6 NICHOLS ST - BUILDING INSPECTION (3) l o C( 906 y
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The Commonwealth of Massachusetts
Department of Public Safety
::Massa,huscl is Stele [it]ild ing CA de(7841 C\IR)
Ill uiIding Permit Application for any Building other than a One-or'1•wo-Family Dwelling
(Phis Section For Offi(ial Use OoIv)
Building Permit Numbers ._.-- -- --- Dale App Iicd: ------_----- Building Official:
SEC HON.1: LOCATION(Please indicate Block 0 and Lut N fur locations far which a street address is not available)
/t/ICHOL $__ ST .._._�1tG _____--.-_01970 No. and Street City/Tutyit Zip Code Name lit Building(it applicahle)
SECPION 2:PROPOSED WORK
I:dilion ul \I:\State Code tiled If New'Co nstru(tion check her�br cfteck ell that apph' in the two rows below -�
hai.slinf; BuddingLl Repair❑ :\Iteration ❑ Addilion ❑ Ucnwliliun ❑ (Please fill out and submit:\ppondix I)
Change of Use ❑ Change of Occupanry ❑ Other X Specify:JA// �U_ gA iW jAL-,._W Aj-_J, —
Are building plans and/or constrwaiun dtK1JIllC tts being supplied os part of this permit application? Yes ❑ No ❑ _
Is an hnlependcnt Structural Engineering Peer Review required? Yes ❑ No ❑
Brief Description lit Prupased Work:"-��/YSMUC.T �L_?A'//VP fl.f_�LL �,5/OE' Gbkn 4NL r ObCzt
07V ✓egfF K_ o 0,7__.gC.D G?(NA n/SoN ST, rioE�_,PcrP �t/6 i.YrEz r� Pi.aW --
�LIAR arrrrr_o.
SECTION 7:COMPLETE:MIS SECTION IF EXISTING BUILDING UNDERGOING RENOVA"PION, AUDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed (See 784)CNIR.i-4) ❑
Ecisling Use Group(s): . —_-- Proposed Use Gruu p(s):_____
SECTION 4: BUILDING IIEIGIIT AND AREA
Existing Proposed
No. kit Flours/Stories(include basentent levels)SC Area Per Fluor(sq. ft.)
Total :\roa sq. ft.)and Total Height(ft.)
SEC f1ON 5: USE GROUP(Check as applicable)
A: :\ssembly;\-I ❑ A-2❑ Nightclub:❑ -A-1 ❑ ;\-I ❑ :\-i❑ B: Business ❑ E: Educational ❑
F: Facto F-1 ❑ F2❑ 11: Hi h Hazard F(-1 ❑ H-2❑ f I-1 ❑ F1-4❑ 11-5❑ „
1: Institutional I-1 17 1-2❑ I-t p 1-a ❑ AI: Alercantile❑ R: Residential R-10 R-2❑ R-1❑ R-4 p
S: Storage S-1 ❑ 5-_❑ I U: Utility❑ Special Use❑and please describe I+cluw:
Special Use
SECTION 6:CONS I'RUCHON IYPF. (Check as applicable)
I:\ ❑ IB ❑ II,\ ❑ IIB ❑ tIL\ ❑ IIIB ❑ IV ❑ I VA ❑ \•IS p
_ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Su I Flood Zone Information: Sewage Disposal: french Permit. Uebrla Rl'IIIUV JI:
PV Y
PANIC Cl Chock if autetde P1.nnl /_one❑ Indicate municipal ❑ A Inv%c It %rill not be Licensed Disposal Site❑
Prisate❑ ��r indvnlih' /one- er,nt .de h\dent ❑ reytdred ❑or Irooth or spe,I(% .
Permit is enc bled ❑
I Railroad right-of-way: Ilaiards to Air Navigation: .. , I ,- . . • ,
Cl Istilnn lure %.rthin,nrport appm.n lt .+rra' I s flies rev n'w Aomplelr-d'
or(,unrnt h, Build em lo,ed ❑ )cs❑ 'rt \'n C2 I des❑ \\" p
tiFCI [ON 8: CON I EN I OF CFI(IIFICA Ili OF OCCUPANCY
Cede: L,r Ureuhld. I\la•..I C.'n.lnn lirntt: %L,up,ml l.A',nl l,ar l bnr.
iIAr, Ihriniildinl; rm,nn.m�priu Ater tit.Irn,) _ __ _..._�Pru,�l �uf,ulahnnv
n A/L PI:Wwf 17 T-0
sAteM Ill A a t 9 Z a
Sl_:Cl7ON `): 1'1(OI'Ifl(TY UWNI:11 AU'lllO1(I'ZAIION_ -
•.Name,md Addrvssof Froperh Owner
-
N,une(Print) No. and titr.et—�—_ City/ Ibwn �tP
Property Owner Coolacl Information:
Title rclvphone No. (business) Telephone No. (Cell) a-mail address .—_.—
If applie,lble, the property Owner hercbv authorizes
-...-- Name _——Stret,Wdress _City/Town State Zip --
lo act on the pro pert owner's behalf, in all matters relative to work authorized by this building permit a +plicalion.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If huildin•IS ICS.s Ihdn-15,1)(X)QI.ft,of CneIUSCd G,Jed'dull or nut tinder Construction Cunlrnl then check here O and ski p Svction In.l
11).1 Registered Professional Responsible for Construction Control
Name(Registrant) Telephone No. _-e-mail address Registration Number
titrect Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
Company Name
✓ � J� C� - - 978 26528y9 _e :2
Name of P tson Responsible for Onstruction License No, and Type if Applicable
�F.'�1 cP �Gl� c�19b3
Slrect Address City/Town State Zip
y 4,y.3) - --- --
'rvlo+hone No. business Telephone No. cell a-mad address
SECTION 11:at11fli ",'tt,xurN:,\) l:,.\.\l,i.mjit,,%\II M.G.L.c. 152.4 25C6
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 a lication? Yes I] No 0
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6) '5---
1, Building 5 Building Permit Fee'Total Construction Cost x _(Insert here
'_. El Irical S_ appropriate municipal factor) 'S
.1. Flumbiny, 5
Noe: \lininnnn fee=S__(Contact nuupiripJlity)
J. Mechanical (IiVAC) 5
3. \Ierhanical Other 5 Fri lose ihcik payable to —
n. total Cost S QQ�Q (iomait nulnicip,dih')and write check number here ---
SECr1UN 11:SIGNAl-URE OF BUILDING PERMIT APPLICANT
` Ile entering, my twine bvlo+v, I IIClCbV attest under the pains and prnallies of perjury that all of the information contained in this
Application is Iruo.mJ .uirur e to the lest n o%Jcdge and oudcrstandiog.
Ploasv 1,riul old ,1go mime ( Ie f, e ho c No. Pow
�trorl .Asides+s City'; town >talu. - /ip
i
\tunicipol Inspector to fill out this section upon application approval: .�f 13
Name ... I+.i
�.
HOBBS ENDEAVOUR CORPORATION
Consultants in the Engineering Sciences
34 Rockland Street.Swampscott. MA 01907 978.857.8848 wlhanchordown@gmail.com
266 Rear Canal Street.Salem. MA 01970
JOB: /fir 9 ?$..7 ¢ 4 . 6 6 0 o Sheet no. of
Engineer: ! jL Date:
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