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157 WASHINGTON ST - BUILDING INSPECTION (4) Mar 031611:44a Rag Associates 19782582012 p.4 1311Z sP fcr NAM Ry 15g — I g� 1Ulb ICES y The Commonwealth of Massachusetts /:'42 ITS Department of Public Safety Uf hfnswrhusLussin c Bunda w Cmle(Mcmit) Building Permit Application forany Building other than a One-or Two-pamlly L)weiling O tts SecXon Ebr O(6dal UaeQn ) - BuBJiteHPermitplumber. Dade Applied: BuiWInR OffldaL• 9E lONi•F.00A11pN(PitasefndltaeeMmky unit Lot#for laeatiunaforwhkhaatceetoddevsnfecalavaBabk) No.awl Street l5iy/Town " Zip Cole Nitrite of Building(if appt=*H SECTION 2 PAOP09®WORC _ .�, Edition of MA ShYe CaeJe use.l If New CuesMoetlan check here 0 oe rhrek ail IMI apply k the two ru.ws beiuw Eteigina BuBdingq RepakO Alecratlon O Add it , Demolition 0 (Pkwe fill out and submit Appendix lj _ ^ m1b; eof tkx O CkangeedOccugancy 13 Otlwy D 5pedfy;_, . \V�i1 i, bulktfng pluaand/or oonsliuctiue ducuendmte britgsuppl4Maep"twlf irpohnitappliratica Yes Q NO ld is ao fndependwiSlnntoral Erg�rhtg peer Review tequliedt - Yee O No. Brief DCwcrkWOn Of Proposed FVoR U 56CI[ON 3:COMPIJ:TETHi5 SECTlMV IF 01SnNG BUILDING UNDBRGOINC AENOVAT[ON,AMM.(')hy OR CHANGE nV UM OROCCUPANCY Clealihore ifnn&mBng poih4ng t»veeligatfon and Evaloadeee is CnclasY.0 IEee 7RRCMR 3ij0 Existing Use Geonp(s) Proposed Ilse t anup(s)• . .SECIION4 BUi1.DING UHG)IT AND AREA .. . 'Esktk+6 piopneel Nu.of Fluorc/Swrlei(kecWde 0.�asn Iweb)d.Area per flow(8%ft.) Total Area(.9%,L)and Total Height pL) .. . SECITON1c USE CROUP(Check u A; Aaeemb)y A-10 A-40 Nikebklub D Aa d A-FG ASO . FC 9Yateeee 0 E: Erhre7Kcotal Q F. 'Fa FI 0 F2 0 1h m Haarrd Hit 0 H-2 q H-0 0 H4 D H•.513 I: Institutional FI q t-2HUM IB: $eakFmtlil R-7(] 'R-2 Q R-1 f] R-7 Q S. Slora S.1 Q S3 O U; a 5 al Use O cal describe betuw: 5 "d Use: SECTION it CONSTRUCTION TYPE check aaa IA Q IBM 111141, 13 UFO G ry D VA O Vs Q SECFION7:SITEINFOpMAnON(ref,,do 7ftCh4m 111.D For defalh-- - - .rem) wale supply: Flood Zone kdormat.ont Sewage Disposal• Trneeh Peewit Debris nee m-aL- Public 0 Cttr.-k i(ourskle Flowl ZuneD lvdlrmO muokipal Q A 1=1 will not be LicansOe!Disposal Site 0 PdvateD or indentify Z,ex: wonsitesyskmO mgtlbeJ Q o"mach Or specil)c pa+mit is enclate,10 Railroad right-oF.waY• Harant,to Av Nw%anorc %t.A,f Iistr.1lS'.LLent"`cum NW Applicable❑ Is Struceum within airport approarh aesslt k tlwir eawiew comphRil? . or Colman to Build ewltted❑ Yes0 tv No Yet No ❑ SECTION e:CONTENT OF CERTIFICATE OF OCCUPANCY EJitiai of Gale: L)VCwup(s): TypeofCan9nn7iun: LXTupaul Load por Flow• Does the kuBJing cuadtln an Sprinkks Systunl: Spavial SlipuLtiknes: CYa a ' SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Pr operty Owner r' a 157 WasLZfih?K%5t- S al eAA /VVk ame Pf ) No.and Street City/Town Zip ( Property Owner Contact Information: Title Telephone No. (business) Telephone No. (cell) e-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) 1, f building is less than 35,000 cu.ft.of enclosed space and or not under Construction Control then check Here 0 and,ski' Section 10.1 10.1 Registered Professional Responsible for.Construction Control I I I _ Name(Registrant) r Telephone No. e-mail address Registration Number L 2 e—le,w,er.rl AAr�7� e 2 J 411E: l� Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Company Name i ,,,.) t; tgnt Nam ofm of Pirson ResponsiWe for Construction License No. and Type if Applicable 'mil rnrjC�,iYrj J�) Lan C /✓/e� ,r 14�-- O Street Address City/Towne State Zip Telephone No. business Telephone No. cell - �-�G 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 a lication? Yes❑ No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ 2 000 Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)_$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ (contact municipality)and write check number here SECTION 13:.SIGNATURE OF BUILDING PERMIT APPLICANT'S B entering m name y g y e 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. Please print and sign name Title Telephone No. Date Street Address City/Town �JState Zip Municipal Inspector to fill out this section'upon application approval: - Name Date Office of Consumer Affairs&Business Regulation-Mass.Gov https://services.oca.state.ma.us/Wc/licenseelist.aspx - .` The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) O Consumer Affairs and Business Regulation / ra•" Home Consumer Rights and Resources Home Improvement Contracting Home Improvement Contractor Registration Lookup To search by registration number, enter the registration number in the textbox below and click the 'Search' button. Search by Registration Number 1181776 Search You must click the "Search Registrant" button to search by name or location. Search by Registrant Company name Search by Registrant Last name City/Town Search Registrant State I — Zip code Click on the registration number to view complaint history. You can also view arbitration and Guaranty Fund history. The list is current as of Wednesday, March 2, 2016. Search Results REGISTRANT RESPONSIBLE REGISTRATION EXPIRATION NAME INDIVIDUAL NUMBER ADDRESS DATE STATUS RYAN ANTHONY GAGNE 181776 7 COACHMAN LN. 04/28/2017 Current METHUEN, MA 01844 ©2012 Commonwealth of Massachusetts. Mass.GovO is a registered service mark of the Commonwealth of Massachusetts. 1 of 1 3/3/2016 3:48 PM Details Page 1 of 1 The Official Website of the Executive Office of Public Safety and Security(EOPSS) Mass.Gov Home State Agencies ensee Details ull am A J TOCCHELLI ender: viner Name: dress: ddress 2: ity: Methuen tate: MA ipcode: 01844 o nt U 'ted fates License NO: (;b-U 1494 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 7/28/2015 Issue Date: Expiration Date: 7/22/2017 License Status: Active Today's Date: 3/8/2016 Secondary License: Doing Business As: atus Change: LAW Renew I o Pre-requisite Information No Discipline Information ocumen um Close Window ©2011 Commonwealth of Massachusetts Site Policies Contact Us http://elicense.chs.state.ma.us/Verification/Details.aspx?agency_id=1&license_id=263897& 3/8/2016 Mar 03 1611:44a Rag Associates 19782582012 p.2 SECTION 9+ rsorfm'tt CNOWt ALETOR&A-floN -• rsta Pr rtyotvv iI Zip Na.and Street City/Tawa t Q Name(Pring33 �mU p rly Owner ConUxl uilorn+ai ^� � �-�� Na o. �iLL�',- _ enla1t a11Jres6 o'`-`G• T.depkwnt (UusHta°) do Tcicphmt Na (ce0) 11 applicably,the prope+ty,owner hereby aulhorizes Stemt Adrb'as City'/Taws Slate Zip Name thisbuiki jta lkalion- m apt on the ro Donets behalf Ina mattes tactic tm work audmdzed endli 2. - 9ECITON l0:CONF31•Au(170N COtdfROL(Plm7rfW oat APP l bu1W' Ulcardmn35.000 eu.A.atrneW:d an or note Cyaad Orme ekhenOaadsta Saoom70.t YOA Re tered reolm, nd We fyl� I an CotskuctlomContent . . -1 0 . (h �IJY IltgWratioa Numbec ant T lep "+ Air lip Dkelplimt Eaplratfo ate l St CurPf Rrl Ys- 102 1Cantractoe - Com�rtog / 7 7(- � IfA[.tame Nu. and Type PPlkib(e Nm•e of Ped'on rtes bk 6 ltncliun - .. Street