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45 MASON ST - BUILDING INSPECTION (2) � -'i.. (� � � � �� 1 ------- - ---�-------------------- , , �� ,, ' The Commonwea'lth oFMassachusetts • t , • �' { �: � Deparfinent uf Public Safety f. �� .. \las.irhiurlltitit.dr Nuilding Ct�dc(73UC\IR) '` • ISuilding Pennit��pplicntion fo�any Buildi�ig'uther than a Ont or'I'wo-Eamily Dwclling . . ., . , _ _ , (I'his Sedinn Pur O(fici,J Usc Onlv) . RuildiugPennit �lumbee -_— D,tle :\pplicd: ------ lluildingOfficinl: -- SECI'ION l:LOG�7lUN(Pl.ase indicafe Illock N and Lut p fur IocaHons for rvhich a street addresw is not available) � .��L�_5��---�L92o - ------------ �lu.,md Strcef Cily /Tuwn ZiFi CaJc N,uni'uf Iluildinl;(if.�pF�lir.ddc) SGC'PION 2: PROPOSEI)WORK I?diliun uF�IA titatc Cndr uscJ.___ I(Nc�v Cuntilructiun rhrck 6crc�ur nc�ck,�II Niat appl)' in thc hvu ru�rti brluw . . I:�inlin�; BuilJing❑ Ri�p��ir❑ :\Ilcrati„n ❑ A�Idilian❑ Ucinuliti�m (Plcasc lill uut,md submit:\pprnJix I) Chang��utUsu ❑ ChangcufOrrup.mry ❑ Ofh�r ❑ Sperify:---, Arc building plans and/ur r�mstrua liun diti'umenls bcing sup��licd as p�irt uf this perinit appliratiun? 1'es ❑ i\'u p ------ Is an IndepenJcnt Struitural Enginccring P Rcviuw rcyuimd? Yes ❑ Nu ❑ liriel Ucsrri�t' n uf Pru��rk:.___ � �Q� _ 4�0 - ` � — , � -- � . : �G�- : �a�� .��,A.,tz L b��` SECTION 3:COhIPLEiE TEIIS SL'CP[ON IF EXIST[NG dUILDING UNDERGOING RENOVA'f10N,AUDff10N,OIt � � � CHANGE IN USE OR OCCUPANCY. � - � � � � � � Chcek here il an F.sisting BuilJing Investigatian and Evaluation is enclused (See 780 CAtli.4l) ❑ � EsislingUsaGruup(s): . ___— ' PrupuscaPUsuGruup(s): � -__'_ ` SEC!(ON 4: BUILDING HEICtIT AND AREA Esititing Pruputicd No.oI Roors/Sl��rics(induJc basemcnt Icvclz)&Aru�Pcr Fluor(sy. (t.) "1'utnl :\rca(sy. ft.).md Tutal Hcight((t.) , SECCION 5: USE GROUP(Check as a Iicable) ,\: Assembly A-1 ❑ A-'_❑ Nighhlub ❑ :\-.1 ❑ A—{ ❑ A-i❑ �: Uusiness ❑ F.: fducational ❑ 1^ Pacto F-I ❑ F2❑ H: tfi h Hazvd H-I ❑ H-2❑ f�l.t,❑ '� ` li-�O ,•��I-I-S❑ � I: Institutional I-1 ❑ 1-2 O bi❑ I-a❑ n�: nt.r��ru�❑ R: Rc�idential R-1❑ � R•_TO : R-.i❑ R-� ❑ 5: Storage SI ❑ S'_O U: Utility❑ Special Use O,mJ plens¢Jrsrribe bcluw: � tiperial Us¢ SEC`I'lON R:CONS�iIiUCI'ION"IYPF(Chcck as a Iicablc) IA ❑ IB � IL� ❑ IIB ❑ I11,\ ❑ ItIB O IV ❑ VA ❑ �'ll ❑ SLC'CION 7:SI'1'E I V GOItMATION(refer to iNU C�IR 111A for details on cach item) Water Supply: floud Zon�Information: S.wagr Uisposal: ��rench Permif: O�l�ris Rcmuval: Publie ❑ Chrrk if uulsido Iln��d 7_unc❑ Inilirero muniriFnd❑ :\ trcnrh will not bc Li:ons.