88 FLINT ST - BUILDING JACKET � �•�
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;� �, ------- I'he Communwe:dth ul M;usachusctts
y�°i�� l3uard uf I�uilJing Regul:rtions and Stand:vds CI'I't'OF
' �'' Massarhusctts Statc Duilding Cude, 730 Cti�R ti�\LL�\I
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'L"•� drrsrd.I/ur_'ll l!
Building Permit Applir,ition To Cunstruct, Rcpair. Rcnovat�Or Dcmuli a
Uur-ur Tivu-FmnilP Dirrllin.e
lhis Section for Official Use Onl
l3uilding Permit Number. _ Date Applied:
`�/��u-�wL �o�'K � —� LZ J '
13inlJmg Olticial�Nrint N;unc) Signature p���
SECTION I: SITE INFOR�IAT OIV
I.I Prope�ty,��i�Ires� s} �,2 pgsessore M1lap.4i Parcel Numben
k � I
I.la Is�his an nccepted street?yes no binp Numhcr Pure¢I Number
1.3 Zoning Informution: I.d Property Dimenslon�:
Zuning Dis�ricl Prapo�cJ Usc Lol Ama(sy Itl fronlagc(Il)
I.S Building Setbacks(R)
Fronl Yard SiJc Y�rJs Rear Y�rd
Reyuircd ProviJed Requircd Provided Neyuinrtd ProvideJ
1.61Vater Supply:�M,G.I.c.J0,§Sa) 1.7 Flaod Zone Informedon: 1.8 Sewege Disposal System:
Public O Priva�e❑ Zone: _ Ouuide Flood Lone?
Check if �esO Municipal O On site Jispusul s��stem ❑ �
SECTION2: PROPERTYOWNERSHIP'
2 Owner�of Record:
�•e.�c,�v�� (sod�r6 i SNOZVV� /1/�,la D��llO
N;mw(PrinQ C ity.S�atc.l.IP Lb.n.�wry�.-.. .
g8' F�,ntSfi 97y-�s�s��xf � �� ,. 33s=[�bo9 No
Nu.;mJ Street �felephune F.mail Addmss
SECTION J: DESCRIPTION OF PROPOSED 1VORK1(check all that apply)
New Construction ❑ Existing Buildiny❑ Owner•Occupied ❑ Repairs�s) �, Alteration�s) ❑ Addition ❑
� Denmlition ❑ AccessoryBldg.❑ NumberofUnits Other B(,Specil'y: �Q,���n, l x.xo
�riaf Description of Propased Work�: $ � ��,,,� � ���
SECTIO�J: BSTI��IATED CONSTRUCTION COSTS
���i�� Estintaled Costs:
I Labor ond.\laierialsl OfIlCial UsC Only
I. 6uilding $ I. Building Pertnit Fee; S Indicate how fee is detannineJ:
'_. 4:kctric�l g ❑Standard Ciry/Tuwn Applicaiion Fee
❑Totnl Pro ect Cast��Ilem 6)s midtiplier ___ �
� i. l'lumhing g � � — -----
_. O�hcr Frer S
� J. \I¢elianic;d �II1':\('1 5 LisY.
� 5. \Icchanir;d ifirc
--'---------- --
----- --- —------
S --- --..
