156 FEDERAL ST - BUILDING INSPECTION l� The Commonwealth of Massachusetts
Department of Public Safety
�,;, ,'.J %Iassachu.etts State Building Cede(780 CMR)Seventh Edition
City of Salem
Building Permit Application for any Buil ing other than a I-or 2-Family Dwelling
(This Section For Official Use Onlv)
Building Permit Number: - Date Applied:_ Building Inspector:
SECTION 1: LOCATION (Please indicate Block B and Lot M for locations for which a street address is not available)
n ; IOC /T-z4 lei — OJ-- ugh 7- S
No.and Street CitY /Town Zip Code Name of Building (if applicable)
SECTION 2: PROPOSED WORK
If New Construction check here❑or check all that apply in the two rows below
Existing Building❑ Repair❑ 1 Alteration 1K I Addition ❑ 1 Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ 1 Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No ❑
Is an Independent Structural Engineering Peer Review required? • �, Yes ❑ No
Brief Descri Lion of Proposed Work: "I S/Tt - �12L/� 6 Z--GI C OSC
e— O — i.K
d h
/ 5 iG' - G
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Evaluation is enclosed (See 780 CMR 3402.0) ❑
Existing Use Group(s): Proposed Use Group(s): 1'
Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34:
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq. ft.)
Total Area (sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2r ❑ A-2nc❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business ❑ E: Educational ❑
F: Facto F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
1: Institutional 1-1 ❑ 1-2 ❑ 1-3❑ 1-4❑ M: Mercantile ❑ R: Residential R-10 R-2❑ R-3❑ R-4❑
So Storage 5-1 ❑ S-2 ❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE (Check as applicable)
IA IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV 1 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(4 Check if outside Flood Zone❑ Indicate municipal ❑ A trench will not be Licensed Disposal Site
I'ri sate❑ or indentifv Zone: or on si to system ❑ required ❑or trench or>pecifv: , Owl
permit is enclosed ❑ 011 S A
Railroad right-of-way: Hazards to Air Navigation: %it% I li>h,rir C"nnlot"11-n Roy I1'11 Pro,,—;
\id :Applicable❑ I,titruclure lecithin airport eppruddm area' k their rem iew completed,
,11 C1m*e1t to Build enclosed ❑ 1'e>❑ or No❑ Yes ❑ .No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
1 dition of Code L'.e C'rnupUl: ivpe of Con>trniclion: llcnipant Load per Hoor:
Dora the building;contain an Sprinkler Salem?:. Special Stipulations:
SECTION 9: PROPERTY OWNER AUTHORIZATION '
Name and Address of Properly Owner
h i 1/h," f S /.S 6 =nt-za �
Name(Print) Nu, and Street City/Town Zip
Property Owner Conti- Information:
fv L v g 78-_71Z�%6
Title Telephone No. (business) Telephone No. (cell) e-mail address
If/a�pplicable, thr prupe/rtt•ow`�er herebv authorizes'L _
l ,ICx d� vLn = S Sc/led�S! CJJ A-r-,al-MwO !Q L 47 2
Name Street Address City/Town State Zip
to act on the pro pert% owner's behalf, in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL (Please fill out Appendix 2)
(It building is less than 35,IA)t)cu. tt.of enclosed s pace and/or nut under Construction Control then check here O and Alp Section IILU
10.1 Registered Professional Responsible for Construction Control
67965
Name(Registrant) Telephone No. e-mail address Registration Number
2ZS ���d� 5 i� W�a� =fzer�Wt� 1MPc OZ4ja :5 ,dam_ C-26-Z0/o
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor 1
CD
Coco any tryyamp: / c— /�+-.�wa va wr
TeiC /2 Ci�-sc�iHn GS 67c? /� / z-3G/ �
Name of Person RespoPBible fur Construction License No. and Type if applicable
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Street Address City/Town State Zip
9a 3 6-12-a2al- ZG trc
Tele hone 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 4V No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs: (Labor
and Materials) Total Construction Cost(from Item 6)_$ '70 o (3
1. Building $ 000 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 $ (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below, I herebv 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.
