50 LEAVITT ST - BUILDING INSPECTION r
The COIIIIIIOtIWealth Of iA(assachusetts -
Department of Public Safety
( ;',,,1' \Lissaihuv'tls�taleBuddml;Cudv(�Nlll'.\IIO
13uilding permit Application for any Building Other tlt`m a One-or llvo-Fantily I)sveIIing
(III is Section For()fill ial Use Only)
Ilk i ldinl;I'cnnit NumberDate Applied: ____ .-_ Building Offit ial: _ _••--��.,�
SECTION I: LOCA IION(Please indicate Itluck *,Ind Lot p fur locations fur which a st •et,iddres •IV le)
o LQZ11 rf s ee
-- . _._ ! 1�P - ree late
:Nu. .nitl ti rret Cily /rowll -_ _.___Zit Code - _ - _
! Nenlc of Bml i g al,plirahle)
.SI`CI'ION 2: 11I40110SEI)WORK
lidilion of.NIA S6nr Code used
_. . -. It Ncw Construction,hark here❑or check all ill It apply in the Iwo rows lwlnw---
I(tislinf; B11ilding❑ Repair❑ Alter,mon ❑ AJdillolt Ucotolilion ❑ (I'lt,sc fill out and submit.\ppcnd it I)
Change of L'se ❑ 1 C'h,rtry{v of O...... ltcY ❑ Other ❑ Spri ify:,_—_..._.__ _ __ _
\rvbuildingplans,uul/uriunslnailiundlkunlcnlsbcing supplied as part of this penuitappliouitm? i s 0 Nu ❑ —
Is an Independent Slructund Enf{inecring Peer Review required?
Orivf Desiriptiun of Proposed Work: 1'cs ❑ No ❑
1A, JEY1 -_—
SECTION 3:COM1II'LE'TE PHIS SL•CfTON IF EXISTING UUILDING UNUGRCOING RENOVATION, AUDITION,OR
CHANCE IN USE OR OCCUPANCY
Check here itan Existing Building investigation and Evaluation is encluxti (See 780 C.\IR 14)
Emsling UNe Gruup(s): -- Prul,osed Use
SECTION J:BUILDING I(EICRT AND AREA —
Fsisting Proposed
No.of Flooa/Stories(include basement levels)C Area Per Fluor(Nq. ft.)
fatal.\rea(sq.ft.)end rm,d Height(ft.)
SECFION 5: USE CROUP{Chet Js J liable)
A: Assembly a-I ❑ A--'❑ ,Nightclub ❑ :V-) ❑ :\4❑ .\-i B; Business ❑
1: I ado F-I ❑ F-'❑ E: Educational ❑
It: Ili h flat•vd II•I ❑ 11.2❑ 11-1 ❑ 1I-J❑ 11-i❑
is Institutional 1.1 ❑ 1.2❑ I-I❑ 1-a❑ \; I: \fcrcantily❑
_ It: RisfdentiJl It-I❑ f(-2❑ R-1❑ R-� ❑
S: Storage S•1 ❑ `_:'_❑ U: utility tipecialUae❑and de-Ise�perial Usk-
SECTION 6:CONSI'RUCTION 1'YI'E(Check.ls applicable)
I.\ ❑ Ill ❑ IL\ ❑ IIB ❑ III\ ❑ [fill ❑ IV ❑ VA ❑ It
.,_ SECTION 7: SITE LVPU IMA IION(refer to 7410('.\II( I I Ln fur details tin each itent)
Water Su pyl I Wild Cone Information: .Sewage UispoNJl; I'rrnch Permit Debris ((eunly al: --
I'ubha Ch,kit outside Ilood /mnc❑ Inditale mania yal( \ Innate ,rill not Fe I I,r 11,1 Itnpns,il�ilr )
( I'rn,llo❑ :-rindenthl., Agw Ieyuircd❑nrtrenth or. nrdc.ohgl ,nl'+1.lam ❑ I I
lrnno is rm In.rd ❑
Itailn r.nl right-uf waY: Ildranls In.\ir 14 Ifllmn:
I \'.a \I`p h,.ildr� Lclru,furo nithin.w nvl.i • vo.nh.o•e'
I 1 ! I - Is Ihru Irt Ian „gym drlra 'i rr l : mrnt h: Iludllrm L:.rl{p lrs
tillllU.VI: C(I,t,'II .N1 "Et I I(IIl:1CAI If Of OCCLI'.\.\( Y 1
i ! Il'„u.luii!e•n t`u ul`.ml l ,.iJ 1rrIL •r _--___ . .+
14v . Ihr buiLlinl,,, iil.un.11, 'l:unllrr ti,.lain' '•I:n i.d '�Ii1't&ll m.
