Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
183R FEDERAL ST - BUILDING INSPECTION (2)
The Commonwealth of Massachusetts I Department of Public Safety =�-,w✓' .\laxsachusetts State Building Code(780 C\IR)Seventh Edition W f City of Salem f Building Permit Application for any Building other than a 1-or 2-Family Dwelling 'ahl (This Section For Official Use Only) Building Permit Number: Date Applied: W Building Inspector: SECTION 1: LOCATION(Please indicate Block N an Lot k for locations for which a street address is not available) /93 P, Sr— char*1 Sq?EM 619 70 No.and Street City /TM%n 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 Buildinglo RepairA Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: sy Are building plans and/ur consinactioddocuments bring supplied as part of this permit application? Yes ❑ No Is aAndependent Structural Engineerin�Peer Review required? Yes ❑ No Brief Description of Propposed Work: Vt-P4a2 j'iAa 1,x/Al..�,}' 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): r 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❑ B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ FH.—High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ l: Institutional 1-1 ❑ 1-2 ❑ 1-3❑ 1-4 ❑ M: Mercantile❑ R: Residential R-10 R-2 ❑ R-3 ❑ -R-4❑ ��" S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ HA 11130 IIIA ❑ IIIB ❑ IV ❑ VA VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) t r112 ter Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: PP y A trench will not be Licensed Disposal tide)p?� Public Check i(oulside•flood Zone%1 Indicate muniapal$I /r required { or trench ur,pccily: rivaty❑ or indenbfy Zone: or on site system ❑ permit d moused ❑ Railroad right-of-way: Hazards to Air Navigation: \L\ I lietu ri.Cinnmissinn Itrc iv„ Pro".": ..\ot Npplicable� Is Struoure within airport approach area.' Is their reciear completed.' ('nnsenl to Build enclo>ed ❑ Yes❑ or No)? Yes❑ \n ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code. Ule Group(+): Ty pc of Gnasl niction:W OO Occupant Load per 1=1oue D,ws the building.on/lain an Sprinkler System.': Special Stipulations: e- SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner A441O y) tLdAi0A2SL J /832 F, 2A ST (MIZE`F/ S4Lcw1 a?4 Name(Print) Nu.and Street C ih'/Town Zip Properly Owner Contact Information: �'tGinS+�r L' ac'�•ca"" Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable, the property owner hereby authorizes Name Street Address City/Town State Zip to act on the *ro pert% owner's behalf, mail matters relative to work authorized by this building permit a >ilication. SECTION 10:CONSTRUCTION CONTROL (Please fill out Appendix 2) (If building is less than 35,tk)0 cu.ft.of enclosed s ace and/or nut under Construction Contrul then check here O and skip Section 10.1) 10.1 Registered Professional Res onsible for Construction Control Name(Registrant) Telephone No. e-mail address Registration Number 1•— Street Address City/Town State Zip Discipline Expiration Date e 10.2 General Contractor i M BULIJAQ-() �TN� Company NamrLe: TC>p4� r["LNAq-L� Name of Person Responsible for Construction License No. and Type if Applicable A DnmAcu AtN� QAwgoz2s �99 C3. Street Address City/Town State Zip TI-8-�4aP 176-774 _q8J8__ _MMr46_AoA+9P r1sw5 -Lolfn Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION QJSURANCE AI'FIDAVIT(M.G.L.c.152.§ 2506)) 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 I7 No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs: (Labor Item and Materials) Total Construction Cost(from Item 6)_$ is 00 1. Building Building Permit Fee=Total Construction Cost x_(Insert here 2. Electrical $ appropriate municipal factor)=$ 3. Plumbing $ an Note:Minimum fee=$ (contact municipality) 4. Mechanical (HVAC) $ 5. Mechanical (Other) $ Enclose check payable to 6.Total Cult $ . ,.-',(�' 'Q.(qO (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 amtaine i in this application is true and accurate to the best of my knowledge and understanding. �tnn �t�up2D � d�.7-,,.� 0LJty� 8 a-moo �0 I'kasr :riot and aign name Title Telephone No Date t� f�aThAa�l A%,rC VAVoJIHA_5 MA 01 "iA 3 titreet Address City/Town State Zip r1 Municipal Inspector to fill out this section upon application approval: �U Na e I ate CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT IIIIY. Nlt., I'Bly„I I 1'ri:WS-N5:1595 •1:.