2 GRIFFIN PL - BUILDING INSPECTION (2) 5'Z3l b 30�
The Commonwealth of �tiT'YF
` A� Department of Public Safe1y,7-0C.'-j I
hiassachuselts State Building Co�pli80 1' A 9' ny�Dwelling Building Permit Application for any Building other t anal ne-or Two-Fami`f
.(This Section For Official Use Only)
Budding Permit Number. Date Applied: Building Official:
SECTION 1:LOCATION(Please indicateBlock ktand Lot pnfor locations for which a sheet address is not available)
"A Q I9
No.and Street City/Town Zip Code Name of Budding(if applicable) .
I� SECTION 2•PROPOSED WORK
tI, Edition of MA State Code used_ if New Construction check here❑or check all that apply in the Iwo rows below
Existing Building Repair❑ I Alteration Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1)
I Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes No ❑/
I-� Is an Independent Structural Engineering Peer Review req Yes ❑ No [�
Brief Description ofPropoy\edWork- ('Zt�-eJ,-V,uired?e ems , Caw-x.l .•...c �-e
cr-ti O-R �•T'C._�a_w� >� �.�CL.S o,ti� �9reJP � z.,.-v�C
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): 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 S.USE GROUP(Check as applicable)
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-f❑ A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-t❑ F2❑ - . Hi h Hazard H-1❑. H-2❑ H-3 ❑ H4❑ H-5❑
1: Institutional W❑ 1-2❑ 1-3❑ 14❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑
S: Storage S-1 ❑ - S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ III ❑ HA ❑ HB ❑ IIIA ❑ Hill ❑ IV ❑ 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❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑
required❑or trench or specify:
Private❑ or indentify Zone: or on site system❑ I permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: \L•\I li;loric�_anmds6m lawuw I'nx,�;<:
Not Applicable❑ Is Structure within airport approach area? Is their review completed
or Consent to Build enclo ❑ Yes❑ or No❑ Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition 4Code: Use Group(s): Type of Construction: (kcupant Load per Flour:
Does the building contain an Sprinkler System?:_ Special SlipulaItons:
ef-R-L-L— L� P •(7
riff I t �Y� L rn O V,� —1 19
SECTION 9., PROPERTY OWNER AUTHORIZATION - -
Name and Address of Property Ownerp
P,ekar.^Q Cevr-k.� LL-L Zg �e weep rve �/ I^ . P 1"`� OI O7 _
Name(Print) No.andStreet City/Town Zip
v
Property Owner Contact Information:.'. a
Da � o� .k ` _7y3 _a 90_ 7S1e o��o� , j Co
/ " _
Title Telephone No.(business) Telephone No. (cell) e•maii address
If applicable,the property owner hereby authorizes
na� 6oF—:w.1-_ -2.3zwes� Ce��._ t�`F Uec MA oZIlb
NMune Street Address City/Town State Zip
to act on the property owners behalf, in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If building is less than 35,000 cu.ft.of enclosed space end or not under Construction Control then check hem D and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control
Name(Registrant) -Telephone No. c mail address Registration Number
Street Address - City/Town Slate Zip Discipline Expiration Date
10.2 General Contractor - -
Company Name
>� VS A-- CS - 1 �D 1 3
Name of Person Responsible for Construction - � License No. and Type if Applicable 1
2a2 WeS f C4-- 1- it oC � _PPC r'7Z ) 1 'O
Street Address City/Town \\ Stale Zip
$0. -7 S 1
Telephone No. business Telephone No. cell e-mail ad ress
SECTION 11:WORKERSS'COn1PENSA'110N INSURANcr AFFIbAVrI' NLG.L.c.152. 25C 6
A Workers Compensation Insurance Affidavit from the NIA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes O No O
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE -
Estimated Costs:(Labor - p
Item and Materials) Total Construction Cost(from Item 6)_$ 21
1. Building $ I 0 p00 SZ;31V
Building Permit Fee-Total Construction Cost x—(Insert here
2. Electrical $ go 0 0 0 - appropriate municipal factor)_$-4-1—.
3.Plumbing _ $ 20 0 o O
d.Mechanical (HVAC) $ 10 0 0 O Note:Minimum fee=$ (contact municipality)
5.Mechanical Other $ Enclose check to
6.Total Cost $ Z 1 0 0 0 L payable o 0
r (contact municipality)and write check number here 4 2
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below, 1 hereby attest under the pains and penalties of perjury that all of the information contained in this
application is true.cod accurate to the best of my knowledge and understanding.
ge� k L % e v__pe� -7035�0.7S18 S 14 6
- -
Please print and si n name Q Title TelephoneTelephone No. Date
2--',2 ieg Co.—'�- 4 I o C'�m � /�L� D Z I 1 6
Street Address City/Town Stye Zip
Municipal Inspector to fill out this section upon application approval:
Name Date
The Commonwealth of Massachusetts
Department oflndustrfalAccidents
l Congress Street,Suite 100
Boston,AM 02114 2017
www.massgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/EleeWeinns/Plumbers.
