Loading...
107 HIGHLAND AVE - BUILDING INSPECTION (2) 4 l( 'to The Commonwealth of Massachusetts Department of Public Safety Y! \1assaehusetts State Building Code(780 CMR) ��� Building Permit Application for any Building other than a One-or Two-Family Dwelling ('rhis Section For Official Use Only) Building Permit Number: Date Applied: Buildutg Official: SECTION 1:LOCATION(Please indicate Block Nand Lot N for locations for which a street address is not available) 017 ",Al4nk AC S4einq r No.and Street City/Town Zip Curie Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Curie used__ If New Construction check here❑or check all that apply in the two rows below Existing Building Repair❑ Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix t) 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 Engmec tin, Peer Review required? 1 Yes/❑- No O Br'ef Descri lion of Proposed Work: 7Y4�Ufn011-bCGvvhe tY\terloy' 67i6.Y�ddtt�Yllf yw61�1 vnw. cetltn6c ; Oct 5tt Al Louisa % ►- o trrvl tnn P hro An SECTION 3:CONIPLETETHIS 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 Cfv[R,14) ❑ Existing Use Gruup(s): Proposed Use Group(s): SECTION J:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Flour(sq. ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as a licable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ 1 B: Business ❑ E: Educational Cl F: Facto F-I ❑ F2❑ FI. High Hazard FI-1 ❑ H-2 Cl H-3 ❑ F1 4❑ 1-I-5❑ L Institutional I-1 ❑ 1-2❑ I-3❑ 14❑ NL• 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 asap licable) L\ ❑ IB ❑ IIA ❑ 110 ❑ 1 IIIA ❑ IIIB ❑ 1 IV 1 VA VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CNIR 111.0 for details on each item) Water Supply: flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public Check if outside Flood Zone❑ hulicate municipal❑ A trench will not be Licensed Disposal Site❑ required❑or trench or specify: Private or indentify Zone: nr on site system❑ permit is enclosed❑ Railroad right-of-way: hazards to Air Navigation: MA,1_L t i �lnnnv i n I airy I r .ra: Not Applicable Vt Is Structure within airport approach area? Is their review completed? or Consent to Build enclOsad❑ Yes❑ or No Yes❑ No ❑ SECTION 8:CON FENT OF CERTIFICATE OF OCCUPANCY Edition Of COLIC: Use Gruup(s): Type Of Construction: Occupant LOad per Hoor DOTS the building contain an Sprinkler System?: _ Special Stipulations: F( a SECTION 9: PROPER'rY OWNER AUI'IIORIZA,rION Name and Address of Property Owner r�res t [-c p �wyty� i nee No.and Street �L Col q Q P(P� Property Owner Contact Information: -� �I 9-t-A C 9- �9/f 6 0-n 'rifle Telephone No.(business) Telephone No. (cell) a-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 buildirlg permit a2elication. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.R.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 76 CY6wel'i �76- 5_91- 966t -176 2 N rune(SR�egist Yint) CCLL Telephone o. a-mail address R �istration Number Wo titsit 1 Jam-- Aw- b 0' - Street Address City/Toni State Zip Discipline Expiration Date 10.2 General Contractor S� Company Name -cs— Q6962g ge6a Mlijcurl Name of Person Responsible for Construction License No. and Type if Applicable se acd ug%, ar All�rl�� N� 01eZ/ Street Address City/Town State Zip '791 -153- 6036 5calf SuQvet.,e6�tldev.neb Telephone No. business Telephone No. cell e-mail address SECTION 11:XW1,'kIiRS C0MI1I;NSn I ION 1NSUPANCH MTH)AVtf M.C.L.c.152.