Loading...
3 WINTER ST - BPA-15-501 REMOVE WIDOWS WALK � 3 3 cry s RECEIVED The Commonwealth of Massac use s W Department of Public Safety h1assachuseltsState Building Code(730 CHO MAY 2b A � O$ Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Budding Permit Number. Date Applied: Building Official: SECTION 1:LOCATION(Please indicate Block#and Lot#for Vocations for which a street address is not available) Q , (..JL�l// sal c i l /A1E/17 '✓W ©t I lO Z> Ul Arr'z-<—a" 44K/A49 /455- No.anti Street City/Town Zip Code Name of Budding(if applicable) SECTION 2•PROPOSED WORK Edition of MA Slate Code used_ If New Construction check here❑or check all that apply in the two rows below —) Existing Building O Repair Alteration ❑ 1 Addition❑ 1 Demolition O (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other e7 Specify: ga±!!1 t4- Ljfbd(,JS' tjPF4 Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No 1' Is an Independent Structural Engineering Peer Review reyui red? Yes O No 0� Brief Description of Proposed Work: IZ,4 rJl� l yeltl)-v 4J'fLK. p4 h'r/{ /LOCI tz- 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): I Proposed Use Group(s): SECTION4:BUILDING HEIGHT AND AREA Existing Proposed j No.of Floors/Stories(include basement levels)&Area Per Fluor,(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) - SECTION 5:USE GROUP(Check as a licable) A: Assembly A-I❑ A-2❑ Nightclub ❑ A-3 ❑ A4 O A-5❑ 1 B: Business Cl E: Educational ❑ F: Facto F-1❑ F2❑ - i1 Hi h Hazard H-1 O. H-2❑ H-3 ❑ H-4 O H-5❑ 1: Institutional I-t❑ 1-2❑ [-3 O 14❑ M: hlercantile O R: Residential R-10 R-2 O R-3❑ R4 O S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and Please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IBCl Ile\ ❑ IIBO IIIAO IIIB ❑ IV 1 VAO 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❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ required O or trench or specify: permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: I'M I Iist'.6, l�nnmistim I:acicw I'nxraa: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No O Yes O No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction:. Occupant Load per Floor: DOGS the building conlain.m Sprinkler System?: Special Slipulalions: MA L- -Tb S-T t"/�( L.CD to I t SECTION* PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner trirtu7� 59 �o,uDa �Xy� 3 tdlur sT s/f43_-' cfr( dsF?a c' Name(Print) No.and Street City/Town Zip Property Owner Contactlnfonnalion: tiA1C_6rki U 778 - -7W 2z05— _ Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes !s _ 2zStreet K ai a I'Ane ddress City/town State Zip to act on the property owner's behalf,in all matters relative to work authorized by this budding permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less thin 35,000 cu.ft.of enclosed space and or not tinder Construction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Clt+"SM CO l)F- 06101 C-S /6tQ6,;7, . Name((Registrant) Telephone No. e-mail address - Registration Number 22 Nl�tI! Street Add ss Ci /Town State Zip Discipline xpir torn Date 10.2 General Contractor. (Z�4DID c�.uT2ete�7lc� .5��.f/lCt� Company Name cK1°.r57td Ag& e- . Name of Pers6n Responsible for Construction License No. and Type if Applicable Street Address 7 - City/Tow State Zip Z8_ 2 to o/67 2'3 7 7 to Telephone No. business Telephone No..cell e-mail address SECTION 11:WORKEKS'COMPENSAI'IONNINSURANCE AFFIUAVD' M.G.L.c.152.§25C 6 A Workers'Compensation Insu nee 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 Rem Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1. Building S Building Permit Fee=Total Construction Cost x—(Insert here 2.Electrical $ appropriate municipal factor)_$ 3.Plumbing $ d.Mechanical (HVAC) $ Note:Mininmm fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ 7 000 (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. 014V-15 phlf e✓_ 0a tzu� e 4,..v&� P7r9 ?YO a/a/ �o i Please print and sign name Title Telephone No. Da e Z e,,Fd'� Street Address'/7Cily/Tow t State Zip .0 Municipal Inspector to fill out this section upon application approval: ^ •J Name Date