388-390 ESSEX ST - BUILDING JACKET LSD �= C�- 2-,-1
The Commonwealth of Massachusetts z
Department of Public Safety _ cn
Massachusetts State Building Code(780 CMR) •++ rn
Building Permit Application for any Building other than a One-or Two-FamilyLawelliq�m
(This Section For Official Use Only) o n
Building Permit Number: Date Applied: Building Official: O �>—
SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not aila n't
388/390 Essex St. Salem-MA 01970 N/A 4:I
' No.and Street City/Town Zip Code Name of Building(if appable)m
SECTION 2:PROPOSED WORK N
Edition of MA State Code used If New Construction check here❑ or check all that apply in the two rows below
Existing Building❑ I Repair IN Alteration ❑ Addition❑ Demolition M (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 ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No
Brief Description of Proposed Work: Strip Existent Asphalt Shingles and Install Asphalt shingles Roofing System
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) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) 4 0005 .ft
Total Area(sq.ft.)and Total Height(ft.) Itowqn.fti 40ft
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ 1 H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional I-1❑ I-2❑ 1-3❑ I-4❑ M: Mercantile❑ R: Residential R-10 R-2 ZI R-3❑ R-4❑
S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use: Residencial
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ IIA ® IIB ❑ IIIA ❑ IIIB ❑ 1 IV ❑ VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details 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: MA Historic Commission Review Process:
Not Applicable IN Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ or No® Yes 13 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?: NO Special Stipulations:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Steven Sass 16 Ida Rd Marblehead-MA 01945
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
Owner 781- 639- 8381 2u- 608 -1951 Steve.sassl@gmail.com
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
N/A N/A N/A
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 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here®and ski2 Section 10.1
10.1 Registered Professional Responsible for Construction Control
N/A _
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
National Management Team.Inc
Company Name
George Vasiliades CS-080145 Construction Supervisor
Name of Person Responsible for Construction License No. and Type if Applicable
462 Boston St. Topsfield MA 01983
Street Address , City/Town State Zip
978-887_58 70 EXT.201 617- 943 _ 8686 thiagoC�nationalconstructionl.com
Telephone No. business Telephone No. cell e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(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❑ No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$ 13,660.00
1.Building $ 13,660.00 Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)=$
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical Other $
Enclose check payable to
6.Total Cost $ 13,660.00 (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 to the best of my knowledge and understanding.
George Vasiliades Construction Supervisor 617 - 943 - 8686 07/09/2015
Please print and sign name Title Telephone No. Date
462 Rosion St TnpsOeld 14A_ 01970
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval:
Name Date
' r
ealth* A'A—� � . ly.
wsacPlu fts'
Department of Public Safety
Vla.asai hlurtls stale 1. i,141 ing• ;i1de `rSj1,6', li) j
fll�l_ Building Permit Application for any BuiFl<linglyulei�.tJ3a"a`(Qtr Lour"1'w F Dv,C fY;iyigS
(Phis Section For Off Vial Use Only)
Building Vomit Number: Dale Applied: .� �, Building Official:
SECrION 1:LOCATION(please indicate Block %and lot N for locations for which a street address ' not availab e
No.and Street City/Town Zip Cade Name of Building(it applicable)
SECTION 2:PROPOSED WORK
Edition of NIA Staly,C,tdc•.IIi?zd,y_ I(Ne,v Gmslnlcliun chn l:.h¢rI�E7•oy<I c;ek a,l�IJtat aP1il),jn41u•IwSenre's hl 1pw
Fsi.sling Building❑ ° 11,
(Repair§�� "Alteration ❑ Addition❑ Uuiiulitiun O(hhlasi t�lt out`:,1fiY+ill�niPApja•I dn`'�)`y" ,
r ,: •.Chanl;i•id$s0 4. -1 ,
L-s,ffg-❑ � _
Are building plans and/or construction dlt'uments being supplied as part of this permit application? Yes ❑ No 0— -
Is an Independent Structural Engineering Peer Review rye fired? s ❑ No e-
Bri f Descri,tio i of Proposed 11' rJ:._- IV q(/ t4 ;Ve 06 /M7r,r
V
SECTION 3:C tgE E TFII .SE TION IF EXtS- 1 BJJI�e1' U DERGOING RI?)1;QVA fA.0 ti°�UI�1 '�(3N O,
CHANGE IN E�A XACUPANCY � I
Check here if an Existing Building Investigation and Ev luation is enclosed (See 780 CNIR.1J) ❑ r,-/' • !` C" ,•ry
Existing Use Group(s): _any Proposed Use Group(s):
SECTION 4: BUILDING HEIGHT AND AREA
' Existing Proposed
No.of Flours/Stories(include basement levels)&Area Per Fluor(ski. ft.)
