Loading...
31 SALEM ST - BUILDING INSPECTION The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Building Code(780 CMR) WImo\/11 Building Permit Application for any Building other than a One-or Two-Family Dwelling N (This Section For Official Use On!-) Building Permit Number: Date.Applied: Build ng_Official: /1 SECTION 1:LOCATION(Please indicate Block k and Lot H for locations for which a street address is not available) SA Sq�P � AAA Otl -70 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 rows below 1 Existing Building d Repair Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ 1 Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Is an Independent Structural Engineering Peer Review required? Yes ❑ No 91, Brief Description of Proposed Work: p �a -j v e ej rO- a;r — x„nn g e r L� rew q r-e (g !Y 4 gir-e 1e ^1c.e 4 wte ,-e lgco `1 l 014 C.¢ r' 1- 4 C v.2Q ri1. 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): SECTION4:BUILDING HEIGHT AND AREA - -- Existing. Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) - SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A.5❑ B: Business ❑ E: Educational ❑ F: Factory F-1❑ F2❑ 1 H: Hi h Hazard H-1❑ H-2❑ H-3 ❑ H-0❑ H-5 El I: Institutional 1-1❑ 1-2❑ I-3❑ 14❑ M: Mercantile❑ R: Residential R-113 R-2❑ R-3❑ R4❑ s: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Su pp Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public y Check if outside Flood Zone❑ Indicate municipal required❑or trench or specify: A trench will not be Licensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: \M--I hstxx C mmktnn R v w,, 1'r xi_ss• Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: r SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner i Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes R Name Street Address City/Town State Zip to act on the property owners behalf,in a6 matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)- If building is less than 35,000cu.ft.of enclosed space and/or not under Construction Control then check here Eland skip Section 10.1 10.1 Registered Professional Responsible for Construction Control - - Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline - Expiration Date 10.2 General Contractor - Company Name Name of Person Responsible for Construction License No. and Type if Applicable Street Address City/Town State Zip Telephone No. business Telephone No. cell e-mail address - SECTION 11:W01O KERS'C0N4l1FNSAI'[ON MgURANCi'U,AFF'IDAVI'I' 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❑ No O SECTION=-.CONSTRUCTION COSTS AND PERMIT FEE: - Rem Estimated Costs:([tabor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ appropriate municipal factor)_$ - 3. Plumbing $ d.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5. Mechanical Other $ Enclose check payable to 6.Total Cost $ (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 accurate to the best of my knowledgeand understanding. Please print and sign name Title Telephone No. Date Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: - Name Date 771 SECTION 9: PROPERTY OWNER AUTHORIZATION„t`--"'� ,pg-"p Name and Address of Property Owner `>' ,.�a.lr✓>°�t �f_� ���.. ��` �,rc5tx7jd'Yt�C, �� {� (2. �jt"L"�-r'iL.t>1�7 j1-�� � 7 a; Name(Print) _ Na and Street 'a City/Town - Lip �Property Owner.Contact Information! f - .tom?"'`S1`iP P„ t1_�! Title Telephone No (business) Telephone No. (cell) e-rKiil address - If applicable,the proper)ty' owner hereby authorizes; 4rT""LB{.fry=�`t�>Vr _ ` Name St set Address City/Town State :Zip. to act an the PropertV owner's behalf,inall matters relative to work authorized"be this building "permit app,licatiota_ SECTION lo:CONSTRUCTION CONTROL(Please fill out Appendix 2) ai? '"t r; f{buildin is lessthan 35.000 cu.ft.of enclosed s ace and: or not underLonsinicnonControl then check here O andski Suction to 10.1Re istered Professional Responsible for Construction Control Name(Rcgistrant), 'lelephime No, e-mail address Registration Number Street Address - 'City/Town State Zip Discipline: Expiration Date t 10.2 General Contractor :.. ._ ..