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B-17-632 - 0055 BAYVIEW AVENUE - Building Permit (a sib The Commonwealth of Massachusetts :c4 Board of Building Regulations and Standaid`s `` ` ., CITY OF Massachusetts State Building Code,780 CMR SALEM ' AN A � � � Revised Mar 2011 F7 Building Permit Application To Construct Repair nov emo tsh a _ - One-or Two-Family Dwelling '• 'Tlus Seefron F©r.(?�c Use C)n: , -711 �ii"ltliti�Perm�tt I�tuitilier Dam --��--�- S :CTIOIV;1'SITE INP0RMA7'ION 1.1 PropertCl� y Address: I 1.2 Assessors Map&Parcel Numbers l.la Is this an acc6pted street?yes no' Map Number Parcel Number 1.3 Zoning Information: ' 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 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.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0� Private❑ Zone: _ Outside Flood Zone? � � Check if yes❑ Municipal�On site disposal system ❑ :WTION 2: PR EII; "Y O VNERST . 2.1 Owner'of Reco Name Tint) �� City,State,ZIP �� 7w � d� No.and Street Telephone Email Address SECTION I DESCRIPTION OF PROPOSED WORK2(Check all that apply) New Construction❑ Existing Building❑ Owner-Occupied Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify: r'ef Description of Proposed.Work2: Al) J � C SECTION 4.ESTIMATED CONSTRUCTION COSTS plem Estimated Costs: Labor and Materials Official Use Only. ding $' "0. ,�' `1. BitilS�g Permit Fee.$. Indicate how fee is deteimirteFi 2.Electrical $ 0�0• 13 Standaul Cit /3 own Alicattan Fee Q TOW Proleet Costs(pent 6)'x uiultipIier x. 3.Plumbing $ v dd, d-v- : Other Fees: $ . 4.Mechanical (HVAC) $ List 5.Mechanical (Fire Suppression) $ Total All bees:.$ Check No. Check Amount: Cash Amount. 6.Total Project Cost: $ 3 5 ��, — 143 Paid in Full 13 Outstanding Balance Du SECTION 5: CONSTRUCTIO►Y SERVICES 5.1 Construction Supervisor License(CSL) j e License Niun er Ex ',►tion ate _ Name of CSL HuIJe' List CSL Type(see below) 1Ile TYI?a Description . No.and Street U Unrestricted DuilJin up to 35,000 cu.It. l 70 R Restricted 1&2 Family Dwelling City utm,State,ZIP M 'tiIasonry RC Roofing Covering WS Window and Sidin SF Solid Fuel Burning Appliances I Insulation Tcle hone ---Pmiril address D Demolition 5.2 Registered Home Imp rove ent Contractor(HIC) �� ) — d A HIC Reg►istra�hon Number Expiration Date III um any Name or IIC Regis ►non Nu ail et . ��-- � ��d Email address Ci /Town State ZIP Tele hone SECTION 6:WORKERS'-COMPENSATION INSURANCE AFFIDAVIT(M:G-L G ISM 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 Isitrance of the building permit. Signed Affidavit Attached? Yes..........o No...........O SECTION 70:OWNER AUTHORIAUTION-TO HE COMPLETED.WHEN. OWNERS AGENT OR CONTItACTOR:APPLIE9`FOR BUILDING* I,as Owner of the subject property,hereby authorize t9 act on my behalf,in all matters relative to work authorized by this building permit application. Print O%mer's Name(Electronic Signature) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Print wner's or uthorized Agent's Name(Electronic Signature) ate NOTES: I. An Owner who obtains a building permit to do his/her own work,or art owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program);will nu have access to the arbitration program or guaranty fund under NI.G.L.c. 1 d2A.Other important information on the HIC Program can be found at ww%v.nwss.eov'oca Information on the Construction Supervisor License can be.found at www.mass.30v/hlns . 2. When substantial work is planned,provide the information below: 'total fluor area(sq.ft.) N (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 Square Footaogc"may be substituted for"Total Project Cost" r 6 # 4¢L.�� •fir` �y, j� F � _ , i •u -710 41 .,p,• ,r. Sf' , :2':„ti �y •_ ......... m