33 HAZEL ST - BUILDING INSPECTION (4) �,
.. . ;� , -
^\
.�:. `,� The Commonwealth of Massachusetts
j��,� � Department of Public Safety
� �.-,..✓� \las.,ichu.rth tilate Building Cudr 1780 G�IR)Secrnth Ediliun
� City of Salem -
� Buildin Permit A lication for an Buildin other than a 1-or 2-Famil Dwellin
� (This tirctiun Fur Official U.e Onlv)
� Uuilding Permit Numbrr: Date Applied: Building Inspecror.
SECTION 1: LOCATION(Please indicate Block M and Lot N for locations for which a street address is not available)
� '2u3 �G2�L 50.� w. OIS.?U
No.and titrrrt Cih• /Tu���n Zip Cudr Namr uf Building(if applicablr)
SECf10N 2:PROPOSED WORK
If New Cunstructiun chrck herr O ur check all that apply in the twu rows below •
E�isting Building�� Repair QJ Alteratiun ❑ Additiun❑ Drmulition ❑ (Please fill out anA submit Appendix 1)
ChanKe of Use ❑ Change uf Oca�pancy ❑ Other ❑ Specify: �
• Are building plans and/ur construction ducuments being supplied as part of this permit application? Yes ❑ No �
� Is.in Independenl Structunl Engineering Peer Review required? Yes ❑ Nu C3
� Brief DescriNliun of Proposed Work� �O'�'we �' G�� f �d+ �p
I�e-tcc, n �F�c vy N..� , �ls�1i �1�o l�s tl�.k4r�+1 Q--�1.1
('rno b1h orc•toY'�- ,,�!1-
'� SECi'fON 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVAT[ON,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
� Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) ❑ '
Existing Use Group(s): 'e 1, Proposed Use Group(s): 2-�i p
Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34:
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
Na of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Tutal Area(sq.ft.)and Tutal Height(ft.)
_ - SEC7'ION 5:USE GROUP(Check ae ap licable) ' �
- A: Assembly A-1 ❑ A-2r ❑ A-2nc❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑
E: Facto F-1 ❑ F2❑ H: Hi Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
1: Institutional I-1 ❑ 1-2❑ I-7❑ 1-4❑ M: Mercantile❑ R: Residential R-I❑ R-2❑ R-3 O R-4❑
S: Storage Sl ❑ S-2 ❑ , U: Utility❑ Special Use O and please describe beluw: '
Special Use: �
SECT►ON 6:CONSTRUCiION 7YPE(Check as applicable)
IA � IB ❑ IIA ❑ IIB ❑ IIIA ❑ IItB ❑ IV ❑ VA ❑ VB ❑
SECTION 7:SITE INFORMATION Irefer to 790 CMR I]lA for details on each item)
Water Su I Flood Zone Infomiation: Sewage Disposal: Trench Pertnit: Debris Removal:
PP Y'
Public ❑ Check if uuhidr Pl�iud Zune❑ Indicatr municipal ❑ n trrnch will nut be Licensed Di.�ntaal tiite❑
Pricale❑ ur indenli(t'Zone ur un.ite at'strm O required O ur lrench ur.F�ecif�':
� prrmit i,endusrd ❑
Railroad righbof-way: � Hazards to Air Navigation: �L\ I li.li�ri�c�„nuni>.i��n K����i�•�� Pr„�o..:
\'u� :\F�F�licablc❑ I.titrutturc icithin airF,urt,tpprii.�eh arra.' b lhcir re��ir�c cumE�lctad.'
��r C��n.cnt to Rudd rnd�,.rd ❑ � Yc.O ��r.Vn❑ Yr. ❑ \��� ❑
SECTION B:CONTENT OF CERTIFICATE OF OCCUPANCY i
G.1i(i��n�d G�.tr: l�.r(;ruupl,l: Tcpc ui Cun.trucfiun: lkai�,anl Luad pi�r Fluuc �.
I)ue.thebuildin�;:nntain,�ntiF�rinklerti��.tem.': }F,ecialtitiF�ulations
� � ��I.�_ � ��,� �.��,s
. . i
SECTION 9: PROPERTY OWNER AUTHORIZATION �� �' 1 li
Nam•;iud Addrcs.a ol Pniperlv Ownrr
�,..�. 1 oa,� 37 Wa11u � 5�.1�.N. �a . 1-��G es �4 � sT�
Name(Print) Nu.and Strcet City/Tu�vn ZiP �
Prupert��lhcner C�mtact In(urm.ili�m:
G�] . ��3 _ D 7D - - lFL�4�Z��a..�._ca,�n
Title 7elrphune Nu. �bu,inrss) Telrphunr No. (cell) e-mail.iddre..
