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12 HANSON ST - BUILDING INSPECTION (5) W'd t L-1 I---- -I--� The Commonwealth'bf N Li-SsacfiusettsDepartment of Public Sae 1 1 i! t .\la+9drluncll9 tilafc llllildinl;Cw .(.V11C,\ R) IA(iIdiitg I'cnoit Application for InyBuiIding'oth ' .thaii.a O e-ur'I'wo-Famil L) (Ihis Section For Official Use Idv) Middiug Penult Number: _._ _... 1 1.)a le Applied: -_� _ Boil, It Ill SECT ION L• LOCATION Wle,ase indicate Illock tl and I.ot p fur lucatl n Ill SVhieh a st "t'radress i9 nI)t JVaIIJble) Irrr Cily' /I-uwn Lip Code Name of Building;(if applicable) SEC PION 2: PROPOSED WORK fdiliun,tf.\I:1 tiLrtr Cede Itself _.._ _. If Nnv Construction cheek hen'❑nr dnrCk all tll,u,t , , I I Iy in the lu'u nnr+ below li+isling But lding; ❑ lirpair :\Iter,Iliun ❑ Addition ❑ Uiwolitiun ❑ (Pleasefillout,uidsubmitl\ppendix1) Cho 11; of !Csc ❑ Chan;c of Uccu ..... O I Y Other ❑ Specify:__—_-.-.. __ _• _ An'building plans and/or Construction hK uolcnls bcingsupplicd,Is pert of Ihis pcnnit application? Yes<� No ❑-_- - _ - Is Jn Independent Slnlcht r,Il Enginecrin' Peer eview reyurred? /' Yes ❑ , C o _ Brief Description of Pntpased lVurk:.--�E re��N.(�__�lr)I ! •n o�. ' ,_ 1 SECTION 3:COMPLE'l-E THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,AUDITION,Olt CHANGE IN USE OR(OCCUPANCY Cheek here it ao Existing Building Investigation and EvaluNort is enclosed (See 7811 C,\IR 14),0 Existing Use Gruup(s): Proposed Use Gioup(s);_—__.___ SECTION 4: BUILDING IIEIGHT AND AREA Existing Proposed No.ut Floors/Stories(indude basement levels)dr Area Per Flour(sq. fL) fot,ll Arc,I(sq.ft.)and rota) tleight(ft.) SECTION 5:USE GROUP(Check as a linable) A: Assembly:\-I ❑ A-2❑ Nightclub ❑ A-} ❑ ;\-4 ❑ A-i❑ B: Business ❑ F: facto F-I ❑ 1:2❑ It: Ili h Hazard FI-I ❑ H-_❑ 11-t p E: FJucational ❑ I I-{ ❑ I I-i I: Institutional I-I ❑ I-_'❑ I-1❑ I-{❑ ,A I: \Icrcantilc❑ ❑,li: Residential R-1❑ R-2❑ R-t❑ R_{❑ S: .5t'o-ruge 5-1 O S7❑ IU: Utility❑ Special Use Cl and please describe below: Special Use i SFC"['ION 6:CONS FRucFION I YPE (Check as a t liable) I,\ ❑ lit If.\ ❑ IIB ❑ MA 1111113 IV %-A ❑ l'11 ❑ - __ St..( FION 7: SI I F. INPOI(tiIA IION(refer to Nu C.\IR 11 LB fur details on each iteut) [Miter Supply: flood Lune htfwmatl ... Sewage Disposal; I7ench I'crmiC Uchris Itcmuval: — Publie❑ Chrrk It oulstdv Il,'od Lnnr❑ 6uli,ah.i.... pad ❑ \ Irrni 6 ,vdl not be I.t'vil"A Ui+pnsal'�itv❑ I'neote❑ or indt-milly /nne� or,m +nc+,.lent ❑ n•yuin•d ❑or lrcnch Or pek 0 tlailroad rich F„bway: . f - IlJranlslu.\ir.Vsigatiun: \',d \I phr.tld''] I Is�Irm lure n rtliin .in j , "n'a,hates' , , I V I I+tltru rrvir,c,,,tn('Ir Ir J '��r(.�,vnvnl h�ihttlJ rmhnrd❑ 1 a 1,'+❑.nr.Ali❑ ),e❑ \n, 0, il(LV9:(iLNIT:.VI'(IF CI It Ilf1C'.\Ili Of()C( L'1'.\.V(Y - " - I ,lihin, lC -,Iv -------- ( +r(;InoPt`I It I'r,4( AnHnn It'll, tot up.inl l •.nl l'rr ll,rr Po Ihr l n11d111? t nt.nn.m� �rinllor tit.Irm' SR IIUN '1: I'KOI'hR TYOWNI!It ,\UIIIOIt I'G\IIUN N. ant inJ \tlJn+s ut Prop,—ill,l lwnt r It 3? s _5 , _ � 1 cjts/ Name (Print) No. and Sin City / — �,p Propel IN, OwnvrCuutacllnlurntalion, ^ f �. ._._ _.— .—._ email address Trlephunc No. (business) rcicphouc It applii able, Ihr properly'owner hereby aulhurin's __--.---- _.—.