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63 JEFFERSON AVE - BUILDING INSPECTION (2) �'�i,�.o � mn , I� lD 3 . __, . �� IMSPE�RON��S��2VICES � � I � -�� 1D15 M�h�eqCc�n{no,q,weaith of Massachusetts � d'ep3�l�nent of Public Safety AlassachusettsStale euilding Code(780 ChIR) Buiiding Permit Application for any Buiiding other than a One-or Two-Family Dwelling (This SetHon Fur Official Use Onl ) `^ � Building Pecmit Number. Date Applied: � Building O[(icu�l: � � SECCION 1:LOCATION(Pleue indicate Block N and Lat Y for loaHona for which a sheet addrese ie nat availabte) � V 1 3 .` d/`1 0 No.and Slr �t�- 1 n� City/Town Zip Code Name uf Building(if appiicable) I I �� 2n I SECTION 2•PROPOSED WORK . �. Editiun of MA Stah C e useJ_ If New Cunstruction rh�v k here O or ch�Yk all lhnt apply Li the lwo rows below ` n Existing Building�l Repair� rVhratiun ❑ AdJitiun� Demolition O (Ple.ue fill out and submit Appendix I) ftl / � Change uf Use ❑ Ch;mge of Occupancy ❑ Other ❑ Specify: I Are buiiding plans and/or cunstrucliun ducumenls being suppli��l as p�rt of Ihis permit�pplication7 Ycs �) Nu O � Is an Imlependent Stmcturol Engincering P��r Review reyuired? Yes O No � � ` . Brief Destription of Propused Work:�llD W�0 L LS N�u1 Lf L�C 7�R1 C `� �/L�/1 y" �� SECiION 3:COh1PLETE TH[S SECTION IF EJ(ISTING BUILDING UNDEAGOING RENOVATION,ADDITfON,OR CHANGE IN USE OR OCCUPANCY Ch�4k here if an FxisNng Building InvestigaHon and EvaluaHon is enclused(See 780 CMR 3F) O Esisting Use Group(s): Propus�d Use Group(s): SECI'ION 4:BUILDING HEIGNT AND AREA � � � � Existing ProposeJ Nu.of Fluors/Studes(include b�uemen[levels)&Area Per Fluor(sq.ft.) Tutal Arca(sy.ft.)and Tohl Height(ft.) SECTION 5:USE GROUP(Check as a licable) � A: Assembly A-I❑ A-2� Nightclub ❑ A-3 ❑ A-F❑ A-5❑ B: Dueineee ❑ E: EduwHonal ❑ F: Facm F-t O F2❑ H: Hi h Huud H-t O H-2❑ H-3 ❑ H-t� H-5� L• InstituNonal !-I ❑ I-2❑ [-3❑ 1-1❑ hL• MercanHle O R: Residential R-l❑ R-2❑ R-5 O R-0❑ � S: Storage Sl O � S2❑ U: Utility❑ Special Use�O and please describe beluw: � Sp��cial Use: SECT(ON 6:CONSTRUCC[ON 7Yt'E(Check as a Ilcable� �� (A O 16 ❑ IIAO IIB ❑ Illr\ 0 lIIBO !V ❑ VA ❑ V6O SECTION 7:51TE INFORMATION(refer to 7B0 CMR 111.0 fot det.ills on each item) LVater Supply: Flood Zone Information: Sewage Disposal: Trench Permit Debris Removal: Public� Ch�tk it outside Flood Zune❑ Indicate municipal QJ �trench will not be Limnsed Dispusal Si[e� rcquircd$ortmnch orsp��cify:' Privale0 orindentifyZune: oronsitesystem❑ virmitisenclosed0 �JpRy�/i��CA�i/T�b RailroaJ rightrof-way: tluards to Air Navigation: �p\i i„n��Gnnmi,ti��n u,n�ie,��Pnx�•..: -�--- -----...------.__..._._..._- Not Applicabie ki Is Structure wilhin airport approach�vea? Is their rcview completeJ? nr Cunsrnt lo�uJJ encluseJ❑ Ycs� or Ni� Yes❑ Nu Q SECiION 8:CONTENT Of CERTIFICA"IE OF OCCUNANCY LJitiun u(Cndc: Usc Group(s): Type uf Cunstruc�iun: (Xn�punt Load per Plnue Does Ihe buildiny,c�mlain an Sprinkler Syslem?: Speeial Slipulatiuns: -- � � 3 T �✓ _ / ,S �,�jZJc-� 77�� OZ- - 203 I13...i , - � ZC, (F,(pC; � SECT[ON 9: PROPERTY OWNER AUTt10RIZA"PION � � Namc and Addnss of Property Owner LI SD �� ,�� G✓Fyma �r� Mfl . Name(Print) No.and Street � - City/Town . �• � Zip Property Owner Cuntact hifonnalion: g��- `��-�_ Tille Telephone IVo.(business) Tclephone No. (cell) e-mail adilress If applicablc,the�roperty owner hereby authorizes ,(�A�1r,l� ��JRV2C�'Ifi/2� fD0 /�y/�!_� �" L�/Nr� /�'�� bl a � Nmne � —�5treetAddress 'City/Town Sfate � Zip to act on Ihe ro er owner s bchalf,in all matters relative to work authorized b this buildin ermit a lication. SECT[ON 30:CONSTRUCTION CONTROL(Please fill out Appendix 2) If buBdin ie Iesa thin 35,000 ca(f.o(enclosed s nrn and or not under Conshuction Conhal then checic here O�nd ski SecMon 10.1 10.1 Re istered Profesaional Res onsible for ConstrucNon Conhol � � �av,� �A�2C,-NR�'� �7�-�9b- S �- An k� 'Q r� � C��iai� J � Name(Registrnnt) / Telephone No. �mail addre 6-P18��. tration Num r f JOa {'�"141"fLLc 1'1� � VN2f�{��r� l�" 2//�`� Slrce[ Add ss City/Town SA�te Zip Discipline Expiration Date 10.2 Cenera!Conkactor � � � - � - � � '�AV� BA�Z•[ �2� C�,��sT2ucTia� � R�na��NL Company Name �r+v� �A� e,11A1�.