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184 ESSEX STREET - OMEN AKA - BUILDING JACKET M�J ( n.K� i6ti EssLx ST) rsuperTabm oversized-Tab Folders 90%Larger Label Area 's N SMEAD pp�� CC p KEEPING YOU ORGANIZED No. 10301 PATENTPENDING SUSTAINABLE MIN.RECYCLED RESTRY FO MITWTIVE CONTJoy . u6r,dm.rs.v,rmo POSTCONSUMER v .aipmgram.org srwrxv MADE IN USA GET ORGANIZED AT SMEAD.COM Certificate Number: B-17-109 Permit Number: B-17-109 Commonwealth of Massachusetts City of Salem This is to Certify that the .............................................................Shop..Center Building......................................................... located at Building Type 2EAST INDIA SQUARE..................................................................... in the .....................................0 t ..of Salem Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY OMEN This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires ...............................Not Applicable,..................._......._. unless sooner suspended or revoked. Expiration Date V 644 Issued On: Thursday, May 25, 2017 ((( • �pON➢I$ty Commonwealth of Massachusetts S City of Salem m 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 X5641 - Return card to Building Division for Certificate of Occupancy Permit No. B-17-109 PERMIT TO BUILD FEE PAID: $253.00 DATE ISSUED: 3/10/2017 This certifies that MARLEY PROPERTIES SALEM LLC has permission to erect, alter, or demolish a building 2 EAST INDIA SQUARE Map/Lot: 350604-0 as follows: Other Building Permit OMEN/MUSEUM PLACE MALL @ 182-184 ESSEX ST: REMOVAL OF EXISTING, NON STRUCTURAL PARTITION WALL; BUILDING NEW PARTITION WALLS FOR EXPANDED SPACE Contractor Name: THOMAS RUSSELL DBA: Contractor License No: CS-109165 3/10/2017 Building Official Date This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance.The Building Official may grant one or more extensions not to exceed six months each upon written request. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. HIC#: 'Persons contracting with unregistered contractors do not have access to the guaranty fund-(as set forth in MGL c.142A). Restrictions: Commonwealth of Massachusetts City of Salem R 120 Washington St,3rd Floor Salem,AAA 01970(978)745-9595 x5641 Return card to Building Division for Certificate of Occupancy Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER. i r t Commonwealth.of Massachusetts ( 9 City of Salem ` 120 Washington St,3rd Floor Salem,MA 01970(978)745-9595 x5641 Return card to Building Division for Certificate of Occupancy lug Structure CITY OF SALEM BUILDING PERMIT Excavation PERMIT TO BE POSTED IN THE WINDOW 5 Footing INSPECTION RECORD Foundation Framing Mechanical ITS Insulation INSPECTION: BY DATE Chimney/Smoke Chamber Final tp Plumbing/Gas Rough:Plumbing Rough:Gas Final U= Electrical Service Rough Final Fire epartment Preliminary Final / Health Department Preliminary Final Commonweaith.of Massy etts .. 4 it ..s.�Fr,.//Aye � I i yft��8an� i ..- Flptpn.3B 3rd R�cr�alem,f+s4 tl1#t0 B78j 7458l+'�x534t �` ,� - •. •`, # `'t' '4t �F,,*�^�a", t� .c?,y'r, . Retum card to&tll 'g C vtMon for cw' ams dr 0604"nray Pderrritt'No 14 � ., ,.A2a M0. p1� To , r �- EE PAID $35$:00 }}' a C �, rr* , r F *, ���'^�,r�rlt� t�v �dv%4�9<T �� 4 �.