400 HIGHLAND AVE - BPA-07-767, UROLOGY ASSOC. SUITE 7* E�� o��E� ___
`'• ' PUBLIC PROPERTY
- DEPr1RT'�iFa�tT A'� l ��
/ f-� �
1:I�LLfFlU.t1'DRLSI:ULL
\1AYOR 1�WASIiiNcrt�N J'TREEI 1�ALFJI��1.ii5,�CN�stl'�507970
'If1:9'.8-7�S959S�Fnx:97&7�f0-9846
APPLICATION FOR THE REPAIR RENOVATION CONSTRUCTI.ON
DEMOLITION OR CIiANGE OF USE OR OCCUPANCY FOR ANY EXISTING
STRUCTURE OR BUILDING
1.0 SITE INFORMATION
LocationName: �Fca�-a� co�✓sc��r.p�JfS Building:
Property Address:
l�G� H/E���V,o �ll/�
property ia lopted in a;Conservatlon Area YM�L_HisWric Dtstrbt Y/N�_
2.0 OWNERSHIP INFORMATION
2,1 Owner of Land �'OcfGEtT ._���`�'r'' �
Name:
Address:
Telephane:
3.0 COMPLETE THIS SECTION FOR WORK IN FYiaTiN� gU1LDINGS ONLY
Addition Existing . f
Renovation Number of Stories Renovated
Change in Use New
Demolition - Existing yoQo s '
Approximate year of � °Area per floor (s� Renovated
construction or renovation ����
of existing building New �
Brief Description of Proposed Work:
���uR9idn/ o�: ad�F �� ����-ic.E.� S�p�E'
�c,c> �3i�t�/�/6, rF+l,vsc,a,�l!•ro�✓� �`1�°�' �GS cn2y
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617-go3- �a�� �
___ - ���, ��j��,��-- - ---- ----- ------- -
_
-------MailPermitto: �`is� �.e.�9 ST T�y'Ie�,d.Ll/ �,p• asyir - -
�
�
What is the curcent use of the Buiiding7 �������' ��f'G�
Material of BuildingT Sr�G r9���G If dwelling, how many units?
Will the Building Conform to lawT ��S AsbestosT
ArchitecCs Name c� ���`'
Address and Phone SJB= � s�/- I5i� _(. )
Mechanic's Name i3��tJ/�UGK- /.'� U�"�- �J�d--S
Address and Phone i�1� �Afi'Q t �/
Co�struction Supervisors License# �3d d 3O HIC Registration#
Estimated Cost of Project S �;�dv� Permil Fee Cakulatlo�
Permit Fee S Estimated Cost X$7/51000 Residential
Estlmated Cost X$11/$1000 Commercial
M Additional$5.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby appiy for a Buflding Permit to buiid to the above stated
specifications. Signed undet penaity of perjury /�/
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' � CITY OF SALEM
, /: �
PUBLIC PROPRERTY
DEPARTMENT
x�eeRc.ev nntscou
MAYOR 120 WASHINGTON STREET�SALFM,tifASSpCH[:SETfS 01970
� 'I�t 97&7459595 �F.�X:97&74Q9846
Workers' Compensation Insurance Aftidavit: Builders/Contractors/Electricians/Plnmbers
Aoolicant Information Plesse Print Leeiblv
Name (Business/organi�ation/Individual): Pt� b✓-1�(✓C� 13U1L/J�l'LS
Address:__ i L/� l�n/3�r
City/State/Zip: ' � ' �1XI Phone#: 6 /�-- �(3 �7�� �_
Are you an employer?Check the propriate bo . Type of project(require�:
1.� I am a employer with 4. I am a general contractor and I 6, �Ne consuucaon
eg+ployees(fiill and/or part-time).• have hired the sub-con�actors �
2.(�'f�am a sole proprieto�or parmer- listed on the attached sheet = �• ���B
ship and have no employees These sub-conhactors have 8. � Demolition
working for me in any capacity. workers' comp. insuraace. g, � g��g�aoa
(No workers' comp. insurance 5. ❑ We are a co�poradon and its
required.] officers have exemiaed their 10.�Electrical repairs or additions
3.� I am a homeowner doing all work right of exemption per MGL i l.❑Plumbing repairs or additions
myself. [No workers'comp. c. 152,§1(4),and we have no �Z,Q Roof repairs
insurance roquired]t employeea. [No workers' 13.❑Other
comp.insuxance required.]
