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39 NORMAN ST - BUILDING INSPECTION (5) �K � oo�y $ � � � � c--- � .I-io� o k� ._ , � � The Commonwealth of Mass��� YlGES tr� FaL SE� 1 Department of Public Safety Massachusetts State Building Code(7S0 CMI2 j� Building Pernut Application for any Building other than a O��o��'�c�FZm����g � . �„ ' �_ ' �Sechon For Offiaal i3se O� � � ` . "• -�.... » .• ;' �. , � � . . ,. :� ��r, < . f�ua� �Y) � r . � ^(� BuildingPerntitNumberN-.. .` �� .. DateApplied.' �- - _: - ,Building0fficial ` " `�"�, m�-�j§:: ¢ °� ��. � . 7 >'�� SECfION 1.LOG4TdON(Piease indicate B(ock#and Lot#for locations for which a street address is not ava�lable) .,, � 3� lVaGn7/bry 5T. � �j..c�E.�-� D 1 p� o ` , . - � Nb.and Street Gty/Town Zip Code Name of Buflding(tf app�cable) � � " ` =�.' , `,.�'°'`, ." . �: " e�SECTION�2:-PROPOSEDWORKw �: :.t�: �+ ,� °; . _,, ,,�.M..,.,.,.�. .,� .='a'.. ' <<.,�: ,��, ,,. , .��... . ��' Ediflon of MA State Code used_ . df New Construction check here�0 or check all that apply in the two rows below � �Existing Building❑ Repair❑ Alteration{� � Addiflon❑ Demolitlon 0 (Please fill out and submit Appendix 1) .. � Change of Use ❑ Change of Occupancy_ ❑ Other ❑ Specify: , � - Are building plans and/or construcflon documents being supplied as paz[of this pemtit application? Yes� No ❑ � � �Is an:Independent Structural Engineering Peer Review required? . Yes ❑ No"� Brief DescripHon of Proposed Work � _ � _ � P O � [� t /t� 2A C.ao/' O c.� /Lc`.Si +-2 . . . ��'-�l B�N n� ' � � . . .. —� '� '"�SF.CTION 3:�COMPLETE TfiIS SECPION IF EXISTING'BUILDING�UNDERGOING RENOVATION,ADDITION,02 ��.��'� - " � � -' '`g` ' ' $ ;n�- �CHANGE IN USE OR OCCUPANCY ;' - ��z�..,��,�: �e�,w. ..c,..m--� .: . . - . Check here�if an FacisHngBuilding InvestigaHon and EvaluaHon is endosed(See 780 CM2 34) ❑ � . - Exisflng Use L3roup(s): � .Proposed Use Group(s): � . � ...,� =v�iia�•. • � .we.;>•SECTION��.4:�BUILDING�HEIGHTANDAREA���.��, �-;C,=.y��<��"a '.',:..}.,�:' � ,�..�,.;�.i . . . . � Exisling Proposed . No.of Floors/Srories(include basement levels)&Area Per Floor(sq.ft.) � � Total Area(sq.ft.)and Total Height(ft.) �"+:G�k. ,--a. �;i , . �^�.':l* '�r�aSSECTIONS:'.USE,GROUP(Check�as'applicable)'��. �;�;� ��i,p"`?����i- ���i,' � - A: Assembly A-1❑ A-2 0 . Nightclub ❑ A-3 ❑ A1F❑ A-5❑ B: Business ❑ E: EducaHonal O � � P: FaMo - F-1❑ P2❑ H: Hi Hazard H-1❑ H-2❑ H-3 ❑ . H-4❑ H-5❑ - � I: Institutienal�I-1❑ I-2❑ I-3❑ I�1❑ M: Mercantile❑ R Residential R-1❑ R-2❑ R-3❑ R�❑ � � :S: Smrage Sl❑ S2❑ . � � U:�UHlity❑ Specia',Use O and please describe below: Special Use: � �`P.`.��`" ,� '_��'� .i �' ":'�: i SECTION�b::CONSTRUCJ'lON TYPE.{Check as applicable) ,.s-a;�;�� �:�•. " ' � �� , i - IA. O - � dB ❑ � , � ?IA ❑ IIS O ItIA O IItB 0 N O VA ❑- VB ❑ I ' � �-- �:«;�3.� ,h. ��t:�";,�:SCCPION�7:SITE'INFORMAITON(refer�to 780 CMIL 111.0 for deWIls on each�item) � .