ass ln¢,/, LSetr G Tao Imne No. asiats bhs. mad aJ.ltyas Telephone SECTION 1L• "IZS' a "NSAYf N_41 M'ilU P M.G.LG7SQ. 25 A Workers'Campemaanoe btsutaoc I Affidavit from the MA Department Of Wdu,W f ate ho b mast be eomplend mtJ Ilwaom. Feflumtopioatde"ofPolavte win result in the Jeutsl of ate ltaource ofdteh4W.IWg paurit suWnftted With'"app 0 submitted wtM Wlta tiant YaO N• O Is a st AffWay 5VM0r4 ar CpNS7AUCIYON Cows AND PERMIT FEE rstira wd Casts(Labor Total Conan--am (from Stem b)a S+ Item aml btaterials) I.oundin 3 O � OuoPubg Permir Fre-Tatai Comtru[tiomCmtx�.(ktserl tan' E Ekstrkai 4 appropriate munklpal factor)'S %Nombt 3 Note:ll tiuimturn Ire=4 (awtartmunkipakty) 4-merhank-4 (HVAC 3 . S.btnehAnit®1 O 3 Facloae dtockpayable to S � � ([ontaG mttnlri i and wade ckock number hem 6.Total Cast , ? SEMO Lk SIGNATURE OF 11IfILDING PEItWr AVPUCAW naltics d ar(nry Umt Alta(Ju� ya trJormotioadmtaLrod in this name ay ing my me Wtom I hereb m y art is true. a k to Ih 1 of my eJ omip+ P ge and \LY6(/&A z Tale ..Telephone� y`� PLase tanJslgnrurn L//12 � . ,PtiL •r�/1� City/Twvn Staute zip 5lrttzt Address hlunkipal Inspector to f911 out thin xctiom upam applicasionapprovab Name pate t 0 W 7 N 1- l- X � Tr' f u�eG"� i S J u s fi 0 0 ' C,eT. Lovv--iu�o co 9 � (N(i11 TO to a Co �.c�l ;�e5� m ZXy ail 2 �CG c� r, S ��vCi-fotilCD ��'en�5 oN Cn'�� cv N 0 N Lc,, W STu m Mar 031611:45a Rag Associates 19782582012 p.5 The Commonweakh ofMassaekuseW Deparbumt oflndssMalAL6Amts I COW=Street,Suite106 Barton,MA 02II4-20I7 wWW.naall:gOir�dfa . Rorkers'CormpentationInsuranceAffidavit:Builders/ContraetorpTAecu*U oaTiamben. TO BE FU"WrrA THE P=b9TTNG AXrMOWrV Applicant lubirinaillon 7 Name(8051' mw): , Address: calyistaleJz;p:. L2 ones: v3 _ Areym an eaplaryarr Chwk Ve approprgte bee: T'ypc of project(axqulred). I•(-14 emaemplpye will raplgera Cfaa antler part-time)." 7. ❑New eOostrucpon 2 w aieur 1prT/^lL'�Wo- e pmpapssmms* nor have aoemplor."&.a for.is INo we 8. []Rermdeling eaperi y. ha.'wmp.inn cc rupued7 IC]I mn a bmamwnerdatae all workmyadf[No wmkas'cam 9. ❑Demolition p.iaawama aegvired.11 s. I®abommwaa amd wN ea❑ Iwall 10❑Building addition idrleS cmkacomm madaCmil vmh an my aroparfy. maeaNetall co¢oaaoreadrr Save worker'twpa a6m mapmrae or era=:a ll.❑Electrical repairs ar additions I=ag=nwayap egmloYaa. 12-❑PlmgiI' g repairs or additions 5.�lsatsgrnad mnbcaor Sad ikavelmd&bpb.eo�etten limdaa Ne mudyedayeee Roof3.Tbeae evbsmtramm have employees and Saw woden'map,lalora t I ❑ nPsits 6.❑wema<ampaaran ead irs oleos hWerraeisaddm»theoraweamrioape Md.a 14.❑Olbetf�)C . 152,§m(4),and we have aw empbyam.[No wml¢ra'c9cp melee ragUtt&l `�✓,'/11"�, 'Myapplkc WX cluda Loa al aeon Wo rlourthe suvoabdew slpwna akev worker'canpaasadan peaoy i>afineaaam, . TFlameawoen who wbmaet Nit atrmdavitindimamipg mbeyee dangell work cad thm yore oarmaecoanecexa muaaplytim aaewaGimlavp tsdian6ag 31Wi. rCaanacmaeapamchbekCftmboa h ff,VI-eaadditiwmtmpeamiy thetwramscm*pb.coanacan andentewberha ar oo[�Ofemdda9 yaws ea�playas. IlNe euh=ctaaanen havicepyloym.ryaY muuprociae Nee waakeaa'mnY+palim'aaaba lama,employer throb provfQing workers''comperaaotioa taturancefor mq emplayea. Eelpw rs nc�ppdiry andjo7Y;dee tnfprmoriaa ImWanec Company Nam: ' PolicyO or Self-in:Lic.0; Expuatiam Date: Job Site Address: Attach a wry of the workers,compensation policy declaration page(showing the pokey number and axpiratton dale). Failure to secure coverage as required ands MOL c. 152,§25A