9 GEDNEY ST - BUILDING INSPECTION� � ,•� � r
-� ;' �;: The Commonwealth of Massachusetts
`���I �f �,� :� Department of Public Safety
v.-�,.•y \tac.,�ihu.etls tit,itr f3uildin�Code 1%30 CJIR)4crnlh Ediliim �
U� City of Salem
�Y Buildin Permit A fication for an Buildin other than a 1-or 2-Famil Dwellin
(This tirctiun Fur l)t(icial Usr Unlv)
Buiiding Permit Numbrr: Datr Af�plird: ` Building In.f�ectur`.
-SECTION 1: LOCATION (Please indicate Block k and Lot M for locations for which a street ad ress is not available)
I�1 G-�n►�^( bi cSauar�l O/99't7 �
.\'u. and titrrrt Cih� /To�cn Zip Cude - Namr uf Binldin}; (if.ifipliral,le)
SECTION 2:PROPOSED WORK
II New Cun,tructi�m chrck hem O ur check all that apply in Ihe twu rows below -
Ecisting Building Repair❑ Alteratiun � Addition❑ Drmulition ❑ (Please fill out and submit Appendix 1)
Change uf Use ❑ Change of Occupancy ❑ Other ❑ Specify: �
Are building plans and/ur construction documents bring supplied as pnrt uf this permit application? Yes No�<
Is an Independrnl Structural Engineering Peer Review requirrd? Yes ❑ No ❑
Briif Descriptiun uf Prupo+ed Wurk:__���allC t� 2 — �<i�,�,�F-nJ � �fS_�� ��>
12"'f1AG� W�nIL`ow�C
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGO[NG RENOVATION,ADDITTON,OR
. CHAIYGE 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):_ �y
Existing Hazard [ndex 780 CMR 34: Proposed Hazard Index 780 CMR 34:
SECTION 4: BUILDING HEIGHT AND AREA �
Existing Proposed
Na uf Fluors/Stories(indude basement levels)&Area Per Floor(sq. ft.)
Tutal Ama (sq. ft.)and Total Height(ft)
SECIION S:.USE GROUP(Check ae applicable) .
A: Assembly A-1 ❑ A-2r ❑ A-2nc❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-t ❑ F2❑ H: Hi h Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
L• Institutional 1-1 ❑ I-2 ❑ I_3 ❑ 1-4❑ M: Mercantile O R: Residential R-1❑ R-2 fJ� R-3 ❑ R-�❑
S: Storage SI O 5-2❑ U: Utility O Special Use O and please describe beluw:
Special Use: . .
� SECTION 6:CONSTRUCTION 7YPE(Check as ap liwble) � .
, IA ❑ IB ❑ IIA ❑ 118 ❑ ❑IA ❑ ❑IB O IV ❑ VA ❑ VB O
. SECTION 7: SITE INFORMATION Irefer to 780 CMR 111.0 for details on each item)
� � Water Supply: Flood Zone Infomiation: Sewage Disposal: Trench Pertnit: nebris RemovaL• �
Public B� C heck i(uu(aidu Fl��,ai L�me❑ Indit.itr municiF�.il ❑ .'� trenrh will nut be Licrmed Di.pi�a�il tiitr❑
Pric,ile ❑ �ir indenti(c Znne:_ urun.ite.c.tem ❑ reyuired O or trench ur.F,ecil��: ��L �
. . F,ermil is end��zed �' (�.S.y}2yqi� L•r� �
IRailroaJ right-of-waY: Hazards to Air.Vavigation: � \I�\ ;li.li,n�t�,�mini..i��n Hr��i,��� I'n�����..:
I \„t :\F�F�li.ablc� �I.tilrurtinr��ilhin .iirF+urt,iF+F�ru.�rh.u�r.i' 6 Uicir rr��ie�c iumF,l��trd'
� ��r l�nn.cnt lu Ruilii rnd��.cd O Yc. O ur.\'n ❑
` Yr. ❑ \�� ❑
� SECTION e: COtiTE:tiT OF CERTIFICA"I'E OF OCCUPANCY �
� I�di�n�n ui C��dc: L�.r(�i��upl>): �cpcul Cun.truch��n: l.)cru�,.�nt Luad pvr 19�n�r
I �I)nr. Ihr l,uildin};rnnt.iiii an CF�rinklcr ti��.lem` CF�ccial tili��ulatiuns:
�� ��
SECTION 9: PROPERTY OWNER AUTHORIZATION
V,ime,indAddrcss��IPn�perh�Owner � � -�
(�n�FWM �i-�t E"S�7Ah�UG ��� Wf1�l�itWr�D IJ� Sf�'Lt—Wl 019'�'t�
Name (Print) Nu. and titreet Cih�/Tuwn Zip
Properl�'l)��'n.r C�mtact In(urm.itiun: q�.q ����y .
