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4 BUENA VISTA AVE - BPA-12-204
• ��' . .. I M o � �� y� . �/ D�� „� fhe Commonwe.�hh of Massachusctts ----- — -- --- — � � �;'i� l3oard of 13uilding Regulations and StandarJs CI"I'Y OF '���,�;, Massachusetts Sta[e Duilding Code, 780 CMR SALC-�1 •y.�„� Reri.��ed IIur=Ol! [3uilding Pennit Application To Construct, Repair, Renovate Or Dcmolish a � Urvr-ar Tivu-Fuuiilv Du elli�ig � This Section For Ofliciai Use Onl , E3uilding Permit Number: ate Applied: � '� 8/a i l7uilJing Official(Prinl N�une) Signature Date SECTION i:SITE INFOR 10 I.I Pro,�p+erty Addres�s:g L2 Assesso p.4� Parcel Numbers L i Y�`J:X'.�IG� �4 SS�'�G� V e w. I.la Is this an accepted street?yes_ no Map Number Purccl Number 1.3 Zoning Information: 1.4 Property Dimenslons: S ,n9 �c� �G���^ /� b Gl L 5 �� � Luning Dislricl PrnpuseJ Use Lot Arm(s-y�t) frontuge(t;) I.5 Building Setbacks(U) Front Y:vd Sidc YarJs Rcar Yard Reyuired Providcd Requirod Provided Reyuired ProvideJ L6�Vater Supply: (M.G.L c.90.§5�1) IJ Flood Zone Information: I.8 Sewage Disposal System: Public� Private❑ Z�ne: _ Ouuide Flood Zone? Municipal,J'l�On site dispusul systcm ❑ Check i f ycsO SECTION2: PROPERTYOWNERSHIP� 2.1 wner�of Recor L-. �f /�� �O.f � � !�v� _ ✓rn' `L�i/i1 I ,/�1 Q ( G11 � Naine(PrinQ / City.Slate.'l.IP - �� i�'7 Ut'r�c%. 1i�j���"� � �� �� � �7� X3�•fJ rl (o Nu.and Streel 'fele� phune Emuil Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction� Esisting Building❑ OwnervOccupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ DemoGtion � ❑ Accessory�Bldg.� NumberofUnits Other ❑ Specily: Brief Description of Proposed Work': � ; . •�.� SECTION .{; ESTI�IATED CONSTRUCTION COSTS ��,i Estima�ed Costs: Official Use Only �I Labur and \Iaterialsl ,I I. �uilding g 7 �� I. Building Permit Fee: S Indicate how fee is determineJ: ' [ileetrical $ � ❑Standard City/Town Application Fee ,� � ❑Tvtal Project Cost��Item 6)x multiplier .e 3. Plwnbing S 2, Other Fees: $ a. .\Icchanic;d ifiVAC') 5 Lish _ S. ,Vech�nir;d lFire g -- Su>>rcs'siun) Total :\II Fees: S CheckNu. ChecA:�muune Cush:\mounl: G. Total Project Cost 5 �Q�� ❑P�id in Full ❑Outstanding[3alanct Duc: - - — � �b l �1�,1 -�O � (��i 2�r.r �i e GvP�� �' • ' I SEC7'ION 5: CONS't'RUCI'ION SF:RVIC'F.S 5.1 Constructiun Supervisur License(CSL) �r S ��Z � ' �'� Ci� f�l ar hYt � �y.(�W'�yri�__ I icensc Numbcr --- li�piratiun Da�c NmncufCSl. IluWcr ` � /7 List CtiL�Opc Ucc hcluwl r.�✓C�!\C"n � �/ �� ✓L � I Nu. :md titrcp•t --- 'fype Dcscripliun i L)�.,, 1 O _,\ i� � � l�. —7� U l Inmsirietcd 113uiIJin�s ii to 35.OU0 ni. it.) . ��� � R Rcstricled la@2 P�unil D�cdlin� Cit��(fo�m.Rlatc.ZIP M Mawn ' . RC Ruo�in Cuverin - W$ Window:mdSidin c,� SF Solid Pucl 13urning Applianccs I � �� "!/�/" �'Q�� �' I Ins-ulnliun � l�cic honc I?mail.iJdress U Demolilion I 5.2 RegistereJ Ilome I provement Cu_q/tractor(FIIC) i� ��� Z ��i3 M�(�`i Yl �G f Wp O(/ IIIC Rcgistratiun Numbcr lispiratiun Umc IIIC Compauy Namc ur I IIC liegistrant N�mc ��Yi1.✓h �. Nu. wiJ Sveet Cmail addrcss Ci /Town, State,ZIP Telc hone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.