48 HOWARD STREET - BUILDING INSPECTION (2) �
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`* '� , ' The Conunonwealth of Massachusetts
/ 1;,�� � Departm.nt of Public Safety
i: �'1 \ ,c�, �� � \Ia+sarliiurllstiLrtrlluildingCude(78UC'\IH) .
� �V/l � . . . � ISuild�iiig�Pcrmite\pplicationfor�anyBuildingotherthansOne-or"1'wo-F.vnilylhvelling
, � •" ('I'his k�etinn Fur Of(ieial Usc Onlv)
� � RuilJiu�;.Pennit Nwubcr: —.------ D.U�Appli�d: ---- ISuilding Offieial: —_—. -----
tiGCfION 1: LOCA"IION(P�casc inJicafe Illuck M an� L"ut kfoi IncatiJns fur which a strcut addrese is nut availablc) .':.
-----4g �Du/A�GZIL�T.�_J_a (�1___Ol�7� __ �
Nu.and tilrcct City/�finvn Zip CuJe N,unu uf Iluilding(if applir�iblc) --_-
Sf:C'1'ION 2:YROPOSED WOIiK
Gilitiun�d i\I;1 Sl.�tc C�MIc iard_�_ II Nc�r Cunstrui tiun chcrk hrrc O ur theck all Ih�iL�ppl�� in Ihc I���u ru�e.s hcluw --
G�istin�; liuilJing .. 'Rcp��ir� :Vtcr;iliuii O"� .\ilJi�iun0 Ucnndition�O (PIC�asc�lill�out,uidsubiiiit;\pp��iidixl)�' �i. "
` � Olher ❑ S nii( • .
Ch;mgci�l l�si�� ❑ Clt�tngcuf0[eu��an.V },.� t -1 `" Yf--._
Arc building plans and/ur ruiutrurliun d�M'ununls 6cing supplicd.�s part uf thiy penvit appliraliun? Ycs �' .. �u O�-----
Is�m Indepividrnt Strurtural Enginccring Pccr Rcviuw rc�uimd,?I/ �j Ycs ❑ Nu J�'
�Unc Dc+rriptiun ui Prupa.cd tVurk:_._� /C Sr� �Nu � U __
p �2 5 �L / D�U l.vi�LL !/�/VYS ___
% � u> i2 2
r �1���� F .�� . —
l �v `�`rl�c�`�r !95 '-T !9<�DT�/lJCr' �IJ�!'t� �'ue5.
SECTION 3:COhIPLETE'CEfIS SGCTIO IF EXIS'i1NG BUILDING UNDERGO NG RENOVA'PfON,AUUI'I'ION,(lfi �
�� � � � CFIANCE IN USE OR OCCUPANCY � � " � ' ' ' " �
❑icck hen�if.in Esisting BuilJing Invesfigation and Evaluation is enrlused(S�w 7N0 C\IIt.ia) ❑
EEislingUticGruuj�(s):. , +. , . - , �PruE�uticdU.ccGroup(ti): _. - . _ .
SEC'�ION 4: BUILDING IIEICtPI AND AREA
� Esisting � PruEniscd
Nu.ul Fluocc/Staries(indude basentent Ievcls)&Area Per Fluor(sy. ft.) �j �,
. .I'olal Arca(sy. ft.)and TuLd Hcight(ft.) '�.
