28 TREMONT ST - BUILDING INSPECTION (2) 2q oc 114
�U— I L4— 12-7-7 RECEIVED .
The Commonwealth of Ma QisjcL S .f
Department of Public Safety
Massachuse I is State Building Code(780Mgt)JU�I
Building Permit Application for any Building other than a One-or-Tvvo-Family D%el
(This Section For Official Use Only)
Building Permit Number: Dale Applied: Building Official:
SECTION 1:LOCATION(Please indicate Block N and Lot k for locations for which a street address is not available)
.2B 7P�i Pt rsT S/1cEM PA diella-
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
Existing Building❑ I Repair Alteration ❑ Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ 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 2"
Brief Description of Proposed Work: �'d RAO RD�JIfCp�/s OM GJ fLo�2 OF
�uis�n�r 3 jc FJIW t"AIAC. N.Cw RiFY7-/ .DELDCt"c" DG sOlifF
GIAZLS
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):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)8r 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 Cl A4❑ A-5❑ 1 B: Business ❑ F.: Educational ❑
F: Facto F-1 ❑ F2❑ If: High Hazard H-1❑ H-2❑ H-3 ❑ FI-4❑ H-5❑
1: Institutional I-l ❑ 1-2❑ 1-3❑ 1-4❑ 1 M: Mercantile❑ R: Residential R-l❑ 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 a licable)
IA ❑ IB Cl IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ 1 IV ❑ VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 78U CMR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal:
Trench Permit: Debris Removal:
Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑
required ❑or trench or specify:
Private❑ or indentify Zone: or on site system❑ permit is enclosed Cl
Railroad right-of-way: Ilazards to Air Navigation: %1'\.I_li i i i oiling ti i l . " l 3 =:
Not Applicable❑ Is Structure within airport approadt area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Curie: Use Group(s): Type of Construction: Occupant Load per Floor:--
Does the building contain,111 Sprinkler System?: tipecial Slipulations:
Cr�� ,
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Addressiof Prop'cty.Ow tier
� 71f1
a�C f'f�lAW11172M/p
:r fZa476tX27A .
Name(Print) ,,tNpo.and Street City/Town Zip
Properly bv,C Z� ,.Conlactlln`o du.n Nil)
�0►1 ti1 Gpl jb1A : 'M
Title Telephone No.(business) "Telephone No. (cell) a-mail address
If applicable,the property owner hereby authorizes
Name Street Address City/Town State Zip
to act on the property owner's behalf, in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If building is less than 33,000 cu.ft.of encloseds ace and/or not under Construction Control then check here 13�5,�dsktp Section 10.1
10.1 Registered Professional Responsible for Construction Control
Nana(Registrant) Telephone No. e-moil address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2'Geeneral Contractor
Lam! Gfl,2i0 A/ COA),q-R
Company Name 10,4 /7,/G y4
4081sro/«7
Name of Persoil Responsible for Construction License No. and Type if Applicable
Street Address City/Town State Zip
qj-2 2 gro
Telephone No. business Telephone No. cell e-mail address
SECTION 11:WORKERS'C:OMPENSA PION IN9UIt:\NCf AH IUAM M.C.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 ❑
SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Toted Construction Cost(from Item 6)_
I. Building $ 15—,0OZ Building Permit Fee-Total Construction Cost s_(Insert here
2. Electrical $ 3 S'00 , appropriate municipal factor)_
3. Plumbing $ I,400
4. Mechanical (HVAC) $ Note:Minimum fee=$ (contact muni`'i{Iality)
5. Mechanical Other $ Enclose check payable to Jv�
P•
6.Total Cost $ c00 (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 knowledge and understanding.
