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BP-6752
.........tzfstf;tsfsifsslisessss;ssslssisafssuftessotasiessfsisetesssas 1600 TO THE APPLICANT/RUEEFERgAL AND APPROVAL Date of Application submission `�. Z S %7 ce- Plat Lot, Street �1y / �• Aquifer Zone " Owner G' Owner mail address Owner phone # 33 O OTHER INVOLVED AGENCIES _ The following agencies require separate jurisdictional Proposed project. CONTACT THEREFOR REOUIt?�rmrts or approval for your -ED 5'IIBHMSiONS. ® TAX COLLECTOR - Approved HOLD By - Date ❑ Board of Appeals = Approved By Date ❑ Conservation Commission ❑ Approved By Date ❑ D.P.W. Water =Approved By ❑ D.P.W. Sewer Z Approved By. Date ❑ D.P.W. Cross Connection _ Approved By Date ❑ Treasurer (Bond) ❑ Approved By Date ❑ D.P.N. Engineering _ Approved By Date oof Health (well) Approved ByDate6ard SC'3 of Health (septic) ^ Approved By Date ❑ Board of Health (food service) _ Approved By Date ❑ Planning Board (parking) ] Approved By Date ® FIRE DISTRICT (I - [I - fII) — Approved By sssssssszssssssssssssessfssssssssssseisssisfessfessssssYsssssssssssfsssssszsssisssessessssDsse 5 ty BUILDING DEPARTMENT APPROVAL: sss ss=P ❑ ZONING ❑ BUILDING INSPECTOR/BUILDING COMMISSIONER ❑ CONTROL CONSTRUCTION AFFIDAVIT PRROJEODE sss,Y:ssis;isssiilssifYisisss=ssisssss;siss*s:fisss:sxs-sissss==sessssssss=Y„i,ss;sass=issss„siY CT SUMMARY: new constructioni alteration/demo sewage disposal • publiciprivate [.Alteradd interior walls] [add rooms] [add foo tPrint] water supply - public/private well [pool] [garage/shed/deck] [game court] [food service] Describe To the various dep This notice has been forwarded to you for your information and anv appropriate action. Should you have any questions please advise. If any reason to withhold the requested permit is found, please advise. Your assistance and cooperation is appreciated. TOWN OF DARTMOUTH .BUILDING DEPARTMENT TELEPHONE 508-999-0720 FAX. 508-999-0738' APPLICATION FOR ZONING AND BUILDING PERMIT Instructions The applicant shag 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 inverted for those sections which do not apply. A properly completed application will help avoid unnecessary delays. Platte FYms "i me 61.1 11 (for office me only) ❑ FOUNDATION ONLY TOW Cost $ Received By Date Reed L —I- Less Application Fee � ��`-- Total Permit Fee /$ Permit # Ind Date 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET / / CURRENT ACCESSORS' PLAT ! LOT 21 ZONING DISTRICT OTHER ZONING OVERLAY DISTRICTS , if applicable NUMBER & STREET 3 r/ U'%7-72,4 �l R Z? NEAREST CROSS STREET SUBDIVISION NAME & LOT # or BUSINESS NAME PREVIOUS TENANT / OWNER 200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only = THIS SECTION NOT APPLICABLE Single family - number bedrooms 5Z'_ number baths 19 - Two family - number bedrooms unit 1 number baths unit I number bedrooms unit 2 number baths unit 2 XAccessory apartment Total gross sq. M 75P _ Accessory structure: C e) C,— — C, _ Garage - detached - attached to dwelling, dimensions L W _ Carport.- detached - attached to dwelling, dimensions L W Shed - dimensions L W _ Deck - dimensions L W _ Gazebo - dimensions L W z7 c-a The Building Department - Date sent for review 274 G CI By _ Swimming pool above ground in -ground Size Chimney - number of Dues _ Woodstove - used (will require inspection prior to installation), new (provide manufacturers instructions). Locatiou(s) (list) The following section for official use only. INSPECTORS' REVIEW Fireplace(s) - (Includes flue) List location(s) - Game Court - describe (include overall dimensions) 71 Tent, Trailer (Mobile Home) oi- Other ) describe 300 CO'.H11ffitCIAL _ pgppOSEp PROJECT/USE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES - THIS SECTION NOT APPLICABLE (The following descriptions are based on the Massachusetts State Ifnildinge Article NOTED) (Stu 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) - Jlercantile - 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 tent[ 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 -taw section 35) - Tent or Trailer - temporary purpose? - Other Describe the proposal briefly, INCLUDE —amber of dwelling units and bedrooms oroau tload as applicable, aLa existing conditionP� le, 400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED - New Construction and/or Addition - total gross square (For commercial only total gross cabic feet) - indicate It will be 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 Will this project be subject to CONSTRUCTION CONTROL (over 35,000 cu.fL) _yes _ No (If yes see Code section 127.0). Designer to submit Code Svnopsis. Will this project require Peer review (over 4(Y0,000 cu.ft.) Yes No (see Code Appendix 1) APPLICANT TO PROVIDE 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 _ DENTED see project review worksheet date - HOLD reason - HOLD Subject to Zoning Board of Appeals action Comments date Inspectors signature)rKti"L.- DaterCAY 0 4 199© Applicant informed of above - Date time __ staff (fax, phone, in person) sssssssssssssesssssssss:sssss:sssss:::sssss:sssssssssssssssssssss:ssssssss:sssessssssss:s:sssssss:ssssssss 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) sssssssssssssssssssssssessssssssssssssss:sssssessssessssssssssssssssssessssssssssssssssssssssssssssss:ss OFFICEVNSPECTORS NOTES e�c)= TOTAL FEE /e7 C, Gross area - new constructionv'p-� Total Sq. Ft. alteration /`3y Total Sq. FL Permit is issued to Commentsinotes on permit T" 0 M I q4F''--0�,.,, 1300 OWNER SIGN - OFF I, 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 this application is true.and correct and that the permit requestedbe issued. Further I understand that the permit will expire in six months, from the date of issue, if no work is begun or 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 written request I understand that once the permit expires a new application may be required, including fees and current other requirements (including Zoning). Name �J Signature '�/.