Loading...
MINOR DEMO NON-BEARING WALLS, ETC BPA-17-246 old k The Commonwealth of \I Department of Public Safety Massachusetts State Building C �} 7 }� Building Permit Application for any Building other haan a�Onee--or Two-Fmmil Dwelling � Y g (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) �— :2(� C 1 Pm 61 �8& o-Tu r--e T 006%C-IL No.and Street City-/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of NIA State Code used If New Construction check here❑ or check all that apply in the two rows below Existing Building❑ Repair❑ Alteration Addition❑ Demolition ❑ (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 ❑ No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No 91'- Brief Description of Proposed Work: 1Y1 n /Je.xp C N)rA b&ul�rmWz"I 15 C 1`e Ira!)3 . �x 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 ❑ A-4❑ A-5❑ I B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional 1-1 ❑ I-2❑ 1-3❑ I-4❑ 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 IB ❑ IIA ❑ IIB [3 IIIA 13 IIIB ❑ TIV ❑ VA 13 VB ❑ SECTION 7:SITE INFORMATION (refer to 780 CMR 111.0 for details on each item) Water Supp . Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: �/_ A trench will not he Licensed Disposal Site EK Public Check if outside Flood Zone❑ Indicate municipal required C'jor trench or specify: Private❑ or indentify Zone: or on site system❑ permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable❑ Is Structure within airport approach 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: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner RC & LLL 7E Lc�jpo�Velfe Safe,#7 01898 Name(Print) No. and treet City/Town Zip Property Owner Contact Information: Mc!4 o Q,-^ cf;� -2*0- ©CIO C cc Title 11 Telephone No.(business) Telephone No. (cell) e-mail address If applicable, the property owner hereby authorizes PO L,r ,ct G;j ss - 03 to Name Street Address City/Town State Zip to act on the propertv 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 t11u135,000 cu.ft.of enclosed space and/or not under Construction Control then check here❑and skip Section 10.1) 10.1 Registered Professional Responsible for Construction Control Ad a- m L _ LV,, 603S-0 62-0k- Name 2--Gk-Name(Registrant) T lephone No. e-mail ad r Registration Number t V-I CoFa c ra 55 �frrr� Pcris die',�h� �1 j�r�A,fr�f j Z 4011 Street Address City/Town State Zip Discipline Expiration Date 10., ^ 2�General Contractor [/ l J `a,, k C 4 Company Name G c Name of Person Re ponsible for Construction /� License No. and Type if Applicable 17.5 1—1 Yt c./c n S 1` /! ciR t4 e_i 4— lel 03103 Street Address City/Town State Zip 6 6° - - Ll m c c-t — N It . Com Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKEP.S'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❑ No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal factor)=$ 3.Plumbing $ 3. i (HVAC) $ Note:Minimum fee=$ (contact municipality) 5. e Other) $ Enclose check payable to 6.Total Cost $ $ oc �el" (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 b of my wledge and understanding. 4�r � Or V�IrA S ft"'i el, C L Please print and name Title Telephone No. Date 5 L 4 031o3 Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: " � ` � Name Date EXISTING DOUBLE ENTRY DOORS EXTERIOR EXISTING STOREFRONT 36 SYSTEM AND GLAZING ' I 36 �' I DFW I , I I , I N sw 1 I I I �1 a o t i I EXISTING STOREFRONT Y sysrEM AND cLazlNc I I o I C? I i / C I I EXISTING ED STRUCTURAL I I COLUMN , Q I I I I I I a N I UI m a 3 a I EXTERIOR 6•_5•• m 519 1/2" I - I SW1_2I' b u I I sw X8 I I T— i I I I I I I I I I I I I I I I I I I I I 82 -�------- ----J , EXISTING WR SWt 2 13 NOTE I 71 ENTRY DOOR ARE4 DENOTES a4" SW %1 FM_65N ACCESSIBLE ROUTE , EXTERIOR FIXTURE SCHEDULE BRANDED ELEMENTS NAME ODANTITY DESCRIPTION NAME DUANTRV I DESCRIPTION NAME OVANTfTV DESCRIPTION NEW EXIST NEW EXIST NEW EXIST AC3_6 1 0 ACCESSORY PANEL W/USB-APPLE DWJ 1 0 DISPLAY WALL)-APPLE M_1 0 D J.URAILSMALL AC3_1 1 0 ACCESSORY PANELWoUSB-SAMSUNG pWK 1 0 DISPLAY WALL K-SAMSUNG M_2 0 0 MURAL MEDIUM AC38 1 0 ACCESSORY PANELW(USB-11 EXAVDIO DWL 2 0 DISPLAY WALL FLEXAUOIO M_3 0 0 MURAL LARGE AC39 1 0 ACCESSORY PANEL W,USB-ANDROIC DWM 2 0 DISPLAY WALL M-ANDROID WR 0 WINDOW WRAP .C3_10 1 0 ACCESSORY PANEL W USB-TABLETS pWN 2 0 DISPLAY WALL N-TABLETS AC311 1 0 ACCESSORY PgNEL WUSB-OVERFLOW DWP 1 0 DISPLAY WALL P- OVERFLOW ADA 1 0 ADA COUNTER FT_dA 0 0 FEATURE TABLE-d'-0'-METAL 81 1 0 BENCH-PRIMARY d'W,INSET 7_48 0 0 FEATURE TABLE-d'-0"-METAL-POWER POLE B2 1 0 BENCH-SECONDARVd' ET 6A 0 0 FEATURETABLE-6'� -METAL CP 1 0 0 CASH POD-15TATION FT_6B 2 C FEATURE TABLE-6'-0'-METAL-POWERPOLE GRAPHIC FIXTURE SCHEDULE CP_ADA 0 0 CASH POO-A DACELLEBRITECABINET SC_1 0 0 SERVICE COUNTER,SINGLE NAME 1 CIANTRY DESCRIPTION CP PRT 0 0 CASHROD-PRINTER CABINET SC_tA 0 SERVICE COUNTERD-ON .SINGLE ADNEW EXIST C_4 0 0 CONSULTATION TAB!E-d SEATS SC_2 2 C 0 SERVICE COUNTER DOUBLE AFt 1 0 1 AFRAME SIGN CT_60 0 CONSULTATION TABLE-65EAT5 SC_PRT 1 0 SERVICE COUNTER,PRINTER BEM 65NS 0 BRAND FOCAL MONITOR--NO SHR DFM 0 0 DIGITAL FRONTWINDOW-6' SW 16 0 SYSTEM WALL PANEL-d]1.d" 1 9FM 82NS 0 0 BRAND FOCAL MONITOR-82'NO SHR DIM 0 0 DIGITAL FRONT WINDOW-6'FREESTANOING SWt_ 2 0 SYSTEM WALL PANEL-2358" L91 0 0 LED WINDOW FRAME SIGN DFN 2 0 DIGITAL FRONT WINDOW-8" SWS 0 0 SYSTEM WALL PANEL-4]t1d" OFW_F 0 C DIGITAL FRONTWINDOW-8'FREES7ANDING SSG 0 0 STANCHI CABLE SWSt_2 0 0 SYSTEM WALL PANEL 2358" T89 0 0 WINDOW CABLE DISPLAYB DS 1 0 DIGITAL SIGNAGE .62 0 WOOD BASE WG1 0 0 WALL GRAPHIC.dp�58 D3R 0 0 DIGITAL SIGNAGE-WITH REMO WB2a 0 0 1- WALL BAY WG3 0 0 WALL GRAPHIC]6x66 WP2 0 0 HANDSET,",RID-ZONE d WG3 2 0 WALL GRAPHIC.112a