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800 MECHANICAIS & PRIMARY FUEL
= 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
900 SPRINKLERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
Required, -plans provided, plans not provided, why?
Not required, not to be installed, Why?
1000 REQUIRED OFF-SIREET PARIING - 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 r' no -. If yes has it been issued yes - no
Submit copy of application and/or permit as soon as available.
1100 IDENTIFICATION (print or type except as noted)
Current owner - name
address e i li 4' ' !� A(✓,
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 plans, affidavits and other documents SHALL BE originals and not
reproductions.
Architect/Engineer - project
Company name
Address
and reports
Phone number
Certified by State of Massachusetts as
Certification number
NOTE Signatures and seals on all plans affidavits and other documents SHALL BE originals aind not
reproductions.
General Contractor (if Homeowner,
Company name
Address
Phone number
Construction Supervisors license nut
NOTE Signatures and seals on all plans
reproductions.
ssssssssssssxsxxsxxsxsssxxxsssssssxssxsxssx
1200 FOR RESIDENTIAL REMODEL WORK
Are you a Home Improvement Contra
Are you claiming exemption from the
Ren_,)del contractor name (please grit
Address
Registration number (if none
Phone number
PERSONS CONTRACTING WITH 1
GUARANTEE FUND! QUESTIONS
Owners name (print)
Signature _
Date
homeowner here then complete section 1300)
07
affidavits and other documents SHALL BE originals aind not
ssxsssssssssssssssxssxssssssssssssss:ssssssxxsxxx
VA
subject to (780CMR - 6) ? Yes _ No _ If no go to) next section!
Arement? Yes No _If yes, submit the requiredl affidavit!
"none")
EGISTERED CONTRACTORS DO NOT HAVE ACC^SS TO THE
COMPLAINTS call or write:
Home Improvement Contractors Registration
One Ashburton Place - Room 1301
Boston, MA 02108
(617) 727-8598
4
1300 6WNER SIGN -OFF Alteration of existing, no increase in Bros square feet. A separate Refuse Disposal Declaration required.
I, the undersigned, am the owner of record or authorized lessee (provide documentation) and I have reviewed'
- Demolition - describe structure
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 be issued. Number of dwelling units umber of bedrooms A separate Refuse Dispos;ad Further I understand that the permit will expire in six months, from the date of issue, if no work is begun or Declaration required.
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 request such an extension in writing. I understand that the permit may be extended only three times by Moving - (Provide copy of D.P.W. moving license) Type of structure
written request. I understand that once the permit expires a new application may be required, including fees and current
other requirements (including Zoning). from where (plat/lot or address)
_ Name
to where (plat/lot or address)
Signature ��' Number of dwelling units Number of bedrooms per dwelling unit
The above signatur my voluntary act and is signed under the pains and penalties of e u
P rJ ry•
_--Date
= Re -roofing - (for existing only, is included ' new construction)
Who is authorized to pickup the permit at the Building Department? (pease print)Number of square feet Number of layers already existing
.--Address- Phone
Number of layers when complete
1400 HOMEOWNER EREMMON - ONE ,& TWO FAMILY ONLY
FOR HOME OWNERS 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 127.0, 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 Regu:ations for Licensing Constmetion Supervisors.
Exception: Any Home Owner performing work for which a Building Permit is required shall he exempt from
the provisions of this section; provides that if a Home Owner engages a person(s) for hire to do such work ,that such
Home Owner shall act as supervisor.
For the purposes of this section only, a "Home Owner" 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
two-year period shall not be considered a Home Owner.
If you are applying under this section sign below:
Signature
Your signature carries certain responsibilities, including but not necessarily limited to, general liability
ssssssss=sssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss
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
2.15.2 of section 5)
sssssssssssss:ssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss
1500 COST
Cost of Improvement S
Items to be installed but not included in the above cost:
TOTAL
Electrical S
Plumbing
HVAC
Other
A separate disposal declaration
— Replacement doors and windows - (for i
enlarged) EGRESS dimensions must be ma
considered as an Alteration, otherwise will
residential and Article 8 fu: commercial)
Temporary structure - includes when allot
Describe
500 CONSTRUCTION PLANS
S None submitted. Why?
01
only) (only where doors and windows exist and wi111 not be
Enlarged or new windows in an existing dwelling will be
included in new construction. (see Code section 3401.110 for
trailers, tents and the like and only for limited periods (of time.
= Submitted, usually three sets required. Fotr sets for food serviceluses. Number of sets submitted
600 SITE PLAN
( Not required, why?
Submitted When? = Previously, date I— C With this application
700 VTILrI7jES
Water supply - required _ yes _ no,
existing? _ yes _ no
If required and not existing have necessary pi
(M.G.L. Chapter 40, section 54 provides that
required, is available. See Code 780 CMR
Sewage disposal - required _ yes _ no,
private septic - on -site Zyes
? _ yes _ no, on site well? t/ yes _ no,
tits been issued? _ no _ yes, date
building permit may be issued unless a water supply,, when
n 114.1.2)
blic sewer _ yes _ no
Submit copy of permit as soon as available.
11