37 TURNER ST - BUILDING INSPECTION (2) CKI
REvEl mIGES
The Commonwealth of Massachl � 2
Department of Public Safety CC A I
Massachusetts State Building Code(780 CMR) ,q �VO 13
Building Permit Application for any Building other than a One-or 7 o-Family Dwelling
(This Section For Official.Use Only):...
Building Permit Number: :. Pate Applied: Building Official.:
SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available)
27 -rvRAint .Pr rl'A- c_a�d4 44A o / 9>a
No.and Street City/Town Zip Code Name of Building(if applicable)
SECTION 2:PROPOSED WORK,> - - - -
Edition of MA State Code used ZO If New Construction check here❑or check all that apply in the two rows below
Existing Building Repair❑ 1 Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change ofUse ❑ Change of-Occupancy ❑ 1 Other X-Specify: LAJ.`ULo s
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No AV
Is an Independent Structural Engineering Peer Review required? Yes ❑ No-43--
Brief Description of Proposed Work: X'I l/> C4 �= G LA : LTG-'} b d✓,A-J 4`f
17FjZJ�T/ _ r�LiLZ�rad. 7__
SECTION.3:COMPLETE THIS.SECTION'IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
',CHANGE INUSE OR OCCUPANCY
Check here if an Existing Building Investigati on and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s):
' • ,5. . .SECTION 4iBUILDING 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.) 3osZ. Z o Z �
SECTION 5:USE GROUP(Check as°applicable) '
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑
R Facto F-1❑ F2❑ H: IL!
Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional I-1❑ 1-2❑ 1-3❑ 1-4❑ M: antile❑ R: Residential R-W R-2❑ R-3❑ R4❑
S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑,and please describe below:
Special Use:
SECTION_ :6:NCONSTRUCTION,TYPE(Cheek as applicable) ?
IA Ill ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 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 ffi Indicate municipaLla' A trench will not be Licensed Disposal Site.'
one: o stem❑ required trench or specify:
Private❑ or inden ' Zone:- r on sites y permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable fli' Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ or No 431- Yes❑ No ❑
SECTION 8:CONTENT;OF CERTIFICATE DF OCCUPANCY , -
Edition of Code: Use Group(s): Type of Construction: - Occupant Load per Floor:
Does the building contain an Sprinkler System?: Special Stipulations:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Z RPTc«ram
Name(Print) No.and Street City/Town/ Zip
Property Owner Contact Information:
2�[9� 1,37RAvw - CDC N�
Title Telephone No.(business) Telephone No. (cell) ail ad ass
If applicable,the property owner hereby authorizes , }
Name Street Address tty/Town S ate Zip
to act on the property owners behalf,in all matters relative to work authorized by this building permit application.
SECTION10.CONSTRUCTION CONTROh(Please fill out Appendix 2)`
building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check he and skip Section 10.1
Y0.1 Registered Professional Responsible for Construction Control
IL/JA,(_7) 13VReIC_7 C1 AP_Z>2-� 1V1f1 S Co 4 .
Name(Registrant) Telephone No. e-mail address Registration Number
��=��p+�' <.r�,=,� .Age D(5t� M&!A.� 31�cv
Street A dress City/T/o�w�nT— State Zip Discipline Expiration Date
`10.2 General Contractor - -•' ' --
Company Name
Name of Person Responsible for Construction License No. and Type if Applicable
3/ M a�e�fz'l�Gsk 0
Street Address City�� State Zip
2P?2?11G z9 q�3 � r�,J, f�Jr�nr,; ,J �mr r.ene"
Telephone No.(business) Telephone No. cell e-mail address
SECTION 11:WORKERS'.COMPENSATION INSURANCE AFFIDAVIT 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 12:;CONSTRUCTION COSTS ANDPERMIT,FEE,
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)
1.Building $ 6 O Building Permit Fee=Total Construction Cost x�-(r- Insert here
2.Electrical $ appropriate municipal factor)_$ _�
3.Plumbing- $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical Other $ Enclose check payable to GZj f
6.Total Cost $ q
5 6 O.P40 (contact municipality)and write check number here
' d SBCTION 13:SIGNATURE OF BUILDIWG PERMIT APPLICANT
By entering my name below,I hereby attest under the pains ancNenalties of perjury that all of the information contained in this
application is true and accurate to the best of my knowle e a derstanding.
Please print and sign name Title Telephone No. Date
Street Address City/Town State Zip
Munrerpal Inspector to fill out tlos seetron upon application approval: - -
- Name -Date -
�e oi �tr>izrct ril� ry �C�/� C1,66(2, �
Office of Consumer Affairs and BusinessRegulation
t f 10 Park Plaza - Suite 5170
� y
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 178530
+ Type: Supplement Card
BUILDER SERVICES GROUP INC.! !- Expiration: 4/23/2016
DON BURNETT
260 JIMMY ANN DRIVE
DAYTONA BEACH, FL 32114
Update Address and return card.Mark reason for change.
SCA I t, 20tA-osni Address I- I Renewal D Employment F—1 Lost Card
l?rn......... u�/�n��.^y.-�fxaioc/rrdGl/t
trice of Oonanmer.trfairl&Business ltcgutatioa. License or registration valid for.individul use only
+L�-' OME IMPROVEMENT CONTRACTOR before the expiration date..If found return to: '
Office of Consumer Affairs and Business Regulation
E egistratlon 178530. Type: 10 Park Plaza-Suite 5170
no Expiration q/23)2016 ,;,r Supplement 1:a/d :Boston,MA 02116
BUILDER SERVICES GROUP''„INC.
JONES BOYS INS6LATI6N:
DON BURNETT -
q CHARTER ST
DANVERS,MA 01923 Undersecretary Not valid without signature
Massachusetts -Department of Public Safety
,Board of Building Regulations and.Standards
Construction Supmisor Specialty
License CSSL 102535 `r#
DONALDLBURN9TT r
31 MARION ROAD c , mt2 _
MARBLEHEADMA
J.•G.- ill c5[ - n "� Explraliml
comoussione, 1210612014