TO BE FUXD WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leeib
Name(Business/orgamzason/lndiviaual):_ (F, c�.r��� C �F A,
Address: zg K2 v w a o d Ave
e \
City/State/Zip: MA p k%8 7 Phone#: ( --7 L> -S ) 9 S'p-? S ( a'
r&[�(W.
err employer?Check the appropriate box:
arm.employer with ,aWloyees(full and/or ��otpr°ject(required):
tIDe)' 7. ❑New construction
m a sole proprietor=partnership and have an employee,working for me in g. Realodelia Y cePacitl'.[No workers comp.insurance required.] ❑ g
m a homeowner doing all work myself[No workers'co 9. ❑Demolition
top.imurance required.]1
a homeowner and will be hiring contractors to conduct as work an m 10❑Building addition
Y property. I will
me that all contractors dtha have workers'compensation insurance w are sole 11.❑Electrical repairs or additions
prietors with no employees.
12.❑Plumbing repairs or additions
a general connector and I lave lined the sub-contactors listed on the attached sheet
se sub-contact==have employees and have workers'comp.maurnaim: 13.❑Roofrepairs
rea corporator and it officers have exercised theanght ofexemption W mGL c. 14.❑Other
§1(4),and we have no employees[No worker'comp,in=urarce required]
-Any applicant that checks box#1 must also bill our the section below showing their worker'compensation policy information.
f Homeowrars who submit this affidavit indicating they are doing all work and than hire ouaide contractors must submit a new affidavit indicating such.
:C nitmetors that check this box mutt attached an additional sheet showing the name ofthe enbcoaractors and state whether or not those entities have
employees Ifthe sub-contractors have employees,they must provide their workers'comp.policy number.
lam an employer,that is providing workers'compensation insurance for my employees. Below is theRaUcy and job site
Information.
--� Insurance Company Name:
Policy#or Self-ins.Lic.M Expiration Date:
Job Site Address: City/State/Zip:
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 cerrNTunder the pains and penalties ofperlury that the mformadon provided above is true and correct
Signature, Date, 6 (_1 A �
Phone M C 7 0 5) 9 g at —7 S I g
Octal use only. Do not write in this area,to be complied by city or town octal
City or Town: Permlt/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phoned:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written." -
_ An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
Liability Companies or Limited Liability Partnerships(LLP)with no employees other than the
. Limited Lr �insurance _ty mpam (I.L
members or partners,are not required to carry workers' compensation insurance. if an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmationof insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the approphate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legrlrly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple perrrdt/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town):"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston,MA 02114-2017
Tel. #617-727-4900 ext. 7406 or 1-877-NIASSAFE
Fax#617-727-7749
Revised 02-23-15 www.mass.gov/dia
Ch YOF SALEA MASSAChISEM
BuzDmDEPAYawa
120 WASIM40MMEET,3IDPioamt
MEL(978)745-9593.
BD�ERiBYDRiSODLL PAX(978)740.9846
MAYOR IMMUSUInm
Construction Debris DisposaiAfdavit
(required for all demolition and,.renovatidn 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 issued with the
condition that the debris resulting from this work shall be disposed of in a property 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:
(name of facility)
Zia . H p , a9P
(address of facility) n/�
Signature of applicant
Tr ( D
Date
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TECTS
10 Juniper Road
Salem, NH 03079
(857) 212 5228
cdowgiert@gmail.com
Mr.Thomas St. Pierre April 24, 2017
Building Inspector Director
City of Salem Building Department
93 Washington Street
Salem, MA 01970
Re: 2 Griffin Place; Attached Townhouse and two condo unit renovation: Fire Protection
Dear Mr.Tom St. Pierre:
The owner(s)of 2 Griffin Place has requested a review of their renovation under building permit#B-16-735
regarding the need for fire protection suppression as requested by the city of Salem's building department.
This review was done after construction was 90%complete and no construction documents stamped by an
architect/engineer of record were filed for this permit and scope of renovation.
i3 Architects, PLLC code review was for the existing three family renovation which includes existing single
town home and two condo units. 2 Griffin Place renovation includes a town home with 3 floor levels of living;
one condo with third floor living area only; and another condo which offers 2 levels of living area. This
project was reviewed under the 2009 International Building Code with 780 CMR Amendments. The
applicable code would be the International Residential Code 2009 with the assumption that the renovation is
an Alteration-Level 3 under the Existing Building Code 2009.
The following excerpts from the code have been reviewed and discussed with the owner(s): In accordance
with the International Residential Building Code 8`h IRC under Code Section R313 Automatic Fire Sprinklers;
under subsection R313.1 Exception: "An Automatic residential sprinkler system shall not be required when
additions or alterations are made to existing townhouses that do not have an automatic residential fire
sprinkler system installed". Subsequently, under the International Existi g Building Code 2009 under
Section 904 which refers to Section 804.2.2.2 which is for both Alterations under Level 2 and Level 3
Alterations it states the following: "if the building does not have sufficient municipal water supply for
design of a fire sprinkler system available to the floor without installation of a new fire pump,work areas
shall be protected by an automatic smoke detection system throughout all occupiable spaces other than
sleeping units or individual dwelling units that activates the occupant notification system in accordance
with Sections 907.4,907.5 and 907.6 of the International Building Code."
Therefore, it is our finding that 2 Griffin Place with renovations under building permit#B-16-735 is exempt
due to the following code subsections as described above. Please contact me with any questions or concerns
that you may have.
Since
Casey A. Dowgiert, RA Ma. LIC: 50547