§ ZSC 6 A Workers'Compensation Insurance Affidavit from the NIA 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 a lication? Yes No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1. Building 'S 2 Building Permit Fee-Total Construction Cost x (Insert here 2. Electrical S1500 appropriate municipal factor)=5 3. Plumbing 5 D (7 4. Mechanical (HVAC) $ Note:Minimumfee=S (contact municipality) 5. Mechanical Other S Enclose duYk n able to P+Y� 6.Total Cost $ 2 0 (contact municipality)and write check number here SECTION :SIGNATURE OF BUILDING PERNIIT 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 accu ra to to the best of my knowledge and understanding. 6"'a A/hS.$, 81 -f53- 6036 Ple:vse print and sign name 'rifle Telephone No. Date Se Glad ualfe�0'r �1Atca (N� c7tAZ� Street Address City/'town ''AA St to ,/Zip Municipal Inspector to fill out this section upon application approval: _f6 cAJ'ti *� Name Date r ( 't ` y' CITY OF S:UzNf, L%cksSACHUSETTS ;'://;c BLtt�L�tG DEP.1RTltr~vr .Yifr• 120 WASHLNGTON SMFET, 3w FLOOR TEL (973) 745-9595 Kid our SY DRISCOLL F.kx(978) TK-904S 7'rto�c�Sr.Plagits � DIZERpR OF Pl 3LlC PROPERTy/HCtLpLNG COSL\IIS5IO,NER Construction Debris DispOsal AtEdav•!f (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 730 0411 section ! 11.5 Debris, and the provisions of MGL c 40, S 54; Building Permit M is issued with the condition that the debris resulting from this work shall be disposed of S I SOA. in a properly licensed waste disposal facility as defined by ,bIGL c The debris will be transported by: 1 k&\ke (name othaulur) The ( ehns Will he disposed of in (nanm of t,cdi__ty) (address of'tacility) signature u(p,:rrnir applicant ----_- Luc ---- ' CITY OF S:U.EM, %L1SS.\CHUSETFS BUILDING DEPARTMENT 120 WASHLNGTON STREET, Sou FLOOR •ICI_ (978) 735-9595 F.A.r(978) 7.30-9846 Kl\IBERLF_Y DRISCOLL NLAYOR THoMAs ST.PIERRE DIRECTOR OF PCDLIC PROPERTY/aL:mDING CO\mISSIONER Workers' Conspensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Infnrmation Plcase Print Legibly Va111C tHurinass Organiratiorulndividual): . SU OYeme DVS U '(S — A llJress: �� G10A V0. &i Vr Cily/State/Zip: b C 0� MA CA821 Phone n: 781' F53` E03(1 Are you an employer:'Check the appropriate box: 'Type of project(required): 1.r$ I am a employer with 2 4. 0. I am a general contractor and I 6. ❑New construction employees(full and/or pan-time).' have hired the subcontractors 2.0 I atu a sole proprietor or partner- listed on the attached sheet. t 7. Remodeling ship and have no employees These sub-contractors have S. 0 Demolition working ror me in any capacity. workers'comp. insurance. y, 0 Building addition [No workers'comp. insurance 5. 0 We are a corporation mid its required.] officers have exercised their 10.01 Electrical repairs or additions 3.0 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.(No workers'cunip. C. 152. §1(4),and we have no 12.[] Roof repairs insurance required) t employees. (No workers' cunip. insurance rcquired.J 13.0 Other •Any appliran Our vhvcks but r l must also rill out the sccliun bdow,howiita their workers'cumpenmtion policy 11114 mailun. 'I lomnswtwn who submit this ailld wit Indicning they arc doing all work and then hire outride cuntmctm moil suhmil a now,an?davil indicating such. I'•imr ,tors Our chvvk this box mist ana<hal inadaitiurul ehvsl showing the noun of rho subaanlneWn and that,workm'temp.put Icy infunnalion. !ant un rurplu}er that!s providing Ivorkers'cunrpensatlar iruuruuce jar my auployees. Rd/taw/s the policy mtd fob slid injnnuutinn. Insur nec Company Name: Enpiration Dnte: Job Site Address: �1A��QM� ,4yC City/State/Zip:_ Gj-G ,eni Attach a copy of the workers' compensation pulley declaration page(showing the policy number and expiration date). I-aiOru to secure coverage as required under Section 25A of\fGL c. 152 can lead to the imposition of criminal penalties of tine up to S 1,500,00 and/or one-year imprisnnnient,as well as civil penalties in the form of a STOP WORK ORDER and