17 BAY VIEW CIR - BPA-2009-106 DECK The Coin nonwealth of Massachusetts
r Bomd of Building Regulations and Standards
Ml'Nl( IP�ll'.\I-III' '
4 j MaSSachtISCUS State Building Code. 780('MR 7"' edition til.
+ p
Building Permit Application To Construct. Repair. Renovate Or Drnu)hslt a Krriwd. auuA,u,
One- or Tit o-FainiA• Dit elling
V This Section For Official Use Only
Buildin, Permit Nu her: Date Applied: _
Signature:
BUJIJn Cuntmissionv nspecturof Buildings Date
\ SECTION 1: SITE INFORMATION
1.1 Propert address: d,,.0- - r'-Ln 1h 1.2 Assessors Map & Parcel Numbers
I.la Is this an accepted street? yes no Map Nwnher Parcel Numher
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area!sq It) Frontage (it)
--- —'----- --_- ---____ _ --.idcd
IF 1.5 t;aildmg Setbacks (ftl ---- —._ .— ------------------
j Front Yard Side Yards _ Rear )'at(]
RcyuireJ Provided Required Provided Required '
1.6 Water Supply: (M.G.L c.40. §54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone'' Munici al ❑ On Site disposal System ❑
Public ❑ Private❑ Check if yes❑ p
SECTION 2: PROPERTY OWNERSHIP'2.11oA�er'off :�TA�A/F 17 a,/ A/
(Prim[ Address for Service:
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Cons[mctirn ❑ Existing Building ❑ Owner-Occupied ❑ 1 Repans(s) ❑ Alteration(s) ❑ Addition ❑�
Demolition ❑ .Accessory Bldg. ❑ Numberof UnIIs Other ❑ Speedy:
Brief Description of Proposed Workt: — ----
----
SECTION 4: EST:MA'fED C(iNS'i'4Eiif':L^i C.t:STS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I. Building $ I. Building Permit Fee: $ Indicate how tee is determined
❑ Standard City/Town Application Fee
2, Electrical $
❑Total Project Cost (Item 6) x multiplies x
3. Plumbing $ ?. Other Fees: $
d. Mechanical (HVAC) .8 List:
5. Mechanical (Fire S
Suppression) Total All Fees: S
O� Cheek No. Check Amount: Cash Amount _
o. Total Project Cost: $ 5,�)V — 0 Paid in Full 0 Ouisumding Balance Due:____J
SECTION 5: CONSTRUCTION SERVICES t
5.1 Licensed Construction Supervisor(CSL)
License Number F\pir:uion Date
Name of CSL- []older
List CSI_Tcpc ace M1clowy 4ddress -
T, c Descri pion
L t'nrestnetcJ (up(u ii,(IOO Cu. I'1.1
R Restricted IBC'_ Family Dwelling
Signature .'M Nlasonry Only
RC Residential Routing Coen n!
Telephone 'S Residential Wniduw :md Sidnh
SF Reside n al Soiid Fuel
\\ I3urnin,: :\ >>h:mec Ina.dLm„n�
PD Residential Denwhuun j
5.2 Registered Ilome Improvement Contractor (1110
HIC Company Name or FIIC Registrant Name Registration Number --
Address
Expiration Date
Signature Telephone
S.sL:10::o: {",'O&i+r.RS' L(Ufvi PEN SA 1 r¢.iN uVSYietwrvi:r.Ar-r tuw'v rT ifr7.G.i. e. :.i2. y 25Ci6:;
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to pro'.ode
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached'? Yes .......... ❑ No —........ ❑
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I• as Owner of the subject property hereby
au r thoize -- to act un rev behalf, ir• all Matters
:a!ative to %vork authorized by this building permit application.
I
Si=mature at Owner Date —_--_SECTION __—
7b: OWNEW OR AUTHORIZED AGENT DECLARATION
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.
Print Name
Signature tit Owner or Authorized Agent Date
(Signed under tie -,dins and :cnal;res cf er'ar)
NOTES:
I. An Owner who obtains a building permit to do his/her own work or an owner who hires :tn unregistered contractor
(nut 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 and
Construction Supervisor Licensing (CSL) can be found in 730 CMR Regulations I IO.RG Lind I IO.RS, respectively.
, When substantial work is planned, provide the information below:
Total flours area(Sq. Ft.I (including garage, finished basement/attics. decks or porch)
j Gross living area (Sq. Ft.) Habitable room count _
Number of fireplaces Number of bedrooms _
Number of bathrooms Number of halt/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"