. SECI'ION 5:USE GROUP(Check ae a licable)
:\: Assembly�:a-1 O .\-3❑ Nightclub ❑ :1-1 p A-I ❑ A-i❑ B: Uusiness O. G: Educafianal ❑
F: Pacto F-I ❑ F2❑ H: IIi h Hatud H-I ❑ H-?❑ Ii-.t ❑ FI-�❑ I I-i❑
I: Insfitutional I•I ❑ I-2 O� 1-t❑ N❑ ��I: \Icrcantilc❑ R: Rceid¢ntial R•I❑ R•'_ R-1❑ li-a❑
S: Storage SI ❑ S2❑ � U: Utility❑ Special Use O and �Icase dexribe Fiduw:
tiF�rci�ilUsc. � I
SEC'CION 6:CONS'fRUCI'ION�IYPE(Check a9 a licablc)
IA ❑ IB ❑ II,\ ❑ IIB ❑ IIIA � Iilll ❑ IV ❑ VA � t'll� �
SGCf10N 7:SffE INPOIt�IA�f ION(refer W 7N0 C�IIi 111.0 Eor Jetails on each itcm)
�V.iter Supply: 1'lood Zune Infonnation: Scwage Uispo+al:
Tnnch Pennih Uchri+ Rcmuval:
Publir� Chcrk il�nrtsiJi PIuaJ l_nni�PZ In�li..�lc inw�iripa�
.\ trcndi �eill nut l,c I.ircnscJ Di.pus,�l�ii�� .
rr��uimJ�urlrcndt at�pr�d\':_.. _� ._..
�'fll',IIC�❑ ! Uf iliilVltU1Y /UO�...,"`**� „ Uf��Il�itC 5\'SIPhI❑ � • 5� •
, .. .. . . . ._--- ,. ::f.t ps�nnil is rnrluvcd O __ .
R.IIIfUJ,fIhI16UP-Wdy: IIdGJfJ5111:�If NJYIhdhUp: � .. V � i���.i.�� � � . . �,�.� . �. .... .. .. . . . .
Xnl :\p�,liiablr.(� . Istilnii�iui��ci�hin,iirp��rt.i����n•eiiharrd.' Is'thvirrrcir�e�i,inplcl�d.'� ,,.�Jw �`
��r C��moirt h�Illuld cnc�uxt�❑ � lrs�'ur Vo�,' I Yrs❑ .Vu ❑
" ti[Cl'ION 8:t'UNII'.N'f OF l'1'.Rl'IIICAI'G Uf UCCUN:\NCY
Eililiunnllrnlr:, . .. ._ L'.rGn�u���.�1: _ , _ I\�pr�dC��n.lrmli��n�. ll�iup,udL��aJ ��rrhL�or � .
I���r. lhriniildin�;canlain,in�prinl.lrrtiv+lrm'�. ti��ni.dSlipulalinn.: . .
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til:("17UN v: I'ROPh:R'IY UIVNGR AUl'l lOHIZA'IIUN
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,\anir,uul AJdtctitiut P u��rtl\'Onncr / --
(_h___�1�_a(e--�S._1fOGv�RD_Sr__�a
� - � � 1��------ ���1�-,
���,inm(Print) �lu.and titrcet Citv/Tuwn Zip �
Pro�crly Ownrr CunL�el In(unnaliun: '�.
� -�-l�1�2�t/' -- �9( Go3_�� Sa�c.�e _ ��(�v s � �iaa, c� '
I'itle frlephune No.(busincss) Tele��hone No. (ccll) rntail address ,
If applir.ible, the pruprrty uwner hrrebV aulhurizes
�a�I����.�.�t��c_� —�S_L eavr'l'1,$f, #`L__s P�/. �YlA_�9To
Vame Street Address Cily/'Puwn State Zip. .
tu.�i t un the �ra�ert uwner's bchelf,in all mntters«�I;�tive tu wurk�authurizcJ b.- this buildin �ermit.i >>Iiraliu�i.�
SECTION IU:CONSTRUCTION CONTROL(Please fill uut Appendix 2)
lf buildin is Iesv Ih,tn 15,Up1 cu.ft u(rnduced s�ace ond or not under Cunstruction Cuntral then check herc O+mJ vki�Sectiun 111.1
tll.l Re istered Professional Res unsible for Conshuction Cunhol
�u.J��sSa.�� �'yb_ zro. Iqd b �uul�2Dau(w�y,� caa� 9734
N.imc(Rcgistmp Tcic hun�Nu. c-m.�il addretis Rc�i+tration Number
f� �P�����'I Sf �v � pi97o � _�c�za�z.
tilrect Address ' ily/Tuwn 5tate Zip D�snpline � Esp ratiun Date
102 Ceneral Conhactor � � ' � � '
_ . ` � . _ . ,. - - �� �, � _ � -
Cump:my N�ime �;' .. ,� � ' . . . . . .
