25A-190 BP-2023-0342 WITHDRAWN , c' - /qO R
The Commonwealth of Ma-sac uslns
�` Office of Public Safety and In•pea.ins 6 cu
I 23
Massachusetts State Building Cod, (780V: I'
Building Permit Application for any Building other than . •rtor? .- • i ily Dwelling
(This Section For Official Use Only)
Building Permit Number4l3° ✓ �✓Z Date Applied: Building Official: _
SECTION 1:LOCATION
5-5NOfrL p,uIOC 01O(, 0 /9V74
No.and Street City/Town Zip Code Name of Building(if applicable)
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State C de used ✓ If New Construction check here 0 or check all apply in the two rows below
Existing Building brRepair 0 Alteration 0 Addition 0 Demolition 0 (Pleas and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other Specify:—F S6VJI 7' Ft'71/ E
Are building plans and/or construction documents being supplied as part of this • cation? Yes 0 No 0
Is an Independent Structural Engineering Peer Review r quired? p Yes 0 No 0
Brief Descri do of Proposed o y1 Ai/ 20 ' T'
(1 -"-----
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING U ERGOING RENOVATION,ADDITION,OR
CHANGE IN USE • ' e .CUPANCY
Check here if an Existing Building Investigation and Evalu• •i n is enclosed(See 780 CMR 34) 0
Existing Use Group(s): if. ' Proposed Use Group(s): 13
SECTION 4:B ILDING - f4.T AND A EA
Ex' Proposed
No.of Floors/Stories(include basement levels)&A a Per ft)
Total Area(sq.ft.)and Total •eight(ft)
SE ION 5:USE OUP(Check as applicable
A: Assembly A-1 0 A-2 0 Nigh' ub 0 A- A-4 0 A-5 0 B: Business E: Educational 0
F: Factory F-1 0 F2 0 H: Hi azard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0
I: Institutional I-1 0 I-2❑ I-3 0 I-4 0 M: Mercantile 0 R: Residential -10 R- 0 R-3 0 R-4 0
S: Storage S-1 0 S-2❑ Utility 0 Special Use 0 an lease descr below:
Special Use Description:
SE ' i 6:C•, STRUCTION TYP' • k as app ' able)
IA 0 IB ❑ IIA ❑ LIB IIIA ❑ I : ■ 0 VA 0 VB ❑
SECTIO •SITE INF•RMATION(refer to 780 CMR 105.3 0 details on eac •tem)
Water Sup* : Flood Zone Information: Sewage Disposal:
Tren • Per •t: Debris Removal:
A trench • not be Licensed Dtiwosal Swe
Public V Check if outside Flood Zone 0 Indicate municipal required or trench ors c•ly 1 �'L e'
Private 0 or indentify Zone: or on site system 0
/CC J7 L_/N6
permit is enclosed 0 Y
Railroad right-of-way: Hazards to Air Navigation:''I MA Historic Commission Review Process:
Not Applicable Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No V Yes 0 No 0
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space: