14 WILLIAMS ST - BUILDING INSPECTION t
What is the current use of the Building?
Material at Building? 0 dwe .how many units? —
Will the Building Conform to Law?
Asbestos?
Awhited's Name
Address and Ptwne
Mechanics Name `
l � /
Address and Phone L
Constriction Supervisors License all 7/t 7 Z_HIC Registration# 61 —/
Estimated Cost of -o�$--?L0 Permit Fee Calculation
Permit Fes i Estimated Cost X$741000 Residential
Estimated Cost X$I 11$1000 Commercial-=-----.—. _- -
-- An Additional $6.00 is added as an
Administrative charge.
Make sure that all fields are properly and legibly written to avoid delays in processing.
The undersigned does hereby apply for a Building Permit to build to the above s led
specifications. Signed under penalty of perjury
Date o
l
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PUBLIC PROPERTY
DEPARTMENT
K1.QWjK"nuscou
wwvaa 120wAm a am w sm" sntbY. t;st»s 01970
'M'978-74-9S95•VAX M740.964
APPLICATION FOR THE REPAIR. RENOVATION CONSTRUCTION
DEMOLITION.OR CHANGE OF USE OR OCCUPANO( FOR ANY VaSTING
STRUC -M OR BUILDIN
1.0 SITE INFORMATION
Location Name: Building:
Property Address:-- ------ --------- -- --- ------------
Property Is located In a;Conservation Arse Y/N _Hft to Distrk;t Y/N
2.0 OWNERSHIP INFORMATION
2.1 Owner of Land t/ I'S
Name: / (Jl? C!//
Address:
L Cli/1
Telephone:
3.0 COMPLETE THIS SECTION FOR WORK IN MISTING BUILDINGS ONLY
Addition Existing ✓
Renovation Number of Stories Renovated
Change in Use New
Demolition Existing
Approximate year of Area per floor (sf) Renovated
construction or renovation
of existing building New
Brief Description of Proposed Work:
-- -Mail Permit to: rsc r� 1 -5 / , - - --
The ('a mnx)mcealth of MassachusertS
it r Board of Building Regulations and Standards Pl)12
NIassaehusetlSSt to Building Code. 7SU(AIR. 7"'edition \11 Nk IPV ll1
Building Permit Application To ('onstruet. Repair, Renosale Or Demolish a Kr.r„,l.huuerr
Om - or Taro-Family Darcllin,e
1'his Section For Official Use Only ---
1uilding Permit Number: Date Applied: l1j _ 6
Bull Cutnnuaiona/ Inspector It Buildings Date
SECTION 1: SITE INFORMATION
1.1 Propem A dress: 1.2 Assessors Map & Parcel Numbers '
I.la [s this in ac�cepleJ SIreeY' yes_{�_ i o M1lap Number Panel \'uuihrr
1.3 Zoning Inforotution: LJ Property Dimensions:
Zoning District Proposed Use Lot Area(sy 11) Frouwge(li)
1.5 Building Se[backs(ft)
I Fro im Yard Side Yards Rear Yard
Requited Provided Requned Provided Rcrluoed Pniudcd -
i
1.6 Water Supply: IM.G.L r. J0, 5;1 l.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zun _ Outside Flood Zone'.,
Public Private❑ Check if yes❑ Municipal ❑ On site disposal sy Nicol ❑
_ SECTI DN 2: PROPERTY OWNERSHIP' 1
ZI ,Qwner'o Record, / ,)Ld
Na r t Prim Address liar Service: -
S gn:rooc Telephone
SECTION 3: DESCRIP ION OF PROPOSED WORK'(cheek all that apply)
New Construction��,C Existing Building Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
11
Demolition i�❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Spenly:
Brief Description a�f Proposed Work': r r 'G Qo __
H S u pp
SECTION J: ESTIMATED CONSTRUCTION COSTS
iEstimated Cost! :
Item Ilahor and Materi Is) Official Use Only
I. Building S 1. Building Permit Fee: $ Indicate how Ice i.:Jel ei'in I lied:
❑ Standard City
_. Electrical /Town Application Fee
$
❑ To(al Project Coat' (Item 6) x multiplier x _
3. Plumbing 'S 2. Other Fees: .$
1. Mechanical (HV;ACI $ List
5 Mechanical (Fire] } ---- ----
i
Suppression) Toni :\II Fees: $
Check No. ('heck Amnunt C,ish Amotoll:
0 rotal Project Cost 'S -- _
� C/, ❑ Paid in Full 0 Outstanding Balance Due:--
• liCTl N 5: CONSTRUCTION SERVICES j
5.1 Licensed Co;nstructimt Supersisor (C'lJ —
t License Numher Papv;u� m Uatc
Name 01 ('SL. I lower List C'SL 11 Ile (,cc heluwl_
__. -fs e Desen roan
Wdres> L l nresti mcd ,u t w t?.04)0 01 PI.l
R Restricted 18c_' Fanulk bw elhuc --4
Signauna MRCRe,iJvi11ijl
nlyl Ruulinc('usn 1ne nJ ]idoi�_ _, _ _SuliJ Puel l -10111 , \ i_w._lu.l.,ll I)emulw,m5.2 Registered Home Improvement Cont actor 011C)
H IC Company Nance or H IC Reg isl rant Nance . 01/>.«C
Address
Fxpirati„nDa:e
2
Signature felepltone
SECTION 6: WORKERS' CONIPE 14SATION INSURANCE.AFFIDAVIT (M.G.L. c. 152. § 2506))
Workers Compensation Insurance affidavit it lust be completed and submitted with this application. I alure m pn'\lde
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... No ...........
SECTION 7a: OWNER AUTHORIZATI N TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT _
U` i� If as Owner of the subject property hereby
I• - —--/"' �) to act on my behalf, in all matters
authorize
relative to w•o,k authorized b}' this building mit application.
Dote ------1
Si natur ut Owner
SECTION 7b: OWNER' OR AUTHORIZED AGENT DECLARATION
1.
LCQ t'� as Owner or Authorized Agent hereby declare
that the statements and information on the fo egoing application are true and accurate, to the best of my knowledge and
behalf.
r
Print Nalre _
Sivnature of Owner or Authorized Agent
Da--
(Si ned under(be pains and penalties of eriu ') NOTES: J
I. An Owner who obtains a building permi to do his/her own work,or an imner who hires an unregl,micJ et nu'a.l"r I
(nut registered in the Home Impn)veme t Contractor (HIC) Program). will not have access to me arbitration
and
program or guaranty fund under M.G.L. 11'_'A. Other important information on the HIC Program A.
Construction Supervisor Licensing (CSL)can be found in 780 CMR Regulation., 110.R6 and I I 0.115. respeOlsely.
s When substantial work is planned. prove a the information beluw�
Total f�Utlr$ area ISq. FL) (including garage, finished basemenl/attics. del kJ-t�r P"fi I),
Habitable room count
l Gross living area ISq. Ft.) Number of hCdn,oms -
-----
Numberoftu'eplaces— — Number„t h•Ilt/halhs -
Number of hatm000's Number nt desks/ p,-rehes
I'vpe of heating system
T�pe of cooling
1. ..Total Project Square Foulage" miry be . ubsututed tor 'Total Pnyect C,nC J