26 BUENA VISTA AVE - BPA-2009-25 r
Fhc l oijimo ii%kcalth (11 NIXIS.Isl1111C11N
4 t li,,aid oI Hwldine Regulations .md S(.u1J°rids FI nt
\II \Il li' \I it l
L `� 1lasaachusrtts .tit:ur HuilJing ('ode. 'Stl lNIR. '°' ednlonl !
HuilJim_ I'r -['u (•unSrrurt. Repair. IlCnttl.itr l h I)rin,tli,h ,I
I)nr" nr Ttln-lt(nul of I'll j l -,; \
— ----� -- I"his Section F a Ottictal ( e Only
'~liu!IJurm Penmt :Nunlha _.____——. _. )•it P Il _ -__ / __ �� —__—_
;._n.ltule ----
__ liu!:J�n� C\mtnu..!vn:Y; I! rihn I ntnlJ mg, U.uc 's
SEC'HON I: SITE: INFOR..NIA PION
i.l Property %ddress: 1.2 \+sensors slap S Parcel Numbers
x 24 V VlSrp AVM
X \I:rn \u!nhef P,u..'I \un!hrt
! I !,I t Ihl, III J�itplcJ nl[I- �l, _ nY)_"�— I
,,:fl _. 1.4 Property Dimensions:
it F ';i'�le_a`t1U
� 1.5 B`r` diJlgFe!Ilr't'dks�ft)WcJ � Ftiyl !id, Jc Y�rJs Pnrv!JcJ_-- �RryuurJ RraTl .ud F'n.-,iJrJ--�
�1—.1 .,_-__ — -- _
I 1.5 `•Yater Supply: (.M G L,— 40, J 54) 1.7 Flood "Lone Information: `L8 Sewage Disposal System: j
Zone: Outside Fla)d 7_orl
n s.. "— Municipal ❑ On ,rte Jmputdl u.tcnt ❑
Pchh. L Pn ate ❑ Check II rs❑
Y
SECTION 2: PROPERTY OWNERSHIP'
_',I Owners of Record: ,
'XI -- .Ja Tf2dvA L3 2(t BUEuq VJS-pj AiI(L i
! 4(;;SE
TelephuneCTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
j Ne, Construction C existing Building ❑ Otsner-Occupied)] Rep: irsls) ❑ :\Iter.Y r!uni,) ❑ :\JJltnul ❑--
r ')etnoiiti,tn Accrv.0 Y Bldg. ❑ Number or(Units�_ Ulhr-r ❑ r !1} ___.__.
- —
i !et Dcscflptitn „t Prop-,Ned W rk-: _6x(4.LNfz__
X ._ _5-17�1/ -�- .. QC, IIsL^J46
-t- - - -✓ S.Lr91r[.S _- ----
—
SECTION
�--- _ -- ----'I
SECTION 4: F,STtti.>TEU CONSTRUCTION COSTS I
Esumeted Costs:
[tern Ildh Official Use Only - 1
� nr.mJ Materials)
1. IiwlJutg ) I. Building Permit Par: 'S—_ Indicate how "tcc !. Jctel nuncJ
❑.Standard City/Illtsn :\pplicannn Fee
'. I-lectncal 5 I ,
❑ Total Project Cast Ihcm G) s multiplier
t 3—Pluiinnhmg Y j ]. other Fees, 5
II J '-fechanical IHV \CI
M cLhdnical !Fire
;u , tres,i,�nt �S F, t,d :\II Fees i --__
X Polal Project cost lherk No .— _—1 heck \Irh null ('.Y•h \ne wnl
h 3000 0 Paid in F•,dl 0 OutsldnJ!n,, 11_YLu tie U!tr_
r
SECTION 5: CONSTRUCTION SF:R% R ES
5.1 Licensed Cuns(ructiun Superaisnr (C:SL1
Lnemi NuuJ,ir
Namc"ICS1. Milder
I.r\t l Sl" klie nev he n,I _—
_--_—t
\ddre,•
l I i❑i,lu.leJ 11, I'T
Rc,t n.lcJ I I'.unils
�iuo.nwi S� 1 I \l.i10nn Villa
R( Rc,iJ,-fit ul Ru,-nnc < n,:iun_
f:Icphuni \\l—rI1:vJ;nu,J \\iudi•„ .ord 1_,Ln
i Ri Rr,id,wi.d sidhd I I,I Ii Ini a \1L1 ui I_n_i. l it •n
5.2 Registered Monte Intprorentent Contractor (III(A
HCI Cou ,gtm Name or I11C Registrant Nalne — — RegU11JU U11 ..\uulher
Address -
F:apu arLm U:ar
Signature fc•Irphune
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 2506)1
Workers Compensation Insurance affidavit must be completed and submitted with this application. F.ulurc to pro,idc
this affidavit will result in the denial of the Issuance tit 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
1. as Owner of the subject property hereby I --
authorize to act on my behalf. In all mJttel:s j
relative to w,nk authorized by this building permit application.
I
Si nature tut Owner Date
SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION
1 , as Owner or Authorized Agent hereby Jeclarc
that the statements and information on the toregoing application are true and accurate, to the best of:my knowledge and
behalf. -
Print Name
Signature tut Owner or Authorized Agent Date
ISwned undo the arna and values of /u I
NOTES: _
I. An Owner who tibial ns a budding permit to Jo his/her own work,or an nwner who h res :tut unre�a,tel cJ c,,nt r•I, t,il
(no( registered in the Home Improvement Contractor (MC) Programl, will nnJ have acces, to me •ohination j
program or guaranty fund under M.G.L. c. 11'_A. Other Important inLamation nn the HI(' Pnlgrant .Ind
Cons(rucuun Supervisor Licensing WSL)can he tound m '30('NIR Regulations 1 10.R6 and 111) Its, re,pccoacly
When substantial work is planned. proslde the inlurmanon below:
Total floors area (Sq. FI.) uncluding garage. finished ha,ememlattics. decks or p,,r.h,
(iro,s ham,1 area ISy. FL) Habitable norm count
Number od nrcplaees_ Ntunber of hedro,,m,
Number of h.nbioom, . _ NUIr1hCl' of h.111:hash, -
",pe nt heitlnB s„lem - Numher of dc,k„' p,nahc, -
ohng ,},tern__
1. -l'ocd Project Suuere Footage" may he ,uh,tituied his "Tntal Pr 'leet Cost" y
S 4
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pG i
W(NODt1J �-0M �INIfJ(� (ZOJM klTLll£I� �. _ ..
41