0060 - 0062 WASHINGTON SQUARE SOUTH - BPA-11-851�, ���/- //
'=�'� - The Commonwealth of Massachusetts
� �II��� Department of Public Safety
� � � V) � biassnchuscttsStatc l3uilding Cudc(7ft0 CbIR)
�"� � Building Permit Application for any Building other than a One-or Two-F m' � elli�
(This Section For Officinl Use Only)
Building Pennit Nwnbec ' Da[e Applied: Building Official:
�, SECfION 1:LOCATION(Please indicate Block#and Lot q for locations fur which a street address is not available)
' ����OZ �LL/�A�fiLl7L G� �K ' - .
. Na and Street City/Tuwn Zip Cude Name o1 Building(if applicuble)
SECTfON 2:PROPOSkiD WORK
fditiun uf MA Stah Cude useJ_ If New Cnnstruc[iun duck here O ur check nll that apply in the hvu rows bcluw
E�istin�;13uilding❑ Rep.iir❑ Altcralion ❑ Addi[iun❑ Demulitiun 0 (Please fill uut and subnti[AppenJix I),
Change uf Usc ❑ Change uf Occupancy ❑ Other ❑ Specify:
Are building plans and/ur cunstructiun d�xuments being supplied as part of tliis permit applir.ition? Yes ❑ Nu ❑
Is an Independent Structural Engincering I'eei Review rcyuired? � Ycs ❑ No ❑
13rief Description uf Prnpused Wurk: .
�T � �
� SECTION 3:COMPLETE THIS SECTION IF EXISTWG BUILDING UNDERGOING RENOVAT[OtY,ADDITIOIV,OR
CHANGE W USE OR OCCUPANCY
� Check hcrr if an Existing Building Investigation and Evaluation is endoscd(Sce 780 CMR 3-4) ❑
Existing Use Group(s): Pruposed Use Group(s):
SECI'ION 4: BUILDING HEIGHT AND AREA � "
Exis[ing Prupused
No.uf Floorp/Sturics(indudc basenten[levcls)&Area Per Floot(sq. ft.)
� Tutal Area(x�.ft.)and Total Hcight(ft.)
SECTION 5:USE GROUP(Check as ap licable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ G Educational ❑
F: Pacto F-1 ❑ F2❑ H: Hi h Hazazd H-! ❑ H-2❑ H-3 ❑ H-�l❑ H-5❑
L Institutional I-1 ❑ I-2❑ I-3❑ I-k❑ M: Mercantile❑ R: Residential .R-l❑ R-2❑ R-;5❑ R-4❑
S: Storage St ❑ S2❑ U: Utility❑ Special Use�and ple�se describe bclow:
Special Usc � � � �
SECTfON 6:CONSTRUCTION 7'YPE(Check as ap litable) �
IA ❑ IB ❑ 1[A ❑ 118 ❑ IIIA ❑ � 111B ❑ IV ❑ VA ❑ VB ❑ � .
SECT[ON 7:SITE INFORMATION(refer to 780 ChIR 111A fur details on each item) '
Water Supply: Flood Zone Infonnation: Sewage Disposal:
Trench Permit: Debris Removal: .
A trench tvill nut bc Licensed Dispos,il Site❑
. Public❑ Check if oulsiJe FInoJ Zune❑ Indiente municipal❑ �.
rcyuired O ui trench or specify:
Privatc❑ ur indentify Zune� , or un site sqsletn ❑ vi•rmi[is i�ndosed❑
Railroadright-of-avay: Ii�zardstoAirNavigatiun: �I-) Ilhi,�ri���.,�,�i,n,.,p��:;:,�.:��.�� 1':y,r,.:
\�ut:\pplie,�ble❑ Is Slructurc�aithin air��ort appruach are;i? Is Ihcir revicw iomplctcd?
ur Conticnt tu l3uilJ cni luticd❑ Ycti O or�\b❑ Ycti❑ Na ❑
SECI'ION&CONTENT'OF CERTIPICA'iE OF OCCUPANCY
fJili��n uf CuJc:____Gtic Gruup(s):__ "I�\'pc nl Cuntilrudion:___ Ocrupunt L.oad per Plour:_ '__
Ducs thc huili�ing r�inlain an Sprinklcr S�'slcin':____Spocial Stipidotiuns: ___ __ ____
�
� SEC"t'ION 9: PROPBR'I'Y OWN@R AU'PHORIZATION
�N,wie.ind �ddress ut Pro/p y���',[}�'U�vncr .