� lMOS `� !lGO,�- . : _"'
�inntt uf Pcrsun�Rcsppnsibir�fur Cunstructiun � .. - . Littnse No. and Typc ifApplie�blc . ,
� S �i�Plr O "r..2v'raG� , 7 sa c" l�R ol9D�
Slrcet Address City/ own State Zip
7Sr,�o3 4��3 a 7_8� -�'_ 43��. 6;l�os �—Gtcv , �o�
Tclu�hune Nu. butiiness Tcic�hone Nu. ccll e-nt il aiA Idress -------
SECTIONll:�cr�r.�.i�.r.:r��i�nu�r��.:�ru���b�r�ur..�.v��i'.u�i-n�,���il M.G.L.c.152. 25C6
_... __._._.. _ ..---- ---- -_._.___. _._
A N'urkers'Cumpensation Insurance AFfidavit from the\�IA Department uf Industrial Attid.nts must be cumplc�ed anJ
submittrJ wilh thic��pplicatiun. Failurc tq..pruvide this affidavit will result in the denial uf the issu.intt uf the building permit.
is a si�ned AfFidavitsubmitMd with this a licatiun? Yes❑ No ❑
SECTIONI2 CONSTRUCTION COSTS AND PERMIT FEE
Es�imated Custs:(Labur
Item ,ii�il \latcrials) Tutal Cunstru.tiun Cost(from Rem 6) =S_��r �� �
1. 6uilJing y � Buil.ling Pennit Fiti�Tutal Cunstnietiun Cust x r� (fnscrt hcre
� 1. [I�Ytric,il S apprupri.�tc municipal 6ich�r)=5��,
t, Plumbiny, 5
i J. \I�t'h,miral (I�{V:\C) y _ �1utc: �lininwm kc=S �S� (cunfact municipalily)
3. .\Icihauiral ONtcr S
Fnclasc chcrk p,��'�iblc tu __
h. fol.d Cost 5 (r��nta.t nwnirip,dity),md »�riM rhrck mnnber hrrc ---
tiEClION 13:SIGNA'fURE OF 13UILDING PEIiMIT APPCICANT
I Bv cntc.ring m�'namc bciniv, I hrrcbv,ittcst undcr Ihc p.�ins,md ��cnaltiry�d perjun' ihat oll uf Ihc in(unn,iliun.unLiincd in tliis
i�F,lii diun is Irm. md.ieuu,itc tu Ihc hi�t uf m�' I.m �cicd+;r and u idnrslanding. �
I��� ( ("�,_ L.ess�.rd' �c�.�,�f�. �,y�� Ard«� ��9) z�o-I46o �z/io/n
— -- - -- ---- -- - - - - _ - __.
19�,i+. �,nnt,md i n namc fidi G I���honc\'u. U,uc
I � S c ��v� �t_ sfi. _ # z _ _ .. -- � _ _._ - �t�1 __o �q�o
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I �VCi't .\��i�fVtiS (�i11' '���t� 1 tilJt' /Iv
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\lunicipal Inspector W fill uut thiy.c.tiun upun application appru�al: _._._ � p-�I. ��
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�:`°"` CIZ'Y OF S.1I.E�I, l�L1SS.\CHL'SETTS
� � dL'l[Dl\G DtP.iRT�(E\T
�+'�,� '� .. �+�� l?O CU.�SHL�IGTON STItEET, 31D F100R
`�`�°`�" TE[. (978} 7�5-9595
F.�.�c(973) 740-98-fb
fU��gFN[ FY DRISCOLL
�,L1YOR "I�+osi,►s Sr.Piaxxs
DIAECCOR OF PCBL(C PROPHRTY/0C[I.DRG COJL��I5SIO�ER
Workers' Cumpensation Insur�nce,�flid•rvit: Duilders/Contractors/Electrlctans/Plumbers
,1 i ilfcant Infiirm•rtlon Ptcase Print Le ihl
.V;,,n���,�„�k,���,,,�,r,�,�ti�������,�,,.���: ��G..�1 � . L.� ssar .
