0400 HIGHLAND AVENUE - BPA-12-276 ' � � The Commonwealth of Massachusetts
i �; �
p� � Department of Public Safety
�� ' �YU � Massachusetts State Building Code(7S0 CMR)
jj� Building Permit Application for any Building other than a One-or Two-Family Dwelling
�(This Sectiun For Official Use Only) � �
Building P¢rmit Number: Date Applied: BuIlding Official:
SECTION 1: LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available)
X �� ; o � v �
No.am Slreet City/To�vn Zip Code Name of Building(if applicablc)
� SECTION 2:PROPOSED WORK
Edition of MA St�te Cudc usc.i_ If New Construction check here O or check all that apply in thc two rows below
Existing Huilding❑ 2ep�ir❑ Alteration ❑ Addition❑ Demolition ❑ (Please fill out vid submit Appendix"1)
Change of Use ❑ Change of Occupanty ❑ Othcr ❑ Specify:
Arc building plans:uid/or constructiun documcnts being supplied as part of this permit applic.tion? Ycs C� No ❑
XIs an Independent Structural Enginccruig Peer Re ew required? Yes ❑ �N.�o. ��'
BricfDcscriptionofProposedWork:�y'��/���j ea�f�i9� �«l �'��.wi/h
/
[�si� 4� �± � 1 � � t�! � QL� S O ( /iJ�i ODraq S�
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. 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):
� SEC'I'ION 4:BUILDING HEIGHT AND AREA
� Existing P�oposed
No.of Floors/Srories(includc basement levcls)&Area Per Fluor(sq.ft.)
Total Area(sq.ft.).nd Total Height(ft.) �
SEC7'[ON 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A=!❑ A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-1 ❑ F2❑ H: Hi h Hazazd H-1 ❑ H-2❑ H3 ❑ H-4❑ H-5❑
L• Institutional I-1 ❑ 1-2❑ 43❑ I-k❑ M: Mercantile❑ 2: Residential R-1❑ R-2❑ R-3❑ R�❑
S: Storage &1 ❑ S2❑ U: Utility❑ Special Use 0 and please desaibe below:
Special Us�: -
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ ❑IB ❑ IV ❑ VA ❑ VB ❑
SECTION 7:SITE[NFORMA7'ION(refer to 780 CMR 1ll.0 for details on each item)
Water Supply: Plood Zone Information: Sewage Disposal:
Trench Permik DeUris Removal:
A trench will not be Licensed Dispwal Site❑
Public❑ �Check if nutside Fluod Zone❑ Indicate municipal❑ required O or trench ur specify:
Private❑ � or indentify Zo�ie .' ', orlodsite system❑ vtrmit is endosed ❑
Y
, Railroad right-of•way: Hazacds to Air IYavigation: �I 1 I li i�ri,c.t nnnu.ei��.�_( ti i u� P� ,�g,,s:
. Nut Applicable❑ Is S[ructure within airpbrt approach area? Is their review completed?
or Consent to Build enclosed ❑ Ycs O or No❑ Ycs❑ No ❑ �_.
SECTION 8:CONfENT OF CERTIFICATE OF OCCUPANCY
� Edition uf Code: Usc Group(s): 'Pype of Cunstruction: Ocu�pant Luad per Ploor.
Ducs thc building contain an Sprinklcr S}'stcm?: Special Stipulations:
c�c� ��t-9���3/�
SECTION 9: PROYE2TY OWNER AUTHORIZATION
Nau/te�and Addr�ss of Property Owne[
/«i��l�`/� /9'0�,1.�8�...9�1 �S� ru6•le ��r� ;f�.< S ' a !9�f
IVamc(Print) —�Io.and Street City/Tuwn Zip
Property Owner Conta�t Infurmation:
�5�'e��e,��'���,�w-��s'J�yAS y�y==
Title Tclephune No. (busuiess) Telephone No. (cell) e-mail address
If sp licable, the pmpe� owner hereby Tuth�riies �
+� .r,�+..� /9'0 .�,�:as$�. , er�� ,�Lyy j
Name �eet Address City/Town State Zip �
tu xt on the �ro er owner's behalf,ui all matters relative to work authorized b this buildin ermit a ]ication.
� � SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)� ' � �
If buildin �is less than 35,000 cu.f[.of enclosed s ace and or not under Constnictiun Control[hen check here O and ski Sectioii 101
10.1 Re istered Professional Res onsible for Construction Control � � � � �
c-� �i � ,. %�
Name(Registran �L"��YC��ie No. e-mail address Registration Number
Strect Address - City/Town S[a[e Zip Discipline Expiration Date
102 General Contractor � � � " � - � � � � �
Cump�ny Name � .
