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281 ESSEX ST - BUILDING INSPECTION (9) i CITY OF S.0 ENf, INLkss,- cHUSETTS BUMI)NG DEPARTMENT \ 130 WASHINGTON STREET,31D FLOOR TV.L (978) 745-9595 FAX(978) 740.9846 K1x�ERi.EY DItiSCOLJ. %U MAYOR T Homs ST.PmRRa DIRECTOR OF PUBLIC PROPERTY/BUnDlNG COMMSIONER APPLICATION FOR THE CONSTRUCTION, REPA19,RI'NOVAiI-10N, CHANGE IN USE OR OCCUPANCY,OR DEMOLITION OF ANY BUILDING OR STRUCTURE Thle Section for 014kJ t se Only i.. Byiidtetgp Pe"Projact. . . ..- . Date:,. 0 F ' Building Inspector::. EsOmeb�Prvsjt Datoe: start: End: Camrnents: 1.0 S M INFORIAATION Location Name: —121oMQL yl 3 Budding: Property Address: * IT She m »'1A o LS 7J Assessors MaplBlodr: Lot/Parcel: 2.Q iVi9Ai 1NF®RAAATION 2.1 Owner of Land Name: —5EC a o Address: a '7 T cu tAmd S `Rv{ yr'Q ✓ncl vh lQ {>pQ AAA b)Ty5 Telephone: ( 7i�)I) 0 i (3.o J 2.2 Owner or Jesse* of buildings or structure Nam*: Address: Telephone: MiName: R AUTHORITYAUTHORIZ1NG CONSTRUCTION 20 r n rn 1r�c/o �lovltc� 4e V �W�3lS�C�m A� 6 1S' 'DINumber. (�Name: �� A A-vvJ) 7kK Ted: P ROFESSIONAIL DESIGN SERVICES:. egistered Architect:e. Seal and Signature ess: Telephone Fax 4.2 Registered Professional Engineers: Nis adds ww sheste Ifnecessmy and.attach ee 9 Name: H`cbb5 � �Tcr vDy - Seal and S - Addresea 3K I�cickjy,� �} Suk, i��s c� jVW al�n"1 Telephone: Fax 00 --Nq v o c Area,d Responsibility:. Name: S®ai and S - -- Address: Telephone: Fax: Area of Responsibility. Name: Seal and Signature Address: Telephone. Fax: Area of responsibility: 5.0 DESIGN AND CONSTRUCTION UTILVJNG MGL C 112 SECTION SIR EXEMPTIONS (Sea note below) Contractor Name: o 4—TYe Address: ( o cok," _ k 0 Sri Area of responsibility: G � 'Ucanse Number.' � 53 bIT 3 Date of Expiration 5 r/oS Telephone: Fax` C�� l 7 ( g37a Contractor Name: , Address: Area of responsibility: License Number. Date of Expiration: Telephone: Fax Contractor Name: Address: Area of responsibility: License Number. Date of Expiration: Telephone: Fax: Note: For portions of work utilizing exemptions of MGL c. 112 s.81R complete the section above. Use additional sheets if necessary and attach to application. 6.0 PROFESSIONAL CONSTRUCTION SERVICES: 6.1 General Contractor Address: Telephone: Fax: Responsible in Charge of Construction: 7.0 CONSTRUCTION DOCUMENTS -to be prepared by applicant Item as Applicable 7.1 Plans (Note 1 this page) Submitted Incomplete Not Required 7.1.1 Architectural 7.1.2 Foundation 7.1.3 Structural 7.1.4 Fire Suppression 7.1.5 Fire Alarm 7.1.6 HVAC 7.1.7 Electrical 7.2 Specifications 7.3 Structural Peer Review 7.4 Structural Tests & Inspections Program 7.5 Fire Protection Narrative Report 7.6 Existing Building Survey 7.7 Workers Compensation Insurance 7.8 Other Documents (Specify) (Energy Narratives, etc.) Note 1 Areas of Design or Construction for which Plans are not complete at the time of this application must be identified herein. Work so identified must not be commenced until this application has been amended and proposed construction has been approved by the Department of Public Safety District Building Inspector having Jurisdiction. 