� ,C5 �oI �31 un�krtiRlc7'c%D Name of Perso�n Responsib/le fur Constructiun License Nu. enJ Type if Applicable /�t7 /ny/�/ C.t ]"�" L'%/,�/'�1 N/Q' 0� d Strcet AdJiess -� Cily/Town , Shte Zip -- 75�1 _C�6. Y�� .��V�'3A/zCNle(L� kE�,a:��L3+� ��-Mli/L Pr� Telc hone No. business Tcle hone No. tell e-mail addmcs � SECTION 11:FVORI:EhS'CORiPENSA170N INtiUIt:\NCH:�PFibAVI"1' M.G.L.c.152 25C 6 A 4Vorkers'Compensation Insurance Affidavit from the h1A Deparhnent o(Industri:il Accidents must be completed and submitted with'tRis application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a si ned Affidavit submitt�tl with this a IicaHon? - Yes O No O SECTION 12 CONSTRUCI'ION COSTS AND PERMIT FEE � Estunnted Costs:(Labor � � ,� «e1° and Materials) Total Cunstructiun Cost((rom Item 6)_$ d � L Ouilding � 0 dd� guilding Permit fee=Tutal Construction Cost x_((nser[here 2.Elcclrical S appropru�te municipal factor)_$ 1. Plumbing $ . d.�lErh�niril (HVi�C� g � Note:Minimumhe=$ (contadntunicip.lily) � 5.bl�ehanic:il Other � � Encluse ch�Yk payable tu 6.Total Cost 3 �� p"0 (contact mu�icipali )and write check number here SECiION 13:SIGNATUAE OF UUILDING PERhtIT APPLICANT Uy enhring my name beluw, I hcreby attest uuder the pains and penalties uf perjury that all of the informatiun cunt�iniai in this � ipp cation is frue�md accurate to th best of my knowledge anJ understanJing. ' a,✓� ��.,u� d,�,vs2 �yi_�L�i -S�29_3 �,S' Ple.ue print and si n name Tide Tclephone No. Dah ia o M �k��r ��r ��n�rJ t�R ol o � Strcet AJdress City/Town State_ Zip i�lunicipal Inspector to fill uut[his section upon application approval: K� 3l Name Date � The Commonwealth ofMassachusetts Department oflndustrialAccidents z� �, ; I Congress Street, Suite 100 Boston, MA 02114-2017 `� www.mass.gov/dia �Forkers'Compensation Insurance A1'}idavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Apolicant Information Please Print Le2iblv NBIDC (Business/Organization/Individua]):�AV�i� �:,. 1. {� �C N/}�.� Address:�0 n �1V (L'�(, k� �-C City/State/Zip: �y ni N �1i1 S S ol�'j•p i Phone#: �S J - (09(o ' ��2V� Are you an emplayer?Check the appropria[e box: Type of project(required): 1.QI am a employer with � employees(full and/or part-time)J 7. �New construC[ion 2.�I am a.sole propnetor or parmership and have no employees working for me in $. �Remodeling any capaciry.[No workers`comp.insurance required.] � . 3.❑1 am a homeowner doing all work myself.[No workers'comp.insurance required.]1 9. ❑Demolihon 10�Building addirion 4.❑I am a homeowner and will be hiring contractors to conducl aIl work on my property. I will - ensure that all wnhacrors either have workers'compensation insurance or are sole 11.�EleCh'ical repairs or additions proprietors with no employees. � 12.�Plumbing repairs or additions 5.❑I am a general contracror and I have hired the subconfractors listed on the attached sheet 13.Q Roof 7epaliS These sub-conhactors have employees and have workers'comp.inswdnce.< 6.�We are a corporation and its o�cers have exercised their right of exemption per MGL c. 14.Q Ot}lei 152,§1(4),and we have no employees.