10 DOW STREET - BUILDING JACKET 10 DOW STREET
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In accordance with the Massachusetts State Building Code, Section 108. 15, this
4+4 See
CERTIFICATE OF INSPECTION
WILLIAM DZIERZEN.
is issued to
MULTI—FAMILY DWELLING
that 1 have inspected the premises known as
0010 DOW STREET
located at in the city of Solent
County of Essex Commonwealth of Massachusetts. The means of egress are sufficient for the following
number of persons:
BY STORY
7i�TiSi7i�7C7�7iTr��7t7i7i�fF7x7i �JC7iii7iti7C7C7i7C7i�lK����7Kf1:
Story Capacity Story Capacity
FIRST FLOOR 3 UNITS
SE=COND FLOOR 3 UNITS
THIRD FLOOR 2 UNITS
BY PLACE OF ASSEMBLY OR STRUCTURE
Place of Assembly Place of Assembly
or Structure Capacity Location or Structure Capacity Location
0058-1997 02/15/ 1997 02/15/200214
kD
Certificate Number Date Certificate Issued Date Certificate Expires Buildi ficial h
The building official shall be notified within (10) days of any changes in the above information.
• MMO..'rlEAL:.. i'1ASSAC:-
DEPT.
31ju. ;
=.PPL:CAT_::: -OR CERTIFT_CaTc SPECT,^id ^
7 Ili yo
J�
=ate a'auire^ :'.mount i
iC1-IEjo;4Fe=_Ls�e�u2red
accordance :;it". -::e ^r�" Bions of
t"e i-lassacnusetts Sate Building
,ode . -act:on i08 , i ; , hereoy apoiy for a Certificate of -nspection for
:he ceic'•a-named premises _ :cated attthe following address :
street s na "lumber f 0 '_�)o ln� 71
:lame ^_ f =remises
?' rpose for Which Premises t c
Liven<,etsi or Permit ( s ) ReDuirea for the Premises by Other Governmental
agencies :
License or Permit Agency
:ertif: _aze to be Issued .p {sJ.���o. d�,
Address
Owner cf Recoro of Building Q; 111a.. tAc., c
Address 1c11, SVw.wuy.
'Jame _ . ?resent ;-:older of Cert:: _ :ace
)lame Agent _f any
1a= = r _ 0 C iJHOM — 71TLE
T- : -M - 1S S ED CR HIS '��7/�S
UTH^R _:Z-_1 dGENT
_ ATE
I _NST° C7 SNS : DAYTIME TELEPHONE NUMBtK
i ) :,lake i eck payable to : CITY OF SALE!-!
12 =.eturn this application ':rit.`. :our checic t. Insoector or Builciinas
3uildina Deoartment . - ne Salem Green . Salem . : .4 ' 1970
EASE ':OTE :
' ) r,00 ; :-aricn form faith =czc n anvina f'_e must . e SUDmlLLed fJr 93Ch buildir
n _rliC ...ire of - ars . nerec : - ;J be cert _. _c^_ .
pC::CaLlOn and fee must ze -eceived tefore :erti_`i:ate 'dill be 'issued .
:uildi.n.g off'_C:al Zhal_ _ e nOLif:ea '•a: -.•_.• -'-n 0 ) -aVs of any Chang
`n = ne aoove '_nI'ormaticn .