Address: I� Le R V/ �J ✓ . �� --
City/Statc/Zip: 7GL l P/� Phone N: 7B Z�0 �196�
��rc ynu aq employerY Check the appropriate boi: 'Pype uf pmJect(requ(red):
L 0 I am a cmploycr with 4. Q I;un a gcn��l cuntractor and 1 6, (�Ncw cmisiruction
empinycea(full anJ/or part-time).• have hired Ihe subcontracWrs
2.�j I am a sole propricror nr p;uinco- lismd on the utached.rhect� �•��modeling
.hip und have nu cmplaycea Thcse subcontrocwn havo 8. � Demolition
warking ti�r mo in any capacity, workers'comp. insuranca 9, � p����i��g�ddition
(No wurkcri winp. insurance 5. Q Wa are a comamtion and iU .
rcquired.j officers have azerciscd thcir �0.[] Electrical repairs or addi[ion�
� 3.0 I mn a homcuwncr duing all wark right oFcxmnpliun per MCL i LQ plumbing rcpuirs or udditiont
myxlE(\o workcro'cump. c. 152, §I(4),anJ we have no �z,� aaaFrepuirs
insurancareyuired.J� amplayeee. [Nowor�eri' �},[�Olhet
cump. inxurance rcyuircJ.�
•nny applic:uiulu[di�Y�box II mup alw fill uul ihe sectioolwlow ahowiny iAait wmkeq'companeaiiun pu�i�y inform�eion.
�I hwn¢uW'm.�n whu a6mi1 Ihia�tilMvi�indie�liny ihq an dainY all wuh and ihrn hiro uN�ide canlm<ton mmt auhmil�new a0?Jyvit indioliny ruch
�(1�mrxiun tM1 ch�sk ihii bua mu+l�nachud an aJdiiiuwl�hm1 rhuwiny iho nane of the mb<umruuon anJ iheir wnhen'wmp,pulicy inlomuiion,
/um urt eurployn rhut!r pruvfdJng�vorken'cumprusaNun ixaurancs jor my unpluyerx Beluw/r 1Gi po/!ay and fob slts
ir�jorururiart.
Insurmice Company Vame: . .
Policy N ur Scif-i��v. Lic. q: __ Enpiratian Date: '
lub Siie Address: CirylStatr/Zip: .
.\�t�c6�cnpy uf lhe�rurken'compematloo pulley declar�tlan p�K�(thowing 1he polley numbor and expinlloo dato)..
F�ilun w vecure coveragn;u required undet Section ZS.\uYMGL c. 152 can laad ta Ihe impo�ition ofcriminal penaltias of a
rinc up ro SI,5011,00 und/or one-yaar imprisnnmcn4 as wcll ay civil pcnaltiea in thu f'ortn uf q STOP WURK URDER anJ,� line
uf up to S�SO.(10 a Jay�yainst ihe violaeor. �13e advi.�cd th�t a copy ul'this.viaiemcnt muy bu furwurduJ to ihc OI'liw ol'
lin�r��igaiiunx�d'ihc pIA f'ur insuranct covcragc vctitiea�iun. .
