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10 PEARL ST - BUILDING INSPECTION
, , �\� --- � 7 I'lic Comnwn�cr:ilth u(ht:is�;irhu�clls y; � Ilu,trJ ul 13uilJing Rcgul;uiuns ;inJ SianJarJs ('I I'1' OF �t,;�� ��1;iss:irhwetts St:it� DuilJing CuJ�. 79U CMR �,�LI:.�I 'L,,•� lyd�'ie�•il 16u'_'rl// . 13uilJing Prrmit �\pplicaliun Po Canstruct, R.p;�ir. Ranuv:it¢ Or Dcmulish � Um�•ur Tu n-fiurulr Uirvllin,�� This Section Fui 011ici�l Us�Onl � BuilJing Permit Nmnbcr. __ att:\pplir • UuilJiny qliicial�I'rim N;un.) , y������ � � ����` - SECTIOIV I:SITE INFOH�IJITION 1.\�N����� � 1.2 .1�u»un��Iwp� Purcel Numbm ! I.la Is ihif an acce �ad slreet? �ee na \lup Numh�r I'urcal NumAur I.J lonina Infonnurlon: I,� Property Dlmen�lonr Luniny Dietriel I'ropnscJ Uru Lol Anu(sy IU Pronlugu(II) I.t BuI1JInQ Setb�clu(R) F'ronl Y:vd SiJu Yunlf Nuor YarJ Rayuired I'ruviJud Rryuircd pruvid�d Nayuimd I'rvvideJ 1.6 1Vwter Supply;�M.G.I.c. JU, §,7a) 1.7 Flood Zone Inform�llons I.S S�w�Q�Dl�po�N Sy�tem: • I'ub�ic� pri���c0 Z�ma: _ UubideFlood'Lunr° Check iF c�0 Municipal p On�i�e Ji�puyul a�.vtem O SECTION7: PROPERTYOWNERSHIP� 3,1 Owner'of Reeord: �;��;�. �� � .� g�.�R�h , ..r���. ���t N;une l Pnnl) C u�.�lute,l,Ip� �o E�.�.n 3+�.n�: Nu.anJ Sinet � �clrphunt F.IIILII AJQR9! SCCTION J: DESCRIPTION OF PROPOSED WORK'(check all th�t apply) New Construction ❑ Evisting Building p Owner•Occupied O Repairs�s) O Alterotfon(s) O Addition p Denwli�ion O Accesfory Bldy, p Number of Uniu Other O Sp.cily: �riaf Deacription of Proposrd Work': .� �� SECTIO,V �: HSTI.�I.�TEO CO�VSTRI�CTION C05T5 ������ Esiimated Cosls: Il..ihur;md \lalrrialfl 0111ciul Ufe Only I. OuilJing S �ij I. Bui�Jing Perntit Fee. f Indicate huw lee ie JetennineJ: � `. h:l��.irieal 5 �Standud Ciry.�Tu��n Appliwiion Fee O Tut�l Projeet Cusl�I hem 6)� im�Itipiier _ _ � I i I'Iwuhin8 S . — - ..._ ._ ' . Uther Feee: S � J. \Iccheni:.il ill�� 1('1 S Lisl: . . ' "_ ..___ __..____ -. � 9 \kch.mii.d illre -- '— —'—.- --- ..._ . . . � �u ��tdsiionl s f irt;d \II FC¢S: S —' - ' ' '- ' � �� Tulal Prnject Cu�t )`�� �,c� (�hal. \'u. _. __(�haA :\m�vnt . _. .._ ..l',ieh \m��unl: i I. �vV , O P.iid in h'ull ❑ UwsianJinq Il.d.mrr f)uc: �. < tiF.('flON S: ( 1)Ntil'R1�<"fl/)NSEN�'l<'FS t.l Cunstrucliun tiupcn isur Lic.usr(C'tiL) 1�./�r�c�.. . �j�J t� �.� ` \ 1 ir��ux Numher f�p�r;tliiw�)nl¢ .���� ._ ..._. . W_L�\1_i^o'�.. . .....'__' � N,mlCnl'CSI Iluidcf � iall'5�. �\�t.l•��h¢I�rel„_'�_ ._ .. �J'J �C.��^^o ��S_'�---- - - --' --'--- �I'�pe Iksiripliun - N��. .inJ 1vcc1 ...'