HomeMy Public PortalAboutBuilding Permit - updated 1-8-20_202101261250579011The Town of Watertown Building .:
Permit Application
This Section For Official Use Only
Building Permit Number:
Date Issued:
Peter J McLaughlin
Building Official (Print Name) Signature Date
Mike Mena
Zoning Enforcement Officer(Print Name) Signature Date
1.1 Property Address:
Plans "11x17" and smaller will be submitted in duplicate. PLANS
LARGER THAN THE ABOVE, will be submitted with one 'Hard
Copy' and one electronic copy.
1.2 Zoning Information:
Other required documents
❑Plot Plan ❑Construction Control
0 Specifications 0
Existing Use Proposed Use
1.3 Building Setbacks (ft)
Front Yard
Side Yards
Rear Yard
Required
Provided
Required
Provided
Required
Provided
PROPERTY OWNERSHIP'
2.1 Owners of Record:
Name (Print) City, State, ZIP
No. and Street Telephone Email Address
DESCRIPTION OF PROPOSED WORK (check all that apply)
1 or 2 Family dwelling 0
Commercial ❑
O❑wncr Occupied
Addition 0
*Interior Demolition 0
*Siding 0
Other 0 Specify:
Brief Description of Proposed Work:
AS A RESULT OF THIS PERMIT APPLICATION, WILL ANY EXTERIOR WALLS, ROOF OR FOUNDATION BE
REMOVED Yes No
If Yes, please describe in detail what portion of the building will be removed and what portion of the building will remain:
ESTIMATED CONSTRUCTION COSTS
Item
Estimated Costs:
(Labor and Materials)
Official Use Only
1. Building
$
1. Building
❑ Standard
❑ Total
2. Other
List:
Permit Fee:
City/Town
Project Cost
Fees: $
$ Indicate how fee is determined:
Application Fee
(Item 6) x multiplier x $15/1000
2. Electrical
$
3. Plumbing
$
4. Mechanical (HVAC)
$
5. Mechanical (Fire
Suppression)
$
Total Alt
Check
0 Paid
Fees: $
No. Check Amount: Cash Amount:
6. Total Project Cost:
$
in Full 0 Outstanding Balance Due:
CONSTRUCTION SERVICES
5.1 Construction Supervisor License (CSL)
Construction Control
If building is less than 35,000 cu. ft. of enclosed space and /or not
under Construction control then check here.
Otherwise provide construction control forms (see section 107 in the
code)
Name of CSL Holder License # Ex. Date
No. and Street
Name Registration #
City/Town, State, ZIP
Discipline Expiration Date
Email Address
City/Town, State, Zip
Telephone #
Telephone # Email address
Company Name
Company Address
5.2 Registered Home Improvement Contractor (HIC)
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
No. and Street
Email address
City/Town, State, ZIP Telephone
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 Issuance of the building permit.
Signed Affidavit Attached? Yes 0 No . 0
OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner of the subject property,
my behalf, in all matters relative
hereby authorize to act on
to work authorized by this building permit application.
Print Owner's Name (Electronic Signature) Date
OWNER OR AUTHORIZED AGENT DECLARATION
By entering my name below, I 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.
Print Owner's or Authorized Agent's Name (Electronic Signature) Date
NOTES: MI
1. An Owner who obtains a building permit to do his/her own work will not have access to the arbitration program or guaranty
fund under M.G.L. c. 142A.
2. Insurance certificates must be submitted with the application, if applicable.
3. Any new site / utility work involved with this application must be submitted to D.P.W., Matt Shuman/Town Engineer, for
his review and approval prior to the issuance of a Building Permit.
4. D.P.W. Non -excavating permit required before any vehicle drives over curbs, grass plots or sidewalks.
5. *All interior demo permits require Electric, Plumbing & Gas permits prior to approval.
6. *All siding permits are required to have Electric Permits prior to approval.