30 FEDERAL ST - BUILDING INSPECTION (3) \� The Commonwealth of Massachusetts
FA�
Department of Public Safety
MassachusettsState Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Onl )
Building Permit Number: Date Applied: Building Official:
SECTION 1: LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available)
So Rderal SAY.Lf Sq�� o199r)
w No.and Street City/Ton Zip COLIC Name Of Building(if applicable)
SECTION 2 PROPOSED WORK -
Edition of MA State Cude used If New Construction check here❑or chock all that apply in the two rows below
Existing Building❑ Repair❑ Alteration ❑ Addition❑ Demolition Cl (Please fill out and submit Appendix 1)
Change Of Use ❑ Change of Occupancy ❑, Other )KrSpecify:
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 $I
Brief Description of Proposed Work: fie" [ 3 -QCL pI{
ndq talon
'( 5 t _
SECTION 3:COMPLETETHIS 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 Gro°P(s) Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Flours/Stories(include basement levels)&Area Per Floor(sq. ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as ap licable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business X E: Educational ❑
F: Facto F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
1: Institutional 14❑ 1-2❑ 1-3❑ 1-4❑ bt: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑
S: Storage S-I ❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use
SECTION 6:CONSTRUCTfON'['YPF-(Check as ap licable)
IA ❑ III ❑ IIA ❑ IIB ❑ IIIA ❑ ❑IB ❑ IV ❑ VA ❑ VB ❑
SECTION 7:SITE INFOR VIATION(refer to 780 Cil9R 111.0 for details on each item)
Water Supp T Flood Zone Information: / Selvage Disposal: .french Permit: Debris Removal:
Public 6� Check if Outside Flood Zone
ID Indicate nwnicipal �\ trench wpll not be Licensed Disposal Site❑
Private❑ Or indentify Zone: or on site system❑ required fi�or trench or specify: Nngp S.
permit is enclosed❑ '-r-y�(ylSfrN 3I"e6�1 Of's
Railroad right-of-w y: Hazards to Air Navigation: \L\t li t „nnu to n I . ,w I r a.
Not Applicable>� Is Stmcture ivithin airportep roach area? Is their review cOmpletcd
ur C.mscnt to Build endusnd❑ Yes❑ ar No� Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition Of Code: Use Gruup(s): T%,pe of Construction: Occupant Lund per Floor: _
Does the building con Lain an Sprinkler System?:_ Special Stipulations:_
0A-d 6)b ( ;� �
SECF[ON 9: PILOPER'FY OWNER r1u'rilORIZA'TION
to and Address of Property Owner
Name(Print) No.and Street City/Town Zip
Property Owner Cuntict Info nrttion:
Title t ( V/ Y✓� Telephone No. (business) Telephone No. (cell) e-mail address ,Ga
If applicable, the pryfperty owner hereby authorizes �'q
MA
UfMOr �c.rnc It 7f2 113 PUa<al1' 5�1"�'_ �t�1�1 i
Nance Street Address City/Town State Zip
to act on the property owner's behalf, in all matters relative to work authorized by this building ermit,1 lication.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If building is less than 35,000 cu.ft.of enclosed s ace arnl or not under Constna:tion Control then check here O and ski Section 10.1
Yo.t Registered Professional Responsible for construction Control
('arrwt�r Nc�rruk 9`6-(al IL,yoaa.
�— ^gb3
N:une((Registr:m t) 'relephuno No. e•nuiil address Registrationt Number `7.ly
113 Q1QC5biae W�a^�L1L1 Jam_ OI F l �tlntu I�
Street Address . City/Town State Zip Discipline Expiration Date
10.2 General Contractor
V(1f1MDW\ Olf fVidc :�K
Contpany Name _9
Ca I rn Lj<
Name of Person Responsible for Construction License No. and Type if Applicable
1\3 v §.o'saY'kt `fit o wRMh(AM IVA, _ aITM—
Street Address �1Y1c� City/Town State Zip
`rele hone No. business Telephone No. cell e-mail address
SECTION tl:\VORKp.tLti'COS\1Yl[N5,\I'Ic>,�INtitJ I::\;NCH A1, 114U'I'f M.G.L.c.152. 2SC 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 0 No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Estimated Costs:(Labor
Item and Materials) Total Construction Cost(from Item 6)=S
1. Building Building Permit Fee-Total Construction Cost x_(htsert here
o. Electrical $ appropriate municipal factor)=S
3, Plumbing 5 contact taut to itit
Note: `liniuunn fee=5 ( �. V Y, ) y
_{. bicchnnical (FiVAC) S '— OCf(,}f��(�(�/J\
3. Meehan intl Other S Enclose check payable to
6.Total Cost $ MOOD (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering illy 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 lily knowledge amd)I t erstanding.
