50 BRIDGE ST - BUILDING INSPECTION (3) n
- 1
The Conuttonwealth of Massachusetts :
t y Board Of 13wldinB Regulations and Standards N11 'NJ( IJ'AH I 1
L ' Massachusetts State 13uilJing Cute. 7tiU ('h1R. 7"' edition Nli
Buildin_ Permit Application ToConstrucL Repair. l2enosate Or Demolish a R, ocd ilow,
One- or Tuvr-Family Do elling -tu)e
^ This Section Fur Oftirial Use Ottly -- —
��`•�J\ Building Permit Nurnh . Date Applied: O o
Signat ul e: ��--_--
Buildii Cununis,ioner/ Inspector of Buildings Date .----�
.SECTION I: S17'E INFORMATION
L1 Prop ty :address: 1.2 Assessors Map & Parcel Numbers
-----
.
l.la Is this an accepted street? yes_ no M❑_ P Norther Panel Norther
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 1'U Frontage(li) .
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
I Required Provided - Required Provided Required Pnroidcd
l
1.6 Water Supply: (M G.L c.40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone:' Municipals❑ On site disposal system ❑
Public❑ Private ❑ Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
� 1 wnert f Record: ` �n t
lb
N e(Print) _r Address for Service:
I I8) - �1 �
Swriature Telephone -
SEC ION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied Rzpairs(s) ❑ Altemtion(s) O Addition ❑
Demolition ❑ Accessory Bldg. ❑ 1 Number of UrI I Other ❑ Specily:
Brief SP Description of P'opus d Work': S -- --
PID
' SL 7YV4fPS
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item (Labor and Materials)
I. Building $ I. Building Permit Fee: $ Indicate how fee is determined:
❑ Standard City/Town Application Fee
2. Electrical $ ❑Total Project Cost' (Item 6) x multiplier x
i
1. Plumbing $ 2. Other Fees: $
J. Mechanical tHVAC) $ List-.
5. Mechanical (Fir z $ I Tonal :all Fees: 5 ---
Su. ression)
Check No. Check Amount: (':uh Ainouni:,—_ _
6. Totaroect Cost:l P
I J " 0 Paid in Full 0 Outst:mding I3al:uxt
SECTION 5: CONSTRUCTION SERVICES
5.1 Lic�ensed Construction Supervisor ICSLI
Lirrn./e .\w11he7 Ualr f
,V��1t111,-•l,Li(�-.1_ Yea er UI [`-e^—)7LXf�.tXll I 1 /V V[ --
I_ut CSI_'I')pr tsct hclowl
\JJros Ty' e Drscri nnat
C Unrestricted oil) to ?5.000 Cu. I'I.
R Restricted 1&_' Famil\ Dskellim_
tit �natuprd ( � Ni Nlasonr\ Only
��!o e -7c-0 —0 2C4 RC I Residential Ro,dme CaJenne
Telephone R'S RniJi nu,aI Wind'm .md 5idin❑
SI= RrsiJemi;J Solid Furl liununc \ 'liancc hnt.illdwKj
D Reudcm Gal Demolition
56 R(uiistem 1 orye Ip� ov tent tractor 011C)
lit p;u Name r I Reg m N n, Re tsltrannuuit Numher
G d
AJdres- _ nC/ /yl 1
F.e aratiun Date
Signature Telephone
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide .
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... ❑ No ........... ❑
L
TION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHENER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
! 1 'l-%rS �' �tAll M'p i l I Q rl/��ID, as Owner•of thesubject-propertyhereby
rize leiact on my beh tlf inalb'rn;utnrs
e to work authorized by this building permit application: _
Signature of Owner Date t.1/
SIEOTION : OWNEW OR AUTHORIZED AGENT DECLARATION
I, C , as Owner or Authorized Agent hereby declare
that the statements Link information on the foregoi application are true and accurate, to the best of my knowledge and j
behalf.
Print .Name /J x9 /-0
Signature of Owner or.Authoriz .Agent Date
t Signed under the gins and penalties of perjury)
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(nut registered in the Home Improvement Contractor (HIC Pru_ram), will not ha.e access to the arbitration
program ur guaranty fund under M.G.L. c. 142A. Other important information on the HIC Progri in and
Construction Supervisor Licensing (CSL) can be found in 780 CMR Regulations 110.R6 and 110.R5. respectively.
'. "W htn substantial work is planned, provide the information below:
Total flours area(Sq. Ft.) Imcludin2 garage, finished basement/attics.Jeck:s or porch) -
1 Gross livin_%aica(Sq. Ft.) - Habitable ruom.counf _
_—
Number of tirrpluces ... . Number of bedroom.,
Number'of hath(oorns .- _. Number of halt/h:uhs ._---
rvpe pit heating system - - - Number of decks/ p,archcs ----_----
Type of cooling s)'Stem .. - Enclosed - Open
3. 'Total Project Square Footage- may he substituted for -Tot:d Project Cost"