39 NORMAN ST - BUILDING INSPECTION t r22� GK I OS 3c7
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The Commonwealth of Masp?VW&Tdit,4�1
__ 11 Department of Public Safety
lV Massachusetts State Building Code(780� P 127 Q
1
Building Permit Application for any Building other than a C1 �]Z)Vw amity Dwelling
L
(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) ' "
3 9 /VDIPM AN S Srf ,LM O/V70.
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 ❑ 1 Addition❑ I Demolition JO (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 M No ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑
Brief Description of Proposed W%rkk: p�
�M GiDL'� /GtMD42= /✓�ETNVLIL (ir�A-liliS' A,Ne? LiGF. _ .�✓d ALL(C f�
r<i's SECTION,3:COMPLETE THIS SECTION IF,EXISTING'BUILDING'.UNDERGOING RENOVATION,ADDITION,OR
";'` '-'•' ;;; r
J,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):
4..':L s).."x,..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)., •n ;W-
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ I H: High Hazard H-1❑ H-2❑ H-3 ❑ H4❑ H-5❑
I: Institutional I-1 ❑ I-2❑ I-3❑ I-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑
S: Storage Sl❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
1,.. tt:a:..,. ;SECI'ION 6:.CONSTRiJCTION TYPE(Check aS ap licable) .'...r=w } 5a , ¢7 •, - •41
IA [3 IB C3 IIA ❑ IIB 13 IIIA ❑ IIIB ❑ IV ❑ VA 13 VB
' �zoy,,4 m 3 SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item).� R�PVYa 13, Al
Water Supply: Flood Zone Information Sewage Disposal: Trench Permit- Debris Removal:
A trench will not be Licensed Disposal Site❑
Public❑ Check if outside Flood Zone❑ Indicate municipal❑ required❑or 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 ❑
,r;t'SECTI0N 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:
eACA t t,C,CD "T-b -: 1V T 1 2
SECTION 9; PROPERTY OWNER;AUTHORIZATION
re and Adddr�ess of Property Owner �J� (�
416 ,/i?/r?.v,c�ry_ �t�v�J' 6Tf /V-
Name(Print) No.and Street City/ToVAn Zip
Property Owner Contact Information:
_/A.CSt /lENe 7,p/_GS$ 070y C t/t�Svicx � �7�i^ laafNc teti
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes //'� r1✓
YL A46 /� / 8va4-rt. IT. Jyt v q 0 fn
N ne Street Address City/ own 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) �.
I. f buddin is tens than 35,000 cii.ft.of endosed sfnce end oz not undei'Cons rucuon Contiol Hien check here O end ski_Section 10.1 M_ -�
10.1'..Re 'stered Professional Responsible for Construction Control':ff: "•' � o _i_,;«:
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2'Geheral Coiitractor `�": .- - , ..1;, .�-, ,r- _." �r Ts„t �trR •�', -�4i.. =moi .,r E' ' {
ivp �>tJjAivGT1b+/
Co _y Name
�y&Ib W4 C5 041041
Name of Person Responsible for Constructionf� License No. and Type if Applicable
/; Bkrtn,rr sr' , l i jjn„ Pte+ — M,4 W-792
Street Address City/ own State Zip
10-tYZ 3Cl/ 70_39'S /6oS �/bEoCa�o�i�,wco�s� crp- •col
Telephone No.(business) Telephone No. celle-mail address
ifs g:« �``"{( SECTION 11:WORTC$RS'COMPHNSA7TON INSURANCE AFFIDAVCI' M.GiC;c.152-§25C(6))
A Workers Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes❑ No ❑
n t'P .'SECFION 12.CONSTRUCTION,COSTS ANDIPERMTTFEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$
1.Building $ Z J v0 U ' as
Building Permit Fee=Total Construction Cost x_(Insert here
2.Electrical $ appropriate municipal factor)=$
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (co ctipality),
5.Mechanical Other $ Enclose check payable to /
6.Total Cost $2-O� ti�V a--a (contact municipality)and write check number here
gua". .l,ryti:Po ' "- FSECTION13iSIGNATUILE OF BUILDING PERMTTtAPPLICANT,„ ,;1" , M f- ' E:
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this
ep—PlYation is truea urate to the best of my knowledge and understanding.
Az.f, n &<
Ple yrint d sign name n Title Telephone No. Date
_�reVX'L,✓t S7'- /lwir+Gyfv N4 079°
Street Address City/Town //. State Zip
# 4 •i ti , �v r "a G a a F ,. ✓6r.yY� /1, l �t L G[ F...
Municipal Inspector to fill out this section upon application approval
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Commonwealth
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Craig Strasnick
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Massachusetts Department of Public Safety 'I
Board of Building Regulations and Standards -
License: CS-061061
Construction Supervisor -
CARLO E CAPONIGRO �;;: W�N?r�o�urrea�a�C3/l�amacLurnotld
159 BURRILL SV A Office of Consumer Affairs&Business Regulation -
SWAM PSC OTT Iy1AOME IMPROVEMENT CONTRACTOR
egistration fig Type;
- _
1c � xpiration:_ DBA
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CAPONIGRO CONS
Expiration: _
Commissioner 0712512017 i
- - -CARLO CAPONIGR*-
159 SURRILL ST
SWAMPSCOTT, MA 019 Undersecretary
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