[No workers'wmp.insurance requ'ved.] •Any applicant[hat checks box#1 mus[also fill out Ihe section below showing theu workers'compensation policy information. � t Homeowners who submi[this affidavit indicating they are doing all work and then hire outside contracmrs must submit a new a�davit indicating such. iContractors that check this box must attached an addiiional sheet showing the name of the sub-contractors and s[ate whether or not those entities have employees. If Ihe sub-conhactors have employees,they must provide their workers'comp.policy number. I am an emp[oyer that is providing workers'compensation insurance for my employees. Belaw is the policy and job site � informatioa. / - Insurance Company Name: ! Policy#or Self-ins.Lic.#: Expiration Date: - Job Site Address: City/State/Zip: . Attach a copy of the workers'compensatiou policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishab]e by a fine up to$1,500.00 and/or one-year imprisonment,as well as civi]penal[ies in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage venfication. I do hereby ce under th pains and enalties per�ury at the information provided above is true and correct. '/ / /� �/ '�n � /� . Si�ature: ��-4.r 0�� C/ �� Date� ��P'� � O'"�5 Phone#: �O � " �a'7 L ' ��J a � ` O�cral use-only. Do not write in this area,to be completed by city or town oJficial. . . City or Town: PermiULicense# Issuing Authority(circle one): , 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an emp[ayee is defined as"...every person in the service of another under any contract of hire, express or implied,ora]or written." An employer is defined as"an individual,par[nership,association,corporation or o[her lega]enfiTy,or any hvo or more of the foregoing engaged in a joint enterprise,and including the]ega]representatives of a deceased employer,or the receiver or trustee of an individual,pazfiership,associa[ion or other lega] 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 dwe]]ing 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." MGL chapter 152,§25C(6)also sta[es that"every state or local liceusing agency shall withhold the issuance or , renewal of a license or permit to operate a business or to construct buildiugs in the commonwealth far any applicant who has not produced acceptabte evidence of compliance with the iusurance 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 affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),addtess(es)and phone nutnber(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liabiliry 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 Indastrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the pemtit or license is being requested,uot the Departrnent of Indushial Accidents. Should you have any questions regazding the law or if yoo are required to obtain a workers' compensation policy,please call the Department at the number]isted below. Self-insured'companies should enter their self-insurance license number on the appropriate]ine. City or Town Oflicials Please be sure that the affidavit is complete and printed]egibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regazding the applicant. Please be sure to fill in the pemtiUlicense number which will be used as a reference number. In addition,an applicant that must submit multiple pemriUlicense applications in any given yeaz,need only submit one affidavit indicating wrrent policy information(if necessary)and under"Job Site Address"the applicant shou]d 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 file for fu[ure perntits or licenses. A new afSdavit must be filled out each year. Where a home owner or citizen is obtaining a]icense or pemvt not related to any business or commercia]venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The DeparhnenYs address,telephone and faac number: The Commonwealth of Massachusetts Deparhnent of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised o2-23-15 www.mass.gov/dia � C�TY OF SALEIV� MASSACHUSETTS . , I - �} BUILDIIVG DEPARTMENf - 120 Wnst�•rGTON SIREET,3'm FY.00R �L(978)745-9595 Fax(978)740-9846 KIIv�ERLEYDRISO�LL MAYOR TrroMns ST.P�xt� DIREGTpR