The URL can be used to link to this page

4 FLYNN ST - BUILDING INSPECTION h Fhe Commonwealth of Massachusetts Boa rd ot'Building Regulations and Standards CITY yl 1y J3 Massachusetts State Building Co e, 780 CMR, 7"edition OF dJannu III Revised Juituurp Building Permit Application 'ro Constru t, Repair, Renovate Or Demolish a 1. 1008 ��IIIJJJ One-or Tn o-Fu ilv Dtt•elling W' V Sectio For Official Use Only Building PeDate Applied: Signature: uildings Date ION 1: SITE INFORMATION 1.1 Propert1.2 Assessors Map& Parcel Numbers sy I.1 a Is this an accepted street?yes L> no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq 11) Frontage(11) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Reyuired Provided Rcyuir:d Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Public❑ Private❑ Check if yes[3 F F y SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner of Record: —F.VN& 4r Mafk VASSv/ N 1%fir Sf Name(Print) Address for 7;T - Sys--a 9ye) Signature Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ Addition Cl Demolition ❑ t Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': 0. S 1 r o�S Id a 1 t x 1 o a r SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials I. Building S 000e I. Building Permit Fee:S Indicate how fie is determined: ❑Standard City/Town Application Fee 2. Electrical S ❑Total Project Cosc (Item 6).x multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (IIVAC) S List: 5. Mechanical (Fire S Suppression) Total All Fees:S Check No. Check Amount: Cash Amount:_ 6.Total Project Cost: .S 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) /J S 3 /a 3 /a Paul (_a fI C Li.ense Number Fxpiratiun Date Name of CSL- halder C/tf �A(k )q✓e. List CSL I'rpe(5ce below) iZ/, ` :\JJr•ss Tt' Description U Restrictinrcstred J ; to ily D Cu.Ft. AA7 ew✓� /� R Restricted INc� Famil Uwcllin Signature M Masonry Only RC Residential Routing Covering Telephone WS Residential Window and siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Regiss�f7ered Home Improvement Contractor(HIC) I() r I / Regis r n�}r.i nn Idl '/ If IC Cumpany am or HIC Regutrunt Name Registration Number ukl�rk � Expiration Date Signature Telephone s SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(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 I suance of the building permit. Signed Affidavit Attached? Yes .......... No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES 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. Signature of Owner Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. P,Suc /e? G�`i 132i t ' Print n Signature of Owner ar Authorized Agent Date Si ncd under the pains and penalties ofperjury) 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 not have access to the arbitration program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I IO.R6 and 110.115, respectively. 2. When substantial work is planned,provide the information below: Total flours area(Sq. Ft.) (including garage, finished basement/attics,decks or porch) Gross living area(Sq. Ft.) Ilabitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may he substituted for"Total Project Cost" ® DATE(MM/DO/YYYY) �`� CERTIFICATE OF LIABILITY INSURANCE 1 9/30/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER CONTACT Office ACCO13nt NAME: _. —_ Cassidy Associates Insurance Agency (��NN EX4:_ (781)598-43( _ �Ac N0) nE1)s99-1s10 E-MAIL 232 Humphrey Street ADDRESS: PRODUCER 00004305 OUS.T-OMERIP_N:_ Swamps COt_t _ _MA 01907 - _ INSURERL)AFFO RDING COVERAGE _NAICp INSURED INSURER A:TraVelerS CaS. $e Svrety of Ill I19046 INSURER B:Liberty Mutual ROYAL CONSTRUCTION CO. , INC. INSURER q__ 48 PARK AVE. INSURER D: INSURER E_ - MIDDLETON MA 01949 1 INSURER F: COVERAGES CERTIFICATE NUMBER CL1093001970 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS, TYPE OF INSURANCE INSR SUER POLICY NUMBER MMIODNCY YYY MMIDO/YE XP LTR YYY I LIMITS GENERAL LIABILITY EACH OCCURRENCE $__1,000,000 DAMAGE TO RENTED �X COMMERCIAL GENERAL LIABILITY PREMISES(Ea accurrence)_I $ _ 300,000 —-� 9/1/2010 9/1/2011 ( Y P ) _I A CLAIMS-MADE X OCCUR Ifi606369NL598 MED EXP An one erson_ $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 _ _- GENERAL AGGREGATE S 2,000,000 GE_N'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $ 2,000,000 JEC X POLICY I PRO -_ LOC - --_-_— $ -- - AUTOMOSILELIABILITY COMBINED D'INGLE LIMIT $ _ ANY AUTO A ALL OWNED AUTOS A3113P267 1/22/2010 1/22/2011 50DILV INJURY(Per person) $ _ _ 100,000 X- BODILY INJURY(Per ac,dent) S 300,000 SCHEDULED AUTOS — — XPROPERTY DAMAGE $ HIRED AUTOS (Per accident) X NOWOWNED AUTOS Medical payments S 5,000 Uninsured motorist 81 split limit $ 20,000 -I UMBRELLA LIAB OCCUR EACH OCCURRENCE _$ EXCESS LIAB CLAIMS-MADE _AGGREGATE _ _ $ _ DEDUCTIBLE _$__ RETENTION $ $ B WORKERS COMPENSATION WC STATU- LOTH-I AND EMPLOYERS'LIABILITY Y/N LIOR.V_LIMITS] ER_— ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT 5 ].00,000 OFFICER/MEMBER EXCLUDED? N/A E]I ' (Mandatory in NH) C2-31S-340850-0310 5/20/2010 5/20/2011 E.L.DISEASE-EA EMPLOYE $ 500_,,00_0_ If yes,tldSQIbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 100.000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Proof of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHEIR E P R ES E N TiliIVE i ACORD 25(2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD E ,00�,�an«�lrr� ill« Office at Consumer Af1'eirs&Brfsiness Regulanoo y -— - HOME IMPROVEMENT CONTRACTOR Type: ;I Registration '103471 Expiration 718/2012 Private Corporati RO ALCONSTRUCTION�} + i- PAUL LABRIE 48 PARK AVE " MIDDLETON,MA 0149 Undersecretary, � .a datrYl Mas+tthusettS Department of Puh( cf�l Rc ufations an ' d { itB Board', Bulf 'ni > .Construgtiod Supervisor LicenS& .`. s; Y.^ License: CS 13523 Restricted to: 00 PAUL M LABRIE 48 PARK AVE MIDDLETON. MA 01949 Expiration: ej�T2012 . . �T Trp: 27289 2pe,6 r,o�q aah CC-- ", � I �r va qa �Srxa� 4 n' � 17 4Q ,�O a '�r AK r�5 ft&? B7n00 ok vivvl 2xf ld 25��H Cov �s, x3 uu ' I � h CITY OF SM .M. &LkSSACHUSETTS BLILDLYG DEPARTMENT 110 W.1.iHLYGTON STREET, 3"FLOOR ` 7-EL (978)745-9595 PAX(978) 740-9846 KI\BERIEY DRISCOLL IMUYOR THci..%Lu ST.PBRRS DIRECTOR OF PLBLIC PROPERTY/BCILDLNG COMMISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR section l 11.5 Debris,_and-tho provisions-of MGL-e-40 S 54;;----- --- - - - — Building Permit # is issued with the condition that the dcbris resulting from this work shall be disposed of in a properly licensed waste disposal facility as dcfincd by MGL c 111. S 150A. Three debris will be transportcd by: 11X4L reN S / (name of hauler) The debris will be disposed of in : (name of facility) /ir/a C S/ S/ %r'iy ��% (address of facility) signature of permit applicant slate lehnvlf JAR