Ma Quincy Permit Form PDF Details

In the City of Quincy, obtaining a building permit is a process governed by a comprehensive form designed to streamline and standardize construction and modification activities. This form, essential for both minor and major construction efforts, meticulously collects information regarding the project at hand, starting with basic identifiers such as the permit number, job address, and submittal date, further delving into specifics including the existing and proposed use of the building, the number of families it will house, and a detailed description of the intended work. Additionally, it captures the estimated value of the work, thus laying a foundation for assessing permit fees. Beyond project details, the form requires personal information from property owners, lessees, construction supervisors, architects, and engineers involved, ensuring all parties are adequately identified and can be held accountable for the project’s execution. This mechanism is bolstered by the inclusion of various regulatory compliance sections such as zoning, historic districts, flood plains, and more, which guide the approval process while considering the environmental and community impact. It also incorporates a section dedicated to homeowners seeking to personally undertake construction activities, emphasizing the necessity of adherence to state building codes and ordinances. Notably, the form includes an affidavit for exemptions related to the sewerage rehabilitation fund, demonstrating a nuanced approach to financial responsibility. Additionally, the Workers’ Compensation Insurance Affidavit encapsulates compliance with worker safety regulations, highlighting the city’s commitment to upholding safety standards on construction sites. Through this form, Quincy manages a balance between development needs and legal, safety, and community considerations, embodying a thorough vetting mechanism for construction-related endeavors.

QuestionAnswer
Form NameMa Quincy Permit Form
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesquincy ma building department, massachusetts quincy building, city of quincy building department, quincy building permit online

Form Preview Example

1

City of Quincy

Building Permit Application

Permit #: ___________

(Please Print Legibly)

Job Address:

 

Submittal Date:

Existing Use:

Proposed Use:

How many families?

Description of Work:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Estimated Value of Work:

 

 

Owner:

 

Are you the Lessee?

Address:

 

Phone/Fax:

Construction Supervisor:

 

 

Address:

 

Phone/Fax:

License #

Type:

H.I.C. Registration #:

Architect/Engineer:

 

 

Address:

 

Phone/Fax:

Debris Disposal Facility:

 

 

"I/We hereby certify that I/we are the owner of record and have authorized the work described in this application and further authorize the people named on this application to act as my agents in matters concerning this project. I/We further certify under the pains and penalties of perjury that all statements made herein are true and accurate."

Property Owner's Signature(s):

Date:

Property Owner's Name(s) (print):

 

Agent/Const. Super. Signature:

Date:

Agent/Const. Supervisor Name (print):

 

 

 

Inspectional Services

Department 55 Sea Street Quincy, MA 02169

Tel. (617) 376-1450

Fax: (617) 376-1465 www.ci.quincy.ma.us

2

Building Department Use:

Permit Fee:

Sewer Rehab Fee:

Total Fee:

 

Zoning District:

Assessor's Map:

Plot #

Lot #

Construction Type:

 

Use Code:

 

ZBA Case #:

Historic District:

Flood Plain:

 

Existing Setbacks: Front:

 

 

Side L:

Side R:

 

Rear:

Proposed

Front:

 

 

Side L:

Side R:

 

Rear:

Required

Front:

 

 

Side L:

Side R:

 

Rear:

Fire Prevention:

 

 

 

 

 

 

 

 

Fire Alarm Division:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Wire Department:

 

 

 

 

 

 

 

 

Plumbing Department:

 

 

 

 

 

 

 

 

Engineering (Grade Letter):

 

 

 

 

 

 

 

 

Conservation Commission:

 

 

 

 

 

 

 

 

Water, Sewer, Drain:

 

 

 

 

 

 

 

 

Traffic Engineer:

 

 

 

 

 

 

 

 

Health Department:

 

 

 

 

 

 

 

 

Engineering:

 

 

 

 

 

 

 

 

TYPE OF IMPROVEMENT

 

 

PROPOSED USE

 

 

NON-RESIDENTIAL

12

 

New Building

21

 

Single Family

29

 

Amusement, Recreation

13

 

Addition

22

 

Multi-Family:

30

 

Church, Other Religious

14

 

Alteration

 

 

 

# of Units

31

 

Industrial

15

 

Repair,Replace

23

 

Hotel, Motel,

32

 

Theater, Assembly

16

 

Demolition

 

 

 

# of Units

33

 

Serv Station, Repair

17

 

Move/Relocate

24

 

Garage

34

 

Hospital, Institutional

18

 

Swimming Pool

25

 

Porch, Deck

35

 

Office, Bank, Professional

19

 

Sign

26

 

Accessory Building

36

 

Restaurant

20

 

Other

27

 

Recreation

37

 

Library, Other Educational

 

 

 

28

 

Other:__________

38

 

Stores, Mercantile

 

 

 

 

 

 

 

 

39

 

Other:________________

Approval/Disapproval by:__________________________________Date:________________Permit ____

Inspectional Services

Department 55 Sea Street Quincy, MA 02169

Tel. (617) 376-1450

Fax: (617) 376-1465 www.ci.quincy.ma.us

3

AFFIDAVIT OF HOMEOWNER

APPLYING FOR A BUILDING PERMIT

A homeowner may obtain a building permit without having a builder’s license if they meet the following criterion:

“Homeowner” as defined in 780 CMR 108.3.5” …person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures.

