25 HANCOCK ST - BUILDING INSPECTION oaf-
wr
NAT vi vWiffionwealthbf.-Muss
MKL ` Budding Perrnit ppplicahon To Construct Reputr Renovate Or Demolish a, �R�cared Jaienur+
ITO
01,0*1 1:
Buildm
ri.
go `414`1. APP.-
.............
S
7 0 W All.
Bu
RIO
QaTANJI",
VISA"
N
0 11 11 4, fiN' r .... ....
13 1 10
r
W��t....... ....
gvy;ian
P_ 7—
A GAN
Mf�.I......Igi i011!1.0,
-too
............
VIEW...........
14
.. . ........ 1�
; r
s IWWI AT4Xseii aDigp(i Is
. LaeF .......
to MnIf;'
MI
IPROPERTY
.4z,
it
v CM cc
............................
irm
if
............
qmq—
New
.....................Coastructfon...............
O_W Unp04=�-,mq -
Oilier
N.
Zu
..............
Nv
tj'�'atal Project Cost'(Item 6)x multiplier x ,
......... ..,
4fWec16WicU (uVAC)
-W, 1090 16 Rom"!AN
..........
MW:I-
v
�.;
IW.
1 15.Ll m"iRi
who"WON96. MAE w9mgm1g
.per .j ,�•'7 . tf t .. y t li Jiir 't.a J ,.. x,J t i.. A � �rri fj,aq rt{ .ir , '-4 3AA! .1
rJl F y tr � t xY
a+i r A 3 1t{� iH i tt Sd
�` x 4.tr S:, IJ .VrIf74i t"Uyq+� , yi?I {}I'
SECTION 5 CONSTRUGTtON SERVICES �, C �4 t $
� �M
�,1„;s F^ui c7
, �51��Lleensed ConsM4ctiontSupervlsor(CSW�
LI ar f,Ir t o r d,/�A�i sft +, te1
v y >ni. t.ry}tr r , C'L r�v{I\�rp� 9 fr•�r vJ-> ep+ '*i4LYll"IIlJUu3 ii��Jl! .,r �t:Zi 4a ) r�: 9 �� `� r''v{v 41'k'1 ;>f,G7 ( a':�
I,I .n
fir �-
tV
ti rf rl kl 1 A71 h ,,✓'�f i 5 3 i r r( t , r F i r - Ay'.Y N ,i _ 9 , r
t. ' � iNaineofCSL Holderh: vF ,[�'•", J f, + ty, t t F � �' j � + _t i ti y '-
Il C,. ,tlr` t�a�r� e�`h`�it`}•`J'���'�3 '��.��ir]n I�.DI��I"�.'G��Ir rW>��I��tufr.9 }�iJ9I CSL1Ty{IC 15CCritGiOw) :�
v f'
'� h,tj b%� �+v�,as �' L + P K 1 1 1' P fl 11 � � ✓ 3. }.a f a U G{4i4 C Uarrslrillnl In t035'000 Cu.FLI'' s '"1'e,e Jr4L "+, r -
�R I ReslritAeililbL.Fumil DwGlim ' .h, i ,- ri
`t - 7 r {SI 1IIi1t1tIC'�L `Y, f ll L r , + 't'r t� }hi , 9 f - o- 1 •L. v 5 r S '!l l.c a �,r -. ':
g I t, s M Mason .Oni vkt a.- e '+ S tc° s , n
R Wl
�, a..i� �Tlephone r 1 r 1YS r_r RoWfillul Wln ival ISMm i-� -c:. ,•` _ -,
a > 1
--t'rt,r2 Y.ya .. 5 , -. < 1 :�� SF :.r Rt.�sldaiilialfSulld.Fuei;Bumm Ahatut.hlttall.uuia 4 -
\
-I - r ,`L 51 Regfsteredllomx�improvetneat Canirlc�or(HIC)h` r 7�o nf7[EI a:�, r f /. ��"� �,.' + .'' }
a �: ` �.•f'i-'HIC Co Name or Re isuan Hank "-: c r .r .�Regtsuadon Number �
A:l{fit `ia 1 r �y}y �!1'Yt.a'.ag rr.�� L1xNyy��'' W"3"�✓ t ' ! 4� ,' �`�,✓� Irr ;t4 t, �
�-„ M1 t i t;AddfPdS tt r ''' y L J a`r�I•/3v�1��ts f a j r l 'Lc i'jt On, 1 hr t t .tzei I r, Yr
Y4,- . +l� � Signature ... + r r t '. v S,. °Telephoner , +5J t {r fr ✓._! ..........
