154 BRIDGE ST - BUILDING PERMIT APP. " -RECEIVED
The Commonwealth of Massachusetts CITY OF-
Board of Building Regulations and Standards
Massachusetts State Building Code, 780 CMR 41b .ERR .� Rev�st )<rr fill
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dtvelling
This Section FotOfficial a Onl
Building Permit Numbers Date A piteds
BuilJing Official(Print Name) Signature` ID_
(� SECTION t:SITE INFORMATION
U 1.1 Property Address // 1.2 Assessors Map&Parcel Numbers
f32iG✓� S
t1.3Zolilng
this an acce to' street?yes no Map Number Parcel Number
Information: I.d Property Dimensions-
Zoning District .Proposed Use -- - Lot Area(sy R) - - Frontage(R) -
1.5 BuildingSetbacks(R)
.: From
Yard Side Yards .. Rear-Yard
!
ReyuiroJProvidnl -Requi!Zone
!Information:
Provided. Required Provided
1.6 Water Supply:(M.G.L e.40,§5d) 1.7 Flood 1.8 Sewage Disposal System:
Public❑ Private.❑. Zone: _ lood Zone? Municipal 0 On site disposal system ❑
_ e9C -
SECTION 2:_PROPERTY O%VNERSHIPt
2.1 Owneri of Record:
/ v
me(Print) City,Slate,ZIP - -
/s�
No.nn Street. Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building O Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑
Demolition. ❑ Accessory Bldg.❑ 1 Number of Units Other ❑ Specify:
Brief Description of Proposed Work=:
S1 �h
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Itcm Estimated Costs: Official Use Only
Labor and Materials)- - -
I. Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
❑Standard Ctty/Town Application Fee.
2. Electrical S ❑Total Project Cost'(Item 6)x multiplier x
*Pitunbing S 2?Qther Fees:
VAC) S List:re total r\II Fees:S
� Check No._Check Amount: Cash Amount:
6.Tutal Project Cost: S 0^� 00 0 Paid in Full 13 Outstanding Balance Due:
i IJ
SECTIONS: CONSTRUCTION SERVICES
5.1, Construction Supervisor License(CSL) /b f-/fie�6
y t' `- 6���I F 1• PQ-I -,i License Number Expiration Date
Irad/ 6a�2 " Jn.
Name ut'CS�L Holder List CSL'rype(see below) 9 5•
Ty Description
No.and Street
Unrestricted(Buildings op to 35,000 cu. It.
, wlarY1 Ir- Restricted 1&2 Family Dwelling
Cityfrown,State,ZIP M Masonry
RC Roolin Coverin
WS Nindow and Sidin
S I Solid Fuel Burning Appliances
S=3 2W 1 Insulation
78/'7/
Telephone. Email address D Demolition
5.2 Registered Home lm_proovera �nttContractorp(11IC) /739 19Ca74
a20"? /• /"! �Z /7 NIC Registration Number Expiration Date
111C Cornmy Nppe or IJIC Rertmnl Name
No.rand Street Email address
g,.s+/pr,-, af�ss. oiri7a• 7d'i--7/r"32s.P
CitvtTown.State ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§2$C(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 Isivance of the building permit.
Signed Affidavit Attached? Yes........j�W No...........O
SECTION 7at OWNER AUTHORIZATIONTOHE-COMPLETED WHEN '
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
[,as Owner of the subject property,hereby authorize
t9my half,in all matters relative to work authorized by this b ' ding permit application.
Print O+vne 's Name(Electronic Signure) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Agent's Nana(Electronic Signature) Dale
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
knot registered in-the Home Improvement Contractor(HIC)Program);will no have access to the arbitration
Ot -•
program or guaranty fLnd under M.G.L.c. I42A.-Other t fin ponant informaton an the H I C-PPogmm can Inro-wad 1t-
+e+vw max,cov:'oca information on the Construction Supervisor License can be found at www.mass.eov,'Jns .
n 2. When substantial work is planned,provide the information below:
'total fluor area(sq. ft.) N (including garage,finished basemenVattics,decks or porch)
Gross living area(sq. tt.) Habitable room coma
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porehes
Type ofcoolingsystem Enclosed Open
3. `Total Project Square Footage"may be substituted f'or•'Total Project Cost"