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95 CONGRESS ST - LAUNDRY BP The Commonwealth of Massachusetts Department of Public SafeWh DEC 28 A U: I 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 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) L-A-c)nN) 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❑ 1 Repair❑ 1 Alteration l>T' Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use O 1 Change of Occupancy ❑ Other ❑ Specify: QL t s-CfyW_ 'E&SA 90LWC Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Is an Independent Structural EngineerI Peer Review required? Yes ❑ No ❑ Brief Description of Proposed Work: - QU\P W1,Ci Li FAts�v�.n� 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)&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 ❑ A4❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-1❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H4❑ H-5❑ I: Institutional I-1❑ I-2❑ I-3❑ I4❑ 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 as applicable) IA 111 E3 IIA E311 1111 IIIA ❑ 11111 [3 1 IV VA VB 13 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 WA trench will not be Licensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ required❑or trench or specify: EtL6 2-1 permit is enclosed❑ V tS(-bSW Railroad right-of-way: Hazards to Air Navigation: NIA I I,istoric_Coinmissiun Kcyivw Pr~kiws: Not Applicable a; Is Structure within airport aper ch area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No 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: m C- k�� SECTION 9.' PROPERTY OWNER AUTHORIZATION N Name and Address of Property Owner Name(Print) 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 rmit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 21 f building is less than 35,000 cu.ft;of enclosed s and or not under Constraction Control then check no 0 and skio Section 10.1 10.1 Registered Professional Reipbnsible for Constractloii Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Company Name 1T-q'wtcS (AA-k-t C-5 ` P -G �-7- Name of.Person Responsible for Construction License No. and Type if Applicable S', ol_.n 5dt C_„ _g k rn' a1��3U Street Address City/Town State Zip -�{ at l f (_�-I`� al( ( wl TUAe>La 7-zC frwt.I-rE L-- Tele hone No.(business) Telephone No. cell e-mail address SECTION 11,4VOR'EK,CO PENSATION WSURANCH A-ffiD kVrr M.G.L..c.152:§29C(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 0 No 0 SECTION 12:.CONSTRUCTION COSTS AND PERMIT FEB Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Budding $ 1100 Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ appropriate municipal factor)_$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact m 1cip� 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ O (contact municipality)and write check number here SECTION 3:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the ams and penalties of perjury that all of the information contained in this application is true and accurate to the best of owledge.and understanding. om Please print and sign name TitleTelephone o. Date Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: _ N✓ '��►� Name Date The Commonwealth of Massachusetts Department of Industrial Accidents a o I Congress Street,Suite 100 Boston,MA 02114-2017 ,� www mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Business/Organization Name: K I S ] I �I V-,"'A C' R.,py,1(�wu Address: �Cy��\4) sik-LF_�Myyk-j) CM City/State/Zip: y b�-��_� Z M ft- Phone#: Are you an employer?Check they appropriate box: Business Type(required): 1.[�I am a employer with employees(full and/ 5. ❑Retail or part-time).* 6. ❑Restaurant/Bar/Eating Establishment 2.F_1 I am a sole proprietor or partnership and have no 7, ❑Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers' comp. insurance required] g• E]Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152,§1(4),and we have 10.❑Manufacturing no employees. [No workers'comp. insurance required]* 11.❑Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers'comp. insurance req.] 12.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. /am an employer that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name: �` � - f L� Insurer's Address: CfIV�_ City/State/Zip: Policy#or Self-ins.Lic.# (/� �— P� �� Expiration Date: I t l Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certofu der th ains and penalties of perjury that the information provided above is true and correct. Si nature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4. Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia From: Brandon Ruggieri bruggieri@glovsky.com B Subject: Confirmation of Landlord Date: December 1,2016 at 4:35 PM To: James Whitmore whitmore22@gmaii.com Jim, As requested,I've confirmed the identity of your landlord at 95 Congress Street. The property is owned by 99-101 Congress Street Realty Trust. The Trustee of that Trust is Luong Nguyen. He was appointed Trustee in 2000. A copy of the recorded appointment of Trustee is attached. The City records may show George Maguire as Trustee because he was the prior Trustee before Mr. Nguyen. As I mentioned on the phone,the City records are not always updated as to changes such as the names of trustees. Regards, Brandon Brandon M.Ruggieri,Esq. Glovsky & Glovsky LLC 8 Washington Street Beverly, MA 01915 Tel: 978.720.3110 Fax: 978.720.3164 bruggigri@glovsky.com I www-glovsky.com This message and any attachments are intended only for the use of the intended recipient and may contain information that is PRIVILEGED and CONFIDENTIAL. If you are not the intended recipient, you are hereby notified that any dissemination of this communication is strictly prohibited. If you have received this communication in error, please delete all copies of this message and any attachments and notify us immediately. Thank you. APPOWTUMM OF TRUSTEE In/tvW 1:0¢ inz 131 Bk 16190 K 347 We,hong Ngayast and Muilyu Mgplise beim the owns of ail of the beoeScid mlerea-as shown on a schedrle of beodkiwies Sled with said Brost pwooset to pw9gugh 9,beseby appoint LAA*Ngw/m as Tlrttstee of the W101 Congress Sttm RadW TTaK m n lied with Eau Sooth Di*ict Resisby odDeeds in Boot 9630 hp 39. 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