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63 JEFFERSON AVE - BUILDING INSPECTION (9) { The Commonwealth of Massachusetts ILA Department of Public Safety VYu I Massachusetts State Building Code(780 C�IR) Building Permit Application for any Building other than aOne-or Two-Family Dwelling (This Section For Official Use Onl ) Building Permit Number: Date Applied: Building Official: SECTION 1: LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) 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 rotvs below Existing Building❑ Repair❑ 1 Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix t) Change of Use ❑ Change of Occupancy Cl 1 Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this per application? Yes No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑ Brief Description o Proposed Work: e. ---e c,,ne c c 5 'La-�.as�c �.➢ Paar�ly.cc Olo 'P vl � a- .5{G —1n4d1 U1 Vt�w S't rX.v. n¢..�1 s tee- tic,Sv+ws 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 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)dr Area Per Floor(sq. ft.) Total Area(sq. ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) \: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A 4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-I ❑ F2❑ If High Hazard H-L❑ H-2❑ H-3 ❑ H-4❑ H-S❑ 1: Institutional 1-1 ❑ [-2❑ f-3❑ [-4❑ hl: Mercantile❑ 1 R: Residential R-113 R-2❑ R-3❑ RA❑ S: Storage S-I Cl S-2❑ U: Utility❑ Special Use❑and please describe beluw: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as a licable) IA ❑ IW113 IIA ❑ If8 ❑ IIL\ ❑ LIID ❑ IV VA ❑ VB ❑ ION 7:SITE INFORMATION(refer to 780 CNIR 111.0 for details on each item) Water Su 1 Zone Information: Sewage Disposal: Trench Permit: Debris Removal•PP Y�Public❑ f outside Flood Zone.❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑Private❑ ntify Zone: oron site system❑ required❑or trench or specify:permit is enclosed❑Railroad y: Hazards toAir Navigation: \I-\I E I n t,,,loon ,� n I .elmNut ApIs Structure withinairportapproacharea? Is their review completed? ur Consent to crl ❑ Yes❑ Or No❑ Yes❑ NO ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of COtle' Use Group(s): l)�pe of Consstruction:_ Occupant Load per Floor:. Dncs the building;iunLtin an Sprinkler System?; Special Stipulations: J z SECTION 9: Pf201'EIL'rY OVVNEII AU'FIIORIZA'FION Name and \tltlnss of property i Owner `��I (^ ��) 0/9 7" e No.and Streset 1X�I�Lo�_,/ City/'Town V "Lip Name( t t) Property Owner Contact Information: 'ride Telephone No. (business) Telephone No. (cell) e-mail address If applicable, the property owner hereby authorizes Street Address Ci�nState Zip I Name to act on the property owner's behalf, in all matters relative to work authorized b this build bt ermit a lication. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,O00 Co.ft.of enclosed space and or not wider Construction Control then check here O and skip Section 10.t 101 Registered Professional Responsible for Construction Control ---/�..__-s..�-F.- z2004--J U..n�EY,r£iJ r�Cy~'Ai I. �c7 Registration Number i e-mail address � 6 cute(Registrant) Telephone No. Street Address City/Town State Zip Discipline. Expiration Date 10.2 General Contractor ,Q �x�(�IW �`� GVVx r�Q.�tln ✓)� Company Name 7-- 1 ::k cw tn.� ti Ll-` LS V Name of Person Responsible for Construction \ License No. and Type if Applicable �YtwWJucY A� -. YCC LJaJ-I A-4 Ot Lt to U StreA Address City/Town / State Zip Telephone No. business Telephone No. cell e-mail address SECTION 11:1\<AF.LIgCi 7RI1 rV5r\11O, INSUVANC h Al_111 h\\I I M.G.L.c.152.