9q ki-I- l03 I 1
Please print and sign❑ap1L Title Telehone No Date
113 Ul D G s rah� tS�YCR7' W 2NI�/1a V✓1
Street Address City/Town zz
5 /
Municipal Inspector to fill out this section upon application approval: Date ate
CITY OF S:uzm, NIASSACHUSETTS
SuILDII)G DEPARnL&NT
t. 120 WASHLNGTON STREET,Y°FLOOR
TEL (978)7454595
FAX(978) 740.9846
KIJBER.LF-Y DRISCOLL THOhUS ST.PiERR13
MAYOR
DIRECTOR OF PCBLICPROPERTY/BI:RDLYG COSL\fISSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrfeian9/Plumbers
Applicant information Please Print Leeibly
Nalne(Busiixss,Orgsnlzatiaruindividual): Cmm��� k F)�yl de, 2
Address: lid Pl lxltsa I�
City/Statc/zip: Wa-h m NA QM4 Phone H: 1,198 l$d 13e 0-3
Are you an employer?Check the appropriate box: 'type of project(required):
1.❑ 1 am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction
employees(cull and/or part-time)." have hired the sub-contractors
2.N I am a sole proprietor or partner- listed on the attached sheet 1 7, ❑Remodeling
ship and have no employees These sub-contactors have S. ❑ Demolition
working for me in any capacity. workers'comp.insurance. 9. ❑Building addition
(No workers'comp.insurance 5.'0 We are a corporation and its.
required.). officers have exercised their 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself.[No workers'comp. c. 152,§1(4),and we have no 12.0 Roof repairs
Insurance required.)1 umployeesi[No iiorferxs 13.f4Other WIWADV3 .
comp;insurance required.), .
Any appllc:ua that checks box All most abw fill out iha section below showing their worlum'mmpmwlo s polity inrumtatfol,
I hvneuwoeis who submit this affidavit indicting they arc doing all work and thou hire outside"mmsaon must submit a new amdavil indicting such
:Cunuautun that check this box must aoached an addilionul,heel showing IN name of the subeomruton and Illdsworken'comp.policy information.
lain an employer that lr prov(ding workers'compellsadon insurance for my employees: Below is the policy and Job s•!te
lnforaratfonr. _
Insurance Company Name: gnlrlrlSSei}'Ibl,, A.Ukily)a, lf1Su1'antk SP'rViLQ,- , ,)' —
Policy 4 ur Sclf--itts.Lic. 4: ��.�r��I a h Expiration Data:
Job Site Address: �i� 1— ��(1 6J City/Statr/Zip: .Sr t IV7l� fO
�
,%ttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration(fate).
Failure to secure coverage as required under Section 25A ofblGL c. 152 can lead to the imposition of criminal penalties of a
tine up to S1,500.00 undlor one-year imprisonment,as well as civil penalties is the form of STOP WORK ORDER and a line
of up to S230.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Invesligulions of thr DIA for insurance coverage verification.
l do hereby certify rnrder the puhrs and penuldea of per/ury that rho infunnuNae provided above it true and correct.
Si s e, �� 1 u
cadtslrr• � -bi.-r���,�-t Dora• I (3
Phoncil; 41 f 6d 138(7 3
OJJlclul use only. Do not write in thfr area,to be completed by city or town ofpfuL
City or'rown: Prrmlt/i.lccnse g __
Issuing Authority(circle one):
