B-19-468 - 0041 UPHAM STREET - Building Permit The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITUF
"-
W
Massachusetts State Building Code, 780 CMR BALM ir <:a
Revised. 201
Building Permit Application To Construct, Repair,Renovate Or Demolish a
One-or Two-Family Dwelling W n- xy
This Section For Official Use Only
S
Building Permit Number: Date Applied: t
Building Official(Print Name) Signatures
r SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
41 Upham Street
` 1.1 a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq tt Frontage ft - s fir.
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provi
~ram
,.J ,tee• ,--
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:. -
Zone: _ Outside Flood Zone?
Public❑ Private❑ Check if yes❑ Municipal❑ On site disposal system El, l
SECTION 2: PROPERTY OWNERSHIP'
2..1 Owner'of Record:
Name(Print) City,State,ZIP
41 Upham St . 978-317-8723 JudyMKauffman@gmail .com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units I Other ❑ Specify:
Brief Description of Proposed Work 2:Re-pointing brick facade, restore/replace
in-kind decorative concrete and brick masonry. All work to be done
on exterior of building, on northeast face.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials)
1.Building $ 1. Building Permit Fee:$ _Indicate how fee is determined:
2.Electrical $
❑Standard City/Town Application Fee❑Total Project Costa(Item 6)x multiplier�x I
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Su ression Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ �� �/� ❑Paid in Full ❑Outstanding Balance Due:
310 -d,93 S� � & ��
Y�C 11'� Nt DrI c� Lt. PN U
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) C S-10 7 8 3 4 11/13/2 019
Andrew DaPrato License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
21 Larson Drive
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)Hampstead, NH 03841 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
-7 (Ilyz3 �4 ra / QSpr�if/ SF Solid Fuel Burning Appliances
BX*a n 2.3 l 2 A ar ;"7- ,W I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 169898 0 8/19/2 019
Murray Masonry And More Corp. HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
P.O. Box 8454 Brendan@MurrayMasonry.com
No.and Street Email address
Salem, Ma 01971 978-594-1138
City/Town,State,ZIP Telephone
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 Issuance of the building permit.
Signed Affidavit Attached? Yes ..........X No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize Murray Masonry and More Corp.
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b: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:
1. 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. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable 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 be substituted for"Total Project Cost"