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B-17-438 - 0048 BAY VIEW AVENUE - Building Permit The Commonwealth of IVlassachusetts Board of.Building.Regulations and Stan c s C TI Y OF AY Massachusetts.Staie Building Code,780 GMK 22 p ,sedMEar 20'IT (� Building Permit Application To Construct,Repair,Renovate Or Demolish,a One-or Two-Family Dwelling. This Section for Official use,my -. 1 BuildingPerit Number` oApplied: Budding Official(PrinfName) SignatureVDate: SECTION 1:.SI"T•E�INFOREMATION J.I.Propeoty A te: i:2 Assenors Mzp&Parcel Numbers �AAIA �J�C-J /lie (sakrl wl 1;I a is this an accepted street?yes x no: NIV Number.: L'aarce)LJ rpkzeF 1.3 ZoUWg.Inl6rnia6Dn:. 1.4 Property Dinteadomm Zo g act � sad`!I i of Area(stj&) r fiage(4) 1.5 Building_Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6'Water Supply:(M.G.L.c..4bk §54) 1:2 Flood.Zene..f darmati": I.1i Sewage Disposal System:, zow: Outside.Fler�rd.-Zone? Public 1 Private EV — Municipal® On site disposal system 0 Check if yes❑ 'SECTION 2: PROPERTY,OWNERSFIIP' 2.1 Own,.'of.Record:. 1ame,(Print) City,State,ZIP /�I,v►Ic+iwt�lOGw ,�G! 6o3-9s7-83ya �i�roC/�4�L 1/Cato 'No.and Street Telephone Email Andress SECTION 3:DESCRIPTION OF PROPOSED WORK2.(check all;that•apply) New Construction O Existing Building j$ Owner-Occupied' 0 > Repairs(s) 0 : Alterati (s) Addition _Demolition . 34 Accessory Bldg ID ` 'Number of Units Other 'O Specify: Bri9f Description of'Proposecf Word: rt rA4 . (dOr S Suia�IOor. niI icr.{c— SECTION 4:ESTIMATED-CONSTRUCTION COSTS Item (Labor and ate ais Official Use Only L Building 1. Building Permit Fee:.$ Indicate how fee,is determined! U Standard C3ityffowrt Application Fee ' 2.'Electrical ❑TotalTroject Costa(Item.-6)x multiplier x 3.Plumbing $ 2. Other Fees: 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ "Su cession Total•All Fees: Check--,No. Check Amount: Cash Amount: 6.TotalProect Cost: J $ �. /o` �.Vl/ Paid in Full l-l.Outstanding Balance®ue: N1 At ueD Tr3 G .L 71i s'j 11t__5 ^RAJ -a3o i2-i r7V�yr rr SECTION'5 CONSTRUCTIONSERViCES' 5.1 Cans#ctrcta©n Supetvssc►r License(CSI.) FjWirdfiwa Date Name of CSL Holder List CSL Type(see below) 34 ��11R� shre.F s No.fl t G Ol I�� V �d. �o.as+�OQ cu.ft..} ,R ';Restricted 1&2 Farnilv Dwellin Cityrfown,State,ZIP M Masonry RC RooSn Couerin WS Window an&d SF Solid Fuel Burning Appliances n��ke;xViel @�►�a►l.cap l Telephone Einar address D I Demolition 5.2 Registered Home Improvement Contractor(HIC) A66W f$ R 1/23/1q � 6L,40/ HIC Registration Number Expiration Date . HIC Company Name or HIC Registrant Name 3y No. Street. Miai,address`' i,Lq if//Q D/fL4, 35� 3 City/Town,State,ZIP Telephone 'SECTION6:WORKERS"COMPENSATION MSURANCE AFFi1DtI,VI i (M'•G.L•c.`I52.§"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 AfJ.THORIZATION TO'BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 4,as Owner Hof he<subjeGt:;pnoperty,hereby artftu�rize �H� C�-1 �C�� to act on my behalf,in all matters relative to work authorized by this building permit application. —7 Date- Print Owner's Name.(Electronic Signature): SECTION 7b. OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of pediry that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES. 1. An Owner who obtains a building perrnit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor,(HIC)Program),wil not have access to the arbitration program or guaranty fund under M.G.L.c.I42A.Other important information on the'IHC Program can be found at wAvw.mass. og v/oca Information on the Construction Supervisor License can be found at www.mass.eov/dns 2. Whein substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finishedbasementlattics,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 11 3. "Total Project Square Footage"may be substituted for"Total Project Cost"