�J Ilispus.�l tiitc❑ ' � Pric.�tc❑ , ur inJvn�ih' Zanr: ._____ . ur�m aitc a\�strm ❑ rryuircd �nr trcndi or sF�rrilt'�._ ._. � . � . . - . pcnnif ii rnrin.cJ O , . _n _ . - _.. . ' H.III(�NJ fI�I16UbWdY: IIJ/dfJ51U Alf NdV��JUuO: \I \ i,�:�.�,�� ',..,��,I.. �. . . ., i -. .. , \'�d :\�,pli.,d,lr❑ Is tilnirtun�lcithin airp�vt,ippru.i�:h arra.' Is ihrir rr��ii•�r��m�+lo�i�d' , i ur C'��nerut tu 14inld onrlu�aJ❑ � 1 c5 O nr.Vn� � I l.rs❑ ....\'�i �� ti1�:C7lUN 8:CUN1la�1T<>F CI'lil'IPIC,\'I'G l)P UCCUI':\NCY � ICdilii�n i 1 C.�ilu ., l\r Gn up�s): _ . I\E�i•nl C� rolru.li� n: . . llrrup,mt I��,i�l pi r Ili �r. I7�� i6� I uil lin��i��nl un.m>��rinAl�r tiv+lrin?: . _ <p�rial�lipul ili�nu: . . . . �.., .____— ___ ___ __ ____.—_—__—_ . _ —____ .: _.____ _ . _._ . I�O��/Y"/( '�l 'r c� � V /�' " ' " GG_. ..----- II � ,/�� r �� r tiLC'IIUN 4: I'RUI'1[K'IY U1Wi FR AU'1'llUIiIZA'1lUN �\'aum an�l �\ilJr��s ut PruFirrl)'U�encr �Lr��T� - —'-�{��-.�- ---�a��-----------Q I_��l0 Namr(Print) No. ,ind Strcet City/Tuwn Lip Pru �r lV O rncr Cun ict �nfurmaliun: � �h�� `7.�L�r"�Z� ��7'�' _`�Q91I_��st_e��(101 f ►,.�ef' fitle falephune No. (biuiniss) Tclephone No. (ecll) rmail address II.�pplii.ihlr, Ihc pruperly� u� tcr hrmbV�wthurizes -��---- N.�me Strcet Address � Cily/�fown� . State.. Ziv, �o art un thr �ru mrt uwncr's bchalf, in all ma�lcrs rcl�itivdto w�irk authorized bv this buildin� crmit.�;,li..itiimi� . SECIION 10:CONS"1'RUCTION CONTIiOL(Pleaae fill out Appendix 2) lf buildin,is kse th,m ti,UIXl ca(t uf end�iavl z,ace and ur nut under Constniction Cuntrol Ihen check herr O and ski i Se.tion 10.1 1111 Ite istered Profeseional Res onsible for Construcfion Control N�ime(Regi+trant) - Telephune Nu. o-mail addruss Registratiun Numbcr 5Ucet Address City/Tuwn State Zip Diuipline Espiratiun D.�te 101 Cencral Contractor - . . . � K.. � � ._ . ic'� t f'ouha" y�� . T�a�r� `7d `{�.�ar�bl¢1�QacP 1� . . �. Cum,any Nnme . .. � • . � . � . . . . . � .. � � aqoi� � � Nome uf Persu Respunsi le ir CunsVucti m Li�mse No. ond Type if Applicablc h b�r� �►q�1a Slrcet Add ess � ity/Tuwn State Zie �' . � 8 7845 S�" b _�i �_ �7�` �ll `7$1=� eueti ea s� ��.2ru� Tcic �hune No. husincss Tcic+hunc�lu. ccll c-mail addms5 I�� SECTION iL�c�_�i:F.i;r.�.'��.��ii�i_�<.�rii��i.y�•ur.:�.�rr.y�t u q��'i�i_ M.G.L.c. 152 25C 6 A�Vurkcrs'Cumpens:�tion Insurance AffiJavit from the MA Department uf hidustrial Accidents must be cumpleted and submiRrd wilh this applicatiun. Failum tu provide this.