�*= v i� r G y. ♦a e !. �t BATE+15SUEDAa � lFQ1201Z "ts k' ✓ dr l�jnx ..��„ rDar-c�ra9'���K'y�p ��`B3 �.'�+ "" n x"ytt'M <�'+�` *'' - this certifies that ; Y PROPER S $/kt:BAA LLC e m fnE.i^+ "F "m,3.6'E� # 'Y` fl= as rmfss on ko®act terror deattotfi a +,S,13 a" x .."'!, x I I '.� , 11 ,-;v't wV G�ry .3�I Y .A T P4,Y tiS. 4ytS�+`F�" 1 J „.. ..: fl as>follpws � O'k�la�er Bui6lyYi� ye�rtY►iyt — svX.`w��'yT , (ri-4 'r+s r,..yY p3fl+w .�"�Y ^f�+RG1�1o� ";V4AI� t 1x1[7 1AWWp _ FF . 1} �M'�1t11�1, VA IF Y wr{'Galru,e -k uy. 4. - N J Yrr) ti 1w nF" , y — ✓� ��e e-;9r:y.� .. ContYaoto( Nafrre r�plylgS RUSSELL'A a �` ( iY a`"'s� `a' `•xr � .r�� " r, ^� >rz`�94 ' itr� P a '- " �'� s Con*actof Ucense� p'x;CS 108165 ,�( iz `' t�'.S r k ry"+4,t�+"tk .''%" ,i, .{l'A��♦ b'�ky,/yr�yp t , ' a ti T "'k traAT«tF1'>f'4iry4��`h4 y `h "'� �a" 3k• '�'%l F�y(y. J 4°1 3tt '� , 'rz *q w, Th�permkshelf ba deemed abandoned end IriyaNd u ed�y*W—pemdtis Isso ` tM` .add q�lfdlal � y11'lay gr�ntt.Q or more aktBitSi0Fl8 not tp Bgoaed aix r.�'`rq m�`� Yre v,'.d Fs �,a 3 -•�`'� :. .. 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Initial Construction Control Document To be submitted with the building permit application by a R Registered Design Professional for work per the 81h edition of the Massachusetts State Building Code, 780 CMR, Section 107 J v Project Title: Omen Psychic Parlor Date:2017.03.03 Property Address: 184 Essex Street, Salem MA 01970 Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: Renovations of existing retail facility. I John Garcia MA Registration Number 50539 Expiration date:8/2017, am a registered design professional, and 1 have prepared or directly supervised the preparation of all design plans, computations and specifications concerning`: X Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information, and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with'the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, I shall submit field/progress reports(see item 3.) together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'. Enter in the space to the right a"wet"or REOARC electronic signature and seal: �o� a�M GA4oiy4, �o N Boston k � MAS osHUSEttS Jw Phone number: 617 723-8808 Email:jgarcia@li en a5.com $oy OF uP Building Official Use Only Building Official Name: Permit No.: Date: Note I. Indicate with an `x'project design plans,computations and specifications that you prepared or directly supervised. If`other' is chosen, provide a description. x Version 06 I 1 2013 i LINEA 5 inc . - Architects 195 State Street Boston, MA 02109 Phone 617-723-8808 fax 617 723-8898 www.linea5.com Date: 2017.03.03 Linea 5 job#: 11705.00 RE: Museum Place Salem To: City of Salem Attn: Michael Lutrzykowski Public Property Department Assistant Building Inspector 120 Washington Street Salem, MA 01970 We are sending you: ® Attached ❑ Under Separate Cover via: The following items: ❑ Shop.Drawings ❑ Prints ❑ Plans ❑ Samples ❑ Specifications ❑ Copy of Letter ❑ Change Order ❑ Other Initial Construction Control Affidavit Copies Date Dwq No. Description: 1 2017.03.03 Initial Construction Control Affidavit THESE ARE TRANSMITTED as checked below: ❑ For approval ❑ Reviewed as submitted ❑ Returned without review ® For your use ❑ Reviewed as noted ❑ Resubmit for re-review ❑ As requested ❑ Returned for corrections ❑ Resubmit for record ❑ For review and comment ❑ Rejected ❑ FOR BIDS DUE: ❑ Other: REMARKS: Copies to: digitally stamped version sent via email. Sent by: John Garcia IF ENCLOSURES ARE NOT AS NOTED,KINDLY NOTIFY US AT ONCE its l i =i4s .,"-w.