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BP-36098RESIDENTIAL ❑ FOUNDATION ONLY 2004 uV AYYLiGATiVN FEE is NUN-KEFUNDALILE 8C NVN-TKAN�FEKASLE u • ter, n, e..f� ,,,zT n as x�. .. _ m . 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 suet toWing and of Appeals action: Date: 1 9. Inspector's Signature: Applicant informed of above Comments: Total Permit Fee: $ TOTAL FEE: Permit Issued To: Date: Time: Clerk: Less Application Fee: $ 25.00 Gross Area - New Construction total sq. Gross Area - Alteration total sq. ft. Remaining Balance: $, Date: CAb1dg.forms\B1dgapp.res.wpd Page 4 Rev. January 1, 2003 RESIDENTIAL 2004 ❑ FOUNDATION ONLY $25.00 APPLICATION FEE IS NON-REFUNDABLE & NON-TRANSFERAMLE CAb1dg.f6rms\B1dgapp.res.wpd Page 1 Rev. January 1, 2003 RESIDENTIAL 2nna a" v SJ�+bly I'1PERlIn Ii':/iUHC1I:11@SEi�IT.; 2.1 'Owner of Record: 11s5el I�. at2,n �� e,2 �re,� t'vIZOU+r L�+Nt= 528- 7"-7737 Name (print) Contact Address Phone Number 2.2 Authorized Agent: Name (print) Contact Address Phone Number a g �� SITTON3 itt�Tlt11! SPR?IC1 S A Art 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 Registration, One Ashburton Place - Room 1301, Boston, MA 02108, (617) 727-8598 Owners Na nt) Signature ;ye, by signing the e home owner acknowledges that there will be no eligibilty to the Guaranty Fund Date g— 3.4 Homeowner Exemption - One & Two Family Only J 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 by the BBRS promulgated 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 intends resides or to reside, on which there is, or is intended to be, a one or tw famil dwell , attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home ' a two-year perio all not be considered a Homeowner. If you are pl in nder*ec 'o ign Mlow: Signature: Y ur signature tames certain responsibilities, including but not necessarily limited to, general liability RESIDENTIAL 4;004 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) >C r©Nx12'�*NclNsl[N+e E Fvi (MGL c 5 Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidlavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached: ❑ yes ❑ no ❑ new construction* addition (energy report required) (energy report required) ❑ deck ❑ pool ❑ accessory bldg. (shed/garage) * If new construction, please complete the following: ❑ alteration ❑ repairs ❑ chimney/ fireplace ❑ replacement window/door ❑ other no. of windows_ doors_ (specify below): Single Family: no. of bedrooms no. of baths ❑ woodstove2 ❑ demolition, (specify Belo*): 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: 66 2(3G tAJ o AJ R6aq O!J FX / j'71V 6 /ZKtfcr4T ,Clo/'2��c 1 �2c��..�c��•,cvc� (please print) Estimated Cost ($) to be completed by permit applicant * Estimated Total $ Z, Spa C:\bldg.forms\Bldgapp.res.wpd Page 2 Rev. January 1, 2003 C:\bldg.forms\Bldgapp.res.wpd Page 3 RPv Tnnn I -nnno 6„ --- - 7 6„ Tv a, io►5T HANGER _../ 16, Dt3L 2 x to R►m JoisT - Ir uuu c. r I 13EA1�1 ZAKE + TRiM DETAIL Tb MA-rCk 01606 r SIOiN((m ON POONA WILL 16L ViN`!L L-r PAPE-9 SETWEENJ Avli1 ! Y o" F A-STMEO FROM GOTSI CAE A6x6 PosT5 PT EAC14 C-o?,Ni=R AND 0vFI. 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