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9 MANNING ST - BUILDING INSPECTION ' The Commonwealth of MassachupFCE1VE0 Department of PublicSafefXSP TIOIdAL SERVICES Budding State Building Code(780 Ctv Bung Permit Application for any Building other than a One-or Two-Family Dwelling (17vs SrT ection For'Official Use Only) Building`Peraut Number ?Date Applied %D�:� Building Offzctal: . . SECTION,I:,LOCATION:(PI i e indicate Block#and Lot R for locations for which a,streetaddress is not available) ,QJIM St No.and Street City/Town Zip Code Name of Building(if applicable) •,SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below Existing Building❑ Repair❑ Alteration ❑ 1 Addition❑ 1 Demolition 0 (Please fill out and submit Appendix 1) Change of Use ❑ 1 Change of Occupancy 0 1 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No Is an Independent Structural Engineering Peer Review req d? Yes ❑ No ®� Brief Description of Proposed Work: `t�'i P /-}M1/� iZ e - R o t7 F e L,4 -e /{o t!S'P_ 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) 0 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(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as.applicable) A. Assembly A-10 A-2 0 Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational 0 R Facto F-1 0 F2 0 H: Hi Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5 0 I- Institutional I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile❑ R. Residential R-10 R-2 0 R-3❑ R-4❑ S: Storage S-1 ❑ S-2❑ U. Utility❑ Special Use❑and please describe below: Special Use: SECTION 6-CONSTRUCHO.N TYPE(Check as applicable) IA IB0 UAO IIB0 IIIA0 HIBO IV 0 VA0 VB0 • c SECTION 7:SITE INFORMATION(r`efer to 780 CMR 11I.0 for details on each rtem) Water Supply: .,., Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ required 0 or trench or specify: permit is enclosed❑ Railroad right-of-way. Hazards to Air Navigation: MA Historic omnussion Review Process: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No❑ Yes 0 No E]--� SECTION 8.CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor. Does the building contain an Sprinkler System?: Special Stipulations: 1 SECTIONS:=PROPERTY OWNER'ALITHORIZATION Name and Address of Property Owner ' IS Ivn'✓� �� 1/c 9 el07'" s� S4 /ern Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes S{rv-e D LkAh-n 6 UJ M e ✓ S t ,(,e,� fad �, to © 3� S Name Street Address City/Town State Zip to act on the property owners behalf,in all matters relative to work authorized by this building rmit application. SECTION 10:CONSTRUCTION CONTROL(Please-fill out Appendix «,- building is less than 35,000 cu.ft of enclosed` ace and or_not ender Construction Control theneheck here t7 and,ski 'Section 101 -10.1 Registered Professional Res�onsible for construction Name(Registrant) Telephone No. e-mail address Registration Number, A h G Street Address City/Town State Zip Discipline Expiration Date ,102 General.Contractor,. Company Name 5'k-e pt 4�ti b s 6 a Name of Person Responsible for Construction License No. and Type if Applicable d �- cuk" fg, e.- St N, lq o3 Street Address City/Town State Zip ?1/ _23/ 056E 7) &I - 3,ff 3 73J--- Tele hone No.(business) Telephone No, cell e-mail address SECTION 11:WORKERS"COMPENSAT[ON CNS[JRANCE AFFIDAVIT .G.L'.a 152.§15C 6 A Workers Compensation insurance Affidavit from the MA Department of Industrial Accidents most be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes O No 0 _ • '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 $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ I p( O 7 (contact municipality)and write check number here SEChON b..SIGNATURE'OF BUILDING PERMIT APPLICANT ".; F; By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to th bes f my knowledge and understanding. S Fc C 1Q,�cl, �✓} — /0 A- Prprint and sign name Title Telephone No. Date F� w� Httf S( JO'.) Street Address City/Town State Zip Munnapal Inspector to All out this section upon apphcation approval Office of Consumer Affairs and Business Regulation t` 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Cotxtractor Registration =� Registration: 116688 i;� TVPe: Individual {s Expiration: 7/6/2016 Tr# 252862 STEVEN PAUL DICHIARA STEVEN DICHIARA 68 WHITTIER ST °r NEWTON, NH 03858 ry � wif��;ve Update Address and return card.Mark reason for change. scA1 20M-05/11 Address Renewal Employment Lost Card 911,0Z41,190 iauolsslwwoo uol;eildx-g �-� .�lo ss u�.ia r kcs 9£0 IIN uoyaaN 7S Japl!9M S9 IG UNl7ARIS ZZ99S0 t/dSD :asuaol-1 ^Hmud Z'8 I Josl.uadnS uu43nulsuo,3 spJepue3S pue suolleln6aa 6ulpllne;o pjeoe AlaleS oilcind 10 luawNeda4- suasnyoesseW