-.�,t ,! m W;'Im �j Z314 , ZZn PITNEY BOWES ,. 02 1P $ 000.460 0000290743 MAR 06 2 L ! N E A 5 n c MAILED FROM ZIP CODE 021009 195 State Street_Boston, MA _ 02109 dubl i r✓Tt0vmf A Tx*- t2o _-i S-_.-3w-2304ultlE�il�i llll1ii11� X91!!! ln�ll111l1! 11H!li111Dui�ud City of Salem Sign Permit Application Worksheet u 'r' �J 8-Feb-17 Omen -! A b; 414 184 Essex Street t0l1 FEB Zoning(res/non-res) B5 Entrance Corridor(Y/N) N Lot frontage 38 feet Building or tenant frontage 38 feet #of businesses on site 1 ( Bldng dist from street center 20 feet r Multiplier 1 1 _ (^ maximum area permitted 38.00 sq ft (V 1 total proposed sign area 19.66 sq ft "��••• ,,, sign 1 length 292.00 inches height 2.60 inches sign 2 length 36.00 inches height 24.00 inches NEW SIGN sign 3 length 134.50 inches height 2.60 inches NEW WINDOW SIGNAGE sign 4 length 84.36 inches height 5.09 inches sign 5 length 84.36 inches height 5.09 inches not applicable maximum area permitted 0.00 sq ft(per side) maximum#of signs permitted 0 signs maximum height permitted 0.00 ft tall sign 1 proposed sign area 0.00 sq ft length 0.00 inches height 0.00 inches proposed sign height 0.00 ft sign 2 proposed sign area 0.00 sq ft length 0.00 inches height 0.00 inches proposed sign height ft Application meets guidelines set forth in the Salem Sign Ordinance yes Recommend approval yes DRB Approved. This approval does not include changing the paint color for the top of the awning. ZI Z� rnsa� Q-e c OMCZVV VqE;F-(v,1 184 ESSEX STREET 812-10 COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM GIS# 1c. 10647 Map :, + 35 id§. ..'` El` + Mjj . siock ` ° '' �' SIGN PERMIT L,ot „ I i 0232 0 Pernut µ S1gn A. „ Category: c'SIGN. :' rs Perml 81210 '=ti,,2�;� , pERMISSlONIS HEREBY GRANTED TO: Protect# .'" JS-2010-001157 -;x'` 4Ki Est Cost ',; $2,000.00 Contractor: License: Expires Fee Charged $0 00 lti` Concept Signs Balance Due:$00 _ = Owner: MARLEY PROPERTIES SALEM LLC #afFixtures }" �;�;'': " luy �a'R `a Applicant: Concept Signs DigSafe# "I' ii _ ," J N, 9`, AT: 184 ESSEX STREET UseGroup .. ISSUED ON: 13-May-2010 AMENDED ON: EXPIRES ON: 13-Oct-2010 TO PERFORM THE FOLLOWING WORK: SIGN PERMIT AS APPROVED FOR(OMEN)jbh THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: SIGN REC-2010-001349 13-May-10 x $0.00 GeoTMS®2010 Des Landers Municipal Solutions,Inc. 5 HIGGINSON SQUARE 813-10 COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM GIS 550 L5 Map r °- � ,35 , > > e : SIGN PERMIT Lot , .ttr 0252 Permtt 'a'' S. ,�;,4i Category 1;,3i?i 40 SIGN + IF =i Pemut �[�# .813 10 l !