�ffidavit will result in the deninl of the itisuance uf th¢building permit. Is a si�ned Aflidavit submitted with this a lication? Yes❑ No ❑ SECTION 12•CONSTRUCC[ON COSTS AND PERMIT FEE ��` Eslimated Cutits(Labur and �latcrials) Tatal Cunstructiun Cost(from Item 5) 'S— I. �O J ' �+ h BuiWing Pennit Fi�=Tutal Cunstn�ctiun Cust s_(hixcrt hcre _. � ititri.al S apprupri��tc municipal(actur) =3 1. Plumbing y J. .\Icahanic.�l (HV:\C) 5 Note: �linimum fcr=5__(conl.ict munieip,dih�) i. \Icch,mic.d O�hcr 5 C:nclusc rhiti�k p,�}'ablc tu . n.�I'ut,d Cost 5 � (ront�xl municip,Jih'),md �critc nc�ik numbcr hrrr --- - ---- �i tiGCftON 13:SIGNATURE OF UUILDING PL'RMIT APPLICANT ' Itv cntrrin�, nn' namc brl�nv, I IicruFy ,utctit undir tlu•peins.md pcnaltica of E�crjury th,it,Jl of tl�c inlunn,iliun cunLiincJ in lhis a��F+lir,itiun is true,md aerur.itc tu Ih¢b�yt��f m1' ��Icdgc.iml undcrstanJing, _. ._._� �-�Q�0'�'',/� //-�'�-y`'��- - �� __ 3� - /� Pli�as.•prinl , i< <i� n.in . 1 -____-- ..__— ( I itic frlr��hnni�No. U.i � ; _ . `�-��N �l_. .--- ,�hG�d�., --_ _ --- �w9-- -- �i`IO Itilrrrt .\�IJress Cilyi fo�.n . I,�Ic Zip I \funi:ipal Inspcctur tu fill uut thiv s¢.tiun upun appli.ation appruvaL• 1 , . -------�--- --�- -- -�._ .. . . _. .� I-- �-- — — — --N,uuc _ e�c—�-- ,� Y <: ' � � CCCY OF 5.1LE,�,[, 1�L15S.1CH[;SE"ITS 1�� UL'IL�I\G DtP.SIt'C>lE..\T ��`��,'�'t`J`'' ,��(�� I?O 1Y/.lSHLVGTON $TIIEET 11O F�.00R ,3�.��.> ' :.::�, ,, �L �978) 7�5-9595 F.��t(979) 11Q98�16 Kl�IpERLEY DRISCOII. �L�YO:Z I�10�LiS ST.P1EiR8 DIQECTO�OF PC9LIC PROPEfl7Y/OCtt.Dt\C C0��1I55IUNER Wnrkcrs' Compensatton (nsur�nce,�tBdrvit: Duildcrs/Cuntractorv/Electric(an+/Piumben \m�llr�nt Inform•rflnn Pfcave Prinf Le��h�� .V;IIflC10u�iix��Urgam�aliarolndividu.d): C�C/�.� i�l�l�Cl'VS: � /VIf2� !S/. —. CiryiStatc/Zip: tSf�LF� /li1A� ��hona N: Q�I�'-7Yy OQ// ,�rc ynu un cmyloyer7 ChecM�,tfh�e rppropriats ba:s Typ�uf prnJeef(�equfreJ): I.(] I am a employer wi�h � 1. Q I;un a gcncral tunlractor anJ 1 6, �Nuw cune�ruction amploycd(fLll and/ot part-�ime).• hava hind�he submn�racmo 2.0 1 am a eala propnctar or p�utncr. liatnd on�he��rochcd rhnct � �. ❑ �emadeling .hlp anJ have nu umpluyeea Thes�sub�cantmeton hava N. (�Dtmolition wurkiny ii>r ma in;u�y capaciry. worken'comp.inewnnce. y. � OuilJiug additiun (No�vurken'.comp, inmrance S. Q Wa aro a rnrpemNan and ib rcyuireJ.) oiflcen hava axemleed thclr �a•C� E�ecrrical rcpsin or addieian� J.0 I am a homcuwnur duing a�1 wurk riyht uf oxampliun pe�MOL �I.Q Plumbing«puin ar udditiom myself. (\owarkcn'cump. aIJ2, ��(4),anJwehaveno �2,(� goafn:pain insuranca reyuireJ.