Loading...
251 LORING AVE - BUILDING INSPECTION ;► ' The Commonwealth of Massachusetts Department of Public Safety I \lassachu,ells Stale Building Code(780 CNIR)Seventh Edition City of Salem Building Permit Application for any Building other than a I- or 2-Family Dwelling (This Section For Official Use Only) Building Permit Number: Date Applied: Building Inspector: _t1) SECTION 1: LOCATION ( lease indicate Block 0 and Lot N for locations for which a street address is not available) JI�J 5 ILo r tWo2s� f'✓ O 1 C) Nu. and Street City /To wn ZipCax)r Name uf Building(i(appliceble) SECTION 2:PROPOSED WORK If New Construction•check here❑or check all that apply in the two rows below Existing Building 0 Repair Cl I Alteratiun.,0 Addition O 1 Demolition O (Please fill out and submit Appendix 1) Change of Use O Change of Occupancy O _ ,„.,.1 1 Other ❑ Specify: K e. l^� Are building plans and/or construction documents being supplied as part of this permit application? Yes O No Is an Independent Structural Engineering Peer Review regVed? Yes ❑ No 01 Brief Description of Proposed Work: SA-C b CC o _a P r S • r'a° ROO- SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) 0 Existing Use Group(s): Proposed Use Group(s): Y Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Fluors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area (.sq. ft.)and Total Height(ft.) SECTION S:USE GROUP(Check as applicable) A: Assembly A-I O A-2r O A-2nc13 A-3 O A40 A-50 1 B: Business O E: Educational O F: Facto F-1 ❑ F2 O H: Hi Hazard H-1 O H-2 O H-3 O H4 0 H-5 O 1: Institutional 1-1 0 1.2❑ 1-3 O 14 O M: Mereantilt O _ R: Residential R-10 R-2 O R-3 O R4 O S: Storage S-1 ❑ S-2 O U: Utility 0 Special Use O and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB O IIA 0 IIB 0 IIIA 0 [HB ❑ IV O VA O VB O SECTION 7:SITE INFORMATION(refer to 780 CNMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: - Public O Indicate municipal O A trench will nut be Licensed Diav,.d Site iH ra:yuindOurlrcnch ur.pacif c: 'Z7U1`n I'ncely❑ or mdenuh' Zunr: or on site w.lem O permit in encl%, e 10 Railroad right-of-way: Hazards to Air Navigation: .•...... 1•n \nl Applicable❑ I.Slruclun•.rnhm aopurt apprnach area I.their review completed.' it In lluild cnclo,vd ❑ N v,O or No❑ Ya•>❑ \o ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Ld Wnn ,-1 G,de. L,a• ra peul Con.lrucoun: Occupant Lund per linur: ILv, the buikfing wnlain.,n Sprinkler S%,tem': Special Stipulation,: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Pnlpert%Owner (�RV /�/ ERPr 9 c3Lj(;v/cG1 .Name(Print) Nu. and Street CiIy/Town Zip Properly lhvner Contact Information: Title Telephone No.Ibusmess) Telephone No. (cell) a-mad address If applicable, the properly owner hereby authorize+ Name Street Address City/Town . State Zip to act on the pro pert%owner's behalf, in all matters relative hp work authorized by this building permit a p +Gcation. SECTION 10:CONSTRUCTION CONTROL (Please fill out Appendix 2) (if building is lass thin 35,000 cu. Mot endonW s pace and/or not under Construction Control then check hrre Cland.,lup Suction IU.1) 10.1 Registered Professional Responsible for Construction Control /le14n cJ I1W.Jq • �3-5.Z 7Lifr�Z- Name(Rr•istrant) Telephone o. e-mail asddr s Registration Numbe Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Company N ,rp tikesa r: v / lZiie-/ Cy-77ia1 Name of Per pgsable for Construction / Li se No. and Type lf A licabl<� Street Address �, City/Town State Zip 7&- -33 Telephone No.(business) Telephone No. cell e-mail address SECTION 11:WORKERS' S O INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) A Workers'Compensation Insurance Affidavit from the MA 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 application? Yes O No O SECTION 12.CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=f 1. Building f ^V d© Building Permit Fee-Total Construction Cost x_(Insert here 2. Electrical f appropriate municipal factor)=f 3. Plumbing f J. Mechanical (HVAC) f Note: Minimum fee=f (contact municipality) 5. Mechanical (Other) f Enclose check payable to 6. Total Cost f 3QQ0 (contact munici alit )and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT fly entering my name below, I hereby attest under the pains and penalties of perjury that all of the information ointamed in this applica Gun is true,,a,/nd accu rat� h� the best f km VIe,,,ufd nderstanding. // �i�c Car�tife� 7�a1. 