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10 BOSTON ST - BPA-14-932 EMPLOYEE LAV . ' � � � � ~ �f32 �lo� � _ ;`��, The Commonwealth of Massachusetts I� Department of Public Safety �� 2f Z(p'1� + VYu � Massachusetts State Building Code(780 CMR) Building Permit Applicarion for any Building other than a One-or Two-Family Dwelling �., ('I'his Section For Official Use Only) �I Building Permit Number: Date Applied: � Building Official: � o K l� 1 , SECTION 1:LOCATION(Please indicate Block#and Lot#fox locations for w ' et address is not availab '�. y � 8 '�O�TO�� S I 6 \ O ON I �.�,. No.and Street City/Town Zip Code N e of i ding(if applicable) 'P(�J . � SECTION 2:PROPOSED WORK � EdiHon of MA State Code used_ If New Construction check here O or check all that apply in the two rows below Existlng Building,IJ' Repair❑ AlteraHon ❑ Addition❑ Demolition O (Please fill out and submit Appendix 1) Change of Use ❑ Changeof Occupancy ❑ Other ❑ Specify: ��` Are building plans and/or construction documents being supplied as part of this permit application? Yes � No ❑ Is an Independent StrucNral Engineering Peer Review re�uired? .` Yes ❑ Nq,❑ Brief DescripHon of Proposed Work: C'. � � �- o�� �\�G—�� L e:, �Gi,✓���"CJ�� � �r, /- u f � l., � e �-�..+ ,r- si .� �,..� � �'� I SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATTON,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an ExisHng Building Investigafion and EvaluaHon is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): 6/� � SECTION 4:BUILDING HEIGHT AND AREA � � E�tisting Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) � To[a]Area(sq.f[.)and Total Height(ft.) SECT[ON 5:USE GAOUP(Check as applicable) . A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: EducaHonal ❑ . F: Facto F-1❑ F2❑ A: Hi Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ Ii InsHtuHonal 41❑ I-2❑ I-3❑ I-4❑ M: Mercantile R: Residential R-1❑ R-2❑ R-3❑ R-0❑ S: Storage Sl ❑ 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 ❑ IIIB ❑ N ❑ VA VB ❑ � � �SECTION 7:SITE INFORMATTON(refer to 780 CMR 111.0 for details on each item) _ Water Supply: Flood Zone InformaHon: Sewage Dispoeal: Trench Pecmit: Debcis Removal: PubGc❑ Check if outside Flood Zone❑ Indicate municipal❑ A ti'ench will not be Licensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ required O or trench or specify: , permit is enclosed❑ Railroad right-of-way: Hazazds to Air NavigaHon: MA Hismric Commission Review Process: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build endosed❑ Yes O or No❑ Yes❑ No ❑ � SECTION 8:CONTENT OF CER7'[EICATE OF OCCUPANCY � � � � Edition of Code: Use Group(s): Type of Constmction: Occupant Load per Floox: � Does the building contain an Sprinkler System?: Special Stipula[ions: �'LL� -.•M6�1L�OK W1�1�'1 �� I s�-t s 1 -z. �� �j�l�l�t. _ ���/� SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Proper(y Owner �� c� r _ Gl �I4 t 77 ✓\D _�„�'�c�\ �iW� Name( int) �No.and Street City/Town Zip � : Property Owner Contact Information: (,Gc7 w cr Title Telephone No. (business) Telephone No. (rell) e-mail address If applicable,the property owner hereby authorizes Name StreetAddress City/Town State Zip to act on the ro er owner s behalf,in all matters relative to work authorized b this buildin ermit a IicaHon. � SECTION 10:CONSTRUCTION CONTROL{Please fill out Appendix 2) If buildin is less than 35,000 cu.ft.of enclosed s ace and/or not under Construc[ion Control then check here 0 and ski Sectlon 10.1 30.1 Re 'stered Professional Res onsible for ConstrucHon Control � � ' �(� ' ' Name(RegiBtrant) Telephone No. e-mail address Registration Number Street Address City/Town State �� � Zip Discipline Expiration Date 10.2 General Contractor � � � � � I 7V\ ��fl'�c �—�. _ . Co p y Name ���� ` � . ,i � �. cs�/-kr<���3 e�� r_, cr,�— Ti�rr�.