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16 BEACH AVE - BPA-2008-917 POUR FOUNDATION UNDER HOME The Commonwealth of Massachusetts 1'OR 5 i s 13oaid of Building Regulations and Standards NIUNIC11).V.ITY i Massachusetts State Building Code. 780 C'MR. 7 edition USG =: :W 1 Building Permit Application To Construct, Repair, Renovate Or Demolish a Rrid.,'rd li„uau.r One- or Tiro-Family ply Dwelling XThis Secli( 'For Official Use Only Building Permit Numbe . /J ate Applied: / Signature: i°�"' `v^ glylol - - — BuildingCommissioner/I nspectorol Building- Date �w\\\ SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map X Parcel Numbers L la Is this an accepted street?yes_ no Map Number Petrel Number — `1.3 Zoning Informations IA Property'Dimensions: LDistrict Proposed Use Lot Area(sq Ill Frunt:�ce (ft) uilding 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) Municipal Jq On site disposal system ❑ Public(A Private❑ Check ifyesO SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Name(print) Address for Service: 1 _ e RIB S78 !4 - Si)_ amre s.�.0 Telephone SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) O Alteration(s)X Addition ❑ Demolition ❑ Accessory Bldg. O 1 Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': 'F- ula F7b1_l"Q L>cc't OA& U tyCYTZ L`xt ST 1 SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) L Building $ 1. Building Permit Fee:$ Indicate how fee is determined: i ❑ Standard City/Town Application Fee 2. Electrical $ ©0 ❑Total Project Cost' (Item 6) x multiplier x 3. Plumbing $ 3. Other Fees: 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire Su ressiun) $ Total All Fees: $ 'O Check No. Check Amount: Cash Amount:__ 6. 'Total Project Cost $ O Paid in Full ❑ Outstanding Balance Due:- 5 SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) J!, [ .��q ©( o e_ 1 " Liceli-isle Numhei I Espirati n Data Name-t�pCS�(olderGd � �A L E� „� S4 List CSL Type(see below) --e/ O 'v( Type Descri Uoo -%ddres Unrestricted to tit.l 5.000 Cu. Ft.i --iceeI4 R Restricted l&2 Family Dwelluia Stgnaturc yy�� M Masonr Only q7 — -t=) RC Residential Roolin•Coverin Telephone WS Residential Window and Siding SF Residemial Solid Fuel liurnm A t,banca Ina.d lamni� D Residential Demolition 5.2 �Re t• ered liome Improv ment Contractor(HIC) or HIC Ll HIC Compan Name or HIC Re�strant Name Registration Nu fiber I �� #j.� „yL 0_,11 oe Address '.. G E. trauua, ate..:.: Signature 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 of the building permit. Signed Affidavit Attached? Yes ..........A No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT III' 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. . Signature of Owner Date SECTION 7b: OWNER' 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. l_--L Print Name/? Signature of Owner or Authorized Agent Datof (Signed under the 2ains and penalties of perjury) NOTES: 1. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor Contractor HIC Program), will not have access to the arbitration registered in the Home Improvement ( ) 7— program(not g 142A. Other important information on the HIC Program and or guaranty fund under M.G.L.c, p Construction Supervisor Licensing (CSL)can be found in 780 CMR Regulations 110.116 and 1 10,115, t'especti%ely. 2. When substantial work is planned, provide the information below- Total floors area(Sq. Ft.) (including garage, finished basement/attics.decks m porch) Gross living area iSq. Ft.) Habitable room count Number of fireplaces Number of bedrooms j 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" - t � 5 1 � i� r: • �Lcg-cF1 (-�2 ��1...1� rL i _ I � s eJ i S7 A r-,,- rev e=