`_'"- �,• �' `�'3 � �¢ � Trench Pecmih � Debris Removal: � � �� � . Water 4upply: Fload Zone InformaHon: Sewage Disposal: [.,��ensed Dis sal Site❑ � � -. �Public❑ Check�if outside Flood Zone❑ Indicate monidpal❑ A trench will not be po � - � - � Pmate❑ � or indenti(y Zone: or on site system❑ required O or trench or specify: . � peraiit is enclosed❑ � .. �Railroad right-of-way. , � .HazazdS to Air.NavigaHon: MA I-Iistoric Commission Review Process: � � . � . � Not Applicable❑ Is Structure within airport approach area? � �Is the'u review completed? � . . . or Consent to Euild endosed❑ _ � Yes� or No❑ Yes❑ No ❑ � '. - �1k�t a ,,,, ,.. '��^' F ;;;�.*t'��$ECTION�S{�CONTENT OF CERTTF[GTE-OF OCC�UPANCY ..���� � .�^ � E�,-.,'.�. ` � . . Edition�of Code: � Use Group(s): - Type of ConstrucHon: Occupant Load per Floor: - � , Dces ttie building contain an Sprinkler System?: Special Stlpuladons: - Mr�� ��b 3� � � . �. . - ' - ' �� - � SECTION 9i PROPERTY OWNER?.UTHORIZATION � �� ` ' . . . . '. � _ . . . . . . ... , .,,.... /�e and Address of Property Owne7r /� l_/LhIG �JL.rQ'Sh)t��C� 7 / {�/�2-�^F�v Jj� .. . r�1�Lr.Yh �� �U ` - � Name(Print) " ' No.and Street City/Town /,� Zip /�rp'perty Owner Contact Information: /( .�ipyy�r,-pN�G£n�T� M �'�'��'y c J . l /�41 f, SII�vrS w�e1`. ���- (�J� b�o�/ _ CS%RASn�c7� o Gaw,.�-i[g . �/uc .LVM � Title .. � Teleptione No.(business) Telephone No. (cell) e-mail address � I/f�pplicable,/c�iq property owner hereby fautho(ri�zes ('^9 YL w �-s4�brl-)�f�l� I S �i )Nri,�t,h., S'T'• �_/?/,� p! p � � . -� Street Address City/T State Zip � � �� � � � � to act on ihe ro ec owners behalf,-in all matters relaHve to work authorized b tkus buildin � raut a licadon. - � . . ,y� x`� ,,�. .,, :��'�" ""°"SECITONIO:CONSTRUGTYONCON'I'ROL(Please�filloutAppendix2)°���,�'�:' � ;'- � j . °'�� bu�ldm is les's than 35,000 cu.ft:of endosed s ace and/or'not under Conshuction Control thert check here O anA sk� Section10.1 � � � � � 10,1:Re� 'stered�ProfessionalAes onsibleforConstrucHonControl�:;� ` ' .�"�' "��� , `�`;&"°�:��"`»J":':+�7x;�m m, ��,�.:_.` ,. ' �� � � . � Name(Registrant) .Telephone No. e-mail address RegistraHon Number - , Street Address . City/Town . � State � Zip Discipline Expiration Date � ii . . 103,General'Coritr'Sctor ri .=�'`' �,,��u�'�?-�,�4 .=ra�i°�- ,..o e. ,�' �`�': -s �'�' ='�'���*`r°-��a �-'axs:. . . . � _� - �i �w�7�'V(iP+� � .. Co zny Name � - � � � - � �bti���w es oblo6l , � Name�+of P/e�rsun Responsible for Constructlon �. n License No. and Type if Applicable � . JJ / lJvn�rtr,�t, S r' � JG�sv� . . . �/� 0/�/'�) . . � � .. Streec Address Gty/Town. � . � State Zip .. . � . , 7Fl_Fi/,7- 3%I/ 7�/- .5�9 /609 C.�vo�,.srj ���tr. NeT' .. � Tele hone No, usiness . Tel hone No. cell rmail address - � ' r ���,d� °��..�+:„��.SECCIFJN 7�1:WORK6I25`.COMI'&NSA'1�fONIIVSURANCE AI�P1DAVl'1'Nr.G.L[":c.152.§25C 6 '�" � P-�.ti4.•NIs� L���� .