A person who constructs more than one home in a two-year period shall not be considered a homeowner.”

I hereby certify that I am a “Homeowner” according to the above definition and will assume full responsibility for the attached building permit. I will assure conformance to applicable sections of both the Massachusetts State Building Code and City of Quincy Ordinances. I understand that I may be held liable for violations of the law, defects in workmanship, and any accidents which may occur in the building of this project.

PERSONS CONTRACTING WITH UNREGISTERED HOME IMPROVEMENT CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND.

Signed:

EXEMPTION FROM SEWERAGE REHABILITATION FUND

City Council Order Number 36 of 1990

I hereby certify that the subject property is a one, two, or three family and I will live here for at least one year from the date of completion of this project. If the foregoing is found not to be true, I hereby agree to pay the Sewer Rehabilitation Fee within thirty (30) days of receipt of a due notice.

Signed:

Inspectional Services

Department 55 Sea Street Quincy, MA 02169

Tel. (617) 376-1450

Fax: (617) 376-1465 www.ci.quincy.ma.us

4

The Commonwealth of Massachusetts

Department of Industrial Accidents

Office of Investigations

600 Washington Street

Boston, Massachusetts 02111

www.massgov/dia

Workers’ Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers

Applicant Information

Please Print Legibly

Name (Business/Organization/Individual):

Address:

City/State/Zip:

Are you an employer? Check the appropriate box:

1 ฀ I am a employer with _____________

4. ฀ I am a general contractor and I

employees (full and/or part time).*

have hired the sub-contractors

2.฀ I am a sole proprietor or partner-

listed on the attached sheet.

Ship and have no employees

These sub-contractors have

 

employees and have

Working for me in any capacity.

workers’ comp. Insurance.

(No workers’ comp insurance

5. ฀ We are a corporation and its

required.)

officers have exercised their

3. ฀ I am a homeowner doing all work

right of exemption per MGL

myself. ( No workers’ comp

c.152, δ1(4), and we have no

insurance required.)±

employees. (No workers’

 

comp. Insurance required.)

Type of project (required) 6.฀ New construction

7.฀ Remodeling

8.฀ Demolition

9.฀ Building addition

10฀ Electrical repairs or additions

11฀ Plumbing repairs or additions

12฀ Roof repairs

13฀ Other

*Any applicant that checks box #1 must also fill out the section below showing their workers’ compensation policy information.

±Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such

**Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees, they must provide their workers’ comp policy number.

I am an employer that is providing workers’ compensation insurance for my employees. Below is the policy and job site information.

Insurance Company Name:

 

Policy # or Self ins. Lic. #

Expiration Date:

Job Site Address:

City/State/Zip

Attach a copy of the workers’ compensation policy declaration page (showing the policy number and expiration date).

Failure to secure coverage as required under Section 25 A of MGL 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and or one years’ imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of $100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.

I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.

Signature:

 

_ Phone No:

Date: ________________

 

 

 

 

 

 

Signature:

 

 

Date:

 

Print name:

 

Phone:

 

Inspectional Services

Department 55 Sea Street Quincy, MA 02169

Tel. (617) 376-1450

Fax: (617) 376-1465 www.ci.quincy.ma.us

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This PDF form requires specific details; to ensure accuracy and reliability, make sure you consider the guidelines below:

1. The quincy application necessitates particular details to be inserted. Make certain the following blanks are finalized:

The best way to fill out ma quincy building permit application part 1

2. Once this array of fields is complete, you have to add the needed details in Estimated Value of Work Owner, Are you the Lessee PhoneFax, Type, PhoneFax, PhoneFax HIC Registration, and Construction Supervisor Address in order to proceed to the next step.

Filling out segment 2 in ma quincy building permit application

Be very careful when filling out Construction Supervisor Address and Are you the Lessee PhoneFax, as this is the section in which most users make errors.

3. This next segment should be fairly straightforward, Construction Supervisor Address, Date, Date, Inspectional Services Department, and Tel cid Fax cid wwwciquincymaus - each one of these form fields is required to be filled out here.

Filling in part 3 in ma quincy building permit application

4. To go forward, this fourth section will require typing in a few fields. Examples include Permit Fee, Zoning District, Construction Type, ZBA Case, Existing Setbacks Front Proposed, Front, Required, Front, Fire Prevention Fire Alarm Division, Wire Department, Plumbing Department, Engineering Grade Letter, Sewer Rehab Fee, Total Fee, and Assessors Map, which you'll find integral to carrying on with this particular form.

The way to fill in ma quincy building permit application portion 4

5. This form should be finalized by dealing with this section. Further there's an extensive listing of blank fields that need to be completed with specific information for your document usage to be faultless: Conservation Commission, Water Sewer Drain, Traffic Engineer, Health Department, Engineering, TYPE OF IMPROVEMENT, New Building, Addition, Alteration, RepairReplace, Demolition, MoveRelocate, Swimming Pool, Sign Other, and PROPOSED USE.

Completing part 5 in ma quincy building permit application

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