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EaS3SSS3!!SSEfassasassssaassiatisstststssfsfsttaststflsssttsftsfaasapOHssisittsas4eaastatfsayritasir 1600 TO THE APPLICANTIREFERRAL, AND APPROVAL ,
Date of App 'cation submission
Plat o Street
Aquifer Zoue�
Owner
Owner mail address
Owner phone #
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OTHER INVOLVED AGENCIES ES - The following agencies require separate jurisdictional permits or approval for your
Proposed project CONTACT T8E11f FOR REOUnm SUB1►IISSIONS.
® TAX COLLECTOR _ Approved _ HOLD By
Date
0 Board of Appeals _ Approved By
�f Date
,/ ❑ �Conservatiou Commission G Aproved gy , V /3
Date
77
0 D.P.W. Water _ Approved By 17 D.P.W. Sewer _ Approved By. Date
❑ D.P.W. Cross Connection a Approved By
Date
0 Treasurer (Bond) 0 Approved By
Date
0 D.P.W. Engineering _ Approve By
_ Date
7 Bo rd of Her (w1� Approved By0 oard of th (septic) � 'Approved By
0 Board of Health (food service) _ Approved By
_ Date
❑ Planning Board (parking) _ Approved By
Date
® FIRE DISTRICT (I - [I III) _ Approved By e,—
sassasssesss»ssssaassssesssss asssassesesasssssaasassasasssesssssessfaszlssssassasseste Date
sase=y`==s BUILDING DEPARTMENT APPROVAL:
❑ ZONING
0 BUILDING INSPECTORBUILDING CO',WWSSIONER
❑ CONTROL CONSTRUCTION AFFIDAVIT
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PROJECT SUMMARY:
new constructioni alteration/demo
sewage disposal - publiciprivate
[.Alter;add interior walls] [add rooms) [add footprint]
[pool] [garageished/4,,m court] [food serviceDescribe g£4rssre::: s ssssssearsss s,
To the various departments:
water supply - public/private well
This notice has been forwarded to you for your information and anv appropriate action. Should you have anv
questions please advise. If any reason to withhold the requested permit is found, please advise. Your assistant
cooperation is appreciated, istanyq�y� ad
I'he Building Department - Date sent for review
1
TOWN OF DARTMOUTH: BUILDING DEPARTMENT
TELEPHONE 508-999-0720 FAX50&999-0738
APPLICATION FOR ZONING AND BUILDING PERMIT
hatrnrbom 'i
The applicant shall complete this applicatioa to the best of their aln7ity prior to umhmission, leaving no item unanswered. The
Department staff will be available during regular business hours to assist as necessary. NIA should be inserted for those sections
which do not apply. A properly completed application will help avoid unnecessary delays. Nis ice-. g feel not aefa I I I
(for office use mly) ❑ FODNDATION ONLY
Total Cost $ Remived By 4 Date Rec'd
Less Application Fee $
Total Permit Fee $_ Permit # Ismed Date
100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET � �P1CS
CURRENT ACCESSORS, PLAT 6,L
LOT e4 ZONING DISTRICT
OTHER ZONING G 7ER:AY DISTRICTS, if applicable
NUMBER & STREET 600 3,,ZKAIfy �S __0X 44)
NEAREST CROSS STREET ALe tFAl'S AIt=GK R „
SUBDIVISION NAME & LOT #
or BUSINESS NAME
PREVIOUS TENANT / OWNER 1/I6-10,P AV2 (='Sit W— 12 Sy( VIA
200 RESIDENTIAL. - PROPOSED PROJECT - one & two family residence only
_ THIS SECTION NOT APPLICABLE
_ Single family - number bedrooms number baths
_ Two family - number bedrooms unit 1 number baths unit I
number bedrooms unit 2 p number baths unit 2
0 Accessory apartment Total gross sq. ft. y0 0
_ Accessory structure:
$0 Garage detached - attached to dwelling, Cimensions L `7 oz- W �
_ Carport - detached - attached to dwelling, dimensions L W
Shed - dimensions L W
_ Deck - dimensions L W
_ Gazebo - dimensions L W
_ Swimming pool above ground in -ground Size _
_ Chimnev . number of Dues
used (will require inspection prior to installation), new
(Provide manufacturers
instructions). Locations) (ut)
The following section for official use only.
INSPECTORS' REVIEW
Firep'lace(s) - (includes flue) List location(s)
- Game Court - describe (include overall dimensions)
-------------
Tent, Trailer (Mobile Home) or Other - describe
sus (oATAfERCIAL PROPOSED PROJEr-T/USE INCLUDING THREE FAMILY OR MORE AND EXEMPT USES
10 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
Section
303.0) 50 occupants - indicate Medical or other professional (see Code
Sec
- Educational - structure for training including child day care for those over 2 y 304.0) ears 9 months (see Code Section
- Factory / Industrial - (see Code Section 305.0)
- High Hazard - (see Code Se:tion 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 -
alsoexisiatgcondidon � afdwellatgunifsandbedtvomsoroaopantload asa
PPLcable'
+w a irc sir tvn�ITtUCTION OR WORK TO BE PERFORATED
j New Construction and/or Addition - total gross square feet / ,y p
(For commercial only total gross cubic feet) - indicate
It will be considered new construction if
alteration(s)-
there an increase in square footage in addition to an_v
If project is an addition to existing structure - Total gross square feet of existing
- FOR COMMERCIAL ONLY
�Vnll this project be subject to CONSTRUCTION CONTROL (over 35,000 cu.ft.) see Code section 127.0): Designer to submit Code Svnopsis. _yea No. (If yes
Will this project require Peer review (over 400,00o cu.ft.)
