Loading...
30 GROVE ST - BUILDING INSPECTION � The Commonwealth of Massachusetts 4 - ��,' Department of Public Safety 1U Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Tvvo-F mil DWeIIin (This Section For Official Use Only) Building Permit Number: - Date Applied: Building Official,: SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not avat 30 aeo t--e- 5f- AW 0/5'7 a /fi9/lirio�% G�ou No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Building el Repair❑ 1 Alteration ❑ 1 Addition Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ 1 Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes No ❑ Is an Independent Structural Engineering Peer eview required? Yes ❑ No ❑ Brief Description of Proposed Work: A .�OOn-- O-� C,fze�h��A.e Y 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): SECTION4: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.) r (� SECTION 5:USE GROUP(Check as applicable) - A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-S❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-1❑ F2❑ 1 H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ 1: Institutional 1-1 ❑ 1-2❑ 1-3❑ I4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑ S: Storage S-1 f3—S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ 1 IV ❑ 1 VA ❑ VB ❑ -- SECTION 7:SITE INFORMATION(refer to 780 CMR111.0 for details on each item). Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public A trench wi of be Licensed Disposal Site❑ Check if outside Flood Zone❑ Indicate municipal required or trench or specify: Private❑ or indentify Zone: or on site system❑ permit is enclosed❑ Qgr,A.f7cx— Railroad right-of-way:/ Hazards to Air Navigation: \d_\I bstonc Commission R_vw" Not Applicable Is Structure within airport appr ch area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No @' Yes❑ No SECTION 8:CONTENT OF CERTIFICATE.OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: I SECTION 9: PROPERTY OWNER AUTHORIZATION ' Na,/me and Address of Property Owner 176kM0*-o 6120 te- 30 61LO✓e— S/ J;VA-,�1 Niune(Print) No.and Street City/Town Zip Property Owner Contact Information: Title Telephone No. (business) Telephone No. (cell) e-mail address If applicable, the property owner hereby authorizes Nurse Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION.CONTROL(Please fill out Appendix2) - If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1 10.1 Registeredg Professional Responsible for Construction Control - Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Company Name �c�Lln Nd4/Ly�Y CS - D9376 6 Name of Person Responsible for Construction License No. and Type if Applicable /5- b6f2 i7/4a _e �iL_ 220 � Street Address City/Town State Zip 7?S V0— /VY6 Telephone No.(business) Telephone No. cell e-mail address SECTION 11:lt'ORKERS'COM ENSAI'IOV INSURANCE A6EIDAVf1' 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❑ No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs:(Labor Item and Materials) Total Construction Cost(from Item 6)_$ : cc OO O 1. Building $ Building Permit Fee=Total Construction Cos x// (Insert here 2. Electrical $ appropriate municipal factor)_ 3. Plumbing $ 4. Mechanical (HVAC) $ Note: Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable i able to 6.Total Cost $ (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 contained in this application is true and accurate to t best f my knowledge and understanding. J�hrl Al t^ey Please print and sign nam� Title Telephone No. Date ) - V- ( < sz 0L. Tan; 3Y S!9/° , oi5v Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: Name Date l t Massachusetts o -Department of Public Standards 'Idin R`e Board of Bw 9. 