•Any app8cant that checiu box A1 mwt eleo fill out the aectio¢below e6owing tAeir workm'wmpeoearion poliq infotmation,
t Homeowom who submit t6i�affidevit indicating t6ey are doing a11 wodc md thm hiro ounide cmtracWn must eu6mit a mw a}Adevit indicatioQ euc6,
=Contrecwn that check this bme must attached an additioaal shat showing the name of t6e sub-contractora and the'v worlcm'com li mfortmGon.
P�Po �Y�
!am an employer that!s providing workers'compensntlon insuranee jor my employees. Be1ow is Nre policy and job slta
injormatioa y� n J
InsuranceCompanyName: w�^�T�/�'�I/ �{/('jK(��
Policy#or Self-ins. Lic. #: Expiration Date:
_ Job Site Address: City/State/Zip:
Attach a copy of t6e worken'compensatlon poticy declarallon psge(showing the policy oumber and e:piraHon date�
Failure W secure coverage as required under Section 25A of MGL c. 152 can lead W the imposition of criminal penaltiea of a
fine up to 31,500.00 and/or one-yeaz imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a capy of this statement may be forwazded to the Office of
Investigations of the DIA for insurance covenge verification.
�uo nereny certijy nnder the pains and penalties ojperjury that the injarmation p�avided above i.f trae and correct
Si natur • � Dat • —O 6
Phone#:
OJJlcia!use only. Da not write in thrs orea,to be completed by ciry or town a�cial
City or Town: PermitlLicense#
[ssuing Authority(circle one):
l. Board of Health 2.Buflding Department 3.City/Town Clerk 4, Electrical Inspector S. Plumbing Inspector
6.Ot6er
Contact Persoo• Phone#:
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e DAVID F
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_____-. . �\�StµED AqCN'r�
HOLLOW METAL FRAME HOLLOW METAL FRAFAE
"� PAINT TO MATCH DaST. � PAINT TO MATCH EXIST. TOP PUTE ANpiOR NE OF STRUCNRE ABOVE e �G�D F. �
�
To oasr. srnuc�uRE � „ ao.
� 18' t TO FF. CAULK k SEAL ALL OPENWG$ ; Be iy M
3' X 33` TEI�IPERED SAFETY cauNG
��
GLA55 IN H.M. FRAME . "o 'S
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� = Qc avid q ith
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j� o- j., � CEILING SYSiEAI
SCW SCW
SEE FlNISH SCHEDULE
VARNISH VARNISH Fat wa�t Fl��s�
� BATf SOUND INSUlAl10N � �
� 3.-�• 2 3•—�•
, (�) u�rt s/s• tw� 'x- �
crP. eo. enncri s�oE
DOOR ELEVATIONS
NETAL S7UD TO AIJGN
SCALE: 1/4" = 1�-0� N7TH ADy4CENT WALL ASSOJBLY
I M P 0 R TA N T N 0 TE. ��R UNE BASE (SEE FlNISH
SdiEDUL.E)
- --- --- - -__
— ----_ tJST OF ABBR VIA
- -- --- ___—_ .
