0196 ESSEX ST - U170 BPA 15-84 JO FREEDOM The Commonwealth of Massachusetts
tr Department of Public Safety RECEIVED
Massachusetts State Building Code(780 4WECTIONAL SERVICES.
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only) 011
Building Permit Number: Date Applied: $uildmg Official:
SEC£TTCO6Nl'I:LCC tOCATION(Pleasse indicate Block#and Last for locations for whi6 a street address is not available);
tcAG €SS€k .l . J��gq\L`M O I Ci1-0 ESS{l, C- 'CNO ,i jmu/ C,
/ n No.and Street City/Town Zip Code Name of Building(if applicable)
/ SECTION 2 PROPOSED WORK
r Edition of MA State Code used_ If New Construction check here❑or check all that apply in the two rows below
r Existing Building K Repair❑ 1 Alteration ❑ 1 Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
V Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes )9 No ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No
Brief Description of Proposed Work Ac c-Q%T oC. C E i�i—'r, Pt_2
i4[2cN,�-ECTv2�c� f�A^�S
M
SECTION 3:COMPLETE THISSECTION 1F EXISTING BUILDING UNDERGOING,AENOV ATION,ADDTITON,OR .
CHANGE IN USE OR OCCUPANCY
Check here if an Existing-B�uilding Investigation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing UseGroup(s): „.$,WC%S Proposed UseGroup(s): fi'.-s,,.,TC5'
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) 2. 'af.0
Total Area(sq.ft.)and Total Height(ft.) I O D 2! N n jA
SECTION 5:U5E GROUP'(Check de a' plicable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business�Zl, E: Educational ❑
F. Facto F-1❑ F2❑ IH: High Hazard H-1 ❑ H-2❑ H-3 ❑ H4❑ H-5❑
I: Institutional I-1 ❑ I-2❑ I-3❑ 14❑ M: Mercantile❑ R: Residential R-113 R-2❑ R-3❑ R4❑
S: Storage S-1 ❑ 5-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION&CONSTRUCTION TYPE(Cheek as a licable)
IA IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑ 1
SECTION 7:STTE INFORMATION(refer to:780 CMR 111.0 for details on eachitemj
_ .. _. _ . i h Pe
rmit:ermt Debris Removab
Water Supply: Flood Zone Information: Sewage Disposal• Licensed Disposal Site❑
Public Check if outside Flood Zone El Indicate municipal A trench will not be p
Private❑ or indentify Zone: or on site system❑ requirecM or trench or specify:
permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable j< Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ or No Yes❑ No
SECON&CONTENT OF CER C TI ATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor:
Does the building contain an Sprinkler System?: Special Stipulations:
era I✓I_ iZ-o r�e-u.r -7, o I Lf (o 7 0
SECTION 9 PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
,1D1L Lke- I �k 4 ST, Ste£^ NtA 615lo
Name(Print) No.and Street City/Town Zip
.Property ner Contact Information:
wNErc L\-c Mew z 6t _20l_y bs-3
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
(_A---TNAE V-'EFGpnI JSJ- -t-�CTFWoob LA3. SAVC-i, 4* "A et9--o
Name Street Address City/Town State Zip
to act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 1/1:CONSTRUCTION
� CONTROI (Please All out Appendix 2)
!f buitdiri is less than 35,000 cv.k of enclosed s u we and/or nder cti Construction Control then eck.herIe❑and ski Section 10:1
10 1 Re 'etered Professional Res onsible for Co nstruction'Control
MAntyEl TA�rt2E5 (,1�_5�� 583� IhTTnccNr(c ET� $96(0
Name(Registrant) Telephone No. e-mail address Registration Number
Zoo cXc aowFh �t lo`{ k \NNc'tE�� MA 6\�Iyp
Street Address City/Town State Zip Discipline Expiration Date
102 General Contractor st777777
WtpjG - 1 waSr2aL-,-, ,�1
Company Name
6Z�>�T <<rJE f�, � C S - -4 61 ( f b2-i -1
Name of Person Responsible for Construction License No. and Type if Applicable
3Ct SA¢A^ `Rf rprVE wi . RoP ./,.,A 0, (SZ ..
Street Address //��^^�� City/Town State Zip
fiT _ 701_ yb-+o t-,u(,T foNSMvtAeN QG....�t_ Cc r-+
Telephone No. (business) Telephone No. cell e-mail address
-� :`. SECTIONII:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L,;c.15Z§ 25C 6
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes 13 No ❑
SECTION I2:CONSTRUCTION COSTS AND PERMIT FEl
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$ coo
1. Building $ ovo Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ t Soo appropriate municipal factor)=$
3.Plumbing $ N /.�
4. Mechanical (HVAC) $ 5-00 Note:Minimum fee=$ (contact municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ S,Ga0 (contact municipality)and write check number here
SECTION A 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 to ttthhJeQb(emsttt of my
knno�/�/'�/7{edge and/understanding.
kLdy�1T I,�..JEEL.AnN) - C l�l`NKLAL Co�rK2/hcs{Z
'-,-�✓E2� w,NG 'T �oN1r. &3 _ Zo1_
Please print and sign name Title Telephone No. Date
Sot SAe AA•o2s la.'€ t,-31 k7r1+R0P 0Z(C Z
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval:
Name 1. Date
Appendix 1
For the demolition of structures the building permit applicant shall attest that utility and other
service connections are properly addressed to ensure for public safety.
