B-19-515 - 0010 VINNIN STREET - Building Permit _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
js� S (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)
1
/0 V i„ ,Q� Sal", G! q70 -S c!ljskj h1ImZr&n Mtoor.-w1 A(1a
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
�1 Existing Building Ed Repair Alteration ❑ Addition❑ 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 Engineerin Peer Review required? Yes ❑ No ��
Brief Description of Proposed Work I'Me M.NC Ot'd rep ie r' A Q ed fa,q•f , s j i n b�j (3� 1 L foo
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 Pro osed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area 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❑ B: Business ❑ E: Ed catio 0
F: Facto F-1❑ F2❑ H: Hi Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ `." H=54 . .�.F
I: Institutional I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile❑ R. Residential R-10 R-2❑ R-3,vR ],
S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below: :
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ Ill ❑ IIA ❑ IIB ❑ RIA ❑ MB ❑ 1 IV ❑ 1 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❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑
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 ❑
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:
l "Yon 17 (vL cow
May 1619 02:10p J.DiChiara&Sons,Inc. 781-233-9756 PA
SECTION 9. PROPERTY GVVNM AUTHORIZATION
Ad 5o1P fawnerVerty
Vinaw Sfyat * VU gla7V
Name(1-am) No.and Street City/Town zip
Property Owner Contact Information;
MUAAVUtfh V I-Vf I
, 6 533 . ierro Pdj40j'j elney'al.10-1
ntle Telephone No.(business) Telephone No. (cell) Je-nvail address J
If applicable,the property owner hereby authorizes
b,cka 3a7 CejWfrj 34 �oj 0;9#t
Name Street Address City/Town State zip
to act on the pm perty owtw&s behalf,in all matters relative to work authorized by dais building permit applicarwri,
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
(M buildimm is less than 35.OM ctL ft of enclosed space W&or not under Construction Control then check hem 0 and sidy Section 101)
10.1 Regislered Professional Respotitsible for Construction Control
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town state zip Discipline Expiration Date
102 Genezat Contractor
-T-
Company Name
CS L 53213
in.da,' a,11 ra-
Name of Person Responsible for Construction License No. and Typed Applicable
3J7 Cedul
Street Address Cit,/To-n State Zip
791,133- 7ioS' 711 993. 50 91 If.k:' fj d,616
Tel No,Rottsiriess) Telephone No.(cell) e-mail address
SECTION 11:WORKERS COMPFMATION INSURANCE AMAVrr CM.Cl-c.1W-j 25C(6))
A Workers'Compensation Imuranoe 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 tliq issuance of the building permit,
Is a signed Affidavit submitted with this application? Yes In No a
SEMON 22:CONSTRUCTION COSTS AND PERMIT FEE
Item
Estimated Costs:(Labor
and Materials) Total Construction Cost(from(fromItem 6) 700
1.Building 70 Building Permit Fee=Total Construction Cog x: here
2.Electrical $ appropriate munici a [actor)
3.Plumbing
4-Mechanical (WAC) $ Note.Minimumfee=$ (contact municipality)
5.Medtanical (Other)
Enclose check payable to
6.Total Cost 5 aJ,70 0 (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name Wow,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 of
'4 .:�y knowledge and undentandirig.
C&./ 't
_70 A3
Please print and si�)name Title Telephone No. Date
20U30'
Street Address City/Town state zip
Municipal Inspector to M ant this section upon application approvak
Name Date
1.00/1.00-d 9CL# 1.1.41. BLOZ/9L/90 001-1. 9ze 9LG NOSNVVIAH A)4S13NV1S:LUOJ=l