑ No ------
IS an bnlependent Structural Engineering Peer Review required? Yes ❑ No Ib'
Brief Description of Proposed Work:-_
_—����+1CS' Oti EE_ �Frro �J�c•t. sti GX! �Cr Go�iYTl�-�S..---
SECTION 3:COMPLETE THIS SL'CrION 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 CNIR.14) ❑
Existing Use Group(s): __. Proposed Use Grou p(s): -_
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Flours/Stories(include basement levels)&Area Per Floor(sq, ft.)
Total:Area Sti.ft.),utd Total Height(ft.)
SECr1ON 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ •A-3 ❑ A-4❑ A-i❑ 1 B: Business ❑ E: Educational ❑
F: Factory F-I ❑ F2 Cl I 11: Ili h Hazard H-1 ❑ H-2❑ I1.1 ❑ 11-4❑ I i-S❑
1: Institutional 1-1 ❑ 1-2❑ 1-3❑ 14❑ �Vt: if
❑ R: Residential 11-10 R-2❑ R-.1❑ It-4❑
S: Storage S-1 ❑ S-'_❑ U: Utility❑ Special Use❑and please describe below:
Special Use
SECTION 6:CONS'rRUCr10N IYPE(Check as applicable)
IA ❑ IB ❑ IIA ❑ IIB ❑ IILA ❑ IIIB ❑ IV ❑ VA VB0
SECr10N 7:SITE INFORMAFION(refer to 780 CNIR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: i'rench Per olh Debris Itemoval:
Public❑ Chet it outside Ilmad Zone❑ Indicate municipal❑
:1 trench will not be Lircnsod Disposal Sitc❑
required ❑or trench or specitv'...__
Private❑ or iudenlify Cane: unm site sysh•m ❑ permit is I'M 10 ad ❑ _ -...
Railroad right-of-way: Hazards to Air Navigation: .i- , .. .. .
\'el :Applic.ibly❑ Is Sl ntchve within airport appmaclt area' Is their review complvlwl'
or 61111e1t to Bu Jd curl..+vd ❑ 1 es❑ or.No❑ I 1 es❑ No ❑
SFC 110N H:CON'I FNT OF CI'.Ri IFICAPL'OF OCCUPANCY
L w Cnnip(s): - - . I\Pe 0d C0nulniclew: Ott upant pvr I k.or
I lovs the building wwain an Sprinkler St stops.': tipn ial Slipulolinits: .j �.
SECTION r): PROPI(R'1'Y OWNER AUT IIORIZA'IION
- — ------- —
Name and Address u/t Proporq�Otcncr / /r
Name(Print) No.and Street Cih'/Town Zip _--
r
Property Owner Contact Information:
-
I itle -- -- telephone No.(business) Telephone No. (cell) e-mail address
If applicable, the property owner hereby authorizes
�r.vi1.✓ o.Cc.s rT- /StlST•� frC---1-, v AfAoL GJ644•'^'- �'1� G'/ 61
Nance Street Address City/Town State Zip
to act on the property owner's behalf,in all matters relative to work authorized b• this building termit a t plication.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
if t,u il1 is less than 35,000 cu.ft.of endoscal space and/or not under Construction Control then check here D and skip Section I0,1
15.1 Re istered Professional Responsible for Construction Control
�r� ,fie« 4_7Yb��_`�39P 7Z77Z
Name(Registrant) relephone No. c-mail address Registration Number
Street Address City/Town Stale Zip Discipline Expiration Date
10.2 General Contractor
/,t/rN/Jow Gr/a�c/> oK aJ,u xi
Company Name
V.-me of Person Responsible for Construction License No. and Type if Applicable
Street Address City/Town State Zip
WF -/ i'j-- e-l(-d
Tvle phone No. business Telephone No. cell a-mail address
SECTION 11:tat wKI i,rt.i.)\yu v..NIio\ Ie. nt:.tvt'I a I I 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 h)provide this affidavit will result in the denial of the issuance of the building permit.
Is a signed Affidavit submitted with this a lication? Yes❑ No O
SECTION 12.•CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor y
and \laterials) Total Construction Cost(from Item h) -S_ r2 /
1. Building S Building Permit Fee=Total Construction Cost x_(Insert here
'_. Electrical S appropriate municipal factor) =S
3. Plumbing S
4. .Mechanical (HVAQ $ Note: fee=5 (contact municipality)
5. Nleclianical Other $ Enclose check payable to
h, rotal Cost S , m�i(contact mcipality)and write check number here
SECTION 3:SIGNATURE OF BUILDING PERMIT APPLICANT
BV enuring ntv name below, I hereby attest under the pains,md penalties of perjure' that all of the information contained in this
applir.dion is toe and,ucur,ne to the hest a tV kn t%led) and understanding.
