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BP-29336RESIDENTIAL ❑ FOUNDATION ONLY $25.00 APPLICATION FEE IS NON-REFUNDABLE do NON -TRANSFERABLE 1. Date plan reviewed: 2. 30 days to review-peiiod expires: 3. OK to issue dater-�_" 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 Signature: Applicant Date: Time: - . Clerk: ►i1IRA Total Permit Fee: $ Less Application Fee: $ 25.00 Remaining Balance: $ TOTAL FEE: �"ft ,> > Gross Area - New Construction total sq. . / �� -Gross Area - Alteration total sq. ft. av Permit Issued To:01 ® RESIDENTIAL 2003 ElFOUNDATION ONLY $25.00 APPLICATION FEE IS NON-REFUNDABLE & NON -TRANSFERABLE; CAb1dg.forms\B1dgapp.res.wpd Page 4 Rev. January 1, 2003 CAbldg.forms\Bldgapp.res.wpd Page 1 Rev. JJanuary 1, 2003 RESIDENTIAL 2003 �_ECiONx©PERTYU (S'iRSHIP AIfJTHORiZED AGENT, 2.1 Owner of Record: 7� Name (P t) Contact Address Phone Number 2.2 Authorized Agent: Name (print) Contact Address Phone Number ?NS'Tit lam' ON'SER I( FS 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 Improvemem, Contractors Registr �tto�n,One Ashburton Place - Room 1301, Boston, MA 02108, (617) 727-8598 Owners Name (print) f � v Signature by signing the abov , the Pome 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 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 considered a Homeowner. If you are applying under sec ' n sign below: Signature: Your signature carves certain responsibilities, including but not necessarily limited to, general liability ❑ new construction* ❑ addition ❑ alteration ❑ repairs ❑ chimney/ ❑ woodstovfe (energy report required) (energy report required) fireplace `deck ❑ pool ❑ accessory bldg. ❑ replacement window/door ❑other ❑ demolitiom (shed/garage) no. of windows_ doors_ (specify below): (specify below): * If new construction, please complete the following: Single Family: no. of bedrooms no. of baths Two Family: no. of bedrooms unit 1 no. of baths unit 1 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:' Item I Estimated Cost ($) to be completed by permit applicant ? Flectricnl 5. Total = (1 + 2 + 3 + 4) I *Estimated Total (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 JL, , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed uy4g thp)pains and venaltie&.of mriurv- Signature of Owner/Authorized Agent Date C:\bldg.forms\Bldgapp.res.wpd Page 2 Rev. January 1, 2003 C:\bldg.forms\Bldgapp.res.wpd Page 3 Rev Tnn,—, t 'hn a r FLOOR FRAMING PLAN SCALE: 1 /2"=1'-0" NOTE: 2 x 12 FRAMING MEMEBERS TYPICAL Iro" O.C. NOTE: 2 x 10 FRAMING MEMEBERS TYPICAL m Iro" O.G. NOTE: 4 x 4 FRAMING POSTS TYPICAL SET ON CONCRETE FOOTINGS 12" ROOF PITCH SCALE: NTS VERT. SECTION SCALE: 3"=1'-0" 1 5/1 6" ASPHALT SI-41NCaLEB )N BUILDING 'APER r2" PLYWOOD iPEATHING SHIM SPACE 2 2 x 10 ROOF JOIST 22x4STUD 4 x 4 PRESSURE TREATED POST t�� B� to t t4 " eelk , LC 0D'L' A Copy Of This Endorsed Plan Faust Be Kept On Site During Construction * 4-7t AE SIZE AND DERTH 1��'L TC7rtav rs REQUrREl) IREFCI,- HE CC?�`CRE7E is Po(jfim. t1tU� DEPART!! c of FnnTING & POST PLAN SCALE: 1 /2"=1'-0" VERT. SECTION SCALE: 3"=1'—O"