is a Criminal violation punisbablc by a fine up to 51.500.00 and/or onrtyear impaisonmmat,as Well as Civil peuahift in the fog of a STOP WORX 0RD$R and a fine Ofu p to=50.00 a day against the violator.A copy eftkie statement nay be forwarded to the office of Inv"USadoas of the DLl for imarsue coverage veri£cation. I do hereby eesti - an p 'Cr ofperjmoy that ehe tnfWmarfaa provided above&free and wrrerG atr¢e fie, 2— _ / Phan a': J b J o FAAutdharUWy only. DO Roe write in this area fo he complaeed by city or town uBleial n: P"Wit/Lheeaae C or#y(Circle oat)! ealth 2.Building Department 3.CftTaOwn Ckrk 4.Electrical Inspector 5.Plumbing 7aspector on• Phone dr Mar 031611:44a Rag Associates 19782582012 p.3 07Y 1F SAIM4 MMSAMW77 BummDEPAmmm . 720�4Syq�IGIIOtVS'JR�T,3�74L1DR T�L1498)7�9595. RiHRRPRiFy�nY]y T FAK"709M4; MAC - TjxN SST.PtBI= J�t8t1L'Yt Q°Ft>aI.tCP �A1.�L1 fNCi COnst/"UCdOJ7 Debris Disposal Affidavit (required for-all demolition and,.renovation w.x)rkl In accarotance with the sixth edition of the State Baildmg Code. M ChM Seed"111.5 Debris, and the provisions of h GL M,S 54;Widing Penmit fi is isnned wiM the condition dWthe debris msukbW from this work shaft be disposed of in a pm1H'dY Aoensed waste deposit facility as defined by M6d,c 122,S 150A. The debris will be transported by; G v � (n&iM of hauler) The debris will be disposed of in: lei (name of facility) AA (address of facility) Signature of applicant -2,_1�_—_/�� Date The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For:Official Use Only) - Building Permit Number: Date Applied: Building Official:' SECTION li LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) 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❑ Repair❑ 1 Alteration tK I Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ 1 Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes El No ❑/ Is an Independent Structural Engineering Peer Review required? Yes ❑ No Q ` Brief Description of Proposed Work: N'01 Pr t0�(�q� N�a 4'�'�Sir✓,"�{' � U (U1 J�N SECTIONS:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOINGRENOVATION'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)&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 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ IH: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1 ❑ I-2❑ I-3 ❑ I-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check aslapplicable) - IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ 1 IV ❑ VA ❑ VB ❑ SECTION 7:'SITE INFORMATION(refer,to 780 CMR 111.0 for details on each item) Debris Removal:it Perm : Water Supply: Flood Zone Information: Sewage Disposal: TrenchLicensed Disposal Site❑ Public El Check if outside Flood Zone El Indicate municipal❑ A trench will not be P Private❑ or indentify Zone: or on site system❑ required❑or trench or specify: permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No D" Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: Appendix 2 Construction Documents are required for structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required for this. