159 BRIDGE ST - BUILDING PERMIT APP (A^\V//7
/� =� I'hc C'omnwmvo;dth of M:us:lchusclls
Board of Building Regultlions and Standards Cl IT OF
"lassadmselts Slate Building;Cute. 780 CNIR S.\Lli\I
\ 'L"• Ke rued.I ldr':11//
Building Permit Application TO Con strucli�Repair, Renovate Or Demolish a
One-fir Tir 4li nilr Dn e/I
This Section Fur OI'Bciul Use Onl
Building Permit Number: _ Da a, J:
Building 007cial(Prim Marc) Signature
I)uic
SECTION I:SITE INFORIIIXTION
ocu�erty r ss; 1.2 Assessors Map ail Parcel Numbers
I.Is Is This an acce tad street? •es no \lap Nwnhcr Purcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Loning District I'mp..ed(/--;w— Lu(Arcu(xy I(1 Fr—on I'ace 00
1.1 Building Setbacks(R)
Front Yard Side Yards Reyuircd Provided Required Side
Reyuircd Near YmdI'ros•ided
1.6 Water Supply:(M.G.1.c.40.§sy) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
PublicX Private❑ Zone: _ Outside Flood Zone?
Check if yes❑ Municipal❑ On site disposal s)stem. ❑
SECTION2: PROPERTYOWNERSHIP'
2.1 Ow e 'of Re orr
NN.131e(Print) --�J— T4"/ 11LlVI iYiF1S��^L/9�0
,ra..n�lrcel /`"1 E ,VMI-I✓` (�' "46 a7 /U.
6 Telephone El oil Address
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building(3 Owner-Occupied` Repair sls) Iteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work :
=N —
At) —
SECTION y: ESTIMATED CONSTRUCTION COSTS
Iletnl Estintated Costs:
I Labor and.\laterials) Official Use Only
1. Building S I. Building permit Fee: S Indicate how fire is determined:
i 2. ENcirical S ❑Standard CiryiTuwn Application Fee
1. I'lunhing S ❑Total Project Cost'(Item 6)x multiplier
_'. Other Fees:
r. \lochanicul illy.\('1 $ List:
Cu,lressiont
n 1'uUl Project Cost 1 f /, Cltcck No. _('hock,\nnomnt
vfO4t/ 'O 0 Paid in Full ❑Outstanding IlAii nce Due:
5: CONS I-ItticrION SFRVI( F,4
.i.1 Const ructioll Supervisor License it.,,9-1
pir'llion Date
I cen,,,:Nunihcr I
loldcr ist 011 1'%rV(ice I'Vitm)
PC Description
No .and sircel II �Ell�Ilrlltyd t�1111 5" 11".�,Y)00
It litc,tricted I&I milli
Dwdin
%I N as'll
L'it%iromi.state./ill RC' Kix)iinit Covering
A S %'indliw inVin.11111
SF Solij I:ucl Miming Appliances
I Instilution
1'ak hone
Finail address D Demolition
.%,z Registered 11orne Improvement Contractor(1111.)
1:\piralitill Wig
IIIC litegiNtration Ntunlicr
I I IC Ct)jnpan) Kong or Registrant Name m—g-11 4�15rcls
No. and Sued
/Town,state,ZIP rate hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L C. 152-1 ZSC(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 ..........O No...........
SECTION 7r.OWNER AUTHORIZATION TOBE COMPLETED WHEN
...,ugnte ArrNir OR CONTRACTOR 'PLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
Date
Print O,,nces Name(Electronic Signaturc)
SECTION 7b:OWNEWOR AUTHORIZED AGENT DECLARATION
'Iny name below. I hereby attest under the pains and penalties Of perjury that all of the information
By critZIn this application is true 0 and understanding
costa' k/ and accurate to the best of my knowledge
Pile
—Wronn;Signature)
NOTES:I. ...
her u%vn work,or an owner who hires an unregistered cunlradur
An Owner who obtains a building permit to do his inut registered in the Home Improvement Contractor(HIC) Program).will no have access to the arbitration
prograll,or guaranty fund under.M.G.L.c. 141.4. Other inipuriant information on the HIC Program can be round at
I Information an the Construction Supervisor License can be found at i%%%Ik t".11;
'Ilt 5Winlr illaion
lien substantial work is planned F17 (incltudinbgcl garage. finished basement attics.decks or por0i
rotal hour area ts+ fl.) Habitable rouin count
(Irnij li%ing area lict. 11 Number of bedroollis
I
f \iiinher of bathrooms Number ot'llAt'liall's
11 lie(11,11vating S\Sion Open
I 1,11clo.,cd
pe of cooling is item
I lolal Project square l:oo1,1gg-111a) be iklbstitkitcd 11or 1'k11;1l Project