7F`z �33� 6 I'la•.re nnl and si •n name itlr p,jvic phi/, n N,p. )a e '411vel Addre" Clt%i Town Fta it! Zip j Municipal Inspector to fill out this section upon application approval: Name Dole r CITY OF SALEM PUBLIC PROPRERTY DEPARTMENT Pitt ' 4i. .� {-.1JaV..•�V Slrtrr .1111\1, fit.\K� �� J1 .:1'�': trl;47/.714•/MIS � 1'\.'t:'/7/•7JJ'111M Co(M.qu rW u0nll Debris lion mmi renovation work)vit In accurdume with the sixth edition of the State Building Code. 730 CMR section 111.3 Debris, and the provisions of MGL a 30, S. is issued with the condition that the debris resulting floor Building Permit M I licenxd woste disposal facility as defined by MdL e this work shall he disposal of in a Properly 111. S 130A. The debris will be 1runsportcd by: iwnr ur hauler) 1'11e dcbris will be disposed of in (n+rtleul aci Orly) V . /ualure nl �wrnur+pylNaM Sale CITY OF S.U.&M, NLXSSAC1it;5E-M 8L'aDLVG Dl1AtiTIL'YE 110 19.%.jmmGTON Sruarr. )"FLOOR TEL (978) 145-9599 Asix(973) 744960 KI}mEA"V D1I3COLL 711011WIlAsSLPUL"s V1AY0IL plLWMAOFrLeLICpWpRRTY/Kl1DD1GCO2041510"A Workers' Compeesallon Insurance AMdavils BuildersiCantracterWElectrlclansonUmben %linlics it Inn m Valneiuwretr.rdry/usaiewlndk►rAta1C eNNL. L Addresr. &-d e L cily/ststelzip��K C 4e 16,11//X dam/Pholus M.- I empbyw?Chock the apprepr/ab hen V 'pa of project(yegdrea mtpby�wits a. Q 1 me a primal coetaciar nod 1 ❑Now caestnordoes (fhave hired theob poprioar a►poerrw6IistNaa thrattarJead eltaet l 7. Q RemalalinL have no antpbyam Theses Iab-eoelumma how !L Q DtmolWass t for nr ie AMy capacity. workers comp`Inanaaoa 9. Q Deming ad"Oss rkew camµ ituurance 3. Q We am a caepaadee and iw10.❑EeceicalropainrYadditiotol ollkats Aave elandaal ehtti 7.Q 1 am a hameowOw doing all work ^rw orsixoraPion par M0L I I.aJhankky tepain or addiclotta camp. e. myself(Ne workers'cam 132.11(41 and we haw no 12. Raef copses insurantereaWt"lr 4'nplO3° Wewoded IJ.QOtbw coinµ imaww ee rlt4inil i — •nrg epratsee 1111111 dude Ma Of nnr AM as d.t w/watrea lelee fa..iy aVr W~ass o"" Derr IrteudoeS '1 Lwwwewr.b ntldsie ode amd"indisiq Our no"M as wet*ad dtr Ara writ swasadwo ell{rdtnk a nw aeedkek iniforiw,M& t'..drwtww dad cbak rW tat~adoatd an aledbtW&%M diselos du maw wide w►e"wawwe Seel stoat wraw' MW P tb istlweweoea /sit our ewptgw rhar to prev/dbe IdrNbeYf'cewpeeerdre lerreawr/br aq satpbayeea aelYw b rAe/ l sec//I11 Jblr /w/ereredela Insurance Company Name. Pnlicy a or Self-ins,Lis.err. Eapicalios Dab: Job Site Adhhta Ciry/ltawrlip: Anaca a copy of the werewn'compowaWe pesky doolongloa pop(sheWht/the pallet'Number and expiraeloe dart)6 F aliurs to a"Ism coveralls as required under lotion 3JA of NOL s. 132 can lead to the impo/iti n of criminal ponaltla of a rent up to S 1.500.00 and/or one-year imprisonment.a dated Y Cavil peaaltiaa is the facto of a STOP WORK ORDEI and a floe Of up to S-J0.oe a day ayainll the violator. 114 advieatl that a espy of this,taarateal may be furwur8sd to the 0111ce of I nccge daaium segue r7lA for insw2me cowraae.vrilkalnle, - /Je hereby Certify tew/er the pe/wt rwI yewr/des r//eat/sq CAar rb infiMwwelow provie/rtl w"m it Irw and:erreA •nn rtt' I)ufe_ P`une a: /L wee wrier is Mis dreg to N wtwph/ed bl rityW/e,re wJ/h'ird City orfuva: ecrmidl.leeeul__ Iwusnt.whonly$circle unel: i Ituaed u/))sank 1. Nuddlea Mp sremene 1. City/rows Cierk 1. Electrical Inspector S. Plumbeng Inspector 6.IIINet, L..ntact Pcnaw: _ _ .. Phone a. r J7assachusetts- Departmenf of Public SafltK Board of Building; ReguL•rtions and Standard9 Construction:Supervisor License License: cs 77882 Restricted to 00, .: KENNETH0,MACDONALDJR i 115 GREEN St WAKEFIELD. MA 01880 "' e Expiration: 9/11/2010 7r#: 3829 yr