� � �mpiuyeea. (No warlten' cump.insurancemyuinrtJ.J I).DOlhar r.\ny uppNuutl iIW ah��W boi II m�ul ilwi fill ow ih�r•c�iue buloq a�awiny tlqit ro�4m'<am�wnudun pull�y inMnn�tlon. . I M1MUYW II�T MIIY�YIIIIIII III1��MAYYII Indleyln�ihry,n doiny ull wvh nnd ihen hin uw�iJ�eaNneean mm�mMni1�new�aill,laril indiain�.ueh �f'�muw�un ihal cA«k ihi�bw mu+l�u.uMd�n.Wdliiuwl.hsl.huwiny iha nwno of iAe iubcunincWn anJ iAalr wnrY�n'mmp.pultry fnfwmmlan. !uin an anpluyti ihufls pruvfJlux ivorkeri'cump�uaaN�n lnau�unet/oi my unp/uyurs Bduw/a 1he polley und/ub sU� i��jur�rrwlnn, /' In,ur,mcc(:uinpany Vame: �/7� g�� - 3-98i�3 Pnlicy 4 or Self-i�u. Lic. d:�/S�U� 0�,1��YO Enpimtion Oote: C pC(/pZ ' lubYiia.l�IJrcyr: K��(�/I/ �` CilylSt�trJZip: c_Y7L�, /2�j�. �ir�c6�cupy u(lh��rorAan'.ompan��tloa puiley dcalar�Uan p�K�(ihowing ih�pollty numbor and upintloe data). F'.uluru w w.ura cuvernqa:ui rcquireJ und�r.Sect(on?JA uY�(GL e. IS2 can I.aJ to�he impayitian oferiminal penaltie�oPa rirc up w i I,SOU.UO unJ/ur mu•yeu impri.�enmcnt��well�y civii pce�Itie�in�hn tbrm uf a STOP WURK URDEA anJ� iine ,;i up to 5_'�0.(l0 i Jay iq�inst �he viulatnr. Ile�dvi.taJ ihat�cupy ul ihif.,i�lemcet in�y bu iurtvardeJ ro iha Allico ul' Invr,�ig.,iiun.�„i ihr l71A Ibr ins�nncc n>v�regc vcritir�liun. ' /,lu hrrrby crni�y uuJri�hr �int m�J prnu/rlr.r�i�p�ijury�dut rh�i��unnuNun pruviJrJ�Guvr ir irut,urJ�•orrrot _..., � . I)atar . �p� I'h;�f ,c�9 U//icr�f rc�e�iuly. O,i nu!iviilt in u:r Jno. ro ht ruurpl�t�J by rity ui�uwn.�/�It'%�! � (:iry nr�Ilnrn:. . _ .__ Pcrmitil.lccnre i._ _ , �, � I.�uiu�.\Whurily (circlJunc): . . �.�__ . . - � I � I. ftuarJ ul Ila�lih !. UuiLllm�I)ep�.irhnew J. ("�;ty�funn Ctcrk J. (ilechf:.J (n��ectnr i. I'hnnbinq In�pxtar (. Ihh.r --- --._. .. . i l'n�ildif I'cnnn: __.___ __— . ____. I'hnnc I: - 4 "''� -�/ `♦ C� 1 L �F J• • • �t.�.�r ti � L1�S.1CH 'S , L ETTS t3C[LDLVC DEP.1ATtF,`T I'0 1V.liHLVG70N STAFBT, )'�FZppR Tt?L �97� 1��9S9S lu1�E.�tBY DItLSCOcl. F,�x(9'7� 1�498�1d .tiUYOA tho.�w Sr.P�Elu.s D f 0.8i,'CO�Op Pl BClC pROPlRTY�9(;Q.pI,YG�p�pqSSIO V EJ� Constructloa Debr1� Df�posal At'tidavtt (rcquired far ill demoliUon and renovation work) fn ucondance with the�ixth e�lition attha Stata Building Cade� 790 C1NR sectian I l t.J Dcbria, and 1he ptovi�ioru of 14tGL a 40, 9 34; Building Permit M ia isaucd with the eondttfon that the dcbri� rwulring from ihi� work ahall be diaposcd of in a properly liceaud wuue di�poaal faciliry as da8ncd by,�IGL c 1 I 1, S I JOA. Tha deb�� will be vanoportca by; �� (n,una uf houler) Tha Jebri� wili be disposed af in : J ��M (n�m�of facdily) ' � (�ldrefl oY f�,iliiy) fJ" � ��n m�sufpermitipplic nt lN { _ �'��a . ,, ..