� N�me of Person Responsible focConstruction License No. and Type if Applicable
Street Address City/Town State Zip
Telc hune No. business Tele hone No. cell e-mail address
� SECTION li: wi)RKEKS'GOn1PENSn'PIQV WsuR4n�CE v'r'���AVIT M.G.L.c.152. 25C 6 � � � �
A Workers'Compensation[nsurance Affidavit from the MA Department of Industrial Acciden[s must be completed ui3
submitted with this application. Failure to provide thisaffidavit will result in the denial of the issuance of the building permit.
Is a si ned Affidavit submitted wi[h this a lication? Yes❑ No ❑
� � SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE -
Item Estunated Costs(Labor �y
� and Materials) Total Construction Cost(from I[em 6)_$�Z�C�u _
1. Building � W "— Building Permi[Fee=Tot�l Construction Cost x_(Insert here
2. Electrical $ pou — appropriate municipal factor)_$
3. Plumbing $ v
-4. Mechanical (HVAC) $ Note: Minunum fee=$ (contact n�icipali )
5. Mechanical Other $ Enclose check payablc [o �
6.Total Cost $�26uvu � (contact municipality)and write check number ere
SECTION 13:SIGNATU2E OF BUILDING PERMIT APPLICANT
By entcring nry namc below,I hereby atrest imder the pains and penalties of perjury that all of the uiformation containcd in[his
application is true and accurate to tlie best of m knowlc�`{ppc and understanding.
! ��// l�fJ/yI�" �.r.n L S �,����3�- �'7�Y1�sl/ / /-�i�/Y ��/�
Plcase rin[and si n ame .�. � ,•
P K J Tifle � �lephondl��� Date
�� �OtLS ��✓� � v
Svicet Address City/Town l.i - Zip
' Municipal Inspector to fill out this section upon application approval: � � /�
� � Name ' Date
�
.� �la;.sachus.tts- Dcp:u'imcn� ol' Public Safctc
� Bu:�rd uf Buildin� Rc_ui:Uiuns and St:ind:irds
Construction Supervisor License
License: CS ���
�
CRAIG W MACINNES
11 LOVES LANE
WOBURN, MA 0180T t
�—�� iy�jE Ezpiration: 7/28/2013
('��inmi>sioncr ,y�,�;;... _ Tr#: 27078
i �
' G�Ie�ouiY/mli(�a[/II�n�Cill.tiJlac�t([Jclld .
�y''� Office of Consumer Affairs&8usidess RegulaHon �
„ MEIMPROVEMENTCONTRACTOR Type: �. �
�� r� ' egistretion: 1'19785
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� " "�xpiration: 8/28/2013 DBA
���
� C-MAC AND SON . �
� CRAIG MACINNES � �
� 11 LOVES LANE �-G--��B"'e
. WOBURN, MA 01801 � Undeisecretary .
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}y ' , ' .,� ,�' ��A CITY UF SALENt
�" � �'' 1� PUBLIC PRUPRERTY
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° DEPARTI�IENT
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��'urkery' Cumpeneation Insuronce :�ffiJuvit: Uuilders/Cuntnctur�/Electrlclane/Plumber�
�tcant Infi�rmution Plcr�e Print l ���hlv
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I I.Q 1:�nt u em lu c�wiih 4. ���7M��I proJvet(nyulrrJ):
P Y ❑ I ,un u ycncnl com�u�or and i
c� �pluye�x(iull�nJ/ur purt•�inw).• buv�hired�hu.uh•cuna•rcwn �• ❑ ��w ewwtructiun
? 1 ,�m�sule prepncux or puMur• lis��d un rhe art�cAcd shcet � �• ❑ RemoJelin`
�hip;m,l h�vu no empluyc�� Thear eub�con�weron havo tl. � Demoliriun
��orkiny li�r me in Jny c�p;tcity. �vurken'comp. mauronca.
I Ke wo�kcrs'cump. inyumnct 3. Q Wa nro a coi 9• ❑ OuiWin��JJi�iun
pontion;mJ its
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1 um r homcowncr Joiny�II work right uf aacmption q;r hIOL 11.0 PlumbinY rcpuirx ur�JJitions
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insuranca rcyuired.J � anpluyuca. �No worksq'
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Pa�lurc w,ucuro w�eruge,tf requireJ unJur Scuiun?JA ul'\IGl c. 13I eau lead io the impuyition of'criminal yenalriea of a
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[nformation and Instructions , � . �
�von m ihe service ut anwhcr�m,ler :my ��mr'�t of hirc.
