28 BUENA VISTA AVE - BPA-2009-162 ----- -- r--- -- -
- The Ctonnnmwralth tit NLISsachusCRS
tit
Board tit Building RC�ulatiuns and Standards
F � \II NIC it, \I I I Y
MONNJihtlNeltS SIJIC Bulldinc Code. 750('SIR. 7"' edition NI
Building I'Crmit :\pplicu TtI C n Nnuit. Repair. Rrno+ete (h Dcnttdl.h a l.un„r,t
� ( )u'� � � Tn rr-l'irmilr lh!rl/inq
.hh . 'coon For Otfic lal l Se t hilt' --_.-.--
Building Perms tit her
IiwlJmf Cominnaunei Ingx•+ ti ul Ru JJmg+
IL— SECTION I: SI FE INFI IR.MA HON -
j ;A Property \ddress: 1.2 \+sensors Map & Parcel Numbers
X ; 2 6 ��gNi+ VsSTP� -ME —. -- ------ -- - ..
Ma Nwnber P.u+rl .Nuu!hr!
I i la Is this all a Cpt•d street ' +es no— I P --.�
r- —
1.3 Zoning Information: 1.4 Property Dimensions: 70
Ltmng Uutn❑ -- Pnrywx•J UseLoI \n'a I+y III Flt)Illage I It
1.5 Building Setbacks (ft)
, From Yard Side Yards Near YarJ
Ne—
yuurJ Provided Reyuu ed Pnn!JcJ Ncyuurd PnniJcJ
1 I I
rWater Supply: (.N.G.L c 40. §54) 1.7 Flood Zone Information: I.8Sewage Disposal System:Zone: _ Outside Fl„id Zone
Ic ❑ Pn+ate❑ Cheek it ves❑ yhnPtm al ❑ On +nc diI
+rnal Irm ❑
-
SECTION 2: PROPERTY OWNERSHIP'
,_.Q Owner of Record: �poiclAtz �U ES Ii JA L
1/ '•lame ! !n I Address Yar Ser
/N q7 T"g �0 384ag _
i
Signatarr Telephone .__�
SECTION 3: DESCRIPTION OF PROPOSED WORK=(check all that apply)
� ----
�Kcw Con+trucaion p Existing Bolding ❑ Owner-0ec upied RepauM s) ❑
- :\{Icrtt!nnl s) ❑ :\ddrtnm ❑J
Demolition ❑ I Accessory Bldg Number u!Units—— Other ❑ Speafy _ --
Brief Desctiption kit Prop(:sed Work': -----
_
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs Official Use Only
t Labor and Mateiiak) 1
1 Building 5
I. Building Permit fee: 5_ Ind!rate hens Ire is dctrl nunrJ:
tmdard Cityll'own :\pphcanon Fee
_'. Electoral 5 ❑ otal Project Cosl' I Item 6) x multiplier
3. 1'lumhing 5 '_ Other Pees: 5
1. Nfechamcal lfl\':NCI S List --------- ----
5 1lechamrd IFue 5 _ -- --- --- . _
Sup ire, I.ml !!�tal :NII fees: S
—1 C heck No ( I Check 1m��unt ('.t•h \unituu— -
b Tufal Project Cost
) Irjr000— i xald III Pull 0 Outstanding Balance I)ue -- -
SECTION 5: CONSTRL.CHON SFRVICES
5.1 Licen . __-- —.— Lu n,C \I IuhCr--_____._ Ilyrll a rII It.u __._._ —.. ,-.
sud Coustruclion Super%is(ir 1('Si t
of SI
iddic"
000 ------
-
I R,"d, m.d \\Inar,r, .,In: :,fi
R�,Id,m,J 1)"IM"I loll
——---------
;.2 Registered Ilorne Impro%enient Contractor (111C)
IIIC CMIIJ,ao, N.,111C oI HIC R"I't'jilt Name
1).ac
10cphone
SECTION 6: WORKERS' CONIPENSATION INSURANCEAFFIDA),IT I.M.G.L. c. 152. 5 2506))
Workers Compensation Insurance atticlivit must be cl-mplefcd and 'Uhnutted \%iih this ipph,at,,,n, F.oluic to plo,I&
this alticlavil will result in the denial of the Issuance oI the building permit.
Signed Affidavit Attached'. Yes .......... 0 No . - , 0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner, it the -,hi,::i limpeti), hereby
I JoElli".ze 411 tin Fill loalrels
to korkauthorized by this building permit application.
"r Date
SECTION 7b: OWNEWOR AUTHORIZED AGENT DECLAR.,LTION
as Owner or Awhonied 1o,en( hereby declare
that the starements and intormation on the toregoinc application arc true and accurate, to the best ,it my knowledge .Ind
behalf.
not .Name
Signature tit Owneror Authoo/ed agent Date
Sigried under i1he 2joi, and penalties I)[perjury)
NOTES:
Owner in, in his/her n h, d mo L I-I
b permit
er I'- "'"k ""n " 0-r 11're' III I
f obtains
d "d MTimn I tiod,,r t -,III ,,t h
e 7 "'am)
not "e"t,.r the it I mpo r (til" I access to the ,ohnr;uum
r g m d - e 4 C
,r,,"a ", go In 1, 1,o"I" r , I , I , ( In t .. and
.,ran n under 4_A )t hteironpoirtant mt Mro' , he HK P
When uhmannal work is planned, pto�Ise the orilorn'JILOn below
-I Dial floors area ,Sq. F'(.i including garage, finished ha.,erientlatn,N, decks ur pt-i,h,
(;,I„% liv irgaiej I Sq, Fr t 14,ibrahle i,,,,m ounr
ssumber,-t treplaces— Nirnber ,,t hedromn,
Nmiihcr M hail-it,,--nis Number tq li,d: ! oh,
dc'k,"
,.,,tern 'cd
pryecl squ.lre ITM\ he 'UhIIIII-ded t"I F-11.11 Pf"JeLl