82 BAY VIEW AVE - BPA-2009-90 REPLACE 10 WINDOWS The C'omnwnwealth of MaSSaehusettS t IR
Htrud of 131111ding IZc_ulatiuns and Standards Nk Nit ll' \I.I'I l
h1assachuscnS State 131,611-fing Code. 750 CNIR. 7°i edition \I,
V Building I'crmit Application To ConsuucL Repair. Renovate Or I)cnudish a
2cw, rJ h�u ,tn-
One- or Ta Durllin,G 'uns
Th . ection For fficia, Use Only
Building Permit N rnher ate Applied:.
Signature: _--------------
If ild C•ommissloner/ Inop o Ines Date
,SECTION 1: SITE INFORMA'rION
1.11 Property Address: q 1.2 Assessors Map & Parcel Numbers --- —"
IJ t /t1
1.1 a Is this an accepted street? yzs '✓ no_ Map Numher I';ucrl \'umhrr
1.3 Zoning Information: La Property Dimensions:
Zoning District Proposed l%se Lot Area(sq it) Frontage(li)
1.5 Building Setbacks (ft)
Front Yard Side Yards Rear Y:ud
I Required Provided Required Provided Required Proc drd
i
1.6 Water Supply: (M,G.L c.4o. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone:'
Public❑ Private❑ Check if yes❑ Municipal ❑ On site disposal s}'stcm ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
)n r r r knrrvan
Name(Print) Address 1'or S rvice:
i c n h ._ F (02S) 7*1 - &6,259
! Telephone
Sienum rc
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction ❑ Existing Building ❑ Owner-Occupied ❑ Repairs(s) ❑ rVlteration(s) Q Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units_- Other ❑ Specity:
Brief Description of Proposed Work':
iv, all ten Ipl V Ir,C P ay ni t.11)1—r
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs: official Use Only
Item (Labor and Materials) _
1. Building 'S Q I. Building Permit Fee: S Indicate hum tee is deicnnuied:
❑ Standard City/Town :\pplicatiun Fez
2. Electrical S ❑ Total Project Cost' (Item 6) x multiplier x .
�. Plumbing 5 2. Other Fees: $
4. Ivlechanical iHVAC) S List: ----- -
5. Mechanical (Fire ti Toed \II Fees: S ----
Su pressioro -
Q Check No. Check Amount (`.i,h :\nn nun:
b. Fowl Project Cost: S ❑ Paid in Full ❑ Outstanding 13;ilanrr Due_--_._---
.
SECTION is CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor (CSLI 15 - —_�� 09 r .
__ hrlsiz 7_or LlceJn>a Numhei I'\pir:wan Dane /
Name )I C'SL- I luldIII Qer
L�- CJ� List CSL l\'pe tea hei'm
WJras> 'I\ e Descn rium
C l'nresMClcd 11111 (a ',5,0 10 Cu. Pt.
R Restricted IR'_ F:umh fAellutg
Signature %I NIauonpY Onh
(q-� 7�{l'e7Nd/{ RC' Rest dentalRowmeCo�etmg
l elopha le \\'S Rea dental \ti ndu�% .md
SF Residential Solid I'.lel Itumme A >>Iema In,(.ill.1two
D Re+Idenlnd Demulmon
i.2 Registered Ilome Ian rovemenl Contractor (H1C1
A �' A SPa ✓I p . Lr�C'
Ii IC Company Name or HI Registrant Name Regl(s�utzoii Number
Addres h ��-t to
i6 O F.Ypll all�nl Dale
Slgnut Telepume
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. FallUl"e to prueide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached'? Yes .......... ❑ No ........... ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S 'OR CONTRACTOR APPLIES FOR BUILDING PERMIT
L -Rr, rhn
rn nry)CAr\ r as Owner of the subject property hereby
authorize v ){CIS to act on my behalf. in all matters
relative to work authorized by this building per mi application.
Signature of Owner Date
�
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
I �'. � 5f.7 -phe Y �r-2-t-A , as Owner or Authorized Agent hereby declare
that the statements and information on the f egoing application are true and accurate, to the best of my knowledge and
behalf.
t'rin[N in
.Signature Owner or thoriud Agent Date -
(Signed under the pains and penalties of ejur )
NOTES:
I. An Owner who obtains a building permit to do his/her own Yvork, or an o\aner who hires in unregistered rontraclur
(not registered in the Home Improvement Contractor (HIC) Program), will not have access io.the :ubili:lion
program or guaranty Fund under M.G.L. c. 142A. Other important inRnmation on the HIC Progrun and
Construction Supervisor Licensing (CSL) can be found in 780 CNIR Regulations 110.R6 and 1 MR5. respectively.
I _ When substantial work is planned, provide the inhumation below:
To(al flours area (Sq. Ft.) (including garage, finished hasement/attics. decks or purchl
f Gross living Linea (Sq. Ft.)-- Habitable room count _
Number of fireplaces Number ut bedrooms
Number of bathrooms Numher of halt/ha(hs
fvpe of heating system Number Ot decks/ p,achcs .--------.._--___-_
l�ype Ot COO]ine s)'stem Enclosed ()pen
3 Total Project Square Footage- may be substituted for "tonal Project Cost"