OF PUBLiCPROPERTY/BUII.DING OD2vIlvIISSIONER Construction Debris Disposa/Affidavit (required for all demolition and renovation work)� in accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris, and the provisions of MGL c40, 5 54; Building Permit il is issued with the condition that the debris resulting from this work shail be disposed of in a properly licensed waste deposit facility as defined by MGL c 111, S 150A. The debris will be transported by: l�oR,rH Sl�� C��r� � (name of hauler) � The debris will be disposed of in: oRi7� Si �� (name of facility) S� �� (address of facility) �� .� Signature of applicant .�� a� -a o l,�`' Date � +io"n��e.,r COIT1fT10fIW0aItI7 O} Ma558CIlU5Btt5 ;�,-\ � � { �� b{ City of Salem � . , ; ' ,. s �, °�;,,�.,.-��='`< Inspectional Services � � ��,��,��- � ��...�� 120 Washington St,3rd Floor Salem,MA 01970 Phone:(978)745-9595 x5641 .. � Application For Building Permit (For Buildings other than a One- or Two-Family Dwelling) -� ,. �nAY `�i" '� �+Iu� ' t[�r r.`r(I, :. . . . �1l�Pt2� r �"""'=��fiG�;, *!v#i�I ��. ,� �, � , � a �� r � L�y,.(Fhis Section for Official Use Only) _� � ._.E,S «�_m�•,,.ldyYd��,��, �,..�'.0 3 ddi v..�4�#�+il&i$�n .... ��i.+��.i...,� .:..a:�. .ve:�..�..::: ��i i, ..i+:i�� tsr,�'�,"'=,`fh�rt*�.�si�F:..."�N'N 5� � y.�i -"w ... 2' �- �a ��iia-`# �r m�� " "� �P nti. P[N TB-15-525 � � � °� DateAPplied 5/29/2015 -�� r��a'� �� y�? ; ,�,. _,.�� r ':R i s.. .....:,,.. s �.,�.,��'..,�..,., �.: ��,a.t1 s'�� ,�a=.�a.,a.,.....� a � ��R��v312'�� x �:-hAaaso-an�a4' ',w c r..�1� .. ....:c..._ _..u v;= 2a F '77� W v m�ii' ��w �i nL. � �p I '. X �s. ,�y �:� r r� �i.� r� 1. ��' *: �#f � b>�� ieuu ert�' �'ki'�8 R�'��' y�1 4t i � r r �;i � �� ,�. �7��Aah� �� x:e v R ''ss+.�: Building Official{Prmt name) '"fl' a �.,.�,,..- -�'wm,��.�.it��.i� s.,.-�'" �ti�,n,� ,.,.,. �� ;,�,:,6n� �... ��.i'.t'�.,'fitk��;?� � �,.� �� y -m�. .� _.- .:,,,�_.-.._-.�. .. ....______.. . . �. . �. ' ��, �'.�.'a.,;.'-.�: ',SECTION 1:SITE LOGATION (Flease indicate Block#and Lot#for locations for which a street address is not available)�;, r�, , ..x,-��...m,_.,.,»„n�. �-�,�. ,,,:� ew,��m�w__�..... .�._ . ..,.,.,m .,, � , .=m� .m.a,., „ . . ..,. ..___. ,.. __,_.� a 63 JEFFERSON AVENUE , Salem, MA "< '� ' "�`'� ` �` �- SECTIONi2 PROPOSED WORK ��'�, L� �°`E��. , r=s � rt�-•, i�''�. .��...x. _,�m._ ��:- u��.H�ar�a..., ..�., ., .�,..t;a.w.-„-_.m.�„ �s,,.�� ° 3`��.� �a'�s6!�C � - ...�.�ss'��. Are Building plans and/or construction documents being supplied as part of this permit application?: No Is an Independent Structural Engineering Peer Review Required? Yes� No� Brief Description of Proposed work: SUITE 103 -ADD WALLS, NEW ELECTRIC & HEAT (FOR TENANTS: COMMONWEALTH LABS 3'SECTION 3r'COMPLETE THIS SECTION IF;EXISTING BUILDING UNDERGOING RENOVATION,'ADDITION,'OR CHANGE IN 3 ��USE OR,yOCCUPANCY(Check Here� � if an Ezisting Buildmg Evaluation is enclosed (see 780 CMR 34))�;"" �� " sa`�`�"•+��t uA.v v�,,,R'."��„t,f� d ' . 4t,.;.n.. �S�-�t,..,.`S1'a�'...v.".u a�iµfii��i� ' .,i Sa�� .:?!t it�=��-�pt��t'.E+.a., i�-� ti' 1".�.f�"�.��3�„>�i.�. �R� Existing Use Group: Proposed Use Group: ��%y�`�.M,��,��F.�� n+!�{ ;SECTION,4 BUILDING HEIGHTAND AREA:� 'll"°'"'*'�199 "'�L�" ':° Gfi"` ° >>- �:rs�v�nwai¢u^+*=....zxnn�avm -a=wa�r.�.23 EiuS�dd»�- lury�u.�s'p��:{.:�., P?Z't�m�.�u �. ,x;ti��. Existing Proposed No. of Floors/Stories (Include basement levels) & Area Per Floor (sq.ft.) 0 0.00 0 0.00 Total Area (sq. ft.) and Total Height (ft.) 0.00 0.00 0.00 0.00 �pr-� ... �.-y E � ru .�. 'tt".��a":a '� ��q� � p kd i ... . . u �=,s�e�.. j.i ,a(� � ;id.. �t� �� ,��5� � � ,�� SECTION 5 USE GROUP , ��+� � � -*��'��r5 }�� = 3 3r... ..c:F `E .t:�u.,::�u. o.nrr. �a��nra�F—„�Ci m -��t 7 u�.' +��i-:'i<<�.n+m-.. ^t�.E� __m�� '�,��,.