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4 CROWDIS STREET - BUILDING JACKET c. s 3 y The Commonwealth of Massachusetts Board of Building Regulations!and Standards CITY OF Massachusetts State Building Code,780 CMR SALEM Revised Mar 2011 l� Building Permit Application To Construct,Repair,Renovate Or I'emolish a One-or 7wo-Family Dwelling This Section For Official Use Only I Building Permit Number: D Applied: t Building Official(Print Name) Signature VDa SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 4 C;rowdis Street i 1.1 a Is this an accepted street?yes_ nc Map Number Parcel Number z: 13 Zoning Information: 1.4 Property Dimensions: rn c� Zoning District Proposed Use - Lot Area(sq ft) Frontage(ft) -1::0 m 1.5 Building Setbacks(ft) rn From Yard .Side Yards; Rear Yard '—<: -17 ID Required Provided Required i Provided equired Provided M G 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 SiTmge Disposal System: Fri Public❑ Private❑ Zone' _ Outside Flood Zone? Municipal❑ On site disposal system ❑ cn Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Clayton Gardner Salem MA 01970 Name(Print) City,State,ZIP 4 Crowdis Street 617-331-8413 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction❑ Existing Building M Owner-Occupied ❑ I Repairs(s) ❑ 11 Alteration(s) O 1 Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ® $pacify: solar Brief Description of Proposed WorV: I I I Installation of a 7.848 kw 24panels) rooftop solar array SECTION 4:ESTIMATED CONSTRUCTION CO STS Item Estimated Costs: ( Official Use Only (Labor and Materials 1.Building $ 12,000 1. Building Permit Fee:$ 1 Indicate how fee is determined: 2 Electrical $ ❑Standard City/Town Applica'on Fee 26,135 ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ - 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fees:$ Check No.I Check Amo t: Cash Amount:_ 6.Total Project Cost: $ 38,135 p Paid in Full 0 Outstanding Balance Due: 1'Y�!mot I,ErJ t � s .�• s .,✓. ;i(�Z i SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 096385 ( 10/8/2016 Romain Strecker License Number Expiration Date Namc of CSL Holder List CSL Type(seebelow) U 55 Sixth Road No.and Street Type Description Woburn MA 01801 U unred:rictad(Buildingsto 35,000 on.fL) R Restri tad l&2 Family Dwelling Cityrrown,State,ZIP M Maso' RC RooSn Covemin WS Windbw and Si SF Solid uel Buming Appliances 781-462-8702 permits@bostonsolar.us I Insulation Telephone Email address I D Dem lition 5.2 Registered Home Improvement Contractor CHIC) 169698 7/27/2017 Boston Solar/Romain Strecker HIC Registration Expiration Date HIC Company Name m HIC Registrant Name 55 Sixth Road permits@bostonsolarus No.and street 781-462-8702 Email address Woburn MA 01801 City/Town, State ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT'(M.G.L.c.152.%25C(6)); Workers Compensation Insurance affidavit must be completed and submitted with th is application. Failure to provide ithis affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes..........® No...........13 SECTION 7s:OWNER AUTHORIZATION TO BE COAIPI XTED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUB DING PERMIT I,as Owner of the subject property,hereby authorize Romain Strecker to act on my behal4 in all matters relative to work authorized by this building perimi application. Clayton Gardner 10/26/2015 print owner's Name(Electronic Signature) - Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DEC 1 ARATION 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. Romain Strecker 10/26/2015 Print Owner's or Authorized Agent's Name(Electronio Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner viho hires an unregistered contractor (not registered in the Home Improvement Contactor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information 4n the HIC Program can be found at www.mass. ovg /oca Information on the Construction Supervisor License can be found at www.mass.aov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished¢asemerr attics,decks or porch) Gross living area(sq.fL) - Habitable room Fount t Number of fireplaces - Number of bedrpoms _ = Number of bathrooms Number ofhalf1haths f Type of heating system Number of decks/porches ' Type of cooling system Enclosed Open 1 3. "Total Project Square Footage"may be substituted for"Total Project Cost" UTAH OFFICES \ ECTOR Sandy Layton St. George Project Number: U1876-0015-151 October 22,2015 