10 GREEN ST - BUILDING INSPECTION (2) i CITY OF &U.&M, 2UNSSACHUSETTS
Bt:II )LNG DEPART%IENT
120 WASHINGTON STREET,P FLOOR
TEL (978) 745-9595
FAx(978) 740-98"
KIJiHERI.EY DRISCOI.L
,MAYOR THOtdAS ST.PIFJLRIL
DIRECTOR OF FLBLIC PROPERTY/BI:IIDING CONMUSSIONER
APPLICATION FOR THE CONSTRUCTION;REPARVAENOVAMIK CHANGE IN USE OR
OCCUPANCY.OR DEMOLITION OF ANY BUILDING OR STRUCTURE
This Season tar Omcid Use Only
I. BLi"Porn! E!roJsot- Datsg. I
B4ildin4:.inspector=. '
EstLnats Piojee!„Dates: stare End:
Coemerft
1.0 SITE INFORMATION
r
Location Name: Bu7dkW
Prop"Address: /O Gkeew ST
SActa� MA
Assessors MaplBeodc 33 Lot/Parcee D S
QWNERS111 .IWORMATION
2.1 Owner of Lend ,e
Name Ncrt'i✓ A. beevAe
Address:
(:�;Aee..
Telephone: p- 7 -
2.2 Owner or lessee of buftc ft or structue
Name c . 13R a G ectE
Address:
Telephone:
3.0 AGENCY OR AUTHORITY AUTHORIZING CONSTRUCTION
Agency Name:
Address: �A,L
�L l
Agency Project Numb .
Project Manag Name: Tat
r
9.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY
For new construction co to sect on 8.0
Addition Usting{ "
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor(sf) Renovated
construction or renovation
of existing building New;
Brief Description of Proposed Work
it USE GROUP AND CONSTRUCTION CLASSIFICATION(Exbtfnp;BulldlnSi:0nW '
... I..... .r i hn t•
EXISTING PROPOSED Changtr. CONSTRUCTIONf
Us
USE Group(a) CLASSIFICATION
Q. Hazard Use , Hazard: Hazard
(note 81b c�); Group Index group Index Index*
A Assembly1A U
B Business 18 k
E Educational, 2A- i
F Factory 28,.:. i
H High Hazard 2C`
1 Institutional. 3A
M Mercantile 38 t
R Residential q .
S Storage 5A
U Utility 58
Mx Mixed Use Hazard Index
Sp Special Use
Note: Include Hazard Index Modifier for Construction Type as applicable
9.0 CONSTRUCTION COSTS (Sae 780 CMR Appendix L)
Total Construction Cost Building Permit Fee Check Number
(1) =(1)x$0.001
10.0 AUTHORIZATION OF STATE AGENCY FORAGENT TO APPLY FOR BUILDING
PERMIT(when applicable)
I, of the authorti ft State
Agency or Authority, hereby authorize, to apply
for the building permit for praj ,
(Of A
Signature Date
11.0 SIGNATURE OF BUILDING PERMIT APPLICANT
Name
L S o=
Signature a 000
12. Certificate of Occupancy required on completion of project? Yes ✓ No
Inspector's Notes:
i
CITY OF S.0 EINI, IN'USSACHUSETTS
BUU-DLYG DEPAR"['ME,NT
• 130 WASHNGTON STREET, 3'D FLOOR
TEL (978) 745-9595
FAX(978) 740-9W
1CIJIBERL EY DRISCOLL
MAYOR T Hoatns ST.PmRRa
DIRECTOR OF PUBLIC PROPERTY/BUILMLNG CMMUSSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 111.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit# is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
�1 RAAAM W45T
(name of hauler)
The debris will be disposed of in :
Tro Ian l2�cyc.�ina
(name of ility)
7/ Fores4 S4 Brya".t . Z&
(address of facility)
s' iature of perm t applic
S a9yoy
date
dcbri.aITdm
Application for Permit to: RENoVE AL4N/oq,4f S &An 4 f ,PE37mtE CEAq�. Sy/�lEs.
RbA(o✓E G'EDRR JrMlegS AAIO RE�A[E Wm! /�AlDiPL/h✓K3 . RE�AiR/IF6scA�6 IX/N 4SE6pD.
e�rloa% .3idi �P � �A/SIT.
Location
/0 4R sT S44.E74, AlA 0/970 - fSDI/
Permit Granted
Approved:
pector of ildings
i