27 BEACH AVE - BPA-2009-858 RESIDE HOME The Commonwealth of Massachusetts Town of
ABoard of Binding Regulations and Standards
Massachusetts State Building Code, 780 CMR, T°edition Building Dept
Building Permit Application To Construct, Repair, Renovate Or Demolish a >fi2omdkim
One- or rno-Fuetilt-Duelling Amos
This Section r Official a Only
Building Permit N mb�e�rr:: t App ed:
Signature: "✓ '✓ —r /S/�-�—
Building Commissioner/ nspectorof Buil Date
SECTION 1: SITE INFORMATION
1.1 z ope . Addrtess: 1.2 Assessors Map& Parcel Numbers
n
I.I a Is this an accepted street'?yes ✓ noMap Number Parcel Number
_
1 Zoning Informsµc��p 1.4 Property Dimensions:
Proposed
U e Frontage it
Zoning District Proposed Use Lot Area(sq R) 6 ( )
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.U.],C.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal 13 On site disposal system ❑
Public❑ Private❑ Check if es❑
SECTION 2: PROPERTY OWNERSHIP'
2. w r'of word:
Name(Print) Address for Service:
'TlC,1414-
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s)A Alteration(s) ❑ I.Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': , - 1 - -
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
Item Labor and Materials
I. BuildingE � � 1. Building Permit Fee: E Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical E ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing E 2. Other Fees: E
4. Mechanical (HVAC) E List:
5. Mechanical (Fire S Total All Fees: E
Su ression
Check No. _Check Amount: Cash Amount:
—
6. Total Project Cost: S ❑Paid in Full ❑Outstanding Balance Due:-
ACJ /o �dlne11 -tom
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) ^^��,
1. W op ias '4 u DID
License Number Expiration Date 0
AAddress
Hylder
List CSL Type(sec below)
T Description
U Unrestricted(up to 35,000 Cu. Ft.)
S11 ature ' R Restricted 1&2 Family Dwelling
.%1 Masonry Only
RC Residential Roofing Covering
TelephoneWS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
5.2 Registered Home Improvement Contractor(HIC)
HIC Company Name or HIC Registrant Name Registration Number
Address
Expiration Date
Signature Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.4 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...........❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
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.
Signature of Owner Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
1, ,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.
Print Name
Signature of Owner or Authorized Agent Date
(signed under the pains and penalties ofperjury)
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program), will not have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I O.R6 and 1 HLRS, respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq. Ft.) (including garage, finished basement/attics,decks or porch)
Gross living area(Sq. Ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Syuare Footage"may be substituted for"Total Project Cost"