3B GRISWOLD DR - BUILDING INSPECTION (2) P
�► The Commonwealth of Massachusetts
Department of Public Safety
\1a..achuwtl>Stale Building Code(,-So CMR)Svventh Edition
City of Salem
BuildinX Permit Application for any Building other than a I-or Z-FamilyDwelling
(rhis Section For Official Use Only)
Budding Prrm:t Number: Delr Applied: Building Inspector:
SECTION 1: LOCATION (Please indicate Block a and Lot a for locations for which a street address is not available)
3g r7•; <;wold0r- S'Qleln Aig Q/9'7c) Pir.t/"7417 Aar',",
No. and Street Citv /Town Lip Code Name of Budding lit applicable)
SECTION 2:PROPOSED WORK
If New Construction check here or check all that apply in the two ruws below
E.isting Building❑ Repair❑ Alteration O Addition ❑ Drmulitiun d((Pleasr fill Out and submit Appendix 1)
ChangeolUse ❑ ChangrufOccupancy, ❑ Other ❑ Specify:
Are building plans and/ur cunstructiun documents bring supplied as part of this permit application? Yes No —❑
Is an Independent Structural Engineering Peer Review required? // / / Yes ❑ No G
Brief Description of Pruposrd Work: ,�' 1'2 /J lP 7Y rl e'r j'ea Z2
rG
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDMON,OR
CHANGE IN USE OR OCCUPANCY
Cheek 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 Flours/Stories(include basement levels)&Area Per Floor(sq.ft.) 1 24'PA"1 -24W/4
Total Area (sq. ft.)and Total Height(ft.) [D' A
SECTION 3s USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2r ❑ A-2nc❑ A-3 ❑ A4❑ A-5 O 1 B: Busineu ❑ E: Educational ❑
F: Facto F-1 ❑ F2❑ H: HI Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
1: Institutional 1-1 ❑ 1-2❑ 1-3❑ 14❑ Ms Mercantile❑ R: Residential R-1❑ R-2❑ R-3❑ R4❑
S: Storage S-1 ❑ S-2 ❑ U: Utility❑ Special Use❑and please describe below:
Special U.se:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ ISO IIA 13 fill ❑ IIIA O 111110 IV ❑ VA ❑ VB ❑
SECTION 7: SITE INFORMATION (refer to 780 CMR 111.0 for details on each item)
tvater Supply: Flood Zone Information: Sewage Disposal:
Trench Permit: Debris Removal:
r'ubl«•O Check tI uuthldr FLN tJ Luna•❑ Indicate municipal ❑ A trench will nut be Ltcen d Die►vial Site❑
required ❑ur trench nr,pecdr:
I'nvale❑ 'or mdrntifY Zone: - -,dr tin.itr n�trm❑ permit I.vnclu.rd ❑
Railroad right•of-way: Hazards to Air.Navigation: \Ia 16•h•rn l •nnnu.•n n It.�t a t. 1•na r•�: '
.\nl :\pphi.ddv O I.�t«:ilun•trnhm.urpnrt.tpprnaih area' L Ihelr re%iet% omirlewd.'
.al •nna•nl tit lluddcndo,ed ❑ lv.❑ nr Xtt❑ Yv 0 \n ❑
SECTION 8:CONTENT OF CERTIFICA TE OF OCCUPANCY
I .liwnt d ( alv. _ L,v lInnipl,1. rt pv,.t l.nt�l«ti hors: lkcul•anl l� ad per ( lour
I r, lhv budJitig i,nu.nn.ot Spnnklvr�,t.la•m': Special stipulation':
SECTION 9: PROPERTY OWNER AUTHORIZATION
.Name and Addrrss of Properiv Owner
./ Oe(t, Pi.i/ir6 0 3AF�✓i'SG✓6�9�✓.L•C�. JG,��hr / '
.Name(Print) .No.and?Ircee lily/Town Zip
I'n.la•rty c'nrr('nntact Inlurm.tUun: 4 boo 1 ve,f1
Title Telephonv Nu. (busmen+) Telephone No. (cell) a-maul address
ItwAble, the property owner hereby authorizes
M
Name Strive Address Cily/Town State Zip
to act on the m. vrty owner's behalf, in all maltvrs relatic a to work authorized by this building piermilapplication.
SECTION 10.CONSTRUCTION CONTROL IPlease fill out Appendix 2)
"'I"
If buJJin is less than 34.UW cu.it.,,(endrwJ space and/or not under Cominictiun Con troll then check hen O and>ki Smicin 10 1)
10.1 Re istered Professional Responsible for Construction Control
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town titate Zip Discipline Expiration Date
10.2 General Contractor
Mal- /` Lu A//7A /'s0h /Company Na c S ! 5 �"S — Pes�rt'c�ccl 0 0
Name of Person Resprnsiblgg fur Cunslr�yr�ion hie rise fyo. and Type if A licable
�. /C E/ e /ro`Crn�_f �� rr 'P/.R Do2lSS
Street Address City/Town State Zip
?-L S� 3ko
Telephone No.(business) Telephone No. cell e-mail address
SECTION 11:WO V (M.G.L.c. IS2 9 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 O No O
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor 00
and Materials) Total Construction Cost(from Item 6)=f S.