�t.»,.�chu:au G�nanl Luws.hap�er I i2 rcywrcx:+II anpluyan�o provide�wrkers' co�apenxauon t�x�hcir¢mp oyee+.
Pursu;uu w�iiir.utWe. �n r�npfuYtt ia Jctined:u"...every {n'.
,.preax or unplieJ..oral or �vritten..•
�n r�nplupr���dc�incd ss"an inJiviJwl. purtnenhip.,��soeianua.�orpura�ion u�uihar Icgal ennry.or�ny two ot moro
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tCCCIVCf Jf l[IIa1C0 UI .�IIIdIv1�IYJI. P
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,�.�.Ihng huuia of rno�her whu amploys {+ana�����o maintenuncr,cun+Uuctian ur repuit wurk on wch dwa����11 huute
,�� ,m �he gruund+or builJinY +pDuRen;uu thercto sh•rll not becaux af such amployment be�r�mrJ tu be an rmpluyer."
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rene�vrl uf r Ileuas� or permlt tu uy�raa�h���h�u or to coa�truet bufldin���p «�ommunwaul�Y for aar
:�yplleunl nl�o has nol produ'rd,SC 71 abr eav Neuher he onunonw rl�h n t any of u poii cal�SubJiv aron�•shall
AJdi�ionully, �iGL chup�er l S_, i- l
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nquiromcna uf ihiy chupie�have been p�'e+enroJ ro�he con�ruu��Y+u�hori�
.�ypUcm�u � 1 to uur Yiwa�ioa an4 if
Plc,�+e iill out ihe workcn' cumpaitrtion atndavit cocyp�d1yhona numbed�)a�11 with t rhais�ertiticvteli)uf
nec�:yy+ry��uPPly.ru�contrrc�or(sI n:une(Q, •rJJcea+K 1' P
insw••rnae. Limite�l Liabiliry Compania�(LLCworked�ean petunu n i�vuc�n a�(ff an�LLC or LLP doon havocr�han 1he
members ar p�+c�+��sn• +ra nut requiraJ tu csrry
en,ployee�.u poliey is requircd. Be advixd chat�hi�•r�lidavit may be Yubmitcud �o U+a Depurhnent of fndustria
ho rc�umaJ tu the c�or town tAut theCaPDI e uon for the penn t or licemepy b�ina roquasted.�nol he [k:poRn+�nt otw
I nJusviul Accidanb. Shou W you huve uny y�atiooa reyardiny the luw ur iC yuu rce royuited to obmin u worken'
�u�npen�tion policy. pleasa call �ha Dep�ent rt iha nwnber IiyaJ below. Self-inrural aomp�aies�hould enter theif
,ulf-inyuranee licenae number un tha a ro riuro liea•
ci�a.ra,.a om�i.i,
t'Ica+c he.ure�hue�hQ���uvit ii cwnplete and printcd Ic�{�bly. The Department hw pruvided u�p+u:a ut�he bu�wm
��t elir�tfiJuvit fur yuu tu lill nut in the tvent tha ORica uf Inve:ti�{atians h;�to cuntut yuu rogatdina tha applicant
I'I:�sa bn suro �o till in�hu purmiNicanye nwnlr:r which will ba usad aa a reYercnce numher. fn aJJi[ion.�n applicytt
pulicy inYorm�tiun lit nrcesaary) �d undar"Job 5ite AJJrai'the upplic•rnt shauld write";dl tucmiun� in lciry ur
ip:u muat submit mul�iple�xnnit'licaiue applica�iona in any given yeat.nead only submit una aRidnvit indic+tins curren
wwn1,.•�\ copy����ha ulYlduvit ihit haf been offlcially stamp�J ur m�kad by dia city or wwn �nay be proviJcJ tu ihu
yt�r' ��here�huma utwner'ur cinzen ia abtainin��licenyo ur'r'nn i not related to ny buy�ine�'or ca smjerc al venturo
�i.,. :� .lug ticense or permit tu burn Iravea c�e.)�aiJ perxun ia YOT required co compleie thi��tfidavit. ue�uom.