§ 25C6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed❑nd 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? Yes❑ No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs: (Labor Item and Materials) Total Construction Cost(from Item 6)=S L Building 5 6'. `1`1 O '- Building Permit Fee-Total Construction Cost x_(Insert here o. Electrical $ appropriate municipal factor)=.,$ 3. Plumbing $ Note: tvlinimum'fee=S (c untact nurt icipalily) 1. Mechanical (HVAC) $ 5. Mechanical Other S Enclose check payable to 6.Total Cost $ 00 l L(�b 66 (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT 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 acc rate to the bes f my knowledge and understanding. Pleas riot uul sigi non Titl Telephone No. Du[c �' o Street Addross City/Tow❑ State ' Zip li Municipal Inspector to fill out this section upon application approval: Name Date Ted Greenlaw P.E. 183 Columbia Rd. Hanover,MA 02339 tel# 781-826-8369 fax #781-826- 8399 E-Mail tedgreenlawpe@yahoo.com September 4,2012 John Shea Martins Real Estate Development 130 Sylvan Street Danvers, MA 01923 RE 63 Jefferson Ave Salem,MA On August 30, 212 I have inspected the structure at the mentioned site to determine damage caused by a fire in recent months. The structure is a pre-engineered steel building. The area of damage was confined to 100' by 481, two bays The following are my findings: The roof of two bays is damaged requiring replacement of purlins, roof sheeting, and insulation The wall panels and insulation must be replaced The rake beam should be replaced and can be done so with a C10X15.3 hot rolled channel One end post extension on the top requires replacement and can be done with a CBXI 1.5 New rod bracing may be required in some areas New bolts should be installed in the main frames(2), the flames are ok Also there are miscellaneous trim fasteners bolts etc. that need replacement With these components replaced the structure will perform as originally designed and actual new components will be designed to meet current code. Respectfully Ted Greenlaw P.E. I z i C(TYOES.�LE�ti! 1 r. , >.,L-kSS,ICHLSETTS v i •• ` Ot:tLnLYG DEPARTMIUNT r 110 vV 13HCICTON$Turr 3to r FtOO;Z ` I1F-L (979) 745-9595 fQUI ERE EY DRISCOLL F.L%(978) 7.10.9344 ,Ir Ayoa 11056tjSr.PjERM 01ZElTOR UP Pt:aLlc PROPERTY/BC MnLNG GOSL�(IS3lO.V ER Construction Debris Disposal At'tldavit (required for all demolition and runuvation work) In accordance with the sixth edition of the State Building Code, 730 Ci�iR section l Debris, and the provisions of iMCL a 40, S 54; ©wilding Permit k this is issued with the condition that the debris resulting front l 1f, S IS woI5 QA.shall be disposed of in a properly licensed waste dlsposa! rauility as defined by iLICL c I'he debris will be transported by.. C*i, vim, (Hama vChaular) The debris will ba disposed Orin ; e Gj (n:mta nt iacdiiy) (aldi ess of ra�ih�ry) uirr,�ipermit.ippliaint CITY OF SAL&Nf, N-ViSSACHUSETTS s BI:ILD .NG DEPARTM&NT 130\'l/ASHIINGTON STREET,3'D FLOOR l EL (978) 745-9595 Rux(978) 740-9846 K1.,fBERLEY DRISCOLL THoMAS ST.Ptem NjAYOR DIRECTOR OF PUBLIC PROPERTY/81LADCYG COMMISSIONER Workers' Compensation insurance Affidavit: Bui]ders/Contractors/Electricians/Plumbers applicant information ( n Please Print Le ably Name(Uusiiws&organizatiorulndividual): t!14 5t4(-F Address: City/Statc/Zip: ��Nt Utl/� otc76PhoneN: `� -it-, I tr7c./o Are you an employer?Check the appropriate box: Type of project(required): 1.®'tam a employer with 4. ❑ I am a general contractor and 1 6. ❑Now construction employees(full and/or part-time).• have hired the subcontractors 2.❑ lam a sole proprietor or partner- listed on the attached sheet.t 7. Q;4Emodeling ship and have no employees These subcontractors have S. ❑Demolition working. fur me in any capacity, workers'comp.insurance. 