—Street r\ Name ddress --- City/� ow,t I' State —__Zip to act on Ilia'pro pert owner's behalf, it,all matter%relative it,is ork.authorized by this build in permit a ,,licam"I SECTION to:CONSTRUCTION CONTROL(I'lease fill not Appendix 2) II built in,is IcSs than 15,000 cu.ft.III enclosed,,ace anti Or not under Construction Control then check here 0 and ski ,Section lu.l IIL1 Registered Professional Res onsible for Construction Control _ �--- _ is rat ,n Nl nber c-maiLul Irrss Nate Kc sutra Ice hone Nt OZ� � \/ city/rows Stole Zip Discipline Expiration Date »>CCC tilrcct Address Y/ 10.2 General ontractor r jug dtil ` j"I n�y ame -- C'A.^a✓ 1 v v h License No. and Type If Ap icablc i 'tme of Person Rcspunslble ft r Conslnlchun ^^ _ rl!o ya-- — �ram/ ! City/Town State Zip Sleet Address A _ 1 q2 felt ,bona NO. business Telc,hone No. cell c-mail address SECTION11:�a�-�rf.i'I;:rra�\Irty.\Ip,�-i�:•ul:.\\� r ,tlill�,',.nl M.G.L.C. 152 25C6 A Workers'Compensation Insurance.\I fide.it . .... the MA Department of Industrial Accident must be annplcicd,and eubntittetl will,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 ❑ SECTION it,CONSTRUCTION COSTS AND PERMIT FEE Estilimted Costs: (Labor Item and Materials) total Constn,diun Cost((rum Item fi) ' 1. Building 5 0o Building Permit Fat'Total Construction Cost s :_(losert here '. Electrical $ f appropriate loolocipal factor) ' S i I'Iunil,in); untl,tit nnutici ,alit. Notu: \lininnun ace'S____( 1 ) i. \Ic%h,mic,d Other) [ni fuse ,heck payable It,it, I,a.11 Cost ) (nnuait nnminp,dih)autl ,%rite,heck number here SECTION I7:SIGNAI UItE OF BUILDING PERMIT AI'PLIcA air Itv vowrint{ pry' name below. I hercbv ,,test under the pains and penalties of prrlury that all of the infarin.ltion a'Ilt'l wd in this applic,tion i,truc.utd as uane to the first of my kI I t.Io,lgv anal undrrstandiny,. 0. ' 0IM. ,ii _ r I Itle rt'Ivphnnc \n 1)alc � I'Ird.r prml .mJ "q;uIl mintr Q{G, ltn,'I \,Llrc,+ �© �+i✓r'CP .00"— Cn\', r,:ttn LTV �7 �I,n �P ( �1� , _ a \lunicipal Inspector to fill ant this+vation upon .Ippliiatiun ppn,c.t l: Ndute I',dr. t i� CITY OF S:1LE.N1, 1AXSSACHUSEam Bl:1LDC443 DEPARTNM.IT !r e 120\VASHLNGTON STREET, 3"a FLOOR TEL (978) 745-9595 F.*,X(978) 740-9846 KI.\fBFRI RY DRISCOLL MAYOR THo&w ST.PIF.RRB DIRECTOR OF PUBLIC PROPERTY/BUILDING CO'XMISSIONER Workers' Compensation Insurance Affidavit: Builders!Contractors/Electricians/Pfumbers A i licant Information Please Print Legibly Name(Busitxss,Orginizatiorulndividual): Address: 3© Cle SC e^" A , City/State/Zip: 111114 Phone M zfl?�S 6 r7 Are you an employer?Check the appropriate box: Type of project(required): Lfn,t'rm a employer with } 4. ❑ 1 am a general contractor and i ---F— 6. ❑New construction employees(tLll and/or pact-time).• have hired the sub-conlnctors 2.0 1 am a sole proprietor or partner• listed on the attached sheet t 7. ❑Remodeling ship and have no employees These sub-contractors have a. ❑Demolition working for me in any capacity. workers'comp. Insurance. 9, ❑Building addition [No workers comp.insurance 5. 0 We are a corporation.and its ME]Electrical repairs or additions required.) - officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions myself.[No workers'cutup, C. 152,)I(4),and we have no 12.C] Roof reps-ni insurance required.]t employees.[No workers' 13.