9 BAY VIEW CIR - BPA-2010-948 2ND FL BATH �o 7
„
a The Commonwealth of Massachusetts
t Board of Building Regulations and Standards CITY
Massachusetts State Building Code, 780 MR, T"edition OF F.M SAL
C' Revised EM
Building Permit Application To Construct, Repair, Renovate Or Demolish a
1 One-or Two-Family Dwelling
This Section For Official Use Only
/1 Building Permit mber: Date Applied:
V' Signature: I �V9//D
Building Commissi6nerl Inspector of Buildings Date
SECTION 1:SITE INFORMATION
1.1 Prop�,rt�•Address: , 1.2 Assessors Map& Parcel Numbers
�Prop"
Gir_
Ma
I.la Is this an accepted street.o yes no_ P Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq n) Frontage(11)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system O
Check if es❑
SECTION2: PROPERTY OWNERSHIP'
2.1 ,,oc�wwner'olG Record:
/"lonariu,�'re /r�ruiPrti �ir.
Name(Print) Address f r Service:
t
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition MI Accessory Bldg.❑ Nuptber of Units_ Other ❑ Specify:
Brief Description of Proposed Work': 0 fp r0r1 .&0)i oor Aa4roopin
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1. Building 5 11a, ( I. Building Permit Fee:S Indicate how fee is determined:
�. Electrical $ ❑Standard City/Town Application Fee
QZ�d ❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing 5 2. Other Fees: S
4. Mechanical (HVAC) S List:
5. Mechanical (Fire 5
Su ression Tutal All Fees:S
^ Check No..�Check Amount: Cash Amount:
b. Total Project Cost: S a/ 0 Paid in Full ❑Outstanding Balance Due:
t
SECTION 5: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) /O
-;;7 rY SG17// l.icense Number I:spimtion Date
Name of C •I SI. lutder I.ist CSL Type(see below)
rs De I Description
U I llnresuicteJ(up to 15,000 Cu.Ft.
R I Restricted 1&2 Family Dwelling
f/Fl /r�o�'�7 % M R Only
f
RC Residential Roofing Covering
I'clepMme WS Residential Window and Sidin
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
FSignalu?51-4
meo Coatr}cto (HIC)I IC Registrant Name Registration Number
iV N US 06 n& n t!t-
ji- c7 o�".�J / X�9 Etpimtion Date
Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c. 152. 1 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 permit.
Signed Affidavit Attached? Yes ..........0 No...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
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.
Sianature of Owner Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
I, C/CIA 67, SN7 as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application arc true and accurate,to the best of my knowledge and
be�ha/l�fJ./y oA
Print
- Signalurc Fwwner or Autho Ced Agent Date�
(Signed under the pains and penalties of 'u
NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program), will hg have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.Other important information on the HIC Program and
Construction Supervisor Licensing(CSL)can be found in 790 CMR Regulations 1 IO.R6 and I IO.RS,respectively.
�. When substantial work is planned,provide the information below:
Total floors area(Sq. Ft.) (including garage, finished basement/attics,decks or porch)
Gross living area(Sq. Ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
J. "Total Project Square Footage-may be substituted for"Total Project Cost"