9. ❑Building addition [No workers'comp:insurance 5.0 We are a corporation and its required.) officers Have exercised their l0.❑Electrical repairs or additions ).❑ I am a homeowner doing all work right ofexemptiun per MOL I L❑Plumbing repairs or additions myself.[No workers'comp, c. 152,}1(4),and we have no l2.❑ Roof repairs insurance required.]t employees:[No workers'.. 13.0 Other, comp,insurance requited.], Any applle:ud that chucks brae d l must also fill ouuho xKaon bdowehowina their workers'mmpensarion policy inn moolon I I hvrwuwnem who,ubmit this affidavit indicating they am doing all work and then him outsidecontroGon must submit a new anldavil tndts:ting such :C�mtrxtun that chuck this box must attached in addieunul salt showing the name of the subs ntradm and theirworkars'entry.put icy information. I am an-etnplayer that Is providing workers'compnrsollon htsurance for my employees,- Below la the policy and job site iojorrnutlom insurance Company Name: t PA ",Jwe:.,j suv", .e T Policy 4 or Self-ins.Lie.N: - a��t< Expiration Date: S+— Tula Site Address: 6 3 J Grfan t City/State/zlir �c J Qte" V"ty4 01410 ,httaeh a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under.Section 25A of,1GL c. 152 can lead to the imposition of criminal penalties of a line up to S1.500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. lie advised that a copy of this statement may be forwarded to the Office of Investigations ofthe DMA for insurance covcrago verification /do hereby cr it r Are that palm W11 lfrt of rjary that the information provided above is+true and correce dt t Dar • 8_ — �3 O/Jiciul use only. Do not write in rhGr area,to be completed by city at-town ajjkiaL City or'rown: PermiU7.1cense Issuing Aulltority(circle one): 1. Uourd of health 2, nuilding Departsaoot J.City/town Clerk 4. Electrical Ltspector 5. Plumbing inspector 6.Other Contact Person: . _ ,. Phone a: onolrr, CITY OF SALEM9 MASSACHUSETTS �S ate PUBLIC PROPERTY DEPARTMENT 120 WASHINGTON STREET, 3RD FLOOR SALEM, MASSACHUSETTS 01970 '�.�,p="' TELEPHONE: 978-745-9595 EXT, 380 poi FAX: 978-740-9846 KIMBERLEY DRISCOLL- MAYOR CONSTRUCTION CONTROL AFFIDAVIT Project Number. y Date: j� Project Title:OR/GEwuLA�/�wt /�Fci2 3��i/t�inlrn Project Location:- al' Name of Building: ,j�a C,6 &/ Gi Scope of Project: &A E - cy 'g IN ACCORDANCE WITH SECTION 116.0 6F THE MASSACHUSETTS STATE BUIDING CODE, I 9%A,gvy MASS. REGISTRATION NO. : cQ/,9 h' BEING A REGISTERED PROFESSIONAL ENGINEER HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS, AND SPECIFICATIONS CONCERNING: t Civil Architectural Structural Mechanical Electrical Fire Protection Other(specify) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE, SUCH PLANS, COMPUTATIONS, AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES AND ALL APPLICABLE LAWS FOR THE PROPOSED PROJECT. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116,2.2. 1. Review of shop drawings,samples and other submittals of the contractor as required by the construction contract documents as submitted for building permit, and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for4l code required control materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specked in the accepted engineering practice standards listed in Appendix 1. PURSUANT TO SECTION 116.4, 1 SHALL SUBMIT PERIODICALLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO WE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. -- P Sign re SUBSCRIBED A RN y� THI 9M DAY OF 2004-3 °°"a'"rs"I'"a r/3 /'� I My commission Expires: �I" Notary Public ��C7�t�✓ r