- --- l�nreNridcJ IDwIJin�s ii io 1t,pUU�u. Il.� ' p r, ��L�SL��..��i. . . __ Rc.Irie�eJ I�l� f.mul b��cllin l'il�i f����n. \wle. . I' \i .11:isun ILC H�Mdin C���crin µ�ti � K'ind���r.md.4iJin ...—. SF tioliJ I'u¢I Iluminy:\pplianc¢y � �����,'�'1�.� 1 Insuluti�in l'el� hun¢ I'm:�il:iJJre.v D Demuliliun �.1 Rr�I�terrJ Ilume Impruvement Cuotrnc�or�NIC) � �-��.�--� �^ \� .*�' ��_� I IIC{ietraliun Numhur Ii\�llflll UII I)J� I UC Compan> Nanrc or I IIC It.yi run1'�tu ��� �t� ` ��� lim�il�JJrtve p{u.�id,Ss�.r^\ t�� O\°i� \\ \1'K—�,�0� . �� 'f¢I. huna Ci lfown. Sint IP S6CTIOIV 6t WORKERS'COM1iPENSATION INSUMNCE AFFIDAVIT(M,G.L c. IS3. � ISC(6)) Worken Compensa�lon Infurance offidevit mu�t ba campleted and submitted with�Ait applfcetion. Failure to provida , this atlidavit will result in�he denlal of Ihe Istuance of�he building permit. SignedARldovitAuechedT Ye� ••••••••••� NO ••� �•'•"'� SECTION 7�: OWNER.IUTHORiZAT10N TO BE C0111PLETED�VHEIV � OWNER'S AGENT OR CONTRACTOR APPLIE9 FOR BUILDINC PERI111T 1, �s Owner of the subject properry,hereby authori:a to act on my beholf,in all matten relativa to work nuihorited by thi�bulidiny permit opplicalfon. Duta 1'rint U�.ncrb Nwne(Elcctrunia Signutum) SECTION 7b: OWNER� OR AUTFIORIZED.�GENT DECLARATION 8y entering my name balow. I hereby aunl under the pai��and penaltie�of per)ury thut all uP the infurmntiun eontainad in this application i�true and accurate ro ihe beat of my knowledge and underslanding. PriN I)��net'��a:\i�di���ircJ,��mu'e N;una I likctrunic.4iynaiuru) D�w VO'fES: 1. ,�n U��ner ��hu obnins �building parmit io do hie.her wvn ��urk,ur on o�rner��ho hires an wvegiswrrd con�racwr �iml regismrcd in ihe Hume Improveinenl Cunuacwr IHICI Progreml, ��ill nu have aaess lo ihe arbitraliun pragrant ur yuaranly ILnJ und.r \I.G.L.c. I JI.�. Ulhar impunam inl'unnalion on the HIC Progrim can be Il�wid a� „�„� �n.r.. �,,� ��� i Infonn;i�iun un �he Consiruction Supervieor Lianse c�n be faund�� ����,� ���.�•: "" 'h'• � ��hen subsi:uniol �wrk is planncJ, pro�iJe�he inl'unnaiiun bclow� f1u�l Iluor arca 1 sy. Il.i _ ----..—i including g;vage. linishrd bas.mcnt aui.s.J¢:As or purch 1 (irus� II�itllj .IfC�I iy. II.1 _. flBbil.Ihli fUUill iJUllt '_ ". ... . . .. . ' \�uuh.I��I�IifC��lacCi . _ � . �unih¢roihrJruumi � � _ --- \umberuYhall'h:uhs I I ♦uwhrr��l'hadvaamt , . . � I�p. ol'hr.uuiyi�,l¢in \umhe���(deeAi p��nli.5 ' I\�w ������oling +),Irnl � I�n.l��,.d . .(l��dn " � 1 ..