ALL DOOR HARDWARE, NOUNTING HEIGHTS ETC. IS TO MEET BOTH �
Electrical Notes:
HM � HOLLOW METAL A.D.A AND I�ASSACHUSETTS HANDICAP CODES. • y �
IHM � INSULATED HOLLOW METAL .� Z
1 Remove existing outlets at a;ounter height and reiocate at 18"AFF SCW = SOUO CORE WOOD � WA LL . TYP E .; � a
SCALE'.: NONE o� o �
2 Remove existing 220/440 owtlet. Install 110 duplex at 18"AFF , !
3 Remove ail surface mounted conduit,junction boxes, disconnects, etc.
Remo�e au 220��0 out�ets. D O 0 R H A R D W A R E S C H E D U L \ ' � �
SOUND INSULATION �
4 Relocate existing quad outiet 16" left, keep at counter height. �..�
�• REVISE EXISTING HARDWARE 3. 1-1/2 — BUTT HINGES 5/8' GYP. BD. � �
5 Provide all required EXIT signs, alarm pull stations, hom/lights, and other �T WFIERE NEEDED 1 — LATqiSET W/ I�VER HANDLE •
devices as required to meeQ code. Provide and program additional . �CYUNDRICAL TYPE) METAL STUDS ..� �
smoke detectors as requiir�d. ' � 16` O.C. N
2. 1-1/2 — BUTT HINGES 1 — SET DOOR MUTES � �
6 Reciircuit lighting as required in corridors, new offices, Biiiing and 1 — LOCKSET W/ LEVER HANDLE 1 — DOOR STOP METAL STUD JACK � �
Transcri tion areas. Relocate fixtures as shown. Relam all fixtures. CYUNDRICAL TYPE �1 �
P P � � FlRE TREATEO �
1 — SET DOOR �AUTES _ _ WOOD BLOCKING AS REQ'D �..� O�
7 Telephone and data wiring will be perFormed by others. 1 _ DOOR STOP 4• �—��2 — BUTf HINGES e CAULK CONTIN. (BOTH SIDES)
1 — LOCKSET W/ LEVER HANDLE — �
8 All of the required electrical demolition is not shown on these plans. All (CYLINDRICAL 1YPE) HOLLOW METAL FRAME
walis shown on sheet D1 to� be removed shall have all electrical devices � 1 — DOOR CLOSER ' (PAINT)
�., and wiring removed as wella. Relocate and recircuit as required tv preserve WALL ANCHORS & BASE �
functionality of ali electrical devices scheduled to remain. 1 — SET DOOR I�UTES CLIPS • , � �
' � V
• 1 — DOOR STOP �
9 Remove all obsolete electrical wiring to existing panels, including wiring � . ' • SOUQ CORE WOOD DOORS � �
i' between existing outlets arnd devices. * ; �
SIMILAR FOR EX[ISTING AND NEW WALL CONSTRUCTION � � � 0 '
10 Replace exh. fan and light ffixture in Women and Men W �
�
1 HEA,D JAMB DETAIL � s v �
. A3 SCALE: 3"=1'-0" . � � �
�
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FINISH SCHEDULE �
� .� .. . . , . . ._. _ ._.. ._ _ ._
- . .. .. ...... . .. .
GENERAL NOTE �S , - -�----
----- - � . - - ------- --- -----_ _ .__.--- -- _ .. .--- _ _ __ _ . _ _.------- . - - -- � �� �
Mark i Room Fioor Base Walls � Ceilin�__� _Door Trim _Remarfcs ____ �
- - - - -- • -- _ -
, . -- ---- . ._.. ---- ---.__ .