Plc ut ot,wd if n name r I,ills h 1 bane No lt,ur
�Irect Address Cih'/raven State Zi
A- P
Municipal Inspector to fill out this section upon application approval:
------ ------ -- N,uuu — - - hate
I
DEC-3er--2011 22:3B FROM:PICKMAN 97e 741 7666 TO:17819324828 P.1/2
OEC-16-2011 23:37 FROM: u:l7ftilYlfpt�b r.�• �
American Properties Team, Inc.
i
i
' TO: 4B Dewey
FROM JetttlJfer Pappas,Property Manager
RE: Window&'Slider.Replacement
DATE' Decembar 23, 2011
I
■�s�f�f iiaififf gfi•fti:�y��f•ff gifif if►,f�,rifiYffff iiif.if fYY Yf YYff�ffifp
.. i
Please be advised that the Hoard of Trustees for Piclanan Park has approved replacement
windows and'a replacement slider for the above referenced unit This approval is contingent upon
them matching the existing windows/slider'and that they fit in the existing opening.{Installation
must be completed from the inn for of.the unit and they must be the same in appearance from the
exterior. Should the installation be completedfrom the exterior of the unit, you will be:
responsible for any damage,that your:contractor night cause(this includes painting). The Board
,rill not allow windows/sliders with grids, crank outs, etc, Should your contractor find any rot or
damage during the window,installation, please make sure that it is reported to my office
immediately.
We also require that permits be pulled.in advance.(regardless of what your contractor may tell
you); and then a copy of the final approved pernut once completed must be sent to APT for the
unit file as well. We also recommend that 16w4ers obtain a cerrificam of insurance ltom the
licensed contractor.
You will:need to bring a copy of this.letter to the.Salem Building Department in order to receive
your petinii.
'Should you have any questions or require additional information,please feel free to call me
directly at(781)569-2675.
wt Unit File
I i
i
Soo WrS7CuIOMMOPAnK.SUntS=0•WeaUAa.MA,01,001.76P03N32.0 FAAM-930AS01
I
I
I
TM f
�r
"Simply the Best for Less
Window World of Boston
24 Cummings Park, Suite 15A
Woburn, MA 01801
(781) 932-4800 • Fax: (781) 932-4828
www.w i n d o ww o rl d of b o sto n.c o m
DP55 211646 IIIlilllllllllllllllllllllllllllllll
AMI
Series 4080 Double Huns
National Feneshafion -CPOa BSB-R-11-00BIG-00001 -
1 RatmgCouncllg SOLID VINYL - VELOEO - DOUBLE GLZO
13/1G IG. OS LOE-ETC. ARGON
I
ENERGY PERFORMANCE RATINGS
U-Factor Solar Heat Gain Coefficient
-030 1 . 70 0 . 30
(A./I-P) (Metric/Sl)
_ ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance Air Leakage
. Manufacturer stipulates that these ratings contend to applicable NFRC procedures nor determining whole
product pennrmanca.NFRC ratings are determined for a fixed setoi environmental conditions and a
specific prodagt size.NFRC does not recommend any product and does not warraniths suitability of any
product for any so d is use.Consult manufacturer's literature lot other product performance information.
wdrva.nlrcmg
PUBLIC PROPERTY
DEPARTMENT A O I
KI%QWA N ORISaXt - C�
N.va. 130 wAsH1N=W!b'nRFbT•sum%L%ssaaMse'rM 01970
_ - h7:976-74S-9S9S 0 PAZ M7404M
APPLICATION FOR THE REPAIR RENOVATION. CONSTRUCTION
DEMOLITION, OR CHANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDING-
1.0 SITE INFORMATION
Location Name: Building:
- --
- Property Address:-- -
I.Properly Is located In a;Conservation Ares Y/N / Historic District YIN ^J _
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land
Name:
Address:
Te1e hone:
p 77- 19,9d O
3.0 COMPLETE THIS SECTION FOR WORK IN �JIll3 BUILDINGS ONLY
Addition Existing
Renovation Number of
Stories Renova
ted
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
adef Description of Proposed Work:
�JaG¢. Ge✓�� Ghc,� C�s�er i"1c,✓cd �����
The Chimney Guys
-_--
Mail Permit to: 978-977-9900
What is the current use of the Building?
Material of Building? It dwelling,how many units?
Wig the Building Conform to ? Asbestos?
The rmaey uys
Architect's Name
- - Peabody.-MA 01 -
Address and Phone 960 i
Mecharhk's Name
978-977-9900
Address and Phone
Construction Supervisors License S HIC Registration f
Estimated Cost of Projed f a Ida Permit Fee Calculation
Permit Fee i Estimated Cost X$7/311000 Residential
Estimated Cost X$ 1/:1ooO Commercial------ - - --An Additional $5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build he above stated
specifications. Signed under penalty of perjury X
Date
� oI
C N
96 \
a
E- •s , � d� o � s`
4
pr.._. .