7 WINTHROP ST - BUILDING JACKET _\ The Commonwealth of NlassachusettS
t Bodid 01131,111ding Regulations :uul Standards F( tl2
l
11assachuxns Stntc Building ('ode. 780('I\IR. 7"' Nil NI( II1.\1 II edition I sl.
r
Building Permit Application To Coils tc Repair. Renus ate Ur I)rnudish a R
Oil(,- or Ti -l-iotrih lhrellin,q
Phis Action fir Official Use Only
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13uilJine 1:1 11 Num ec le . plied: ___-
SI_nalune: -
Building ('ununrN,umert Inspector I f Bwldu Date
SE '"I'10 : SITE INFORM:\"PION — -- -_--- --
1.1 ProperIN \d ess: 1.2 Assessors Slap & Parcel Numbers
I.la Is this an accepted street"yes no Map Numher P:uvcl Numher --
1.3 -Zoning Information: 1.4 Property Dimensions: — —
45in
rict Proposed Use LolArea(sq lit Frontage ittng Setbacks (ftlFront Yard Side Yards Rear Yard
Provided Required Provided RequtreaSupply: (�1.G.L c. 10. §sal 1.7 Flood Zone Information: L8 Sewage Disposal System:
Zone: _ Outside FI«td Zonc" \.tunici al ❑ On snc dis NtsaI sy�irmPrivate❑ Check if yes❑ PSECTION 2: PROPERTY OWNERSHIP'
/�e�r ` 1 f YIY1) �� (uj Address for Service: I�
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) Alterations) ❑ AdJiii�vt ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units O r ❑ Spectl"y: I
Brief Description of Proposed Work'': -i
it
SECTION 4: ESTIMATED CONSTRUCTION COSTS
$en,,, Esti mated Gtsts: Official Use Only
(Labor and M:uerialsl
ne 5 .� 1. Building Permi[ Fee: $ IndicWe hose❑ Standard Cilylfown Application Fee
cal S ❑Total Project Corr (Itzm 6) s multiplier xing S ? Other Fees: Snind (HVACI S List:nical (Fire -----
Su resNion) FT:tl :\II Fees: S
Check No. Check Amount: — ('.oh Amount:-- -- - i
b Total Project Cost: S ?)� 0 Paid in Full 0 Outmandine B,dance Due --
SECTION 5: CONSTRUCTION SERVICES
5.1 Lice�nssed�CuustructionSuper\isor(CSI.I
A Luring �lunhrr Iapn w, U.ur
\'jntr „I l �I _— I.ul C'SI_ r�lie err hrlur�
I -- 1--- —
i \JJrrs� I N e Deseii Nlunl __�
( Rc,ri,ed J u i to lk D cil ht.
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R � Rr,inrteJ I,\' I anulN U„rllin�_
Si_nauur \I \I.nonrn Onh
R(_ RC,iJ:,uwl Roolluwl ,,,:,in,�_ _ __farphunv, f \\5 Rr"Jrnli.tl NiuJu" and iodine _7 S .nd SIdi- - -
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L D, �� aG; �if Rradenu,J SultJ Purl 6m I-," \ t�l i.m.0 III.I.II MI, I i
D Rradrulial Urinulnitm
5.2 Registered re Irn ups lent 1 t, uctor (IIICI
III( Conlon Name or III -tram N` ne Rrg Dlrat1011 ?:unlhrr
re
�� j
Stgnatwc telephone
SE ION 6: WORKERS' CONIPENSATION INSURANCE AFFIDAVIT (N1.G.L. c. 152. § 25C(6))
Workers Compensation Insurance affidavit must be completed and uhinitted with this application. Failure .r pen ode
this affidavit will result in the denial of the Issuance of the budding permit.
Signed Affidavit Attached? Yes ....._... No .......... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT __;I
Owner (if the suhject property hereby
authorize --_—_ to act tin my hchuit. in all mattel:s j
re!au•:e to •.vork authorized by this building permit application. I
Q f� Ii
Signature tit Owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
Rai r-
1• � _— , as Owner or Authorized Agent hereby Jrclare
that the statements and information tin the foregulne application are true and accurate, to the best of my knowledge and
behalf4r1he
Prtt .Signatur AuthorizedAgent Uate
tSimedu and ..]ties of rmrvi
NOTES:
1. An Owner who obtains a building permit to du his/her own work. or an owner who hires an unregistered ctnnruclt,r
(not registered in the Hume Improvement Contractor 0110 Program), will not have access n, the :ubin'auon
program or guaranty fund under M.G.L. c. la'_A. Other important inthrmalron on the HIC Program ;md
Consuucrion Supervisor Licensing (CSL) can be found In 750 C'NIR Regulations 1 10 R6 and I I0.R5, respeeuNely.
' When substanu;d work is planned, pn;r!de the information below:
Total flours area tSq. FL1 (including garage, finished basenlent/aulcs, decks or p„rch,
Gross living area (Sq. Ft.) Habitable room count
Number rt fireplaces Number of hedrooms _-- —
Number of hathnn,ms Number tot halr/h:uhs
I\pc of heating sy>tem _ _ --_— Number of decks/ po,t,hcs
I vpe tit euUling, aN,lem —_--
i
J. Total Project Square Footage" may he substuuted for "Tolal Pruleet Cost