�'��I.I� ��fU�iil $��II,VI' �'����1.1_l'C �tl.l\ ��C .�ih�IIlU1Q� IiV " ���1.1� ��fPfiil <<��I.• ,: ' << Crr�t �F S.u�.�,[, 1�L�ss.�cf-[�'s�.�[T5 ' � l U�'i[�i�c Dea.�Kr>t��;T '' ,� �'1� �' +(•'� I�O VV.\SHLu ' �° ��,, 4TON5T'tEET, l htuo� J�.4. ,`.1,� v: 1�L �979) 7�5-9594 F.�.�c(979) 7 50-93-f6 !�1�tpkRLEY DAISCOLL �L�YO:t � I�iO1L13ST.P1EAR8 DIQECTUR UF PC'�LIC P40PEA7Y/BC[iDtNC COSL\Itu[UNER Wurk�n' Cumpensatton fnsur�nce,Vlid•rvit: l3uildcrs/CuntructurvlElectrlcianyPlum6en �t�iilic;�nt In(arm�dnn PI ve Prhit L��Ihlr .V;1111CIUmiia,�Urg,tronii��nlndividu.�1): � ��� � o-.� �� :\clJress: �� �� '�.5�\ c CityiStatc/Zip: � ����Phona Nr_ �`\`6 —�'�'� � �'1�� ,\n ynu un umplayer'!CheeM th��ppropriau bast fyp�uf prnJeet(rcqulred): �am a employe�with _� � 1. Q �;�a guneral cuntmc�o��nJ I .mployca(fLll and/o►part-�ime).• hava hinJ�ha wlacoNncWo b• ❑Nuw eunyuuc�ian 1.O I am a eole propdc�or ur p;u�ncr- lis�ad on ihs anuhed.rha�t : 7. ❑ Remadeling , .hip and have nu umpluyeea Thes�sub.onhncton havo !l. � nentolitian wurkiny �iir ma in:u�y capaciry. �vo�kers'camp, ineurnnca , �� o�wrkcrn'wm inaurence S. 1. ❑OuilJing additiun � . p. ❑ Wa aro a cnrpamNan and iu re�ryireJ.) otflcm hava axarcieed ch�l� ��•�E1�crrical rcpaire or�ddiciant ).Q 1 mn a hameuwnur duing al1 wurk ��yht u/�xemption per MCL �I.Q piumbing repuin or uddiHon� myulf. (Yo workcn'cump. c. 132. �j I(4l.nnd we hnve no 11.[] ILoof n:pairf insuranca reyuireJ.� � ampluyaea. �No waryeq' cump, i�xurance rcyuin:J.� ���0 Oiher �.�ny.�ppll�ml tlW ch�aY�bos il mw�iiru 011 uul iA�wciiwlwluw aAawin�i�ai�rpbd aam�wnudun putlay mMrmuUoe, I l,�,n�uw�aw wAu�ulimit�hi�u}IA�ri�indi�ufn�ihry��dainy ull�wrk nnd i�rn�in uW�iJ�tanlmetp�m�ul mAmil�naw ailfy�ril indlain�.ucA, �<',��im.wn�Aal ch«k ihi�Eux muyl�nx�ud�n.WJuiu�ud.A,�l�huWiny rta nwnu af iAa rv0aomnotw�inJ ihalr worYrn'wmp pul�ry inlwmmlas. /uie un nnp/uyn thu!/�pruv/Jla,r ivorkos'cumpruaaNun/�uu�unei�oi my anp/uyrra B�luw b r/�i po/%y undJub sl�� in�o�nrullnnb p � In,ur.mce(:nmpuny Vamr O_�'�"'tC�y� Pnlicy J or Self-iaa. Liu. tl: �COO��y�jT����� Eap����ian �o�e: I�bSita.��Jtcyy: �C� �1ZSti�C� CSt` f:iliStute/2i ,�0�� i`l Y p:S ev w. .\�f�.6 �cnpr u(Ihr worMrr�'compam�tloo polley d¢.larallon p�K�(ihawing ih�poUcr numbet anJ�TpIr7Uoq dato). f'.iiluro w iccury euvar�qe:u rrquireJ under Reuion ?l,\ ot'SIGL e. I S2 an IcaJ ro�he impoyition oFeriminal pen�ltie�oi a ;inc up to i1,SCUAO and/ur m�aytar impri�anmcn4 �l�vell�y civp pcn�hiuf in iha lorm ul'a STOp WURK URDEK�nJ a line �:i�.ip t��5_'SO.QO i Jay ig�inst ihe viola;nr. Ile �dvi;aJ ih�t�u�py ui ihi�.,r�tamcnt may ba iurwdrd�J ro iha n�iicu ol' I,rrr,iig�iinn.�,�i ih� f71,1 A�r ine�r�ncu cov,,•r,igc vcritic�tiun. /,lu hrrrby rn�i/'y nnJ�r�hr poinr m�J prnq Nr. �.�p.•rjury J�ut dr�iu�unnudw�pruviJaJ uGuvr iy vu�vuJ�'onrtC ; .,,,,,, , �"'�� � � ^ 5 u,r�� 1'?`�-T� rr,�;�,i: �l1`5 -� �o ^ --l"�"�� I,�/�ici�!�oe�infy. /7,i,�,�/ivritt in I/n:r imq rd.Sr c mup/��dJ by rify rii/own n��loiol City ,ir I'nv;r ____. . .. ___ i'crmiULlcen�t '1 (.�uiii, .\ulL�uily (circluude): "—_' . . ... ._ . I. :iU:lfl� ul��Cllli�i !. 114i1�1�11�� I)e�I.lYllilcut (. (-�lyr'I�oUll ����'f� 7. i���iCtlli I� �n� Ieefn i, �i. I)ilrct 1 � 14�i�n6in•„ fn�ptchi� /'�i,il,i•f i'rr���ic . . . _._.._ . . :___ ____' . -' I hnii� h t :,- Crr�ro� S.u.�a[, �tiL�ss.�cHc,��E-r-rs f�llL.06VC OEp.1RTtE\T I '0 �.n.IiHLVGTON $T1lEgT� )'°F�aQA �` 11L �97� 7��959! !UJ�ERL6Y DRLSCOtl. F.Vt(9�� l�9&16 .tiUYolt n�ro.+w St P�us Dirv�a4 a�a�;suC PRap��ry/s�•¢.o�c cosnusscov e�t Con9tructloa Debrl� D1�posal Af'ftdavlt (required fo��ll demolitton snd renovation work) (n ucordanee with the eixth editlon olthe St�ta Building Cade� 790 C��iR section I ( I.S Oebri�, and the proyi��oti af,ytCL a 40, 9 J4; � Building pertnit M i� is�ued with the condllton that the dcbria re�ulting fnorn ihi� wurk �hall be di�posc�i of in a prnperly liceaaed wmts dt�poa�l faciliry aa doBncd by,�IGL c 111, 3 I JOA. The deb�,t will be tran�purted by: - ��z'd"�-o-�.,. � , �:- - � ln+ma u1'Aauler) V v =� The Jebri� wi II be dispoaed of in : � ��(n�m�o/%�i�i�y) —�� S �., a.��� �?� � �-.�, (�Jdr tt af f��ih�y) ��\ I��OJN/Q UI�Cfmlt l�� � � � �- -�. , ..,; . i I � � � i I V — ._ " _�`-1 � '��' _'�����"� ���/.�- � � _ ����%��--�. . ���-7�._��.��.�� . � ( -- - - ! � - - -___ _ --_ _ __- � � _}- -- � � ' � � �. ��- � . � � _ - � -- ----� , , � �� ;� _ l�� r�' ; ' ! i ! � � � � � ������_ � i i � I ,..-, �, ,, � : �; , , � �- � � -- - -' � /�� -, .T� j _ �� � � � -�-T �e: _ /.-�"". t —{#— /�� ��� � � — ���� � � , . " ` � �4`�S t�,� _�>G��'l _- � `�; i �� �. - �i : -_-----+ �' �--_.__J - , . , �., _ : --- _ __ - -- -- � �. ------- - _ , _ � � , , , __ -- -- �� j ' .�' 1 � -- I � ; __��, ,,.�� ' � . -- ; � i � _ __ ' c��� tci�% _ � � ; , ^ • --- _ , � _� ��� `s , ', ; 1� .�{-�T— :: . _ __ ____� � � � � � , , �-� � - tr '• Li' I^, '_�..`ti" , yn �\ • �M1 _ �� �% ��v I/v � � ,���� _ C;� V�'`�,54-- � � � 1 � ,� \ ; _ � �-� w -� i� ��� � ,� ,. p � �f. �,�� �� � � ��� v � � � � � � � �