�r � . , i + i i , I I � 1 I I ! I �i i i ' i ` f � j � i I I � , , � t � C � t i i I � t i � � i I f f � i I t I 7 � r � r i : �. J � i 1 I i ; ; i , � it i i � t � � � � ; � � r � � � I ' � ' i f � 1 ! f I t _ i + I f � I . ,_ � t � j t_ t t � _ - - - r � , i � � � � � t i � � � , �-- r --1 i f � � � f , r f T r � f T t 1 i r- j- -r t 7 � - I � i � ' i ' I ', � , , � � � t i I ! + � , 1r � If � � ' , r � t � , , fit � , � i 1 � � f � 1 I 1 �� I t I T � i { I i � 1 � i f � T � � _ � } t 1 � j I , � � � i � 1 j fi t- t t .t r t r t r 1 i � � j I , 1 { ! ' j � i i i ' f 11 � ; j I 1 h � � � � ( l: T � � __� I � I 1 I T i ' r_ i_ .� � �. � � � } r t -7-- r � I �, j � � ! � � � , _ � � � f , _.' � ! � i � � I i � , t � � , � �_ i � , r � � f t - } � ; ; r ; � r t I _ r t � t i r_ fi , _, I _ t f r � _ }_ i-_ f . r � � r I � ; , � � t # ' �'S'�W�C� � � ' ' ' , , � , , � I � �I � � ' I I� � �I � � T � � � � � � f 1 � � � � � ' I i � � , ' � � i 1 �� I I �i�� r- �� j r �-- � i � � 7 � �� i � r --t— � � i ' i � f , 1 ' .' t , j I� ' � ' j � ! j � I j fi i i .i � � i I fi � 1 t I C f r r ' ! ' � i i 1 i 1 r r � i C f r i 1 � r r r -� -� r � 1 li � ; I I ' I 1 ; C i I ;" 1 f 1 j f t I ! i � � - r I � 1- '� 1 � i ! f i � I I i I 'I j i � r ; � � � � r � � I i , i j , i r � f 1 � � r t i i � � j i ( i � �; ( ? 1 fi � �_ � 1 � j � 'r f t � � � t i I � i � ' � I � ' � � 5�5�� i � � i i i i � � �; t - , , � C i i I I i f f � ?I ' � � � � � fi � � ' � ' I ' I ' f r ' , � I �- ' I i I ; i � I � j � I j I i i I 1 I j i i � _ � _� � � � i r ' � i i � I � � � I t � I I I f � i � i � i f � � t � � . � i � i C. . j _ ; - j I i i i ' r f � , ' , 1� I f f ' � i i � �I � j f I � I lb l I � ` I f I I 1 i t 1 t r � � � � I fi i 1 � i t � I 1- J � i - � � r fi r ' , � � i 1 I i I , ! i � ' � I ; ' ' � , i � � , � � ' � � ' I �, I � � � I i ; i �'' i � j��r� , T ' � - � r - �1 - � � � i - � -�--� - 1 - -� -i -� --C--�--� -i --�- - - , , � � - , , r �7 �--� i i , ; � i I i � i i i � � _[ I I - I_ _� . I ! � � ' � � } i � �, � �' � � � � j � ' � I � I ( I � � ( t �� ( i - Y j i � �; i � T r i1i � i � ll � l I ! � � �� i i � Ijl � t � l 111 , , I I li � C ; � ; ; ri i, � � � I � , i t } � I , ji ; I l i ' Ij _ I � j � � I I � I ', � ; � i i � i � f _ � _ 1 _ i i � � ; � , i _ ,, � � � f I ! � ; r 1 � - I I i , � 1 , ; � I ! $ I i � i f i 1 � i '�Ji I � , I � , i � � ; i j _� �_ � I � i I I � � i I i ; �� I � _ � � ��, � � �� i , ! i I � � � j 1�Ob VLAN°� S'(OP ' � ! 45° � r ', � � ! � I � I 1 i I 1 � 1 I l � ! i I I j 1 r � . " � i I j � i; . , � � _� _ i r � �- � � � r i � � �� I � � � i � i � � I � �� I ( i ( �� , i i t � j f 1 ! E � � ' � ; I � � ! ! � � i � i C �r � - �� i i � r � i I I t i ; 1 I f i � ! � 'I � � � � r I � ( ; � 'r j 1 i i t j j i j � T � ( i �, i E , t i 7 � 1 t � i � J r r , � i f � � � r � ; � tl' � � 1- ; , � � - � � ( j ; iJ + � 1C � jf , � , i � 1 � � fjlr � I ' { fi ? � , tfj � ti � 7 ! 1 � � � � f f � � i l� � t � C J � '�� I � i � I � ' � f �� 1� r � I I � �C �' 1 1 r � -T r f I I� j j f i 1 i rt j + i_ fi t .� fi t r t �-� -�� - i � � ' , r i ' i �� / , I � _ . _ . i 1 � � i 1 � F } r �__ t r t i i r T ; , r � r � r � 7 _ i � - t r _, t � T � � � , r ; � , � , , , � , , � fi � � � � 1 _� � I ; � i � � C I I �� l� ! ! � ! I j � i � l l I r r f ! k � i � j r i i � f � i T r � � � t t t � i ,_ I � . , t r 1 j , r r � ; � I : ; ' � iI � �. t 1 � � -t � , � , t� � , ' , 1 � 1 ! � �d� �� r t ' � � � � I � I i ; ' i � ` r ' ` 1 1 � � I , I t � J t � t i . I � i ' I r �� ' i ( : � � � � I I ! I I 1 � � � � � I � � I � I ! � � i � i � � I I ! I � � � i � i 1 I. � ! � j I � I I ! 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I . .�-� - t -r r ; i --1 -r - � - J -� f- �- Y i- t i_._ � . ., � _, .� ; _r ; , �- -r fi -$- t .� - � �- M - � � f _3 � r � � t - - , � , �- � 1 � � -� � -� ( � , � I ! - 1 t RT, � � � fi � r �j _� �'00 12��A M � i f- I —� t - � i -r � I t t - 1 r � r fi ? -t : f , � t _ i . }II� � 1 _ j � �._ $It� � ' t _ , t � t � _ ' ' � ��t1�' - � � � - � � � ._ r--r _ � i � � �- � i � � , � � i ,. � , +r � t i � ; - Y r , _ t -r - {-- i } -A1-zY� �t,r�C r � ._ t � i i i i i I s��'f� t- � � r i � � � j � I } , I ; � j 1 � � � _I at�G 1b � ��.,�,. 1 ! � - � � ' i � � - r r � r � rt r � �(,� i �-+,- t ! � t I �_ f I 1 ; 1 t I i 1 � ' � 7 r I _' __ ' `�'� I"`.�'� �L. 0 '� r.�_ Ou _ I � I f I I I t � I ! r 1 r t ! � ' � i -- � � � � r t r t � J t , C � f 1 1 J fi 1 r t fi r � � , � � � � � sTo -ro , � , � ��D� I � � � - ��. � _ � _ � � _ , � 1 - � � 1 � 1 � - � � �� v� s � i I f f I � � ; -r I 1 _ 1_ i 1 ( , � t � i r r I t i � r ; i i � � ' f i � � r- ' - i � � ' I � � I � f � I � �- � fi 1 i � fi � , rt t � - 1 � � � i i � 1 F - -1 � � � � r � - � �� I � ? ' r � ; I __ � ., i. �_-i -fi � � } j t 7 ; � i } t j- �- � � �- � - -� � i f r _f - � f ( f � fi � t j _. -- j i � � } ( � I i , t- t r . t - _r , r � - } f , I i � i j , i f i � � t- t I r i } i I I � + { , 1 - r t t - r t I r t � � 1 1 r _ r_ 7 i . r i f t I r f i � � �_ t t .