The URL can be used to link to this page

37 CHESTNUT ST - BUILDING INSPECTION (3) y� The Coin nionwea Ith of Massachusetts Board of Building Regulations and Standards Cl TY OF Massachusetts State Building Code, 730 C�[R SALEV[ Revised tkfar 2011 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Divelling This Section For Official Use Offaly ' Building Permit Number: Date l e >` Building Official(Print Name) C'Sign a Date SECTION I:SITE INFORMATION 1.1 Propertyy Address: L2 Assessors Nfap& Parcel Numbers it ( EST N Ur .'S? 1.l a [s 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 R) Frontage(it) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water pply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage I * posal System: Public Private❑ Zone: Outside Flood Zone? Municipal On site disposal system ❑ Check if yesO SECTION 2; PROPERTY'OWNERSHIPL 2.1 Ownert of Record: SW-gigw\. ,4 4 • C2Z 270 Name(Print) City,State,ZIP �� Chi STvd>~ S7 ,7F Fo4_oolS &NE(�tL -in(r) aL No,and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK"(cheek all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) Addition ❑ Demolition ❑ Accessory Bldg. ❑ I Number ofUnits1_ Other ❑ Specify Brief Description of Proposed Nork': SECTION 4: ESTENUTED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only. . Labor and Materials) I. Building g ,=CO I. Building Permit Fee:S Indicate how fee is determined: Standard.Cityfrown Application Fee 3. Electrical $ pOQ ' ❑TotalProject Cost'(Item 6)xmuItipIier x �3. PlumbingPlumbing S o©�= 2_ Other Fzes: .S I. \kechanic.tl ([IV,\C) S List:_ i. ,,\Iechanie.tl (Piro SuPL,—r,1ssioiion)___ 3 Filial :kit Fees:.S Check No. Chcck Auwunt: C:uh Auwunc I'nCtl I'rnjcet ('oif -- I � / � ❑ I'url m PuII ❑ Oldst:utJm" li;ilance I tir . � Y SEC PION 5: CONSTRUCTION SERVICES 5.1 Construeliou Supervisor License(CSL) /6 CS 2 2 [,16 -7 License Number E.epiradon Date Name of CSLllolder_QQ List CSLrype(see below) 01. w� type Description No. and Street U Unrestricted (Buildings UP to 35,000 cu. ll. R Restricted 15r2 Faintly Dwellin City/rown,State, LIP NI Masonr RC Rootin Coverin J WS 1Vindow Ind Siding SF Solid Fuel Uunting r\ppliances 9Ia zlO C�91 1 Insulation reie hone Email address Ui Demolition 5 ered one Improvement Co,ntr.cto (tl[ ) 171 (�� 3 a/ L m HIC Registruion Number spa•flan Date I IIC Corry Nat or Ill ' eg sta t to No S _ �! Email address 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 ..........❑ No...........E3 SECTION 7a: OWNER AUTHORIZATION TO Is COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, as Owner of the subject property, hereby authorize 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.kGEN'r DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained ' is app icati true nd accurate to the best of my knowledge and understanding. s 3 Print wner'>or Autlwrired:\;ear's .one(Lleetromc Signature) Date NOTES: I. :kn Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (nut registered in the Home Improvement Contractor(HIC) Program), will not have access to the arbitration progr:un or guaranty fiord under M.G.L. c. 142A. Other important information on the HIC Program can be found at www luaus.euvhxa Information on the Construction Supervisor License can be found at wwtv.utas.•v��-d tL'• 2 when substantial work is planned,provide the information below: Total tloor:trea(;,I. It.) __ _(including garage, finished basemendattics, decks or porch) fabictbla room count ----- Number of lireplacc, _—_--------- `.lumber of bedrooms .; - --_- umbdrnfh:dEbaths Nuothcrotbathrruln rvl?o of haaliug ;y;lew I lumber of,lah+'porches -- --- - I',pe ,rFe,i ,lur� ,yaem . __ ._ telo;e`I -- open _ e {. `I LlI I'nq.it � prvd Foot l.,e" ui.ty f.d Pwje t'--_---- _ .