17 BAY VIEW AVE - BPA-2010-332 REPLACE 8X10 MUDROOM F 3
The Commonwealth of Massachusetts(� Town of
Board of Building Regulations and Standards
v�lhJl �� Massachusetts State Building Code, 780 CMR, 7"edition Building
Building Permit Application To Construct. Repair. Renovate Or Demolish a 1d '
One-or Ttro- coni1v Dwelli g
This Sc it n For Official se Onl
Building Permit Nu c e Ap lied:
Signature: Date
Budding Commisstone Spector o(Bu
SECT[O ITE INFORMATION
1.1 Prop Ad ess: 1.2 Assessors Map& Parcel Numbers
Ma Number Parcel Number
I.I a Is this an accepted st eet''yes_ no p
1.3 Zoning Information: 1.4 Property Dimensloas:
Zoning District Proposed Use Lot Area(sq ti) Frontage(fl)
LS Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40.154) 1.7 Flood Zone Information: 1.3 Sewagee/Dlyposal System:
Zone: _ Outside Flood Zone? Municipal Cr On site disposal system ❑
Public Private ❑ Check if vcs0
SECTION2: PROPERTY OWNERSHIP'
2.1 ert of Reco i e� Ave,
a e(Print W Addresls fo ice:
��- 2VV--6 9,kD
atu Telephone
SECTION 3: SCRI ION OF PROPOSED WORK'(cheek all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_ YYI to Other Specify: e r
ono
Brief Description of Proposed Work':
t
OVA a
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: Official Use Only
EPlumbing
I ahor and Materials
f I. Building Permit Fee: f Indicate how fee is determined:
❑Standard City/Town Application Fee
f ❑Total Project Cost'(Item 6)x multiplier x
S 2. Other Fees: S
HVAC) S Ltst.
s .Mechanical 1Fire S Total All Fees: S
Su ression
Check No. _Check Amount: Cash Amount:_
6. Total Project Cost: S Q6G t 0 Paid in Full 0 Outstanding Balance Due:
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL)
License Number Expiration Dam
N;poe of CSL Hplder
a List CSL Type(,cc be ow)
Address Type Description
U Unrestricted(up to 35.000 Cu. Ft.)
Signature R I Restricted 1&2 Family Dwelhn
M I Mason Only
RC I Residential Roofing Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D I 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.§ 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 .......... O No...........O
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
i• 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, 'e ,as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing ap lication are true and accurate,to the best of my knowledge and
behalf
r
Print ame
Signature of Owffer or 01h6rized Agent Date
Signed under the pain and Penalties of peru
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 W have access to the arbitration
program or guaranty fund under M.G.L. c. I42A. Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I l0.R6 and I IO.RS,respectively.
2. When substantial work is planned,provide the information below:
Total floors area(Sq. Ft.) (including garage, finished basementiattics.decks or porch)
Gross living area(Sq. FL) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of halfbaths
Type of heating system Number of decksi porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may he substituted for 'Total Project Cost"