—d� Name of Person Responsible f r Construcflon License No. and Type if Applicable � , � ��v� ����r� ��-� � �� Street Addres� T City/To State Zip -�so'-_'7—'r�� ( �-�'�� CJD�YC�.�r� Q CM!'a.� ` <CC�7M Tele hone No. usiness Tele hone No. cell e-mail address . SEC1'ION 11:WORKEAS'COMPENSATION INSURANCE AFFIDAVIT(M.G.G.c.152.§25C(6 . - � A Workers'Compensation Insurance Affidavit from the MA Departmen[of Industrial Accidents must be completed and �� . submitted with this application. Failure to provide this affidavit will result in the denia]of the i suance of the building permit � II Is a si ed Affidavit submitted with this a lication? Yes�No O SECTION 12:CONSTRUCTION COSTS AND PERMTT FEE Item EsHmated Costs:(Labor and Materials) Total ConsWcdon Cost(from Item 6)_$�,�L 1.Building $ �. � • Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ ��U appropriate municipal tac[or)_$ 3.Plumbing $ - - 4.Mechanical (I-IVAC) $ Note:Minimum fee=$ (contact municipality) � 5.Mechanical Other $ Enclose check payable to - 6.Total Cost $ 5 (contact municipality)and write check number here � 3� SECTIO 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury[hat all of[he information con[ained in this applicaItion is true and accurate to the best of my knowledge and understanding. �o�o�� `���:��J—�,�"�1�, � �5�,r--e.-� �z3q6�Fa7 �`_`/_ � Please pfint and sign name �J nTitle Telephone No. Dace ���C/1�1�4!6c—r'�1`2 \�2.f'-!/�n � � � � . Street Address City/Tow State Zip Municipal Inspector to fill out this secfion upon applicaHon appraval: � � � Name � Date i gPPrzc>vj D 5eUI cr -rz> Gc1.� t, � (1cnnS }�bTE'U BC-wW. 5TRAFPED WAIL WITH 1/4" TILE BOARD F. 4'-111SW Toilet by others 2-6X6-5 HOLLOW GORE Hand sink by others PRIMED SPLIT JAMB b PANEL 21 DOOR w w J r eu q E 0 G r[ 1st Floor onre: sp/zoia s SHEET: Arge's © tiew-FA1znv r 0 Ta BE Fi�sT�� z K DlnetltY � u TD exv5n),* n �' SM�ctuurc I 2x4XcIb walls and strapped shelf wall covered by Marlite the board 2x4 ceiling drop calling / 2X4 WALL WITH 1/4 TILE BOARD 2-bx5-43 primed hollow core door unit with privacy lock Bathroom vent and light unit provided and installed (by others) 120V GPI Duplex outlet (by others) ADA flush toilet (by others) Wall hanging lavatorty sink (by others) F. 4'-111SW Toilet by others 2-6X6-5 HOLLOW GORE Hand sink by others PRIMED SPLIT JAMB b PANEL 21 DOOR w w J r eu q E 0 G r[ 1st Floor onre: sp/zoia s SHEET: Arge's FjPPt2o�ED �D[�eq' -ra � lu BCID�J' ADA Toilet by others -0ll Me n STRAPPED WALL WITH 1/4" TILE BOARD ); P Ta BE FASTCI,4e-0 � 4 DtnEc's-�Y u 6' -it 13116' 1 TD exv5,n,.1y J) Hand sink by others 2x4X96 walls and strapped shelf wall covered by Madite the board �— F-3'4-4 2x4 ceiling drop ceifing 2X4 WALL WITH 114 TILE BOARD 2-bX6-5 HOLLOW CORE 2-bxb-b primed hollow core door unit with privacy PRIMED SPLIT JAMB b PANEL lock DOOR m w J Bathroom vent and light unit provided and installed � (by others) w i 120V GFI Duplex outlet (by others) ADA flush toilet (by others) Wail hanging lavatory sink (by others) `v c i�c�RsE1—'�K y g TO -Ewwwsv �—Fv. 1st Floor 5p/zala SGIF: SHEET: Arge's r