E:tPI:'A'__ _:I .,aT` `a Il5 f�?06d
FORM SBCC-3-74
_ I
=� The Commonwealth of Massachuset s
a'. .1 k • Department of Public Safety
::\Iassarhusrlls Stile l4uilding Qnlc(7811 C\IR)
SSS Building Permit Application for any Building other than a One-or T% an w n
(Ibis Section For Official Use011IV) AV I -
Building Permit Number Dale Applied: _ Building Official:-
SECrION 1: LOCA PION (Please indicate Block if and Lot N for locations for which a street address i tit available)
No. and Street City /I"own Zip Cute Nance of Building;(if applicable)
SECI ION 2:PROPOSED WORK
F,litionof MA Stale Code .ed" If New Construction check here O or check ell th,d apply in the two rows below --
1_\tsting l4ui1ding Repair Alteration ❑ 1 :Addition❑ Demolition (Please fill out and submit Appendix 1)
Change of Use ❑ I Change of Occupancy ❑ Other ❑ Specify:------ -----
\re huilJing plans and/ur cunstrurtion Jt><'untenls being supplied as pert of this permit application? Yes ❑ No ----
Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑.�
Brief Description of Proposed Work:-_�A.�����`C�f1�1rt` / 6'/I�CJ%��_�16b 61b P�
SECTION 3:COMPLETE TI IS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,AUDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 78O CNIR.14) ❑
E\isting Use Group(s): Proposed Use Group(s): --. _
SECTION 4: BUILDING HEIGHT AND AREA
Existing Proposed
No.of Flours/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 C3 Nightclub ❑ A-1 ❑ A-1 ❑ A-3❑ B: Business ❑ E: [educational ❑
R Facto F-I ❑ F2❑ H: Hi h Flazard H-1 ❑ H-2❑ FI-.1 ❑ 11-4❑ 11-3❑
I: Institutional 1-1 ❑ 1-2❑ 1-3❑ 1-! ❑ AI: I., cantile❑ R: Residential R-10 R-2❑ Rae❑ R-1❑
: S: Storage 5-1 ❑ S_'❑ U: Utility❑ Special Use❑and please describe below:
Sper i,d Use -
SECTION 6:CONS'rRUCrION'IYPE(Check as applicable)
IA 13 IB ❑ IIA ❑ HB C3 ILIA ❑ Mlle ❑ IV 1 VA VII
SECTION 7:SIFE INFOMIArION(refer to 780 CMR 111.0 for details an each item)
Water Supply: Floud Zone Information: Sewage Disposal:
Trench Permit: Uehris lienuwal:
Public :\ lrcneh will not bo I-t eliscd Disposal Site
Pro.ov
�— Cheek it oulsidc hood dnx•❑ Indicate numicil+al
C3 or
❑or trench or spvicefv:-. - _-
or iudenlily Lnnc: oron silt system ❑
—___-- permit is rnclusrd❑
Railroad right-et-way: Ilizards t o Air Navigation: 11, : ,
Not Applicable❑ Is StrucluFt' witItiitairpert.tlit,rnach.trea? Is their ii io+vcomplvled?
or(,mwnt to Budd anclused ❑ 1 es ❑ or.No❑ I 1\'s❑ No ❑
SECTION 8:('UNl'IeNI'OF CEIi'1'IFICA'I"Ii OF UCCU1':\NCY
hdol"ll t Cod". L'se Gr oip(s): _ - . . 1%l' of Umstni n. n:
,r
iAu•s llw building r,•nl1to.ut Sprinkler System' tilc,ml St i p ul Vions: -
exi+Y SE(:'IIONY: PROPERIY OWNERAIJ IORIZAI ION
;Vamc.mrl Address tit Prooppey-r-ley Uwner —tr .•
'It (Print) Net and Street City/Town ----zip
Property Owner Contact Information: vZ �L1Sr- c
Title -- — 1'elrphone No. (business)f Telephone Nu (cull) a-mail address
If applicable, the property olvner hereby authorizes
-- _-- Name - --- Street Address ---- City/Town State Zip —
to art on the property owner's behalf, in all matters relative to work authorized b• this boilding permitaPplication.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If building is less than 35,1100 cu.ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1
10.1 Re istemd Professional Responsible for Construction Control
_tse— V ll�MrrtiM�J
ame(Ro�istrant� �,y Telephone No. c-mail ad hre�ss �j Registration Number
� - J 1 �ilnall l/R G7ml -
514cct Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
mlomm
Cunl,any Nance
S*evz mz' Dlw/ qj L --
Name of Person Responsible for Construction License No. and Type if Applicable
��,_ st 6mve%� �
Street Address City/Town State - 1p
/�s9ar7 _
Tcle ,hone No. businessTelephone No. cell _ e-mart address
SECTION 11:tet pKI-lst't AIN V,.n 110\ .V,1 JUA.\rr.tll1p F11 M.G.L.c.152.§ 25C6
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 iys �ince of the building permit.