Boston Solar 55 Sixth Road - Woburn,MA 01801 - ATTENTION: Race Traver REFERENCE: Clayton Gardner Residence:4 Crowdis Street,Solent,MA 01970 Solar Panel Installation Dear Mr.Traver: Per your request, we have reviewed the layout and photos relating to the installation of solar panels at the above- referenced site.The following materials and components are proposed in the installation of the solar panels. Roof Structure:2x8 rafters at 16'O.C. - Roof Material:Composition Shingles Solar Panels:Sunpower E20-327 Rail Connection System:Invisimount Mounting Connections:5/16"x 6'Lag Bolt Based upon our review,it is our conclusion that the installation of solar panels on this existing roof will not adversely affect the structure of this house. The design of solar panel supporting members is by the manufacturer and/or installer. The adopted building code in this jurisdiction is the 2009 International Building Code and ASCE 7-05. Appropriate design parameters which must be used in the design of the supporting members and connections are listed below: Ground snow load:45 psf per Massachusetts amendments to the IBC(verify with local building department) Design wind speed for risk category II structures: 110 mph(3-sec gust) Wind exposure:Category B Our conclusion regarding the adequacy of the existing roof is based on the fact that the additional weight related to the solar panels is less than 3.5 pounds per square foot.In the area of the solar panels,no 20 psf live loads will be present. Regarding snow loads,it is our conclusion that since the panels are slippery and dark,effective snow loads will likely be reduced in the areas of the panels.The attached calculations verify the capacity of the connections against wind,the governing load case.Solar panels will be flush-mounted,parallel to and no more than 6 above the roof surface.Thus, it is our conclusion that any additional wind or seismic loadings related to the addition of these solar panels is negligible. _ During design and installation,particular attention must be paid to the maximum allowable spacing of attachments and the location of solar panels relative to roof edges. The use of solar panel support span tables provided by the manufacturer is allowed only where the building type, site conditions, and solar panel configuration match the description of the span tables.Attachments to existing roof joist or rafters must be staggered so as not to over load any existing structural member. Waterproofing around the roof penetration is the responsibility of others. All work performed must be in accordance with accepted industry-wide methods and applicable safety standards. Vector Structural Engineering assumes no responsibility for improper installation of the solar panels. Please note a representative of Vector Structural Engineering has not physically observed the roof framing. Our conclusions are based upon the assumption that all structural roof components and other supporting elements are in good condition,free of damage and deterioration,and are sized and spaced such that they can resist standard roof loads. Very truly yours, VECTOR STRUCTURAL ENGINEERING,LLC ��N OF ROGER T. A IVI Roger T.Alworth,P.E. 0 Principal RTA/ksa - TONAL. 10/22/15 9138 S. State St., Suite 101 1 Sandy, UT 84070/T(801)990-1775 1 F(801)990-1776/wwwmectorse.com JOB NO.:J18 5-151 DESIGNED: KSA E C TO R 10/22/ DATE: 10/22/15 E n O I n E E R S PROJECT: Clayton Gardner SUBJECT: Enclosure Calculations Com onents and Cladding Wind Calculations Label [Sol'ar Panel(Unit Area) Note: Calculations per ASCE 7-05 SITE-SPECIFIC WIND PARAMETERS: Basic Wind Speed [mph]: 110 Notes: Exposure Category: B 'Used 16 sf for effective wind area. I ADDITIONAL INPUT&CALCULATIONS: Height of roof, h [ft]:r--725-7 Comp/Cladding Location:�Gable/Hip Roofs 70 Enclosure Classification: Open Buildings GCP: 1.6 -f Figure 6-11 C (enter largest abs.value) a: 7 Table 6-2 zy[ft]: 1200 Table 6-2 Kh: 0.701 Table 6-3 Kj: Figure 6-4 (leave blank for negligible topographic effects) Kz: [Figure 6-4 (leave blank for negligible topographic effects) K3: Figure 6-4 (leave blank for negligible topographic effects) K=: 1 Equation 6-3 Kd: 0.85 Table 6-4 Velocity Pressure,qh [psf]: 18.45 Equation 6-15 GCP;: 0 Figure 6-5 (largest abs.value) OUTPUT: Design Pressure, p [psf]: 29.51 psf(1.0W) P=9n GC„ — GCS„ JOB NO.: U1876-0015-151 DESIGNED: KSA o R DATE: 10/22/15 