342 ESSEX ST - BUILDING PERMIT APP The Ct umu,nwealth of Nfassachusetts —
a Board of Building Regulations and Standards I l llt
Massachusetts Stile Building ('uJe, 780 ('!\IR. 7" edition
\IlNII if, \1I-I 1
I �I.
lit ildin_ Pei mit Applic:ui n To Construct. Rrp�aii _IR a ate (h Demolish a R ;r rJ fwm,,,;
(hn - rn' Tu'u-P}urttili l IJ rrl/in,G 1. ';rr,,\ .
. 1-his Sectirn Fo Official wle onvy
13utlding Permit Number: _ D ne . p led:
Stgmtture _ 14, 3Jo S
Build ('onunr.,unan/ Inspe rr rt uddmgs ' :ue _.
SECT )N 1: SIT FORMATION
1.1 Property Address, z 1.2 Assessors flap & Parcel .Numbers - -
c3y� EvSrX Is < -_ ,
I.la [s this an accepted slice':' yes_l/ t o Map Number __. P'll,cl ,Nuiuhcr—.____.._._
L1.3 Zoning In.01 motion: LJ Property Dimensions:
Zoning District li Proposed Use Lot Area tsy lit Flowage Ut)
1.5 Building Setbacks (Il
( Front Yard Side Yards Rear Y:ud
F
RequiraJ Provided Rcyuued Provided Requited Pio,iJrJ
1.6 Water Supply: (M.G.L c. 40. y 54) 1.7 Flood Zone information: 1.8 Sewage Disposal System: .
Puhlic ❑ Prolate❑ Zon __ Outside Flood Zone? Municipal ❑ On site disposal system ❑
Check it'yes❑
r SECTI JIN 2: PROPERTY OWNERSHIP'
,t -1
rOwner'ofRecord: �.S'.S �X s rinll Address or Sern ice:
Telephune
Y/
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Constructionl,C Existing Building ❑ Owner-Occupied ❑ Repaus(s) ❑ Alteration(s) ❑ . ,WJ111MI ❑
Demolition •�O Accessory Bldg. ❑ Number of Unil I Other ❑ Spealy:
Brief Description of Proposed Work':
SECTION J: ESTIMATED CONSTRUCTION COSTS
Estimated Cost! :
Item tLahor and Materi Is) Official Use Only
I. Building l S 1. Building Permit Fee: $ Indicate how lee is Jetei nuncd:
i ❑ Standard Cily/Town Application Fee
_. Electrical ❑ Total Project Cost' (Item 6) .x multiplier x _
3. Plumbing 5 2. Other Fees: $
4. Mechanical MIVAC) $ List:
5 Mechanical (Fire
Total All Fees: S
Suppression)
G Check No. Check .\mount Cash Amount
j 0 Total Project Ci us[: S`����. ❑ Paid m Full ❑ Outsctnding
� Balance Uue
SECTION 5: CONSTRUCTION SERVICES _4
Licensed Cuitstructiun Sup/ervisor (C' 'L)
. S//r (`_ _—_ Lren>r ..\'umber I'.,po:nio❑ Date
L Ilu� ,jdr � 1-I'l CSL ripe. I+rr heluw I
Tr e Desert mitn __ _�
\JdrC+> l llrCNtlr ird nt r to j?.lN)O c I'1.t __
�✓I R Restrletcd L@_' Fanuh Dwelling —
_y
Slgn:uurt ? IdNlammrn
RC Re'Identul Reruline ( nsri In•s
role{thone \1'1 Rr+idrnoal \1-tndun ,tnd lull t_i„
SF RQ'Idcnu.d Sohd Purl liw_nmil, \\Ppt_mec lu.l_ill.un n
D lieadeu(l.d
5,2 Regi tere I )me Impruvemegt Cun[ • clot (HIC)
d
Regutruuun Xunth
HIC CCo, piny Name u 1 JRcga tt Na c m C s
S O
Addrr++ q78 Jys=�.3/ F.,1 tratiwt :u;
Signature Telephone
SECTION 6: WORKERS' COMPE SATION INSURANCE.AFFIDAVIT (M.G.L. c. 152. S 25C(6))
Workers Compensation Insurance affidavit olust be completed and .submitted with this application. Failure tt, pnrstde
this affidavit will result in the denial of the issuance of the building permit.
Signed Affidavit Attached'? Yes .......... No ......._., O
SECTION :a. OWNER AUTHORIZATI N TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR PPLIES FOR BUILDING PERMIT _
I. _.
�¢L rld Ll✓�• 611 , as Owner of the %object property herebv
:mthorizr � it)act on my behalf. in all mullet:+
relative nv
t .:1 k authorized wilding hermit application. —
_
Date --'- -------- —
Si nature of Owner
SECTION 7b: OWNE I OR AUTHORIZED AGENT DECLARATION
- , as Owner or Authorized Agent hereby declare
1. _
that the statements and information on the foi egoing application are true and accurate, to (he best of my knowledge and
behalf.
%Owncror
Print Name -
Date
d 6
Sienature oAuthorILC . gent
(signed under the 2ains and penalties of er'u I NOTES: f
I. to do his/her own work,or an ow who hires an M unre CI Cd runt r
An Owner who obtains a building permi u.lor
(not registered in the Home Impruveme t Contractor (HIC) program), will not have access to me arbitration
program or guaranty fund under M.G.L. 142A. Other important information on the HIC Pntgr:un :nod
Construction Supervisor Licensing (CSL 1 can be found in 780 CMR Regulations I I0.R6 and I lo.R5. re,pecoeely
When +utistannal work is planned, F-- .- me information below: j
Te IinrlUdmg garage, finished ba,emenilal[K deck-etc porrht
aal floors area ISq. Ff.)
Habitable room ounl
Gros living area Ft.) Number of hedroom., ._..—
Vumbar offu'rplaces ces Number ofh,tlbb.ohs
I Number of hamroonts --.---- ----- ---_ .
Number of Jerk,/ penrhe,
fvpe of heating syslem
Pype ul rnolmg system — ---- —�
11 ..Total Project Square Foolage•' may he ubsotuted for "fot:J Project Cost-