89 FLINT ST - BUILDING INSPECTION C-I,<- zx:)Os-
-RECEIVED
kY The Commonwealth of Massachusetts
OF
Board of Building Regulations and Standards �CITY M%pp
Massachusetts State Building Code, 780 CMR 201b:NAR kv/ed l..MI/
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Avo-Family Dwelling
This Section For Official Use Onl
Building Permit Number., Date Ap t d:
Building Official(Print Name). Signature
SECTION 1:SITE INFORrIMATION
L1 P,(oper Address: �/ _— 1.2 Assessors Map&Parcel Numbers
l.la Is this an acce ted street?yes na Map Number Parcel Number
IJ Zoning Information: 1.4 Property Dimensions:
"Coning District +, Proposed use - Lot Area(sq ft) Frontage(II) -
1.5 Building Setbacks(R) .
_ Front Yard . . - Side Vwds -... Rear Yard'
.
Required Provi Required - Provided. Required Provided
1.6 Water Supply:(M.G.L 4tt,§ 4) 1.7 Flood Zone Information: L8 Sewage DisposalBysrem;
Zone: Outside Flood Zone? Munici d O On site disposal sol s stem ❑
Public❑ Private.❑ - — Cfieck if es❑ P po y
(� f SECTION1 PROPERTY7OWyNERS1NIP!'
2�Crf IOSf R t(. LI l) A� /fin! S/
�m�l(Print)l , City.State,
'�-]Y )Vl f V9 I ' Z
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORIO(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied O 1 Repairs(s) ❑ I Altemtion(s) Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work-: p... oe 6 u of rvr de "
2
SECTION 4:EST6NATED CONSTRUCTION COSTS
ucm Estimated Costs: Official Use Only
Labor and Materials -
1. Building $ 3U )5-0 1: Building Permit Fee:$ Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $ ZSQ 0 ❑Total Project Cost'(item 5)x multiplier x
J.Plumbing S J p P ether Fees: S
4.Nlcchanical (FIVAC) S List:
5. k lee hanicaI (Fire $ Total All Fees:S
Su T un)
Check No. Check Amount; Cash Amount:
G. orrcssital Project Cust S 3$ 7j 5"Q ❑paid in Full ❑Outstanding Balance Due:
a79 - 'A0i
mr�«� LA
a
—tit. SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Su crvisor Liccnse(CSL)
tn�n 1/
r Q r' �j") License Number Espi atiun ate
Name of
CSL Holder List CSL'rype(see below)
kd Type, -- Description .
No.and Street n -
_rU' U Unrestricled(Buildingsup to 35,000 cu. It.
@-- �, l� //�,�/ R Restricted 1&2 Family Dwelling
Cityfrown,Slate,ZIP I M Masonry
RC Rankine Coverin
WS Window and Sidln
/� SF Solid Fuel Burning Appliances
f i/f✓1jtlL�s @ Gj 11' COPh I Insulation
Tele hone Email:uld34 D Demolition
5.22 Registered llonal Improvement Contractor(HIC) )040,75
UJ3'7 CG to BD C Ne:5 HIC Registration Number Expiration Date
III.0 Company Name or HIC Registrant Name -
No.and Street Email address
Ci /Town State ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152§ 25C(6)p:
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..........❑ No........... ❑
SECTION 7a:O WNER AUTNORIZAT[ON:TO BE COMPLETED W HEN'
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERf#IIT
3De�6
1,as Owner of the subject property,hereby authorize ) f �)') -
t9 act on my behalf,in all matters relative tg work authorized by this building permit application.
cevd o5 A 1va,rJ o /��i 31,30 1 N
Print Owner's Name(Electronic Signature) - Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below, 1 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.
% - Cg-do5 Alv4{ad 0 30 Ib _
Print Owner's or Authorized Agent's Name(Electronic Signature) ate
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
not registered in the Home Improvement Contractor(HIC)Program);will Wt have access to the arbitration
- - —
program or guaranty Fund under M.O.L.c. I d2A.Othcr tmportanl information on the HIC-Program can be bun
www mass eo�Information on the Construction Supervisor License can be found at www.ntas�
2. When substantial work is planned,provide the information below:
'rota) fluor area(sq. ft.) N (including garage, finished basement/attics,decks or porch)
Gross living area(sq. R.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type orcouling System Enclosed- Open
3. "Total Project Square Footage"may be substituted 1'or"Total Project Cost"