90 COMPLETE THIS SECTION FOR N EW"CON$T'RUCTION ONLY For Existing Buildings Proceed.to Section 9.0 Number of Stories above Number of stories Below Grade Grade Story Height Flo4 Area Per Floor Total Building Height Total Building Area Above above Grade Grade Total Building depth below. Total Building Area Below Grade Grade. Brief Description of Proposed Work: / 8.2 USE GROUP AND CONSTRUCTION CLASSIFICATION (Neer Construction Only) USE Ggq.uw. USE,GROUP SU, ATEGORY CONSTRUCTION as appll able (�l as applica4le� . CLASSIFICATION A Assembly A-f A-2 A4 A-4 I B Business 18 E Educational 2A F Factory F-1 F-2 28 H High Hazard H-1 H-2 H-3 H-4 2C I Institutional: 1-1 1-2 1-3 3A Pot Mercantile 38 R Residential. R-1 R-2 R-3 4 S Storage S-1 S-2 5A U Utility 58 Mx Mixed Use Specify: Sp Special Use Specify: 9.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY For new construction comDlete sec tio Addition Existing Renovation Number of Stories Renovated Change in Use New Demolition Existing Approximate year of Area per floor (sf) Renovated construction or renovation of existing building New Brief Description of Proposed Work: IL4 I V 7 75 -T`-e Fx4e✓lc 9;1 USE GROUP AND CONSTRUCTION CLASSIFICATION(EzistlegyllcilllwE 06a1y) EXISTING' PROPOSED Change` CONStRUCTIOI USE Groups) in `CLASSIFICATION Use Hazard Use _ Hazad$ H d (noes subcategory) Group Index 'Group Index in�, (J ao 1000cak* A Assembly IA' B Business t B E Educational 2A F Factory 2ff H High Hazard 2C I Institutional 3A. M Mercantile 3B R Residential g ASpecial 5A 58 Hazard Index Note: Include Hazard Index Modifier for Construction Type as applicable I 9.0 CONSTRUCTION COSTS (See 790 CARAPPendix L) Total Construction Cost Building Permit Fee Check Number (1j =(1)x$0.001 �Ij t / 10.0 AUTHORIZATION OF STATE AS3ENCY FOR'Ai GENT TO APPLY FOR BUILDING Y y PERMIT (when applicable) on behalf of the authorbk4 State Agency or Authority, hereby authorize, Eeapply for the building permit for project number. Signature Data 11.0 SIGNATURE OF BUILDING PERIIAB'ir APPLICANT Name e� Q. ,A�- Ij ch 3w) Sign ure v Date 12. Certificate of Occupancy required on completion of project? Yea No Inspectors Notes: r ----- The Commonwealth of Massachusetts �� (U Department of Indfistrial Accidents 91f1ce ollimestlodoifs 600 Washington Street - Boston, Mass. 01111 - ,, Workers' Compensation Insurance Affidavit name logation C n nhonc N I am a homeowner performing all work myself. Q 1 am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this lob. ol is .s,::(s<`;.srn- h + x::^:I S � �.x4.£� I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: - f'. F s i0m0aaY name � �� s `• } -? l,:£ + s.'. � x .sxr L ♦ 16 n.r¢ s� 1 x aat� &, ( �,x � ¢� .a. 'x"F 4'{'s Iddress. x •<s:. r .sT '�x3£ ,�.