90 FLINT ST - BUILDING INSPECTION (2) I'he C ommonwealih uf'b1:u};,rhuscus
IJ►• r '� IluerJ of Iuilding Regulations and Standards CI'11' t)F
\las.cachusctts Statc Building Code,'780 C'NIR^ v,
Building Permit Applicatiun 'Po Construct, Rcpair. Renuvatc Or Demolish a iIL•ri.,rJ Ihir`rrl/
1 onc•ur Tuvi.Pirmrls U,rrl(ir{y
Phis Sectiun for 011ici Use Only
Building Permit Number: Dal Applied:
"",Ung 011lcial(Print Mune)
tiig„aturc UaIC
I.I Property Address SECTION I: SITE INFOR�IATION
:re? 11 Assessun 11ap,k Parcel Numbers
�i.in_?' S�
I.Is Is this an acre ted street? es no \Wp Nun,her Purcell NumlNr
1-3 Zoning Information: 1.4 Property Dlmenslons:
Luning District Propusc 1Iln—e
Los Ana(sy It)I,3 Building Setbacks t(g) Fronlagc I It)
From Yard Site Vunle
7 Rayuired I'rovidcd Rear Yard
Required I'ruvided Required Rear
1.6 Water Supply:(M.G.1.e. JU, 154) 1.7 Flood Zone Informatlont 1.lf SewaEe DlsPoint System:
Publlc❑ Prh ate❑ Zone: _ Outside Flood Zur
Chock If es❑ Municipal❑ qn site disposal s►shm ❑
7•I�Qwnor of Recordt SECTION?: PROPERTYOWNERSHIPt
�o ��� Cut stam,nP
Nu.trod Snnus --' felephune Email Address
SECTION]: DESCRIPTION OF PROPOSED WORKS(check all that apply)
New Construction❑ Existing Building❑ Owner•Occupied ❑ Repairs(s) ❑ Alleraslon(s) ❑ Addition ❑
Demolition Cl Accessory Bldg.❑ Number of Units
Other ❑ .Spcepy;
Brief Description of Proposed \Nark': l'dhs•�u_,T r
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Eitinmled Costs:
ILuhur and\Ialerials) ORlclal Use Only
I Building f m I. Building Permit Fee: f Indicate how tee is determined:
2. lilearical f v ❑Standard City•Tussn Application Fee
1 t 1'lunihing f ❑Total Prujat Cost (Item,6)x mulliplier _ x
_'. OnherFea:
J, \Icch.mival ill\ \('1 f List:
? 1lech.uiic.d 11.Ire _ ---
`u„rCssiunl f foul \IlFees: S_ — — —
n Total Project Cast: f ('hcd, \'u. _ —(7iecA .lmoum: l',i,h \nioum:
3. SvV J` Cl Rlid m Full 0 Outstanding Bul.mce Due,
St:("I'Il)N S: ('ONtiI'RUC ION 5ERY1('F'.S
5,1 ('ul'�tructimt Supen'isur Licenst((tit.)
-L--7
N•uoe,dl'\L IInIJer
_ .Lspg Deteriplion
Na„n1d Sueet 11 (Inrcstricled IUmldin s ti u1)t,UUn eu, ll.l
pl57 J 1( Halrictcd Lt:?(.unit Decllin
('ipi Il+en,Stale./II' R(' Rodin l'oserin
µS µ'indow,utdSidio
SF sulid Fuel lluming,\ppliastccs
Insulation
1russ U Denudiliun
4na!Iadd
acityrrown.
Est�"Itez—fllp
mprovement Cumfor(HIC)C 1gis ant Name
address
UYY
T'el 2SCM)
SECTION 6t WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.
C. IS2.
Workers Compensation Insurance affldavit 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.
Yes ••••••••••
No...........O
SignedAMdavitAttached7
SECTION 7e:OWNER AUTHORIZATION TO BE CODIPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property.hereby authorize A�. I 0
to act on my behalf,in all matters relative to work authorized by this building permit application. 2
-Q CJ I Data
cr
Print U%N11ef 11 Wlte IElectrunie Slgnulurv)
SECTION 7b:OWNERI OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the informatiun
contai din this application is true and accurate to the beat of my knowledge and understands.
I� k!s f IL — Duty
Plill!0 ncei or:\ul1NlrieW \�NII .�Nallle 11 Lslt1 Itµ\Ig1i Illlre)
No rEs:
I. Inul registered iobtain$ one hnpruvementtCu,umctur IHICI%Pragr nt)n 011nef shave access totihe arti trditiunuractur
other impuriant prograniur guurmi)li fomt ours M..l Cuastfucticn Supers for Lim information
pan be round at
Program can be filwtd at
\\hen subilantial swrk is plonne on
d•provide the infurnmtiun below:
I including yarege, finished basenwnt attics,decks or pords)
fowl flour ar'I I W. I�.1 . --"— Habitable ruunt cuunl _ ..
(in+ii lis ing area I iy, d.l ..-_, vunlhen,f hedtuums
i \unlherul'lireplaces _ —•— \wnbcrul'hall'haths -
\unihcr of halhrpwns \anther ol'dccks parches
I)pc of 11c.nmg ))'MII !)pen
I'nda'cJ
I\pe nl Coolntg '�item
1 ..!'od.11 l+ngcd Square loon.!ve" nt•,) he .uh.ldn!cd Ilir'ro!al Ilrojcd 0I,t..