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The Commonwealth of Massgfi"NAL SERVICES
Z p Department of Public Safety
Massachusetts State Building Code(780 CI A6 ' P 1: 52 ,
Building Permit Application for any Building other than a One-or wo-Family Dwelling
(Phis 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)
30 0
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
Existing Building❑ Repair❑ 1 Alteration ❑ 1 Addition❑ 1 DemolitionX(Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑
Is an Independent Structural Engineering Peer Review(equired? Yes ❑ No ❑
Brief Description of Proposed Work: b�Crscn_ZW%!:SQ o F (--QT'Q'f..tE..
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 Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.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: Educational ❑
F: Facto F-1❑ F2❑ H: Hi Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional I-1❑ I-2❑ I-3❑ I-4❑ M. Mercantile❑ R.
Residential R-10 R-2❑ R-3❑ R-4❑
S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable) N
IA IB ❑ IIA ❑ HB ❑ 1 MA ❑ IIIB ❑ IV ❑ 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 trencl`w'1 not be Licensed Disposal Site
Private❑ or indentify Zone: or on site system❑ required]&or trench or specify:
permit is enclosed❑
Railroad right-of-wa . Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable? Is Structure within airport ap roach area? Is their review completed?
or Consent.to Build enclosed❑ Yes❑ or No Yes❑ No ❑
SECFION 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:
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SECTION 9: PROPERTY OWNER AUTHORIZATION -
Name and Address of Property OwT,,er
'A aq� cx� -L.
Name(Prin No.and Street City/Town Zip
Property Owner Contact Informationp:�,�n
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
Name Street Address City/Town State Zip
to act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) - ,
If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O and sldp Section 10.1
10.1 Registered Professional Responsible for Construction Control ,
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address Gty/Town State Zip Discipline Expiration Date
10.2 General Contractor _ - -. _
Co pan Name c
Name of Person Responsible for Construction License No. an Type if App icabh
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Sntr��tgAJd�dress �] �(�' G /Town State Zip
931-t1T�`� mil-__;n-!
Telephone No. usiness Telephone No. cell e-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§25C 6 .:.. .. - . .,
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 of the issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes❑ No O
SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$
1.Building $ Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)_$
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical Other $ Enclose check payable to
6.Total Cost I $ 0on (contact municipality)and write check number here
SECTION 3:SIGNATURE OF BUILDING PERMIT APPLICANT=.By entering my name below,I he by attest under the pains and penalties of perjury that all of the information contained in this
application is true and accu the be o y knowledge and understanding.
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Please pAs rim s' ignname w Title _ Telephon—O erN/obq` Date
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Street Address 'ty/Town State Zip
Municipal Inapector to fill out this section upon application approval: A -
Name ' - Date
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One Team• Total Solutions
CRANNEYCOMPANIES
Electric•Fabrication •HVAC•Plumbing •Communications
10 RainbowTerrace • Danvers,NU 01923 . 800-559-7000 • FAX 978-750-0535
August 6,2014
Jorge Hernandez
Swampscott Quarry
Aggregate Industries-US
Northeast region
30 Danvers Road
Swampscott MA 01907
Subject: Power to Old Scale House Swampscott Quarry
This letter is being generated to notify Aggregate Industries that all of the power and fiber to old scale house location at
the Swampscott MA Plant has been decommissioned and removed from the structure.
The structure is now free from power and safe for demolition.
Sincerely,
Robert W.Pasquariella Jr.
Electrical Operations Manager
www.cranneycompanies.com
Excellence Since 1982