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3 HAWTHORNE BLVD - BUILDING INSPECTION (3) ao a The Commonwealth of Massachusetts �-a °'lb Department of Public Safety Massachusetts State Building Code(780CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling I _ (This Section For Official Use Only) IWA Building Permit Number: Date Applied: Building Official: SECTION 1:L ATION(Please in irate Bock#and Lot#for locations for which a street address is not available) 1I t' � ��✓ .7 - 47z r 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❑ Repair Cl I Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) 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 ❑ Is an Independent Structural Engineering P liyyiew rgy�rc�j? �7 Yes ❑ No ❑ Brie Description of Proposed Work: g ant /( ��0,e ff�� `'� "e D J fOU 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 ClvIR 34) ❑ Existing Use Group(s): .„ Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)8r Area Per Floor(sq.ft.) Toted Area(sq, ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ Alf❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2,0 H-3 ❑ H-4❑ H-5❑ I: Institutional 1-1❑ 1-2❑ 1-3❑ 1-4❑ 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 ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ 1 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❑ permit is enclosed❑ Railroad right-of-way: Flazards to Air Navigation: tits llis6,n, Not Applicable❑ 1s Structure within airport approach 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: �81 SyN 87157� SECTION 9: PROPERTY OWNER AUTH RIZATION Name nd Addre s of Property Owner Name(Print) No.and Street City/Town Zip Property Owner Contact Information: ec1, Title Telephone l�o. (business) Telephone o. (cell) e-mail address If applicable, the property owner hereby authorizes Name 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 Appendix 2) 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 Registered 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 Coin y Name ot Name of Pe or5on Respon11ble for Construction pp / � L cense No. and Type if Applic. le yTY b�a/�7"t.✓J3�A- Street Address Cit} Town State Zip elc ���� hone No. ishress Telephone No. cell ail address SECTION 11:4VORKFI6'CONIPk[NSA 1'IO.V INSURANCE 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. 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? I Yes❑ No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Rem 6)_$ 1. Building $ Building Permit Fee=Total Construction Cost z (Insert here 2. Electrical $ Q appropriate municipal factor)=$ 3. Plumbing $ _e 4. Mechanical (HVAC) $ Note: Minimum fee=$ (contact municipality) 5. Mechanical Other $ Enclose check payable to 6.Total Cost $ (contact municipality)and write check number here SECTOWII&ASIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below, I her attest gins and penalties of perjury that all of the information contained in this application is to and accuug o the bes ry knowle ge and understanding. rr Please ,nt mu1 s' lame 1 Title TzDate Zu Street Address tty/Town State Municipal Inspector to fill out this section upon application approval: Name i�r `,C ` � r �+` � ( + ` ` / [fir - :t�ir• CITY O Ji�r .r�.lyl, %L"lss.lI HUSE1 1.S !.Y a, BUILDING DEPAIM LEINT 1'4' f- lit' 120 WASHLINGTON STREET, 3'a FLOOR TEL (978) 745-9595 F.ic(978) 7d0.9844 IB Rt F.Y DRSSCOLL ELM& T1iONW ST.PtERRs DIRECCOR OF PCBLIC PROPERTY/BCILDMG, COSLMISSIONER Workers' Compensation Insurance Affldavit: Builders/Contruetari/Electricians/Plumbers Applicant Information Please Print Legibly AA.\I;Inlc tnuaiiw,.&0rganitation,iml> '11) ,\ddress: 5 City/State/Zip: Phone Are yo employer?Check the appropriate box: 'rype or project(required): I. I am a employer with IT 4. ❑ 1 am a general contractor and I enipinyees(full anri/or rt-time).•' ' have hired the sulscontractars 6' New construction 2.❑ I am a sole proprietor or partner- listed on the attached"sheet. % 7• ❑ Remodeling ship and have no employees These subcontractors have B. ❑ Demolition working for me in any capacity. workers'comp. insurance. 9, j] Building addition (No workers:comp, insurance S. ❑ We are a corporation and its required.] officers have exercised their 10.C3 Electrical repairs or additions 7.❑ 1 am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions myself. (No workers'sump. c. 152, 11(4).and we have no 12.❑ Roof repairs insurance required.) t empluyees. (No workers' 13,CJ Other comp. insurance requitud.l thny appli,akm dwr d"Via,box I I moat alto fill out the sactiot iwlow showing Chair raker'<ompenudon policy infi marion. 