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80 BRIDGE ST - BUILDING INSPECTION The C( nmxmwrallh of Massachusetts ~ - t Board of Budding Regulations and Standards Fult Massachusetts tit ite Building Code. 780 CNIR. 7i'edition \II Nit \I I I 1 ks� 13t i iIdin_ Permit Application To Construct. Repair. RenoN ate Or Demolish a R„; „l l,mn rr ru(I Building Permit N I hr< - as Section For Otrcl(Us Phis Seetiun Fur Official Use Only Number: Date Applied: 0'7 Scn:uure: Iluddmg Cununtssioncr/ Inspeaar ;It Buildings Date SECTION I: SITE INFORtINIAHON 1A Property A dr .s: 1.2 ;\ssessors .Nlup & Parcel .Numbers . 64 4, 4 I.Lt is this an aee{i ed street:' )'es t o \lap Number Parcel ,Numher 1.3 Zoning Information: 1A Property Dimensions: Zoning Dutrirt Proposed Use Lot Area tsq to Frun t age(1i) 1.5 Building Scibacks(ft) 1 Front Yard Side Yards Rear Yaid F t Required Provided Required Provided RequocJ PIu,Id, 1.6 Water Supply: tM.G.L c. 40. §S4). 1.7 Flood Zone Information; 1.8 Sewage Disposal System: Zon _ Outside Fd Zone:' Public ❑ Prolate❑ Check i Flooloo❑ Municipal ❑ On site disposal system ❑ �I _ SECTI DN 2: PROPERTY OWNERSHIP' 1111_2.1 Ok�ner' >'f Recor / 1; S din!rG S e/ �• J ��Sil1 fs.uiw i Proi Address for Servi e: _ Sien:,ture Telephone SECTION 3: DESCRIPT ION OF PROPOSED WORK (check all that apply) New Construction,[ Existing Building ❑ Owner-Occupied Repairs(s). ❑ Allerutun(s) ❑ _Addition ❑ Demolition Ii❑ Accessory Bldg. ❑ Number of Units 2 Other ❑ Spealy:— Brief Description of Proposed Work: SECTION J: ESTIMATED CONSTRUCTION COSTS Item Estimated Cost ; Official Use Only (Labor and Matert ds) y I. Building $ I. Building Permit Fee: $ Indicate how Inc is Jetrrui ua•J: 2. Electrical g ❑Standard City/Town AppliCA(M Fee ❑Total Project Cost' (Item 6) x multiplier x _ 3. Plumbing S 2. Other Fees: S 3. Mechanical MV'AC) S List: 5. Mechanical (Firei $ -------------- Su t re.>t;ml ' � Tnlal All Fees: S Check My _('heck : mount: (';uh \ntuunL o Total Project Cost: 5 �y� Co KJr ❑ Paid m Full ❑ Outs(anding Balmce Due:.—--....._- . i SECTI N 5: C'ONSTRUC'TION SERVIC'F.S --- L, .• --�� 5.1 I.icrnsrd Cu�nt7 suctiu)y5uprrvisor (C"L) _-4/ 1 t d _ Licrn.e N'umher Lnt Ndnli ul (- 5I. 4— tdr ©e / C Lul('S 1. f%pe n¢e helu,�l C . 'I'i Descn nnm \JJrre 9 l' l'nreSlnrled It'll lit iC.(Nlll Cu hLt R Restocled I&_' Fanuh Diicllinc —� .SI�t1:11U 1'l' \1 td.t onrn Only Rc.IJrnual Routine l'usrime liliphmu• I,. J U'S RevJ.nlial and iF Jenu.tl Sohd Iitrl Ifwuiue \ „li.mcc lii.i.illaln u D ReaJenual Drnuthuon 5.2 RrKisfered 1 me mpr vrmr t Cunt ctu 1! I 1-4 egntlauun Numhrr HIC Cuntpany Van e or HIC R lIstrunt � t t Address 2 /s Frp, ati„It :a: Signature Telephone SECTION 6: WORKERS' COMPS SATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 25061) Workers Compensation Insurance affidavit must be completed and submitted with thisapplication. Failure it, pion lde this affidavit will result in the denial of the Issuance tit the building permit. Signed Affidavit Attached? Yes .......... ❑ No ..__.... ❑ _ r SECTION 7a: OWNER AUTHORIZATI N TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIE FOR BUILDI G PERMIT — �� as Owner of the subject property hereby jl - --� - to act on my behalf, in all nuu ;mthorizr e n relative it) NY.),Is: autha( ed y this building permitapplication. p� aft Si nature ul caner D SECTION 7b: OWNS t OR AUTHORIZED AGENT DECLARATION F,r , as Owner or Authorized Agent hereby declare I. that the statements and information on the fo*of eguing application are true and accurate, to the best of my knuwledee and behalf.PrintNameSi@nature of Owntror AuthDateISi ned under the ❑ins and enaltie er It 'I NOTES: 1. An Owner who obtains a building permi to do his/her own work.or:n owner who hires an uniegl,le,cd eontrn,lor (not registered in the Home Impruveme t Contractor(HIC) Program). will not have access to me arbitration program or guaranty fund under M.G.L. •. IJ'_A. Other important information on the III(' Prograni and Construction Supervisor Licensing WS )can be tiwnd in 780 CNIR Regulations I IO.RG and 1 10.R5. rc,pecntcly. i When substantial work is planned. Pnivllie the information below: . Total flours area(Sq. Ft.) Habitable garage, finished bu,enient/uutcs. deeks�or porcht Habitable room count (irons living area ISy. Ff.) Number of hednvnn, Number of fireplaces Number of halt/bath, Number of hathrooms ---------.__-------- Number tit dtek,/ pt ache, fvpe of heating system . -- Type tit cooling system — ------.. 1. "Toed Project Square Footage" may be ubstituted fur "total Project Co,[- _.