Status message (*) Mandatory field (*) Check 2023 Fees Schedule for increase in payments Requester’s Information * Company Name * Drain Layer Name * Certificate of Liability Expiration Date * First Name * Last Name * Phone Number * Phone Type Phone TypeCellBusinessHome * E-mail Address * Owners Name/Address * Owner's Name * Job Address * Neighborhood Select NeighborhoodAllston/BrightonBack Bay/Beacon HillCharlestownCentralCitywideEast BostonHyde ParkJamaica PlainMattapanNorth DorchesterRoslindaleRoxburySouth BostonSouth DorchesterSouth EndWest Roxbury State * Zipcode * GSA Type GSA Type Repair New Install Repair * Account # * Type of Repair Water Firepipe Sewer Drain Sewer Liner * Lateral Program Yes No * Location of Cut - Select -StreetSidewalkBothOn Site * Cut Size New Install * Site Plan * File Upload Select File UploadRough Sign OffPhoto of House * Rough Sign Off One file only.2 GB limit.Allowed types: pdf, doc, docx. * Photo of House One file only.2 GB limit.Allowed types: gif, jpg, png, svg. ISD Covid Safety Confirmation One file only.2 GB limit.Allowed types: pdf, doc, docx. Comments CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. “I certify that the information I have provided in this application is true and accurate. By submitting this GSA Request Form, I acknowledge that, if issued this GSA, I will only perform the work as requested on this Form, and I must perform all work authorized under this GSA in accordance with all applicable Massachusetts laws and BWSC’s Water and Sewer Use Regulations.”