E n s in E ERB PROJECT: Clayton Gardner SUBJECT: CONNECTION CAPACITY Lag Screw Connection Capacity: Demand: Lag Screw Size: s/16 Wind Pressure: 29.51 psf Cd: 1.6 Tributary Area: 12 sf Embedment: 2.25 in Demand: 354 Ibs Capacity: 205 Ibs/in.emb. Number of Screws: t Total Capacity: 738 Ibs Demand<Capacity: CONNECTION OKAY Project Data Codes MA CMR 78051.00 IBC-2009,ASCE 7.05 2005 NOS,NEC-2014 Inyerter: SolarEdge SE600DA-US-RGM PV Panel: 24 Sunpower E20-327 Racking: Imislmount-Flush To Roof System Rating: 7.848 kW OC-STC _ 1 st Year Produdlon:9,201 kWh Design Factors \ - GrountlSnowLoatl 40 psf \ Wind Speed 100 mph \ r Roof 2 Azimuth:247"N Tie:30' \ Shade:10% \ - 12 Panels-1.113 \ � sewxx 1 2 Roof 1 Azimuth:152°N Tilt 30° Shade:12% 12 Panels-1.232 ` Utllity_Meterter - ® BOSTONESOLAR 0 rter V thudty Dlecanrrtct ww.eoemnader.w I infc®Bo,mnaobcw Drawing Name Site Plan Date October 6,2015 CLIENT INFORMATION: Drawn by BG Clayton Gardner Cheded by 4 Crowdis Street REva 00 Salem, MA 01970 PV - 2.0 (617)331-8413 Scale As Noted STRUCTURAL ENGINEERS November 24, 2014 SunPower Corporation 1414 Harbour Way South Richmond, CA 94804 TEL: (510) 540-0550 Arm.: Engineering Department, Re: Engineering Certification for the SunPower Corporation Invisimount Design Tool This letter is to document that PZSE, Inc.-Structural Engineers has reviewed SunPower's Invisimount Design Tool, an online tool that: • Evaluates structural design loads on SunPower Invisimount solar arrays • Evaluates the maximum allowable spacing of attachments of the system to the roof to resist design loads • Estimates the bill of materials for specific projects to assist with ordering parts from SunPower SCOPE OF THE TOOL: Invisimount by SunPower is a solar panel support system for installing solar photovoltaic arrays on sloped roofs of buildings. Typically such buildings are residential with shingle or tile roofs. Each row or column of modules is supported by two rails, which are attached to the roof structure. The number and spacing of attachments to the roof structure can vary depending on, for example, structural loads at a particular site,the type of attachment hardware used; and spacing of the supporting roof structural members. SCOPE OF OUR REVIEW: PZSE, Inc.—Structural Engineers provided a review of the following • Invisimount online Design Tool algorithm and design methodology and has determined that the Invisimount Design Tool is a rational approach and is in compliance with the structural requirements of the following Reference Documents: 1. Minimum Design Loads for Buildings and other Structures, ASCE/SEI 7-05 2. International Building Code, 2009 Edition,by International Code Council, Inc. 3. Aluminum Design Manual, 2005 Edition, by The Aluminum Association 4. AC428, Acceptance Criteria for Modular Framing Systems Used to support Photovoltaic (PV)Panels, November 1, 2012 by ICC-ES This letter certifies that the Invisimount online Design Tool is incompliance with the above Reference Documents. 8150 Sierra College Boulevard,Suite 150 • Roseville,CA 95661 • 916.961.3960 P • 916.961.3965 • www.pzse.com Page 1 of 2 s.+ STRUCTURAL ENGINEERS DESIGN RESPONSIBILITY: The Invisimount Design Tool is intended to be used under the responsible charge of a registered design professional where required by the authority having jurisdiction. In all cases, the tool should be used under the direction of a design professional with sufficient structural engineering knowledge and experience to be able to: • Evaluate whether the tool is applicable to the project, based on the "Engineering Basis of Calculations"document and the characteristics of the project, and • Understand and determine the appropriate values for all input parameters of the tool. Results of the tool should be checked against the design professional's judgment. Excerpts from standards such as ASCE 7-10 are presented in the tool as pointers to the standard and are not intended to diminish the user's responsibility to consult the applicable figures and sections of the standard directly. The user or design professional in responsible charge assumes full design responsibility. The tool does not check the capacity of the building structure to support the loads imposed on the building by the array, such as bending strength of roof rafters spanning between supports. This requires additional knowledge of the building and is