1. Building f Building Permit Fee-Total Construction Cost x—(Insert here
2. Electrical f appropriate municipal factor)a f
3. Plumbing f
4. Mechanical (HVAC) f Note:Minimum fee.f (contact(��\unicipality)
5. Mechanical (Other) ZA
f Enclose check payable to
6. Total Cost I f (contact munici alit )and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT `
Ily entering my name below, I hereby attest under the pains and penalties of perjury that all of the information con6unjh,%.
applicauon ,s true and accurate to the best of my knowledge and understanding.
h'1ai A w /*h�P/S d? tnix/D P?��� _ 231 . ! �619caw pr' 1 trial �rgn n Telephone.\o.Sheve Address Ceh/Town <tate Zt , 1
Iclefveliq." S /;17 e fttw� a1 fMunicipal Inspector to fill out this section upon application approval:
\ame
CITY OF S.U.&NI, JNWS.-%CfiU5EM
0L•aDN(;Oman.TENT
120 W.\sHmTON Smxr. )'a Room
T9L (978) 745.9595
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KINMEA"Y ORiSCOLL TtloikwSLptnili
MAYOIL 01IT.WOR OP PL 0L1C pW#tgTV/K ILDNC CO."01ISSICLNER
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a main prepriev or paraw` listed t>e the ataehai wheat.t y. (]Remodeling
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!ob Sire Adtkrse Cityistalellip:
'w"IN a caq of the werlien'campeesatlee peticy datantles pap(sMkrhy like po ft wm er bee and ssplraNW d }
Failure to s"wre covarsp of required under Ulloe 2fA of NaL a. 1 f2 eao lead to the imptrhion oh:riminal pauaides of a
fine up to 11.500.00 amYse onayear imprisennia'K L wag a aril paarltiaa is tha form of a STOP WORK ORDER and a floe
of up to 32]0.00 a Jay mlpinss the violator. Ile 34M.* l lhal a copy of this starmanl may be forwarded to the 011lee of
In%caheatium al'Ifte MA for insurance coverap v'zillLid"
/,/a hereby cerw jo�ary�n/�/e.,r�rAa paths and ywna/rlw ojper 7 rAw rho in/orweNso/nrialeal ulsm is true"al.weres
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- Job -Name Job ti
A
Job Location
r ; t o pateDate of Plana
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We hereby submit specifications and estimates for: . ...
ex 1"e rvaa.
rc_pl4.c_erne_•�+._
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propose hereby to furnish material)and labor —complete'IIl acocirgapnp�c—e-with the above specifications for the sum of: S'O
XXIC
$ I— tJP TYIC)l�i3Gh(x Dollars
with payments to be made as follows: I Ssi r�gGAfi /S! /y_.
Eb.po'*n7dI.('
ere[bn or dawaeon from above epectllcatlans Nvdving extra coals wID Respectfully�..-�-L—
d wily upon wMtan order,and will beocme an extra charge over and submitted b /alimare.Aa egreememswnrmpem upon etdhe9,s�nls,erdalays Odda control. Note-ails proposal may be withdrawn by us g not accepted within days.
Pix"Pttzvo of Prapasral
The above prices.specifications and conditions are satisfactory and are
hereby accepted.You are authorized to do the work as speafied. Signature
Payments will be made as outlined above
Date of Acceptance �U Q Signature
M NC3818
M " a:sPOST IAGOEDTO 2RALEAOER
STAOLINGTHA OECK FPJUa TO
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DECKS OVER Y•0'AWVE
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NOSUN & ASSOCEATES ptemm ►"W ea a ommum DECK PLAN
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JUL-13-�blb ixeq rrtiml.:5rttrt lF.L.D HEIEfTS 7M2312363 TO.19767417666
American Properties Team, Inc.
• d�
TO: 3B Griswold Drive
FROM: Jennifer Fappal,Property Manager
RE: Deck'Replacemem
DATE: July 13, 2010
**1***rrrrr*rrr04Pr6!*******W*W'r***t***********.ti**4r*********'**0****W.***
Please be advised that the Board of Trustees for Pickman Park has.approved.the replacement of
your deck at the above referenced unit. TI'liia anproval.is contingent upon it matehingthe existing
deck. The Board will not allow any design.alterations.
We also oequkcthat permits be pulled in advence(mggacdiese ofwhat your conaMor may tell
You),and then a copy of the final approved permit once completed must be,ant to APT for the
unit file as well.
You will need to bring a copy of this letter to the Salem Building Department to order to receive
your perk•
Should you have any questions or require additional information;please feel free to call me
directly at(781)932-9229.
cc: Unit File.
snovuFs7mi�e�Nns r�uei•aurra wan-xroeurta•mt.os�s•zsa$sier»•rnx�e�a.uee
CITY OF SALEM
PUBLIC PROPRERTY
F DEPARTMENT
I x,j I[\,, N S 11 11 T # $A I I %T,
')74.74 i-')n95 # 978.174�- 984o
Construction Debi-is Disposal Affidavit
(required liar all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CN-lR section 111.5
Debris, and the provisions ofMGL c 40, S 54;
Building Permit 4 - is issued with the condition that the debris resultingfrom
this work shall bcTusposcd of in a property licensed waste disposal facility as defined by MGIL c
111, S I 50A.
The debris will be transported by:
cc/ �a g f if
(name of hauter)
I lie debris will be disposed of in
4 . C
(name of facility)
/r 60 e"- e
(address A'facility)
eg�
signature Ot*permit appricant
bs /I da 4a
/ date