9G,Iations an Constr'.ction Supervisor License: CS-093708 JOHN C HARVEY-`` 15 HERITAGE DRIVE` T'. SALEM MA 01990 ' ���`- • ,rro`' Expiration �+- 05101120114 Commissioner i .,ponD1E( - CITY OF SALEM, MASSACHUSETTS PUBLIC PROPERTY DEPARTMENT o 120 WASHINGTON STREET, 3RD FLOOR ....� SALEM. MASSACHUSETTS 01 970 TELEPHONE: �r LEPHONE: 978-745-9595 EXT, 380 Doi FAX: 978-740-9846 KIMBERLEY DRISCOLL MAYOR CONSTRUCTION CONTROL AFFIDAVIT Project Number. Date: Project Titte: Project Location: Name of Building: Scope of Project: IN ACCORDANCE WITH SECTION 116.0 OF THE MASSACHUSETTS STATE BUIDING CODE, I MASS. REGISTRATION NO. BEING A REGISTERED PROFESSIONAL ENGINEER HEREBY CERTIFY THAT i HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS. • COMPUTATIONS, AND SPECIFICATIONS CONCERNING: Civil Architectural Structural Mechanical Electrical Fire Protection Other(specify) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE, SUCH PLANS, COMPUTATIONS, AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES AND ALL APPLICABLE MAWS FOR THE PROPOSED PROJECT. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.2.2. 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction contract documents as submitted for building permit, and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for-all code required control materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in. Appendix 1. PURSUANT TO SECTION 116.4, 1 SHALL SUBMIT PERIODICALLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. Signature SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY OF 2004 My commission Expires: Notary Public Y CITY O �, L�,GISS;ICHUSETTS •��•��� r ocunwc D �.�;��{ .13HbVGTOV ST;iEET } F7.Oo.t TeL.(973) 71J.9595 '<B(0&U-EY 0RISCOLL FL'c(973) 7•IM3M r�rL�YO;i CPia1619 ST.PtE�'ut,g DtZECTOR UP PCOUC PROF ERTY/at:UZLVc Ca.1W155ION ER Construction Debris Disposal Aff7davit (rcyuirbd for all demalition :utd renovation work) fn aecardanca with the sixth edition of the State Ouilding Coda, 730 CjbiR section I Debris, rutd the Pro visiuns of MOL a 40, S J4; ©wilding Permit k this wort steal! is issued with the condition that the debris resulting from I, s i sots. be dispuscd of in a properly licensed waste disposal raoility as defined by ,b(GL o t I The dehris will be trusportcd by; 11, (name ut'fiaulu�) The debris %vitl be disposed ot'in ; D l/rM PSTC2 i (nantc ur ficdil�) I� --(iJJrcsa er'raal,i7) •{uanvc of permi .ippli• nt J io: I CITY OF S:1 mfli nAXS&XCHUSE'ITS BUILDING DEPIRT L&NT } +_ 120 WASHIINGTON STREET, 3}a FLOOR TEL (918) 745-9595 FAX(978) 740-9846 KI.NIBERi EY DRISCOLL MAYORTfiaatAs ST.PtaaRe DIRECTOR OF PUBLIC PROPERTY/BUILDLIIG CO.ILMISSIONER Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers applicant information Please Print Legibly �o�� NW 2 V81nC(Uusitx�siOrgtni¢alimulndividual): "'e-V Address: /f �i779q � lbfltC¢y� P/� fit/ City/State/Zip: 3,1/elm , Ma 0/9?19 Phone H: S )f 6yy4, Are you an employer?Check the appropriate box: Type of project(required): 1.El I am a cm to erwith 4. 0 I am a general contractor and{ P Y 6. ❑New construction iployees(hill and/or part-time)." have hind the sots-contracWn 2. 1 con a sole proprietor or partner- listed on the attached sheet t ?