327 ESSEX ST - BUILDING PERMIT APP o Sbt
S The Commonwealth of Mas§ac u"dffl#L
Department of Public Safe�{p''`` J
Massachusetts State Building Code(? RAvIAYL _8 A (�
Building Permit Application for any Building other than a One-or Two-Family Melling
(This Section For Official Use Only)
h Building Permit Number: Date Applied: Budding Official:�ffl I Ile
1 1 SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street addgjUpls is not available)
No.and Street City/Town Zip Code Name of Building(if applicable)
-3 2 - �j Z'� U 3 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❑ Alteration b3 I Addition❑ 1 Demolition ❑ (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-V N�❑
Is an Independent Structural Engineer�s g^Peer Review Sequired? \ 11,Yes 11�❑ No ❑
�nef Dg{crip�ion of Pro sect Wo k: !X/w1V �e16 1h 'LI�G Y� ��`f'�'I'�
u u 4GG\L (iut_
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): Proposers 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 ❑ A4❑ A-S❑ B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional I-1 Cl I-2❑ 1-3❑ 14❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑
S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA IB ❑ IIA ❑ IIB ❑ IIIA ❑ 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 trench will not be Licensed Disposal Site❑
Private❑ or indentify Zone: required❑or trench or specify:or on site system❑ permit is enclosed ❑
Railroad right-of-way: hazards to Air Navigation: MA I Int;ii_Comnusy>n I roc,.'s:
Not Applicable❑ Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ 1 Yes❑ or No❑ Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor:
Dues the building contain an Sprinkler System?: Special Stipulations:
CV1 R: 8D trp qzl,C -
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13
SECTION 9: PROPERTY OWNER AUTHORIZATION
van {dress of P oyerty Own ^
Name(Print) No.and i Street City/Town Zip
Property Owner Contact Information: '
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable, the property owner hereby authorizes
Narne Street Address City/Town State Zip
to act on the property owners 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-s ace and or not under Construction Control then check here D and skip Section 10.1
10.1 Re istere -Professional Responsible for Construction Control
,:urye,(l�t�'g^ist=� ,.n Tclep�ho'Qle�No. a-mail ,,a dress O1 Registration Number I
Of
Street Add ess J City/Towwn State Zip Discipline E&piration Date
10.2 General Co ctor
OI—
C any NaAnk
oAhNmta I-A f,lys
Nam f Person Res on ible fur Construction License No. and Type if Applicable
IAAv Ulh M46- o�g
Street Addr.�s/ Cfty7Town State Zip
s'1tTLI�MI,� I".y�27�'
Tele hone No. business Telephone No. cell e-mail address
SECTION 11:4VORKP.R.S'COMPE'NSA'I'ION INSURANCti AAFIDAWr M.G.L.c.152.9 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 ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE'
Item Estimated Costs:(Labor
and Materials) - Total Construction Cost(from Item 6)_$
1. Building $ T 31 b Building Permit Fee=Total Construction Cost x_(Insert here
2. Electrical $ -10 appropriate municipal factor)=$
3. Plumbing $
4.Mechanical (HVAC) $ Note: Minimum fee=$ (contact municipality)
5. Mechanical Other $
r e,�- Enclose check payable to
6.Total Cost $ (� (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this
ap Mation is a and accurate to the best of my knowledge and understanding.
GV) 0-4w jib _nL- M *11111
�. print and s�i�irtna n�n� Title , - Telephone ne Ny Date
.�-� 4�4� tM-Rk3--
Street Addre s City/Town State Zip
/3 Municipal Inspector to fill out this section upon application approval:
Name Date
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Custom Woodworking Client: Mr. John Burington
Built-ins Bookcaeee Cuetom Kitenene Description: Kitchen , Approved by:
781-710-6169
www.dncc.uotom.com Date: 06/19/16 Job Number: Burington Sheet 1 of 1
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Lot 4 Parcel 24-2D a< 4
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Trust//63 1/2 Jefferson Aw(, Salem, MA 01970
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