BP-31493RESIDENTIAL
❑ FOUNDATION ONLY
2002 RESIDENTIAL
❑ FOUNDATION ONLY
WIN
25.00 APPLICATION FEE IS NON-REFUNDABLE be NON -TRANSFERABLE
1. Date plan reviewed:
2. 30 days to review period expires:
3. OK to issue date:
4. OK to issue subject to requested submittals (see project review worksheet): Date:
5. DENIED (see project review worksheet): Date:
6. HOLD reason: Date:
7. HOLD subject to Zoning Board of Appeals action: Date:
8. Comments:
9. Inspector's
Applicant informed of above Date: Time: Clerk:
Comments:
Date:
Total Permit Fee: $ -30• 00 Less Application Fee: $ 25.00 Remaining Balance: $ S'�fJO
TOTAL FEE: Of ,;�-O, 00 Gross Area - New Construction total sq. ft.
Gross Area - Alteration total sq. ft../ / l
Permit Issued To: �'�� �� /Y��J" /l 2C_- "IY1,5 �C/ 6/Q� '�f1
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RESIDENTIAL
2003
4 yl'a IC?N PRbPEf2TY 0WI1,ERSffIP/ WUTHORIZEDAWVNT
2.1 Ow er of Record:
Name (print) Contact Address Phone Number
2.2 Authorized Agent:
Contact Address Phone Number
Name (print)
n ** SECTI0N 1CONSTRUCT10N EItVICES a ,
k`
3.1 Licensed Construction Supervisor: Not Applicable ❑
Licensed Construction Supervisor
License Number
Address
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor:
Not Applicable ❑
Are you a Home Improvement Contractor subject to (780 CMR-6)? ❑ yes ❑ no
If no, go to the next section!
Are you claiming exemption from the requirement? ❑ yes ❑ no
If yes, submit the
required affidavit!
Company Name
Registration Number (if none, state ❑ none❑)
Address
Signature Telephone
Expiration Date
3.3 For Residential Remodel Work Only
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND:
QUESTIONS OR COMPLAINTS call or write:
Home Improvement Contractors Re i ration, One rton - oom 1301, Boston, MA 02108, (617) 727-8598
/Ash �Pace
Owners Name rint
(print)
P ) 1yt
Signature
by signing the above, the home owner acknowledges that there will be no eligibilty to the Guaranty Fund
Date
3.4 Homeowner Exemption - One & Two Family Only
FOR HOMEOWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT
109.1.1 Licensing of Construction Supervisors: Except for those structures governed by Construction Control in Section 116.0, effective July 1,1982, no individual
shall be engaged in directly supervising persons engaged in construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of
buildings or structures, unless he or she is licensed in accordance with the rules and regulations promulgated by the BBRS entitled Rules and Regulations for Licensing
Construction Supervisors.
Exception: Any Homeowner performing work for which a Building Permit is required shall be exempt from the provisions of this section; provides that if a
Homeowner engages a person(s) for hire to do such work, that such Homeowner shall act as supervisor.
For the purposes of this section only, a "Homeowner" is defined as follows: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on
which there is, or is intended to be, a one or two family dwelling, attached or det rQctures accessory to such use and/or farm structures. A person who constructs
more than one me in a two-year period ll not be considered a eowner.
you are a lyin under this section si o
Signature:
nature carries certain responsibilities, including but not necessarily limited to, general liability
u
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