I I1C �)IIiG¢ul II1Vi�ftyAllUflr NUuI1I IIAO W �1811If}'�lU IIl :1JV;IOCtl IL(yJ1/f�OJPC�7IIOII 711�I.huu1J quu hu�v:mY 4
ple��e du nw httint¢ to grvc ua u c�ll.
fhe U.:p:unncm's�Jdra+s, ccicphuna anJ fax numbtc
The Cortuuonwealth of Massachusetu
papatanent of InJustrial Accidenu
Otife�of[svad��dona
600 Washin6ton Street
Bo�ton, MA 02I 11
'fal. q 617•'127-4900 ext a06 or 1-877-MASSAFE
Fa�c M 617-727-77J9
, •• �„� <.��,.us www.m�v.gov/di�
� CiTY OF S.�LE.�[, ��L�SS.ICHL'SETfS
9ClLDLYC DEPARTIENT
\
I?0 W.1.iHLYGTON ST7tEET, )'°Ftoaa
� ���s� �;s-�s�s
Ki\�ERLEY DIUSCOCL F.�(�7� 7�9&id
.1�UYolt �1+o.�w Sr.Pi$aas
DtAF.CTO�OP Pl,'BLlG PROPERI1f/8l'QDLYG COJL�IISSIO�EI�
Constructioo Debrls Dfsposal Attldavtt
(required for ail demolidon and renovation work)
►n ueordance with the sixth edition of the Stata Building Coda, 78U CMR section I I I.S
Debria, and the provisiona of MGL c 40, $ 34;
Building Permit p ia isaued with the condition that the dcbris resulting from
�hia wvrk shall be disposcd of in a properly liceaaed wayte dispoeal faciliry aa dcfincd by hIGL c
` l 11. S 1 SOA.
The debri� will be transpartcd by:
/� J/?�s�P l�/(�t/��.o „K �
(nama uf hau
The debri� will be disposed of in :
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(name of fudjty)
(�ddreaa oYF�tihtY)
� na�u ofpermit�ppliconf —
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C-MAC & SON �9e wo. rn Pages
�`. MA �2°°$'."'° #1'9'$5 Remodeling Proposal
11 Loves Lane
WOBURN, MA 01801�
(78f}�3?-@466
�JY/-�G2rdd! cournncroa ucoa�No. .roe wia+E No. /
� rSo,y�� 7$"/-�i.z��[ 8'
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Submitted:£=F�-F+ft'�'°'✓F�— � �JL/LlF� �/JB+12 S ��/•�.S �L
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. . MCHfiECi DATE�PInNS
, 'DL'E1S�l�`���C � ��/�`/ APPHOXU�w7ESTARIMOOIITE APPPOI@lATECOWPI.Ef10NDATE
We hereEf'submit sPecilieatla�s end asNnates tor- � � .
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This Proposal tloes not imlutle:
>
nu marertei�s 9uarameed m ce as�eafiea qp wmk m be com- yye Pro hereb to fumish material and labor-com lete in accordance with �
plelee m a wononen�ae menneracm�ing m standam pmclices. P�� ��Q - �� fpr the sum oF. P
My alte�a6on or Cevlallon fiom tl�e a6ove spadliratlore irrvdving - .—
extra cosis vnll he done oQy upon a w�inen d�arge ortler.The cosb �
willOeWmeenexl�ed�eovararMahoveMe�mate.7l�p .���/'�'y�p,y� ��,� �
to indutle.bu[is rot limitetl ro.ttiddmi dam�qas ttat are uncoveretl . /
durlr�g Me aourse oi the job arM addido�al work requirad Mal i
buOAi�insP�rs. ' � ��—. ����y��. d"'�l.
Au elemer�b ot this 89reemerrt are coniingent uPun shikes.aaMenb � e j1t`� � dollazs(yc�,c�—). -
or tlelays beyond nur con6oL iTe e5imate tloes�ot iMude materiai P�� .
price increases.or aAd6onet gborarM meteriaLS whirh msy 6e . ���i — '
required�ould�mforese�en pm6�arise after tl�woAc has started
You,the buyer,may cancel�is transaction J ` � -�= ,
at any time prior to midnigM of the ffiird
business day after the date of this trang '`
action.CanceilaUon must be do�in writing. � i oc.a�i
N�rids p�opom
�rey 6a cv�@awn
� by�edm�a�ptetlwuM�aeys .
Accep !J�O PI'Op088�: The above prices.specifications and conditions are satisfac[ory and are hereby aeoepted.You are
�y� authorrzed to do the speGfied.Payment wiN be made as outlined abo've. :
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