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BP-17366RESIDENTIAL STI©�' $ [t�5'ECTflI2's RE.'I)h 1. Date plan reviewed: % ---�— Q 0 2. 30 days to review period expires: 3. OK to issue date: 4. OK to issue subject to requested submittals(see project review worksheet): 5. DENIED (see project review worksheet): 6. HOLD reason: 7. HOLD subject to Zoning Board of Appeals action: 8. Comments: Clerk: Date: Date: Date: Date: Date: /K}— _S l � J 1 C1blde.forms\Bldgapp.res.wpd Page 4 Rev. January 13, 2000 RESIDENTIAL 2000 ❑ FOUNDATION ONLY $25.00 APPLICATION FEE IS NON-REFUNDABLE & NON -TRANSFERABLE CAblde.forms\Bldeapp.res.wpd Paee 1 Rev. Januan- 13. 2000 RESIDENTIAL 2000 RESIDENTIAL 2.1 O(w'tnerr of Record: A� 2S2 2Zr-/GO'/�vnde�. ��. Cs� Name S.D _ - °s,`t L % —� (print) Contact Address 2.2 Authorized Agent: Phone Number Name (print) 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor Address Signature Telephone 3.2 Registered Home Improvement Contractor: 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 A - ss Sigr., .re Telephone 3.3 For Residential Remodel Work Only Not Applicable ❑ Registration Number (if none, state "none") Expiration Date PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY 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 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 tr 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 detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be consider6,*vner. If you are applying undert is sec Io sign below: 'SIC nature: ililies, including but not necessarily limited to, general liability NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that any licensed Construction Supervisor, whether or not they have taken the permit are responsible for code compliance. (see Appendix of 780 CMR R5.2.15) Workers Compensation Insurance affidavit must be completed and submitted with this application. will result in the denial of the issuance of the building permit. Signed Affidavit Attached Single Family: no. of bedrooms ❑ alteration ❑ repairs ❑ replacement window/door no. of windows doors no. of baths .r Two Family: no. of bedrooms unit 1 no. of baths unit I no. of bedrooms unit 2 no. of baths unit 2 ❑ Furnace (hot air) - fuel gas (natural or propane), fuel oil, 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 Electric Fuel Oil Other Brief Description of Proposed Work: 2000 ire to provide this affidavit yes ❑ no ❑ chimney/ fireplace ❑ other (specify below) Item I Estimated Cost ($) to be completed by permit applicant 5 Total = (I + 2 + 3 + 4) I ' Estimated Total $ Zl (please print) 1, , 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. Signature of Owner Date ❑ demolition (specify below): is 1, ,—r tf as Own /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to best of my knowledge and belief. i Signed ynd4er the dins apt p�[ialties of perjury. C:\bldg.forms\Bldgapp.res.wpd Paize _ Rev. January 13.2000 C:\bldg. forms\Bldeapp.res.nrod Date Harman makes choosing a pellet stove easy. Specially designed for effortless operation, the all - new Harman Advance automatically adjusts its flame level to maintain your optimum room tem- perature. And with an array of special features, elegant good looks, and the widest heating range in the industry, the Advance makes choosing a pellet stove incredibly easy. Call Harman today for more information on the Advance or visit us on the Web at wwwharmanstoves.com. BTU Range 48,000 Fuel Wood Pellets Outside Air Size 2-3/8" Height 32-1/2" Depth 20-1/2" Venting Size 3" Pellet Vent Pipe 6 lbs./hr. (maximum) Clearance to Combustibles Side .1011 Corner Installation Side View 28.825' ^ 20 6 i0vew Front View Tested by Intertek Testing Services/Wamock Hersey ASTM E1509 • Mobile Home -Approved 352 Mountain House Road Halifax, PA 17032 (717) 362-9080 Fax: (717) 362-4251 Avww. harmans toves . com Discover The Difference IArim 41MY� A C3py Of T;,',Is Endo d Pian V.€151 DV - t 3 ;t SitDuring construction x9 Date i l;ft F7 tt+.ryil ll:ll 1. rlr�lil; �