• j' l<x 'f`r^`�."c¢¢ .. ..4 E3:`>"v z t �',°E aa^a:,Ru. ° .fl;a9Y > �, �€ `i € [ � YbanL. Y a {^ c K iF,�aytx al s x F sn _ s<Y fx s a F x��nt'�9xxL q.. a> rl.Ik.x+((F a ,4 e t a� t Fii r s Y L.> a 4'u'•ytc+xy: .z< xy �,{ 'a°+'r•— x3 r�'¢a '1`ytx >.x.,�, 'rh'ss{/tia:=£ra (£aria( yt f?' I a F,E 31x Ci.. t•Si�'ur,'i�Ik d .s x c s ,k�a •I ,:; y r'c>'Ca nd dear.. city. ERiogf insurance c 2 .,..a.. �, y�sY s �� -n� et rIY>3 F4¢ S •wx ,x mtu. Y'.w4( (i 'i7, -�Ila<kaJ itianigs ce + nccesaaa s Failure Ia secure coverage as required under Section 25A ur(.IGL 153 cart Ind to the imposition of criminal peso l liu ors rine up to s1,300.00 andtar one ycu n'Im prison mrM ss well us civil penal lies in the form of a STOP WORK ORDER and a fine of s 100.00 a day ago!.at cat. I ondenland Ihal a copy of this$to lent cat muy be fur-u rded to the Office or Inv uliga lions of the DIA for coverage veri notion. I do hereby certify under th a pains and penalties of perjury that the information provided above is true and corrcce Signature --( Date (91 b -1 7 Print name Phone N amcial we only do nol-rite in Ihls ores to be eontplaled by elly or to-n omcial ury or to-n: permiVliccmc a rt Building Department 0Liccn3ing Board chcclt If imnladimc response is required - CiSdcctmen's Orrice OHaallh Department comxl person: phone 9; nOther Irv>N 1NI rl.(I MAY-25-2007 FRI 12:30 PM JENKINS INS. FAX N0, 7812459563 P. 01/01 ACORDTM CERTIFICATE OF LIABILITY INSURANCE PA5/25/07M •RPDUCER THIS CWn FICATE IS ISSIE,DASA MATTER OF INFORMATION Wayne C. Jenkins Insurance Agy ONLY AND rE HOLTICERTIFICATEPOESNOAM END,WENDOR 50 Salem St ALTER THECOVERAGEAFAORQEDBY THE POLICIES BELOW. P.O. Box 69 Lynn£ield, MA 01940 INSURERS AFFORDING COVERAGE NAIC# Ineuam INSURER A: Safety In S:lAra$SC0 Tremblay Contractors, Inc. INSURERS: Chic Casualty G 10 Colonial Rd Ste. #4 INSURER C:AI Salem, MA 01970 INSURERD: INSURER F COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE-FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SU0.ECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. .. D' O POLIOy NUMBER P00 CY EFPc-C TI LE MUCY WPIRATION LIMITS R GE_NERALQABILITY EACH OCCURRENCE S 1 OOO LO ..__ h i4TAGkTO'R>=NYED--'4 cPMMERcwLGENERAL UAealry $KW52519822 4/15/07 4/15/08 pREMISFS1Eeoccurencol $ 59,000 $ LX JCLAMS MIRE LXI OCCUR MEO PXP(AIryMA.Parmm) 5 5.,000 FX bfpd,_xcu, cunt PFRSONALSADVINJURY S 1.DDO,000 X- Contr. ProtOct± GENERALAGGREGATE_ $ 2.000,9Q2 DEN'LAGGREGATEDMITAPPUESPER: PRODUCTS-COMP/OP AGG S S,O90,.000 POLICY X J_C7 LOC AUTOMOBILELIABILITY COMBINED SINGLE OMIT p ANvnurP 1500143 4/19/07 4/19/08 1,000,000 X ALL OWN F_D AUTOS BODILY INJURY S X SOHFOULPD AUTOS (Pm X_ HIRED AUTOS BCOILYJNJURY X. NON-O�.NED AUTOS Pm PmldeM) I ......___.. _._.. .. .—.I PROPERTY DAMAGE IRK Widm�) _GARAGE LIABILITY AUTO ONLY•EA ACCIDENT S .