§ 25C(6)) � Workers Compensation Insurance aftidavit must be completed and submitted with this application. Failure to provide . � this atTidavit will result in the denial of the Issuance of the building permit. - Signed Affidavit Attached7 Yes .......... ❑ No........... ❑ � SECTIOIV 7a: OWNER AUTHORIZATION TO BE C011IPLETED WHEN OWNER'S ACENT OR CONTRACTOR APPLIES FOR BUILDING PERMtT I, 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. � Prin[Owner's Nume(Hleclronic SignaWre) Dale SECTION 7b: OWNER� 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 appiication is true and accurate to the best of my knowledge and understanding. I'rint O��ncr's or�\uthorizcd Agcnt's Nwnc IllccUunic Signauvc) Dutc ��o�res: 1. :\n O�vner whu ubtains a building pennit to do his�'her own work,or an o�mer who hires an unregistered contractur piot registered in the Home Improvemant Contractor(HIC)Program),will iio!have access to the arbitmtion program or guamnty fund under�I.G.L. a 1�2A.Other important information on the HIC Proyram cnn be fuund m ������_,n�,i�..�.��+�_���,i hifonnation on the Construction Supervisor License can be found at���s�r.in:i;>.g�.��.'J��, _'. 1\'hen substantial ���urk is pl�nned,provide the infunnation below: Tutal fluur area �sy. ft.l _1 induding garage, finished basement'attics,decks or porch 1 . Gross living area Isy. RJ__ Habi�able room count � \umberuflireplaces____ .___ \umbero�bedrouins _____ _ ___ __ Numbcr of b�throunu Xumbcr of halLbaths --------------- ------ ----- — 1)pc of hcating systcm ------------ -- Number uf JctAs�purchcs_ l)pe of couling sys�cm F:ncloscd----------Opcn —_ ---- --_ — i. "fulal Prujoct Syu;vc Pouiagd'may be subs�itmcd ti�r'Puial Prujcct CosP. I F/67Z3 ����o� b�ad �a�oo� �]��oQ��Qo�� B��o Professional Land Surveyors 8 Civil Engineers ESSEX SURVEY SERVICE 1958 - 1956 OSBORN PALMER 1911' - 1970 BRADFORD & WEED 1885 - 1972 PLOT PLAN OF LAbID I�OCATED IN ✓`"if�E/�I MASS. � - LG%�G� �,� 1,7�� �� � da�7 �`s� �� � � \ �b � l�r,�3 yt�,.�,r,,::�,�«.<«f 1 r/ �-CiF� � L L�J J J i . - � �/SY/�(r � r I��,ELL:�E � . ; y: �,�, �� , l r;.; f- . ' - ;� . . � _ .�,., r � ��f�DSL7'� � � � � 57�1���� � �a' � . , _ s' ��, � � M . � � � •/Y �� i� � I '�{ . _ : __ _._.. . _ _ . __ ._�V�/6�U�.. .�'�i�Si o� � yb. _ _ . 5 � ___ . _ _ . . ---- - - V � _ _ _ . (���NP I hereby certi,,fy to r✓E- S.�l�'/�I �G'/L t�/!L6 /f�l�C�iz that the buildings are located on the �'�,::.3 a� s:own. . . �-� � . . � � � d - - �V12�P����A'�2 L!, ."i�'.9LE: � ZO / ' �pY S�rrh�$+ f � F IRISTOPHER �Gia�' DATE: VOLY S ZOI/ � d�iV c�ULY�S Z�G ' � e `=��� �,�_ �F-• ��`o� MeLf.0 . REFERENCS: �� BK jj PG� Christopher R. Me11o�P F�l 1 ��,`�. �q, tsTti �� �1'C��`7 SC '�f',t� 104 LOWELL STREET � �,,. PEABODY, MASS. 01960 � � (978) 531•8121 FAX:(9781537-5920 , � . . ' � �o P� sG� �i A CL H-� E ' �__L3JG'�� �/�STY� RJ�. (<�• . , . _��LCM,___M�. C�t�t70 . . 3p S�Ht� . \ ' _ t � - � ` � C � , . • � . I _ � � � � � � _ � � ' , • �� - � - � � _ , � � i I� � I � , ---_--- ��--�--_} � � f _ � � i ii � i � F � t �I i '---r - �: r __ - - - -- � - �;jT' � � , � � ' � _ � _ ' � . ,I f�— .�. .. . �:� �I. . �� i1 �i��:�. � . �� . . . . .' . . .. . . . . , . . . , ..,, � f - �--- � . .. �- �I-_yl � � .' I � �.� i . . � ��� � . :� . . . ... . , :. .. ... . . . . , ,�. �. � . �.:._ �_.._._____—_� .A . . _. __� ---. - - - � � � � i . .. . .. . � -. , � . . ( ;. 9 -. � � ; � . �y , . � j � . • " 1 . I I t �.SO ,.�-.r-_�� _ . _ �C .._. Y3'-�/ ' _:_.,.a.�-0 . � �'-o=' - +- � 3 0 " �..� �' , L.� N _6 �.� � � 4�'_� " ."_ , . . . . . . . . � . . { .. . . I . _ -.�_. 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