5 NURSERY ST - BUILDING INSPECTION (2) I'he C'omm11un\vealth oI'blassa0lusclts
Board ot'Building Regulations and Standards Cl I'1' OF
I ' Massachtuelts State Building Code, 730 C NIR ti,\LI:..1
flevorJ l610,_'till
L:..
Building Pertnit Nppiication 'ro Construct, Repair. Renovate Or Demolish a
One-or rroo-k1mo V Du cllhrgr
This Section For Official Use Only
Building Permit Number: Date Appl'ed:
IhiilJing Olticial(I'rinl N�une) sigtlalure Bute
SECTION 1:SITE INFORI11AT1
1.1 Property ddress: 1.2 Assessors Stap Sl Purc I Oars
_ 1jlU/t�S_O
I.la Is this an accepted street?ycs no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Cursing District Ihnpused live Lot Area(sq 11) Frontage(I1)
1.5 Building Setbacks(R)
Front Yard Side Yams Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40.§54) 1.7 Flood Zone Information: 1.3 Sewage Disposal System:
Public❑ Private O Zone: _ Outside Flood Zone? Municipal❑ On site disposal s)stem 0
Check if yesO
SECTION2: PROPERTY OWNERSHIP'
2,1 Ownery�ofgcord: / ,
Ttl rimed, r.(JAJ 42.W L ��1 Una So,�, < 7- f?/, A44 / I7d-
Name City.State.ZIP
Nu.and Street relephone Email Address
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied O I Repairs(s) ❑ 1 Alleration(s) &I Addition O
Demolition ❑ Accessory Bldg.O Number of Units_ Other ❑ .Spccily:
Brief Description of Proposed Work':
:rJAil
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Itcnt Estimated Costs: Official Use Only
ILabur and \laterialsl
1. Building S I. Building Permit Fee: S Indicate how fee is determined:
❑Standard Ciry.?usvn Appliwlion Fee
2. Electrical S
O Total Project C'ustt(bun 6).1 multiplier __ x
119unihing S '. Other Fees: S_
4. \Itch.mical ill\ \('1 S List:
\u +n•ssiont Fodal .\II Fees:
�� ^�� ('heck No. ('heck Amo ntt: Cat h \nn utn:
h I'Mal Project Cost: i Y 0 Puid in Full Cl owstandinq Bal.utce Due:
SF.( I ION 3: CONN FRUcriON SFRV ff FS
5.1 Construction Supervisor License(('S[,)
I \pmilion Miss:
I "'t 01. F\IV 1'ev Klu%i).
I'%Pe Dvsrriptisin
No. ana Nircct V�
llarvstriovd illitildio,s aLo 000 cu. 11.)
It l4c,irivied 1&2 F-imil 15%%cllili
SLllc F1 ll� M Masoll
RC K,xiiiii Guerin
WS Window xid Sidin
9 SF Solid Fuel IlurninsAppliances
10cpholic �D— Fmail address L) Demolition
.41.2 Registered Home Improvement Contractor(111C)
4.a' S=/� 111C Islegibiraliurs unitier E%piratioo Dule
111C Cj)1llpall)gJAjliu or IIIC 4gistruniNams:
No. and Sued Entail address
6rvlTown, Slate'ZIP relephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.11-c. 152.1 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this atfdavit will result in the denial of the Issuance or the building permit.
Signed A Mdavit Attached? Yes.......... a No ...........0
SECTION 7a. OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1.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.
