BP-64154t' = VICES
;,_SECTION3: -`CONSTRUCTION SER
3.1 Licensed Construction Supervisor:'
Not Applicable ❑
Licensed Construction Supervisor:
License Number:
Address,
Expiration Date:
Signature: Telephone:
SECTION COMPS 4.=.WORKERS: NSATION INSURANCE AFFIDAVIT
(NiGL c 152.§ 25)
Worker's 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
SECTION 5-;DESCRIP T ION.OF PROPOSED VVORtC (Check a►! applicable)
❑ Repairs ❑ Accesso
Ne w Construction ❑ Addition p rY Building (Shed/Garage/Other)
❑ Other (Specify, Leo: 6) ❑Demolition ❑Sign ❑Replacement w indow/door
No. of Windows Doors
❑ Fire Protection
SECT ION 6 -PROPOSED PROJECT USE - INCLUDING THREE FAMILY. OR:MORE AND EXEMPT USES .
The following descriptions are based on the Massachusetts State Building 7th Edition, Code Article 3, as noted, See the Code,
❑ Assembly - restaurant, lounge, theater, school, etc. (see Code Section 303.0)
Describe:
❑ Business- office, assembly with less then 50 occupants - indicate Medical or other professional (see -Code Section 304.00)
Education - struction for trainingincluding child day care for those over 2 year 9 months (see Code Section 305.0)
❑ Factory/Industrial (see Code Section 306.0)
❑ High Hazard (see Code Section 307.0)
❑ Institutional - hospital, nursing home, infant day care (see Code Section 308.0)
❑ Mercantile - retail stores (see Code Section 309.0)
® Residential - three or more family, hotel (see Code Section 310.0)
- including garage (see Code 311.0)
Vlrage
ity & Miscellaneous Structures - includes tents and agricultural structures (see Code Section 312.0)
Tenant -for any of the above, please indicate (see Code Section 110.0)
❑ Tent or Trailer - temporary
Purpose?
Other:
Describe the proposal, INCLUDE number of dwelling units and bedrooms or occupant load as applicable, also existing
condition (if extra space is needed, attach an additional sheet):
:n a rn'f.V1n J fc"'n c
J
40
SECTION 7•,=;TYPE'OF COf\ISTRUCTION;OR YVORFC TO BE PERFORMED .
❑ New construction and/or Additional (total gross cubic feet proposed) - indicate
If the project is an add(tion to existing structure - total gross square feet of existing:
❑ Alteration of existing, nro Iincrease 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 1160 Designer to submit Code Synopsis in additional to original plans and if existing building Section 3402.1.1
Will this project require Peer Review (over 400,000 cu ft.) ❑ Yes ❑ No (see 110.11.1 Code)
APPLICANT TO PROVIDE PEER REVIEW AT THEIR EXPENSE. SEE 780 CMR.
❑ Demolition* - describe structure:
❑ Trench Permit Required? [],Yes ❑ No See Trench Requirements G.L.C. 82A and 520 CMR 7.00 et seq.
❑ Moving*- (provide copy of DPW moving license)
*Type of structure: from where (map/lot or address):
to where (map/lot or address): number of dwelling units:
number of bedrooms per dwelling unit::
❑ Replacement doors and windows (for existing only) (only where doors and windows exist and will not be enlarged)
9 )
EGRESS dimensions must be maintained.
-
e and uses - includes when allowed, new tenants, traders, Gents and the like and only for limited periods of time..
❑Temporary structure ,
Describe: s
SECT[ON 8'-`MECHANICAL;& PRIMARKFUEL
❑ 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):
❑ HVAC (combined unit) - primary fuel, natural gas, propane, electricity, other (specify):
[I Air condconditioning(se Roof Top Unit (RTU) New ❑ Replacement ❑
(separate unit)
❑ None of the above to be provided Mechanical Ventilation ❑
❑ Hot Water: Gas Electric Fuel Oil Other
❑ Required: plans provided plans not provided, why?
`
❑ Not required, not to be installed, why? Narrative Submitted? ❑ Yes I El No,
❑ 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 ArchitectlEngineer 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.
11.3'General Contractor
Company Name _
Address:
Phone #:
Construction Supervisors License Number:
Note: Signatures and seals on all plans affidavits & other documents SHALL BE originals and not reproductions.
Page 3
Page 2