22 GARDNER ST - BUILDING INSPECTION FID7The Commonwealth of Massachusetts
Department of Public Safety
Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(This.Section For Official Use Ohly)
Building Permit Number: Date.Applied: BudduigOfficial: Z
t
( ^ SECTION 1:LOCATION(Please indicate Block if and Lot H for locations for which street address is nola
Al 22 6-o.ra.Aer S. ler.•, MA 01470 W.
`I'J(1 NVEdf
d Street City/Town Zip Code Name of Building(if app tfable) m
,11 I SECTION 2 PROPOSED WORK. - t--G
MA State Code used_ If New Construction check here❑or check all that apply in the two t�Avs beq;n
uilding Repair Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Apo hdix
f Use ❑ Change of Occupancy ❑ Other ❑ Specify: W rn
ing 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: jCrjati,,.c,.1 O�- C�I�t e; ,a�e�.-�o� r .,A. - r,� rer ik
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): Proposers Use Croup(s):
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-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ 1 H: h Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional 1.1❑ 1-2❑ 1-3❑ 14❑ M: Mer e❑cantil R: Residential R-113 R-2❑ R-3❑ R4❑
S: Storage S-1 ❑ S-2 Cl U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ III ❑ IIA ❑ IIB ❑ HIA ❑ Hill ❑ IV ❑ 1 VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Suppl}`: Flood Zone Information: Sewage Disposal:
Trench Permit: Debris Removal:
Public fl 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: NI,\I listoric G_, E
jcw I'ro_c_c,_s: ;
Not Applicable❑ Is Structure within airport approach area? Is their rleted?
or Consent to Build enclosed❑ Yes❑ or No❑ Yes -
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction: Occupant Load p
Does the building contain an Sprinkler System?: Special Stipulations: -
°
y j 5
(
SECTION 9: PROPERTY OWNER AUTIIORIZATION +
Name and Address of Property Owner
Cmoe Ga., -22 Cru,rA_nEY 5-A 16m AA A ri1970
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information::A a3!? ,r 1
Title Telephone No.(business) Telephone No. (cell) e-mail address
If licable, the property owner hereby authorizes �'4 � C
CD At
_
arne- Street Address City/To State Zip
to act on the property owner's behalf,in all matters relative to work authorized by this building permit a22lication.
SECTION 10:CONSTRUCTION CONTROL(Please fIII out Appendix 2)
If buBdin �is less than 35,000cu.ft.of enclosed space an d/or not under Construction Control then check here O and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control It
anne( egistrant T• lone No. e-mail adjf e__ss r,1 T �m Registration Number /61
A�� -'d� `'� 1/�(�
Street Address City/Tow State Zip Discipline E pir<Lion Date
10.2 General Contractor - -
Company Name C 0930—/ //
Name ok4ron Responsibl Construction License No. and Type if Applicable
'11 1"/ t
Street Address Ci n State Zip
Telephone No. business Telephone No. cell e-mail address -
SECTION 11:WORKERS'COMPF:NSAI ION INSURANCE AFFIDAVer 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 0 No 0
SECTION 12.CONSTRUCTION COSTS AND PERMIT.FEE -
Rem Esthneted Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$
1.Building $ 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 -
SECTI 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.
.Qy Y1 Jr./� O✓7.3� �3�_�
Please print and sign nmne Title Telephone No. Date
Street Address City/T vn State Zip
Municipal Inspector to fill out this section upon application approval:
Name Date
The Commonwealth of Massachusetts
Department of IndustrialAccidents
I Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH TIM PERMITTING AUTHORITY.
Applicant Information Please Please Print Le ibl
Name (Business/Organization/Individual)'Zw p Lot
Address: -501-L 4dc (((
City/State/Zi : -t' 6/ Phone#: / - 5oZ6-
Are you an employer?Check the appro riate box:
Type of project(required):
L❑I a employer with employees(full and/or part-time).* T ❑New construction
2. am a sole proprietor or partnership and have no employees working for me in g, ❑Remodeling
any capacity.[No workers'comp.insurance required.]