��/�� The aT signature is my volua c[ and Date srgned under the pains and penalties of perjury. Who is authorized to pickup the permit at the Building Department? fpiesse prim Address Phone 1400 HOMEOWNER E 31MON - ONE & TWO FAMMy ONLY FOR HOME OWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT 109.1.1 Licensing of Construction Super►isors: Except for those structures governed by Constructim, 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 1141es and Regulations for Licensing ConstrLctioo Supervisors. Exception: Anv 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 Home Owner shall act as supervisor. For the purposes of this section only, a "Home Owner" is defined as follows: Persons) who owns a parcel of land on which heishe resides or intends to reside, on which there is, or is intended to be, a one or two family dwellin , 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 applying under this section sign below: Signature %� Your Stgnamre carves certain responstownes, including but not necessarily limited to, general liability iiiaititiiitffliiisitstaiaitialafiflaflifliiitififtsiisiiifsiiasaiiiitiiftlifafiftitaiai!lslaitatifaii>i NOTICE TO LICENSED CONTRACTORS; The Building Code provides in the Rules and Regulations section that any licensed Construction Supervisor, whether or not thev have taken the permit are responsible for code compliance. (see 2.15.2 of section 5) :efassiiiasssssssstesta!lisssssalass*tislafitsiiissississfassitsssssisaasss•siieitfitfsssif isslitasa»ss 1500 COST Cost of Improvement t Items to be installed but not included in the above cost: Electrical Plumbing HVAC Other TOTAL Iteration of existing, no increase in gross square feet A separate Refuse Disposal Declaration required. _ Demolition - describe structure Number of dwelling units Number of bedrooms Declaration requited. - Moving - (Provide copy of D.P.W. moving license) Type of structure from where (plat/lot or address) to where (plat/lot or address) A separate Refuse Disposal Number of dwelling units Number of bedrooms per dwelling unit - Re -roofing - (for existing only, is included in new construction) Number of square feet Number of layers when complete A separate disposal declaration REQUIRED Number of layers already existing - 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 it._ commercial) - Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods of time. Describe 500 CONSTRUCTION PLANS - None submitted. Why? - Submitted, usually three sets required. Four sets for food serviceluses. Number of sets submitted 600 SITE PLAN 0"Not required, why? - Submitted When? - Previously, date C With this application 700 UTILITIES Water supply - required _ yes _ no, public ? _ yes _ no, on site wen? yes _ no, existing? _ 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 CMR section 114.1.2) Sewage disposal - required _ yes ono, public sewer _ yes _ no i% private septic . on -site _ yes _ no. Submit copy of permit as soon as available. 800 MECHANICALS & PRDNARY FUEL Architect/Engmeer - project supervision and reports Furnace (hot air) - Fuel gas (natural or propane), foe��lectticity, 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) E.None of the above to be provided _ Hot Water Gas Electric Fuel Oil) Other i 900 SPRDQKLERS - FOR STRUCTURES OVER 7500 SQUARE TFET and certain multifamily residential Required, --plans provided, plans not provided, why? = Not required, not to be installed"WV 1000 REQUIRED OFF-STREET PARKDVG - 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 _.o. If yes, how many as a pirt of the total required number. I 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 — %7////Ci��E/E1--J5=Tz1 address �C% V/7/ �� /L /� phone # (.t , — Z-3 20 If corporation, officer in charge Arch;tect/-.gineer - for overall design Company name Address Phone number Certified by State of Massachusetts 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 Contractor (if Homeowner, state homeowner here then complete section 1300) Company name DC�/✓G/� /I�FF��L %l/tri/y�2% Address % 0211c% RP Phone number G3�'-a331� Construction Supervisors license number dY"f NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not reproductions. i R! t ii RtttfiifiittiiiitttYiffff f i tfitiiiiiitiiitiitittiiiiitttiiiiitttitftttY!!t 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! Rea Adel contractor name (please print) Address Registration number (if none smre "none") Phone number 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) 727-8599 Owners name (printl Signature Date 1 i j- FILE COP - TOV'f! OF DARUMUTH I RECORD PLAN A Copy Of This Endorsed Al - Site Plan Must Be Keepuut j ,{On B €t3 19y/ ion.._ Cate L-Ivij\"7 iMA. : � (1)�. ; � i k,-�- 7 zi 0 ti ----------- f\j HIZ-V 7k 34l 11 7'C) I -f ,-� Ctc IMP, FIRE L4 X. I .q w ILE C Op if T"w"' U MMVIOUTH -1- -4- .4 RECORD PLAN C10A Copy Of This Endorsed i K1. 2 Plan Must Be Kept On Site ILOVEM ?19 Q During Construction Date ---MWA� �A Ln YOUR DRAWING MUST BE KEPI AT THE BUILDING DURING. THE PROGPESS OF THIS WORK. tTILDING DEPAPTMENT Town of Dartmouth WCE561,1� I FLWI �LA L F 1'0 S j 1 --V 1-v C Z- 7