27 ESSEX ST - BUILDING PERMIT APP ........
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;' r Massachusetts Stare Building Cade 78U CMR.7 �edtuon'S USES` ` ' �' '
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Ix , Brief Description of Proposed Work ' iF6,A
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' ' ,:a.`'Name of SLR Htllder;' ASyd t£ k "xju F'� t h ♦} F {; F lr\ � (U`' } y�r1 yr^^�T�}� 4]t {i f
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5 RegLstered Harrrc[ rtivement Contractor
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y z , ' ` ,. SECTION 6 i RKERS'COMPENSATION INSI)IW Nt:E>AFFiDA VIT(M G.L.c ISZ..�t25C(�) xt, { ;.it
YJ i r�+ Workers Compens`auori Insu nie�affidavtt`m'utt be completed and submitted With`this`applicaaon.),Failure ai piuvlde�'��E �
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?'- {w" 2', thts affidllVlt Wdlreauit In the dtuunl4of�thetlssuance OfthC,bUllding permit. :,]-1 ` T >< `r ' ` { '
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,.' �pt�-'}'�� SECTION,7as,0WNERrAiTfHORIZATION TO,HE COMeLE'FFA Vi!HEhT'a{�i L y,, .F �,* si �` " F' t �< �r
AGEN'P10RCONTR�ACTOR`.APPL'iESROR�BIIQ.DBHGP'ERM�T':a
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.y'k s .r � E -_ ! lr� 1�v.:yk{ f^'r ;3:ikn.l r v l:Y x rr-G� ) ' {3 �os Owner`of thesubjecisProPnrtY hereby v:, t
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r- y reladve to.work attth r l by this bwidmgJpermit applieallon. �' t k + / ,a':: r J
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Pr° ECTION 7b 'UWNERr OR.AUTHORIZED AGENT DECL'ARi1`TION
T. as l7wner or Authorized Agent hereby dtxlarew-�
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. � > t< ,,thaathrstntemetus aril infotmmion on the a Ileatlon are hue stld accurst to thdbest of to knowled undue ;„
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nntute`ofOwner'or -ufhorizedAgent,�, , :,�\f.t7tr. ,„.�'\�? }s>i a',tJste" „ _ 1`
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S ed under tiie 11t:and nitli:nr bWU
'k1 wAti Owner whd obhuns a building p ESSb �-
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' ,,r r,' ;,\ (not`'�regisiared'+fo°the`HomeImprovemem'Connectoi,(HIC)iPtogram)'fwill gg{hnv"efaeceks m'the arbnintiunT�- '� � „i r ';
� Program faatanty fiord itr�erM(}L cAl42a t7tha t,WIM ,information on the1HIC Program and \m om k + J
{a t s f z Constri ctionSuperrvisrirxL�censing(CSL)crin tie found ln`lbu t;4K Regulations A 10 R6 attd 1)D RS lespechvely <E r
Url 2 kY rotten aubsmm iel tt7ork is punned pmvide'thn infoitwttoa lieloW' s ,
f Tmel fltwts IV
arcs(Sq Ft)t w`� .' i r (itit ing pfage finished bsschum gntce daks,ur
i t3mss livtrig arw,(Sq'7FY) ' . 1 ; ' Wobimble rnotrt wwus `' ' `' a<
lYumb"ar of fireplaces'-. t !. u { r , Number of bedrooms F' ?A> a
r,. ;; Nurnwsofb`athrooms.
14%x £ Type))ufdeiWngsystem� +' a Numlierofdecks/ponhes ?r YA
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TypetioPtnol(ng sysletn v L I + i %hl ,�' .t' EnllUsed '` �f I Qpen�r rt 'X, .5't' �. >:{.
•:'x F,+ : ° ] .§;,'"I'otel'PttijectSquate'Fooiuge tnny`be subsatuted far„"TOtal'}i'roject Cost :,' , '- ,t � ' sa /
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