80 BAY VIEW AVE - BPA-14-638 RELOCATE KITCHEN ON 1ST FL *qTD 27 9
The Commonwealth of Massachusetts CITY OF
Board of Building Regulations and Standards Sr\LENT
tl Ih� Nfassachusetts State Building Code, 730 CNIR
Building Permit Application To Construct, Repair, Renovate Or Demolish a
One-or Two-Family Dwelling
This Section For Official Use Onl
Building Permit Numb r. Date Applied:
- - f Z
Building Olticiul(Print N:tme). Si at Data
SECTION 1:SITE INFORNIXTION
1.1 P ertyA dress: 1.2 Assessors Map& Parcel Numbers
rYU
I.la is this an acce ted street?yes noe Map Number Parcel Number
1.3 "Zoning Information: 1.4 Property Dimensions:
Tuning District Proposed Use Lot Area(sq 11) Frontage(It)
1.5 Building Setbacks(ft)
Front Yard Side Yards Reur Yard
Required Provided Required Provided Required Provided
1.6 Witter Supply:(M.G.L c.40,§5d) 1.7 Flood Zane Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Public❑ Private O Check if es❑ P p
SECTIONZ: PROPERTY OWNERSHIPtL
2.1 Own t of Record: AAA
mi3EA CH�nwie—
17�hme(Print) City,State,ZIP
6 /�a Yzl-wf>iVE _rof_� 5ySS�� r��t a6�sma,�•c
Nu. mid Street Telephone Email A drHs
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ 1 Existing Building Owner-Occupied Repairs(s) ❑ Altemtion(s) el Addition ❑
Demolition Accessory Bldg.❑ 1 Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work': _-z- I• cza t crn r , ti•—
IS
/ SECTION 4: ESTIMATED CONSTRUCTION COSTS
t/ It`in Estimated Costs: Official Use Only
Labor and Materials
I. Building S jUVn 1. Building Permit Fee:3 Indicate how fee is determined:
❑Standard City/Tuwn Application Fee
3. Electrical ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing S i. Other Fees: Sj� j
d. Mechanical (BVAC) S List:
i.:Mechanical (Fire rroad All fees:S
Suppression)
� Check No._C'heck Amount: Cash Amount:_
6,'rutal Project Cost: S S aZ 00 ❑Paid in Full ❑Outstandiu, Balance Due:
m�1 (_ 3j
.h
SECTIONS: CONS RucTfONSERVICES
5.1 Cmtstruction Supervisor License(CSL)
License Number E.epiration Date
Name of CSL[[older List CSL Type(see below)
Type Description
No. and Street
U Unrestricted(Buildings tip to 35,000 cu. IL)
R Restricted l&2 Family Dwelling
c'ityll'own,State,ZIP M Masonry
RC Rooting Ccvcrin
WS Window and Siding
SF Solid Fuel Burning Appliances
1 Insulation
'felt hone Email addrss U Demolition
5.2 Registered dome Improvement Contractor(HIC)
HIC Registration Number Expiration Date
f 11C Cuntpany Nome or 111C Registrant Name
No. and Street Email address
City/Town,State ZIP Tale hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(NI.G.L.c.15Z§ 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 Is§uance of the building permit.
Signed Affidavit Attached? Yes ..........❑ No...........❑
SECTION 7a:OWNER AUTHORIZATION,TO HE CONIPLETED WHEN.
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT'
1,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 Owner's N:mte(Electronic Signature) Date
/ SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
v
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 Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or anowner who hires an unregistered contractor
(not registered in the Nome Improvement Contractor(HIC) Program),will no have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program can be found at
wwwmasS. �04 y:!U Information on the Construction Supervisor License can be found at www.m:u,.aov!d.Ls
2 When substantial work is plumed,provide the intormation below:
'total door area(sq. 11.) (including garage, finished basementlattics,decks or porch)
Gross living area(sq. 11.) Habitable room count
Number of fireplaces- Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
l'ype utcooling system Enclosed._Open_
1. "fatal Project Square Foumge"may he Substituted tl)r"total Project Cost"