§94lher ✓e- W,1 comp.insurance required.) •Any applicant that cha�ks has el mutt ales 611 uul the welioa below showing their workers'compensation policy information t Iforneuw,s s who submit this affidavit indicating they am doing all work snit then him outside contractors most submit a row atlidavil indicating such :Con Imtors that chczk this box meat attached an additional shout showing the name of the sub.comragon and their workers'comp.pulley infommNon. e am an employer that Is providing workers'compensadon Insurance far my employees. Below is the policy and Jab site information, e` Insurance Company Name: ✓rxy C Policy d or Self-ills.Lie.N: It�IJ t �I Z Expiration Date' ( ) Job Site Address: t2 •1 "trsa— S . �� City/State/Zip: ©1' t�0 Attach 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 tine 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 fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may bo forwarded to the Office of Invesiigutions of the DIA for insurance coverago verification e do hereby certify ender th pu and pemmhles of per/ury brut the h!foreraNan provided dbuve is true and correct r S1en;uure: �� Data' Pined, OJjicial use only, Do not write in r/r/i area;to be completed by city ur town ;fjlclut City or'ruwn: _._ Permit/R.lcense q __ Issuing Aulhorily(circle one): I. Board of Ilcullh 2. Building Department 3.City/town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.01her ___-- Contact Person: Phone H: CITY OF SAI.EI, XLxSSACHUSETTS • BUILDNG DEP ARTNIENT A 120 WASHIIGTON STREET, 3' FLocia TF-L (978) 745-9595 Rja(978) 740-9846 R KI\tBERI-E EY DISCOLL MAYOR D THO%W ST.PIERRE. DIRECTOR OF PUBLIC PROPERTY/BUILDONG CONNISSIONER 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 It 1.5 Debris, and the provisions of MGL c 40, S 54; Building Permit # is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c l 11, S 150A. The debris will be transported by: tl!o c04r, s w I.It 6 1421 fir- (name of hauler) The debris will be disposed of in : (name of facility) (address of facility) - f signature o per it applicant date lcbdsuif.dx 1 y f t EXISTING BUILDING FUTURE ADDITION 60'-0"± - 20'-Y I BASE _ / 3'-0" L BASE _ 3'-0° BASE SEE WALL REPAIR _' 4 6" NOTES BELOW WALL WALL #2 # I PLAN - NEW RETAINING WALLS NOT TO SCALE WALL REPAIR NOTES 1, REMOVE ALL LOOSE STONES AND MORTAR IN FOUNDATION WALL. THOROUGHLY CLEAN REMAINING WALL. REPLACE STONES IN NEW NON-SHRINK MORTAR TO BE WATERTIGHT. 2. EXCAVATE SOIL TO EXPOSE LEDGE BUT NOT BELOW DEPTH OF EXISTING FOUNDATION WALL, REPAIR NEWLY EXPOSED FOUNDATION WALL AS PER NOTE 1 ABOVE. trig 12 HANSON STREET SALEM, MA DATE 7-1e-1e ESABAGH ASSOCIATES, INC L,G STRUCTURAL ENGINEERING CONSULTANTS NEW RETAINING WALL SCALES AS NOTED TEL 7B-STREET X: 22240 11 90 STRUCTURAL DETAILS S-1 C❑❑RDINATE CHAIN LINK TOP OF WAL FENCE AND FENCE HEIGHT WITH OWNER f FINISHED GRADE AT jNEW PARKING AREA ' IIIlillll #5 @ 18" 11 LEI II #5 @ 12" =1 I. MIN #5 @ 121, io 4 #5 + BOTTOM -t L 3" COVER, TYPICAL 4'-6" 12" CRUSHED STONE I WALL #1 DETAILS SCALE: 1/2'=1'-0" 8, a, .az'ras z° 12 HANSON STREET >,•u<,,;r ram' -�` rr -a�•,, �.��.�� SALEM, MA DATE: 7-18-12 ";rrw ALGA EeBAGH ASSOCIATES. INC �. STRUCTURAL E„„,„EER,„a CONS"Tn„Ts NEW RETAINING WALL _.CALE� ,as NOTED TES: 781 STREET 22JO„'m 2,2aO31HO STRUCTURAL DETAILS S-2 q. Y C❑❑RDINATE CHAIN LINK TOP OF WAL FENCE AND FENCE HEIGHT WITH OWNER I } 0 FINISHED GRADE AT ` NEW PARKING AREA =1 I EE 11= x Q III iI_� �o I 4'-0" #5 @ 18" ± w MAX #5 @ 12" Q 6" > 3'-0" �7 #5 @ 12" + CD 4 #5 BOTTOM �.� L TYPICAL R, 4'-6' 12" CRUSHED AT AREAS OF LEDGE ❑MIT STONE CRUSHED STONE, ANCHOR BASE TO LEDGE WITH #5 BARS GROUTED 12" INT❑ WALL #2 DETAILS LEDGE; REDUCE BASE SCALE 1/2'=1'-O' W 3 0 12 HANSON STREET SALEM, MA DATE -ie-iz Es'lBeAGH ASSOCIATES, INC STRUCTVRAL ENGINEERING CONSVLTANTS NEW RETAINING WALL SCALE1 AS NOTED .,, NaN STREET STONE„AM, MA 02180 STRUCTURAL DETAILS S-3 rEL: 781-272-2223 FAX: 24