Te,.I� P/�1(1� i"-'=1'1='s'--- —"_
Tide TrleE�hune Nu. (busine�s) TrleF�hune No. (cell) e-ma�l.iddress
I(apE�licablr. thr pruprrh�u�aner hrrrby .iuthurizrs �
V,�me �trert Addrrss Citv/Tuwn Stale Lip
tu act��n Ihr �ru�erl�'�m'nrr'.beh,ill, in aIl matters relati��r tu work authurized bv this buildin � �rrmit a , �lic.uiun.
SECTION 10:CONSTRUCiION CONTROL IPlease fill out Appendix 2) � �
(If buildin�is Ics.than 35.1h�cu. fL ut i•nclos.d<uxe and/ur iwt und��r Cunstru<tion Conlrol lhen check here 0 and ski�S.cliwi lU.l)
. 10.1 Re istered Professional Res onsible for Construction Control
. Name(Registrint) � Telephune No. e-mail.address . Registration Number
Strert Addrcss City/Tuwn SWte Zip Dixipline ExpiratiunDate
10.2 Ceneral Contractor
O l�'l f�-'�N�1^'A� LLe--
�mpany Name: (�f� �O✓1 S� (�UP
t�v,D Pwa,ca-I
Name uf Person Responsible for Cunstructiun License No. and Type if Applicable
0. elnOr�(�V�[�,J "1"L�Q.� `�1k1 ✓Y''� �( �197t1
Street Address City/Town State Zip
9�8_�-9�--
Tele hone No. (business) Tele hone No. (cell) - rmail address
SECTION 11:WORKERS'COMI'ENSATION QJSURANCE 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. Pailure to provide this affidavit will result in the denial of the issuance of the building permit.
Is a si ned Affidavit submitted with this a lication? Yes❑ No O
SECTION 12:CONSTRUCTiON COSTS AND PERM[T FEE
Estimated Costs: (Labor
Item and Materials) Total Constmction Cost(from Item 6)_$
1. Building $ J�� �� Building Permit Fee=�I'otal Cunstruction Cost x_(Insert here
2. Electrical S 8�v appropriate municipal factor)_$
3. Plumbing $ �� p, y�
Note: Minimum fee=$ (contac[munici ilit
4. Mechanical (HVAC) $ �
5. Mechanical (O[her) $ ^'� Enclose check payable to ,
6. Total Cost - . $ �� � (con Wct municipality).nd write check number here
� SECTION 13:S►GNA7URE OF BU[LDING PERMIT APPLICANT �
Bv enlerin}; my name beluw, I hereby attest under the pains and pen.ilties u1 perjury that all of the informatiun cnntained in thi.
applicatiun is trur and accur,ite to the be.t nf my knuwlyd�e and under�tandin�.
MhN�� ��-�- �Z �2 �
I'le.i:r print d .� �n � me iitle TcleF�hune V��. . Date�
��A�-� MA- a ���°to
Ititrrcl ":�.idre.c � CitciTu�cn la e ZiEi .