� PERMISSION IS HEREBY GRANTED TO: Protect# ;;; JS-2010-001160 Est.Cost , ('$10,000.00 j '„` t;lt' Contractor: License: Expires Fee Charged:$0 00ii °EI u ' ' TBD Balance Duei$ 00 Owner: 10 DERBY SQUARE CONDOMINIUM TRUST #'of Fixtures r " 'Applicant: TBD Di afe#' ;fig g S , AT. 5 HIGGINSON SQUARE L seGroup ,ur , h_ "E' „2' ConstClass £' ISSUED ON. 14-May-2010 AMENDED ON: EXPIRES ON. 14-Oct-2010 TO PERFORM THE FOLLOWING WORK: SIGN PERMIT AS APPROVED FOR(10 DERBY SQUARE CONDOMINIUM TRUST)jbh THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: SIGN P-EC-2010-001352 14-May-10 x $0.00 GeoTMS®2010 Des Lauriers Municipal Solutions,Inc. _ 1 P a ! M ..a JThs;CymniunwCal h,o�M,,tsstltliLst:tii a, 1 A i`daa of J r gaar�QMgul�dinj)(�sgliiatl Ong,und StandatilR is` �u 9 c�u�t�us' lure (Ildrnl{C t1e, 1 0,G'A&MN edition �' 94ifJi . i i t To '� tt�c1° a sr "R� ate,Or D S.rrtgllah a Qulid Og Petrdil�►ppl r/ay Ian; hs F�1 y n -�: , ' , r�=,iJ 4dtl�0/':Ti1`Q, i)tililt°�►uelingae - oIll �' sa- 1 '" '` a 1tr.Stotioti OlGciei tJ Onl to Y z Oul`fdlny:fell `� JI 8 8ul�ditlr CorNnlssi r s perta of tlultn 9 rV I .•'t761.�t �Nb,IA Sl FrY �TIUM�; , c 4 n l,�s'ee>iip� �hiap` �oseellYumben ` i�� 'l w, .� 1 Pwcl Numba ' •^ ' , •, Ig II!Is toil t tad Stillnp n 5 ,, z• 7 � "� Fy r:1.IkAW�rDlracall der, s Y F. ,� IJ Zonit�,p fsfdlf�offbsf ,�,',Z , � r ,?� ,. �' �"7.11'>u"' n�h"� }• M .s '4 ": , •�umnd iItIMCt r F pApo - Use 1.'3 9W IdIRi•$RIbRcW fin). kR ,,' r,'i J er Yud FrcnaYatd u ♦ 9 _ J iced Provitlttd JII! i titer Supplyt(M,(3 4 e 49.!i!�) �t7 FI71`Zoai(gt8mtf�flopi x i �� ago DUp6041 SYe)e1Oi d A Ar,so'° rrfiyr Ft�ed Zd*?? a ;tlMlirlieipei•� rSn sits dl�q�,syrttmt �pu¢17eD tkiviuly 1 CFeekil �; . ,ram 7" $JECTtOM'!s, PRO i7;Y�S. iJMNERSHIPI " AI 7 3c �� QCpR1 ��� �rY{s � � A '.,R f Y �,. 1 �fIL•w✓r' 44 ✓� 1 �� M .4 �,� J ..Z", Y, - 1 J "jay�$'{i Er..Z , • �W- - . • ' Tel looly n s �crttatwt biscl'`ohCl�ehb" �u;WttKltc4eekTi fn.l�tppi)') f e er OeCu itt� d !Re lita>ta) O AI' retion(s) :O Addition Q NewCt►d8ftitcti811�+ tciatin�dui t1ih4'd ti ON'0 p. ;, , y' .rljy`pof Uhl ' � OthRt''d sjoc'fys Doing tinN 11 -Acce�ad��1�d(h Cl _�—. 8t+efDa��Ptivh'of:pro�oced Vl�brk c A " v }��1 ' oe Ij -• � t ' a 7, - $IECTIOK4: rile► ad rv;;r,�ucrign cgsT 7.E�tlmiled;al07t�i� A r"r '•a/ OIcW�ll� Alyy. .?'�„ ° J �,: Y 7 ` item I:Utsor arfd(wiatenWs tcetd how:fee a, Net}ptncd I. durldip/ I ¢mulldii+h Pcrtriit'fee f _llid` ; +'�, .• 6;�'swldtird t`Itygr�Wp�pplal�tian peg' _,- s, <,: Pi,I y� l 44 /i F ,* •w a JLISIr=, iJ„ A W +� J .h n' ° ,yC =h, �i•f��CltanlQt'1 1)I�NCd)'s J L)_ { y Mechanic a IFi*�." '` "S '� Aa ,Tote ni :p ei fu rF%uon m :, hy'' £ �ayii,AmouNt r - .f :. * � •" �•'• "i�0iiti;land7n�Bdancr Ou+E � � ' ` , ° x �q ,^71rmd � `"d � �' '� 4 .,�•� 'f c �A -Y -, L IT ! 7 p SECTION.3' �C0WAKTI'ON 410"ICES s ' S,I irJtensitd Con ruNlon N�roeutlSL Iql LIMES[ Typutx61 11*400 Lf ,y U floe Yliii•11ed. u''t$'J3.o000 ft. i ttL4 ld1''Fa i ,D ellin .< gfk_S iat%ndowandSidinietidentialSo Id Ftfel'BuMin A haiitSF RS.2Regl tried H'_ t IApt4v' enl oottseip►(HIC)1 / gJlumHIG Co YN prfile, egiitrt. 1 EapirflionDd< i �� ;Tel!<phront 'F7. ;StSiT10'N tit WO�R7l(E ',�OM�EN'STION iNSIfR.(NCE A RII�AVIT IS? !!C(6)► ^- lhrorker>{CbrtipeAiatipn lnautylee dilidsvit must;tie tofhpltied lii submitted with tht9 ipplieanon,-Fitllurt to pravidp this ffidrvlt will ersult fih�iho':deniil of.the IaseitvlcS of lilldl p penmt 5lgned Af�Idsvit,NltschetN - '" 'Yes ,:•., a , Ng,' . ;17� � `c � '` � a SECTIt� ,7i:9W',NER AUTHORIZATION TQ igE COM$LETED WHEN i OWNERr OR•C'ONTitACTOR APPLIBS IrOR BUILDING P IIMIT a i ` t _u!