\X:978.740.9846 Construction Debris Disposal Affidavit (required lur all demolition and renovation work) u 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 to _ 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 tILS 150A. The debris will be transported by: (name 01 hauler) The debris will be disposed of in (name ul act ny) (address of facility) \isnaturc of 1x tit applicant date CITY OF S.U.ENI, ,LkSSACHUSETTS BI:ILDLNG DEPART%LL'4T • /r 120 WASHINGTON STREET, 3'O FLOOR TEL (978) 745-9595 FAx(978) 740-9&M KI.,IBEA EYI�DRISCOLL THOlus ST.PMAU MAYOR DIRECTOR OF PCOLIC PROPERTY/gC[fDLYC CONMB55202JER 1 orkers' Compensation Insurance AMdavit: Builders/Contractors!Electricians/Plumbers alsal�cant Information 0 Please Print Leaiblr Natni tdwimw rpmzalion lndiv�du:d): GL(LtJ�fl `i JOQ� S Adds ss: 6 QOmAiy A-JC CityZate/Zip. -DAn.1Vir2S r'MA 016�23 phone k: ei-)1B — 7�7 — L+8 I S Are yowl to employer'Cheek the Appropriate box: Type of project(requlred): 1. 1 am a employer with 4, ❑ 1 am a general contractor and 1 employees(full and/or pan-time).• have hired the subcontractors 6. ❑New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet: y U Remodeling :I�ip and have nu employees The=subcontractors have S. 0 Demolition w rkin for me in an ca aci workers'comp.insionsa . g Y P tY• [tier workers'comp. insurance S. El We are a corporation and id 9. 0 Building addition required.] officers have exercised their 10.0 Electrical repairs or additions 3.0 1 11m a homeowner doing all work - right of exemption per MOL 11.0 Plumbing repairs or additions myself.(No workers'comp. c. 152.11(4),and we have no 12.0 Roof repairs in§urance required.]t employees. (No workers' 13.0 Other comp.insurance required.] Any applialanl nag check&ban$1 must am rail wt the seclim bclowshowing their waken'comp&n,"policy infur n aaac '11, n owiim who subout this affidavit indicaing they am doing all work aid thm him outside co enncron tour suhrnil a new allid&vd indicating suck ['.ntrawrt tlul cheek this bas mug a"=had an additional shad showing In name o/rly.u►avngngcfam and their woria m-comp.pal icy inh.'sidwo I are an amplayer that B providing workers'compemarbn Insurance jar my employs" Brlow/s the poll&y andM site informallOtl. Insurrn. Company Name: ��UA� 105017- ez- 40MVA+U`( Policy M r Self-ins. Lice p:&m L a6 O 1 a 0.7�j Expiration Date: Job Site AlIddress:1912 l FI XX Ste£ 'd CV -' f- City/StawZip: SAkzty� i-nA ©K 7 O Attach a icopy of the workers'compensation policy declaration page(showing the policy number end expiration date). Failure to secure coverage as required under Section 25A of MGL C. 151 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 ring of up to S 30.00 r day against the violator. lie advised that a copy of this statement may be forwarded to the Office of I nvcattgatlunn of the DIA for insurance coverage verification I do here certify under the pains and penalties of perjury that the information provided above is true and rorreeg �i litre_ �y .G i ii c--eLi Date: 0 -690 —,94:�I/b Pl:nne d: 1-78 iD�cial use only. Do nor wrile in this area,to be,umpleted by city or town gyii-iaL � I City or Tuwn: __ Pcrmit/Llccme N Issuing!.%uthorily (circle one): L Board of(Ile 2. Auilding Department 3. C'ilylfown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Ol her Lmilacl Person: _ _.. Phone g: L The Willis Tuttle Condominium Trust C/O Kim Armstrong 183R Federal Street Salem, MA 01970-3244 February 23, 2010 City of Salem, Massachusetts Building Department 120 Washington Street, 3`' Floor Salem, MA 01970 To whom it may concern: I have seen and read the renovation requests proposed by Matthew Kaminski, owner of Unit #1, 183R Federal Street, Salem, MA as put forward on the City of Salem building permit application for any building other than a one or two family dwelling, Massachusetts State Building Code (780CMR) Seventh Edition. The request for the renovations has been reviewed and approved by The Willis Tuttle Condominium Trust. Sincerely, Kim Armstrong Trustee Willis Tuttle Condominium Trust