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark'Y'where applicable No. Item Submitted Incomplete Not Required 1 Architectural 2 Foundation / 3 Structural i 4 Fire Suppression 5 Fire Alarm(may require repeaters) / 6 HVAC / 7 Electrical / 8 Plumbing include local connections 9 Gas Natural,Propane,Medical or other 10 Surveyed Site Plan Utilities,Wetland,etc. / 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investi ation 16 Energy Conservation Report 17 Architectural Access Review 521 CMR 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction.Work started prior to approval may be subjected to triple the original permit fee. Registered Professional Contact Information r �A � Name(Registrant) Telephone No. e-mail address Registration Number �/ �e„ tj env �1iJ�ilrJUerU U/�'z/y Street Address City/Townn/} State Zip Discipline Expiration Date Registration Number Name(Re istrant)/ Telephone O. e-miVaddress Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Discipline Expiration Date Street Address City/Town State Zip Appendix 1 For the demolition of structures the building permit applicant shall attest that utility and other service connections are properly addressed to ensure for public safety. Please fill in the information below and submit this appendix with the building permit application. The building permit applicant attests under the pains and penalties of perjury that the following is true and accurate. Property Location (Please indicate Block # and Lot # for locations for which a street address is not available) No. and Street City /Town Zip Name of uilding(if applicable) For the above described property the following action was taken: Water Shut Off? Yes ❑ No Provider notified and Release obtained? Yes ❑ No L� Gas Shut Off? Yes ❑ Noe Provider notified and Release obtained? Yes ❑ No �' Electricity Shut Off? Yes ❑ No Er Provider notified and Release obtained? Yes ❑ No V Yes ❑ No I'J Provider notified and Release obtained? Yes ❑ NoJ Other (if applicable) Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No Other (if applicable) The Commonwealth of Massachusetts Department of Public Safety " m Massachusetts State Building Code (780 CMR) Building Permit Application to Construct, Repair, Renovate or Demolish any Building other than a One-or Two-Family Dwelling Code and Other Requirements for Building Permits The Department of Public Safety has issued these building permit application forms so that municipalities across the state can move toward use of a single permit form and consistent permit application process. The MA State Building Code specifies the requirements of building permits and the applicant is advised to review and be familiar with these requirements in order to avoid some of the common permit application problems. Likewise the applicant should be aware that some municipalities require that the owner confirm, even prior to acceptance of the building permit application, that no outstanding property taxes, water fees, etc. exist. Filing Instructions 1.Please contact the city or town where the work will be done to ensure that the city or town will accept this application form and if any additional information is required, and obtain the correct mailing address. After doing so, print the application, fill in completely and then submit to the local city or town where the work will be done. 2.All applications shall be considered complete and will be reviewed if construction ,documents, Y specifications, fee, and other materials that may be required as indicated in the Building Permit Application are included with the application. 3.Please include a check for the Building Permit fee. The fee may be calculated using the information to be supplied in section 12 of the Building Permit Application. The check is to be made payable to the local city or town where the work will be done.