BP-17874COMMERCIAL
2000
2000
.. Item Estimated Cost ($) to nearest dollar. To be completed by permit applicant
1. Building
2. Electrical
3. Plumbing
4. IGCfialllcll (FIVAC)
5. Total = (1 + 2 + 3 + 4) Estimated Total Cost Including Labor: $
please print)
as Owner of the subject property hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, ✓J pl, as Owner/Authorized Agent hereby declare that the statements and information
o the foregoing application a e true and accurate, to the best of my knowledge and belief.
Signed nder the pai penalties of perjury.
Signature of O er/fAgent Date T
1. Date plan reviewed: 5. DENIED (see project review worksheet):
2. 30 days to review period expires: Date:
3. OK to issue date: OCT 3 ® 20O 6 HOLD reason:
4. OK to issue subject to requested submittals (see project Date:
review worksheet): Date: 7. HOLD subject to Zoning Board of Appeals action:
8. Comments:
9. Inspector's Signature: "'y' T Date: (If"T
Applicant informed of above Date: // /c2-
Comments: 1-/)("17t„ A n),-,V I zi
Total Permit Fee:
Gross Area - New
Gross Area - Altei
Permit Issued To:
Application Fee: $ 25.00
Balance:
COMMERCIAL
$25.00 APPLICATION FEE IS NON-REFUNDABLE & NON -TRANSFERABLE
cAblde. forms\bideapp.com Paee 4 rev. January 20. 2000
c:`,blde. formsibldgann.com Paee 1 rev. January 20. 2000
COMMERCIAL
2000
COMMERCIAL
2000
3.1 Licensed instruction Supervisor: _
Name of Constructions Srupe rr'
Address
®�
Telephon6Fb -?07
Not Applicable ❑
License Number 4V
�17
Expiration Date qO 2-
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit
will result in the denial of the issuance of the building permit (MGL 152 Section 25A) Signed Affidavit Attached: ❑ yes ❑ no
❑ new construction ❑ addition ❑ alteration ❑ repairs ❑ accessory bldg. (shed/garage)
❑ other (specify Sec. 6): El demolition ❑ sign ❑ replacement window/door no. of windows doors
The following descriptions are based on the Massachusetts State Building 6th Edition, Code Article 3, as noted! See the Code
❑ Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0)
Describe:
❑ Business - office, assembly with less than 50 occupants - indicate Medical or other professional (see Code Section 303.00)
❑ Education - structure for training including child day care for those over 2 years 9 months (see Code Section 304.0)
❑ Factory / Industrial (see Code Section 305.0)
❑ High Hazard - (see Code Section 306.0)
❑ Institutional - hospital, nursing home, infant day care (see Code Section 307.0)
❑ Mercantile - retail stores (see Code Section 308.0)
❑ Residential - three or more family, hotel (see Code Section 309.0)
❑'Storage - includes garage (see Code Section 309.0)
❑ Utility & Miscellaneous Structures - includes tents and agricultural structures (see Code Section 311.0)
❑ New Tenant - for any of the above, please indicate (see Code Section 119.0 and Zoning By -Law Section 35)
❑ Tent or Trailer - temporary
purpose?
❑ Other: C J#q+.i t sTm h . .2 o.Tirj, eax j 1'r^l 2 C, CS CeA • •i ; G/t �} l r eTr ^� .
Describe the proposal briefly, INCLUDE number of dwelling units and bedrooms or occu Ant load as applicable, also existing
condition (if extra space ig needed, attach an additional sheet): 6-1,C 7 _ rf' i/ /d 'e S-r-tt
( K cc <T. -L' S T r dA 'Ji- F►...+nuk ) PC or1 r—kJJ C'7rrt— _
❑ New Construction and/or Addition (total gross cubic feet proposed) - indicate
If the project is an addition to existing structure - total gross square feet of existing:
❑ Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration is required.
Will this project be subject to CONSTRUCTION CONTROL (over 35,000 cu. ft.) ❑ yes ❑ no
If yes, see Code Section H6.0. Designer to submit Code Synopsis in addition to original plans.
Will this project require Peer Review (over 400,000 cu. ft.) ❑ yes ❑ no (see 110.1 Code & Appendix I)
APPJLICANT TO PROVIDE PEER REVIEW AT THEIR EXPENSE. SEE 780 CM
W/Demolition* -describe structure:_ C v t.— . :�
"V f1
❑ Moving* - (provide copy of DPW moving license)
* Type of structure:
to where (plat/lot or address):
number of bedrooms per dwelling unit:
from where (plat/lot or address):
number of dwelling units:_
❑ Replacement doors and windows - (for existing only) (only where doors and windows exist and will not be enlarged) EGRESS
dimensions must be maintained. Enlarged or new windows in an existing dwelling will be considered as an alteration, otherwise will
be included in new construction. (see Code Section 3603.21 for residential and Article 10 for commercial).
❑ Temporary structure - includes, when allowed, trailers, tents and the like and only for limited periods of time. Describe:
❑ Furnace (hot air) - fuel gas (natural or propane), fuel oil, electricity, other (specify):
❑ Boiler (heating) - fuel gas (natural or propane), fuel oil, electricity, other (specify): --r
❑ HVAC (combined unit) - primary fuel, natural gas, propane, electricity, other (specify):
❑ Air conditioning - (separate unit)
❑ None of the above to be provided
❑ Hot Water: Gas Electric Fuel Oil Other
❑ Required: plans provided plans not provided, why?
❑ Not required, not to be installed, why?
❑ Parking plan submitted to: Building Dept. Planning Board date submitted
Number of spaces - indoors outside total provided
Handicap spaces - required yes no if yes, how many as a part of the total required number
Is Route 6 (State Road) entrance permit required? yes no if yes, has it been issued? yes no
Submit copy of application and/or permit as soon as available.
11.1 Architect/Engineer - for overall design /
Company Name:
Address:
Phone #:
Certified by State of Massachusetts as:
Certification Number:
Note: Signatures and seals on all plans. affidavits. & other documents SHALL BE originals and not reproductions.
11.2 Architect/Engineer - project supervision and reports
Company Name:
Address: -
Phone #:
Certified by State of Massachusetts as:
Certification Number:
Note: Signatures and seals on all plans, affidavits, & other documents SHALL BE originals and not reproductions.
F1-3 General Contractor
Company Name:
Phone #:
Construction Supervisbrs License Number
Note: Signatures and seals on all plans. affidavits. & other documents SHALL BE originals and not `reproductions. -
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