APPLICANT TO PROVIDE Yes _ No (see Code Ap
pendix I)
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
- HOLD Subject to Zoning Board of Appeals action
Comments
Inspectors signature
date
Dat R 0 5 1998
Applicant informed of above - Date time _ staff (fax, phone, in person)
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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)
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OFFICEUNSPECTORS NOTES
TOTAL FEE67
Gross area - new construction Total Sq. Ft.
alteration
Permit is issued to
Comments/notes on permit 6 O //L
Total Sq. FL
1, the undersigned, am the owner of record or authorized lessee (provide documentation and I have reviewed
the application herein submitted. I state that to the best of my knowledge and belief that the information provided in
application is true and connect and that the permit requested be issued. this
Further I understand that the permit will expire in six monthsfro work is begun or
om the date of issue, if n
six months after the last inspection if work has begun and that the pe, rmit may be extended for six mouths 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
written request. I understand that once the permit expires a new application may be required, including fees and curre '
other requirements (including Zoning).
Name
Signature
The above signature
Date /o/i/4 7
my voluntary act and is signed
pains and penalties o—urn
Who is authorized to pickup the permit at the Building Department? i
_.76 `1DImennn%Ha) (IId
�Address�O $:pAle7-YS Z), Rti �Phone 73 2 �L
1400 HOMEOWNER EXEMPTION - ONE & TWO FAMILY ONLY
FOR HOME OWNERS 17,'HO INTEND TO PERFOR.lI AND BE RESPONSIBLE FOR THEIR OWN PROJECT.
109.1.1 Licensing of Contra zi a 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
RLIes and Regulations for Licensing Corstructica Suyervsors.
Exceptions .sny 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 .
Home Owner shall act as supervisor. that such
For the purposes of this section ..nly, a "Home Owner' is defined as follows: Persons) 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 dwell' n , 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 appl�*12 under this section sign below:
Signature ZA041)/
a Your signature Carnes certain responsibilities including but not necessarily limited to,
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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.: of section 5,
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1500 COST
Cost of Improvement
Items to be installed but not included in the above cost:
5 00 rX7
Electrical S Poo 00
Plumbing / SD0 0O
HV AC
Other
TOTAL S > z JrOU, co
_ Alteration of exurtnq,,no increase in gross square feet. A separate Refuse Disposal Declaration required.
_ Demolition -: describe structure
Number of dwelling units Number of bedrooms
Declaration required.
_ Moving - (Provide copy of D.P.W. moving license) Type of structure
from where (plat/lot or address)
to where (plat/lot or address)
Number of dwelling units
A separate Refuse Disposal
Number of bedrooms per dwelling unit
_ Re-roofiag - (for existing only, is included in new construction)
Number of square feet
Number of layers when complete
Number of lavers already existing
A separate disposal declaration REQUIRED
Replacement doors and windows - (for existing only) (only where doors and windows exist and will not be
enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwelling will be
considered as an Alteration. otherwise will be included in new construction. (see Code section 3401.10 for
residential and Article 8 for comt.ierciaq -
_ Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods of time.
Describe
500 CONSTRUCTION PLANS
= None submitted. Who
j Submitted, usually three sets required. Four sets for food servicemses. Number of sets submitted .7
600 SITE PLAN
❑ Not required, why?
19 Submitted When? _ Previously, date 10 With this application
700 UrH TTFS
Water supply - required .2�_ yes _ no, public ? _ yes L` no, on site well? X yes _ no.
existing? Z— yes _ no
If required and not existing have necessary permits been issued? _ no _ yes, date
(M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a water supply, when
required, is available. See Code 780 C.YIR section 114.1 ?)
Sewage disposal -required X_ yes_ no, public sewer— yes no
private septic - on -site X yes _ no. Submit copy of permit as soon as available.
800 MECHANICALS & PRD4ARY FUEL
Architect/Engmeer - Project superrision and teporrte -
0 Furnace (hot air) - Fuel gas (natural or propane), fuel oelectricity other (speciff)f�Xi,' SC=,f��Poa ,F/,yJ
- Boiler (heating)- Fuel gas (natural or propane), fuel oil, electricity, other (specify) 1\
- 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 _,,Y Fuel Oil Other
900 SPRINIQ.ERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
- Required, -plans provided, —plans not provided, why?
- Not required, not to be installed. Wiv?
l000 REQUIRED OFFSIREE'I' PARSING - for ZONING & Architectural Access
10 NOT APPLICABLE
- Parking Plan submitted To - Building Department - Planning Board Date submitted
Number of spaces - indoors outside total provided
Handicap rpaces - required _ yes _no. If yes, how many as a part 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 IDENTIMCNTION (print or type except as noted)
Current owner -name 28110 A4 7 L/n/aA CCIRWELL
address J 1 _/nvfWALEYS —)VX
phone# (Sel�� L36 — eZ76
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.
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.
General Contactor (if Homeowner, state homeowner here then complete section 1300)
Company name701E�(
Address
Phone number
Construction Supervisors license number
NOTE Signatures and seals on allylans, affidavits and other documents SHALL BE originals and not
reproductions. - -
fa<ttis �iti Ytiif t i ititiif iiif it i itif tilttitfifiit itiiftttitiiiitttif ititi! i i fifii
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_idel contactor name lease 7311nd
Address
Registration number (if none surf "none')
Phone number
PERSONS CONTRACTING NViTH L'NREGIS f ERED CONTRACTORS DO NOT HAVE ACCESS TO THE
GUARANTEE FUND! QUESTIONS OR HomleLAINTS; call or write:
improvement Contactors Registration
One Ashburton Place - Room 1301
Boston, MA 02108
(617) 727.8598
Owners name (prim
Signature
Date /0/l/ /C %
n