� _ fi j t - . r__-�- 1 1 � Y I , i � � I i _ I ? 1 I fi t fi � 1 �_ . � r t J r ; r rt_ i r � t , � 1- , Y � ;- - +- ; ' C i _. .� t � -fi t i fi--r j� -fi- t - Ii 1 � ! C � i � r � � ttti _ ., ; rr + � r i . r .. r i , m . � �� i 't r r � + r �- �. r . r �� . �, . . . . w r . . � � r -r r__* __ r- . r . r. r . +. .. � � � 2 �� Bo �']�� I� u � ��. . � � Commonwealth of i�Iussachusctts � � � Sheet i�[etul Permit . n:,tc: .-?_�� 'crnucl� --� � -------- Istim;itcd Job ('u,t: $y_�Q l'rrmit I�ec: $��(�� Pl;ins SubmilteJ: YF.S _ VO_� Pl,uts Revicwc�l: 1'Eti NO Business Liccnse # Appliranf License t#�� l3usincss Inti�rmatioii: I'roperty Owner/Job Locution Intiirmation: Nnme: � 1 �!' h('.��'-�At'�LL'�`' i di1 ,� -- . Slrr�t: ��/ �� C{ / � U�P Straet: Citylfown: �L SZ�(iQ /�/l'1 �� Ciry/'fown: fcicphone: �� xZ{—' T�O Telephone: Phutu LD. reyuired/ Copy oFPhoto I.D. attached: YES NO ��:1��111��:1� J-t / :�i-l-unrestricted liccnse J-2/ ��i-2-restricted w dwcllings 3-,torics or Icss and commercial up to f 0,000 sq. fL / ?-sturirs ur Ic,s Residentlai: I-2 Family_ N(ulti-tamily_ Cbndo/ "1'uwnhouses Other Commercial: OFtice_ Retail�Industriul_ Educational 4istitutional Other Squarc Footage: undcr 10,000 sq, t3. �uver 10,000 sq. tt. _ Numbcr uYStorics: Sheet mchrl �vurk to i e completcd: Ne�v �Vurk: _� Renovatiun: ✓ I NAC'� i�(etal �Vatcr,hcd Roufing_ Kitchcn C.ehaust Systan_ �fctal ('himncy i Vunts_ Air 13alancing— Pruvidc �ctail�J �Ic,criptiun uF�vork [u b� done: �1��i1 �� -St��(v�.�-�c� �'rt-ov�-�-�" S �cl.e a� �-�o��-- —6•� Y-Cq� Cj � �- /rl�4� C�uc-� �Jn�� i � i-�-� �2 C G YI C� ��---- _ ,��vl��-- -- , INSURANCE COVERAGE: I have a current Iiabilitv(nsuronce policy or its equivalent which meets the requirements ot M.G.L. Ch. 112 Ves❑ No❑ If you have checked Yoe, indicata lhe type of coverage by checking the appropriate box below: A li�bility insurance policy ❑ Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: 1 am aware that the Iicensee does not have the insurance coverage required 6y Chapter 112 of the Massachusetts General Laws,and lhat my signature on this permit applicatlon waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By chacking lhis box❑,I heraby certify that all of the detalla and Informallon I have submltted(or enlared)regarding thls appllcation are true and accurate