�.1 «k-iw� �_ �1rua Qy�S (L do 2-6
Ilea se print and>ign name Title Telephone.No. Date
Street Address City/To wrt State ip
.Municipal Inspector to fill out this section upon application approval:
Name Uate
t
B 9 e�'Zi�
Operation
T Independence LLc
Richard Castino
Jl President
j Watertown,MA
j 617-923-4545
operationindependence.net
0
Salem Historical Commission
120 WASHINGTON STREET,SALEM, MASSACHUSETTS 01970
(978) 745-9595 EXT 311 .FAX (978) 740-0404
CERTIFICATE OF HARDSHIP
It is hereby certified that the Salem Historical Commission had determined that the proposed:
❑ Construction ❑ Moving
❑ Reconstruction ❑ Alteration
❑ Demolition ❑ Painting
❑ Signage )K Other work
as described below has been approved under a finding of Hardship, as per the requirements set forth in the
Historic District's Act(M.G.L. Ch. 40C)and the Salem Historic Districts Ordinance.
District: McIntire
Address of Property* 156-616 Federal Street
Name of Record Owner: St. James Parish
Description of Work Proposed:
Replace existing platform lift with enclosed vertical platform lift, located at the southwest corner
with the gable capper drawings and specifications provided. Unit to have tinted glass with the
metal being as close to the color of the glass as possible (similar to the catalog) and with the
guardrail designed to replicate the fence but with a top rail.
Reason for Issuance of Certificate of Hardship:
o The application affects only the building or structure on which work is to be done and not the historic
district in general.
o The application is approved because it does not cause substantial detriment to the public welfare.
o The application is approved because it does not cause departure from the intent and purposes of the
amended Historic District Act.
Dated: 10/14/09 SALEM HISTORICAL COMMISSION
By:
fhe homeowner has the option not to commence the work(unless it relates to resolving an outstanding
violation). All work commenced must be completed within one year from this date unless otherwise
indicated. THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from
the Inspector of Buildings (or any other necessary permits or approvals) prior to commencing work.
CITY OF SALEM
• PUBLIC PROPRERTY
a` tires DEPARTMENT
I l KN
V `,1„Ir 1_'�\Y',\il11\G;i?N�1'a LET •SA r\I, -
I rI:478-74 9595 •1;%.x:978-740-/846
Construction Debris Disposal Affldavit
(required [or all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit _ is issued with the condition that the debris resulting from
this work shall he disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris,will be transported by:
(name of hauler)
The debris will be disposed of in
(Ilanle Ut faCl Ilyl )
(address of facility) _
\ignature of permit applicant
o Z3 - U9
,late
CITY OF S.UXA1, UNSSACHUSETTS
gL'DDLNG DEPAJLT%L NT
120 W.►SHLNGTON STREET, 3se FLOOR
TEL (978) 74S-9595
FAX(978) 74119844
ICl\®ERiEY DRISCOLL - TNO&WST.PMJLU
HAYOR
DIRECTOR OF PL BLIC PROPERTY/RL'1IDLV G COSODS510N ER
Workers' Compensation Insurance AlRdavit: guilders/Contractors/Electricians/Plumben
Allillicant Infnrmatlon 1 PIcase r nt Legibly
.4aine (eusirnas.Orgamralionln hv,dual): O (7 c=e&/ 1 6 10 L N cl i=/a tf�J C LAC C L
Address: 222 SGi17t7oal .51
City/StatdZip: w Gdw Phone M: 617 7
Are you to employer?Check the appropriateboa: Type of project(required):
1�I am a employer with� 4. 0 1 am a general contractor and 1 b b. ❑New construction
employees(fall and/or Part-time).* have hired the sub-contractors
2.0 1 am a sole proprietor or partner- listed on the attached sheet. : 7. �,Remodeling
.hip and have no employee Thew wb•contnetors have 8. ❑Demolition
workin for me in an can i worken'comp.insurance
8 Y Pat tY• 9. [3 building addition
(No workers' comp. insurance 3. 0 we are a corporation and its 10.❑Electrical repairs or additions
officers have exercised then
3.Cl I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself.(No workers'comp. c. 152,$1(4),and we have no 12.0 Roof repairs
insurance required)t employees.(No workers'
comp. insurance required.] 13.0 Other,
-Any applicant Ilan Hindu Dos el must also fta was raw atria below showing their wvAae'carrypanmykyn pubey infunrysttoa
'I I.vttenwynns who subant this aaldevir indicting 1heY am doing all work and than him outside contractors must sobmil a new altldevin indieritq sock
T.,mmlon the chock this bola mud anmhad an additional der showing the news of ants akevpmoon and their Warinss'ramp,paliry informoua.
l arts an employer that Is providing,workers'rotwpeesadoa lnsaronro jot ANY rwploytes Odetr his thelowley andm Ili
information. 1
Insurance Company Name: C-3 U A-,/' t5 —1 v\ C U V fd' A C_Q_
Policy Al or Self-ins. Lie.fl: 0A) -2r°"� C-9`0��3--2//��a ClExpirrtiao Data: � - 20
Job Site Address: /�G Finlz 57, .�-�t Pq L-14 City/StatdZip:_ C1 (0l76
.lnack a copy of the workero'compeasstion policy declaration page(showing the policy, number and expiration date)`
Failure to secure coverage a required under Section 23A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S 1.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S'_30.00 a day against the violator. Ile advised that a copy of this statement may be forwarded to the O►Yce of
I11vc,11gatiuns of the DIA for insurance coverage verification.
