82 BAY VIEW AVE - BPA-12-200 REPLACE 5 WINDOWS The Commonwealth of Massachusetts
' Board of Building Regulations and Standards FOR
Massachusetts State Building Code,7.80 CMR, 7i'edition MUNICIP E,ALITY
US
Building Permit Application To Construct,Repair,Renovate Or Demolish a RevfsedJwmary. -
One-or Pwo-Family Dwelling 1, 2008
This-Section For Omci s Only, .
Building Permit Number Date p
�C Signature:
'Building Commission eetor ofBuildmgs
SECTION 1:SITE iNmKmATION
1.1 P opep{y Add\egs;, : J I.2 Assessors Map &Parcel Numbers
, e.a sw y.y.- 13 LI.-.. ..
1.1 a Is this an accepted street?yes_ no Map Number Parcel Number. t
QK�
' 1.3 Z QnnningInformation: 1 7.4 Property Dimensions:.
Zoning District Proposed Use. 1 Lot Area(sq ft) Frontage(fl) -
1.5.Building Setbacks (ft),
-Front Yard Side Yards ReaYard-
Required Provided .' Required Provided Required Provided .. .
L6 Water Supply: (M-G.L n.40,§54) 1.7:Flood.Zone Information:-, 1.8 Sewage Disposal"System:..:..."-..-"
Zone Outside Flood Zone?•. F 0 On site disposal system 0
Public❑' Private — Munici al.
' Check if"yesO
SECTION 2- .PROPERTY OWNERSHIPt
2,1 Ow ert of Recordj�,
Name(Print) - Address for Sery cc '
�t S' 7gLi s3 i
Signature .. Telephone
SECTION 3:D SGI2IPTION OF I'I20I'OSED'WQRK�'(ekeak all that apply)
1vea''C nsuct on ❑ Ext t.r- Bu klui^.❑ Omher-�ccu d ❑ ;qe ai s s .0 "at is ) G^' cdeuc^ p
�.�
Deriolitinn ❑ AccessoryBIdz'D J NumberoMnits_ Other Specify:_.-. :_ .- q�j?
Brief Description of Proposed Work'': t c '
� 0 STfue�J��
SECTION 4:ESTIMATED CONSTRUCTION COSTS "
Item Estimated Costs:
(Labor and Materials) Official UseDnly
I.Building $ oo 1. Building Permit Fee:$ Indicate bow fee is determined:
2.Electrical $ 0 Standard City/ own Application Fee "
11 Total Project Cost(Item 6)x multiplier x .
3.Plumbing $ 2. Other Fees: $
4.Mechanical.(HVAC) $ List
5.Mechanical. (Fire
Su Sion) $ Total All Fees:$
CbeckNo. Check Amount: Cash Amount.
b.Total Project Cost: SR., F59,00
0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRIICICIN SEIISCES
5.1 Licensed Construction Supervisor(CSL)
License.Number .Expiration Date.
Name of CSL.Hold 'g LisrCSL Type smbelow
�lo �-V`n_,�\ l'i(` li✓0/� Wt�al6�3 1'P ( ) 1` y
Des,:`tion
Add .e `:2i:�"•-_.`;.;•,: . :. :.,.
_ U Unrestricted ' to 35,000 Cu.Ft
Signature - .: R Restr=Q 1&2 Famrl Dwelling .
_Sb 2 G k�i Y cict NI Naas Ord
Telephone. - RC Residential Roofing Covtnn - - -
WS Residential Window and Siding,
. _ SF. Residential Solid Fuel Burning ApPliance Installation
D Residential Demolition
Registered Ho a Impr`q�vemQQnt Contractor(MC)
iGPI�Pt�.✓ ( .. Whc7eY7C '1 I -I �� CUI ..
H1CCo yNam orH] istrant a Registration.Number
ta4 i� 1 . ar a n2o
nd=2igna ur (�F`UP{r/•a Expiration Date _ . . .
Telephone .,
SECTION 6:WORKERS, CONEMNSAITON INSURANCE AFfiIDAVIT M.G.L.c 152.:y 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 pemrit
Signed Affidavit Attached Yes ......... No..........❑
SECTION 7a:,OVV? Y?giiTHbR 4TIPNTOBE•C!p&IP ETFID N
OWNER'S11AGENTfl1 Cnn'NT,h-kC.T- R SPPLt] SFA3LBIIILi1Il� P 12t11�T- .
Z VOa r tl n vv�� ^ as Owner of the subject property hereby
authorize (5 r, n U to act on my behalf in all matters
relative to work authorized by this building permit application.
Signature of Owner .. .. Dare .. _
-S'EC3`"lrbt OWNERt•:OR 43]l HmRl yAa
l4rverprAttf}tcm- d-Agent hereby rtdO to
Ilia(tilt staFM13LS and itifotatation on.the foreeoiu- appU---,-n aretrue ais"d acc'tua t;to ilia best of m;k roarledge and
.Print Name
Signature of Owner uthar7zzel.. _ Date -
(Signedunder the ains and malties of -u T -
NOTES:
1. An Owner who obtains a b0ding.petmit to do his/her own work,or an owner who hires an tmregistered contractor
(not registered in the Home Improvement Contractor p (HIC)Program),will not have access to the.acbitratim
program or guaranty fund under 1vLG.L.c. 142A.Other important.information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 780'CNIR Regulations 110.R6 and 1102,5,respectively.
2 When substantial work is planned,provide the information below ri
Total floors area(Sq.Ft). (including garage,finished basemenUattics, decks or patch)
Gross living'area(Sq.Ft) Habitable room count
Number of fireplaces Number ofbc&ooms
Number of bathrooms Number ofhaMaths
Type of heating system Number of decks/porches '
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted"for"Total Project Cost" �u U