I' S7unicipal Inspector to fill out this section upon application approval: � �
. 'ame I), te
'`� CITY OF S.�1I.E.�I, �L�SS.�CHL;SETTS
� BL'IIDL�(G DEPAd'i1t&�iT
� 1'_O WASHINGTON S'TREET, )�O�.00R
. TEL (97� 7�5-9595
F.Vt(97� 73Q98i6
KI�BEgIEY DRISCOLI.
�tAYOR 'IHoac�s Sr.P�axs
DIREGTOt OF Pl.BLfC P0.0PEA1Y/BCQ.DLVG CO�L�RSStONER
�Vurkers' Compensation Insurance AfTidavit: Duilder�/Contracton/Electricfan�/Plumben
annUcant Inform�tlon Plcax Print Leelbiv
Vamt ie�,���,,ors,,��:.�iotii����d�,:�)' �41E1� K�N�P(L- LL �
Address. � ���1 � S�
,
C;ty/Statc/Zip: �A-L��"L M� Phone M: � � ���- �Z
Are you n employerT C6eck the yppropriate bor,; Type of proJeet(requlre�:
I. am a employa with_�_ 4. �;un a g�.�n�rai canhxwr and I 6. ❑Nnw conywetion
amployees(full and/or part-eime).• have hired rhe wbcontracron
2.O I am a sole proprie�or or partner- listed on the attuhed yheet : �• ��makling
:hip rnJ have no employeen � These sub-contneews have 8. � Ikmolition
workin for me in an ca xi �vorken'comp.inau�ance.
6 Y P h'• 9. � Duilding addition
(No worken' comp. irourance S. Q We arc a eor�wrution and iCt 10.[,,�.Efecrrical rcpairs or additions
r�quireJ.] otrcm luve exercixd thair
J.� I am a bomeuwnar Joing all work nght of cxemption per MGL ��.[,]-Pfumbing repain or addidons
myself.[\o workers'comp. c. 132.ff 1(4).and we have no 12.� Roof erpairs
insurance requircd.] t �mployea. (No worlten' 13.0 01ha
comp. insurance required.J
•nny appliianl�lul chects Om�I mutl aisu fill w1 IM aenim bcloM�hovie�tlqir rvorken'compenution yuliry infurma�lon �
�I I�xneuirnen w1a su6mit�hit aRldrvi/indicatinr ihey an doin�{dl work,vd thee hi,e ouMide eonnectpf mw��uhmit a naw allfJori�indio�in{wek �
{'.miraw��lu�•�haek�hi�Eat mup anxhed an aJditiwml�hs�showin��ho nome of Oy�ulavmnctps and�hc4 wuhm'mmp.puliry infpmauw.
/uiw aa employer rha!lr providlnR�vorAren'rompen.radoa lnaqraece jor my erap/uyees, Bs/aw/r Ihe pa/!q and fab r!q �
injormuiion,
.. �
Insurenct Cumpany Vame: v�- l �fJC>>fLA-r7Px-. �
Pnl icy q ur Snlf-ire.Lic. H: Ezpirr�ion Date: �
Jab Sirc Addreu: Ciry/S�ate/Zip:
,\nac0 a copy of t6a worken'eompen�rtb�poUey declaratba paQ�(s6owtn�tW pollcy aumbtr ind e:plraHo�dab�
Failure to�:curc coverage as requircd�nJer Sectian 25A af MGL e. 132 can lead to the impo�ition of criminal penalties of■
fine up to S I,S00.00 am1/o�one-year imprisonment,as well as civil penaltiea in the form uf a STOP WORK ORDER arM a fine
uf up eo 5?SO a Jay agai ihe violaror. Ik advi.wed�hat a copy uf ihis atatement may be furwardud to the Olfice of
In��csugaiiun uf d�e n1A for nsuranct covcraga vcriticalian.
