90 FLINT ST - BUILDING INSPECTION :a I'lie Cbnunonwcallh of Massachusells
r: Board of Building Regulations and Standards rl"I'1' OF
tI Massachusetts State Building Code. 780 CNIR
/ •L'.•' k ri.,sJ Building Permit ,\ppliemiun To Construct, Repair. ICcnov:ue emulish a Ida _'W
One-or rnu-flunil) Duellin,p
This Section For( se Oill
Building Permit Number: I /n/ Dot A plied; /J, v33 z i Yew-4 _
Ilw ding ORieial(Print Mum) iT� Siy Dale
SECTION is SITE INFORMATION
I.I Property Address: S 7' s.N di Parcel Assessorap Parcel Numbers
_ G✓O �t i n—T
I.la Is this an acre ted-re— no Map Number Purcel Numh r
I.! Zoning Information: 1.4 Property Dlmenslons:
Lnniny District 11n,pused tl:w Lot Area Isq II Frontage—(it)
I.t Bulldln`Setbacks(lt)
Frunt Yard Side Yards Ruar Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.0.1.c.40.§JJ) 1.7 Flood Zone Information: 1.3 Sewage Disposal System:
Public❑ Privute Cl Zone: _ Outside Flood Zuna?
Chock if ss❑ Mwicipsd❑ On site dispusul system ❑
SECTION2: PROPERTYOWNERSHIPt
2.1 ¢�•ners of Record:
Care Go<c� �x�. h.g
N;one I PnN) City.State.ZIP
9d Graff SV `117o`—
Nu.;utJ Street rclephunt Fmuil Address
SECTION J: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existi)tg Building❑ Osvner•Occupied ❑ Repairsls) Alteration(s) ❑ Addition ❑
Dentulition ❑ Accessory Bldg.❑ No nber of Units_ Other O .Sp,:vq:
Brief Description of Proposed Work*:
SECTION a: ESTIM.ATED CONSTRUCTION COSTS
hero Estimated Costs:
(Labur and Materials) Official Use Only
I. Building S ma I. Building Permit Fee: S Indicate how fee is determined:
'. Flecirical ❑Standard CityiTuwn Application Fee
t. I'lunlhing S O Total Project C'ostt I Item 6)x mulliplier
�- cr'� '. Ulher Fees: S_
J. \Icch.utical IIIC \(') S List:
\Iccltenic.tl
i Cu„ressionl S total .\II Fees;
r- Total Project Cost: S _ ('hcd No. _ _('11eck:\1110u11t: . ('.lob \m,nlnL
OY9 ❑P.lid m Full ❑outscmding Ral.mce Doc:
SF:("I'IUN 3: ('ONS'1'Rli("rlON SF.RVI( FS
5.1 C nslr coon Supervise l.iceuse((Sl•) CS Q�'I 5�
/ I lecnse Numberr�piralIon Uute
.unelll'l'SLIhlldcr IwtCSl. 11peVicebclulsl.__._-__--.._
I PC
No. .ulJ Street _----- _-. - (t Ihlrc4trielcJ UluilJin sti to )S,UII()cu. IL1
= It
Ia•?liunil Ilecllin
l'ipifall n,State.Lll' RC Ruolin C'uscrin
A indoomdSidinit
in
SF Solid Fuel Burning 1ppllalices
I Insulation
— - fmatl aJJrc4s
1'cic hone U Dcnudiliun
S.2 Rellstered Ilunte Improv ment Contractor(111C) 5 i
IIIC'It3g�unlxr •.vllir lion I-
I IIC Cunt al Nam'or I IIC Itegl4trunt Nw11e G,�I / 4 F
D P?= l:muil address
No. and s?� `yam J�7Ur(.2S�r0
Ci !Town, Slate ZIP T¢Ic hone
SECTION 61 WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 2SC(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this atfldavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... No "' Cl
SECTION 7a:OWNER AUTHORIZATION TO BE COM1IPLET G WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERM1IIT
I,as Owner of the subject property,hereby authorize l� ' le
to act on my behalf,in all matter,relative to work authorized by this building permit application.
o ld
Print Ulsncr's Nanlu Ifuctnlnic Signature)
SECTION 7b:OWNERI OR AUTHORIZED AGENT DECLARATION
By entering n e aw, 4y 3tt st under the pains and penalties of perjury that all of the information
y knowledge and understanding.
contained i this application is tru and a curate to the best of m
I'ru ,r: ,.nl'a N; w Ililcctrunic Signawro)
0utu
NOTES:
I. .fin Owner whu obtains a building permit to do his.her own work,or an owner who hires an o the unregistered contractor
Cllot registered in the Hume Improvement Contractor tHIC) Program!.will nu have access to the arbitration
Progrmn or guaranly fund under M.G.L.c. U_'A. Uthcr important information on the HIC Program can be found at
N IIq Ip.l,. � % ,•,.I Infonnaliun on the Construction Supervisor License can be found at II—% I,,.1" a1'4 .111,
?. \!lien substantial Iwrk is planned. provide the inlu1including
gaf7 b e, linishcd basenlentaltics,decks or porch)
rota) floor area 1% 11.1 - _---"- � . . ..
Habitable roam count
Urois li4 ing area l sq. It -. _... _-.. . .- Number of hcdrooms
Number of lireplaccs .. -_ Number of hall balks .. .
Nunlherof halhroaus . . _ Nunlherofdceki, porclws
I\pc ul heating is aeln Open
l 1 pc `I Pn,l lllg i
1,11dosed
44tctn I
Project Sklllare 1:0ol Acc" 111114 he sub, ilutcd thr"fowl Project