10 BLANEY ST - BPA-11-646 CONSTRUCT 10' SEA WALL , r
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� � , � � The Commonwealth of Massachusetts
F �.� Department o( Public Safety . '
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' � City of Silem �
Buildin Permit A� licafion (or �n BuiWin other thrn a I- or 2-Famil Dwellin
i fhi.��h,m Fur Uffici.il U.rUnlvl , �
� OuJ.hnti Prnnn Numbrn Datr ApF,hr.l: Bwldmg In.�+rcl r
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� 5ECTION L• LOCA�ION IPle�fe indicatr Block I �nd Lat I for locatwnf for which a ftrett addr�s�is not av�il�blel
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\.i. .ind�trrrl . C rte i Lnvn Li�,Cndr Namr u� Bu�ldm�;Uf.�yp6rablrl
SECf10N i:PROPOSED WORK
�. . . . li Nrw Cunstrucnun check hrrc ur chrck all �hal a��ly�n tfir two ruws brl��w
� � " - �Ecoting-Bmldinti.0. . .RrFairO-�--A�Itrraliun-p--qJ�lita�n-0� -0irmulitiun-0-S�'Irax-fi74iwF.�nd�.ubm�1-Ay�d�a-.�.j—__
ChangrJlUx � ❑ ChangrufOcnipancy ❑ U�hrr O GNrcdy: � . � -- .. .
- Arr bmlding plans nnd/ur curulructiun ducumrnte being�upplird as part of Ihis�rrmit applicanun? Yr+ O Nu.Pj.�
I.an Indrpnndrni Slruciural Enginrrring Perr Rrvirw rryuired? � � Yrs p N�i O
Dni! Dr.rcnpti�m uf t'rup�i.i•� Wurk: t-.-x�•sz ct . o r � g2• . �V�
li�� _..at -Zta S� \� ` aR-�� -to S3n a��p�iP�oa �w A � ��c �c�
Trc7vt\�lGa '—!� J O 14LL"'C.y�LY.-4J�SF '—lT� � '1�� �
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SECTION�:COMPLETE THlS SECTION IF EXISTINC BUILDINC UNDERGOING RENOVATION,ADDITlON,OA
CHANCE IN USE OR OCCUPANCY
Cheek hrre if an Ex1�Un6 Bulldins Fvaluatlon ie enclosed(Sre 7gp CMR 3402.0) O •
Exi>ting Use Group(s): Pruposed Use Croup(a): �•
Exivling Ha�rd Indea 780CMR J4: Proposed�Haznrd Index 780 ChIR J4:
SECTION 4:BUILDING HEICHTAND AREA
� ��5���8 Propuaed
. No.uf Fl�wrs/Storiry(includr baarmrnt Irvrls)&Area Per floor(sq.(t.)
Tutal Arra(sq. R.)and Tutnl Height(ft.) ,
SECi10N S:USE GROUP(Cfieck a�a licablel
A: A��tmbly A-1 O A•2r O A-2nc� A-3 ❑ A�4 O A-5 O B: Bu�lne�s O E: Educalional ❑
. F: Facto F-I ❑ F2 O H: HI Hazud H-I O H-2❑ H-3 ❑ H-4❑ H-5 O
- 1: Inetitutlonal 1-I ❑ 1-2 O I-7 O 1-i O M: Mercantllt O R: Ileaidentlal R•1❑ R-2❑ R-3❑ R-�O
5: Ston e 5-I O 5.7 O U: Utilitr O Special Usr ind Irax drunbr brluw:
Sprcial ll.w: � L -�\l..\''C . �
SECTION 6:CONSTRUCTION 7YPE IChcck�i a 8cable)
' IAO IB ❑ IIAO IIBO IIIA ❑ IIIBD IV ❑ VA ❑ VB ❑
SECTION 7� SITE INFORMATION Irtlerlo7BOC�1R 111.0 fordeliiif on earh ite�n)
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IW�ter Supply: Flood "Lone In/orm��ion:�� Sew�Re Oi�po�al: I'reach Permil: ' Vebrie Remuv�l:
Publ�i ❑ l'I+ee��Iuu1.�Je I�Lw�.l Lnn.•O ImLv.ilr mumn�•.�I❑ :\ Irrnah will nnt hr f.i:cmod Ui.p��..il ��Ir❑ '
� Prt�.nv❑ ��rmdcnld� Lmv�_ ��r��n.�tr.�. �cyuucdO��rlrenah ��r .�,cah.