- .. ' . .. __ . . . .. .�.e. . � .�� � ��A Workers CompensaHon Insuxance Affidavit from the MA Department of Indastrial Acddents must be completed and . "submittedwith this application. Failure ro provide this affidavit will result in the denial of Yhe issuance of the building pernut . . � � � Is a si ed�Affidavit subatitted with this a licaflon? � Yes❑ No ❑ � . � � ,Q`�-�3 � ��,.t�'.� �,�. � =�-'SECTION�I2:COMSTRUCI'IONCQSTSANpPERMITFEE �.�°jr �;;.t.�++^ ,,,�,.��y� ,1;:¢'�� . ��and Male ts��. ) bor Total Construction Cost fro � Item � ( m Item 6)_$ . -� 1.Building $. �'3, ao o � ' - .Building Perndt Fee=Total Conslruction Cost x_(Insert here . . . z������ � § ��f, 9'o fl: _ appropriate municipal factor)_$ . _ � � 3.Plumbing - $ � �. . '�, . . . 4.Mechanical (HVAC�:._.... . $ . . ��... . . . Note:Minimum fee=$ (contact municipality) � .�,. 5.Mecliaz�ical Other $ Enclose check payable to �. . �. i 6.Total-Cost . � �$� /�, 9�� (contact municipality)and write check number here - � � ' 4��,iz;�-.,� � I�' ;��x�'` , �. SECTFON�3:`$IGNATURE OF BUILDLNG PEYiMCC APPLICANTo- ��,�:=�y�„;�'',',��,:��:�;;. . . . :By.entering my name helow,l hereby attest under the pains and penalties of pe�jury that all of the informatlon contained in this' � � � , � � .. . � �.. �.: -a plic 'on is true accurate to the best of my knowledge and u dersCanding. � � . - � . -� � � —�� �n.�s�ocN r 7 YI_8��� 3,I� 3 i7 i PIe�p nnt and si�i' �� � Tifle �Telephone No. Date � � _ . (��2�0 `-/llrvh!lrt,o� v� � � �i@_ o/qo� u Stree Ad��jess � � � . � ' . City Town � ' � tate Zip � � -- . �" �7✓n-ar✓L� ST ' � ( � � � . . . . ... dt�" ��'�ix�+ax���,�.�� wr +.�l;d*:-.� �r,>i x e,�.„�. �a�a �.4��� 5 :� / 8"�. i ° . � Mwucipal[nspector:to fill out tlus sechon upon appl�cahon approvsl ��+� v . �- . '�� � ��� . . � � ��t�'��.t"°�-�,���+1F^;'fl-F w-� � a.�".� �r-;� " ?;" _. ��.� ,r.r-,M,�n..n,�N� x n.�Nmne:�+.� _ � �Date __ _ _ .._.__ _:_., �� � � � � � - d{���,p;�,n,��e�/��ja��i;,Q� _ �!�( Massachusetts -Department of Public Safety` �' . Ottce otConsumcrnttairs&nusinessiicgu�xaou . L� Board of Building Regulations and Standards � � � . . - - OME IMPROVEMENT�CONTRACTOR � � � � I � �� Construction Supervixor � . egistration: gg � TYPe• License: CS-06106'I � � ' � � �; �zpfration: {�-- DBA ' • .- . . � :.`` � i r�. ��R ; . CARLO E CAPO GR �', � .. . ' CAPONIGRO CON ,�.._� ._ : -. . � � ;�'� �. �. , . q , . — ; 159 BURRTLL S� _ . i SWAMPSCOTT K1A� , 7 ; : I � �CARLO CAPONIGR � - � - 159�BURRILLST � � . . .: � � �. . . � . . � - . �+...h-->B..p...�� �'' .`'� . . .. . . .SWAMPSCOTT, MA.0190 �`� Under�— .. - . . �✓�, �� ,rur.'� . .. . Expirahort. ; �. .. . . � . � � . . : � . . , � . Commissioner . . U7/25/2095 � .� � � - �� � � � - � , � � . .. . �� - � � � � - . � . ... , , . . .. . . . . . . . . . . .. � . � . � � � .. . � � . . . _ . : . .. . . ,` . � � . 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