47 SOUTH SHORE AVE - BUILDING PERMIT APP ! CTI'Y OF SM EN NL-kss�kcHusE=
BUMING DEPAM.MT
' 130 W-MUNGTON SnEEr.3m FLooR
Tlu- (978)745-9595
KntBFRL.EY DRISCOLL FAX MS) 740-98"
MAYOR THOMAB ST.PIERRB
Dt WMI OF M;Buc PROPERTY/BUVMING COMMSSIONER
0 APPLICATION FORTHE CON URUCnOK REPiiIR:REIRWAIM CHAIM IN USE OR
OCCUPANCY,OR DEMOU'TION OF ANY BULDM OR STRUC MM
'� Thls 8sWon.tar OIl1_eW_I the OtNY-
I: p ink Pam,
8uiing IrNspedor
t F�iojed Oldw Start
Commenic
1A UM INFORMATION
Location Nsmss b Cep
p'°pa'tyA° s',:;kl.
Assesaare uspaodcUia , LwFir * y b
Q� ![/FORMATION
2.1 Ownw oft and
Address A-)o b. -11 A,
ovAA, , lie. 0q,5 6
Telephone; 693 5163
2.2 Owner or toss"of buMAV or s&uolwo
Name:
Address
Telephone:
F
AGENCY OR AUTHORfTY AUTHORIZING CONSTRUCTIONY Naesss:
Agency Projed Number.
Now T4*
9.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
�.�
For new eons cti
Additia�
Renovation Number of Sntoriees Renovated
Change in Use r° New
Demolition �' Existing CAI Cf
,Approximate year of r� Ares per floor(sfl Renovated
conswcton or renovation
of existing btu'Itling
13 W Description of Proposed Woric
_
9.t IJSE GROUF'AND CONSTRUCTION CtASSWIGATiON(EzistTnk6`tUtf11n 5Qn{y
USE Groups} EXISTING PROPOSED Ch e. 'CONSTRUICTIOlif
User. Hazard Use Hazer¢ CCASSIFICAT
( = M, x
Group" Index ''iroup Index indek* (`f� 1.,
A Assembly 1A
B Business
E Educational ti,
F Factory 2B:
H High Hazard = 2C
Institutionat 3A.
M Mercantile 38
R Residential q
S Storage 5A
U Utility 59
Mx Mixed Use Hazard Index
iflar
Sp Special Use U
' Note: Include Hazard Index Modifier for Construction Type as applicable
8.0, COMPLETE THIS SECTION FOR NEW:CONtU N ONLY
For E dsft Buildings.Proceed to Section 9.0
Number of Stories above - Number of Stories Below
Grade s In Y _
S H ' ) . Fto�
Per Floor
con► e�nt z
,sue i �
Total Building Height l I Total Eui OV Area Above
above Grade . .: . Grade
Total Building depth below.. > Total Building Area Below
Grade _ t/ Grade
Description of Proposed Work
ldyt . 4vol
Ilr2 USE CaRMW AND CON$T!Nl WN CLAfl8IWA3lON(Nett[ uctton Orr 1 '
USE OROUF `'- USE G SURD" Rr ' CONSTRUCTION
applicabCe CLASSIFICATION
A .. y /F� A-2 A-3 A-4` IA,
B Business 1 B
E Educational 2A
F Factory F-1 F-2 28
H H10 Hazar! H-1 H-2 H-3 H-4 2C
1 Institutiona 1-1 1-2 1-3 3A
M Mercan tit e' 38
R Residential; R-1 R-2 R-3 4
S Storage :t S-1 S-2 5A
U Utility 59
Mx M'pced Use SPedfy-
Sp Special Use Spy'
8.0 COMPLETE THIS SECTION FOR NEI I� ONLY
For Existingi BullidlimisArocead to.Section 9.0
Number of Stories above -. No of Stories Below
Grade Grade
Story Heigh. /v ' Flmgr Area Per Floor �� �' b l.J
Total Bukft TO Height %b Grade
above Grade Area Above r .8,
Total Building depot below, Total Building Area Below`
Grade-.: UGrade
Brief Description of Proposed Wor c
uN►1s 40,6
�2wiev,� �tral<' 9rivrex� s�ne lj Ce�,� } -) P c'
02 USE GROUR AND CONSTRUCTION CLASIFICAXI .019W Consbvctton Only]-.
U ;�RQ USE GRE)lJP1i8-C tCf
:. (�Ias.aiUCley.' , ah � i.. CATION
A .. Assembly A-i._ A-2. A-4 1A
8 Business 1B
E Educational 2A
F Factory F-1 F-2 2B
H 1-110 Hazard H-1 M-2 H-3 H-4 2C
Instiiutionat 1-1 1-2 1-3 3A
M Mercantile 38
R ResidentW, R-1 R-2 R-3 4
S Storage S-1 S-2 LL± 5A.
U Utility 5B
Mx Mbred Use Specify.
Specify: ,
Sp Speraal Use
Application for Permit to:
Location rn,
Permit Granted
A roved:
Inspecto of Bull ngs
i ,
A
I�4
I
I A,
I
�� Z U,
l }
i
C �
i
I
i __
&0 CONSTRUCWK COSTS(See Tao CURAppendbc L)
Total Conauuc*m Cod a M*q Pen*Fee Cheek Number
(1) s(1)x f0A01
5" JW
10.0 AUTHORIZATION OF STATE AGENCY FOR AGENT TO APPLY FOR BUUJW4 G
PERIBT(when )
1. on behalf of the audwea ft State
Agency or Authority► hereby autleorFiei to apply
for the building per"mor pnjeat mmeer.
Signature oat®
11.0 SIGNATURE OF BUILDING PEWIT APPLICANT
Name
Swoturoy Oa*
12. Cortiftcab d O=panay required on oomphidan of projed? Yes No
Insoectoes Notes:
y �Z d w+ Je.• Ca ere —rtg v�J
C� St�w`l �l �, a gz� ✓® A ai's