48 ESSEX ST - BUILDING PERMIT APP The Conimomcealth of Massachusetts I
1ON
t Board of Budding Regulations and Standuds \Il NICII' 11 1 1"
i %IaSSuchusrttS Slate Building Code. 7S(I (AIR, 7"' edition
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Building Permit Application To 'onsVuct. Repair. Renus ale Or I)cnlolisll :l d l i rJ O 0n u- ut To( 1. '�iu:1'
'his Sec 0on For Official Use Only _
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13w11Jing Permit NuI lb Date Applied:
13uddmE 'ummn,i net/ I p• 'art al Bi mgs U.nc
"PION I: SITE INFORMATION
1.1 Proper y tsr C 1.2 Assessors Map & Parcel Numbers
i.laI ihls anIccept-d .Iris ses_.__.— nu.___ \lap Numher
1.3 Zoning Information: 11. 4 Pr..u-rty Dimensions: — --
Zoning Duoir; PnrlwseJ Use I �• area Uy Ill _i'I onlage Ilil
1.5 Building Setbacks (fU
Front Yard Side Yards Rear Yard
! Required Provided Requited Prnv ided Rcyuued PruiJcJ j
1.6 Water Supply: IM.G.L c. 10, §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone:' munici al ❑ On site dis weal s stem ❑
Public' ❑ Pnvate� Check it pb❑ P I Y
SECTION 2: PROPERTY OWNERSHIP'
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2.l O� eOrl ofeo rd: 561/'
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N'.urc i Prim AdLi cs for SS e:
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Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK(check all that apply)
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Ncw C'unstructiun ❑ Existing Building; Owner-Occupied ❑
Demuli,ion ❑ Accessory Bldg..❑ Number of Units Other ❑ Speedy:_
_.._ --
B ief scriptum of Proposed fk _ - — -
_ l�(�'v��T. .►�C�(�-K__.Czc��w__�a.L-�t-��.n.,
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SECTION J: ESTIMATED CONSTRUCTION COSTS
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Estimated Costs:
Item (Labor and Materials) Official Use Only —
I. Building j I. Building Permit Fee: lndfcute how lie i> Jc(enwne l:
❑ Standard City/Town Applicanun Fee
?. Electrical S _ � ❑ Foial Project Cost' (Item 6) x multiplier _ x
3. Plumbing S —� ?. Other Fees:
4. Mechanical IH\':\C) 5 List:
I !
5. Mee hanicaI (Fire —� -- ----- _---
"rota) All Fees: S
Suppression)
- -� Check No. Check :\mount: ('.uh ,\mount
0 Total Project Cost: S '! Q 0 Paid in Full 0 Outstanding B:d:mre
SECTION 5: CONSTRUCTION SERVICES
F5.1 Licensed Construction Supervisor(CSI.)
Llci n,e Clunher I..spIr.IWm D.u.• `.. � i
Name of CSI.- I folder I 'i
[-I,l ('S1. 'I*%pe nee helow)
_— .1.`, c Desi ri igloo
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1. lnrc,tnrlrJ nl l lu T5.lN1U Cu. hI ___� i
-- — R Reslncled L@ .Innll 2 F Dw:llluc --4
Signature .%I \Ll,onn Onls
RC Re,iJcnual Rlnllinc ('oi ni mom_
IL•Iephune \\'S oid lidn_wc
lF Rcvdcnu.11 Solid fuel Bwnine \I+I+I i.lur; In.LJl.n ini
D Rc,iJanu:l Denwhwm —__—_-
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�. eKistered [lame Impr cement Cun[rac r( '1
i CI nipanv Name or HIC Reg ,grant Name Regletrauon \muhrr
l IAji /�r�c�s T� r�ox �Y� Ito
.Ayldre ' 03 7 Qa3(, . Fsplrauon Date
Signature , releplwne
SE O 6: WORKERS' COKPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152. § 25C(6))
Workers Compensation Insurance affidavit must be completed and .submitted with this application. Failure nl preside
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes .......... No ........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject pnlperty hereby
authorize n)act on my behalf. in all matters
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relative n) wolk authorized by this building permit application. j
Signature of Owner Date ----_---- _ _�
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
L , as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate. to the best of my knowledge and
behalf.
kPrintNameure of Owner or Authonzed Agent Date
d under the ams and enalties of erju i
NOTES:
n Owner who obtains a building permit to do his/herown work,ur an owner who hires an umegl,teicd contra.for
nut registered in the Home Improvement Contractor (HIC) Program), will trot has'e access to I-ne mbitration
program or guaranty fund under M.G.L. c. 142A. Other important inhumation on the HIC' Progr:un and
Construction Supervisor Licensing (CSL)can be found in 780 C,%IR Regulations 110.146 and 1 IU.R5, respectncly. l
' When substantial work is planned, provide the intormation below �
Total floors area (Sq. Ft.) (including garage. Imished basemen Uatucs. decks or porch)
Gross living area ISq. Ft.) Habitable room count
Number of fireplaces Number of hedroom, ---- -_----
Number of hathtuunls Number of led lih,u hs _,
1\lx of healing ,vstent - -- Number of deck/ porches
f1pe of 'ooling ,yblem 1.11closcd
1. 'Total Project Square Footage" may be substituted tier Total Project Cost" _