BP-563083068 3068
DECK
6'-0" x 4'-8"
existing sun
room
DECK
23'-5" x 21'-6"
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6 1611 T-O 3/16" 4'-2" 41-21' 6'-11 1/4"
— — — 7F-
+ DECK
-19'-1 1'+x 2'-8"—
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ladder for pool
48 High rails with double gates
swing out self closing and latching
Rest of deck normsl hight 36"
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12'x48' Sona Tubes
BC4 Post Cap
ABU Post Conectors
H2.5 Hurricane Ties Joist to Beam
Joist Hangars against House
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2"x10" Floor Joist 16"oc span11'-0"Old
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Post span 8'-0"Trex Decking
Self closing self Latching Gates
Rail 42" high pool side
54" deck side
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RESIDENTIAL
SECTION 2 - PROPERTYwOWNERSHIP/AUTHORIZED
AGENT
2.1 Owner Record:
> �J /2 �2Pfe-1�G L
-%
.
Name (print)
Contact Address Phone Number
2.2 Authorized Agent:
zze
Name (print)
Contact Address Phone Number
--7777
SECTION 3 - CONSTRUCTION SERVICES -
3.1 Licensed Construction Supervisor:
Not Applicable ❑
Licensed (Construction Supervisor. OAVF
License Number: 9
Address: r �, r&
Expiration Date:
Signature: Telephone:,?,? 5P-Y'-ar.z y
3.2 Registered Home Improvement Contractor:
Not Applicable ❑
Are you a Home Improvement Contractor subject to (780 CMRA 10.R6)? KYes ❑ No
If No, go to the next section!
Are you claming exemption from the requirements? ❑ Yes ❑ No
If Yes, submit the required affidavit!
Company Name: -- -C,-n1Tz314e7ZKf
Registration Number (if none, state "none"):
Address. z2e Atd)-- / h *a %✓
Signature: Telephone: - e > 9"
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:
4 Home Improvement Contractors Registration, One Ashburton Place - Room 1301, ,Boston, MA 02108, 617-727-8598
❑ 1 am a Homeowner performing all the work myself.
Owners Name (print):
Signature:
By signing the above, the homeowner acknowledges that there will be no eligibility 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
5108.3.5 L:mcensing 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 this section sign below:
Signature:
Your signature carries certain responsibilities, including but not necessarily limited to, general liability
SECTION 4 - WORKER'S COMPENSATION INSURANCE AFFIDAVIT (MGL c 152 § 25)
Worker's Compensation Insurance Affidavit must be completed and submitted with this application. Failure to provide.'ahis
affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached: kYes Q'No
f Deck ❑ Pool ❑ Repairs ❑ Alteration ❑ Chimney/Fireplace
❑ Woodstmve/Pellet Stove
❑ New Construction* 0 Accessory Bldg. ❑ Roofing/Siding
❑ Other
(Specify,lbelow)
(Energy report required) (Shed/Garage)
❑Addition ❑ Replacement window/door
`
❑ Demolitii'on
(Specifyj'.below)
(Energy report required) - No. of windows_ Doors s
*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
❑ Air conditioning- (separate unit)
❑ None of the above to be provided
❑ Hot Water: Gas Electric Fuel Oil Other
Description of proposed work:
Item Estimated Costo be comp e
1. Building
2. Electrical
3. Plumbing
4. Mechanical (HVAC)
5. Total=(1+2+3+4)
SECTION TA - OWNER AUTHORIZATION
(to be completed when owner's agent or contractor applies forbuilding perrmit)
(Please Print)
authorize
1 1I ` j/ ��/s c����� as Owner of the subject property hereby
,;
to pet-,pn m behalf, i all matters r lative to work authorized by this building permit application.
Signature of Owner Date
'SECTION 713 - UVVNt_tVAu i nurtIc�u r►��r. ��..._...v.......
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 uarth pai s pen of perjury.
Date
Signature of Owner/Authorized Agent
SECTION 8 -INSPECTOR'S REVIEW/COMMENTS
ro_ Date plan reviewed:
2. DENIED (see project review worksheet):
Date:
3_ HOLD
Reason' /) Date:
4_ HOLD subject to Zoning Board of Appeals action: Date:
Comments:
[nspector's Signature: Date:
RESIDENTIAL ❑ Approval in Part (Per 780 CMR.5111.13)
SECTION 1 -SITE INFORMATION
1.1 Property Address:
�s0&6-
�7
1//�d E
1.2 Assessors Map & Lot Numlber.
Lot Area (sf.j
Lot
Frontage
Map_ Lot, -
61
Provided
Front Yard
1.3 Historical District ❑i°Yes ❑ No
Side Yard
Has application been submitted to the Historic Commission?
Rear Yard
❑ Yes ❑ No Date:
1.4 Water Supply (MGL c40 s54):
1.5 Sewage Disposal Syst ::
❑ Munici al
❑ Muniapal
Private Well
Private Well
� P i ate
-
-
❑ Municipal On �;Ite Disposal System
❑Munici al On ite Disposal System
P P
❑ CONSTRUCTION PLANS ❑SITE PLAN ❑ ENERGY REPORT �