aline of up to SM.00 a day against the violator. Be adviss:d that a copy of Ihis statement may be forwarded to the Of lice of Ineestigotions ol'thu DLk for insurance asvemge veriricatiun. /do hereby certify 1111dof ere pains ud ) nulde.s ojpmrury'but the injunnuNmr pro vide)above ix true uttd correct. Si,n III ra' phone 03(a OJ(iriul use only. Do,tor wile he Ibis area,to be completed by city or faun o�Jlt'iat City or'l'otvn: _ _ 1'crmit/l.lccnsc M i Issuing Authurity (circle one): -- - —_ ---- L hoard of llealih 2. I)uildlo;, Dcp;lrtmcm 3.Cityi rnwn Clerk I. F.Icctricsl Inspector 5. Plnmhing luspacror 6. Omer Phnnc !t: Commonwealth of Massachusetts to City of Salem 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5541 D° Return card to Building Division for Certificate of Occupancy -. Permit No. B-14-1188 FEE PAID: $35.00 PERMIT TO ro-WILD DATE ISSUED: 7/16/2014 This certifies that STYCZKO ROBERT A has permission to erect, alter, or demolish a building_-17,OSGOOD STREET Map/Lot: 360261-0 as follows: Repair/Replace ERECT:,10' X 18' GARAGE FOR STORAGE '(DEMO OLD GARAGE) 6 Contractor Name: r k DBA: js �;0- tf Contractor License No: r 7/16/2014 Building Official �jp Al 'g i 11 1! Date This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official may grant one or more extensions not to exceed six months each upon written request. err,,, it ' _ gam All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. a 1E.� �i� t i'1' .. All construction,alterations and changes of use of any building'and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public Inspection for the entire duration of the work until the completion of the same. ' a'2,AO s,-ti atC S The Certificate of Occupancy will not be issued until all.applicable signatures by the Building and Fire Officials are provided on.this permit. r..dL �r y' HIC#: Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGL c.142A). Al Restrictions: i4yt § Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER. Commonwealth of Massachusetts — - $' Citv of Salem 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 nna Return card to Building Division for Certificate of Occupancy Permit No. B-14-1190 FEE PAID: $50.00 PERMIT TO BUILD DATE ISSUED: 7/16/2014 This certifies that ROIKE PROPERTIES, LLC has permission to erect, alter, or demolish a building,„ 107.HIGHLAND AVENUE Map/Lot: 140198-0 as follows: Insulation REMOVE NON-BEARING INTERIOR PARTITIONS, DRYWALL FROM CEILINGS, UPDATE ELECTRICAL & PLUMBING "DEMO Fir id Contractor Name: Supreme Builders --- . a, _-• ,i" _ t DBA: c - 7. Contractor License No: 69628 fob r 7/16/2014 Yt l Building Official Date y S '. I I s o This permit shall be deemed abandoned and invalid unless the work authorized by this permit Is commenced within six months after issuance.The Building Official may grant one or more extensions not to exceed six months each upon written request ' ' ; 11'IPIr Ftt< All work authorized by this permit shall conform to the approved application and the approved construction documents for which.this permit has been granted. 44 ilk All construction,alterations and changes of use of any,building and structures shall be in compliance with the local z6ming by laws=and codes. 4;jl,?. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open:for public Inspection for the entire duration of the work until the completion of the same. "�' `I7i I i ii nf�f Ip (11 The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. r HIC #: Persons contracting with unregistered contractors do not have access to the guaranty fund"(asset forth in MGL c.142A). s u 1,itl"+ ay' Restrictions: € tkry !t rd 4 z r y Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER.