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2 CLARK AVE - BUILDING PERMIT APP /�� ��� Applflcation for �°er�i8 to: /�G��P ✓C�a-�-��� l�Pic.., , Locatfon � C���/1 /5�s�- Permit Granted � ad- ��.7 Ap rovea: � � Inspecto � f Buildings C , ,�. � . � CITY OF S.�I.Eltii, I�L�SS��CHL'SETTS `' BLu.nLvc Dsrnim�r ; �� 130 WASHnvGTON S'['REbT.3'O FLooR 'I�L (97� 745-9595 F,►�t(978}740-96a6 KIJtBER[..EY DRISCOLL I�X�,,�� ,�AYOR �I�iObL1S ST.Pff.�RB U DIRECI'OR OF PL:BLlC PRpPHR1Y/Bl'IIDING COSLtifISSIO,iER APPUCll410�FaRTNE CmNSTR9JCTi0P1, RE�/UW�REN�VA�tOBV.C41/ltdGE EI� U�E d9R OCCUPAAICY.O�DEA9mLft10P10F ANY BWLmtNf3 OR�TRUCTU� Thts S�sdoet for��Us�ontY ; , 84�Pe�m(2 Pro�Ct : OaU�� / B 8uitdin� �tnspector:. 9fgo�a�urm:.=` . , Ea�fe6hf Pno�s¢OaS�: Start Er�: . Ccrteme�4x 1.0�INFOPtAAA4101Y Lor.a9Jon Nam� C..�clv ��Z, Buildin9: � ��: a ��avk :�-,� � ,��e >vvo o�i�l� �ss�sors aeaares� LotlParc� �!Q� , �:t�o�uato� zt o,�n..�tt�nd . Wame: L v Z, n s�; nad�: a c.�,-k �av�e.. -, Sa;LPm �vw ol�� Q 7e�epPwnm: �!7 9 -`7�P5�l "15' . 2.2 Own�r or lessea of bvl/d/ny ar alruchrn Name: '� Address: �9�me c�,� c�, �au-e� 7'etept,one: 3.C. AGEPlCY OR AUTHORtTY AUTHORI2IN(i CONSTRt1CTtOlH Ageney Name: �, ,,�Ti-e�n 2a v�, r.r i.�,- � " Addres9: [� Ce�la�n��' V�tc1� .Su��� y ��iCP'1,� YVW OLG?a Aqenry Praject Number. ��t'7 Lg� '7 Y S -;3o S� Project Manager Name: "�"�� —�'yei,,ti Lc; Tel: 7U5-•,3t�Slo I _::... . . _ 4.0 PROFE�SIONAL DE�IGN SERVICESe: 4.� lteglsteeed Archi4ec� Name: Seal and S'ignaturo Address: �t� . �: ,: � Te�apP�ana :s; Fa�c � 42 R�ytstar�Proi�sslpnat k�ieglnears: Nss ad�mnal ahsed Y nsasamyr and at�h m appleatla49 _. N�me: . $ea6 aR�S Addrese: �j q Telephone: Fa�c A[eB�:�Respon�bility: �� . - � Nam� �aaf"�rid gBg�� Address: ' n�1A re�epnnor,e: �� afea o�R��«,s�butty: Name: Seal and Signature Address: �1� Telephane: Fax: Area of responsibility: S.0 DEStGN AND CONSTRUCTION UTILIZINa MGL C 112 $ECTION 81R EXEMPYIOP9S (Sea note be�ow) Con e ctor �o ,a l�Vv\bl� �U � y�� Address: � o C�l�rt�-�. 1(L� ..sil�� � ,.5�:�e m mo 0 2q'Y� Area of responsibility: "Cicerise Ntumher.' ' CS 6536`t3 Date of Expiratf�►: 5 ( � f b"1 Te{ephone: Q7� '1�P53a✓fb Fa�c• . �i�C� "� yl $3 7° eontractor _ Namer. Address: Area ot responsibility: ticense Number. Date of ExptraUon: Telephone: Fa�c Contractor , Name: Address: Area of respo�sibility: License Number. Oate af ExpiraUan: Telephone: Fax: Note: For portiona ot worf[utiliziny exempUons of MGL a 112 a BtR complete the secSon aboye. Use addiGonal sheets it necassary and atlach to applicatbn. . . / 6.0 PROFES�IORlAL CONSTRUCTtON SERViCES: 6.1GeneralCcntr�ctor �� q��mb � �S �'�`< Address: �a La �o,,.��Q �� �� `f SG�,Q.i rn i'VVa a YZ�.a Tesa�non.: C����u53�� F�: 5 ��7 7�C �3� ftesponst6l� in Charg� oT ConstrucUon: �c s se �re rti,�ul� T.0 COPISTRUCTION DOCUMENTS-to be prepared by applicant Item �as Applicable 7.1 Plans (Note 1 this page) Submitted Incomolete Not Reauire� 7.1.1 Architectural 7:1.2 Foundatlan 7.1.3 Structurai 7.1.4 Fire Suppression 7.1.5 Fira Atarm 7.1.8 HVAC � 7.1.7 Electrical 7.2 Speciftptions 7:3 Structurat Peer Review 7.4 Structural Tests & Inspectfons Program 7.5 Fre Protection Narrative Repart 7.6 Existing Building Survey 7.7 Workers Compensation Insurance 7.8 Other pocuments (Specify) (Energy NarraGves, etc.) Note 1 Areas of Design or Construction for which Plans are not comptete at the time of this applicatron must be iden6fied herein. Work so identifred must not be commenced untii this application has been amended and proposed construction has been approved by the Departmenf ot Public Safety DisUict Building Inspectar hav(ng Jurisdiction. . _, 8.0 CONiP�EiE THIS SfCT10N FOR NEW COIV�TRUCTtON �NO.Y For Existing Buildings Proceed to Sectton 9.8 Number of Stortes aDove Num6er of Stories Selaw Grade � Graiie Story Neight Floqr Area Per Floor Total Buitding Height 7ot�1 Building Area Above abov� Grade Grade 7ota1 Building depth betow. Totai Building Area Betow Grade Grade Brief Descriptlon ot Proposed Work: � — _ • - - - - - � ,, - �.-. � _ _ � . _ �_ .. ._ . . . . . �.Ju-,. _. .- � .. - -_ _ �. - _ ri - _ . - i' ' �.r i _. _ - - 8.� USE GROU�AND CON3TRUC310N CLASSI�ICATtOP!(N�w�Cons4ruct9on Only) iJ8�GRQU�y` '' USE GROUW BU�:CA'fEGORY: . , CON8TRlDCTlON (J as applicable� . _ ., :: (d as appUca�fe� :. ClO.SSIFICATIOM A , Assembly � A:1. ' A-2 !�` � A-d 1A , , . , . . . ,. , ,.. 8 Businesa S 1 B E Educadonal 2A F Factory F-1 F-2 2B H High Hazartl H-1 ti-2 H-3 H� 2C 1 tnstitutlonaL t-1 I-2 I-3 3A M Mercantile ': 3� R ResidenUaF. R-1 R-2 R-3 4 3 Storage St &2 5A u utii�ri 5B : 14Rx Mixed Use Specify: Specity: Sp Speciai Use 9.0 COMPLETE THIS SECTION FOR WQRK IPI ��cT��r BU7LUINGS ONLY For new consUuction om et secNo Addition Existing ` Renovation Number of Stories Renovated Z. Change in Use New . Demolition E�cisting Approximate year of 7Crea per ftoor{s� Renova4ed consUuction or renovallon of exisGng building N�` � ... .:._ ._ _ Brief QescripUon of Proposed Woirk: ' �v� l� �e� a `�� � �_� ��� �� 3 �� ��..,,,, b�-���.. �-- CL o�e-� � & ,��,,,,, ,2�.�(� �..-� �t �..,,� �,-eQ � � 9:i. U3�G9�OlDP AND CONSTRUC2IQN ELA381FICATION(Ezisttng BuOdtlJingq Only)' ' _ , EXISTiP10 PROPOSED Chang� Ct3td8'�`RtIC'Ti�6� USE Group(sy �rt CCA�SBF9CATfON ' UsQ Hazard , Use _ Haz�rd �"O�s"�'��0�'� Group Index 'ti8roup Index- ,nd� (Jaaappncmbt:p' /! Assembiy 9A� � a ' B Business 18 E Educadona{ 2q. F Faetory 2g" H High Hazard 2C I lnstitutional 3q. M Mercantile 3B R Residentia{ � S S4wage 5A t! Utility 5B 11Ax Mixed Use Hazard index Sp Special Use U � ' Note: include Hazard Index Modifier for Canstrudion Type as applicah�e 9.0 COId�UCTlON COSTS (S�e T80 CMR App�ndfx L) ToPal Constructlon Cast Building Pertnit Fea Checic Number (9) �(1)xg0.001 � !y�' �� ��� ��'`/ 90.0 AUTNOFYtZq770N �F STATE ASiE7dCX FaR AGEN'P TO APPLY FOR Bl80LDIMC3 P�t2AA[f(wheo applicabl�) 0. 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