Pease print and sign name / Title Telephone No. Date
Street Address City own State Zi
Municipal Inspector to fill out this section upon application approval•
Name ate
CITY U E S.1L E'�t, Lti L-1SS:1CR US ETTS
BL•ILDNC DEP.1R-IItENr
Yr r• 1_1) WA314LYGTON STREET 1, 'O FLOOR �
TM (973) 745-9595
KIMBERUY DRJSCOLL FAA(973) 7-1-9344
N L1 YO;t
T'-tasc�s Sr.PtE.�tg
DIRECTOR OF PU3UC PROP ERTY/aCILoLN(; CO\NISSIONEZ
Construction Debris Disposal A tldavit
(required for all demolition and renovation work)
In accordance Debris, with the sixth edition of the State Building Code, 730 CDdR section It 1.5
and the provisions of rbtGL c 40, S 54;
Building Permit !# is issued with the condition that the debris resulting &am
this work shall be disposed of in a properly licensed waste disposal facility as defined by bIGL c
111, S I50A.
The debris will be transported by:
ti J /
(nantc u( hauler)
The dchris will be disposed of in
(name of ractl(idJtas.c or raetht�)
S ufprrrnit applicant
r CCI'Y OF 5iu Em, iNvL\SSACHUSETTS
BUILDING DEP.SRTMEINT
120 WASHNGTON STREET, 3aa FLOOR
TEL (978) 745-9595
Fla(978) 740-9846
KIMBERLEY DRISCOLL
MAYOR THo&L\s ST.PIERRE
DIRECTOR OF PUBLIC PROPERTY/B(YLDING CONNISSIONER
Workers' Compensation Insurance Affidavit: t)uilders/Contra(tors/Electricians/Plumbers
,lpplicant Information Please Print t eoibly
Name tnusiness�Organiration'Indiv_iA/uaq:�
Address: �D Qir1-CiAS€ 3f.�6
City/State/Zip: S. d5o" �Y14 Phone fit: 97-7yy—EW70
Are you an employer;'Check the appropriate box: Type of project(required):
1.❑ 1 am a employer with 4, ❑ I am a general contractor and 1 6. ❑New construction
eta Inyees(full and/or part-time)." have hired the sub-contractors
?. am a sole proprietor or purtnur- listed on the attached sheet. S 7. ❑ Remodeling
ship and have no employees These sub-contractors have 3. �] Demolition
working tsar me in any capacity. workers'comp. insurance. y. Building addition
(No worker•'camp. insurance S. ❑ We are a corporation mid its
required.) oRicers have exercised their 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions
myself. (No workcas' comp. c. 152, §1(4),and we have no 12.[ Roof repairs
insurance required.) I employees. (No workers' 13,Q Other
comp. insurance required.)
'Any upp ltcani dui cheeks but B I must also 011 cut the section below showing their wotken'compenaaeon policy in Abrmation.
'I h•meowncrs whu uhmit this allldnvit indicating'hey arc doing all work and then hire outride contractors most submit a new aMduvil indicating such.
t'nilmaoo Out chuck this box mass.nlochal on:Idditiorurl.hut showing the n:une of the subtenlrsclors and their workers'camp.policy infurmalion.
I ant an euspluyer that is providing workers'cunlpeusadon insurance for my employees. Ualuw Is the policy and fob rile
irlf rnralion.
I nsorutcc Company Nainc—i,
Policy i!ur Self-ins. Lic. N: ��[n 53�S�r '1,?�2F�o1�_ Expiration
tub Site Address: o?P i ci Q � �y ryep: �4 7
Attach a copy of the workers'compensation pulley declaration pare(slowing the policy number and expiration date).
failure to secure coverage as required under Section 25A of SIGL c. 152 can lead to the imposition of criminal penalties Of a
line up to S1,500.00 und/or One-year imprisonment, as well as civil penalties in the form of STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Ile advised that a copy of this srrtement may be funvardcd to the Off-tce of
Invraigwiunz ul lhu DL\ fur insurance coverage veriticatiun.
/da Itereby t y uudet the pains s d peaulties u peri ry that the infuriation provided ubuva i.v true and tarrecL
rc Bate 6�L3//t/
Phunc t
OJticial use only. Donor write in this area, to be completed by city us,tatvn ajjlciuf
City or Town: _... -- Permitfi.lccnsc p__....
