SOUTH SHORE AVE BAKERS IS - BUILDING INSPECTION (2) �� - ��
.� �
�� Q
i ►
_�-
i�� �.
'. / I '
ii
- __
i
4i
,�
,�.
--- �" - - � 1_�Wd-�____ ._ . tom w
� __ .__ �
.� _ � � -
� '
I�
���
- -- - I -
- - � ,
; �
-- ,i. _ . _
�,
,;
�,
t� ��,
- - �r� --- - - ---- - - � -�- - �
I�
r8.0 CONSTRUCTION COSTS (See 780 CMR Appendix L)
Total Construclon Cost 8uiidirig Pernik Fee Check Number
$0.001
boo
10.0 AUTHORIZATION OF STATE AGENCY FOR AGENT TO APPLY FOR BUULDMG
PERIAIT(when applicable)
1, on behalf of the author zLq Stets
Agency or Authority. hereby authorize, to apply
for the building permit for project number.
Signature Dam
11.0 SIGNATURE OF BUILDING PERMIT APPLICANT
/ . I f VJ
Name
I L�z
Signature Da
12. Certificate of Occupancy required on completion of project? Yes No
Inspector's Notes:
F6A
PROFESSIONAL CONSTRUCTION SERVICES:
General Contractor
ress: \
Telephone: 633 ,9-1G Fax:
Responsible in Charge of Construction:
r I
7.0 CONSTRUCTION DOCUMENTS -to be prepared by applicant
Item J as Applicable
7.1 Plans (Note 1 this page) Submitted Incomplete Not Required
7.1.1 Architectural
7.1.2 Foundation
7.1.3 Structural Ll
7.1.4 Fire Suppression
7.1.5 Fire Alarm
7.1.6 HVAC
7.1.7 Electrical
7.2 Specifications
7.3 Structural Peer Review
7.4 Structural Tests & Inspections
Program
7.5 Fire Protection Narrative Report
7.6 Existing Building Survey
7.7 Workers Compensation Insurance
7.8 Other Documents (Specify)
(Energy Narratives, etc.)
Note 1 Areas of Design or Construction for which Plans are not complete at the time of
this application must be identified herein. Work so identified must not be commenced until this
application has been amended and proposed construction has been approved by the
Department of Public Safety District Building Inspector having Jurisdiction.
5.0 DESIGN AND CONSTRUCTION UTILIZING MGL C 112 SECTION SIR EXEMPTIONS
(See note below}
Contractor J"�c
Name:
Address:
Area of responsibility: owoAr,,
'License Number.'" Date of Expiration.
Telephone: Fax
Contractor
Address:
T
Area of responsibility:
License Number. Date of Expiratlon:
Telephone: Fax
Contractor
Name:
Address:
Area of responsibility:
License Number. Date of Expiration:
Telephone: Fax
Note: For portions of work uliHzlnp exemptions of MGL a 112 s.81R complete the section above.
Use additional sheets if necessary and attach to application.
4 w,
8.0 COMPLETE THIS SECTION FOR NEWCONS
RUCTION ONLY
For Existing BuildingsProceed to Section 9.0
Number of Stories above " ;° Number of Stories Below
Grade Grade-
Story Height ' 5,
n iw% Floor Area Per Floor
Total Building Height ' , Totai_Building Area Above Jul
above Grade ' Grade
Total Building depth below: i� , Total Building Area Below
Grade:. 3b. Grade.
Brief Description of Proposed Work:
l�k a
8.2 USE GROUP AND CONSTRUCTION CLASSIFICATION (Newt Construction Only),
U$R:OROUP° ` USE GROUP,. SUB-C. TEGO_RY
. a
NCON
(dasa CLASSIFICATION
A .,. Assembly ;. .. j A 2`, A=3 ' A-4' 1A
B Business 1 B
E Educational 2A
F Factory F-1 F-2 2B
H High-Hazard H-1 H-2 H-3 H-4 2C
I Institutionat, 1-1 1-2 1-3 3A
M Mercantile 3B
R Residential- 1/ R-1 R-2 R-3 4
S Storage S-1 S-2 5A
U Utility 58
Mx Mixed Use Specify:
Sp Special Use Specify:
Iry
d1d hl� y C9 o/Y-t lig
l
I
6'
1 �
'---
I
r-,
CITY OF S.U.F.Nl, NLkssACHUSETrs
BuI mr,DEPARTMENT
130 WASHINGTON STREET, 3' FLOOR
d' T EL- (978) 745-9595
FA.X(978) 740-9846
KIMBERLEY DRISCOLL
MAYOR THomAsST.Pm Rm
DIRECTOR OF PUBLIC PROPERTY/BU DLNG COILNIISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit # is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will betransported by: (� ,
UCH' . .
(name of hauler)
The debris will be disposed of in
'G- ,
(name of acility)
(address of facility)
signature of permit applicant
!l s#
date
Jcbrirw0'.Jce
CITY OF S.UMN4 2UNSSACHUSEM
BLTMLNG DEP.Jan NT
l /' / 120 W.uHINGTON STREET.V*Ft.00R
/ G U % TEL (978) 745-9595
i /A L PAX(978) 740-98"
KI518FRi.EY DRISCOL
,MAYOR THomAs ST.Pw-m
DmE(TOR OF PI;BLIC PROPERTY/BIMMING COMNaSSIONER
APPLICATION FOR THE CONSTRUCTION;"RWAI f RENOVAT�N. CHANGE IN USE OR
OCCUPANCY.OR DEMOLITION OF ANY BUILDING OR STRUCTURE
Sodlan.for OiMlold Use One
\� i Byi1d41E Parmte,Pro�eCt. :, Deft
8uild(ng -
^�Estlm--e--�� Dstes Start
ic
1A SITE INFORMATION
locallon Naffs: Budding:
Prop"Address.
Maaraloag: 0 ���
2 N i*ii RMATION
2.1 owiar of Land S'
Namx
Address: kb,,v-- ILA S61 Zs, Pte, D ys76
Telephone: ,09 LLSy
2.2 Owner or lessee of buUdWg or s&uef u*
Name:
Address:
Telephone:
[Agenc
a AGENCY OR AUTHORITY AUTHORWNG CONSTRUCTION
ency Name:
dre=
y Projed Numberjed Manager Name: Tel