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95 BRIDGE ST - BUILDING PERMIT APP
_ � , r �-K I 5�a� � 2( �{S � t 4 u �r�Ts �5 �c�,zs � g (yg� �s� � ` � The Commonwealth of Mass���i�t�Al SERVIGES � �� Department of Public Safety blassachuselts State Building Code(730 C�� �PR 3Q A �(�, I,{, O Building Perniit Application for any Building other than a Onr or Tw Famt i7'weTll`ng �— .(This SecNon Fur Officia!Use Onl ) � Building Permit Nwnber. Da[e Applied: Building Of(icia � SECTION 1:LOCATiON(Please indicate Block#and Lot k for locations far which a street addrese is not available) � �s �.QIlJ`C�Q S/� ��19%fr� �/rl7(f r '� No.anJ Street City/Town Zip Code Name uf Duilding(if applicabie) , �(I� SECTION 2 PROPOSED WORK � L�.J Editiun of MA State Code used_ If New Constructiun check here�or chak all that apply in the�wo ruws below �— Existing euitding Repair Altcratiun AdJitiun❑ Demolition 0 (Ple.ue filt out and submit AppendLr I) Change of Use � Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or cunstruction ducuments being supplied�vs part of this permit applic.�tion? Ycs ❑ Nu ❑ Is an IndependentStructural Engin��ering Pecr Review m uir�rl? Yes O Nu ❑ Brief Description of Propused Wurk: /PR fj�p�Y Uiu�'TS 6�Pus �e-�/,P��' � �RA-T1�,S .5�� .f-.�S �1�T _ AI.T , SECI'ION 3:COMPLETE TFIIS SECTION IF EXISTING BUILDING UNDERGOING RENOVAT[OIY,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check hcre if nn Existing Building Investigallon and Evaluallon is endos�rl(See 780 CbIR 3�F) ❑ Existing Use Group(s): � Proposed Use Group(s): SECT(ON 4:6UILDING HEIGHT AND AREA . Existing Proposed i Nu.of Fbors/Stories(indude basement levels)&Area Per Fluor(sq. ft.) Total Arca(sq.ft.)and Total Height(ft.) SECIION 5:USE GROUP(Check as a licable) A: Assembly A-L❑ A-2❑ Nightclub ❑ A-3 ❑ A-f❑ A-5❑ B: Dusiness a E: Educallonul ❑ F: Facto F-t❑ f2 O !L• Hi h Hazud H-t❑ H4 O' H3 0 H-d❑ H-5❑ 1: InstituNonal 4l❑ !-2❑ [-3❑ I-1❑ hL• MercanNle❑ R: Residential R-l❑ R-2❑ R-3❑ R-0❑ S: Storage Sl ❑ � S2❑ U: Utility❑ Special Use O anJ please describe beluw: . Special Use: SECTfON 6:COYSTRUCIION'fYPE(Check as a licable) � IA 0 16 ❑ IL\ O IIB ❑ 1(IA ❑ ❑IB ❑ IV ❑ VA ❑ V� O SECTION 7:SITE INPORAIATION(cefer to 780 CMIt 111A for details on each item) 4Vater Suppl • Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public� ChcYk if uutside Flood Zune❑ fnJicah municipal❑ ��trench will nut be Licensed Disposal5ih� required O or trench ur specify: Private O or indenlify Zune: or on site system❑ ��nnit is endused❑ Railroad righRof-way: Haiuds to Air Navigation: �I,�\i_I�_� .0 U�mn�i,c� n H ���;g,I�,x�...: Nut Applicable❑ Is Structure wilhin airport appronch area? Is their mview completeJ? or Cunsent tn 6uild enclosed❑ Ycs O ur No❑ Yey❑ Nu ❑ SECTION 8:CONTEN'i OF CCRTIFICA'IE OF OCCUI'ANCY Gditiun uf Cud�: Ux GrouN(s): PYpc of Cunsiniction: Occupant Load per Plnur. Ducs thc buildiny,c��ntain,m Sprinklcr Systcm7: _ Special Slipideliuns: --- T3- I S- '�-►o Ur�tr I 15- 3"1�,, UNLT 3 3"I I Ut�t-r Z �5- 3"13 UNi-t' � C�Lt,� � � ,v . 5i� SECTION 9: PROPERTY OWNER AUTtIORIZA'fION � Name and Address of Property Owner irli�RG %Ri4n.t�S 6�% Ue�'c� f/-r.� sj9/�sn Name(Print) �No.and Street � City/Town Zip Property Owner CpnWct(nformation: �j�(�-� • , :.�-�-52 a-�u ---- Tille � � ^� - Telephone No.(business) Tclephone No. (cell) e-mail address (f applicable,the property owner hereby authorizes TO�n I�{11E2v�t�Y" • 30� /�/2��.e__ ,S�'2t.P/� S�/�l?� �Ylff O/5'1'J N.une Stree[Address City/Town Sthte � Zip to act un the ro er owner s behilf, in all matters relative to work wthorized b this buildin ermit a lication. SECI'ION 10:CON57'RUCTION CONTROL(Please fill out Appendix 2) If buildin is Iese th�n 35,bIX1 cu.ft.of encloseJ s nce and or not under CoretructionControl then check here O and ski SecHan l01 lU.l Re istered Profeasional Rea onsible for Conshuction Control Qi cl�,W+etQ (�2+•�+'•�/ )8-Z� "7FI!y Name(Registrant) Ty;l�p�ie No. e-mail m�ress O�,d Registration Numbcr �� - JA � � Strcet Address - City/Town State Zip Discipline Expiration Date 70.2 General Contractor � � � � - � � �n�nh l�42ve% LC,G . Comp.�ny Name � `,��9�W !-��42v� �i cs- oq��o6 Nnme of Person Responsibie fur Cunstruction � License Nu. end Type if Applicable 3ea F� G2o v� �ST���i �s�/e� � vi5�o Shcet Address City/Town , State Zip • -_ �- y,� 6vv� ��cf/�,eve�Y��oo Telc lione No. business Tcle hune No. cell e-mail addmss SECTION 11:4VORI:EhS'COR�PEN5�1'�70N WSUIt:\NCN APF'iUnVl7' M.C.L.t.152 25C 6 I A 4Vorkers'Compensation Insur:mce Affidavit from the Iv(A Deparhnent of Industri:il Accidents must be completed and submitted with�this applicaCion. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a si ned Affidavit submitted with this a IicuHon? - Yes O No ❑ SECTION 32 CONSTRUCI'ION COSTS AND PERMIT FEE . ��e� Estimated Costs:(Labur � and Mahri.�ls) Totat Cunstruc[iun Cost(from Rem 6)_$ L Duilding � ��� Building Permi[Fee=TuNI Construction Cust x_((nsert hcre � 2.El�titrical S ' Q � � appropriate municipal factor)_$ i. Plumbing $ Q � d.blechanicai (HVAC) � '� ��(� Nute:Minimumfce=$ (contactmunicipality) � 5. bl�tihanical Other - '6 Enclose ch�rk pay��ble tu 6.Total Cos 3 (contact municipality)and write check number here 19�K SECI'ION 13:SICNATURE OF 6UILD(NG PERNIIT APPLICANT . 6y enler e below, I icreby attest uudcr the pains and penalties of perjury that oll of the information contained in lhis application is true and accurate th bes f my knuw dge and understanding. s��_ya��� P1yu�Qe print and sign name S{��e w�le Tclephune Nu. Dah S �l Q/�i'2(� Slrcet AJJmss City/Tuwn ate Alunicipal lnspector to fill uut this section upon application appmvaL• � N,me Dale n = � i .. i '''ll(' ��. � �I_;�_ �� I :. 1, i ..i I _ . - �'�I� I I .I� 1 �.II l �I\ I A\\_ I I �' I� �I I ��'.�� \ !'I�I'\ l� �� �I ll •.^` � V ' � O . .. ... .. .-.-_. . ..._.. _ . __._.. .. . _ ._. __ _ ...._._... _..�---_ /1 � ��[ . . .. . . ____ •" ■ V . . . .. _ . \�./ � __ _ � - --=_--- _ _ . � O I __---_—- -..--=-- --- -_ � 4J -- -- ------- - '', -- ---:-.—.- - � � _----- _--- --__ ____ ---- . _ __ _ _ _ - _ _ _ --- _ - -- - � -------------- � -- -__--- - ---- --- -__ _..-..--- ---- '� --- _----- — _ �► 1 + --- -- _ _ _ _ _ � --------_------------------- --------- --.._.._.._. - -- � -- -- --- -- - As-Builts ----- -----_ --------- - March 22 2015 — ------ ---- — -- -- Desian -- - —---- ------ --- _ _= March 29 2015 -- --- . . . . ... — _—. 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