Please fill in the information below and submit this appendix with the building permit
application. The building permit applicant attests under the pains and penalties of perjury that
the following is true and accurate.
Property Location (Please indicate Block # and Lot #for locations for which a street address is not
available)
No. and Street City/Town Zip Name of Building(if applicable)
For the above described property the following action was taken:
Water Shut Off? Yes ❑ No Provider notified and Release obtained? Yes ❑ No ❑
Gas Shut Off? Yes ❑ No Provider notified and Release obtained? Yes ❑ No ❑
Electricity Shut Off? Yes ❑ NoV Provider notified and Release obtained? Yes ❑ No ❑
Yes ❑ Provider notified and Release obtained? Yes ❑ No ❑
Other (if applicable)
Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑
Other (if applicable)
Appendix 2
Construction Documents are required for structures that must comply with 780 CMR 107. The
'checklist below is a compilation of the documents that may be required for this. The applicant
shall fill out the checklist and provide the contact information of the registered professionals
responsible for the documents. This appendix is to be submitted with the building permit
application.
Checklist for Construction Documents*
Mark"xP where applicable
No. Item Submitted Incomplete Not Required
1 Architectural
2 Foundation
3 Structural
4 Fire Suppression
5 Fire Alarm(inay require repeaters)
6 HVAC
KElectrical
Plumbin (include local connections)
Gas atural,Pro ane,Medical or otherSurve ed Site Plan Utilities,Wetland,etc.S cifications
Structural Peer Review
Structural Tests&Ins ections Pro am
1 Fire Protection Narrative Report
15 Existing Building Survey/Investigation
16 Energy Conservation Report
17 Architectural Access Review(521 CMR)
18 Workers Compensation Insurance
19 Hazardous Material Mitigation Documentation
20 Other(Specify)
21 Other(Specify)
22 Other(Specify)
*Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work
so identified must not be commenced until this application has been amended and the proposed construction document amendment
has been approved by the authority having jurisdiction Work started prior to approval may be subjected to triple the original permit
fee.
Registered Professional Contact Information
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State IF,
Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address Registration Number
Discipline Expiration Date
Street Address City/Town State Zip
NEW 2'-0"X4'-0" ACOUSTIC CEILING WITH NEW CEILING NOTE : BEFORE INSTALLING ACOUSTIC CEILING CONTRACTOR
GRID, ARMSTRONG MESA SERIES WITH ACAC RATING OF 40
TO INSTALL 8" THICK SPRAY ON ICYNENE OPEN CELL
OR EQUAL WITH CLASS A FIRE RATING. W / DC-315 IGNITION BARRIER PAINT FINISH 6EJ cJTp jxq&(.
\ PESO
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- NEW TRACK
LIGHTING
NEW _ - -
10,
—HEAT-
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C I SENSOR
1
{ NEW HEAT SENSOR
- F -- -- —'- -- _ EXISTING
- -- -� STROBE/HO
EXISTING
- . - - PULL STAT(
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I h
EXISTING
t 'I, EXIT SIGN
4 11X3
t -
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896
Moo. ?9G6 '
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EXISTING EXIT SIGN NEW SECOND FLOOR STS ASSEMBLY RATNGS
?.. EXISTING 4" CONCRETE FLOOR STC-45
NEW 8" THICK OPEN CELL FOAM STC-37
(n REFL E PLAN TOTAL STC RATING STC-82
MAJAVARES ARCHITECTS
PREPARED FOR: JOE FREEDOM � A SHEET:
200 BROADWAY PROJECT: DAIS. e.H. �.T.
LYNNFIELD MA. 01940 COFFEE SHOP 01/15/2014 /�
TEL 781-595-840o FA%. 781-595-MOO ADDRESS: SCPAE: /-�
194 ESSEX ST SALEM, MA
EMAIL: MJTPRCHITECTSOVERIzON.NET
Michael Lutrzykowski
From: Manuel Tavares <mjtarchitects@verizon.net>
Sent: Friday, January 23, 2015 11:51 AM.
To: Michael Lutrzykowski
Cc: 'Bobby Kneeland'
Subject: 194 Essex St. updated Ceiling plan
Attachments: SCANNED CEILING PLAN.jpg
Mike,
Attached please find an updated plan, showing the installation of Icynene open cell foam, to sound proofing between the
residential space above and the coffee shop.
The final STC rating will be as follow: existing concrete floor above has an existing rating of STC—45 the new spray
foam will add an STC rating of 37 totaling STC- 82.
The final STC-82 rating will well exceed the code requirement of STC—51.
Please let me know if you have any questions, please let me know if I could be of further assistance to you.
Best regards,
Manuel Tavares, Architect of record
1