- �ANY AUTO O7NCR THAN EAACC $- AUTOONLY: AGG $ IXC_ESSIUMBRELLALIABBITY EACH OCCURRENCE e _ OCCUR 4lAIM9 MADE AGGREGATE S $ _ DFDUCTISLE RETENTION 11 % $ A WOWERSOOMPENSWION AND ., B _ C EMMOYERS'LIFMUTY WC 9948958 7/l/06 7/l/07 E.LEACHACCIDENT $ 100,000 ANY PRO�OF ICERMIEMTE'R EXCLUDFO??CCUTfu£ - E.L DISEASE-EA EMPLOYE $ 500,000 M .,deecno�IPwm EL DISEASE $ 100,000 SPEOIAL P ROVIB W$yeHw OTHER D EaCRIPTIO N OF OPERATIONS/LOCATIONS/VON CLES I EXCLUSIONS ADDED BY RNO ORSEMa1T I SPEGMIL PAOMMNS Contracting Operations: CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DEBCRI BED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOP,THE ISSUING INSURER WILL ENDEAVOR TO MAL —DAYSWRIYTEN Certificate HOldsr NOTICETOTHECERTIFICATEHOLDER NAMEPTOTHELEFf,BUT PMLURETO DOW SHALL I MPOSENO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATNES AUTHORDISOREPNESENTI{ VE".""'•� • ••v.-.A'-:. ACORD 25(2001108) ©ACORD CORPORATION 11988 — 07t29P P.001 HOBES EMEAVOTJR COPXORA17ON bD 34 Rood SWaAa scoff amd Street SHeer HD. P ,Massachuse w� 781.581,2454 �01007 — oe 978,744.4640 CAICULATeDSY "=� DATE l._ ✓-...F r. i L7 n��-• . CHECKED By / »-- �� �, / �.-.�J f�•-��.n GATE C:,. 5- t� /r.1 6--..qf•M Y SCALE r _h S k � 6 7 l� `• i y a� w TY' ,lam ! C•eY /, U. / —CI•-�.... —� I�-f L-U �•L',-`.L'.. 07:ZSP P.00Z HOBBS J;NbEAVOUR CORPORATION -- 34 Rockland Street eHeero-o._ Swampscott, Massachusetts 01907 :. 781.581.2454 9787444846 CA<CVlATEOEr—,_ l' � a..-..... DATE77 '• J F-'Yl.'T /l`1 . ...-.._.__� / .i-_ 4. yd CMECKEO BYE._. G DATE .`. l-( C� G H" ^`� L SCALE_ G-. vl/ ' %•.•I. r .�i r � J (...• f`� '�� � ! i f. ! Cis`•. f-Gn /G j. Y i - `- tom.-, �. .r-.� V,�. .• � . .s ,L i i e b5l14/O7 07:28P P.001 ROBESNAEg VOT7R CoIZXoRAT,tON JOa ^�e- 34 Rockland Street pscott,Massachuse HE¢rND. 581.2454 01007978.744.464E CALCVUTEDDATE CHECKED sr r••-+-:�� �1r' ' L^, DATE / �.' 5' /b •1%r..L !.•y f•M SCALE ,r ` Z 3�; G •fr✓iarr " ��S' o S M �• ,o °o v I , a/ :r I '-"" "' '��o YJb/1•F/�o/ 07:29P P.002 UOBBS ENDEAVOUR CORPORATION JOB - 34 Rockland Street SHEET .- / f Swampscott,McWachusetft 01907 °F 781.581.2454 978.744.464C \ CALCUGATEDBY_.- / /' • ~• I PJ� �GT C � CI G � IInd�JlBY-- ..... DATE -t � CHECKED .J FH'Yl::r✓f�' DATE ��— J� SCALE Y- . i le �%G i � fi h i ✓/, i Y .�''i y�e 7JmAmtOnulP��ifc a�./l2'aggp�/F�4@�3 1 r�o[��4d �i!49Pa@ntl�'SYa,Q�a��s I ' >� In*� l�i4R'FLIa'se /19fi8 tw ow" t M T I! _ F6110i6-46 pd05ess a elft#itt�+e�d"tti�on'of the-- . J 6 �. Ma3sachajjetts Sate'RnjIdj.. G'O t r. - , - is cauie-for'revdiotion of t iU-Hcen'se. i t sv A ✓� 10M1NH992UI86UR O�i/(ZL�J�K(1B«6 . t� \ Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Re istltlb3Y 5375 Board of Building Regulations and Standards Ps One Ashburton Place Rm 1301 /2009 Trif 126164 Boston Ma.02108 T>yate Corporation - —UK, 'I ROGER A TREIrJI � �TORS,INC. ROGER TREMBIylf ::% O 10 COLONIAL RD -- SALEM,.MA 01970 Administrator Not valid witho t si nature �v Vv Application for Permit too V�GI G�1/Y✓� �Ul�i Y �' II f0 Pr•'�/ ! 1�SAnC Location ass �hSey �f Permit Granted :2 App� ed Inspector of ildings