�a�lwper of the eub ect hfte J A�P�IY Y' alufhoriie /Li�Y a" - }— ' F to act,on my tietlslf,it!Al,malt, �. trlsnve}1d,Werle ItuthonYtd byriiis t/ullding Perrriir applitstipn ff . . • $i aMregf^Ownm.,r : � : "._ :_.r .: ..:IIatel - _ '' ' SECTIO[Yy7•b AWN RI,OItA[L'FHORIZEDrii�EfilTt ECW 0-Ot4. . r 5 v 1s Ownoror Apthorizrd AgdClt Krcbytliettrtis u. I Ii thgtthe auremen d i q dgblr on tLc foregoing a�pheatiocf ate we apd xeuals o the best o7tny knowlyd�e punt N `: ��aF 5iipisiule afOwner or.Aulh >edA;en w e Dile j Sf under the aids aiwt naliiba of , 7 NOTES•' ;. f. Ah Owner wllo•dbtsins`i bp�IdmS perinil,to doehis/het owtt work,of an owner who hire#an unceghtered.cohtrsptor T. Inal reaYsterl;d'irt..{kle Honiii'lm�foirement Contrlu b7('atC)ProSroni) w�lll have scearlo:the aibilrsGpll . - prodterftwr guirs'nly kvW"dpt(N 011 c I dam' Oiher rnponant infdrtQauon pq the H'JC,PtograYii and -an siNclia(t.SllpRlyiso�l;ie�psl��IGSIIJ can befo nd 1ir'�g01CMlt Regiilshona I Jp R6 and f,Ip.R3,rGspec`IuvelY j �i hsn sgbstaaut±l work as phoned prpvidt the;�`nToiman. . befoi� ,`,' 1'oltll Itodta arei(SQr J?L) �ffnduding gsn,ge finished bssetrotnpaNrF�i Jrc�t.oP=pQrth) C,eosa ltv5i}g''arti.lV Ft 1 H4b3:lablp room Eoun{ M1umtfkr,Lirfir lases: �iimberofbtit►olfma �_ `�yrribRtlof ba h tlomi * �"r Vumber'ortialf�atha 4 . 1'�pCofhealtng cyittili;�` ` — Vum.6SrofJeci2s/liorehelt - 1 ripe.oliooling sytterri Enclosed T _Qfiee i 1 Toral,:Ptaiei Srliia{fl Fuojge �Ioi+mKs.cuh.liruieJ fo►7ui co, r - v. ° b 1� Y • y •d r ,� .� - v 0 �hnva s�' Salem Historical Commission 120 WASHINGTON STREET, SALEM, MASSACHUSETTS 01970 (978) 745-9595 EXT. 311 FAX (978) 740-0404 CERTIFICATE OF NON-APPLICABILITY It is hereby certified that the Salem Historical Commission has determined that the proposed: ❑ Construction ❑ Moving Reconstruction ❑ Alteration Demolition ❑ Painting ❑ Signage ❑ Other Work as described below does not involve an exterior architectural feature or involves a feature covered by the exemptions or limitations set forth in the Historic District's Act (M.G.L. Ch. 40C) and the Salem Historic Districts Ordinance. District:_ McIntire Address of Property: 2 Andover St I JB (25 13cakford S 1 Name of Record Owner: David Trainor Description of Work Proposed: Replacement of black, 3 tab asphalt roof ofgarage with new black, 3-tab asphalt roof No changes in color, material, design or outward appearance. Non-applicable due to being in kind maintenance/replacement. Dated: March 17, 2010 SALEM HIS ISSION By: The homeowner has the option not to commence the work (unless it relates to resolving an outstanding violation). All work commenced must be completed within one year from this date unless otherwise indicated. THIS IS NOT A BUILDING PERMIT. Please be sure to obtain the appropriate permits from the Inspector of Buildings (or any other necessary permitsw approvals) prior to commencing work. r t` w h"Number: The Commonwealth of MassachusettsDepartment of Public Safety \lassachusetts Slate Building Code(780 CNIR)Seventh EditionCity of SalemPermit A lication for an Buildin other than a 1-or 2-Famil Dwellin (ThisSection For Of ici I Use Only) Date Applied: Building Inspector: SECTION 1: LOCATION (Please indicate Block N and Lot N for locations for n eetAdjilress is not available) No. and Street