-... . ,_ + :r '12 iw r .;--K `?, t" -,t..,k c t,, 3�,. } LY v. Company Nameo 1 l cs Name of Person Responsible for Construction License No:. and Type if Applicable - _.21 S Street Address -City/Town 1 I Stag( Zip 7o3 -9Po. 7Sl8 �I6r K �ev�e6 � ...Ca Telephone No. business' Tele hone ML cell) e-mail address :'p'„�.; ,F;a. SECTION II: 4ffaidk!_RSShi(`1`U`.�'S'7; '*r PJWjhtt �lfvf fi9'V"Y M.G.L:c.152. 'e-.r,' ' A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed:and. submitted with 0ns.apphcadon. railureto provide this.affidavit will result in.the denial of the issuance of the building permit. is t signed A(hdavifsubtmtted with this application? Yes No yii t SECTION 12:CONSTRUCTION COSTS AND:PERMIT EEE f. „ br- Estimated Costs:(Labor . i ..: Item and Materials) Total,Construction Cost(from Item 6) O C� 1 Building S +c) p p b Building Penrut Fee=Total Construction Cost x_,(Insert here 2.Electrical $ appropriate municipal factor)-$ 3.I'luinbmg, - 4 Mechanical(I-IVF}C) $ Note Minimum fee r f (contact municipality) 5 Mechanical (Other) $ Enclose check payable to 6.Total Cost- S (] d 047 (contact municipality)and write check number here `t' _ " t`r`'a4 9 SECTION 13:SIGNATURE OF BUILDING PERMIT ARPLICANT ` 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 accurate to the best of my knowledge and understanding. Please print priintand sign name`+ -y fitl' Ielephonc No. Date `t 4i Streeet.Address - City/Town State Zip frN. f, i)'po- C rMumeipal Inspector to fill out this section upon appication approval 'n -' s '^ tr a" w" eNamcu ` r 4� t-„ =Date. '^' A COMMERCIAL INSURANCE APPLICATION DATE(M OP ID: APPLICANT INFORMATION SECTION 1/2812015 1 AGENCY CARRIER NAiceoDE Dadgar Insurance Agency,Inc. To be determined 400 West Cummings Park -- _ Suite 6726 - - UNDERWRI ER: - :UNOERWRRER CPPICE: Woburn,MA:01801 POI ICIM 0R PROGRAM REQUESTED- POLICY NUMBER GL INDICATE SECTIONS ATTACHED ELECTRONIC DATA PROC TRUCKERSRAOTOR CARRIER ACCOUNTSWEERWABLEI EQUIPMENT FLOATER UMBRELLA CONTACT VALUABLE PAPERS. NAM • BOILER a MACHINERY GARAGE AND DEALERS VEHICLE SCHEDULE PXONE , 781-933-2626 BUSINESS AUTO GLASS AND SIGN PENSATIDN FAN 781-932.6341 'X CONERAL LIABMMERCIAL GE ILITY. INBTALLARONIBUILOERB RISK YACHT ADDRESS: CRIMENISCELLANEOUS CRIME OPEN CARGO CODE: SUBCOOE: DEALERS PROPERTY...._ ENCYCUSTOMERID: COUGA-3 DRIVER INFO SCHEDULE TRANSPORTATION/.. STATUS OFTRANSACTN)N -- PACKAGEPOLICY'INFORMATION - - - - X QUOTENIQTGRTRUrKQARrQ IBBUE POLICY Li RENEW::ENTERTHIS INFORMATION WHEN COMMON DATES AND TERMS APPLYTO SEVERAL LINES,OR FOR MONOLINE POLICIES.. BOUND(GN,DM endiwAUeda Cupy): P110PCSEDEFFDATE PROPOSSDE1PDATE BILLING PLAN PAYMENT.PLAN. .. AUINT ...CHANGE DATE I TIME X: AM - - - CANCEL 12:00: PM ' 02105115. 02(05116 DIRECT BILL AGENCY BILL PACKAGE. YPREMMM• APPLICANT INFORMATION ... NAME TIM NM9dh "d a DOW NeuMd luauf%dN MAILING ADDRESS INCL 7IPM(W RMt NemeE 1. ) .. Cougar Capital 1,LLC Dan Botwinik 215 W Canton St,p4 Boston,MA 02116 FEINCRSOGSECO.� PHONEofFIMNa AlC,N a BOB: E-MAIL dbotwinik@gmail.cam wEesrrE I PARTNER8HIP JOINT VENTURE CORPORATIQN lLC NO.OF MEMSER ADDRE831ESP __ -PK RORG ' DMANAGERS._ CR BUREAU NAME: OATSaUS INDIVIDUAL CORPORATION BCHAPTIO X _ STARTED. D)NUMSEPo INSPECTION CONTACT:Oam 50twinik ACCOUNTING RECORDS CONTACT: _— PHONE EAAAES,oDowAniNglilman.cow— EftPN NE ' E-MAIL PREMISES INFORMATION ACORD 823 attached for additio at Dremises LOCO BLa7 STREET,CITY,COUNTY,STATE,M" � CITYLMIITS INTEREST BUILT LT _ EMPLOYEES ANNUAL REVENUES OCCUPIED 215 West Canton Street NSIDE OWNER 1 1 Boston MA02116 -:DUTSIDE TENANT -- - --- -INSIDE OWNER- OUTSIDE I TENANT _ I INSIDE OWNER OUTSIDE i TENANT INSIDE OWNER --- OUTSIDE TENANT NATURE OF.BUSINESSIDESCRIPTIONOF OPERATIONS BYPREMISE9 t.,., Contractor-mostly renovation jobs ACORD 12S(2007110) Page 1 of 3 ©1993.2007 ACORD CORPORATION. All rights reserved.. The ACORD name and logo are registered marks of ACORb i s g'9V � a� � d x ,� ' "` a 7 4•"" r `' �` nw y �i a^� :. a4t a n � �' � �mx��� ,, � �"{ � r�" t vsA' x b 'NIr+.. c r { 1,. d " ax firard ,a�a s� ° Yx„a a E IF f i. R mass + � . s y fl o i Reg and st c o Sup 'I,` r License.- C -101? ? * ' is DA . . -a 215 'west Canton 94 Boston MA 0211 �.1 ' n05/1412016, Scanned by GarnScanner