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BP-6351Yi##ifYi�;s:::ssssssssss:ssi7t;71t�t/�ss�tslR;�;;ss:!llsis:sssssl:s:s:sls::s:s::s::ss:s:s:s:ss:sss:sssssss:ss 1600 TO THE APPLICANIyREFIMRAL AND APPROVAL 12 Date of Application submission Plat Lot Street CY er Zone Owner . , ., . ..+fiifl1J Owner phone # I i#Y#YY#iYYYYiiilYiii;lii!!#Yi!##!!##!!is#lilti#titiiii#!!!!!!i!i!!illY!#!i#iti!!!i!lsiiitt!!!s#!!!!!!!!!!i OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your Proposed project. CONTACT THEM FOR REOL1IRR S NffBSIONS. is TAX COLLECTOR - Approved:: HOLD By Date ❑ Board of Appeals . y Approved By ❑ Conservation Commission Approved By ❑ D.P.W. Water - Approved By 13 D.P.W. Sewer - ❑ D.P.W. Cross Connection - Approved By ❑ Treasurer (Bond) ❑ Approved By ❑ D.P.W. Engineering _ Approved By 7 Board of Health (well) - Approved It Date Date By Date Date Date Date .7 Date ❑ Board of Health (septic) ;- Approv y Date ❑ Board of Health (food service) :,'Approved By Date Q Planning Board (parking) -'Approved By Date a FIRE DISTRICT (I - II - IIn — Approved By sssssssssassssssssssssssssssssslssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss Date BUILDING DEPARTMENT APPROVAL: ❑ ZONING ❑ BUILDING INSPECTORBUILDING COMMISSIONER ❑ CONTROL CONSTRUCTION AFFIDAVIT sssssssfiY!#iii!*fiti!!!:fls#!!!s#ss!!#YiiiY:i**#sss!#sxs#si!!i#Yi*i#iYi##s#x*ii*i*i!s###sis#YY#Y###!#i# PROJECT SUMMARY: new construction/ alteration/demo sewage disposal - public/private [Alter; add interior walls] [add rooms] [add footprint] water supply - public/private well [pool] [garage/shed/deck] [game courtj f service] Describe, To the various departments: This notice has been forwarded to you for your information and any appropriate action. Should you have any questions please advise. If any reason to withhold the requested perm' is found, please advise. Your assistance and cooperation is appreciated. ell The Building Department - Date sent for review By TOWN OF DAR11MOUTH .BU1LI3ING IDEPFAR TENT TELEPHONE 508-"9-0720 FAX>508-999-0738" APPLICATION FOR ZONING AND BUILDING PERMIT I�n[t�0aL7 The applicant shall complete this application to the best of their ability prior to submission, leaving no item unanswered. The Department staff will be available during regular business hours to assist as necessary. N/A should be inserted for those sections which do not apply. A properly completed application will help avoid unnecessary delays. Ili= JVm1g an its =I y4 ie" (for office use only) _ tOpUIMIDA111720, ONLY Total Cost s '• Rteeived By Date Reed IA= Application Fee � Total Permit Fee Z Permit # Issued Dai 100 LOCATION OF PRO'00 TOTAL LAND AREA SQUARE FEET CURRENT ACCESSORS' PLAT LOT Zd ZO';4ING DISTRICT `1C OTHER ZONING OVERLAY NUMBER & STREET if applicable_ h(S_ N'J k PG � \ KkA - NEAREST CROSS STREET SUBDIVISION NAME & LOT # or BUSINESS NAME PREVIOUS TENANT / OWNER 200 RESEDE TTIAL - PROPOSED PROJECT - one & two family residence only - THIS SECTION NOT APPLICABLE 2/Single family - number bedrooms number baths - Two family - number bedrooms unit 1 number baths unit 1 number bedrooms unit 2 number baths unit Z Accessory apartment Total gross sq. ft. Accessory structure: - Garage - detached - attached to dwelling, dimensions L W Carport.- detached - attached to dwelling, dimensions L W (Y1/" -Shed -dimensions L W - Deck - dimensions L W N Gazebo - dimensions L W - Swimming pool above ground in -ground Size Chimney - number of flues = Woodstove - used (will require inspection prior to installation), new (provide manufacturers instructions). Location(s) (list) Fireplace(s) - (includes flue) List location(s) Game Court - describe (include overall dimensions) Tent, Trailer (Mobile Home) or Other - describe 300 COMMMCIAL PROPOSED PROJEMUSE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES THIS SECTION NOT APPLICABLE (The following descriptions are based on the Massachusetts State Building Code Article 3, AS NOTED) (See the Code) _ Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe = Business - office, assembly with less than 50 occupants - indicate Medical or other professional (see Code Section 303.0) = Educational - structure for training including child day care for those over 2 years 9 months (see Code Section 304.0) — Factory ; Industrial - (see Code Section 305.0) — High Hazard - (see Code Section 306.0) = Institutional - hospital, nursing home, infant day care (see Code Section 307.0) = Mercantile - retail stores (see Code 308.0) — Residential - three or more family, hotel (see Code Section 309.0) = Storage - includes garages (see Code Section 309.0) = Utility & Miscellaneous Structures- includes tents and agricultural structures (see Code Section 311.0) = New tenant for any of the above, indicate above (see Code Section 119.0 and Zoning By-law section 35) = Tent or Trailer - temporary purpose? = Other Describe the proposal briefly, INCLUDE umber of dwelling units and bedrooms or occupant load as applicable, also existing condition 400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED = New Construction and/or Addition - total gross square feet (For commercial only total gross cubic feet) - indicate It will he considered new construction if there an increase in square footage in addition to any alteration(s). If project is an addition to existing structure - Total gross square feet of existing — FOR COMMERCIAL ONLY The following section for official use only. INSPECTORS' REVIEW Date plan reviewed 30 days to review period expires OK to issue date OK to issue subject to requested submittals (see project review worksheet) date DENIED see project review worksheet date HOLD reason date HOLD Subject to Zoning Board of Appeals action Comments Inspec