If applic.iblr, the prupert��uwner herrby authurizes
!Vame titrert Address Citv/Tuwn SLile Zip
tu.xt on the �ru�ert�������nrr's brhalf, in.ill matters rel,iti��r tu+vurk authurized bv this buildin� �ermit a >>lication.
SECTION I0:CONSTRUCTION CONTROL(Please fill out Appendix 2)
(11 buildin�i.Icss than 3i,UU0 cu.ft of cndns�vl s�aic and/ur not undcr C�msUuctiun CmVrul thcn check hrre�and ski�Scetiun IU.11
10.1 Re istered Professional Res onsible for Construction Control
�f'i� �hQ.rsL �- [Fis - �� � C'C:C.,�n�[lr�rnt�tuG�:rK�
Name(Rrgistrant) Telephune No. e-mail address �,� `� Q Registratiun Number
Il �'Co5. `'� . e,rl m'� 1L�3'�—
Street Address City/ uwn �State Zip Discipline Expiratiun Date
I
10.2 General Contractor
� �C � L 6� ��h �Ow �Jn
Companx Name:
Yc+c Qn�� C� �0053 � OD
Name uf Persun Respunsible fur Cunstructiun License No. and Type if Applicable
I� CrnsS �! �6.,. �v.c� ' ¢hP �715� S
Street Address City/Town - State Zip
�-�- U�iIL �_Z65 _yyl0 er:c A �',`n�5e Co��'1cac4,v�c . v��L--
Tele hone No.(business) Tele hone No. (cell) � e-mail address
� SECTION 11:W02KER5'COIvQ'ENSAIlON INSURANCE AFFIDAVIT(M.G.L.c.152. 25C(6))
A Workers'Compensation[nsurance Affidavit from the MA Department oE 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 si ned Affidavit submitted with this a lica[ion? Yea O No ❑
SECI'ION 12:CONSTRUCI'ION COSTS AND PERMIT FEE
Estimated Costs: (Labor
Item and Materials) Total Construction Cost(from Item 6)_$ ��� �ror��i
1. Building $ 'U 8uilding Permit Fee=Total Construction Cost x_(Insert here
2. Electrical S appropriate municipal factor)_$1�.
3. Plumbing $ I�
4. Mechanical (HVAC) $ Note: Minimum fee=$ (contact municipalily)
5. Mechanical (Other) $ � Enclose check payable to
6.Tutal Cust S ��a ,� (contact municipality)and write check number here
SECTION]3:SIGNATURE OF BUILDING PERMIT APPLICANT
Bv enterinK my name beluw, 1 hereby attest under the pains and penaltirs ut perjury that all uf the infurmatium m�tained in this
applicatinn is tnie and accuratr to the besl uf my knuwledhe and understandin};.
Plia<c print.md >i�;n name Tidr Tclephune \o. D,itc
I �trerl Addre>s Citt�iTu�cn ..tate Zip
�tunicipal Insprctor to fill out this section upon application approvaL• ��" "�u� �� �
Xa me Ua te
_ . � ' �
� "`-� CITY OF SALEM
\
- � PUBLIC PROPRERTY
; ,� �i
�� ��'��� Y�EPARTMENT
?,.��i
�.I'.11:: XI hl !'MIw �'�i l
\I'(1��1/ I���'.\il ll\I.:�lpl)lNlt'T ��.\I I'fl.��.\ii.\I I II :1 1��:1'!-
'I'FI:'17U-7�i9;9S �I'.\X:978.7Ja'18Ni
Constructlon Debris Disposal Aftidavit
(rcquired I'ur all dcnwlitiun�uiJ renuv�tiun wurk)
In �ccurdmice �vith the sixth edition of the S1ate Duilding Code, 730 CMR sa:tiun 1 l l.5
Debris, �nJ the provisiuns oF MGL c 40, S 54;
Duilding l'ermit !f . _ is ix+ued �v�th the condition that the debris resulting from
this wurk shall he dis4wscd of in a properly licensed waste Jisposal facility as defined by MGL c
11L5151)A.
The debris will be tr�nsporteJ by:
�.
