4 BAY VIEW CIR - BPA-13-330 ROOFING I'lie C'urnrnulm,callh ql .uv,lvhusclls
�{�U r; " Board al;Ilt(ildinb Regulations and Standards CI I 1 OF
tJl s ";lSSachusettS Slate Building IlurE'�� �cede, �sD chlR SALM
b"•• /?,,I t ed
I)uilJing rermit �\pplicrtion To C'onstnlct. Repair, Ilrnuv;tte Or Den dish a
One- or Tuvr•Piundl On l(Ar,�r
This Section For Dtli•' Use Onl
Building Permit Number: D e Applied:
Ihu IJmy 1)111c1a1 I pant N;une) /��.J/
.tiiyrmlurc Dote
SECTION I:SITE INFORMATION
�Y1/��Ll n A t n
t.l Pro/11,erty address: LS Assessu Alap dt Parcel Numbers
'7
I.la Is this an acce led street? a x no \lop Nun,her Parcel Nmnlxr
I.! Zoning Informatlont 1.4 Property Dimensions:
Luniny Disiricj— I'n�puscd(/.ve Lor Anu(y It)4 Fnmtuye(Il)
1.1 BuI1dInE Setbacks(R)
From Yard Side yads
Reyuimd Provided Near Y;ud
Required Ikuvided Reyuimd II'rovideJ
1.6 Water Supply:IM.G.1.c. J0,§! ) 1.7 Flood Zone Informatlont I a SewaEe Disposal System:
Publk❑ rris ale❑ Zone: _ Outside Flood Zond?
Check it es❑ Munkipd❑ On di site disposal y)yhm ❑
SECTION 7: PROPERTY OWNERSHIPS
2.1 Ownerl of Recor
is/a f'A CLaC SAl Env /hA O!rrl0 Nunu(rnN) c u>,SWtu,l.IP
--��/fir GaQT
Nu.and simet
' telephone Emuil Addmys
SECTION JI DESCRIPTION OF PROPOSED 1YORKS(check all that apply)
New Construction ❑ Existiny Buildiny❑ Owner•Occupied O 11 !: ll) O 1 Alteratlon(s) ❑ Addition ❑Del lulition ❑ 11Accessory Bldy, O Number of Uniq_
DriafDescript(onof—poled \vork-: Other ❑ .Specify:
�'Ch�v6 /a.LG
SECTION J: ESTI,►IATED CONSTRUCTION COSTS
Iten, Estimated Costs:
ILahur and \laterials) Ofllclal Use Only
I. DuilJing S I. Building permit Fee: S Indlcme how ke is determined:
'. Electrical S ❑Smndard City:Tussn Applkalion Fee
I 1'lunih;ng S ❑Tonal project Cost'I Item 6).r multiplier
Olh er Fees: -
J. \Icch.mic,,l III\ \('1 S List:
ltceh.mic-11 --
_Ilf"re"lool S fatal \II Fees: S_ — -
0 Fool I'r+,ject CI,NI; i p ( hceA \'u. _ __( hcd .\mount: lash \nnnnn:
(��j Ob w ❑raid In Full 0 Outsumdil,g llal.mcc Due:
n, 1 x
SEA 1'I0Nt: ('1)NSI'RI1CrIONSFR%'1('ES
cs$-L o97W 2_& -IP41
S,1 ('onstructiuo Supenisor License ICSI.I j: ,ir:aion Ilat¢
icenw I
SOSA Nuulhcr
'... ---
N.uned'l/'�SI. ILdd/cr
/i7�_ 4%L V p; Ihicriptiun
No. .u1J jIraet 4 (1 l�nreslridcdllluddin sli to lt,11110 cu, Il,l
R RnlricteJ IRS P.unil Daellin
Nlasoll
OlNikre1,,Stine.LII' R,Mdin 0,%erinil
µ'S µ'induw.mJ SiJin
SF ,,ulij Fuel Ilurning APPliunces
I Insulation
9��'25� _ U Dmnoliliun
l'elc hone fm;lilaJJrcr1
S.2 Registered Ihime Ingsruvenleat Contractor(IIIC) l y( 7f12_ °13
!0 nJ�fI/G IIIC Rcgistr;aien Number I'\pinuion Will
I IIC Cuulp�n) N,une or IIIC Regislmnl Nanto lintel!uJdress
No. and hit
�6 I elc hone
Ci /Town, State ZIP
'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 157.1 35C(
SECTION 61 WORKERS
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this alfidavit will result in the denial of the Issuance of the building permit.
Signed AffidavitAttached?
Cyip
••••
O No...........O
SECTION 7al OWNER AUTHORIZATION TO BE CODIPLETED 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.
I'/rioit ULeAa er's
lccwnic la Oale
lNa
n"(E Swn
SECTION 7bs OWNER' OR AUTHORIZED AGENT DECLARATION
By entering Itsy name below, I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and a curate to the best of my knowledge and understanding.
f//ci ok Sd SAMINI
Ihiul Uaner's ar:\ulhuNeJ,\gull Na11W I IIktfn1� SiVil Jl
NO'TESs
1. .\n \%,ner red in the a e I hires am unrcgistcre
n pro vanenttCu umlctor IHIC) Programl.n allnu, `have access to the arb'nrditiun tractor
pmgra i1or guarmtyinfomru fun on the Construction4upen iar Li close can be found atormtion on the C Program c'n`bel'WunJ a,
ro%ide the information below:
\\'hen substantial lsurk is planned, p I including garage, tinisllcd bascnlcnL attics.decks or Porch)
rots) floor area(,y. R.) . --- llabil.lble ruunt count
tiros lining area 154. It .--... ._. .. Number of hcdroouts . . .
1 \unihcroftircplaccs .. ... _ - -- \unlbetol'halthatbs
\uniherol'hathroonls - \un,hcrol'dcck;. po%llcs
I\pc of hc.aulg s),Iem Fnclo,cd .01wil
f�pc I'av,hng s�:mm
1 •I Baal prolvo Square I',1nt14c 111,11 he .uMllt IiP 'I'olal I'rgjcct Cu,i