• ❑Remodeling ship and have no employees. These sulscontractors have S. ❑Demolition working for me in any capacity. workers'camp.insurance. 9, 0 Building addition (No workers'comp.insurance 5.10 We area corporation and its. .- required.) officers Have exercised their MCI Electrical repairs or additions 3.0 1 am a homeowner doing all work right oPexemption per MGL. I LEI Plumbing repairs or additions myself.(No workers'comp. c..152,$1(4y.and we have no 12.0 Roof repairs insurance required.)t employees:W6 workers'_ 13.❑Other comp:insurance required.) •Any appliesun nut chmiss box s 1 must also fill out the s 11m below showing then waken'swmpenution palmy infohmatfors. !Ih owners who submit this affidavit indicating They ars doing all work and then him uatsidecontractaf must submit a new affidavit indicating such !Cunlractors that chak This boa most atlachod an adidurud shoot showing the name or the subi nuactort and thaw workers'comp.put icy infarmation. lain an employer that is providing workers'compearatlon lirsurance for my empluyeez Below is the pollcy and fob site information. Insurance Company Name: I1C4eCAeA,,7-T _Z -At5 Policy 8 or Self-ins.Lie.U: Expiration Date: i Jub Site Address: City/Statta/Zify ,tttaeb a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 und/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a day against the violator. lie advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. l du hereby certify wider die putts aad pe mlrles-of perfary char rke infurma/lar provided above is True and coneeL 1 JICRilillre: Dara• Phoned: Official use only. Do not write in this area,to be completed by city or town n/flcfaL City or Town: Permit(f.leense p _ Issuing Aushori/y(circle one): I. Uuard of Ileullh 2. nuilding Department J.Cilyffown Clerk J. Electrical inspector 5. Plumbing Inspector 6.Other . ContactPcrsnn: . Phone It: l LLFo w FD-EXIST W N 10'-9". z Q ¢ o Z, - 0 U � ¢ X 3 2x10 HEADER w z EXISTING w BELOWEXISTROOF ¢ FOUNDATION STRUCTURE PER SECTION D WALL o O 3 z z n 3 z ' z 1 1/4'X9 1/4" Q N R o TIMBERSTRAND of W N H w EDGE BAND \ n Y z .EXISTING STONE 0 'J u f ¢ 1 PIER o Z nMal o O O mango O.ZG VI cc I 11/4'X91/4" I TIMBERSTRAND EDGEBAND F - 12"GRADE BEAM; '. , � - - W INTEGRAL TO SLAB - ' 2'RIGID INSULATION F- O E-,O AT 18'BELOW 1 T PERIMETER GRADE RIMEE R AT FULL 10'-9}" C7 W.+ ------------- -EIGHT OF CONCRETE Q Fo WALL EXISTING NEW - �+ NEW _ - - Ui Z li 0O 12"X24"GRADE BEAM AT FRONT WALL m a FOUNDATION PLAN ROOF FRAMING PLAN � q c�jvi. 1 SCALE:1/d'=1'O' L SCALH tld"=1'O` DWG NO. CODE REVIEW . 1. General Building Data Building Use Group Classification: F1- Moderate. . Hazard Industrial' Z Construction Type: 4B -Combustible Unprotected Existing.Building Area-= 1-1 65 SF New Addition = 160 SF. W New Building Area = 2,325 f= rn 2. Allowable Tabular Area (table 501) = 8,500 SF U o 3. Existing Building.Code.(IBCEBC) Change-of Q j Hazard.'Index = No change of Use or change in ¢ . hazard index w Means of E ress - 3. Finishes- Addition uses moisture resistant GWS W with finished interior suface meeting Class III. F7 a flamespread requirements, Enclosed Rooms: Class III W • SCOPE OF WORK V CC Ct w 1. The Work in-this project consists of the addition of a Z 10'xl5' Morgue room to an existing crematorium at Harmony.Grove-Cemetery in Salem. 2. The building is a 2x6 wood frame construction in-filled CO with polyurethane foam insulation, and manufactured Number in the roof framing as shown on the drawings. 