Plan View002800 MECEANICALS & PREW Aity FUEL
= ,
Furnace (hot air) - Fuel gas (natural or propane), fuel off, electricity, other (specify)
= Boiler (heating)- Fuel gas (natural or propane), fuel oil, electricity, other (specify)
= HVAC (combined unit) - Primary fuel, natural gas, propane, electricity, other (specify)
= Air conditioning - (separate unit)
- None of the above to be provided
= Hot Water Gas EIectric Fuel Oil Other
900 SPRINKLERS FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
Required, --plans provided, -plans not provided, whv?
= Not required, not to be installed, Why?
1000 REQUIRED OFF-STREET PARKING - for ZONING & Architectural Access
NOT .APPLICABLE
- Parking Plan submitted To -- Building Department Planning Board Date submitted
Number of spaces -indoors outside total provided
Handicap spaces - required yes _no_ If yes, how many as a part of the total required number.
Is Route 6 (State Road) Entrance permit required? yes = no _. If yes has it been issued yes = no =.
Submit copy of application and/or permit as soon as available.
1100 DENTIFIGITION (print or type except as noted)
at owner - nameTlu
address
phone
If corporation, officer in charge
Architect,Engineer - for overall design
Company name
Address
Phone number
Certified by State of Massachusetts as
Certification number
NOTE Signatures and seals on all lans, affidavits and other documents SHALL BE originals and not
reproductions.
ArchitecoEngmeer - project supervision and reports
Company name
Address
Phone number
Certified by State of Massachusetts as
Certification number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
General Contractor (if Homeowner, state homeowner here then complete section 1300)
Company name 10��
Address
Phone number
Construction Supervisors license number t,
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
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1200 FOR RESIDENTIAL REMODEL WORK ONLY
Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes _ No r If no go to next section!
Are you claiming exemption from the requirement? Yes _No _If yes, submit the required affidavit!
Remodel contractor name (please print)
Address
Registration number Of none state "none")
Phone number
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE
GUARANTEE FUND! QUESTIONS OR COMPLAINTS call or write:
Home Improvement Contractors Registration
One .Ashburton Place - Room 1301
Boston, :MA 02108
(617) 727-8598
Owners name (print)
Signature
Date
1300 OWNER SIGN - OFF
I, the undersigned, am the owner of record or authorized lessee (provide documentation) and I have reviewed
the application herein submitted. I state that to the best of my knowledge and belief that the information provided in this
application is true and correct and that the permit requested he issued.
Further I understand that the permit will expire in six months, from the date of issue, if no work is begun or
six months after the last inspection if work has begun and that the permit may be extended for six months if no work is
anticipated if I reouest such an extension in writing. I understand that the permit may be extended only three times by