37 CHESTNUT ST - BUILDING INSPECTION (6) � '� --- I he C'onununtceahh of�bl;usachuselU
I` y, Ilu.ird of Iuilding Regulations and Smn6rds' CIT1'OF
y ' \lussachusetts Slate Building Cute. 7SI)C NIR SALIM
• � N Building Pennif ,\pplicmion 'ro Construct. Repair. Renovate Or Den ish a
!)rie-or Tun-Punnly Uu dim r ritrd (ldr:ll/
Phis Section Fur Otrici Use Old
Building Permit Number: Dal applied:
11uilJiny Oliiciul(Prim N,une) Signature
SECTION I: SITE INFORAIATION
L I Pro erty A d sf: 1.2 Assessors Nlap S Parcel Numbers
I.la Is this an;ace it street? •es ncl Map Number Purcel Number
1.3 Zoning Information; I.4 Property Dimensions:
Loring Disiricl I'ropuscJ file Lot Area(sy Il) Pronlage ill)
1.3 Building Setbacks(R)
From Yard Side Yards Rear Yurd
Required Provided Required Provided Heyuired Provided
1.6 Water Supply:(M.G.I.c.JU.§Sy) 1.7 Flood Zone Information: 1 1.8 Sewage Disposal System:
Public O Pris ate Cl zone: _ Outside Flood'Lune? Munici d O On disposal site f stem O
ChrekirrsO F Du >�
SECTION2: PROPERTYOWNERSNIPt
2.1 wnert f q�gprd•/
Al II�J., ('per !�2/S'7 6
City.Slate.ZIP
Nu.;mJ Stme9 relephune Fnsuil Address
SECTION!: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ FExisling Building(3 Owner-Occupied O 1 Repairs(s) ❑ After forts) ❑ 1 Addition
Demolition O 1 Accessory Bldg. O 1 NumberofUnits_ I Other O .Spuciiy:
Brief elcri t(on of Propos d Work-:
SECTION 4: ESTIMATED CONSTRUCTION COSTS
licnl Ellintaled Costs:
bur;md.\I:mrrialfl Omclol Use Only
I. Building S OO`cj I. Building Permit Fee: S Indicate hew fee if determined:
2. Faaaricel a Standard City:Tuvsn Application Fee
S / O Tuutl Project C'osl'(item 6)% multiplier
1 I'IuniMng S 2-0 ?. Other Fens: S_
J. \Iceli,mic.d ill\ \('1 S 7�. OOP List:._ __..._��✓. `� '�V
' � \Iechunic.il IFve "V
�u gC>Siunl S S-1 000 roial All Fces: S
n Pula) Project Oust . .
/�OQ.J O RtiJ in Full O OulslanJi_n-41.-al.mce Me:
1()N .4: ONS I-1111c I-IONSERVI( FS
S.I ('oastruc I ion Su lien kor License(C S L)
-11rall it
al CS( IF,-I%Icr Ilse CSI. I'%N(,cc I'VI....)—Q.- --
t.%pe I)e S,r i pt ion
14o. jod Strvct i1rcstricted( tilldill'J'10 It'31-229'it 11
it lie,ir
Add,
I(E7— K,,oliji Co%crill
VA S Window.old Slums
SF Solid Fact Ih-milla Appliances
57�-80I Inhillution
1—(-0CVe I mail addresi D Demolition Talc'llong
d 11 to In )ru%.tn ell(Con rilclo (HIC) MI 75
IIIC I(q6tration Nilinkf
IIIC 'o, in) NA or jq I btrjllt Nill a
/J.2 — Email a,ldrults
No, an P, lga91 �y�eVlloy-or)7L
City/Town. State,ZIP na—h—.
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.1 2SC(6))
Workers Compensation Insurance affidavit must be Stimpleted and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issue of the building permit.
Signed Affidavit Attached? Yes .......... No ...........C1 SECTION ED WHEN
REIt,:kU--TE— Ise OWNER AUTHORIZATION 0 1PL'
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT.
1, 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.
Data
1,,i,,t Uoner's None(Electronic Sidnature)
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
and understanding.
contained in this application is true and accura he t of myknowledge
_�p 9
I Wig
...im .............
Nqmt
[1,:.\:n:0\�net o,hu—obtains a building permit to do his.her own o, r ,or an owner who tic unregistered cuntraour
(nut registered the Hume Iniproveintill Contractor(HIC) Program),will nu have have access to the arbitration
is r ujr.11t) I x Other iniplan on the HIC Program can be found at
program or guaranty lund under M.G.L. v. 142 ant information
\,\%,% I illrorniation an the Construction Supervisor License can be found at k%%k,k w
c
k\Ilea substantial\�ork is planned,�jproNidtc the iinir&nviflon below:
r r 111, r�.J 1 4 11 ) 1 including garage. finished basement attics. dvvki or rtirch)
otai iloorarca tici. 11 1 Ijbitable room count
Grois li%ing area 114 \timhcr kit'hedrokinis
\uIlltivrot hall'bailli
\,1111her"I haillrooills porches
I Jig of lV.lt1llg ii,Mll \unlhcr of decks
I I,V 01011lit! I'nclo,cd
1 11.11 Ilrolv't ;qllare I ool.lQg ' 111,1.\ I'e 'llb'llititcd 11'r *I oral ilrtljct 01,1"