�'��ry�� ,�:��SECTION 6 ,CONSTRUCTION TYPE -�ATE��'��`��_ ^:,� '��{°� �x��' _� n� � ia N �� -mar�'vs.x�'��t.a+#� Comm Storage <<,': '"�T�r.�SECTION 7�SITE INFORMATION(refer to 780 CMR 111 0 for details on each rtem) ��"�� ' `�s� �'�,. � � ?'� m.�,aan.mw�a�,aea�..dac...a^m.i.:,:ek'xsiw-s�„ : ac�-....n.aeo-:.vo- viu�,o:�n�iu,n� � wm-�� nv�n�.� , w...' !, �,..,a-iaJs-�sn� Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public Check if inside Flood Zone � Municipal will not required � Licensed Disposal Site � or a� Identify Zone: Is enclosed � or specify: Railroad right-of-way: Hazards to Air Navigation: MA H�Stor�c commission RePort Proces5: Not applicable ❑ Is Structure within airport approach area? Is their review completed? or Constent to Build Enclosed � Yes � NO � Yes ❑ No ❑ � � a a��{�' °" SECTlON 8 CONTENT OF CERTIFICATE OF OCCUPANCYF+'� '�t 6��`��'� `� z�a� �r i v-o'�v m<m iC(ILt?e ..- ..tlAT.NUFAt vi.vTT9�t�>4�Vfi�?FSf i:a. ,m...-��btae",°vm„�' �,��._�a'7;4ry :9+[58'""� � ,..II. n .� . . , ....a�r .a �...�,� Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor poes the building contain a sprinkler system?:#Error Special Stipulations: �,:z�'�'� ��;�§� r'�rr�i : �° ;;�'�SECTION 9 PROPERTY OWNER AUTHORIZATION''„2 r` ,;=t��,�� F ,,,�:ft: °� ..<�`�,.�;:.,�I �s ,�. m�: .,�.�..,�-. , :. - r�a Ia�`�"°"i.. ,� .!""'4:..I�S�"^�N3,....�§SC��"rx �. »�.,!s�9°t�Hk."`""".AHft��s��u�n �r� �°'' ' '� THIS IS ,NOT�i4��PERMIT� ' `r�' '�� .��:�"�a&'mam.=,�;,�,r�u,a�m- @ .��eRe.�3' „�.s ,-;r.T., II�_ Symbol Legend ROOM FINISH SCHEDULE �S Exir sicN Po au�� sTnnoN ROOM FLOOR WALL NAME FINISH FINISH � O SMOKE OETECTOR PRIMER & FINISH WAT OF PAINT, � EMERGENCY LI6HT OFFlCE VCT OR CARPET TILE SOUND ATTENUATION BETWEEN ADJ � W/COVE BASE (TBD) OFFICE WALLS HIS 2X2 ACOUSTICAL CEILING TILE SYSTEM I—I HORN/STROBE ARMSTRONG-)70 CORTEGE PRODUCTION BY TENANT PRIMER & FINISH COAT OF PAINT b-' ACT-1 AREA FEC FIRE EXiINGUISHER CABMET GARAGE BY TENANT PRIMER & FlNISH COAT OF PAINT � C� EXiERIOR WALL SCONCE LIGH DUPLEX OUTLET � 8' LWEAR FLOURECENT LIGHT W/WVER � �B 2X2 FLOURECENT LIGHT FIXIDRE A NOIE: ALL LIGHTING, RIRING, SWITCHES LIFE SAFETY DEVICES, AND LOCAlIONS SHALL BE THE RESPONSIBILITY OF THE ELEC7RICAL CONTRACTOR AND BE APPROVED BY THE SALEM FIRE DEPT. ALL SPRINKLER HEADS TO BE LOCAIED IN CEN7ER OF TILE-BOTh' �IRECTIONS. REFER TO ENTERPRISE SPECIFICATIONS FOR LIGHT FI%NRES AND CEILING FINISHES. � NEW 200 AMP, 3 PHASE ELEC7RICAL PANEL TO eE INSTALLE� ELECTRICAL OUTLETS IN REMAINOER OF UNIT TO BE INSTALLED AT 8-12' SPACING. 7ELC0 & DATA OUiLETS BY-0THERS _� PAINT ON CEILING � � g�LJ ° , -T-----_--- ---- - ----------��____-----�—� ❑ � ' � �-- � ---�( � � 0 0 0 I A A ELEC. OUTLETS TO BE A SURFACE MOUNTED ON � THESE WALLS En� , u' 0 0 � i ' N A 103 A A Garage I � 45'-9" � PIS C ES 0 0 0 A A A � -_— FEC � �__ _ 20�_ll�� : °.-- --------—- --- � _ ❑ i . _ _ ..� _ . _ .._ �.� � �❑�— �_�_ � � � 0 � 0 _ ,o � �' rod cti n A ea � � N ❑ ❑ ❑ I GLASS DOOR, � � � � � RH — — -- — —�-- _C�i x� � � — -- � F C � � � 11 � — � 0 'ce '� � ❑B ❑B . �r-_ - ------- A.C. .-1 - i � ❑6 ❑B � _ I n �6� 2�� __. . _ O_._..__ .. ..._..._ O O�.__ � . _.....U❑. ._----.�_......--- �- I - -- -- �� I N �SUITE 103 - Commonwealth Labs, Inc. SCALE I/8" = 1'-0" DRAF'P-FOR REVIEW ONLY SUITE 103 RCP SEGER ARCHITECTS,INC. A�� Datc Apii11Q2015 ti�a��:,�s N„�e� 63 Jefferson Ave. 10 Derby Square, Salem,MA Sa�em�MA P:978-744-02-8 johnaseger@segerarchitects.com Symbol Legend ROOM FINISH SCHEDULE �5 EXIT SIGN Po auu srnnoN ROOM FLOOR WALL O NAME FINISH FINISH � SMOKE DETECTOR PRIMER & FINISH COAT OF PAINT, � EMERGENCY LIGHT OFFlCE VCT OR CARPET TILE SOUND ATTENUATION BEiWEEN ADJ � W/COVE BASE (TB�) OFFlCE WALLS HIS - 2X2 ACOUSTICAL CEILING iILE SYSTEM � HORN/STROBE ARMSiRONG-770 CORTEGE PRODUCTION BY TENANT PRIMER & FlNISH COAT OF PAINT ACT-1 AREA FEC FIRE