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2-26 FRONT ST - BUILDING INSPECTION The Commonwealth of Massachusetts _ I1Ij� Department of f ublic Safety Yyu/ Massachusetts State Building Code(730 CNIR) Building Permit Application for any Building other than a One-or Tw r li (This Section For Officiod Use Only) Building Permit Nuutber: Date Applied: Building Official: SECTION 1: LOC 1`10N Tlease indicate Block#and Lot#for locations for which a street address is h h a e) 2-2 0lci 7`1-0 n'1j� 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 t6 I Alteration ❑ Addition Cl Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ 1 Change of Occupancy ❑ Other ❑ Specify: Are building plans and/ur consGactian documents being supplied as part of this permit application? Yes ❑ No Is an Independent Structural Engineerio'Peer Review required? g(� Yes ❑ /�N _ Brief escriptiun of Proposed Work: uU.�^-e,�.0 /tc - �lN- y,v, J.h,h,,,� ;X{ �,� �R ' / n .K Ire Q S2 it a 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 Nn.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 ap Iicable) A: Assembly A-I❑ .A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ B: Business T E: Educational ❑ F: Facto F-1 ❑ F2❑ 1 H: High Hazard H-t ❑ H-2❑ H-3 ❑ H-h❑ H-5 Cl l: Institutional I-t❑ 1-2❑ I-3❑ 14❑ NI: Mercantile❑ R: Residential R-111 R-2❑ R-3❑ R4❑ S: Storage S-I ❑ S-2❑ 17U:IUtility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as ap Iicable) IA ❑ IB ❑ IIA ❑ 116 ❑ IIIA ❑ [Ha13 IV13 VA VB ❑ SECTION 7:SITE INFORIM[ATION(refer to 730 CD1R 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: 'french Permit: Debris Removal: Public Q( Check if outside Flood Zone❑ Indicate municipal l� r\trench will nut be Licensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ required-El-or trench or specify: permit is enclosed❑ Railroad right-of-w Hazards to Air Navigation: \1!\.I I� t n t'nnun si n I v", t ow: Nut Applicable 7 Is Structure within airport ap roach area? Is their review mmp{eted?or Consent to Build enclosed ❑ Yes❑ ur Nu® Yes❑ Nu L� - SECTION 9:CONTENT OF CERTIFICATE OF OCCUPANCY Ldition of Code: Use Group(s): Type of Construction: Occupant Load per Fluor: DUOS the building contain an Sprinkler System?: Special Stipulations:_ SEcrION 9: PIiOPEIt'rY WNEIt AU-f11ORIZA,r1ON Name and Adt r•ss of Property caner 0(4 f� 2"� OQPi -3 l Name(Print) No.and Street _.. . City/'town Zip Property Owner Contact Information: - 1 fo3 �.._ \) fro Title Telephone No. (bus `) Telephone No. (cell) / e-mail adiccress If applicable, the property owner hereby authorizes .��// 1.- • � '� 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,O00 cu.ft.of enclosed z ace and or not under Constmction Control then check here O and ski Section 10 1 10.1 Registered Professional Responsible for Construction Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor 1 Company Name v,;: C' Name of Person Responsible for Construction License No. and Type if Applicable -9 Qa}��n� �Sfi CL)\�& tO3 $ eocy�V . P4a Ol�l Street Address City/Towel State Zip �_`j'•L2-. 09Gy alb.-4`�. �3y�( SC� �.`4e��'C�a �deue��r�er�t� l2�- 'relc hone No. business Telephone No. cell c-mail address SECTION 11:lVORKI;aa'ClJA1PI;:N5AT1ON N';1A NV E%I 111NAVI I M.C.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 ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs:(Labor Item and Materials) Total Construction Cost(from Item 6)=$ I. Building 6) © Building Permit Fee-Total Construction Cost x_(Insert here 2. Electrical $ appropriate municipal factor)-,$ 3. Plumbing $ Note: Minimum fee=5 (contact mmllicipolily) .1. Mechanical (HVAC) 5 r--- 3. Mechanical Other 5 �� Enclose check t able to v�r� 6.Total Cost 5 Zr V `� C5 (contact nuuticipUlity)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 application is true and accurate to tit of ill knowledge and understanding. S�t "g, k 60 M (!� bes d%,,l)u\ev 4('* -4 D -C.?q cit R�2k- 2df3 Phase riot and si m name title Telephone No. Date )3•eUer ( . NIA mg Street Address City/Town State Zip Nlunicipal Inspector to fill out this section upon application approval: Name Dale