/Jo herrby crr�i w�J rhr painr und yuiu/t!u ujperJury tbat r6e infarmuNoa provideJ abovr i.f lrpr und corircL
�n, r i ire� I)utc� ��2�f�v9
Phane�i: �� r� '� (Z�
iO�cru!u�e mdy. Du no!��riie rn ihis�reu, �a bs cumplrted by ciry or rown o/f7eiuL � �
�
Cityar 1'u�rn: __ __ Ncrmit/I.IcemeM__.. I
� 6suing.�whurilrlcircleunc)t � � --- ��---� - � ---�—
� I. ISu�rJ uf IIe�Uh 2. RuilAln� Deprrtmcnt J.City/fown Clerk �. Electrinl Inspecror 5. PlumbinR fmpeetor
� 6. Oihrr __.
' . l'unlacl Pcrson: _. .. . --. -_ PhOOt p'
�
, ,
' � CITY OF SALLM
��'� l� PL�BLIC PRc)PRFRTY
;,•�, !:y ,•�?
'. '`�„�
>,,.,• DEP.�K'I�LtENT
,I �- . . � I:: N ��.�u•.�. ,•�.�..:iir � ��ii ��. \I�•.�� . . � 'I � _
. .. I i� 'i'9.'J:.-r:.,: � I �� '.'V '�_ ',:1��
('onstructiun Ucbris Uisposal .al'lid:�� it
(rryuirr� li,r all Jrnwlirion :uiJ ivnu�.iUun �vurk)
In accunlancr ��iih th� sixtl� rJition ul'ihc Slatc Duil�ing CoJc, 7SU CA1R s�c�iun I I L�
D�Uris, unJ ihc pro�isiuns uF'�1GL c �0, S 54;
[3uildin5 Permil t► is issucd �vilh Ihr canditiun th�t thc dcbris resulting from
diis w�urk sh:ill bc di,poscd uf in a proprrly IittnsrJ �va,te ilisposal I�cility as dctincJ by M(iL c
I l 1. S I SUA.
Thc drbris ��•ill bc tran,portcd by:
��Cr-� �115���
. -- In�mcol'haulcr) .
7 hc Jcbris will bc dispuscA of'in �
�`�-7
(OJIOC uI IJ�1 UV�
.. I.iddre.. ul�I�cililVl .
� .i�ndlwc ��Ypirn
�/���v `I
,i��,•
BEDROOM � DINING LIVING
i
KITCHEN CaMMON
o O OFFICE
� � o
e C� AREAS OF DEMOLITION
BATH
KI TCHEN BEDROOM
,
SCALE
5 0 5 10 20
AUGUST 24, 2009
EXISTING CONDIT[ONS � 9 GEDNEY STREET, SALEM
PRESENT�D BY: SALEM R�NEWAL LLC
NOTES:
BUILDWG CONTAINS 3 IDENTICAL UNITS, EACH TO BE RENO'VATED AS
SHOWN.
KITCHEN AND BATHS TO BE RENOVA7ED AS SHUWN.
BEDROOM DINING LIVIN�
NEW WINDOWS �NSTALLED THROUGHOUT.
WALLS, CEILINGS AND FLOORS TO BE REPAIRED AS NEEDED.
LIVING ROOM, DINING ROOM, BEDROOMS AND Of�ICE �AYOU'TS TO Q5 O
REMAIN UNCHANGED. co
WINDOW TRIM, UOORS AND DOOR TRIM TO REMAIN. o O
REF � o COMMON OO
COMMON HALLS AND STAIRS TQ REMAIN UNCHANGED. OFFICE
HEATING SYSTEMS AND WIRING TO REMAIN. NEW WIRING ADDED AS L o� W/D
NEEDED. —��
DW �
HARD-WIRED SMOKE DETECTORS TO BE INSTALLED THROUGHOUT AS BATH
SHOWN. ADDITIONAL SMOKE DETECTUR T0 8E INSTALLED IN �
BAS�MENY. � � �
FRONT PORCH AND EXTERIOR STAIRS TO BE REPAIRED AS NEEDED. KITCHEN BEDROOM '
r
OO
SCALE
5 0 5 10 �0
� AUGUST 24, 2009
�
PROPOS�D CONDITIONS 19' GEDNEY STREET, �ALEM
pRES�N'TED, BY: SALEM RENEIIVAL LLC
I � -
:!
'r /,
� '.
