0040 REAR HIGHLAND AVENUE - BPA-15-1170 113Z-
�� The Commonwealth of Ma# 911031 seifsL SERR+ICES
41 Department of Public Safety
Massachusetts State Building Code(78
Building Permit Application for any Building other than a& 1 T2v3-F tAi ilPb1JlHng
0 - _(This Section For Official Use Only)
r Building Permit Number. Date Applied: Building Official:
SECTION 1 LOCATION(Please indicate Block if and Lot 8 for locations for which a street address is not available)
^ No.and Street City/Town Zip Code Name of Budding(if applicable)
SECTION 2•PROPOSED WORK
( Edition of MA State Code used_ If New Construction check here❑or check a8 that apply in the two rows below
Existing Building❑ Repair❑ 1 Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix I)
Change of Use ❑ Change of Occupancy ❑ 1 Other ,Specify: 1 n
Are building plans and/or construction documents being supplied as part of this permit application? Yes R No ❑
Is an Independent Structural Engineering Peer Rev'ew re uired? _ Yes ❑ No 99
Brief D ascription of ropu d Work: s0'ho^ 57rti,G'
lns E 5
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(sy.ft.)and Total Height(ft.)
SECTION S.USE GROUP(Check as a livable)
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-1❑ A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-I O F2❑ H: Hi h Hazard H-1❑. H-2❑ H-3 ❑ H4❑ H-5❑
1: Institutional 1-1❑ I-2❑ f-3❑ 14❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ _ Rvk O
S: Storage S-t ❑ - S-2❑ U: Utility❑ Special Use❑and lease describe below'
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable) -
IA ❑ Ill HA 1111 ❑ 111A0 IIIB ❑ 1 IV ❑ 1 VA ❑ VB ❑
SECTION 7.SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Wate#115
y, Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal:
PCheck if outside Flood Zone❑ Indicdtemunicipal❑ A trench wilt not be 'censed Dis osalite❑or inak st a sys a re aired❑ ify:
permit is enclosed❑ `4J
Railroad rightof-w y: Hazards to Air Navigation: YID\1hitjgic coouni-Swo gcview�I'rgics:
Not Applicable' Is Structure within airport ipproach area? Is their review completed?
or Consent to Budd enclosed❑ Yes O or No Yes❑ No ❑ - >
SECTION 8:CONTENT OF CE TIFICA'TE OF OCCUPANCY
Edition of Code: Use Croup(s): Type of Construction: upant Load per Floor
Does the building contain an Sprinkler System?: Special Slipulations:
C�t,a� y P . v . (® (2—
�MA��� — 10, ( ,4 �.
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SECTION'r. PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
A5 koyL- 'at k awl tp1 Sa lGw
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
lvl� Ve- 791 Jig-D 60r"inor& w if-14
Title Telephone No.(business) Telephone No. (cell) e-mail address
If plicable,the per y owner hereby authorizes �q� � �
t Lr- Alto Aw 1 r�bON 4
Narne Street Address City/Town State Zip
to ad 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.R.of enclosed space and or not under Construction Control then check here O and skip Section 10.1
10.1 Registered Professionall Responsible for( stCoonstrruc/ti(oon Control
k/Xuw� CUN„utylfl ��� )of® COw1WDnweu ti crM CS 703
Name(Registrant) Telephone No. mail address Registration Numbef0��._�,�
Of�It�
Street Address City/Town State Zip Iscipline Expiration Date
10.2 General Contractor
Co p, ry Name
"-P,Jt'v,- � A)114
Name of Person Respo ible or onstruction License No. and Type if Ap icable 1
Street A ress City/To - Shute Zip
Telephone No. business Tele hone No. cell mafl address
SECTION 11:b!'OR1:Eh5'Ck1PENSA'1'ION INtiURANC1i.41'FI DAVI
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 budding permit.
Is a signed Affidavit submitted with this application? Yea O 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 $ /�{Q�^�
d.Mechanical (HVAC) $ Note:Minimum fee= (conta(ctt municipality)
5. Mechanical Other $ Enclose check payable to TOtjj t ON Sa lam"
6.Total Cost 3 �'� (contact municipals )and write check number here 1 132�1
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below, 1 hereby att der the pains and penalties of perjury that all of the information contained in this
application is true and accurate to the est of y knowledge and understanding.
�, S;J[(L4\
Pleas print and Sign „_ / fTiNe_� ITdephune No. Date
Street Address ,YYIV/�` CiityL//Toowwnn rStttattee Zip
Municipal inspector to fill out this section upon application approval: Ll-/r"1°'""'
Name Dale
EMAIL fet,4 �O Joe WtW�6K L-0 ea- l��l 21 , 6VO4
8 ft6z0 S\j l[ t(JttiV--,i lS 60 hleV,W p djovt-tovu AAA 027 6b
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CITY OF SALEK AWSACHLSEM
B[IIIDnYG DEFAR7mm
120 WA9MgGTCN STREET,3ID RoOR
7kL(978)745-9595.
FAX(978)740-9846
RIIvIBERLEYDRISQ7LL
MAYOR THCUM ST.P F"
DIREcroROFpLmucPROPERTY/jiumDm07M99IS omR
Construction Debris Disposa/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 coo, 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 deposit facility as defined by MGL c 111, S 150A.
The debris will be transported by:
w„A
(name of hauler)
The debris will a disposed of in:
� V
(name o f ility)
(address f facility)
nature of applicant
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Return card to Building Division for Certificate of Occupancy
Permit No. B-15-1170
FEE PAID: $198.00 F-TRM110 TO BUILD
DATE ISSUED: 10/26/2015
This certifies that FAIRWEATHER PRESERVATION ASSOCIATES LIM
has permission to erect, alter, or demolish a building 40-REAR HIGHLAND AVENUE Map/Lot: 250019-0
as follows: Other Building Permit COMPLETING ANTENNA DESIGN TO.THE EXISTING CELL ANTENNA ;
INSTALL THREE (3) ANTENNA` ARRAY:TO EXISTING MOUNT SYSTEM (ON PRIMARY PERMIT)
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Contractor Name: KEVIN CUNNINGHAM d Sti ,; ' '� •"- •� �� •�_ `. ` ' "' .
DBA: AERIAL WIRELESS SERVICES LLC F !s= ;{ rT r s t
Contractor License No: 088703
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N1, ' t s 10/26/2015
F
t { t Building Official !l��tt�F �,. Date
This permit shall be deemed abandoned and invalid unless th•e work authorized by this permit is commenced within six months after issuance.The Building Official
may grant one or more extensions not to exceed six months each upon wntten,request ,� !�,,•nn., a ,'yw�!t° "'^.�
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All work authorized by this permit shall conform to the approved application and the approved constructon documents for which this permit has been granted.
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All construction,alterations and changes of use of any bulldingand structures shall be in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same.
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.
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HIC#: Persons contracting with unregistered contractors do not have access to the guaranty fund"(as set forth in MGM c.142A).
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Building plans are to be available on site.
All Permit Cards are the property of the PROPERTY OWNER.