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39 NORMAN ST - BUILDING INSPECTION (6) . o�,`� Q S7 � b� �02� � `�9 �.r n�� . � .. ' , q ,x �r.e�l.un: �.w�..,.�.:. � Ti3—�y - I 25�� � �°y �o k� y Kar� � The Commonwealth of Massachuse T�ONAL SERVIGES °� Department of Public Safety Massachusetts S[a[e Building Code(780 CMIZ)j11�� � 'Z q! � y� Building Permit Application for any Building other than a One-or Two-Family�Dwe111fi��'1 , ('Chis Section For Official Use Only) . � Building Permi[Number: Date Applied: Building Officiali � � � � . SECTION 1:LOCATION(Please indicate Block#and Lot tk for locations for which a street address is not avaIlable) 3 9 a�ear,�ai ss. .1',�0�-�, 0147a No.and Strnet City/Town Zip Code Name of Building(if applicable) � `� r ' � � - . . � � .SECTION�2:PROPOSED WORK � � � .. � � � ' � EdiHon of MA State Code used_ If New Construction check here 0 or check all that apply in the two rows below Existing Building Repair� Alteration ❑ Addifion❑ Demo]iHon O (Please fill out and submit Appendix 1) — �Change of Use ❑ � �Change ot Occupancy ❑ Other ❑ Specify: Are building plans and/or mnstrudion documenls being supplied as pazt of this permit application? Yes No ❑ � Is an 7ndependent Structural Engineering Peer Review required? Yes ❑ No ❑ Bri(((e���f Description of Proposed Work: �i�a Nfia✓ AA :���b,..J , /v�Tln..i� 9Gvf��Ylll� y�5�/L. I�rYE.c�o+.._ .�J�L��. 6�r+L.✓�FBHN IL tf. -F .SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,.OR � �` � " ��"' "� "� � . .CHANGE IN USE OR OCCUPANCY :�� ' .. ,.. � . . � . _ . , Check here if an Ezisting Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Usc Group(s): Proposed Use Group(s): az..... � � �:. . :, � `, . - �--�SECTION 4:BUILDING HEIGHT AND AREA :. s-:I.:. � "�" �'� � ,. " `�� E�cisting Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) � • - �, ���_ .. ' �- �SECPION 5:USE GROUP�(Check as applicable) �'� ' '^-'- � � . A: Assembly A-1❑ A-2❑ �Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-1❑ F2❑ H: Ai h Ha�ard H-1❑ H-2❑ H-3 ❑ H 1❑ H-5❑ I: Instihitional I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile❑ R: Residential R-1❑ R-2❑ R-3❑ R-4� S: Storage Sl❑ S-2❑ U: Utility❑ Special Use 0 and pleam describe below: Special Use: :�_" • "*'=- � �� �t'' �'��i:SECTION 6:CON5112UCTION 1'YPE(C7ieck as.applicable) " ` ' "` � IA ❑ � IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑ „x: _� �r; z�.��.a SECTION 7:SITE INFORMATION(refer to,780 CMR 111.0 for details un each item) ` .,, �` x �,._�� Water Supply: Flood Zone InformaHonn Sewage Disposal: Trench Permit: Debris Removal: PubGc❑ Check if outside Flood Zone❑ Indicate mm�icipal❑ A trench will not be [acensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ required O or lrench or specffy: permit is enclosed❑ Railroad right-of-way. Hazards to Au Navigation: MA i-li+roric Co�imission Revic«-Process: Not AppHcable❑ Is Structure within airport approach azea? Is their review completed? or Consent to Build enclosed❑ Yes O or No❑ Yes❑ No ❑ � -"' ^ �';;�w �g "�' . � '�:°SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY ���� � Edifion of Code: Use Group(s): Type of Construction: Occupant Load per Floor: , � Does the building contain an Sprinkler System?: Special Sfipulafions: ����J �k �.V . -1 �3� ('°aeQ u�tie�, �� r �• � '" " SECTION 9: PROPGRTY OWNER AUTHORIZATION �� Nazne and Address of Property Owner . � (3n,q+., S7r�en,,� 3f G�7Toes J�T• —r,�.n�.�s�' d� qa� Name(Print) No.and Street City/Town Zip Pro erty Owner Conta/ct�Information: / C c! � �s �aE+4Y - l��b 7�l v✓L 01aT - - �-$ KA NIC COMHCJ}6S .4J�y Tifle SI��v�'Telephone No.