I. Board of licaith 2. Building Department 3.City/town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other_.
Contact Person: - .__. Phoned:
f
` •�
....r"
Salent Historical Coil/ nissio11
120,VIASNroIG roPj S:.REET 5ALl=6A.!J4�AAC 11 USE TTS,)
iI]g)drL,ryS FAt C11!3, !:q-01!O4
APPLiCA"r[ON FOR A CERTIFICATE OF NON-APPL[CAkBILITY
Pursuant to the Historic District's Act (NLG.L. Chapter 40C) and the Salem Historical Commission Ordinance,
application is hereby made For issuance of a Certificate of Non-Applicability as described below for:
f I New Construction 11 Moving ❑ Reconstruction
LI Demolition I Painting Alteration
I_l Slg❑ Other
District: I Derby Street ❑Lafa Lafayette Street LWY)C t4 l�iehrt¢.r
Y LIMo[ntire ❑Washington Square
Address of Property: �� ��.� ��Tr,�-�
Name of Record Owner(s): CCLA3 c,� ) `—
lYv
Owner Mailing Address: 2L
�(
Description of Work Proposed:
��lacew ¢�n inc�wi� I3(.cz-lf (k ue) -flea {'row, k t itia b�tic<tr�� 1cc
h'ec� erc.� 19�✓+nt t' A, Woo � m4o�,4 vitI N1Gi�c�1 Ph15iI ri
in Size; wio'r; t%na oeZ'U-{i )n , L_x' IVIO VVIM, ow s }riw\ avn;nnut WindarvS
Wil i v cR �a 6L wum or¢ c41 rtny� VUAJ4 'ifivy\ `v W use, Iv)Stailu , MA't, m m,
P=x�s���y� eatntit��lttill�t� mhh* it) be 'gIALut vML, vifiryk) boor 4nd
WlndoW ;ALL 41 I leO
6 , atlo 061 i > t 6�t_
VAYl(. WOSVIIA; kck �AotS5 A bu, t�E� Corte, t-C
Name of Applicant:V�—J� L;.���
Owner�'iC'ootractor f 1 ren,mt Otbcr:
l mail Address:
[ ra/Ic '!n' n i11/,�'uluDrll In lh�nn Ilu .Inh'.¢v olher ,, _
igJicn/o (S�r
( wufiuue :;hould he m.ukd h�
\failing address:
A
City _ titatc:/./ziu: j�C>
Massachusetts -Department of Puic Safety
bl
Board of Building Regulations and Standards
Umstruction Supervisor
License CS407170-
U Lt�S Utip i
CARMON E HERRICK JR ?,
113 PLEASANT STiX y
WENIIAMIYJA 01904
Ati"P„4 Expiration
Commissioner 12/17/2013
f ��
- � (�/!t0 Tpm.ur na9ewe�b�l�L o�V��aklru�tuJeCld-
`Ofrice of Consumer Affairs&Business Regulation
SOME IMPROVEMENT CONTRACTOR, TyPW
egrstriston 168022 Individual.
xpuatr _]2,,/2014,
g
Vu
CARMON EMERSONiHERRICK Ja
CARMO,N HER RICK
113 PLEASANT-STREET Undersecretary
WENHAM,MA01984
V
_ CITYCFSAL.EM, LI,L, 5s . CHUSETTS
i ,•l ;: ` ) OL'ILDLVC CEPA-ITb(S,YT
�;�,��{ iHLVCTOV STitEfiTj } Ft,do2
.'C11(Ot;2LcY D2fSC0f1.
F.k-((973) 740-9344
t Ct YO;t t�tasc+�Sr.Ft>:�ts
Of.LCTc7tt OF?COLIC PRaPER7y/gt(LpLVC GOSL\(I59lO,V EQ
Construction Debris DlspOsai Aft7duvit
(rcyuirEd tur all demolition :uid runuvation work)
to accordance with tilt)sixdt edition artha State Building Coda, 730 C�bfR 1
Debris, uld tile provisions of provisio ofMOL a 40, S 54; section ! t .5
0uilding all sh �
this war!< shall b is issued with the condition that the debris resulting morn
e disposed oe in a proprrly licensed waste disposal Facility as do8ned by ,L(GL a
I It, S I50A.
1'ht: (labris will be tr.wsportcd by;
Q
(tome uChaulur)
The tiubri,r will bu disposed ot'in :
(m n(a(jr rcaily)
I
C�� i �d arr�evs AM
( idJre cs ut rau6ly)
i(u.,utr� �!prnnit,ippl4'.tnf d
SCOPE:Replacement of 18 windows located at 30 Federal Street Salem,MA 01970
Replacement of 18 windows located on the front of the building located at 30 Federal Street Salem MA.
New windows will match existing style in size,color,and operation. Existing window trim around
windows will need to be removed for removal and new trim will be installed matching exactly what is
currently existing.Trim color will be painted brilliant white. New window frame color will be bronze
matching existing color.
Picture 1:View from the corner of Washington Street and Federal Street
F-t riu-U 1 &i.e&
w
ANY
T
U17ES
r f I? per
C� winA�,vJ� -b be plrncQGL. � �1 &eUF
tYliM ANDOYtfA WIV')6)Vv3 N+I �A
Picture 2: Federal Street
I '
Picture 3:Washington Street
O IOE SUITES
g 00
ntn
y 9 -745-923,
i