14 BAY VIEW CIR - BPA-2010-1000 17 REPLACEMENT WINDOWS �0
The Commonwealth of Massachusetts
I IUI v Board of Building Regulations and Standards CITY
Massachusetts State Building Code, 780 CMR, 7°edition OF SALEM
r Revised Jum,ury
Building Permit Application To Construct, Repair, Renovate Or Demolish a 1. 20011
One-or Two-Fumdy Dwelling
This Section For Official Use Only
Building Permit Numbe Date A p ied:
�,p�,,,,.,,
Signature: 6�ow/o
Building Commissioner/Impectuf of Build
i gs Date
S C I:SITE INFORMATION
1.1 openly ddress: /n1 '�/ 1.2 Assessors Map dr Parcel Numbers
(. '
I.I a Is this an a e led street?yes ✓ no Map Number Parcel Number
IJ Zooing Information: IA Property Dimensions:
Zoning District Proposed Use Lot Area(sq 11) Frontage(11)
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:
Zone: _ Outside Flood Zone?
Public❑ Private❑ Check il' es❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 'of Rec�o��nd..��
AaM
Name(Print) Q �- Address for
/Inn /tic� 97,f-3�- 72/ 3
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units_ Other ❑ Specify:
Brief Description of Proposed Work': Y✓G
G✓, nDowC
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: OMCISl Use Only
Labor and Materials
I. Building S 1 I. Building Permit Fee:S Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical S ❑Total Project Cost(Item 6)x multiplier x
3. Plumbing S 2. Other Fees: S
4. Mechanical (IIVAC) S List:
5. Mechanical (Fire S Total All Fees: S
Suppression)
Check No. Check Amount: Cash Amount:
6. Total Project Cost: S 016 0 13 Paid in Full 0 Outstanding Balance Due:
SECTIONS: CONSTRUCTION SERVICES
5.1 Licensed Construction Supervisor(CSL) . 0 /�
boo -! ua�a lf} I.iccnse Number I:\pIrJ11Un Date
N rur�e� of C'SI. I lolder f/ List C'SL Type(see below) .
NDRcii'"dential
Description
ress uicteJ a to JS,000 Cu. Ft.
re n enilRoli I'dephone enilSul(d Fuel Bumin A (lance Installation
Demolition
5.2 Registered Home Im rovemeot Coatnctor(HIC) �Sg7'
Roane � - go%A„�ss ,k
-
I IIC Com�my Name or HIC Registrant Name Regisimllionn Number
AJJre ' �1,2--7 Al-0 7-
97,f-,'a 5-yo Expiration Date
Signatu Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. 1 2SC(6)) 41
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 .......... d�-' No...........O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
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.
Signature of Owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
1. [ n aC,&�yl ,as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and
behalf.
P '
lfo�2.1 /D
Signature o' )wn Agent Date
Si pain d penalties of 'u
NOTES:
1. 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 VJ 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 I I O.R6 and 110.1i respectively.
2. 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
3. "Total Project Square Footage"may be substituted for"Total Project Cost"