96 BAY VIEW AVE - BPA-13-247 REDO 2ND FL BATH :1 --- I he C'onunonsvcahh of blassachuscits _
�\ s; S� Board of Building Regulations and Slandards CI'I'1 OF
/ s{' N1as.aarhwelts State Building Cute, 79U SIN M
L.,., lr,•tl, IGu all
Building Permit Application 'rn Construct, Repair, enuvate( Demolish a
Otte-or Trrrr-t"o nrlt Dtrdll 11,11
This Section For 011iciu Use Onl 1
Building Permit Number. Uate,\pplicd:
s r '
S 1 e
IuilJinp Ullicial(Print N;une) tiisignal '
� Owe
SECTION I:SITE INFORI T16
L Itpperty Address: 1.2 Assessurs Sle & orcel Number
r
1.la Is this an acce led street?yes t,,` no \lap Number Parcel Number
I.J Zoning Infortnaliont 1.4 Property Dimensions,
Znnin DDistrict 1'mpoxd tl---w Lot Arch s Iq I V Fmntage(Il)
1.3 Building Setbacks(R)
Front Yard Situ yardsRequiredI'raviJed Required Side
Require Rear Yardd Provided
1.6 Water Supply:(M.G.I.e.40. §sy) 1.7 Flood Zone Information, 1.11 Sewage Disposal System:
Rtblic O Private O Zone: _ Outside Flood Zone?
Check If es0 Municipet O On site disposals)stem 0
SECTION2, PROPERTY OWNERSHIP'
2.1 Owners of Records
C/ C il),Sulu,/.1P
tE-� fl�� �� YID(]��l�UT��
Nu..md StrceV � �� �� M,41 i7tinSo l/%.
felephune hmatl Address
SECTION J: DESCRIPTION OF PROPOSED WORK'(check ail that apply)
New Construction t7 E.eisting Building❑ Owner-Occupied ❑ Repairs,,) p Alteratton(s) 0 Addition O
Demolition O Accessary Bldg.❑ Numberof Units
Brief Description of Proposed \York': Other ❑ .Speeity:
SECTION 4: ESTI;II.ATED CONSTRUCTION COSTS
Item Estinmled Costs:
ILahur:utd\I:nerlall) Ofllcl+tl use Only
I Building S J—d 9p I. Building permit Fee: S Indicate how tee is determined:
2. 1,1wrical S o O Slandard City:Tuwn Application Fee
1 11'lunihing S ❑Tutal Project Cust'(Item 6)v multiplier x
/�v v '. Other Fees: S
I �. �Ieenattie.tl n\ W) s List:
\tech.wir.d (Fire ---
�u,vessionl S r,tal .\it Fees: S_ -- -• - - .._ . ._ . ._
rolel Prnject CoH S �v O ChecA \u. _ _( hacA.\m,nutl: _. .._ .
l'ioh \uuninc
P.iiJ m Full O(htstauding Hal.mcc Due:
SECI'loNt: ('()NSI'Rl1C' I )NSI'.HVI('Es
S.1 Construction Supenisur Li ce n se ICSI.1 — j y;inuiau Dale
I icensc Nunthcr
- L61
cr InI01. 1)pelaecN,._.____ I nresuictnJlllwlJi❑ sti ut 1t,UW)at I .I
Itetrioed I&?1'.uni1 LIP Hl' H,M)1in Cuverinpg Rindoa ,utd Sidin
SFInstitutionI'InailaddnaaDemolition
�,2 Registered Ilume Improvement Contractor(HIC) ill-'I-- r Evpiraliuo Date
I IIC Canlpmt) N,une or I IIC Rcgistrunt Nmne limuil----s
No, and Street
Few one 23C(6))
SECTION 61 WORKERS'COMPENSATIO
Ci lfown.State ZIP
N INSURANCE AFFIDAVIT(M.G.L C. I32.
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this atfidavit will result in this denial of the Issuance of the building permit.
Signed AllidavitAttached? Yes..........
No...........O
SECTION 7a1 OWNER AUTHORIZATION TO 8E CODIPLETED 1VHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1, 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.
Data
I'riot Usvner's Nmne(Elccounic Signutum)
SECTION 7b:OWNER' 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 applicalian is true and accurate to the best of my knowledge and understanding. �
Dual
I'rintUu let,sir:\uthuricd,\ 1'+Name 11!Icctruni'Signauua)
NOTEst
1 InutOregistered inbhelII Hume ImpruvViltnttContractorlHICII Program), ill% ner lhavehattess to ircsin thearbi unre ft
gistered at
grog`am or guarm lyt lfomxu tin tin he Coastruct, Other important ian Supers for Li ease.,nn be found atdon on the C,Prugrans'c'n`bel1itund at
+ \\hen subil;uuial ourk is planned, provide the inlunnatiun below:
t including garage, linished basement attics, Jerks or purclu
rotal Visor,area 1'+ 11.1 - --- Habilabte ruuni count
GruisIt\irtgareal411.) -,. \uother kit*hedraants
I \umber of lireplaees .. ... _ --- \amber of hail'hell"
\unihcraq badtremni , . - \untheralJocks parches
I\pe al'he.lung i),tem l)pan
iIhtclo,eJ
I\pc,dcralwg ,)aeut
t ..I,tial 1'mlra Square Paalage•' m,t) De,ub,liaaed li,r"ratal llrujeo Coal'