to the beat of my knowledge and lhat all shaet melal work and I�ftallatlone performed unde�lhe pe�mit Ieaued lor Ihia applicatlon wlll be in compllance with all partinent provialon of Ne Maaeachusetts Bullding Code a�d Chaptar 112 ot the Genaral Laws. Duct Inspection required prlor to insulatlon Installation: YES_NO_ Pr�eress Inspections Date Comments � Final lnsucction p.i�� Contments � Type of License: oy _ ❑ Master nue _ ❑ Alaster-Restricted G�;�Tu�.vn ❑JournayPerson I Signature of Licensee Pennd x._. 1 �Jaurneyperson-Restricted License Number I i r-oa 5 `. � �--- �� -- Checkat�.;�r.�.�n.�ss.r�uvl�IL i � � Inspactar SI n�turo af Permif Approval . �I _______________. -_._� � �ru�usttl & �rPsmPz�f 110 ASTI AVE. . � � - � _ � � REVERE, MA02151 , , , Office 781-284-1900 Ce11617-447-4154 PROPOSALSUBMITiEDTO PHONE DATE ��4�c 16 STREE � JOB NAME CITY,STATEAND ZIP CODE JOB LOCATI . o a -� +. e ARCHITECT DATE OF PLANS JOB PHONE We eby submit specifcations antl esllmates for , ^.�i� 1 �� ..� � �1�� n ' ��! '" .�I��.... 1 I'l ._..Ge.� � .�t��'I�y� �� c il �"t�. Y15 -�Yd.1�'1 � l�,J �;�$S Y}$ - .�rls�.� � . _11P� �� _ � , -'-ru� G � fo� �.e, r�..__... -� .�'.�.��1,��,.. P�l l. �ts�ttilof�� _ � _ _ - �Q�tc- u nd �SQc.,� du�, c�o�l� �, ba�,� ��,ua �vG��roQ�2,S -. .. �o.�.i�.. ... c.�trtd . ._� n �5��.,1 l .-F, l� � .� �< <.�.� - - � ��k��_� _o� � l �� '_�� r ,-l_�� __ _ _ _ __ __ - _ _ __ _ _ _ _ _ _ _ __ _ ___ _ _ _ _ _ _ _ _ __ ___ _ _ _ __ _ _ _ _ _ _ _ _ __ __ _ _ _ _ _ _ _ _ _ _ _ __ __ _ _ _ _ _ _ _ _ _ __ __ __ _ _ _ _ _ _ _ _ _ __ ____ __ _ _ __ __ _ _ _ �P �CO�tuS¢hereby to fumish material and labor--complete in accordance with above specifcations,for the sum of: dollars($ ��0 'O� ). Payment to be made as follows: All material is guaranteed to be es spedfetl.All work�o be comple�etl in a wotkmanlike man- AulhOfiied ner according fo s[antlartl practices.Customers are responsible for paymen�in etivance for all Signature changes to original agreemeM[hat become adexYre charBe over antl above ihe es�ima�e.All � �! agreementsmntingen�uponsNkes,accitlentsortlelaysbeyondou�coM�oLOwnertocarzyfre, NOIe: jf tomaao,ana omer necessary insuranre. This proposal may be withtlrawn by us if not accepted within 30 tlays. i� / i�� ,/ � - Signature �� 1"`- �CCC}tfMY[LP �{�TA�.TQ82[I —The above pnces,specificalions and contli- � tions are satisfacto and are hereb acce ted.You are,authorized to tlo the work �� i �Y Y P //�I as specified.Payment will be made as wtlined above. Signa4fre � DateofAcceptance