EXIINGUISHER CABINEi GARAGE BY TENANT PRIMER & FlNISH COAT OF PAINT � C� E%TERIOR WALL SCONCE LIGH , DUPLEX OUTLET 0 8' LINEAR FLOURECENT LIGHT W/COVER �� B 2X2 FLOURECENT LIGHT FI%TURE A ' NOIE: ALL LIGHIING, LNRING, SWITCHES LIFE SAFETY DEVICES, AND LOCATIONS SHALL BE 7HE � RESPINJSIBILITY OF THE ELECIRICAL CONTRACTOR AND BE APPROVED BY THE SALEM FIRE DEPT. ALL SPRINKLER HEADS TO BE LOCAIED IN CEN7ER OF 11LE-BO7H DIRECTIONS. REFER TO EN7ERPRISE SPECIFICAPONS FOR LIGHT Fl%IDRES AND CEILING FINISHES. NEW 200 AMP, 3 PHASE ELECTRICAL PANEL TO BE INSTALLED ELECiRICAL OUiLETS IN REMAINDER OF UNIT TO BE INSTALLED AT 8-12' SPACING. - iELCO & DATA OU11.ET5 BY O7HER5 �I — — I PAINT ON CEILING I � �J�LJ _1�._..__ �-� ❑ . � — _ -�_�� --- �_�__ 0 0 0 I A A ELEC. OUTLETS TO BE A SURFACE MOUNTED ON � THESE WALLS �i� � 0 0 0 � A to3 A A Garage I � 45'-9" � PIS C J \ES 0 0 � �., A A A ! � FEC � � 20-11�� — — -- — ..—� G; _ ❑ � 0 � 0 �- � � � � 0 � ,o � �' rod cti n A ea � � N ❑ ❑ ❑ I � � � RHASS DOOR, —... � od 0 0 Y Fc � � 0 � 0 ce N � � —. O!Si ------ A.C. .-t �B ❑B In �6� 2�� -------—�: ,__U�...._...._O O. ..-----_� ..... -.4❑.... ..------ �---- � �� . .. �� N SUITE 103 - Commonwealth Labs, Inc. SCALE: 1/8° = 1'-0" DRAFT-FOR REVIEW ONLY SUITE 103 RCP SEGER ARCHITECTS,INC. A-103 Date: Apri110,2015 scai�:ns N«ed 63 Jefferson Ave. 10 Derby Square, Salem,MA Salem,MA p:978-74402-8 johnaseger@segerarchitects.wm ��°""'"+ Commonwealth of Massachusetts , C � �� 5 �a. °'t { ;`�p �+ ' City of Salem � I �� ' ", `""��.,,k;.r�2 Inspectional Services �°�`�`"'��"""'�"g 120 W ashington St,3rd Floor Salem,MA 01970 Phone:(978)745-9595 x5641 � ' �REGEIPT,;,� Application For Building Permit (For Buildings other than a One- or Two-Family Dwelling) w t W' f "LEi.�.� � .::� � � :: .. :::�, �:�: ��3, -� ,.�.. �� '��'�,+��i��` , � � ��(This Sectiqn for Officraf Use Only)�� , , �+— ��:__� ;,-_ „ '";.�.�y x,.. ,., tm a. . =r �..-h.n.sttE�kfu.',��,EE„ :aw».�.aa-a.w,c..ua� u+.a-a „u-�.au�ry�.a�na .,,��,: �U9i6va�;,,.:!!iR �n��.d:u-x..,.'+�,..,..,._....�c.,� u..�'ds�_ . PIN TB 15 526 � ' '� � ` 31��s�� *' �yy Date Appl�ed '5/29/2015�'2° �° � ` �.�� " ` .o..f .N� .v{�dL+ .�+�au�r 4 4��5 I � C Waca'suv ir44��mNf Iv4ss Y i�.'{��i I�� 1i¢.3+R V�.i .I.�3� -�..,� �#`'r�� IfI a..[ ': '� �R" ,6fv�:g�< < e�� a� ..�.a{v �-u v� 7�, ` T'�y � � � �a� s s s -�3 ��a :� ;; .es_,,:r�v�..ti , v� ! . a,� rF 6--�r m f ��i �� i� ��C�. Bmlding Official(Pnnt namep .. ,...��..� ;v�'� .��r �.,��' .. ��.,.�?" ;� �, ,.,.,.�.��!�".°'�m�E�;v��s��.�,��,.'��'�#°'� �'� _`€,�.: _n_.�. .._.n.�,�r W.. .,.W _. �. . .. _ .: _ �». u..��,,u� ,-..SECTION 1:SITE LOCATION (Please indicate Block#'and Lot#for locations for which a street address is not available};'.". w...v_. W-,. ��x. Y� ...H. v�,� � ,.N�� ...,..u��.. ,F,�,.�� , _ ,..m.: ,ww,....��,.m ,.. .: n. ,��. . .,., � �. ....,. � 63 JEFFERSON AVENUE , Salem, MA s�tv s ',µ r r� i C H� � t .I�.,3� �wr . . .. i x�r�I3. s v �"r b� ;�;�= nz`�'- s ,� ��`�'�` �� + � �� ..SECTION 2.TPROPOSED WORK ,� �" ��"`� :'� ^¢ h'� �'a�� ;�` < < . _ .,_r , .�,,,,��_ ,.;�;�x .� ..,, �-,»:�„��m,.�:.,,��,..m,�..�,mU�;,§v.'�.�1G��'i�,l:�4&� tl.Fu, 't Are Building plans and/or construction documents being supplied as part of this permit application?: No Is an Independent Structural Engineering Peer Review Required? Yes� No� Brief Description of Proposed work: SUITE 202-203 -ADD WALLS, NEW ELECTRIC & HEAT (FOR TENANTS: KARATE INTERNATIONAL) SECTION 3:,COMPLETE.THIS SECTION IF EX�STING BUILDING UNDERGOING RENOVATION ADDITION,'OR CHANGE IN:' =�} USE OR O^�CaC�;UPAg�N;.CY(Check Here,�uif an EzisUng Building EvaluaUon is enclosed (see 780 CMR 34)) ��T;:�,�;' �'�.��'�'.'k:sN�`.,.�,`��i�'.'k�.i:du{�h[tu�..+[7"��"��' ,�„=�rz�°�'`�F.��"�rdl.,at�4Ei��a-�,.'�Si�;�..i.�a�...:',4iA_.�, �� L..,�S�v��'�!t.. ��kvu��,'�s.aai.,��1.