Issuing Awhority (circle one):
1. Board of Health 2. Buildlm„ Bep:ji Imeut .1.Glylfnwn C'Ierk I. F:Iectrical inspector 5. Plumbing htspaclur
4. Other _. -- --. ._
'
(bnh.td Ptrtnn: Phone !I:
G,v EXISTING BFOftin
3' xaem
DEMOLITION
L — � pOevYY Pose 4uWs3 VA@&5
re-eor�AA-
NEW CONSTRUCTION �ZTEFpgl ���
15'-2" ; .30958 1 E
'ARBLEHEAD . y [
MASS.
q( pssq.
-E REES
II
II
LIVING ROOM I BEDROOMI I LIVING ROOM
0
9'-0" x 8'-6" . 0'-II" x 5'-2" x 9'-O"
II � o z
REMOVE
WALL,-
PATCH FLOOR �\ a
V - BEARING ` \ Q
REMOVE
FWALL WALLS AND
F - - - - - - PATCH E,
Irk \I I FLOOR t WALLS a a
\ r -�`
L - - - - L - - J z H
—� L - - - - REMOVE W0
r.. ....::.: a WALLS. L - - - - - L H a
1 - —_� L - - - - - - - - - F ] Q'
I' FIXTURES AND m
FLOOR FINISHES \ 0 W
------- REMOVE — LJ ICJ c n KITCHEN \ W W w Z
— ] H
i.E CABINETS, I 1 -�,� -�-j 13'-5" x 13'-2"
PATCHE
EWALLS 1 ��_ n z 0 F,
- - - - DN ¢ z'
M_ O ;�, REMOVE V. E� 0
CABINETS t o z
FIXTURES, BEARING =
REMOVE PATCHWALL
LE WINDOW m WALLS W F
REMOVE cREs m W F N
DOOR - UP
I �r - - ter- - — - - - - � � — _ —�
III GR II r ��
===J _ JI r - - 11- - -
L - - � �.. L _ — J
�I �I
_ PERMT SET
- I I
L _ — — — — — — _ — _ — J
EXISTING AND DEMOLITION FIRST FLOOD FL ,4N Ex. 1.1
1/4" = 1'-0"
BFortin
4T-2 1/2"
EXISTING 5 _2" _e°
�STEA F
.DEMOLITION r � E
- - - - - J � .30958
NEW CONSTRUCTION A sLEHEAD
MASS.
-2 I/9" FAIIHOFMPSn��
E REES
I r
n
P
a- SLIDDING DOOR
5'-4 1/2" ry T —POST POST
V.L F. BEDROOM DOWN OWN
BEDROOM BATHO
Is'-2" x 9'-0" LIVING
x 13'-6" 0'-II" x s'-O"
21" x 60"
EXIST VANITY NEW —
SD SO
tb
n
C
m
I- El
N
w — — — — — — — — \ ?. NEW p„ INFILL WALL t DOWN v
POST DOWN
t6a CW7 SD�g1. INSTALL NEW DOORIN
771—
r' NEW
• OPENING EXISTING
I p CC Q
Q —
BEAM 0
O (NEW WOOD FLOOR) `�
5'-0" x 6'-e" W KITCHEN
p Q W
SLIDDING DO R -
EQUAL EQUAL 2'-0 I/ q -0 m POST
DOWN 13' S" x 3'-2" POST
NEW m --
ry _ SD �x - DOWN W [-
A Q
M • ON REMOVE EXISTING DINING O W �+
BEDROOM WINDOW AND OPENING I'-8" x II'-O' _ 0
x I0'-9 I/2" O
m
(NEW WOOD FLOOR) NEW CABINETS
UP -EGRES m AND COUNTERS P E N
��-POST �� OST
INFILL DOWN OWN
EXISTING
DOOR
a o o - - - - -
PERNT SET
NEW WINDOW
7REBUILD 7�
STAIRS
4l'-2 I/2"
FIRST FLOOR FL �4N A1.1