/do hereby,edify unde/r/,j{�ha pains and I
naldes of perjury chat the injrrrwadorr provided above is true and correct
PhoneA 1 617- 92 /.5
Official use only Do not write in this area, to be curnplefd by city or lawn 01/J1ciul
I
City or ruwn:
i
Lsuing.\ulhurily (circle one):
I. Itoard of Ileallb 2. Huilding Department ).City/ruwn Clerk 4. Electrical Impeder 5. Plumbing Inspector
6. Other
l,olacl Person: _ ._. _.. Phones'
I� FOVIR FLOOR
�.
__
r
i Ir I
i� 1IS 1 ORIC GWIT�LANDING
(NO CHANGE),
O,, r
3
HISLORIC WROUGHT IRON RAILING
w.
♦ ♦ 0j rpP� ��' ♦ ��. �' TO RE REMOVED IN THIS LOCATION i ♦♦
CONCRETE EXTENSION OFLANDING `" � ♦♦♦ �'��
(EXISTING) , ♦�
\ 4 2 CLEAR
c7\ FOR EGRESS
a
ACCESS DECK: STEEL .: 13 K S
GRATING ON PT FRAMING
U� tFOWDERmCOATED STEERiI
�,� I � iiV �0'�R'W?ROTfGATfROT7�;.
-
ze` HISTORIC WROUGHT
8,_8" IRON STAIR RAILING
y HISTORIC GR NITE STEPS
(NO Cl- NGE)
II II
II I
II II
II II
II II
II II
II II
II II
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14420/NAT
Model PCDE Vertical Platform Lift with ACME Screw Drive Buyline 6071
Model HPCDE Vertical Platform Lift with Hydraulic Drive
The PCDE and HPCDE models come equipped with factory supplied
enclosures made with clear or tinted acrylic panels. The acrylic panels
provide a smooth interior for the lift to operate. All other features are the
same as the CDE and HCDE models. The PCDE and HPCDE models are
attractive and permit ambient light into the lift hoistway. The user has a w
view from the lift during operation. The PCDE and HPCDE models can be
enclosed overhead to protect the user from the elements.
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® a 14420/NAT
Unit Dimensions Buyline 6071
Please note.All units shown are equipment dimensions only and are subject to change. Platform size
and configuration may change dimensions.Additional room for running clearances will also be required.
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MODEL BC, BBC and RE MODEL PCDE and HPCDE
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MODEL COE and HCDE 3-GATE MODEL CUE and HCDE 2-GATE
MODELS RE' BC,CDE,PCDE ACME SCREW DRIVE, Shroud Dimension"W" ALL UNITS 36 1/4" 0.92m
MODEL 24 RE ONLY 42 60 72 96 108 120 144
MAX.LIFT HEIGHT 1 27" 0.69m 45" 1.14m 63" 1.60m 75" 1.91m 99" 251m 111" 2.82m 123" 3.12m 147" 3.73m
SHROUD"X" I 46"(1.17m) I 64"(1.63m) 82"(2.08m) I 94"(2.39m) 118"(3.00m) I 130"(3.3om) 1 142"(3.61m) 171"(4.34m)
MODELS HBC,HCDE,HPCDE 1:2 CHAIN HYDRAULIC DRIVE Shroud Dimension"W" ALL UNITS 41 3/8" 1.05m
MODEL 24 42 60 72 96 108 120 144
MAX.LIFTHEIGHT NA 45" 1.14m 63" 1.60m a 1.91m 99" 2.51m 111" 2.82m 123" 3.12m 147" 3.73m
SHROUD"X" NA 69" 1.75m 87" 2.21m 99" 2.51m 123" 3.12m 135" 3.43m 147" 3.73m 171" 4.34m
REFERENCE: -RE AVAILABLE IN 24,42,60&72 MODELS ONLY! LIFT HEIGHT MUST INCLUDE PIT DEPTH,WHEN PITTED!"
'Due to variations in the printing process,actual colors may vary slightly.
Standard Color Optional Optional Optional Optional
Pearl White Texture Beige Brown or Brown Texture Gray Black Texture
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