BP-44891COMMERCIAL
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The following descriptions are based on the Massachusetts State Building 6t ition, o e rice ,
asnute
❑ Assembly - restaura , lounge, theater, school, etc. (see Code Section 302.0)
Describer � A
Business office, assem y with less than 50 occupants -indicate Medical or other professional (see Code Section 303.00)
including child day care for those over 2 years 9 months (see Code Section 304.0)
- structure for training m g Y
" n strut g ❑ Education
❑ 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)
- retail stores
El Mercantile (see Code Section 308.0)
M
❑ Residential - three or more family, hotel (see Code Section 309.0)
El Storage - includes garage (see Code Section 309.0)
o 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)
0 Tent or Trailer - temporary
purpose?
p ®Other:
er of dwelling units and bedrooms or occupant load as applicable, also existing
Describe the proposal briefly, INCLUDE numb
condition (if extra space is needed, attach an additional sheet):
COMMERCIAL g )� EGRESS
❑ Replacement doors and windows - (for existing only) (only where doors and windows exist and will not be enlar ed
_ . will be considered as an alteratk6n otherwise will
existing dwe
ll wi ,
dimensions must be maintained. Enlarged or new windows m an e g g
be included in new construction. (see Code Section 3603.2 i for residential and Article 10 for commercial).
❑ Temporary structure - includes, when allowed, trailers, tents and the like and only for limited periods of tune. Descriibe:
❑ 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):
❑ Air conditioning - (separate unit)
❑ None of the above to be provided Other
❑ Hot Water: Gas Electric Fuel Oil
❑ Required: plans provided
❑ Not required, not to be installed, why9
plans not provided, why?.
F
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 reprroductions
11.2 Architect/Engineer - project supervision and reports
Company Name:
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 11,11'neral Contractor
Company Name:
Phone #: 7 G I f `!` / Y_) r
Construction Supervisors License Number
Note: Signatures and seals on all plans, a)
G,z
other documents SHALL BE originals and not reprroductions.
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to a on my beh 1f w as Owner of the subject property hereby authorizes /�. fi^--1
f, in all matters relative to work authorized by this building permit application.
Signature oPOwner
Date
/>; ��� �� as
on e foregoing application are true -and to
Signed under the ams and penalties of perjury.
Signature o weer/ gent
ent Eby declare that the statements and information
edge and belief.
Date
1. MOLD reason:
3. OWNER/CONTRACTOR NOTIFIED ON
Date:
Date:
2. MOLD subject to Zoning Board of Appeals
-Action:
4. Comments:
DateJUN 2 3 2003
5. Inspector's Signature:
ii rr i
ly'..`z / " / y'F //p ' °hv �i •.�S �/: Y` A'� / siY
Applicant informed of above Date:
Time: Clerk:
Con-=ents:-
IV®R
Total Permit Fee:
Less Application Fee:
Remaining Balanc .
Gross'Area - New Construction
Gros Area - Alteration -
Perx, `' _ s o:
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rev. September 2004
COMMERCIAL
$25.00 APPLICATION FEE IS IVON-REruNDARLE & NON-TRANSFERAR?t_v
ill
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