/du lrrrrby ern�/iJ�y uuJrr� C tlI/It1(lII�,I��),!./ly/ll���ury t/iu!dre Lrjunnulluu pruviJrJ�Guvv ir vu wid currrc4
�i�a±�iiiirc' II//��• A..� �Z 20 20//
I);iW:
Chune,�7�� Z/� � ���jQ �
iO/)icru!ust only. Oo no/rvrilt in!lris unu. tu ba cuurpleted by ciry ur�own n�ficiuL
� City nr'Pu�rn: . __ . __ Pcrmit/IJccnye,Y �
f�suin \WLuril �
K� Y Icirclu unc): - --_. ..'--- ,
I. fSwrd ul Ilc�lih ?. quildinq Ucpariinrnt .1.Cityi fn��n Clerk J. F.fectri.al Inspcctur i. P�umbinq fnspeetor
G. Oihcr
. .--- ��--� I �
' Cunlact Pmnnn: � Phone;J: �
� —_" - . . � . .— _____._ '
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��$o�ma��o� au�d Y����'��tIloa��
\fassachusetts Gcneral Laws ch�pter 152 reyuires all emp(oycrs to provide wurkers' compensation for thtir em�loyeesr- �,
Pursuant to this s�atuee,an einployee is ctatined as"...every person in ihe service uF�notlixr under any contract of hire,
express or implied,oral or written."
An rmployer is defined as"an individual,partnetship,association,coryoratiun ur othet legal entity,ur any two or more
of the Eoregoinb cngaged in ajoint enterprise,and including the legal representatives of a decwsed employer,ur�tse
rcceiver or crustee of an individual,partnership,association or other legal entity,emptoying employees. However the
owner of a dwclling house having not more thun chree apactments and who resides therein,or the occupant of tha
�welling huuse of another who employs persons to do maintenance,conswction or repair wurk on such dwelling houae
or un�he gmunJs or building appurtenant theroto shali not because of such emplayment be dcemed to be an employer."
.
�iGL chaprer 152, §25C(6)also s�aces�hat"every state or local Ilcensing agency shaU wil6hold the issuence or
rencwal of n Ifcenee or permit to uperate a buslnese or to construct building�In the commauwealih for any
applicant who hus nat produced acceptable evidence of compliance with the Insurance coverage requlred."
`" Additionully,MGL chapter 152, $25C(7)staEcs"Neither the commonwealth nor any of its political subdivisiom shall
entar inta any cuntract Por the performance oF public work until acceptable evidence of compliance with the insurance I
rcqu'vements uf this chapter have been presented to the conhacting authority."
� .4pplicanh -
Please fill out the workecs'compensation aFfidavit completely,by checking the boxes that appiy to your situedan and, if
necessary,supply sub-contractor(s)name(s),address(es)and phone numbet(s)ulong with their certificate(s)of
insurance. Limited Liabiliry Companies(LLC)or Limited Liability Pactnerships(LLP)with no employeee o[her thazt the
membcrs or partners,are not required ro carry workers'compensa[ion insurance. iCan LLC or LLP dons have
�mployees,a policy ia required. Be advised thnt this uffidnvit may be submitted to tha Department of Industrial
Accidcnts for confirmation of insurance coverage. Alw be sure to aign eod date the a(fidaviL The affidavit should
tx rctumed to the ciry ur town that the application for tho permit or license is 6eing rcquested, not tha �epartment of
Industrial Accidents. Should you have any questions regarding the law or if you are required ro obtain a workers'
compensacion policy,please call[hc Depactmcnt a[the number listed below. Scif-insurcd companica should entor thau
� self-insurance licens�num6er an the apprapriate line.
, Ciry or'fown Of7lciala
Plzase be sure that the affidavit is complete and printed legibly. The Deparnnent has provided u space at the bottom
uf tha aftidavic for you ro fill out in the event[he Office of Investigations has to contact you regazding[he applicant
Please be sure to till in ihdpertnit/license number which will6e used as a referencn num6er. In adcGtion,an applicant
thnt must submit multiple pertnidlicense applications in any given year,need only submit one at7idavit indicating current
policy information(if nccessary) and under"!ob Site Address"the applicant should write"all locauuns in (ciry ur
tuwn)."A cupy of the at�davit that has been officially stamped or marked by the city or town may be provided ta the
npplicrnt as proof that a valid aFfidavit is on tila for future pormits or licenses. A new alfidavit must ba filled out each
yerr. W here a hmne owner or citizen is obtaining a license or permit not related ta any businoss or commercial vennue
(i.a.a dog liccnse or pccmit to bum Icavcs etc.)said person is NO'C rcquired to complete this affidavit.
