135 BOSTON ST - BUILDING JACKET „r
The Commonwealth of Massachusetts
® Department of Public Safety
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)
t 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)
/3s� jX S4 1r,9, 17,4 (V`!.>,O
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❑ Repair❑ Alteration ❑ Addition❑ 1 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 I3
Is an Independent Structural Engineering Peer Review required? / / Yes ❑ No ff—
Brief Description of Proposed Work: ,i of /1&, l 7 0
W1 Maw ,n.;ei l,.✓J/1- _f`i✓.� r `��L ,!� .y sa. ;i” 'exyJ
��✓mac-:A/ yP✓/rSti- ioe.F d✓r✓ �rsra�w� `ti /iso
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.R)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ I H: Hi Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional I-1 ❑ I-2❑ I-3❑ 1-4 1:1M: 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 O IIIA ❑ HIB ❑ I IV ❑ I VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Supply: Flood one Information: Sewage Disposal: Trench Permit: Debris Removal:
Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑
Private❑ or indentify Zone: or on site system❑ required❑or trench or specify:
permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation 1 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:
tDoes the building contain an Sprinkler System?: Special Stipulations:
SECTION 9, PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner p /'
)or/-,,, ,4!" 14 ( /3S 0��lTGry n 4�//
Name(Print) No.and Street '" City/Town Zip
Property Owner Contact Information: � ,I r' 2 _ -re)7f
/ri I01WY - 6 --/ -
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 permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 0 and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor p /
le1^ditff494 Al /Coa �u-y GoHV`i� G�o>/ �yG
Company Name
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Name of Person Responsible for/Construction License No. and Type if Applicable
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Street Address / Sta Zip
6/7 zp3 ogd $78 - �4�-Gs,Pty/Town t r !c
- � nro ,sf/lo al rar �*- ' �vrsiTa'+ , tir
Telephone No.(business) Telephone No. celle-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§25C(6))
A Workers'Compensation htsurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
Is a si ed Affidavit submitted with this application? Yes 0 No 0
SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$
1.Building $ 2 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 $ (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 best of my knowledge and understanding.
I W S4e-
rl>f n
Please print d sign name Title Telephone No. Date
Jkre_1
Street Address City/Town State Zip c
Municipal Inspector to fill out this section upon application approval: CH
Name Date
18-
The Commonwealth of Massachusetts RECEIVED
r "I� Board of Building Regulations and Stand CITY OF
4 ; Massachusetts State Building Code, 78CTIOHAL SERVICES SALEM
;1w Revised Nlar 201/
Building Permit Application To Construct, Repair, Rencj&( *)WTliAa� 14$
One-or Two-Family Dwelling tY1V JU
This Section For Offici se Only
Building Permit Number: Date Appllliiy"ed:
Building OlTicial(Print Name) Signature
SECTION I:SITE INFORMATION
Li Property Addresp 1.2 Assessors Map& Parcel Numbers
1.1 a Is this an accepted street?yes_ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Properly Dimensions:
Zoning District Proposed Use Lot Area(sq 11) Frontage(11)
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❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system Cl
Check if yes[]
SECTION 2: PROPERTY OWNERSHIP'
2.1 Ownterl of Record:
A/-7v S417h/ 17,I//
Name(Print) / City,state,ZIP
>31 13a/ T,- 779 -317- y111
No.and Sued Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building❑ 1 Owner-Occupied ❑ Repairs(s) H(I Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Dri�ptiooProposed Work': 7r4 K,l
/ti Mrw s
r' a
SECTION 4: EsTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials Official Use Only
I. Building I. Building Permit Fee: $ Indicate how fee is determined:
❑Standard Cityfrown Application Fee
2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: S
4. Mechanical (I IVAC) $ List: (�
5. Mechanical (Fire $
` Suppression) Total All Fees: $
_ Check No.___Check Amount: Cash Amount:
!,."Total Prgject Cost $ 7r'l�1 0 Paid in Full 0 Outstanding Balance Duc:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor.Lic nse(CSL) �'S-G/�7-2 0f
J n Z.( Q% '(.'h YA T^,2,Gr?yl License Number Expiration Date 1
Name of CSL Flolder
j List CSL"Type(see below)
No.and Street
"fy Description
f U Unrestricted(Buildings u to 35,000 cu. ft.