Irm ❑
�•rrmtl �.cnclu.ayl Q
I R�ilro�dnght�uf�way: H�t�rdsroAirN�riguion: �i.rii„�...�. � ..,,��n�_,�..,ii1,,,,,, ,-- �
\��1 \�•��L�dl�tvO ' I.�Irwliuc ��tlhm.nr�•ort.��•�•b�ethdn•.i' I.Ihvrt�c� , . I
ic�. : .m��I.A�J� I
.�il��.,�.cnln� Ilwl.Ivn�L�.c.10 I lr.� ��r\n0 1i�. Q \.� Q •.
� tilC�IUN A:lON�EVT UF CF.RTIFIC.1 fE UF UCCUPANCY � --�
I .Ii�n�n .,� t ,�,Ic _ l�vt.�,� � f� � --�
, '__ ul•�' __ �r.ql���ny�u�Ih�O ..__ l ��(u��dnl � ��d.l ��ctll���.� .
� 16.��. ihr1•�iil,6np,�,rq.iin.in��vu�Alcr ?�.icm' •�,.�ci.il�ii��ul.ili��n. . .. .. . . _ �
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SECTION 9: PROPERI'1'OWN ER AUTHORIZATION I
\'sone sold ,%ddrvss of 1'rul.crtr l)s.'ner
\emr IPnm1 ..\'o. .u+ct Sl rvrt Ca., r.nvn
1'rui,,rtc lh. ner Contact btlurmallun:
tt",C- Pmt —'—
r.tlr reiephone No. (busmrs,) rrlephone No. Iceli) e-mad.I.Wrc'11
If applicably, the property ow ner heretw authonres
r]!+ I
Name
Strart Address Cltvi Toon State Zip
111.10 on the •n. •a•rtc o., orfs l+rhell, Instil maltrrc n•laucr lu .cork authonta•d by this bwlshn • ,remit a + dlr.oun+.
SECTION 10: CONSTRUCTION CONTROL IPlaase fill out Appendix 2)
III Inuldm • s Les Ilun 13,Iaalal. it ul .•naluxJ • wia• anJ/w nut unater Con>Iro.nnn Cuntrot then cher► here C1.+nd •k. + S ,lnn+ III II
1 .1 Re the
Pm(essional Res onsible for Construction Control
p vww3�-6 RC���cc U wry\ 3D�'�
r-mal —i ss � c�Ixtratil Number 6
Street Addles)% AN / < City/Town State Lip Disctplinr Ex ira on Dalr
Company Name:
T
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Name of Perslm Respmsiblr for Constructiun
License No. and Type if Applicable
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S. 1\�.��� Nc-S
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Street Address
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City/Town
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StateZip
Y-E.`it�pS��N���\-� 114
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Telephone No. (cell)
_ e-mail address
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 oft issuance of the building permit.
Is -a si ned Affidavit submitted with this application? Yes No O
SECTION 12: CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs: (Labor
and Materials) Total Construction Cwt (from Item b) = f
1. Building f Building Permit Fee - Total Construction Cost x _ (insert here
2. Electrical f appropriate municipal factor) = f
3. Plumbin f -
Note: Minimum fee (contact municipality)
4. Mechanical (HVAC) f 1 L
5. Mechanical (Other) f Enclose check payable to
6. Total Cost 5['/• gfitact mstniri alit ) and write check number here
5EC"nON I3'SIGNATURE OF BUILDING PERMIT APPLICANT
Bs• rntrnng my name below, I herebv attest under the pains and penalhr..d perjury that .dl u( the Information c..nt.unrd m this
apphcalwn 6lrue and aecunite to the brsl nt my knowled rand underaan.hng.
� ..r• .���., � •J. Gam. \'SES �U\ 435, \\3 3 ,3�\�
iI'Ie.n.• peon ..nd -.pn n.nne foie rcicph.me \,. U,nv
�LIle
Municipal inspector to till out this section upon application approval:
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