The Olticc of Investigaeio�u would like ro th�nk yuu in advance for yuur coaperation and should you have any questions,
please do not hesit�tc to give us a c�ll.
"fha Dcpartment's aJdress, relephune�nd fax number: - '
'The Commonwealth of Massnchusetts - "
Depaztment of[ndustrial Accidenb . `
Ottice of Iuvesilgadon��
600 Washington Strcet
Baston, MA 021 I i
Tcl. #b 11-�27-4900 ext 40b or L-877-ti1ASSAFE
Fax#617-727-7749
2ev!;cd 5-?6-05 www.mass.gov/dia
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CITYpF $,11,g,«� 1tiL1SS.ICHL'SETi'S
9CtLOLVC DEP.1A'1TtEVT
I�O W.�,iNLVGTON STAEg'r� JiO F�aQ�
�. ���e� ��s-�s�s
KlJ�E1lLEY DRLSCOLL P.IX(97� 7a0.9g.{6
.�UroJt 1�o.�w sr.Pr�us
DIIIE(,TO�OP Pl.'8LlC PROPF�7y�81'p_p�G CO\L�IISSIOVE�
Constructloa Debrls Dl�posal Atfldavlt
(required fo�all demolidon and renavation work)
In accordanca with the sixth editton of the State Building Coda� 180 CMR section 1 !I.S
Ocb��, �d t�e provi�ioru of MGL c 40, 9 34;
8uilding Permit p is isaued with tha condltion that the dcbria resulting from
ihi� wurk�hal1 be disposcd of in a properly liceaaed wnyta di�poaol faei���y y� d��ncd by MGL c
I 11, S 1 SOA.
Tha deb�� wi11 be Uansportcd by;
�r i k Z. n���o s �e (
(oama uf haular)
The debri� wi II be disposed of in :
_— (nama o��Y) '—�
� (J�dRff Of��7Cl�IlY) . . .
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I�.��W�✓
' vyn�ture o(permit�ppl�c�at
lZ Zo �Dl/
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HATCHED AREA - NO WORK w Q W �
J � N 'm
a
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QwJN
� PAINTING a � °� �
� BR NEW SMOKE DETECTORS �
O , PER CODE
PAINTING
FIRE STOPPING AT TOP NEW ELECTRICAL PER
AND BOTTOM OF WALL CODE AS REQUIRED. o
AND AT FLOOR, WALL & �
CEILING PENETRATIONS
ou
NEW FINISH FLOOR �;o
o �_
NEW �" FIRE CODE �M
Z GYPSUM BOARD AT �� ^
wo WALLS & CEILING Ww �;i
� PAINTING 'o� � a
EW BATT INSULATION FIRE STOPPING A P az o vvi
� T EXTERIOR WALLS AND BOTTOM OF WALL
AND AT FLOOR, WALL & �
NEW 2'-2" yy NDOW CEILING PENETRATIONS a
1 HR RATED DOOR EGRE z
� NEW FINISH FLOOR z
N �
NEW �" FIRE CODE 6
GYPSUM BOARD AT
WALLS O z
NEW BATT INSULATION E-' � a
AT EXTERIOR WALLS � � �
z �
o' s' ,o' z � H o
NEW W W
WINDOW P� rw ] �
� x
z
U F
SCALE �" = 1'-0" W � � �
� ca
. � \g,��PEDA,qCy�` F., 3 � �ry
Q,C� vp.LESS �i p z
1 UNIT 2 FLOOR PLAN * Q°'� � * � x � �
3/16��_ ��_��� � 0. �' � d, � A
� S M, W
�o • �,j DWG N0.
n PV � �
1� 1 A(tHOF�Psy
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