sssssssss#ss#sssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss#ss###ssssssssssssssssssssssssss Over six months since approved for issue - DEEMED abandoned! Advise applicant. Hold 90 days for return then dispose if not picked up. Inspector Date Advised applicant Date Time staff (by phone, fax or in person) OFFICE\INSPECTORS NOTES '11 TOTAL FEE Gross area - new construction Total Sq. Ft. alteration Total Sq. Ft. Permit is issued to Comments/notes on permit 6LW'_"e'_ a_o� 9 Will this project be subject to CONSTRUCTION CONTROL (over 35,000 cu.ft.) Yes No. (If yes see Code section 127.0). Designer to submit Code Synopsis. Will this project require Peer review (over 400,000 cu.ft.) Yes No (see Code Appendix 1) APPLICANT TO PROVIDE 1300 OWNER SIGN - OFF L Alteration of existing, no increase in gross 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 Number of dwelling units Number of bedrooms A separate Refine Disposal application is true and correct and that the permit requested be issued. Further I understand that thepermitwill expire in six months, from the date of issue, if no work is begun or Declaration requhv& 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). where (plat/lot or address from (P ) Name to where (plat/lot or address) Signature Number of dwelling units Number of bedrooms per dwelling unit The above signature is my voluntary act and is signed under the pains and penalties of perjury. = Re-rooimg - (for existing only, is included in new construction) Date Number of square feet Number of layers already existing Who is authorized to pickup the permit at the Building Department? please vrina Address Phone Number of layers when complete A separate disposal declaration REQUIRED 1400 HOMEOWNER EXEMPTION -ONE &TWO FAMH.Y ONLY = Replacement doors and windows - (for existing only) (only where doors and windows exist and will not be FOR HOME OWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in as existing dwelling will be 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 considered as an Alteration, otherwise will be included in new construction. (see Code section 3401.10 for 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 residential and Articl- 8 fL commercial) Rules and Regulations for Licensing Constn.cdon Supervisors. Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods of time. Exception: Any Home Owner performing work for which a Building Permit is required shall be 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 Describe Home Owner shall act as supervisor. 500 CONSTRUCTION PLANS For the purposes of this section only, a "Home Owner" is defined as follows: Person(s) who owns a parcel of land helshe intends P11 6 y on which resides or to reside, on which there is, or is intended to be, a one or two family dwelling, attached None submitted. Why? 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. _ Submitted, usually three sets required. Four sets for food servicetuses. Number of sets submitted If you are applying under this section sign below: 600 SITE PLAN Signature ❑ Not required, why? Your signature carries certain responsibilities, including but not necessarily limited to, general liability ssssss##ss#sssssssssss#ssss#sssss*sssssss##s:#ss#ss###ssssss###ss##sssss#ssss#ssss#s##sssss#####s#ss###s =Submitted When? -Previously, date With this application 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) 700 UIUXriES Water supply - required _ yes _ no, public ? _ yes _ no, on site well? _ yes _ no, 1500 COST Cost of Improvement g �� , d G existing? _ yes _ no Items to be installed but not included in the above cost: Electrical 5 2, o o o If required and not existing have necessary permits been issued? _ no _ yes, date Plumbing Si (M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a water supply, when HVAC required, is available. See Code 780 CMR section 114.1.2) Other Sewage disposal - required _ yes _ no, public sewer _ yes _ no TOTALi do v private septic - on -site _ yes _ no. Submit copy of permit as soon as available. 800 MECHANICAIS & PRIMARY FUEL - project supervision and reports = 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 11EQUU= OFF-STREET PARE3NG - 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 pirt of the total required number. Is Route 6 (State Road) Entrance permit required? yes :- 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 \ a_ \ `?.(:z address t a 3 9 i i2rl n' V phone # 21 Z — ? ? ( - If corporation. officer in charge Architect/Engineer - for overall design Company name Address Phone number Certified by State of Massachusetts as Certification number S vt?tZ NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not reproductions. Company Address _ Phone nuz r 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. General Contractor (if Homeowner, state lhomeowner here then complete section 1300) Company name Address Phone number ( `( Construction Supervisors license number C CaS t 3 j� NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not reproductions. ssssssssssssssssssssssssssssssssssssssssssssssssss*sss*sssssssssssssssssss•sssssssssssssssssssssssssssss 1200 FOR RESIDENTIAL REMODEL WORK ONLY Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes "No _ If no go to next section! Are you claiming exemption from the requirement? Yes No If yes, submit the required affidavit: Ren_odel contractor name (please print)�� Address Z e' � Registration number (if none state "none") Phone number 1? 4 — L Sc� ,C. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTEE FUND! QUESTIONS OR COMPLAINTS call or write: Home Improvement Contractors Registration One Ashburton Place - Room 1301 Boston, MA 02108 (617) 727-8598 Owners name (print) Signature Date .7 .