3.The foundation has a concrete grade beam on its two P newsides to avoid the root system of an adjacent tree. IThe grade beam follows the methodology of grade beam design as proscribed In ASCE 3201, "Design and Construction of Frost-Protected Shallow Foundations". Z N N 4,=Stucco will be applied to the outside of the structural N wall.panels to match the existing building. J: l N o r 5.A membrane roof over tapered-insulation will join the CL Z 'I existing membrane roofand is.designed to support a Q snow drift load of 70 IbsdSF. V W Q O tL a 2-6 to CODE REVIEWce E%ISf. IXIST. 1.General Building Data BENCH SfORACE Building Use Group Classification:Ft-Moderate d Hazard lndustdal Z PROCESSO Construction Type:4B-Combustible Unprotected LL ew Existing Building 0SF 1165 SF, LL- F N Area= °i New Building Area=2.325 CC = do 2.Allowable Tabular Area(table 501)=8,500 SF 3.Existing Building Code QBCEBC)Change of 2 a = WORK/STORAGE AREA Hazard Index=No change of Use or change in < �`r�1 hazard index Means of Egrese Q 2 < z 3.Finishes Addition uses moisture resistant GWB11� W 9rfzQ"' ., with Mlshed Intedor suface meeting Class I II Q - tj a 12'-gr Aamespread requirements,Enclosed Roams:Class III w= —V, r � w RETORT #1 - 10-9, ro SCOPEOFWORK U CC w L Tha Wadlri this pmiectoo,desolthetudit.h.l. EE 2 O = 1ome,Ggbe rooms existing A gc t d mat - j X Romany GmwC try Salem NEW ul 2The building) 20 Wf construct. Pletl on DOOR �eatpdWasm f insulation,andmanufactured tl lumbernthe Nor 'rg M1 - thed ga. s'-0•xr DOORS a The foundation has w wet greds beam on Its two _ rem sides toamid(h Not system Iadjacentaee .The g.do beam hallows the meth add,yol grade beam ✓•\ j y �; M den as presented In ASCE 3201 'Dadgn and s[A ao RETORT #2 T/ CoNeuceon of Frost Protected Shallow Foundations' N w / ' ?� 6 StNew al IN applied to the Naiades of structural Z R ' ._F• Or was panels tN mat earth a datagbuneloA. J Nno S AmZutnul raotowrtepared insulation will loin the C_ �Yaan l i # etlsi ng membrane raofund is desig ed to supports F••Z 6 ��/ / / r• �+ nowtltllt load of TOlbsrSF 0 1 10'4. i Ste. .. W 6 J rc�<U LLZGN U• A� {,- � .:� Env 2 Y •�ROOLIC 42ral ACaS W M RGUE F U Z . in _ - 1—OE,0 - p004 wti [yam rn E%ISTIN NEW _ �,r}y�.. `'x`"=s.'zoSeence AREA OF WORK x Do FLOOR PLAN DWG NO. eCALE 1l411 Al LENGTH OF ELEVATION d z n'd Ll.. F n — C m �nn2 W V O¢ f w Q . a LU Q Uw 0 If 2 SIDE-ELEVATION o_ w. F UyN6 Z wm..IJi BUILDING 0 okra ' TURNS lL ire On BEHIND 11'-D' STONE ' a METALCOPI G _ F (DARK BRON ) w W 514k6- Q WOOD TRIM Q W STUCCO TO MATCH Q F EXIST }yL W EXISTING D O STONEWORK BEYOND cr,W, 0 C'+k7 FLOOR LEVEL Hl mm NEW EXISTING ' DWG N0: FRONT ELEVATION A2 1 scua ve=ra d z U" Q p C7o � a W MQ W y K LL CUB " EE w ROOFCONSTRUCTION 1 314'xB 114'1-VL8Q24'o.c. - Wl R-30 SPRAY FOAM INSULATION 314"PLYW D DECK WIRIGID INSULATION TO MATCH EXISTING 15'17 FULLY ADHERED MEMBRANE ROOF TO MATCH EXIST. INTERIOR-518'M.R.GWB n z ON IX3 STRAPPING _ ZO Uwn4 ~ 0 U OT zoo ��a - w coao a PITCH - W WALL CONSTRUCTION: "2 w ' 2x6s WIR20INSUlATION 516'MOISTURE RESISTANT '32'x10" W SHEETROCK INTERIOR UCCO AND HEADER U 112'CDX PLYWD SHEATHING WOOD TRIM - Z 10 DENSGLASS STUCCO BASE PER - STO SYSTEM STUCCO FINISH ELEVATIONTO MATCH EXIST > x" o ~ F 0 WOOD TRIM AS INDICATED mo. Qap1 LL - Q W 6-CONCRETE SLAB W Zi WMIRE MESH Z)C)C 0 2 3#6 REBAR mto DWG NO. SECTION THROUGH ADDITION A3 NEW EXISTING scue.yr-rs