3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t
9. [ Demolition
4.7 lam a homeowner and will be hiring contractors to conduct all work on my property. I will ]0 ❑Building addition
ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.$ II _,^,I �y���' ��
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other C U r�/,(G rr/✓�w'
152,§1(4),and we have no employees.[No workers'camp.insurance required.] T�
'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I mn an employer that is providing workers'compensation insurmrce for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.#: Expiration Date:Job Site Address:_ 2 Z 6-0-rAN It' t "f" City/State/Zip: .AI) A 01 q70
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains and penalties ofperjury that the information provided ahoy is tr a and correct.
Si ature: Date: 7
Phone#: `
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
" QTY OF SALEM, MASSA(iuSE s
BU MING DEPARTMENT
120 WASHINGTON STREET,3'm FLOoR
TkL(978)745-9595
KAMERLEYDRISOOLL FAX(978)740-9846
MAYOR THOMAS ST131EM
DIRECTOR OF PUBUCPROPERTY/BUILDING(DAWSSIOMR
Construction Debris Disposal Affidavit
(required for 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 c40, S 54; Building Permit#! is with the
condition that the debris resulting from this work shall be disposed of in a properly licensed
waste deposit 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:
SUS
(name of facility)
A
(address of facility)
Signature of applicant
Date
CITY OF SALEM, MASSACHUSETTS
BOARD OF APPEAL
� PIIIV� 120 WASIENGTON STREET 1 SALEM,MASSACHUSE'ITS 01970 -
KIMBERLEYDRISCOLL TELE:978-745-9595 ♦ FAX:978-740-9846
MAYOR
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tassazusMts Depa�rtept PybliC Safety
'B66rd .BuIIdlgg Regulations grid Sta4ntlat
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{GREGORY C I)E)yklN '
Petition of TROPICAL PRODUCT $TRhET s
of Sec. 3.3.2
�Qumcy MA 02178
Nonconforming Uses to allow an erF ,`a s ermit from the
provisions of Sec. 3.3.3 Nonconforri3j' axpiratron y nfotming front
setback dimension for the property 05t04/2o15 of 124)
(B2 Zoning District). ,,, • � s Com issioner'r
A public hearing on the above Petition was opened on March 18, 2015 close on that date pursuant to M.G.L
Ch. 40A, § 11 with the following Salem Board of Appeals members present: Ms. Curran Chair), Mr. Duffy,
Mr. Watkins,Mr. Copelas, Mr. Tsitsmos (alternate)
The Petitioner seeks Special Permits ry ttA�r g e it s %Jatloo
�5 ddice of Consa `T . , Sion Of a non-
The use and a Special Permit 4 t NIE i�pRD'VEMENI CONtRACSDR Type: rer Of the Salem
Zoning Ordinance. 4- - e0straiio tT75ss ' ogA
x ir>d'on
Statements of fact: p
GRE G DEERING CONS7RUC GN ",
1. In the petition date-stamped FeB y i# � is per Section
3.3.2 NonconformingUses and S , ` '`
9 non-
RE pEERWG g A� Sion of a non-
conforming front setback dimens i4o pAVIs ST
2. Attorney Atkins presented the pet . QUINCY,M
02'1711 = Undersecretary
3. The petitioner proposes to consdi uoii'ro'th" efirst floor and a 3, 485 square
foot addition to the second floor on nt left side of the existing structure in accordance with
plans titled"220 Highland Avenue"A-1 through A-4 and C-1 dated February 24,2015.
4. The requested relief, if granted, would allow the Petitioner to allow the extension of a non-
conforming front setback dimension.
5. At the public hearings no members spoke in favor or in opposition to the proposal.
The Salem Board of Appeals, after careful consideration of the evidence presented at the public hearing,
and after thorough review of the petition, including the application narrative and plans, and the
Petitioner's presentation and public testimony, makes the following findings that the proposed project
meets the provisions of the City of Salem Zoning Ordinance:
Findings for Special Permit:
1. The board fords that the proposed expansion of this dimensionally non-conforming building is not
more detrimental than the existing structure to the impact on the social, economic or community
needs served by the proposal.
2. There are no impacts on traffic flow and safety,including parking and loading.