'I4"co sm"wha,uhkilil this Affidavit Indicating they am doing all work and their him oantde eannatrox mnxi anllmll a news afndavit indtsaing.wh . :(',,mmcton ihol chaclt Ibis boa must imbed on additiunul.heel showing the mmnia of the sub<uinnctorx and ihalr warkan'Camp,pulicy infeemmtian. l um an employer that Is providln orkfrs'campe/trallan lu rarance jot my employers Below Is the pulley and fob alre inf0rin4lioa. Insurance Company Name: Policy"4or Self--iiu. Lie, 0: /_J__ -S21 Expiration Date: l0 - job Site Address: 7 .", / al(tiAI-'4 ',S/� C/ CilyiSlat lZip: y'-- Aeach a copy ur the workers' compensation pulley declaration page(showing the policy number and expiration date). Failuru 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 S 1,500.00 und/ur one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of up to M0.00 a day against the violator. lie advised that a copy of this statement may bc: furwirdcd to the ohled of luvrstigaiiuns of the OIA for ins •coverage veriticati /do hereby c era rut the pains oil Pena rr w perjury that r/ infurmalohl provided above ' rue wild c• eca ih•1 t � Unto: _. / Phone; Oj/icial use wily. Da net write in this area, to be cunhpleted by city ur fawn n/jiviaL Cityor l'uwn: PcrmiuT.iccme 4 luuiag Atilhurily (circle une): I. Iluurd of lseallh 2. Iluildin� Departurcnt I. Cilyi fawn Clerk J. Elactrlc.11 Insp7Phimbiniglimpector Contact Person:_ Thane rh. i Information and Instructions \lassachusetts 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 attodier 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." NIGL chapter 152, §25C(6) also states that"every state or local licensing agency shag 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 atdavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the 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 confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should e he 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 appropriate line. City or'rown Officials Please be.sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to till out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to till in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permitilicense 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 Lila for future permits or licenses. A now 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. ` "I'he Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-NIASSAFE Fax# 617-727-7749 aav!;cd 5-26-05 www.mass.gov/dia ill CITY I OF S.1L.E,�l, AkSS.ICHL'SETTS ©t.Il.nrvc DEP.�xTatEVT 20 W.1iNLYGTONSTURTr S'ACCII It+1. (978) 74l.959f KI\tBERLSY DUWOLL 17.Vt(978) 140-98" ,%CAYO)t nIO..%4U ST.PMUA DIaECTOrzOPPl SLIC PROPERTY/Bt:MJOL c COANISSIONEIt Construction Debris Disposal Affidavit (required for all demolition and renovation work) rn accordance with the sixth edition of the State Building Code, Debris, and the provisions of MOL c 40, S 34; 780 CMR section I Building Permit M is issued with the condition that the debris resultingfro this work shall be disposed of in a properly licensed waste disposal facili as defrn m I l I, S ISOA. tY cd by,yOt c The debris will be tra nsported by; (mane of hautnr) The debris will be disposed of in : � 1 r: vim lily) (name oW liryj (addrerr of ray try) nature a perms proof 'late �— I . 2 C-4 AL 7 � I GI + Q L+ L 1�Eg1G f� A TO THE RS _ -% -INSPECTION - 'i AND M 71T1TNE - I CERTIFY THAT THE BUILDINGS SHOWN Qq ( ) CONFORM TO SETBACK REQUIREMENTS LOCATED IN I.E. (FRONT, SIDE, & REAR SETBACK ONLY) OF SaC_E�/� ��_C_ IIAV WHEN CONSTRUOTED. OR ARE TIME Mi. CHAPTER 40A, SEOTIO EXEMPT. UNITS OTHERWISE NOTED ENT AC770N UNQER MA55. C:L MASSACHUsIMS I FURTHER CERTIFY THAT THIS PROPERTY IS LOCATED IN THE ESTABLISHED FLOOD HAZARD AREA OOMMUNITY PANEL NO.:2 DEED ,{ �QI INDENTURES MA I (j DATE: TO THE 8� BOOK Z2d3`r THIS COMPANY A NOT RESPONSIBLE FOR ANY INDENNRES MADE SUBSEQUENT TO THE RECORDED DATE OF THE LATEST DEED OF RECORD. PACE * WHENEVER BUILDINGS ARE SHOWN LESS THAN ONE FOOT FROM THE PROPERTY LINE IT IS ADVISED THAT A MORE PRECISE SURVEY BE MADE TO VERIFY THESE MEASUREMENTS CERT. NO. NOM THIS CERTIFlCATION IS BASED ON THE LOCATION OF SUR (HERS, AND DOES NOT PLAN BK.r-23-46 PAGE'4 REP ESENT A PROPERTY SURVEY. VERIFICATION OF SUR § D OFFSETS, AS SHOWN, q►ry'/ MA BC ACCOMPLISHED ONLY BY AN ACCURATE, INS PLAN �0 DATED ON IRIS 7Lus pV,N�t;ER YS ARE NOT DEPICTED TIFICATION TO BE USED FOR GAG RP NLY. OFFSETS AS SHOWN A $O�i ,; ,.. .M SCALE t'o 'Q� USED FOR THE ESTABLISHMEN (N PR%Wh LI F Tt BRADFORD SUM ENGINEERING CO.. P.O. Box 1244 .fQ M:4 UL HA% RHIII MA MR, � K-4-2 CITY OF SALEM, MASSACHUSETTS BOARD OF APPEAL 120 WASHINGTON STREET, 3RD FLOOR 7. SALEM, MASSACHUSETTS 01970 �e �r TELEPHONE: 978-745-9595 �P FAX: 978-740-9846 I KIMBERLEY DRISCOLL 1�I1 FEB - I A I� 1 MAYOR FILE k February 1, 2012 CITY CLERK. SALEM.MASS, Decision City of Salem