BP-11020t - 1999
2.2 Authorized Agent: R
Contact Address
Name (print)
Telephone
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3.1 Licensed Construction Supervisor:
P
Not Applicable
Licensed Construction Supervisor
License Number
Address
Expiration Date
Signature Telephone
3.2 Registered Home Improvemen actor:
Not Applicable
Are you aHome Im o em t ontractor subject to (780 CMR-6)? ❑yes ❑ no
If no, go to the next section!
Are you claiming exe 'o, 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:
Hone Improvement Contractors Registration, One Ashburton Place - Room 1301, Boston, MA 02108, (617) 727-8598
Owners Name (print)
Signature
1� by signing the above, the home owner acknowledges that there will be no eligibilty to the Guaranty Fund
Date
3.4AHomeowner Exemption - One & Two Family Only
s
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
accessoryto 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: app7lyin u der this section si n;b.
Signature:You
gna . r Carriain res onsibilities, including but not necessarily limited to, general liability
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January 20, 1999
Residential
1999
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1.
Date plan reviewed:
2.
30 days to review period expires:
3.
OK to issue date:
4.
OH 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:
8.
Comments:
MAY 3
Date:`
9.
Inspector's Signature:
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Applicant informed f above Date: —Time:
'
Clerk- /2,
Comments:
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