Total Area(sq.ft.)and Total Height(ft.) -
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-213 Nightclub ❑ A-t ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-I ❑ F2❑ H: Hi h Hazard H-I 'C.. -� ti ?I}-.1 ❑ 11-4❑ 11-5❑
1: Institutional I-1 ❑ I.2❑ 1.3❑ 1_4 ❑ NI: Mercantile❑ jjy Residential'`' -1❑ R-2❑ R-1❑ R-1❑
S: Storage 5-1 ❑ S-2❑ U: Utility❑ Silqui- se anil please describe below:
Special Use
SECTION 6:CONSTRUCrION TYPE(Check as applicable)
IA ❑ IB ❑ I1,\ ❑ 1111 ❑ HL1 ❑ '4&q'gy "•f`V.NO I VA ❑ VB ❑
SECTION 7:SIT-E INFORMATION(refer to 781)CNIR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit Debris Removal:
Public k I d Zone❑ Indicate Immicip d❑ A trench a III not be I i,enst d Disposal tide❑
I Ill tic ❑ Un, if outside I lua
Pric•de ❑ fari It IILv\Z�i m, -- •a I,n site csr,i,;m❑r napu«d ❑or t«nch(,� or sp<<Ilt.
.}MriNS 7...� - I;e;It�l lsiUx)e°Sc cl❑\ \,,� vC�. \Ii.�
RailrUad right-of.w ty; , Hazards to \tr Nae Iganon
NolA 'plicahleCJ,;,yQ��1 'e.1isstrurturr,c illrtlt,�iirp,lr.t appn utli�th 3r��;;y�,yy Is llxir�Fir,\'4�rr�,tPhd�e�,, , C' l�
or l on,ent ICI Budd enclll,ed El1as❑ or.No❑ I -'Yes❑ No ❑
SECTION S:CON I FNI'OF CF.R'l WWA'H;OP OCCUPANCY
Ediunn nl Code: _ ._ L w Group(,): - \pe of Gnulrllcnon: llr,upant l olid for I loor:
Por+ lhrbwilding'010.lin.ul1�prinklrrtic,Irul': tipiviulSlipululiuns'.
t `
I SF(A ION 9: 1'ROPF:R'I'Y OWNFR AUTIIORIZA I ION
- --
Nanm,uul AJJn'vti ut Pnppc ray Utt nSao gig
Name(Print) No.and Street City/Town Zip
Pro xsty Owner Contad Information: .
I itle petephone No. (business) Telephone No. (cull) a-mail address
It applicable, the property owner hurebv authorizes
--- Nance --- ---Street Address Y/I'a n State ..TCipf.<<� . . ,.1
to act on the property owner's behalf, in all matters relative to t6�Likt.truthtiriYiat=bWtttks,boild"in conic, ication!`, �, ^';, �u
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
if buildin•is less than 35,OW cu.ft.of enclowd s pace and or not under Comtruction Control then check here 17 and ski Section 10.1
10.1 Registered Professional Res ovisible for Construction Control
v✓Cato
(I�;I'�'StraM)t r•I h N e-nail address Re gistiatioi Number
Street Address CityjT iwn State Zip Discipline Expiration Date
10.2i3Gene" ..CC�on iatto}r
r .`• ,'•3 �, < .., �'s`+<•'.\•'s `-`t \.c'
Cot pan NMile / ,9�/f �p ri ♦ t,�cs.ti,� * 4 .y;�.. � .q i .";p,
V✓
ante of Person Responsible for Construction Licens•No. and Type if Applicable
3 �l3l�N�y f,!P ��/110 evJfy 018OP0
Street Adt ress n —- City/Town State Zip
'cute phone No. business Telephone No. cull `n a-mail address —
SECTION 11:1nu:1.kW', t�Mu•fps+nut�� fV,1j1t.\Vt.'r.vIII ,\Vll M.G.L.c.152 9 25C6
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❑ No 13
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=S_
1. Building S W. ano Building Permit Fee-Total Constnuction Cost x_(Insert here
'_. Electrical $ Qjalt�q to appropriate municipal factor)-S
1. Plumbing S a•'aP.e
1. Mechanical (IivAC) S Note: Mlininnmt fee=S (COILICt nuu rep, ity)
5. MIuCh,miatl Other S Fncluse dieck payable to _
f,.Total Cost S (contact municipality)and write check mmmber here -----__-___
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
14v entering my name below, I hurebv altest under the pains and penalties of perjury that all of the information Contained in this
ippliC,nion is true,red acCur.de t the hest oft v knot♦le. • aril understanding.
N of.wc pr lilt , d Sitpt name title 1 It 'I Lone No. Date
titrcet :\dd ress Cit.N town _ _ State /ip .
Municipal Inspector to fill out this section upon application approval:
_---