�'�:�!. �. �: ..-d� i� auw�i��. Existing Use Group: Proposed Use Group: ,. �it ,.�: i i1 �d o. .1 t'�r -� i Cni k � . - yh�fi � -�c- s }�� i � `�� Ea-"' ` '"�a�' � �� }�� SECTION 4 BUILDING HEIGHT AND AREA � y= a ��"'� ..e�x..a.!_,�:.«��P� {I�.-'.U,`P,��!;;K�� .d�.�� .,,,,�"3..:�sR�anxw 3.,� a. . ,s.�ue ii�j�a.? �rv. i i &� �� ._ „ ;�,.�s-.. =e.,�.G..- u.,=.�em.:�.,� �� Y . -� ,. .,,, , .. � Existing Proposed No. of Floors/Stories (Include basement levels) &Area Per Floor(sq.ft.) 0 0.00 0 0.00 Total Area (sq. ft.) and Total Height (ft.) 0.00 0.00 0.00 0.00 ��' n'l'�re�svitii�"�'�,s�,��n`h i� � �, ..x`��r H'v��E?'�i*�SECTION 5 USE�GROUP u""ij ��!"f :�� i �t} {; 3 �� n,n? �- �� .X ..2. ,tt,� .-kW=�:....6��,a+ - Sk�..�9t`i�d�� ..arc�rtmao+�--...,?'��nt�3„ i� 1.L_ „�', ;�eG.:' �..�`._. ...v_ �!,i� .� ,?'�. [ i ilk v �fi � �a z'. � `v r�.7 m, i`�t =s, ,� ;�.„�1a,� ,� ,��,'��` �°�:»��SECTION 6'CONSTRUCTION TYPE '�� .: ��4{ :� a � x` ��, _�+„ .. i �k �:....�:'��+�t�.f+.,�,„�',`�rs' '�: � ,�. ,. , a,. ,�.-.. „ ,..,«H...... .�.G, Comm Storage � b `�'�� m�",4 °h� � SECTION 7 SITE INFORMATION(refer#0 780 CMR 711.p tor details on each item) u� �`;,�°='�`fi�,�-� �''&'.,`�k��i��„��".` '�i��-._�c ,w.,.�,�u��eia��a.�x�uy .a��sa rox ,.iar,�,�aa.-ssc ,�...�.._ �-*�...�,:cvfya�mmmz.r�u.ea+*r crv+� �e3�em.�� Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public CheckifinsideFloodZone � Municipal willnotrequired � LicensedDisposalSite � or or Identify Zone: Is enclosed � or specify: Railroad right-of-way: Hazards to Air Navigation: MA H�S�or�c commiss�o�ttePort arocess: Not applicable ❑ Is Structure within airport approach area? Is their review completed? or Constent to Build Enclosed � Yes � NO � Yes ❑ No ❑ � ".,.s nG � d � ��-5,._ � . . . . ,:: ,� � y �I��;;t "6, � �� ,�,� �- SECTION 8 'CON7ENLOF,CERTIFICATE OF'OCCUPANCY d � _�, � � °��M �� wvn v� -a�+wkc.._�,x.m.msi. �aa�..i'�imY��abnn.um,e v=.h . �IE ..k.a�5e»ft?a'n.rveEf, .y _. .3G`��. :'s,�� 2ru �i:� �.ect��r. r,.;{ri.ev.m,., lbu.,, ,.n,«xrh_..�*�+v� �'� � Edition of Code: Use Group(s): Type of Construction: Occupan[Load per Floor Dces the building contain a sprinkler system?:#Error Special Stipulations: ��;`��'�" �'��m"�`��'�;�E� ' � �`�``'�SECTION9 PROPERTYOWNERAUTHORIZATION��= �;� e� �'��-`� ��:R'� P��,Iim�� t e�t ��IE l� �' �t me�.S{y :.�� .�— �:3...iv: � ��' . �,..� �r_�`��-�,.. -a�' . st,t.� aa '_-�.;%t �F '. 4t;€�y.:Fn "�nh"�,.,�ilz�:l�`+e�,2t � �_.�5_s.W a �'i�� ,r��xwm�R xtS.�� .�.��`��:�„��THIS�ISµ,NOT�A:`PERMIT��,�e��. � ��° w ( � � EQ. EQ. E4. EQ. 2X6, BEVELED SYMBOL KEY � � � 1/2" PLYWOOD � � CARPET TILE SYMBOL DESCRIPTION I /'C .�.--_,_,�_. �:�_� FEC FIRE EXTINGUISHER CABMET � � � � � �TRANSITION DET. No�S: � � � 1 xq� �_i�2._�._a- —ELECTRICAL OUTLETS TO BE INSTALLED AT 6-12' SPACING. z � / I —TELCO & DATA OUILETS BY OTHERS. � � � � � - H � ��. � i � � w � s� �� sz'-z" � ��, z � m � \ " � / zi'-z" � � �_ I J a � � � �� `� � j \ - :: � � � � � Q � � ( �� COVE BASE CARPET STAIRS � ! � � rn ( / ' II a � � ,Raised Platform i �" RouN� srEE� 'i \ \ I / f 2og ( RAILING SYSTEM / � \ / II �� anwr cEiuNc & A-Office Vl/all B-Elec/Tel Wall C-HVAC Soffit \/ � P,PES B�A�K, TYP. , scn�: i/a' = Y-o" sca�e i/a' = Y-o• sca�e i/a' = Y-a' //� N � . \ i - /� �� Wf2AP EDGE OF WRAP BASE W/1X3 � NOTE: \ '�� PLATFORM STRAPPING, TYP. ! SEMI-GLOSS WHITE I W/2X2 WOOD PAINT ON ALL WALLS i i� il / as'-2" \ / \ 2 6�8 NSF ' , - � , , > a C � , i � ��, i � � �- � CARPET STAIRS � 105 � ` I I � m ^ i � �IeCh � � � � Ii -�% COVE BASE, , i' ��-.rn " WRAP BASE W/1X3 / TYR � en I. �i STRAPPING, TYP. . � i ' . . GLASS DOOR, LH CARPET TILES ' , I, 7 ! ';, � �' � . 