Zoning Board of Appeals Petition of TERI KALGREN for a Home Occupation Special Permit and a Variance from off-street parking regulations to allow an herb shop in the first floor of the building at 3 HAWTHORNE BLVD. A public hearing on the above Petition was held on January 18, 2012 pursuant to Mass General Law Ch. 40A, § 11 with the following Zoning Board of Appeals members present: Annie Harris (acting as Chair), Richard Dionne, Jamie Metsch, Jimmy Tsitsinos, and Bonnie Belair. Petitioner seeks a special permit pursuant to Section 3.2.2 and a Variance pursuant to Section to 5.1 of the Salem Zoning Ordinance. Statements of fact: 1. Ms. Kalgren is the proprietor of Artemisia Botanicals, an herb shop located at 102 Wharf Street, Salem. 2. In a petition date-stamped December 28, 2011, Ms. Kalgren requested a Special Permit for a home occupation and a variance from off-street parking regulations for a home occupation at 3 Hawthorne Blvd. 3. Sean P. Pray and Richard L. Smith are the owners of 3 Hawthorne Blvd. Ms. Kalgren has the property under agreement and seeks to move her herb shop there from 102 Wharf Street. 4. At the hearing on January 18, 2012, Attorney James Burke presented the petition on behalf of Ms. Kalgren. 5. In her application and at the hearing, Ms. Kalgren stated her intent to occupy the residential unit in the building once the current tenants' lease is up in August 2012. 6. At the hearing, the petitioner and the Building Commissioner noted that the building had a long history of having a commercial use in the first floor, but because of a two-year lapse, the commercial use was no longer grandfathered. 7. The property has parking available for three cars; however, installation of a required wheelchair ramp will cause the loss of one of the parking spaces. 8. At the hearing, two residents spoke in favor of the petition, and two other residents submitted letters of support (Kathie Driscoll-Gauthier, 52 Bayview Ave.), and Donald Fyfe MacFadyen, 1 Hawthorne Blvd.). No one opposed the petition. The Board of Appeal, after careful consideration of the evidence presented at the public hearing, and after thorough review of the plans and petition submitted, makes the following findings: 1. A special permit and variance may be granted to allow this request without substantial detriment to the public good and without nullifying or substantially derogating from the intent or purpose of the Salem Zoning Ordinance. On the basis of the above findings of fact and all evidence presented at the public hearing including, but not limited to, the Plans, Documents and testimony, the Zoning Board of Appeals concludes: 1. To allow for the home occupation, a special permit may be granted under the Salem Zoning Ordinance § 3.2.2 Home Occupations. 2. To allow for only two parking spaces, a variance may be granted under the Salem Zoning Ordinance § 5.1, Off Street Parking. 3. In permitting such change, the Board of Appeals requires certain appropriate conditions and safeguards as noted below. In consideration of the above, the Salem Board of Appeals voted, five (5) in favor (Harris, Dionne, Belair, Metsch and Tsitsinos) and none (0) opposed, to grant petitioner's request for a special permit subject to the following terms, conditions, and safeguards: 1. Petitioner shall comply with all city and state statutes, ordinances, codes and regulations. 2. All construction shall be done as per the plans and dimensions submitted to and approved by the Building Commissioner (specifically, elevation drawings titled "Europa Antiques Facade Improvements, Salem, Massachusetts," dated 1/31/08, Scheme 2, pages A-4 and A-5). 3. All requirements of the Salem Fire Department relative to smoke and fire safety shall be strictly adhered to. 3 4. Petitionershall obtain a building permit prior to beginning any construction. 5. Exterior finishes of the new construction shall be in harmony with the existing structure. 6. A Certificate of Occupancy is to be obtained. 7. Petitioner is to obtain approval from any City Board or Commission having jurisdiction including, but not limited to, the Planning Board. Annie Harris Salem Zoning Board of Appeals A COPY OF THIS DECISION HAS BEEN FILED WITH THE PLANNING BOARD AND THE CITY CLERK Appeal from this decision, if any, shall be made pursuant to Section 17 of the Massachusetts General Laws Chapter 40A, and shall be filed within 20 days of filing of this decision in the office of the City Clerk. Pursuant to the Massachusetts General Laws Chapter 40A, Section 11, the Variance or Special Permit granted herein shall not take effect until a copy of the decision bearing the certificate of the City Clerk has been filed with the Essex South Registry of Deeds.