_.. --
- - ---�
� %�.- . . .. . , ' 41 � � OFFICE _,.-- -QqFtPET CAf2PET . . .., .PAINT___ REWUORKEXIS77NG URETHANE - --... PAINT � Overabstingfloor --
1. THE GEMERAL CON1RpCTaR wiLL BE RESPONIBLE FOR ALL OiHER WOR1C TNAT IS SFIOWN IN THE CONiRACT DOCCUNENTS THAT `' ._42_ _ _ CORRIDOR _CARPET CAftpET _ PA1NT _ IXISTING URETHANE PAINT - Overradstir�floor •�
43_ OFFICE __ CAFtpET CARpET � pA1NT REVWORKEXISTING URETHANE PAlNT Overexistirgfbor �
---' � �
IS NOT SPEqFlCALLY IDENTFIED TO BE iHAT OF A SUB-CONiRACT01� INCLUDING ALL WORK 1HAT IS SHOWN IIN THE CONTRACT ,__44 ____ CORRIDOR _. __GjRpET_ CARpE7 - pqINT -�- REVNORKEXISTING- URETHqNE ^ PAINT �� Overebsti eoor `�/{
' DOCUAIENTS, THAT IS NOT IDENi1FlED AS BONG ANY CONTRACTOR'S SPEpFlC RESPONSIBIUTY. iHE SCOPE OF 1fHE WORK OF _ as CONFERENCE CARPET CJIRPET PAINT EXISTING URETWWE � pAINT Overepstingfloor `� ^ � �
1HE SUB-CONTRACTOR�S ARE DEN�FlED IN THEIR WDIVIDUAL SPEGFICATION SECIIONS _�_ _ PATHOLOGY � � CARpET CqRpET pAINT REVNORK EXISTING PAINT pAINT Over e�dsting floor �
� 47 : TOILEf ROOM FXISTING EXISTING PAINT EXISTING PAINT a,vHr . � J � � Q,�
2 1HE GENERAL CONiRACTOR NiLL PRONDE - BARRICIIDES, 1E�11PORARY IJGHTS, IENPORARY iELEPHONE SERWCE. AND CLEAN-UP � BILLING SUPERVISOR CARPET CARpET pAlry7 EXISTING PAINT PNNT Overebsting 800r
$FRNCE TO TFIE VYORIC ARE� 49 : BILL�NG � � CNRPET --� --CARPET PAINT � EXISTING PAINT PAINT Overexis6'ngNoor -7
. --....50 . ..-TFtANSCRIPTION � CAFtPET CARPET � PAINT-- —IXISTING PAINT �--� PAINT Overebsti floor --- � � L � � .
3. 1HE �RAI. CONTRACTOR YNLL VE�Y ALL DUAENSIONS AND CONDIT10N5 AT 1HE .108 SITE PR� TO PRO(�D�NG VHM THE -�s� -.. eReaic----- -- vc1 - -�m-_ -aaNr REV�/ORKEXISTING PAINT � PAINT Overebstingfloa � � � .�
52 � WOMENS TOILET DCISTING EXISTING PAINT FXISTING PAINT PAINT
WORK THE GENERAI. CONIRACTOR WILL CAORDWAiE WORK AfxORDINGLY YAiH ALL SUBCONTRACTORS AND 11iE OWNER. 5� MENs roi��r EXISTING E%ISTING PaNT EX�STING PAINT PAINT --- � �
... • . � 54 � � CAATCLOSEf _..- ---VCT �— VINY��-- PPJNT . EXISTING -_. _. PAINT � PAINT Overebstirgfloor � r T ■.
4. 1HE GQJERAI. CON7RACTOR IS RESPONSIBLE FOR 1}IE COIAPLETE AND 7HOROUGI-I CLE/W-UP AT 11'IE END OF THE JOB, AND FOR _ 55_ I _ DATACLOSET -- - •-vCT----v�t�ri - -- P/UNT-- EXISTING -- - PAINT----- PAINT Urere�s floor �F� G�
� - - - -- ----- -- ----- -
-- ----- ^
DAILY REIdOVAI OF CONSiRUC DEBRIS AND CLEAN-UP. ; --C�B---; --- CL0.SET-- — VCT-- - VINYL ----. - PAINT - ----EXISTING --- -- PAINT PAINT Overe�asstinafba � � S�I
' ..__57_.,' ...._._CORRIDOR ---. _ CARPET CAF2PET_.... ..__PAINT__ EXISTING UREiHANE_ - PAINT � Overe�ossting floor --
5� iHE GOJERAI. CONTRACTOR YIQ.L PERFORIA UINOR SPAqCL1NG AND REPAIRS TO DOSTiN6 WAl1.S THROUGHOUT THE WOFi1C F�B VESTIBULE MAT CARPET PAINT IXISTING URETH/1NE PAINT Overexisti floor � �� �„�
AREA AS IS REWIRED W Pf2EPARA710N fOR NEW FlNtSliES .