f , 1• t)
Z
L —y-1 t -1" J r •P aJ i r 5 4 f i
t''u + ' r. ' SEC7°Iblt{61WORKERB�COMPENSATION IN5URANGE�A6FIbArYM'(M G L.c 15Z: ZSC(6))`�,, ,l
r 3 1 ," ask '[xY HAt ii np i+sumtFg Y:rv^Y'owc }.. i ti. Jl•t 1 N r i;
y' Workers Compenssfibn Insdrattce:nffidn�ttmttstibe cortpleed and$rlbmttted with Phis applicaaon rFatlure at pruytdeV
1W fHRllfIS't'
���y 9 r,f' jlhis Lf�davtt w�ItresWt,in tha deni�ltof theais�;�tnnee�Pa�lle bwidt�'g permit. _,£,,;,�,,rf ,r �, ,,. < i r ,
7l f a 1 C d t n.AkT Xry,¢�h7 ri S i4r,"<tr Y *rf"„ h}G 7Jt" uy P„ li h c zr
SigneddffiddOifAtfachtldlk gYwrii"v1ri9Oart,p i, Nb,Jtra O v
:k b) t) M\',.. • rvr - -an7, (1`t�'F
WNERPAUTHORIZAT1ON T0;BE COMP.tiET®:WHEN` ��' " t"
S ,1 ,7 9ECTl{UN{7a3 O
t 1 `yu: k. ..\ ( 5..z...�,.. . .--,. . 4.. c.�. -t .,,...v.. •. }.r 1 �... ..d7 r 'sir: a '(''s 1r. t'j , 'v
r f r�� `; v'OWNER'S)AGENT:'OIEFCONTRACTORAPPLi(35.FOA�BUII.DING PERM1iT ?. � { ' .'� (, . t r ,., .
V ;m(r�f5bi'y}: u x:v ' v.ea.., s � s'.a.:H': f r'� .< 'J f7L. .,•... 1 s. a'.t \ , !;{.
"t,• lr+ a t U Ir it J r t .
thesubJectl property hereby 1 T� t
s
ant110ttZC'''3 ' +Ih ',1iC/ i�A'�.� `. ° sr 3 £ ( m Ila[On my behalf(in rli,ma�ers e
� I r y rehitive to work authonud by hrs 6uildtng�permi[application 5�,.: " �`', r ' r -��'t< 3:+'"` r
SECTION 76 OWNER'OR AUTHORIZED AGENT DECLARATION
orAuthariudAgenth�iebydet.lare >,
r ' st
s 'that the stbtemenfs nod tnfonmation an wo foregoing application are true and accm to the.best of my knowledge and
auNamer
r
t i
r t Signattm of Owtler'or,Autho dzed Ageii[r 3
1. f �•: �: P..R:.M l.. k i — t
I An Owner who3obtatns a bwId" permit to do h gsltter own rwork,or an owne who htm an unregistered lronaal for ' r y'
Cnot rogiste +tn:the Home ImprovementContractor(HiC)Program)`will have actross t`o the urbitrtiuun
program or$tmranty fiind under Mrill',cti 142A Othertmportant mfdriaalion,on thaHlC Program and
Consrlicdan3upervlsorrIsrceasIng(CSL):cun be,falind��n 780 CMR Rngulnifons 110 R6:and 1 LO,RS respectively
v-1 When sitbAkAt al4wbrk is planned provide the mformbtion
1 '- ,e scNt� o f r99t q ,f ar 1 a iMt
Tn[al floors area(Sq-Ek) 4 (ineludtng garage finished basemetit/amis de 6s ur ptfnhl '
i t Gr0m I(ving'aRn($q,FL)'' '_. _`. "! "'Hnblmble rantti Wams ••r"_:-1 r 1 '.
lYilmba of fireplaces ` Number of bedrooms
Numhei of liathiolims Number bf haif/buths
x, ;Type of heating system-^ ' Number of de ktJ poahes
LOOhngtsyWRIM, buG .1 J �tr ¢; J yEIILh7lYd n
•S':a.�-.-Ope ' ` 4 ?r ♦ + \
t
�( luJ "1 otalSPtojtxt Square{rFooioga may 6e stitisntuted'Far,s"1 alalm yi' Ject Cast 4 , t rt+aJ
t t}�i4 Sdf^•' YSIf !J 'I•..IYAl �l)..Jli4 •f H1�itAl•LI.4l1j {SS J11 A'111�UJ I' 117 �, 5 t ( 1 1( T> fa/ llti'' USSf{ r'JI{ d11,4'Ii II�t4 IJj rr.
{:- t" < i. u v $+ Ai' Y raf r Y,l.ia• 'tiY r✓$rP '.5 r r' ? . rsn f w.� r i; i t., �:\ x Sp,Y rt 1 a
i f 11
x
at1