Cih' /Town Zip Code Name of Building(it applicable) 7 ~oSl SECTION 2:PROPOSED WORK YNewCtAstructiun check here❑or check all that apply in the two rows below Existing Building FI Repair 61Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ 1 Change of Occupancy ❑ 1 Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Is an Independent Structural Engineering Peed Review required? _ Yes ❑ No O7 — Brief Description of Proposed Work: :..L / %/R L L / 3/`-� q y7///-.14 �' �� ✓Lr i-u / K -- tL SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) ❑ Existing Use Group(s): Proposed Use Group(s): r Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: 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-2r ❑ A-2nc❑ A-3 ❑ A4❑ A-5❑ B: Business ❑ E. Educational ❑ F: Facto7yF-I ❑ F2❑ 1 H: Hiah Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ 1: Institutional 1-1 ❑ 1-2❑ 1-3❑ 1-4❑ 1 M: Mercantile❑ R: Residential R-113 R-2❑ R-3❑ R-4❑ S: Storage S-I ❑ S-1 ❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ISO IIA ❑ IIB ❑ Fit IA IIIBO 1 IV ❑ 1 VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Suppl Flood Zone Information: Sewage Disposal: Trench=trenchOr is,Removal: Public Check if outside•Flood Zone❑ Indicarte municipa A trench Disposal Site❑ I'ri va to❑ or i nientifc Zone: or an site system❑ required ❑ : i permit is e Railroad right-of-way: + Hazards to Air Navigation: ]IA I li,lwi;c nnmi��ion Itocir++ Pr,n r..: \ot :\pphcable❑ F Sln,cture wnhm airport appn,ach,trra.' Is their review cnmplelvd.' a l-„n.cnt to Rudd rndo+ed ❑ ,'e.❑ or Nu❑ Yes❑ \o ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Lduion nl (-, dc: l'.c Gnupl�l: r_cpeot Cun,trucuun: Occupant Load per I lunr U. e. Ihebudding :oniain,m Sprinkler Svstem': SpecialSlipulatiuns SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner :Name(Print) Nu.and Street City/Town Zip Properly Owner Contact Information: Title Telephone No. (business) Telephone No. (cell) a-marl address If applicable, the property owner herebv authorizes Name Street Address Citv/Town State Zip to act on the pro pert%o%%ner's behalf, in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) (It building is less than 35,tXX)cu.ft.of enclosed s ace and/or not under Construction Control then check here O and skip Section I0.1) 10. Re istered Professional Responsible for Construction Control registran e-mail address Registration Number� /;PX-4- V 2i Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Company Name: ?n �`e/Nub n �J IS �LL Name of Person Responsible for Construction License No. and Type if Applicable Street Address City/Town State Zip Telephone No.(business) Telephone No. (cell) 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 application? Yes O No O SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Est(contact Total Construction Cost(from Item 6)_$ 1. Building $ 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 $ 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 t p uion is ru and accurate to t e best of my knowledge and understanding. 1'e..e r n name ,D Title Telephone No. Dale titres dd �Kfd �t Town Zip D D S 1 D218 Municipal Inspector to fill out this section upon application approval: i ame I) to l/y l „ 1LAW lbi 1 f Ilk GGt �i Gl/� 7F- 3 2►i c- �1