outside the scope of the design tool and our review. Please feel free to contact me at your convenience if you have any questions. Sincerely, Paul Zacher, SE- President SH OFF 9 PAUL K. ZACHER TRUCTURAL y 50100 90 Fr+/STERO �SSIONAIENG EKP.6/W/16 8150 Sierra College Boulevard,Suite 150 • Roseville,CA 95661 • 916.961.3960 P • 916.961.3965 • www.pzse.com Page 2 of 2 % 14 c; 2 The Commonwealth of MassachusOMIVEb Board of Building Regulationgv,440,9 SERVICES CITY OF Massachusetts State Building Code, 780'CMR SAMar Revised Mar 2011 Building Permit Application To Construct, Re4bFJ04A3 C*DJ9hc3i0h a One- or Two-Family Dwelling 00 This Section For Official Use Only Building Permit Number: Date pplied: Building Official(Print Name) Signature DZ SECTION 1: SITE INFORMATION 1. Property Address: 1.2 Assessors Map&Parcel Numbers I— C7,71,Yd 5 S� L l a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 1 7, NSH Zoning District Proposed Use Lot Area(sq�it) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 10 Private❑ Zone: _ Outside Flood Zone? Municipal& On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: SaIQ wt . )aA Name(P nt) City, State,ZIP C(CXq 4o N , 4Z . g a��neredk; y Crewdis �i 617331 ?'Yi3 No.and Street Telephone Email A dress SECTION 3:DESCRIPTION OF PROPOSED WORW (check all that apply) New Construction ❑ Existing Building ❑ Owner-Occupied y7 Repairs(s) 91 Alteration(s) IN I Addition 0 Demolition ffl Accessory Bldg. ❑ Number of Units I Other ❑ Specify: Brief Description of Proposeldl Work': V-1 wx 1)V P An kt— %o aQ C A)411 /41 v`I� ('k E ✓l G�h C7L,� /i -n tJ �fi 4L La/ .r t i� C6 90 SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Official Use Only. Labor and Materials 1. Building $ 4, 800 1. Building Permit Fee: $ Indicate how fee is determined: ❑ Standard City/Town Application Fee 2. Electrical $ (7U ❑Total Project Cosy'(Item 6)x multiplier x 3. Plumbing $ tivo 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ D Su ression Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ 44006 ❑Paid in Full ❑ Outstanding Balance Due: Q - 112-71 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) cl License Number Expiration Date Name of CSL Holder List CSL Type(see below) No. and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town, State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address City/Town, State,ZIP Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. § 25C(6)) Workers Compensation Insurance affidavit 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. Signed Affidavit Attached? Yes .......... ❑ No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION 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. Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program), will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/d/d s 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage, finished basement/attics, decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" �lll� �g4CIC��c IIIl ad UPC 10330 HASTINGS,LIN .•,.�:..�.o-_.n_ r..�eraac:...au....a« -.. ..,:.'�mW�,a�a.._4-... e„w,...:..�.� _, _.....a. , . ... .z....,....uwa.uo�m...Y.�....�..�....�t...,:.a_:. ...,:,u_e;A,..w.�...... .. ... ._.. ,....,.......... RJV ROBERT J. SWAJIAN & ASSOCIATES, INC. INSURANCE ADJUSTERS 161 SOUTH MAIN STREET MIDDLETON.MA 01949 TELEPHONE(978)777-1400 FAX(978)777-2255 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC 3B TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman RE: Our File No: p a - a L S g 7— Insured: Insured: / ,( J Ire- vim„l . �-v Loss Location: S%J4 Date of Loss: _2 U Policy Number: /x/17 �oG e Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass, Gen. Laws. Chapter 143. Section 6 to be applicable. If any notice under Mass. Gen Laws Chapter 139. Section 3B is appropriate please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss, and claim or file number. AMUSTERS TITLE . On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Fred M..NeWell, ,p 3 afl AD]llSTER DATE APPLICATION FOR ISO JAN "2 ivi 10: 14 PLAN EXAMINATION AND BUILDING PERMIT r?4 TANT - Applicant to complete oil items in sections: 1, 11, 111, IV, and IX. O I• AT (LOCATION) 1 T^�(�,r�bw t.t-f.s r � ZONING DISTRCT !