r , , I
Bly OWN1 It ;\U I IIOHILA1 ION
I N I me- Proj,cri\ Olt wr 0/970
City/ fawn
Name (Print) No, lilt[Sired
j,r,jj,t.I ill,Uwnar Ctlwa,I Information:
C.111,111 address
I tile 1,1,-pluloe No (11110100 roit-j1horte No (tell)
11 applicebly, Ilit,Vrope)l),owner hort-lis, lodiori/c.i
—-------- City/ rols it Slate
Name Strtvt Address tin ierI'di'llf in 11 Inattv"r,.I,Iivt to work ilhorized by 1114 btijdii g,tmlit1"Plicatiol
NTROL(Please fill out 1,,eod'x
sicrION CO Control then check
e'It he,),cland.44)Section 11)1)
I If boildwir,is IV.S4 than13.001)to. ft.ol
11),l Registered Professional R,,pomible for Construction Control
entail address Registration Number
Name(Begistrant) I'dephone No.
,te Lip Discipline Expiration Date
,;liver Address city/Town
10.2 General Contractor
Company -J.Milne
-PR 3
�2
Nome of Person Responsible for Construction .License No. and Type if Applicable
OD IVAJA"n k,? city/Town state Zip
Street Address
%17J-267-9-5-li�—SiW address
rk-lotilione No. 111u.'"110S) riL hone No. cull I I it IM.G.L.c. 152.
SM I IULN Lai V,I It,
tit Industrial AccjjIQjjt3 1111W bQ01111plUtt'd 1111d
Compensation losur,111CLI v Workers' I Affidavit from the Department
lavit will result in the denial tit the Li.5wilice tit the building P rolit-
submitted with this application. Failure it,provide thi.5,iffit
fined Affidavit submitted with this apPlic,nit"'? Yes C3 No 13
SiCl ION 149 CONSTRUCTION RUCTION COSTS AND PERMIT FEE
Item Estilo,ltutl Costs:(Labor rotal Construction Cost((rum [tell'(1) -
I. and \11ateri'lls) vrinit Feu uX,tICoII.SIru iwcostx—(Insert here
2. Electrical 5 pri
priPlOolboll', y Note \Iullllltlln ft-e-5 (contact I 111111wip'llitv)
J. \IMI'lilik"I
3, Z,it Fvl,�"'Fc)) :11close ,11vt It --1
It Intel G„t1 ,3 7 1
(contact ollillik palih)'lilt, ,trite check number 1wry
IEC"rION 13:SIGN,%I UR E OF BUILDING nmirr APIlLic,%N
let t1j, ,11.11tit-i of Verl m HIM III A the Illf"rolatioll wilt'llov'l tit do,
It%,viovirt f; my I.olle b0ow. I he LAIV litv,I till,
"n'll"I it'll i,Itrut.antX tit rate I, the 11,St of nil ku,m lvdge aad tilderNt'lli'lille,
rholl'. \I, I).Rv
' Intl Wdl'
ll,prov.d:
fill oul thii 1Q,tion 11d,
lo,pcctor ill
CITY OF SU1 Ell, NL-1SSACHUSETTS
Buiwt:NG DEPARTIt&NT
3 !r 120 WASHINGTON STREET, 3" FLOOR
` TEL (978) 745-9595
FAx(978) 740-9846
KINMERL.EY DRISCOLL
;VLAYOR THO.%W ST.PIEM
DiREcroft OF PUBLIC PROPERTY/BUILDING COMMISSIONER
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 11 1.5
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:/
(name of hauler)
The debris will be disposed of in
(nanic of fa/ciillity)
(ad�tacilay)
Signature of permit applicant
date