' ` 5
'-- � L
�numc of hauler)
I'lie dcbris will be disposed of'in :
_.___...__
(n;uneur ui rty) '
�aJdress ul't�cilityl
(.—�'_'_.._` - -- - —
�'—��.�
�ig��ur o' '�ant -
� '1
�'-�� �d I 20��)
. �i��r
- i,i���..ii,sk
I
� F
.�• °�, � CITY OFS.�ILE.�I, �L�SS.�CHI:SETTS
Bl'IID4YG DEP.�IITt&�iT
� ' 1'_O WAS}1INGTON S'i�IEET, 3�O�.00R
, TEL (97� 7i5-9595
F.�x(97� 7iQ98�16
(V�BEgiEY DIUSCOLL
4tAYOA IHoaus ST.P�aaB
DIRECTOt OF Pl:BLIC PROPERtY/Hl'QDL�1G CO�L�(ISSIOVEt
1Vurken' Compmsatlon Insurance Aftidavit: Ouilden/Controcton/Electricirn�/Plumben
apn��cant Inf�rm�tlon Picax Print Leai6lr
� V�iTIt IBusin�v.Ortan�za�ionln�Lv�du.Jl' �r�� lvvQS�, b� C�`(�r,cQ��� n�.1nv�,�
Addresa: II C'rr.cc SE , �s-
City/Statc/Zip: .>e.c(.0 v�l� , l� l�i l� Phone N_�-�(Sr-`l�i'l6
,�re you r�employer'C6eek Ihe appropriate boa: Type o/proJett(requlre�:
1.� I am a cmploya with 4.`� 1�un a general contrxwr sud 1
employces(ful)md/or pan-dme).• have hired the wbcwuracmn 6. ❑New conawcdoa
2.� 1 am a sole pmprietor ar panner. listed on�he attuhed yhce� : 7. �Remakling
.hip;u�d huve no employed Thae subcontraewrs have 8. �Ikmolition
worl[ing for me in any capaciry. wotltm'tomp.inswanoe. 9. � Duilding addition
�No workcn'comµ inaurance S. � We aro a eo�porarion and ib �p❑��«�cal rcp�in ar addieiom
requireJ.) ot7icen have exe�eixd their
J.� 1 am a homeuwnnr Joing all wo� �ght of ecanption per MGL 1 I•Q Plumbing repain�additioro
myselt[No worters'comp. c. IS2.4l(4).�nd we hsve no 12.0 Raof repairs
insunnce requircd.J � empbym.�No worken' I3.0 Other
comp. in�wrance requircd.J
•nny�pplicanl ilm chab Ew sl muN alau fill w11M s[stim bcla►.f600ie�tlqir�rorkew'cpnyenwGm pylicy infunnallpl
� 'I h.neuwnn rM eu6ni��Ae�Plldve indiain�they an doiny dl MoAt aM tho Ain amide eantmeeon m�w mhmil a ne�.a16J�vi�ind�;�wd
{'.mi�ton�AN��h�sk iAu baot muq anached an sldi�iuW+Irel�howin�IM�n�d 1M 1u4tenlntlon aid tAek wutlten'comy.puliry infmroua�.
/um aa employn�hot b providln�worArsn'compsnra�loa lntr�vwei joi my emp/uye� Bdow/i fhe palfey aMd Job r!N
injormaiion.
InsurrnceCompanyVame: �e�c�-'A�n.er:�t. 1.n5.
Policy N ur Self•im. Lic. p: Expirr�ion Date: °SI/o
1ubSireAdJres: 33�C12e,�SF y �] �x�.,cG. ^ Ciry/StatrJZip: ��<^'�'n�, �'�gb
.�ttacb�copy of tM worksn'compen�rtb�poller dtclanlb�paQ�(thowln�th�pollry oumMr�ad e:pinHo�dat�}
Faifure to xcurc coverage�requircd unJer Sec�ian 23A of�1GL c. 132 c�n lead to ths imposition of criminsl penalrie�oh
fine up�0 51,500.00 anJ/or one-yeu imprisonment,a�well as civil penrltia in Ihe form uf o STOP WORK ORDEA and�fine
��f up to S?50.00 r J•ry against ihe violaror. Ik adv't.w.d ihat o cupy uf this�lucment rtuy be 1'urw;uded to ehe OI'fice of i
Inrc,uga�ium ol'iho DIA for insur�nce covcmgo vcnticrliun. �
/Jo hneby err�i/r �dn�h�j prina unJ penu/drs ujperJury rhai rR�in/'wmarfo�provided ubovr ia rrui uud rurrrer.