� '' . LOCATION (.1 (NO•) (STREET) y� {� OF BETWEEN .tltb?iLWANi� AV'C AND nAL•M f l\J"C- BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE N II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D A. TYPE OF IMPROVEMENT D. PROPOSED USE - For"Wrecking" most recent use m m -i 1 New building Residential Nonresidential 2 ❑ Addition(If residential, enter number 12 ® One family 18 ❑ Amusement, recreational of new housing units added, if any, in Part D. 13) 13 ❑ Two or more family - Enter 19 ❑ Church, other religious number of units- - - - -o. 20 ❑ Industrial ^ 3 ❑ Alteration (See 2 above) 14 ❑ Transient hotel, motel, 21 ❑ Parkin 4 ❑ Repair, replacement or dormitory - Enter number 9 garage 5 ❑ Wrecking (Ij multifamily residential, of units ------- - y 22 ❑ Service station, repair garage enter number of units in building in 15 ❑ Garage 23 E] Hospital, institutional Part D. 13) 6 ❑ Moving (relocation) 16 ❑ Carport 24❑ Office, bank, professional 7 ❑ Foundation only 17 ❑ Other - Specify 25 ❑ Public utility , 26❑ School, library, other educational B. OWNERSHIP 27 ❑ Stores, mercantile 1^ 8 Private (individual, corporation, 28 ❑ Tanks, towers VJ nonprofit institution, etc.) - 29 ❑ Other - Specify - 9 ❑ Public (Federal, State, or local government) C. COST (Omit cents) Nonresidential - Describe in detail proposed use of buildings, e.g., food ��.rr�� processing plant, machine shop, laundry building at hospital, elementary 10. Cost of improvement,,,,,,,,•,,,,,,, 5960CJ school, secondary school, college, parochial school, parking garage for, department store, rental office building,.office building at industrial plant. To be installed but not included If use of existing building is being changed, enter proposed use. in the above cost a. Electrical....................... 2000 b. Plumbing ....................... Z50 0 c. Heating, air conditioning.......... / 570 O d. Other(elevator, etc.)............. 11. TOTAL COST OF IMPROVEMENT $ 40100,0 III. SELECTED CHARACTERISTICS OF BUILDING —' For new buildings and additions, complete Parts E — L; for wrecking, complete only Part J, for all others skip to IV. E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS / 30 Mosonr 48. Number of stories................ �] y (wall bearing) 40 ® Public or private company " 31 ® Wood frame 41 ❑ Private (septic Conk, etc.) 49. Total square feet of floor area, all floors, based on exterior py/� 32 ❑ Structural steel dimensions ..................... 33 ❑ Reinforced concrete H. TYPE OF WATER SUPPLYG�, 34 ❑ Other - Specify 42 CK Public or private company 50. Total land area, sq. ft. ........... 43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed ....................... 35 ❑ Gas Will there be central air 52. Outdoors........................ 2 36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY 37 Electricity 44 ❑ Yes 45 4 No 53. Number of bedrooms.............. 3 3B ❑ Coal 39 ❑ Other - Specify Will there be an elevator? ' Full.......... 54. Number of 46 ❑ Yes 47[X No bathrooms P Partial........ 1 NOTES and Data — (For department use) .z 46i i 4 r ` 7 F _ i IV. IDENTIFICATION - To be completed by all applicants Name Mailing address — Number, street, city, and State ZIP code Tel. No. . L 7F C ) � ode}Z3 O-/ JV Owner or Lessee BBuilder's $, 1 er lie V,<. / ' M License No. O Contractor O 7Z fy�1C ✓. 0 t 3. 7 e t Architect or /- eeM N ,� 13movr' N Engineer I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application as his authorized agent and we agree to conform to all applicable laws of this jurisdiction. Sig ure of applican - Address Application date DO NOT WRITE BELOW THIS LINE V. PLAN REVIEW RECORD - For office use Plans Review Required Check Plan Review Date Plans By Date Plans By Notes Fee Started Approved BUILDING $ PLUMBING - $ MECHANICAL $ ELECTRICAL $ OTHER Is VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS D.!e Dote Permit or Approval Check obtained Number By Permit or Approval Check obtained Number By BOILER PLUMBING CURB OR SIDEWALK CUT ROOFING ELEVATOR SEWER ELECTRICAL SIGN OR BILLBOARD FURNACE STREET GRADES GRADING USE OF PUBLIC AREAS OIL BURNER WRECKING OTHER OTHER VII. VALIDATION Building FOR DEPARTMENT USE ONLY Permit number Building Use Group Permit issued 19 Building Fire Grading OU Permit Fee $ Live Loading Certificate of Occupancy $ oaaapanay Load Approved b - Drain Tile $ Plan Review Fee $ TITLE Vill. ZONING PLAN EXAMINERS NOTES SIDE YARD SIDE YARD IX. SITE OR PLOT PLAN - 1111..,.. ,.w1.........N:....::............._._._._N_n_._._._._._._..._.. ---- 1111,. 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