B-17-494 - 0085 BRIDGE STREET - Building Permit I023
The Commonwealth of Massachusetts
hr� 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)
Building Permit Number: Date Applied: Buildng Official:
SECTION 1:LOCATIO (Please in icate Block#and Lot#for Iacations for which a street address is not available)
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* No.and Street City/Town Zip Code Name of Building(if applicable)
SECTION 2:PROPOSED WORK
ti 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❑ 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 1Y No ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No
Brief Description of Proposed Work:
Con v1/' r4i t''2
. 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 OT B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
1: Institutional 1-1❑ I-2❑ 1-3❑ 14❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑
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 ❑ I1B ❑ ILIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑
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 J 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: .\dA I hsloric Commissu n Revitgy._I'n.��ess:
.........._............_.-................_............- - ...
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:
Dues the building contain an Sprinkler System?: Special Stipulations:
At(-C—� �t� C 9
SECTION 9: PROPERTY OWNER AUTHORIZATION /
Name and Address of P Ity Own er
Name(Print) No.and eet City/Town Zip
Property Owner Contact Information-
01
Title Telephone No.(business) Telephone No. (cell) -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 bu ild ing is less than35,000 cu.ft:of enclosed space and/or.not under Construction Control then check here❑and s kip Section 10.1
10.1 Registered Professional Responsible for Construction Control
Na i e e to ) Te phone N e-mail a idres Registration Number
Street Address City Town State Zip Discipline Expira ion Date
10:2 General Contractor
Comp y Name
Name of Person Responsible for Construction License No. and Type if Applicable
Street Address City/Town . State Zip
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Telephone No. business Telephone No. cell e-mail address
SECTION 11: I.NSUR:1NCii AFFIDAVITM.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 $
1,iVlechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical Other $
al90 Enclose check payable to
it 6.Total Cost $ 00)' A40 (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
applicatio is t e tin ccurate to the best of my knowledge and understanding.
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Plea• prinytfzc�d sii nai}ie� Title Telephone No. Date
Street Address City/Town tate 1 p
Municipal Inspector to fill out this section upon application approval: I,/141WI 0b
NY me Date
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® 19'-4 3/4" GENERAL NOTES FLOOR PLANS
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r 1. All dimensions at the windows are to the center line.
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a 2. Interior dimensions are to the face of stud at new walls and to _ .__ � J
the face of finish at existing walls. C� —
w 3. Exterior dimensions are to the face of framing,centerline of LL
opening,or to the rough opening,unless otherwise noted. 7
CLOSET- CLOSET L? 4. Prior to construction,verify all critical dimensions with existing .� Z
— I site conditions and manufacturer specification-, O �- —
5. See floor elevations§ions for additional door/window LO Q
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BEDROOM 2 tj
r Product & Material Info - Floor Plans Project#: 17024
STAIR 1 Date 04.28.2017
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9'-10 5/16" 16'-10 1/16" Drawn by: G EW
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PROGRESS SET
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n.Upper Floor Plan
1/4" = 1'-0" Scale: 1/4'