BEDRO�M � DINING LIVING
KITCHEN COMMON
o O OFFICE
0 � �
o � AREAS OF DEMOLITION
BATN
KITCHEN BEDROOM
��,.
�
SCALE
5 0 5 10 20
AUGUST 24, 2009
- EXISTING CaND'IT[ONS � � GEDNEY STR�ET, SALEM
,� PRES�NT�D BY: SALEM RENEWAL LLC
_ :''
NOT[S:
BUILDING CONTAINS 3 IDEfVTICAL UNITS, EACH TO BE RENOVATED AS
SHOWN.
�
KITCHEN AND BATHS TO BE RENOVATED AS SHOWN.
BEDROOM DINING UVING
NEW WINDOWS INSTALLED THROUGHOUT.
WALLS, CEILINGS AND FLOORS TO BE REPAIRED AS NEEDED.
LIVWG ROOM, OINING ROOM, BEDROOMS AND Of�ICE LAYOUTS TO � O
REMAIN UNCHANGED. co
WINDOW TRIM, DOORS AND DOOR TRIM TO REMAIN. o O
REF 0 o COMMON OO
COMMON MALLS AND STAIRS TQ REMAIN UNCHANGED. OFFICE
HEATING SYSTEMS AND WIRING TO REMAIN. NEW WIRING ADDED AS � W/D
' NEEDED. ' ���
�W II I
HARD—WIRED SMOKE DETECTORS T0 6E INSTALLED THROUGHOUT AS BATH
SHOWN. ADDITIONAL SMOKE DETECTOR T0� BE INSTALLED IN �
BASEMENIf. O ;
FRONT PQRCH AND EXTERIOR STAIRS TO BE REPAIRED AS NEEDED. KITGHEN BEDROOM '
i
0
SCALE
� � 5 � Q 5 � 10� ��0
AUCUS'T 24, 2009 !
� PRC�POS�b GONDITIONS 19 G�DNEY STR�ET; SALEM
� . �'RESENTED•BY: SALEM RENEWAL LLC
:,
BEDROOM � DINING LIVING
r
KITCHEN COMMON
o p OFFICE
� � �
e � AREAS Of DEMOLITION
BATH '
KITCHEN BEDROOM
�
SCALE
5 0 5 10 20
AUGUST 24, 2009
;; EXISTING CONDIT[ONS � g GEDI�EY S�"REET; SALEM
� PR�SENT�D BY: 5,4�.EM RENEwA�. LLC
,
,•
. ,
�
NOTES:
BUILDING CONTAINS 3 IDENTICAL UNITS, EACH Td BE RENOVATED AS
SHOWN.
KITCHEN AND gATHS TO BE RENOVATED AS SHOWN.
BEDROOM DINING LIVING
NEW WINDOWS INSTALLED THROUGHOUT.
WALLS, CEILINGS AND FLOORS TO BE REPAIRED AS NEEDED.
UVING ROOM, DINWG ROOM, BEDROOMS AND OFFICE LAYOUTS TO QS O
REMAIN UNCHANGED. co�
WINDOW TRIM, DOORS AND DOOR TRIM TO REMAIN. o O
REF
COMMON FiALLS AND STAIRS TQ REMAIN UNCHANGED. O o COMMON � OFFICE
HEATING SYSTEMS AND N�RING TO REMAIN. NEW WIRING ADDED AS L ol W�D
NEEDED. � pW �,'I��
HARD-WIRED SMOKE DETECTORS TO BE INSTALLED THROUGHOUT AS BATH � v �
SHOWN. ADDITIONAL SMOKE DETECTOR T0 8E INSTALLED IN �
BASEMENIf. O �
KITCHEN BEDR�JOM '�
FRONT PORCH AND EXTERIOR STAIRS TO BE REFAIRED AS NEEDED. �
�
�
SCALE
5 0 5 10 20
,
AUGUST 24, 2009
; PRC�POSEb CONDITIONS � 9`GEDI�EY STR�ET� SALEM
� pRESENTED, BY: SALEM RENEWAL LLC