9 BAY VIEW CIR - BPA-15-248 FINISH BASEMENT The Commonwealth of Massachusetts RV I ES
Board of Building Regulations and Standards INSP CT 106
Massachusetts State Building Code, 780 CMR SALEM
I1t15 ts=�M`�°� 2
Building Permit Application To Construct, Repair, Renovate Or Demolish 4P
One-or Two-Family Dwelling
y This Section For Official Use Only
J^ ' Building Permit Number: Date A hed:
1 n Building Official(Print Name) g 1
Signature Date
1J l SECTION 1:SITE INFORMATION
I 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
RAV V rty
Lla Is this an accepted street?yes ✓ no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage Ill)
1.5 Building Setbacks(ft)
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?
Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
E!hfo"r <l +V� Mtn �crs�rrie SdLM HA 4'>1970
Name(Print) City,State,ZIP
` 1�TV�w 42�z14 7 1-.321'7373
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED ORKZ(check allthat apply)
New Construction❑ Existing Building&I Owner-Occupied 91Repairs(s) 9rJ Alteration(s) V1 Addition ❑
Demolition ❑ Accessory Bldg.❑ 1 Number of Units_ I Other pecify:
Brief Description of Proposed Work: �Jtish ce.wrnrf— DraO �rtr�iiwg
�XH Fr®u,q I
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
Labor and Materials Official Use Only
1.Building 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x
3.Plumbing-N .F- $ 2 1 �o "`1 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fees: $
Check No. Check Amount: Cash Amount:
6. Total Project Cost: $ � 23 ❑Paid in Full 13 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) Oea`)'{3 > /6 -2
mimes R. License Number Expiration Date
Name of CSL Holder
4
List CSL Type(see below) U
f�rmaK .St
No.and Street Type Description
.� U Unrestricted(Buildings up to 35,000 cu.ft.
�S<by it t/ O( P7 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
��b%6D`'1-91s� S6 CSr N®�v !o II Insulation
Telephone Emahjddress D I Demolition
5.2 Registered Home Improvement Contractor(HIC)
[f >5�r3�P /n 7/e r� y_� ow r r`t K HIC Registration Number Expiration Date
HIC Company N e or HIC Registrant NAde
.Sr, A). Py±nAm a- l�6sbvdsSian 1� c�i/n�.k.co
No.and Street ail address
f�.,verr Mgt o192�'�%�-77y-000Z
Ci /Town,S e,ZIP Telephone
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. Failure to provide
this affidavit will result in the denial of the Issuance -building permit.
Signed Affidavit Attached? Yes .......... 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 A—Mxx /2, P�iZe
to act on my behalf,in all matters relative to work authorized by this building permit application.
C-7r„e�h J 6-`LAI�, 'r C 6 -A-,d>1 r
Print Owner's Name(Electronic Signature) I Date
SECTION 7b:OWNEW 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 application is true and accurate to the best of my knowledge and understanding.
Print Owner's or Authorized Age P e(Electronic Signature) Date
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 not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.masssov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor 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
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
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