Print 0%wncr's Nusna(ElectrunicSignaturv) Dula
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the inliarmilliurs
contained in this application is true and accurate to the best of my knowledge and understanding,
I-rini owner's or %whori/vdAI;ou'4 Nallic IIA"rolliq Signature) Dute
NOTES:
I. In 0,� cr who obtains a building permit to do his her own %wrk,or an owner who hires an unregistered contractor
'Jut registered in the Home Improvement Contractor(HIC) Program).will LiU) have access to the arbitration
prograin or guaranly Isind under.M.G.L. v. 142A. Other important information on the HIC Program can be round at
11%%1% 01,111 �0% " I Information on the Construction Supervisor License can be found at
2. \%lien subsiantial wurk is planned, pro ide the inrurination below:
row Poor area(sq. 11.) 1 including garage. finished basement attics.decks or rurch I
Gross li%ing area 154. it,I ilabitable roue count
\mtiher ot bcdrokims
Number'll hathroullis \umhQr ot'hall hathi
I livol licalifig ,'%Stem pordici
Ile (c"'d i lig i�'Iclll
Ioi.il Ilrojcct Square Fool.1cc,''11a.N hV'116,11(tacd flor I*"I.1I Project 01,1-
Additions—Renovations —Repairs
FitzGerald
CONSTRUCTION
M411171 ,
781-750-8042 Residential—Light Commercial
www.FitzGeraldPMG.com
&)0J
Beatriz Andrianzen
Steven L. Winders II
Re: 5 Nursery Street Condo Renovation
Scope of work
Obtain building Permit
Floors
• Remove all laminate flooring throughout unit and dispose.
• Install sound reducing layer
• Install Cumberland 1 Common, red oak flooring throughout the
condominium.
o Sand and finish with 3 coats of urethane.
o Flooring to go under appliances
Cost: $ 7,400
Bathroom
• Remove shower and dispose shower doors, walls and pan.
• Install shower base and walls Swanstone solid surface 38" Neo-Angle (Specs
attached). Base and walls provided by client
• Shower doors will be measured and ordered once shower has been installed.
Glass door company will install doors for the shower.
• Paint walls
• Re-secure Toilet (replace\re-do tiles under if needed)
Cost: $3,180
Kitchen
• Demolition
o Remove and dispose current cabinets and appliances
• Install:
o New Cabinets Jim Bishop 'Builder Basics" shaker style cabinets in
birch per drawings. Lead time 2 to 3 weeks. Color TBD
o LED lights under cabinets—provided by owner
o Counter top - Granite selected by owner. Ordered once cabinets are
installed.
ti
FitzGerald
Additions—Renovations—Repairs
CONSTRUCTION
781-750-8042 Residential—Light Commercial
www.FitzGeraldPMG.com
o Tile black splash with glass tile accent. Selected by Owner,please
provide amount to purchase
o Install new appliances (Fridge, Electric Stove, Dishwasher and mounted
microwave) Provided by the owner
o Replace fan/light fixture with new fixture provided by client
• Under mount sink(Reuse existing garbage disposal.)
Cost: $11,370
Others
• Replace back entrance door with 6 panel solid pine door with new lock set and dead
bOlt
Cost$525
Electrical
Remove fan and block off
Kill breaker in basement
Hook up undercabinet lights
Replace light switches, outlets and switch outlet covers (provided by client)
Change fanlight provided by owner
Electrical hookup for all appliances, includes new line run to basement
Cost: $3,100
Plumbing
• Replace all plumbing for shower unit
• Re connect sink and dishwasher in kitchen
Cost$2,400
Total cost: $27,975
Yr-
Accepted
r�. CITY ON S.U..E.%I, 1L1SS.lCH("5EITS
1 1#
0L•ILDING DEPART ENT
120 %V'ISHLIIGTON STREET )oa FLOOR
P.Lic(778) 7104846
.<j%IOF Ill EY DRISCOU
MUYO:t DIOALU ST.P/EAAB
DIRECTOR OF PULIC PROPERTY/OCttDINC CO\OIISSIONER
Workcn' Compensation Insurance A117davit: i)uilders/Contractors/Electrician.0 Plumbers
Uiplleant infnrmutinn Please Print Li:gIhly
.NoinC tlimitivas,t7rgamraliun lmlividu•dC X� —m 0.✓� / i�/'n. ��
Address: dti
City/Statc/Zip: G O Phuna N: 3��i'— Z7 —�3CZ
Are you an employer?Check the appropriate bait 'rype of project(required):
I.[] I am a employer with a. [] I am a guncral cumnmar and i
'nlployees(full and/or part-time),• have hired the sub-contnctan 6' ❑New construction
2. am a sale propitiator or partnur- listed on the auachcd sheul. t 1. ❑Remodeling
,hip and have no ompluyeea These sub-aontractan have 8. C] Demolition
working for me in any capacity, workers'comp,insltrancea q• O building addition
(, o workers'camp, insurance 5. ❑ We are a corporation and ife
requirud.) ofllcers have eaarcised thelr 10.0 Electrical rcpain or additions
I.❑ 13111 a homeownur doing all work right of exemption par MGL 11.❑Plumbing repairs or udditlons
myself.(No workcra'sump. c. 152, 11(4),and we have no 12.0 Roof rupaira
insurance required.) / ompluyeea. (No workers'
cump.insurancemquired.J II.ElOther
All but rl mail alga nll our the wcliuo hulow showing their rakers'camrynmtun puliay innumullon. -
I hvnvuwnans who whmil ihls ainMvit indlcaing they in doing all.cask and then hiq uu4ids eonlmeteq mime snhrnil an"3171davit indicating.ach,
l\mtnvWn that chIak this bug must attached an addulurvd ahead.huwing IN nwne a/the sub¢umruWn and thalr wnrYm'camp.pulley Iniortrmdon.
1014 an onp/ayrr that It pruvlding warksn'eumprnrm/un In.rargqu�ar my empluyerse @duw/t d�epgl/ry and/ub sire
irrlarlliatlen,
In,umncaCumpany Vmne: _.._..._._
Policy 4 or Self•itu. Lie dt Expiration Dale'
dub Sits.lddruss: CityiStutrl2ip:
A uacb a copy.!of the workers' coin penwtloo polity declaratlen page(Ihowing the policy number and expiration date).
1- liluru to wcuiu cuveragq as required under Suclion 2JA ut•SIGL e. 152 can lead to the(inposit(on orcrimina)penalties of a
tir.0 np to S 1,500.01)ond/ur ane-year impri.mnmcnt.is Well is civil penalties in the form of a STOP WORK ORDER and a iina
ar tql to S250.00 s Jay igainnt the violamr. fie advised that a copy of this nUlcmunl May bu furwardcd to the 00%a of
I,rvr,ti galiuna of dlu r)(A (I)r i'lsunnce covurngc vcrilicaliun.
1,10 lrnrby eerri%y ran Jrr/ire pains msJ null'ev� Perjury Ihar/Ae irsjurorallun pro vlt/e./Y(agveit Ira)•rlyd correct.
. I ^
63 Z
O's nor writr in th area, trr.Sr cumplrteJ Sy or'/y ur tuna•1/11riv[
City or fu+vn;
I. t;u.t nl ul Ilcalth !. ILlilding lh•p.trhncnl 1. l ily faun Clcrk 1. 1•:ftctri:al ht.pevior i. Pbunhin•{ fntpecav
i. Uthct
lnnla.l i'iruuc Phone R
1
CITY OF 5.,11.E�`i, �tiL�ss.,CHC'SETTS
t3t.tLDI.VC DEv.�RTJtE\T
I A �, ASHNGTON 5riMM, 1'��pOg
r1L t978) 741.9501
'UJCEIEALAY OXIWOLL F.Vt(979) 114.9844
MU YOIt 1}toat u ST.PMAU
DIitEGT04 OP PC BUC PROPFATY/eCMDLVC CO10/133tON Eli
Construction Debris Disposal Affidavit
(required lot all demolition and renovation work)
rn accordance with the sixth edition of the State Building Code, 180 CAMR section
Oebris, and the provisions of MOL a 40, S 54; 1 I I.1
Building Permit a is issued with the condition that the debris resulting from
I If. S IJOA.
this work shall be disposed of in a property licemed waste disposal facility as defined by&ICE c
The debris will be transported by:
•Ci/7 EatiA �9��0,� rf
(n.uoa ul'haulu)
The��d**ebr`is will be disposed of in :
((,AM@ or hcday)
1 rddrm a r rj,d,jy)
urn�mraofprr iPP6�rnf — .