C/�
6. IT WII.L BE 11iE GENERAL CONiRACTOR'S RESPONSIBILITY TO VERIFY AND EXECUTE ALL WORK IN ACCORDANCE NM1H -- ��~
11A5SApiUSETTS BIALDWC COOE AND ALL OiHER APPUCABLE STATE, FEDER/LL, AND LOCAL CODES AND REGWA110N5. DOOR SCHEDULE � � �
_ ._ _ _. __ . -. . _
__ �_.. _ -- -.. __ S
7. IT WILL BE 1HE GENERAL CONiRHCTOR'S RESPON9BILIiY TO SEE iHAT ALL WORK PERFORNm IS IN AC(XK2DAN(CE WI1H iHE __._.._ _--- __--_DOOR _--.__ ...... . _ . ..--- -T--- � - FRAME_ �„�"
NATIONAL FlRE PROTECTION �SSOGATION S UFE SAFETY CODE (NFPA-101, 1985 m.�. MARK r ELEV SIZE I MATL LABEL LFS t---DETAIL'' � MpTL LABEL HARDWARE -- -- REMARKS------ O �y � W
- --- --_1--�---- - —._ . HEAD _JAMB— +_..— �
8. iliE GO�IERAI OONTRACTOR WAJ. BE RESPONSIBLE FOR INIilAT1NG. NAINTAINWG AND SUPERVISlNG ALL SAFETY PRECAUiIONS -- - -- ----- - --- � --� � --- -- -- OO
- --�-- - -� _ _ __ -- ------—-- ---- _
AND PROGRAUS NECESSARY FOR TFIE COIAPLEiION Of THE VYORK. 31 __ _ _1 3'-0"x 7'-0"-1-3/4" -_ SCW -.--- 1 �1/A3 .1/A3 _ _ -HM
- _ _ -__ _ ---- --- ----
92 1 3'-0'x 7'-0"-1-3/4" SCW - 1 ---1/A3 1/A3 HM
—.... ----- ------------- ----
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•• ' 33 1 3'-0'x 7'-0'-1-3/4' SCW 1 1/A3 1/A3 HM
" 9. 1HE GQJERAL CONiRACTOR WILL PROVIDE THE OWNER WIiH WSURANCE CERiIFlCATES FOR iHE REQUIRED WSUFtANCE PR10R -- . ...----.__. _._._---------- - ---+-----._ _-- ------ --------- ; �
34 2 _._3'-0"xT-0"-13/4" SCW i 1 1/A3 1/A3 HM ___,.. ----------- ---..__ _ .
TO STARTWG iHE WORK ----- -----.
35 --. -- 1 - .----_ Relocated SCW - ---- 1— -- 1/A3 1/A3 WD ___. --V- ----- Drawing Number
36 1 3'-0"x 7'-0"-1-3/4" SCW- ----- 1 1/A3 '1/A3 HM
1Q iHE GQJERN. OONTRACTOR N11 FlLE i0R AND SECURE ALL APPROVALS. PEW11TSr AND CERTIFlCATES OF CO►IPLIANCE AS _3i -i _ 3 0 x 7'-0' 1 3/4= SCW - 1 --—1/A3 1/A3 -- HM - — - ------
--- --- - -- . _ _---- -----
REQUIRED. _38_ . -1--- - 3-0 x7'-0" ,1-3/4" --- SCW __ 1--- -'1/A3 1/A3 HM
� 39 - 5'-0'x 7'-0"-1-3/4. � -- --- .__2_. _- � �--- - --- - �
� Slider ---- - -- _._______ �
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