tiu>>n�siunl Tutal :\II Fcros: S
' �,. Turol Pruject Cnst: 5 � 3S Chak Vu. __ ('hcek:\nwunC C'ash \nuium:
/ � � v ❑PuiJ in Full ❑Oulslanding llul:mce Du¢:
C�.w`���-�
�,� g -Ss3 -8 I & f
tiF.<"I'ION S: ('ONS"1'RIiC"f10N tiF:RVI('F:S
�
��. 5,1 Cunstructiun Su �crvi�or Licciue(CSL) "
� 3 a��
-�' r1' _iv33 r- -- -- �� --- 3
I � \'f�V�.`O �I"'Y�.\`n�_(l�� I.iceiucNwnhcr I�cpir,iian ):uc
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ti;unc al Ctil. I Inldcr
' �� �f � �l'Vl- C L I.i.ICtil.�l'��x:l>echclowl_U__—.—
� —y.= ---------�c _ lSV ----------
'�'�� Descriplion
No. .u���JJJ SVecl
.. f/�0�� Nn ,^ Oly/ � — U 1 inrestrictcJ 1 Uuildin�s�i to i5.011U eu. Il.l
� I�' �I'"� (9 g Rc,�ricteJ I r?fumil D��dlin�
Cilci fo��n.tilafc.Z P "�__----__. .— bl Ma;un
. RC Riw�in Cuverin
_.__ W$ N'inJuw:mJtiidin
cI1� � tiF Solid I'ucl 1lurning�\ppliancca
�7S"�$��6 �5� 7� iC'�.��,nvy�/1C0..5�'n,Jc'�a��TnG I Insu�a�ion
l'cic hunc h:mail;iJJR,. (lVnw�. D Dcmolitiun
5.2 RegistcreJllomelmprovementCmrtr;utor(HIC) /v7�"i(�� �J�Z
���.W.Qp �.�,�h✓�p'/� f IIC Rcgistration Nwntur Ilsp r;itiun b�tc
I IIC Cumpan� Namc or�I IJC Itcgi+uunt Nanu /�� A�' .�+i"�"
(�f� 'Ra1v��' �Sh �'1�c,�r�� �o��It�r�u�
���i����rl / I 1Y' Q, I�jV � �O O���IU� LIIIJII�tlllfC�'J
Ci /'fown,State,ZIP Tcic hone
SECTION 6:WORKERS'COMPENSATION INSURAIVCE AFFIDAVIT(M.G.L.c. 151.4 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this applica�ion. Failure to provide
this atTidavit will result in the denial of the Issuance of the building permit.
'I Signed Aftidavit AttachedT Yes .......... � No...........❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S ACENT OR CONTRACTOR APPLIES FOR BUILDINC PERMIT
I, as Owner of the subject property,hereby authorize ��'K,tJ1J\l`� oM�V��--r'�1u1/�
to act on my behulf,in all matters relative to work euthorized by this building permit application.
�-��'��., � i II
Print wncr's Name(Elcctrunic Signuwrc) D�tC
SECTION 7b:OWNER� OR AUTFIORIZED AGENT DECLARATION I
/ By entering my name below.I hereby attest under the pains and penalties of pery'ury that all of the informatiun
contained in this applicat'�i is true and accuram ro ihe best of my knowledge and understanding.
/2 I I 1
I'rin�Owner's or:�u� vcJ,\gcni's N;mtc Illlccuunie Sibn;auru) DaW
�ores:
1. ,�n Owner whu ubtains a building permit io do his,her own work,or nn owner who hires an unrcgistered cumracror
U�m registered in the Hume Improveinrnt Contracwr�HIC) Progr�ml,�vill�in have access to�he arbitmtion
program ur guar:mq I'und under�I.G.L.c. I a_'A.Other imponant inf'omiation on the HIC Program can be liwnd m
������ n�.r.. .•,�� ,�;.i Infonnation on the Conslruction Supervisar License can be found at��>��� n�a;: ��,�� ,q„
�. \1'hen subsi:mtial�vurk is p��nncd, pru�ide Ihe infurmatiun be�ow:
Total fluor arca Isy. R.1 _____1 incluJing earoga, linished baxment'�uies,daks ur purehl
Gruss li��ing;uea 1 sy. f1.1 -- , --_—__-, H:�bilabla ruom tuunt
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I \umbcrol'limplaccs-- -- �umberufbcJruunu
I I',�peh�(���ulingrsy�,'tcm _ _ . ... _ _ I\i�c'lob�dul'deck�,tp�rehcs(i��en _... ._ _. . I
� ). "�fowl I'rojcCt Syu;IrC PootagC"ntay b¢ iUbslifulad fiR"I'ul;ll PrujtCl Cus�.•