Is a gn
si ed Affidavit submitted with th 'lislication? Yes6 Nc O
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs: (Labor
and Materials) Total Construction Cost(from Iteral 6)-5-
1. Building $ Building Permit Fee-Total Construction Cost x_(Insert here
2. Electrical $ appropriate municipal factor) -S
I Plumbing $
;. \tech,lnit'll (HVAC) S Note: \hnimton fee-$__(contact municipality)
3. .\Ictlianital Other $
Fndosc check payable to
h,Total Cost $ (contact nnmicipahiv)and write check number here ---_----____
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By rntvring uty mune brluw, I hereby attest under the painsand penalties of perjury that all of the infonnotion con[.lincd in this
,tlpplir,llion i+frac and ,lCcura hl tht bey 11f ntt 11111111cdye and understanding. -
��er�ht
Pleas, ant till sil;n nanm I isle 1 �bplione No. Date
;y; 41-evn S T - - 61�s t�+�n olc7 f
tilreel ddr.ys Cltl'/ Fown tittte Lip
Municipal Inspector to fill nut this section upon application approval:
-------- -- _--- - -- ---Nance -- -_ hale---
25 �c-( tiO3s 02
r
�t, The Commonwealkh �y�e
4}q Deparhnentb22�rPP tc a e
M
i` Nff Massachusetts State Building Code(780 CR)
Building Permit Application for any BuildirNWIW,h2hja Q&4 TRIO-Family Dwelling
l n .(Illic Section For Official Use Only)
rJ I 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)
J I 5- S 6 hA 0l C
No.anti Street City/Town Zip Code Name of Building(if applicable)
SECTION 2PROPOSED WORK
Edition of MA State Code used_ If New Construction check here O or check a8 that apply in the two rows below
Existing Building O Repair 13 Alteration ❑ Addition 13Demolition O (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes O NoLV
Is an Independent Structural Engineering Pec Review required Y s 12 o
Brief.Qesc! ion of Propose.) ork: � (60✓1 f
��P!
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 a licable)
A: Assembly A-I 13A-2O Nightclub ❑ A-3 13A4 13A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-t❑ F2❑ - H: High Hazard H-t O. H-2❑ H-3 Cl H4❑ H-5❑
I: Institutional W O 1-2 Cl 1-3❑ 14❑ 1 M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4 O
S: Storage S-1 ❑ - S-2❑ I U: Utility❑ Special Use O and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as a licable)
IAO 111 IIA13 fill 13 IIIA ❑ 11180 IV ❑ 1 VA 13 VII ❑
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 O Indicate municipal❑ A trench will not be Licensed Disposal Site❑
Private❑ or indentify,Zone: or on site system 13required E3 or trench or specify:
permit is enclosed❑
Railroad right-of-way: Ifazards to Air Navigation: \I_\i fktwic C}mmn,5ion itr,;cg:.
Not Applicable❑ Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ 1 Yes❑ or No O Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Cade: Use Group(s): Type of Constnuyion: Occupant Load per Flour:
Ones the building,contain an Sprinkler System?: Special Stipulaliuns:
mr�t� tsv (k, ��zz
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
A-ulDOath ,6,0-, 171 X1151 6bi4 G �
Name(Print) ;,., {GNod'-i_Street City/Town
f 0Lq 6Zfp
-- t i .J FS V
J Property Owner Contact Information: ——
Title Telephone No.(business) Telephone No. (cell) a-mail address
If applicable,the property owner hereby authorizes
ubHHA-O&D r.)Ad-� 7t L6wejl sr Aaloce,14 — of bQ
Mune Street Address City/Tow 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)
If building is less than 35,000 cu.R.of enclosed space and/or not under Construction Control then check here I]and ski Section 10.1
10.1 Registered Professional Responsible for Construction Control
Name(Registrant) Telephone No. c mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor - -
CammnyName
, ;,fz ,4 e s -0?38,3 fI wfBsfG•c �t
Name of Person Responsible for Construction License No. and Type if Applicable
reet Address C— State Zip
M- B.27 L&I3 qza-$s'l�
Telephone No. business Telephone No. cell a-mail address
SECTION 11:VVORKEhS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152. 25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
Is a signed Affidavit submitted with this application? - Yes 0 No ❑
SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and MatLrfals) Total Construction Cost(from Item 6)_$
1. Building $ Building Permit Fee-Total Construction Cost x—(Insert here
2.Elcr.trical $ - appropriate municipal factor)_$
3. Plumbing $
d. Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
rha -7 nicil Other $ - h Enclose check payable to
.Total C
6ost $ / 0 b t 0 D (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering iny-itarni6below, 1 hereby attest under the pains and enalties of perjury that all of the information contained in this
application is true anal accurate to the tof knowl understanding.
� rez
Please print and sign name Title Telephone No. Date
Street Address City/'town State Zip �?
Municipal Inspector to fill out this section upon application approvaL• "
Name ale