� `i�iature: � l �� I)utc� �i � 'e���
Phune��� `�170=0(�1(�� . �
iO�ciu(use a�Jy: Do not�vriie in�hu areu.ra b�.ump/�ted by eiry oi rown�,/Jli•iuL � .
I I I
Ciry or fuwn: __ Ycrmit/I.Iccme M__.
� hsuing.\u�hurilr (circle uncl� - --� - -- - — j I
I. Ifu�rJ uf IIe�I�A 2. Huil�tln� Ocparrment J. Cily/fo»n Clerk J. Eledrical lnspecto� 5. PlumbinR In�peetor � j
� 6. O�hrr . _, ;
l„nuct Pcrson: - � . _ --_ --- P�ont p: . I
`
�
,. ..' � . .
�J�70 .� �'pe �
/t� Q� �Crs��,�--
/ __._.__.__
< _.._-----
_.._._----- -
._.--
�� � �� 3 0� a s
�j�n^KIP� b�c.t�����z �7—�
. �--^ —_.
.1!
L__
. _ _ __ _ _ __ �
--- - -- I
I
OECK DECK
EXCLUSIVE USE IXCLUSIVE USE ROOF II
UNIT 1 UNIT 2 DECK
BEDROOM BEDROOM EXCLUSIVE USE
UNIT 3
120Y � 120V I
;
0 AH O �IH �
COMMON
I
, �
� .
� CLOSET 120Y P S � CLOSET 12OY . � DR� 126V II
✓ SC 0 c SC I
S�
HS o �° CLOSET
HS BA7HROOM 8A7HROOM • i
KITCHEN �•�
Ow KITCNEN KITCHEN
CLOSET � 120V
0 LIVING ROOM
, ' 120V S
0 � 120Y
I BEOROOM �H _ 0 SC
BEDROOM YN BATHROOM ' I�
❑ O . _. � """'
� 12QV
O
• S
O pH uH 120V
. . .., I
CIOSET . '� . S
.. . _ . . ecaus�vE us�: �
UNIT 3 " �? �BEDROOM 0 •
O CLOSET � .: I . BEDROOM
� o .
V I
fRCP UVING ROOM
UVING ROOM
UP • _ DOIM�' �
0 p . 0 NS 0 O ;CLOSET CLOSET
, 0 O .
$B OB '
BASEMENT ELEVATION .
F(IRE ALARM LEGEND n�iR� F�ooR
SECOND FLOOR ELEVA710N •
FIRST FLOOR ELEVATION • ' � '
120V OS 120 VOLT SMOKE DETECTOR Z'ONE #1 FRONT STAIRWELL ,, �
��Dy SC 120 VOLT COMBO SMOKE & CO DETECTOR . .— - �
. ,� o�/ !2 ! i
Z!ONE #2 REAR STAIRWELL � �r-:���1 b�f-�.�c _
=_ + �, ... '��ioa.
• O SYSTEM SMOKE DETECTOR ZIONE #3 BASEMENT � =� �'�;.� ^ e �==�U
_ r,� �
O . . .. . ... _ . . . . _ . � rL ':°YiER°PROI�£u C'L L �Ci�.� • I.
SYSTEM HEAT DETECTOR ZONE #4 UNIT HEAT DETECTORS ' ��.��i� �,�n cF�i � . � '• I
. !- .Fl7C P?JIE^'(Inu� nnn�c� r.c:C � ^.� !l ,
O SYSTEM PULL STATION Z(ONE #5 SPRINK�ER � " . r � u �e.'co � �r:• :�. -
, ,r, „T. _�: _c,�..
OSYSTEM SPRINKLER FLOW SWITCH .
SB SYSTEM SPRINKLER BELL
HS SYSTEM HORN STROBE - .
FLOOR PLAN
MH SYSTEM MINI HORN (N
SALEM ��'`� � �
FIRE — O SYSTEM ALARM BEACON � — � � iil
PREPARED FOR "' � '" ` ` `""'
ALARM FACP FIRE ALARM CONTROL PANEL RENAISSANCE CONDOMINIUM
FA-1 � . � GRani�c sca� AT
6 " s ° ,° .. . . � � 33 HAZEL STREET
. • , SCALE 1" = 5' MARCH 12. 2010
� � �' � NORTH SHORE SURVE1f CORPORAl1aN
i iach = 6 it, . 14 BROWN STREET — SALEM, MA
' 978-744-4800 #3364