(business) Telephone No. (cell) e-mail address �If p(icable, e property owner hereby authodzes � i�tc� �,N�cn.o t>4 f3�tiR,w S r - S�-A*7,�r /Ll.v o�S'a7 Name Street Address City/Town State Zip to act on the ro er owner's behalf,in all matters relaHve to work authorized b this buildin emut a Gcafion. ' ' � SEC'IION 10:CONST1tUCTION CONTROL(Please fiil out Appendix 2) � If buddin is less than 35,000 cu.ft.of.endosed s ace and or not under ConstrucHon Cbntrol then cfieck here O and ski Section 10.1 ��•101 Re 'stered Professional Res onsible for Construcrion Control� :� '"'��" � � �-�� � `"� - " - `�`-� 1�"ES c/l���ATT- ,d�-,yY ���3 AinNcr a/6' / _ Name(Reg�strant) Telephone No. e-�ma�l address Registration Number 3/. 1/�aB1.v�n ��fnG� C--,�,i � l ov Street Address G�ty/Town � � State Zip Discipline ExpirationDate .,102 General Contiactor.. . ';. . ., ...,..,t . «m ,�.. . ��..,.V• �;,,.,... 3 .� .,�,M.,..... � . . . , k��., �Nl YLJ ni�'Ut^-GJ)O+J l.�a � Co�q y Name C.�2� ��n�/G� C S a 6/o�/ i Narne of Perspon R ponsible for Construction /� License No. and Type if Applicable �J J /J✓ML[r.✓ SZ` �/�.�Ju'�' ��i 7) D Street Address f�+ City/Town State Zip L��Z 3��� � �0!� Ltd n Go.vf v� C-o�.4M�. N�T- Tele hone No. usiness Tele hone No. cell � e-mail address � � ' -". SECTION 11:WORK8R5'COMPENSA'CION INSURAn�CB AFFIDAVI"C� M:G:L�c.152:,§25C 6)., " � A Workers'Compensation Insurance Affidavit from the MA Depaztrnent of Industrial Acddents 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 si ed Affidavit submitted with this a Gcafion? Yes❑ No ❑ ""�`"'�_' ._i,'!�+"'. " '� SECTION 12:CONSTRUCTION COSTS AIVDPERMIT FEE' ".. �.�� ? #��" �' »°"' � Item Estunated Costs:([.abor p and Materials) Total Const�uction Cost(from Item 6)_$ � z, `Da' � 1.Building � % `��7' � guilding Permit Fee=Total ConstrucHon Cost x_(Insert here 2.Electrical $ appropriate municipal factor)_$ 3.Plumbing $ 4.Mechaztical (HVAC) $ IVote:Minimum fee=$ (contact municipaHty) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ / g, G�d ' � (contact municipality)and write check number here _ � �}`6'��� �1y1� "'SECTION 13q S[GNANftE OF BUIC� � � r T � +�i°-'����i�.;: ruN'r ,mr��"..A .�d' ,. ._ .� . .DING PERMI,T A�'PLIGNT� , . .°� -'E�- }:.`..�-�� �.��..^, By entering my name below,I hereby attest under the pains and penalties of perjury diat all of the information contained in this a licaflon is and accurate to the b of my k pwledge and understanding. J � rn � J� � �,W ��on/16iw - � -E&3O�ar' �4[-�����7�� �Ple prinnt and sign name Title �A Telephone No. �ate �Yl�AIiA i.(... S��/ rfw ��' /l�{✓� O cD ' Street Address _ City/Town State Zip , ., � ��.,.< ... . ..:. . . 3) � Municipal Inspector to fil(out this secHon upon application appro0al: b . -" � � � � �` Name � : �Date , _. ., _ ; .. _. ., . . ... . �. _ . � .> P ._,..-- Y ; i; � � d/�e�v��ru.�P�� C��omac6�..velk, ' �� Massachusetts -De artment of Public Safet � . � Office of ConsumerAffairs SBusincssRegulation . - , BO"afd of BUlldlfl9 RegUIdYl0175 afld St2nd�fd5 � i " � i' , - � - OME IMPROVEMENT�CONTRACTOR . Cons[ruction Supervisor � - egistration: gg Type: License: CS-06106� � ! � . . �zpiration• � - DBA ' . � .� rry � � � . (C. . .P� ��e � - . �� CAPONIGROCONS� �. _ I � -=� -- ' CA�I2IAECAPOt�ZGR �"' ��p � I ' � � 0 159 BURRII,L S� � � ! ! �� SWAMYSCOTT1GIp .� '� - I � . � � CARLO CAPONIGR� � O� � . , . � � � . , � , 159-BURRILL ST � >/ � � � � s% �"`s"-��-�—� . �'. �` �. - SWAMPSCOTT,MA.0190��" �Uudcr— r���e�4— . � _cj,��U�.�rur" EXp(r2tlOn . � � .. . � � _ . ; � Commissioner. . . �7/25/20i5 � ;� f � � ' .� . . ..� � . � . ... _. _ _ _ _ ___ ___ __ ___ _ _ � ,� _ _____ _ — _ _ __ _ _.._.. .. . _ : : __ _ _, __ _ _ ____. __- ,-_ , .. _ _. _ , I ' I ' i � _ . I . � � . �XTS"r�N�._�E.I�I:N:�, p �- , � � -g�c c.-V JZ..� 'C� -:S 4 pL"Z... _ ��� I . . . . ... � . � � � � � � � � � � I__._Gj.'_��.']�S . 1_.__. �.-r_L�-c�:YS�Zi 1_��cV�=---r4As.lri�.c. ---_-,o,e.._ r . � •- -�--- . . ----�'"F'-�.--w_r_._"1_�_... �.�. . . � � . � , . � _:W G 3'+1�'."Y"''�-L�_L�.:_.-__ .�,._ . . � I ! : . - ._ . � I I - � I � � I ! --- - - —': � � I ' I I `� J J _ __ iI , � I i �I . . � . , �S-�iCti .S7 � . 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