14/Yr7 �d Restricted 1&2 FamilyDwellin
Ciry/Town,State,ZIP M -Wa;o®ry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
I Insulation
"fete hone Email address D Demolition
5.2 Registeered Home ImprovementContractor(HIQ 62 76O/ `
A&11!7<or� 9(G�¢'/ty Zva �r.0 CrG� ( FIIC RegistrationNumixr Expiration Date
HIC Company Na��m11e or HIC Registrantt'Name /'
LIP Olr z J i�� / )c Piv frf!ta4,,7/t96111 fLZ0 V<vt70: Ale
No.and Street Email address
C41
r r /M�1 U/�11U 6/ Z/�3' E/Of1
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 .......... 93�' No...........❑
SECTION 7a:OWNER AUTHORIZAT[ON 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 N:une(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.
ml Owner's or Authorized Agent's Name(FIccoonic Signature)- Date
NOTES:
I. 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.nmss.aoy/oca Information on the Construction Supervisor License can be found at www.ntass.gov/dos
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.) I-labitable 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"
The Commonwealth of Massachusetts
Department ofPublic Safety
Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-o w Fami Dwelli
(This Section For Official Use Only)
Building Permit Number: Date Applied: Buflding Official:
SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a s t address is not.available),
0l %70 Ar rri ZdtlN ry
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 a6 that apply in the two rows below
Existing Building 19- Repair 63- Alteration ❑ Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ 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 Peer Review re�rcured? p Yes ❑ No ❑
Brief Description of Pro�osed Work: �dr r O d/!// .^v U r//ti / /wJ��l�_ N 7«-
I-ei�i /�? /1rJ cr.s.- /ot Fy /� A �i .•n /' sv /'up r'7
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): I 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❑ 1 B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ I H: High Hazard H-1❑ H-2❑ H-3 Cl H-4❑ H-5❑
I: Institutional 1-1 ❑ I-2❑ I-3❑ 14❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑
S: Storage S-1❑ 5-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ 113 ❑ x IIA ❑ IIB ❑ IHA ❑ IIIB ❑ 1 IV ❑ VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Trench Pernik Debris Removal:
Water Supply: Flood Zone Information: Sewage Disposal: Licensed sRemoval:
al: ❑
Public Pf Check if outside Flood Zone❑ Indicate municipal❑ A trench will not beDisposal
required Cl or trench or specify:
Private❑ or indentify Zone: or on site system❑ permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: I list ric Cmiiinissi.n Rcvry Process:
Not Applicable❑ Is Structure within airport approach area? Is their review completed?
or Consent to Budd 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:
P t'
SECTION 9: PROPERTY OWNER AUTHORIZATION -
Name and Address of Property Owner // • // ('S
A/*.- 4(m z�c l /3S /9,j s f/ �r�
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 permit application.
SECTION 10:.CONSTRUCTION CONTROL(Please fill out Appendix 2) -
If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 0.and skip Section 101
10.1Registered Professional Responsible for Construction Control .'
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 Generale Contractor • > > -
0 41.110•L N QU l r' GN {1- L-
Company Name
�n/10(
Name of Person Responsff'ble for Construction // License No. and Type if Applicable
L,T 4ae-. 5a. h �� f4<7/7 / a191 V
Street Address City/Town State Zip
Telephone No. business Telephone No. cell e-mail address
SECTION 11:Yt0RLh.R9'CONII'ENSA'HON INSURANC H AHFIDAVFf 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 $ 3 r 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 $ 3 3/t�r ' (contact municipality)and write check number re
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 accura e to the best of my knowledge and understanding.
S�f w tir< �.,, ;sue �• i� G d/� �93 �arsG /// / 3
Please print and si name - Tide Telephone No. Date
4J zs� 6�,w J
Street Address City/Town State Zip
Municipal Inspector to fill out this.section upon application approval: '
Name Date