P�Ji J�d.�/
Nome(Print) No. and Street City/Town Zip
Property Owncr Contact[nlormation:
Title . � ',� `, � Tclephone Na (business) Telephone No. (cell) o-mail address •
If applicable, lhr property owner hereby aulhoriz.es -
Namc Stree[Address City/Tuwn Statc . Zip
tn.ict un thc ro er owner's bchalf, in all matters relative tu work authorized b this buildin ermit n lication.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If buildin is Iess tlkin 35,000 ca Ft.of endosed s uce und or nol imder Construction Control then check here O and ski Section 10.1 �
101 Re i ed Professional Res onsible for nstruction Control
o ,�.a T y c T t __y ��✓, �o.� l00�'",�/
Name( trant) , � Te1e me muil iddress Registra[ion Nwnber
/L'i� fi'�l� Q/��/� �/�.Qie �,c ��a�'T.'�
Strcet Address � i /Town State Zip Discipline Expiration Dnte
/ �'o�� !� .� .� -
10.2 General Contrador - f
Cumpany Name . .
Name uf Person Respunsible for Cnnstruction License No. and Type if Applicable
Slreet Addmss City/Tuwn State Zip �
Tcle hune Nu. business Tele hune No. cell e-mail addmss
SECTION 11:\vO�:f:P.I:S C:0�1�'IcNSiYCIU\�IK�4UI::WCIi:\I'FIn��V�I� M.G.L.c.152. 25C 6 �
A Workers'Compensution Insurance Affidavit from the MA Department oF Industrial Accilents must be cumpleted und
submitted with this application. Failure to provide this affidavit will result in the denial of[he issuance of the building pennit.
� Is a si ned Affidavit submitted with this a lication? Yes O No O �
SECI'ION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Es[imated Cos[s:(Labor
:nd Materials) Total Construction Cost(from Item 6)=5 i
1. Building $ Build'uig Pennit Fce=Total Construction Cust x_(Inscrt hcre
2. El�wtrical S appropria[e municipal(actoc)=5
3. Plumbing $ .
�. �1ech.inical (HVAC) � Nutc Alinim�S,u,m fec=/�$ (cunt�.c�t�myyu�ni/cipality) �J
i. Mechanical Other S ��� vVG�'U4/� �n �r/p/`�"�`fiL �YrY./"�
_ Enduse cheiic payable tn
6.Total Cust 5 � (contuct municip;ility)and write check numbec here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
B��cntering my namc beluw, I hemby:ittest widcr[he pains anJ pcnalties of pery'ury that all uf the infurmatiun euntained in this
applicatiun is true and aceurah tu the best uf uiy knuwledge,md understanding. .
I'Icasc print and sign name TiHc �I�clephonc No. Uotc
Strcel Aildretis CiIV�I'own S ete Zip .
Municipal Inspector to fill out this section upon application approval:
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� 55.63'
! 64.91' N 180.20'
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0.9'� � N85'24'45"E ^
oN ~ S84'33'33"W \\ S85'54'30"W
LINE -- \
RAILROAD �
SPIKE
FOUND
SEE PL. BK. 171 PL. 63
WASHINGTON SQUARE SOUTH
BENCHMARK ;
�
I CERTIFY THAT THE PROPERTY LINES SHOWN ARE THE LINES '` . II
DIVIDING EXISTING OWNERSHIPS AND THE LINES OF STREETS AND
WAYS SHOWN ARE THOSE OF PUBLIC OR PRIVATE STREETS OR WAlYS I
FOR REGISTRY USE ONLY ALREADY ESTABUSHED AND NO NEW LINES FOR DIVISION OF ,
EXISTING OWNERSHIPS OR FOR NEW WAYS ARE SHOWN. '
CHM7ER 41 SEC710N 81X.
',
�F��HOFMqgs4c PILAN OF LANID �
9
I CERTIFY THAT THIS PLAN CONFORMS TO THE �° �^'� `"�,
RULES AND REGULATIONS OF THE REGISTERS OF DEEDS. �- � sM,n+ y
A No.35043 � I N
���sRF�'�:Q�9� SALEM
I CERTIFY THAT THIS PLAN FULLY AND ACCURATELY DEPICTS THE `�R�a'-�p"ose
LAYOUT, LOCATION AND DIMENSIONS OF THE BUILDINGS AT - PREPARED FOR i
60-62 WASHINGTON SQUARE SOUTH, SALEM, M,a., a,s eui�r allo -- •� GRAPHIC SCALE RENAISS�ANCE COND01�1NIUM AT I
FULLY USTS THE UNITS CONTAINED THEREIN. '
� ��� . 60- 62 W�ISHINGTON SQUARE SOUTH '
s o s s ,o su I
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T REGISTERED ROFESSIONAL LAND SURVEYOR � IN �ET � RIL 6, 2011
1 inch = 6 t�. NORTH SHORE SURVEY CORPORATION
14� BRONM STREET — SALEM, MA
978-744-4800 #3492 �
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