2X6 BEVELED WOOD ��, �I I Q! ' �10'XS' WINDOW O . TRANSITION STRIP ; 16" A.EF, i i, HVAC SOFFlT ABOVE, 4'X6' 'I � . . � i o SUITE 203 W/3'X3'-6" DOOR CENTERED STORAGE ABOVE A i � " 1137 NSF j w/s'xs'-e" 000R D � Office ;i , � `�' � CENTERED m 210 / � STORAGE ABOVE W/3'X3'-6" � � �Ch. Rm Ch. Rm' - L pqINT FLOOR GREY / � �� PAINT CEILING & DOOR CENTERED �COVE BASE, Zn Z�z o � ; �� PIPES BLACK, TYP. ! TYP. 9'-6'� 4'-0�� ; 4�-0" � �n ' i ,�� !!�� — _ �� COVE BASE, TYR � �+ . _`�-_-�C`'_____... ` ' o l� _ � � ' � CARPET TILES , � o 'I ' a" wA�� ` EI2GTel � � � covE ensE , C z � �� FEC �210 _ � G i ,. !iv,* ., i�� :id:,,/,i:� ��oa��^ i'�%/%/;�%%/�; . �� .,",�'„c'✓iin��.;i- i.�. �i r j .r i:'��.�iiiiio,-yiiioi�a>-I - � O� �w� !� . �� O N N Suite 202-203 Floor Plan-Karate International o scue: ,�e�_,•—o• N DRAFT-FOR REVIEW ONLY Q , � Symbol Legend ,� ES � EXIT SIGN � 8' LINEAR FLOURECENT LIGHT W/COVER A � EMERGENCY LIGHT � 4' LINEAR ROURECENT LIGHT W/COVER � C � HORN/STROBE P� B� 2X2 LIGHT FIXNRE z E�, V � PULL STATION ""' � �+ 2X2 ACOUSiICAL CEILING TILE SYSTEM � E � OS SMOKE DETECTOR � ARMSTRONG-770 CORTEGE V � � ACT-1 w � �' � SWITCH i j � `y"@�j GWB GWSUM WALL BOARD CEILING I I .T+ � � �3 3-WAY S'MiCH , U �� C � NOTE: ALL LIGHTING, WIRING, SWITCHES LIFE SAFETY DEVICES, AND LOCATIONS SHALL BE THE I - Rn � N RESPONSIBILITY OF THE ELECTRICAL WNTRACTOR AND BE APPROVED BY THE SALEM FIRE DEPT. I' 4�-O�� 3�-lO�� 3�-10�� 3�-10�� 4�-O�� (,w') A � < ALL SPRINKLER HEADS TO BE LOCAIED IN CEN1ER OF TILE-BO1H DIREC110N5. REFER TO ENTERPRISE SPECIFICAlIONS FOR LIGHT Fl%NRES AN� CEILING FINISHES. � i � � H m � � i I a I A '� i A A A � I � ' ( � � i i � I ^ i 0 I � A � A A i i ! � i I � I I � � ^ I i �� 0 A I A A A � . � I �I � GWB - � 6� C � � � I � � _ � m i i 5'-0" 0 5'-0" 5'-0" 3 i� y E � I � � 0 0 .°'-,�n w' A - A e+1 � A A A ( � A A o � � L � � 6'-0" O � I � � ^ � � � , � � �'� 0 � �!. ro � —� I � � A � A I � o o � � � � A A A � � ! i H� 20 �! $O i � WS /S � � � P/5� � � ��S i i� I �I S � � iwa A �' � A A A � ��3I � I 0 � H/5 � o PIS � Es I A.CS.-1 �A.C.T.-1 0 � � 200 AMP . �� _6° AF.F. � 7'-6"�A.F.F. I,. ' o� ELEC. PANEL � I 0 �! cZ � ' C� � j � � " /�--, C�n / I � N Suite 202-203 RCP - Karate �nternational o ' SCAIE: 1/8'= 1'-0' N DRAFT-FOR REVIEW ONLY ' �6 J� ' EQ. EQ. E°. E°. 2xs, BEVELED SYMBOL KEY � � 1�2" PLYWOOD SYMBOL DESCRIPTION � � CARPET TILE I \ I . . � '� -� FEC FlRE EXTINGUISHER CABMET � � � � �,1TRANSITION DET. No�s v � o � 1 �p�E. �_��Z._�._a. -ELECTRICAL OURETS TO BE INSTALLED AT B-12' SPACING. 'z '�-� � � -TELCO & DATA OUTLETS BY OTHERS. � � � � � i / F" v � U ea � ( i � W � � 52'-2" I � ci� Y y � z x � � � � 2t'-2" \ � �� Q o T^ � � o � � I � / w v � � \ � c7 A � � I COVE BASE CARPET STAIRS . � � � � � ° ` / i ri II � � / � � I � � q ,Raised Platform i Z' RouNo sTEE� ; \ I / _ f . \ 209 / � RAILING SYSTEM ; ' � ' iI' A-Office Wall B-Elec/Tel Wall C-HVAC Soffit ��' _ � P"'"T �E'�'"� & �' m PIPES BLACK, TYP. � � i i SCALE: 1/4' = 1'-0" SCALE: 1/4' = 1'-0' SCALE: 1/4" = 1'-0' � � N I� WRAP EDGE OF WRAP BASE W/iX3 � NOTE: � pLATFORM / � - SEMI-GLOSS WHITE '�,;:: � / \ � II W/2X2 WOOD STRAPPING, TYP.� � i PAINT ON ALL WALLS � i � � ' � � SUITE 202 � � °' � � �� a5-z" �� ; ; 2368 NSF � ❑ � i CARPET STAIRS � ��' � \ i i � � m � , �. ' � ' ,Mech � � � s , v w d ..... . . � / COVE BASE, , � �� °J-.�n � � � WRAP BASE W/1X3.... TYP. �' � . � � i STRAPPING, TYP. ' � ' i ��'� GLASS DOOR, LH CARPET TILES� . L 2X6 BEVELED WOOD � !� II �� 10'XS' WINDOW � TRANSITION STRIP � �' ' HVAC SOFRT ABOVE, 4'X6'J �li I�! i6" A.F.F. I '��.. o SUITE 203 W/3'X3'-6" DOOR CENiERED � STORAGE ABOVE A = i � 1137 NSF w/sx3'-s" 000R � � OffiCe � � ;� CENTERED a' 210 i � Ch. Rm Ch. Rm _ � ;� ' STORAGE ABOVE W/3'X3'-6" PAINT FLOOR GREY� i '�'�� i �� pAINT CEILING & DOOR CENTERED �." ; CWE BASE, 2�� 2�2 0 , i PIPES BLACK, TYP. � �� ,� TYP. 9'-6" 4'-0'� 4'-0" �n i � �� COVE BASE, TYP. 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