BP-5201600 TO THE AM ICANVREFERItAL AfqD APPROVAL
Date of Application submission .
Plat Lot Street Aquifer Zone
Owner
Owner mail address
Owner phone #
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OTIIER INVOLVED .-AGENCIES - The following agencies require separate jurisdictional permits or approval for your
Proposed project. CONTACT THEM FOR REQUIRED SUBMISSIONS.
® TAX COLLECTOR _ Approved = HOLD By Date
(3 Conservation Comm = Approved By Date
i
a D.P.W. water = Approved By Date
a D.P.W. sewer = Approved Ev
Date
a D.P.W. cross connection — Approved Date
a D.P.W. engineering _ Approved
Date
a
Board of Health
well = Approved
Dam
a
Board of Health
septic - Approved
Date
a Board of Health food service = Approved Date
S FIRE DISTRICT J - II - III) — Approved
Date
Planninz Dept = Approved Date
Other = Approved Date
hcr _ Approved Date
C-inntents
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Prnlect summary- new constructions alteration
rdemo sewage deposal - puhiic:private
fAlter-add interior walls] [add rooms] [add footprint) - water supply - public:private weiI
(pool] [garazershed] (game courtl [food service]
Descrtoe
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Co the various departments:
This notice has been forwarded to you for your information and any appropriate action. Should you have any
uestions please advise. If any reason to withhold the requested permit is found. please advise. Your assistance and
000eruion is appreciated -
TOWN OF DARTMOUTH
TELEPHONE 508-999-0720
BUMDWG- DEPARTYffNT
FAX 508.999-0738
APPLICATION FOR ZONING AND BUILDING PERMIT
Insu-oatioos veered. The
The appiirant shall complete this application to the best of their ability prior to submispon.-leavnng no item miaas
Department stair will he available during regular business hours to assist as neeessdelays.
� MA 5 � for those settion�
l<iee is t+ras
which do not appiv. A properiv completed application will help avoidunnecessary necessary Y -
(for omm use on'Y)
Application fee S � received by Date _e�'-04
Total Permit Fee $___ P&mit #
100 LOCATION OF PROJECT j�%
CURRENT ACCESSORS' PLAT-�z�`-- LOT
OTHER ZONING OVERLAY DISTRICTS :.if applicable _
NUMBER & STREET
NE xREST CROSS STREET
SUBDIVISION NAME & LOT #
or BUSINESS NAME
PREVIOUS TENANT; O«'NER
ZONING DISTRICT lR
200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
-- THIS SECTION NOT APPLICABLE
= Sinale family - number bedrooms S number baths
= Two family - number bedrooms unit 1 number baths unit 1
number bedrooms unit 2 ___ number baths unit Z '
11- .accessory apartment Total gross sq. ft. -
_ Accessory structure
_. Garage -detached - attached to dwelling, dimensions L w_
= Carport - detached - attached to dwelling, dimensions L w
= Shed - dimensions L W
Gazebo - dimensions
— Swimming pool above ground in -ground
Size total square feet
he Building Department
Date sent for review
By
= Chimney - # of flues
Woodstove - used (will require inspection prior to installation), new (provide manufacturers
instructions). Location(s) (list)
OK to issue subject to requested submittals (see project review worksheet) date
DENIED see project review�worksheet date
Fireplace(s) - (includes flue) List location(s)
Game Court - describe (include overall dimensions)
Tent, Trailer (Mobile Home) or Other - describe
300 COMMERCIAL - PROPOSED PROJECT/USE - 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 3n6.0)
= 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 number 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
Will this project be subject to CONSTRUCTION CONTROL (over 35,000 cu.ft.) Yes No. If es
see Code section 127.0). Designer to submit Code Synopsis. ( y
Will this project require Peer review (over 400,000 cu.ft.) Yes No (see Code Appendix I)
APPLICANT TO PROVIDE
HOLD reason date
HOLD Subject to Zoning Board of Appeals action
Comments
Inspectors signature Date 4f "
r
Applicant informed of above - Date time staff - (fax, phone, in person)
ssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss
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)
ssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss
OFFICEIINSPECTORS NOTES
d D/�
TOTAL FEE
Gross area - ne onstruction Total Sq. Ft.
alteration Total Sq. Ft. / %gam jao
Permit is issued to
Comments/notes on permit
i
written request. I understand that once the permit expires a new application may be required, including fees and current
other requirements (including Zoning).
Name ✓1�p Y - [/l (� %1 C/C/
Signature
The
Date l
tune is my voluntary act and is signed under the pains and penalties of perjury.
«Vho is authorized to pickup the permit at the Building Department? iplease pr nn
Address Phone
1400 HOMEOWNER EXEMPTION - ONE & TWO FAMILY ONLY
FOR HOME OWNERS 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 I27.0. 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 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 defi:.,d a, follows: Personis) 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
two -rear period shall not be considered a Home Owner.
If you are applying under this section sign below:
Signature
Your signature carries certain responsibilities, including but not necessarily limited to, general liability
_____________=====s==ssss=ss==sssssssss===s:s===ssssssssssssssss==ssss===ss=sss=ssss=**ss=s=ssssssss=
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
?.I;.= of section 5)
150o COST
Cost of Improvement 5
Items to he installed but not included in the above cost: Electrical 5
Plumbing
HVAC
Other �^J
TOTAL $ �(1
The foiloµing section for official use only.
INSPECTORS' REVIEW
Date plan reviewed JAIL 2 9 1997
30 days to review period expires
�Atter,tion of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required.
.. x
Demolition - describe structure
Number of dwelling units Number of bedrooms A separate Refuse Disposal
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 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
`>Z Replacement doors and windows - (for existing only) (only where doors and windows exist and will not be
enlarged) EGRESS dimensions must he maintained. Enlarged or new windows in an existing dwelling will be
considered as an Alteration, otherwise will he included in new construction. (see Code section 3401.10 for
residential and Article 8 for commercial)
— Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods of time.
Describe
500 CONSTRUCTION PLANS
None submitted. Whv?
/submitted. usually three sets required. Four sets for food serviceluses. Number of sets submitted 3
600 SITE PLAN
W Not required, why?
= Submitted When? _ Previously, date = With this application
700 UTILITIES
Water supply - required _ yes _ no, public ? 4yes _ no, on site well? 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 _ no, public sewer _ yes _ no
private septic - on -site -yes _ no. Submit copy of permit as soon as available.
OK to issue date
n
8o0 mECHAMCAIS & PRIMARY FUEL, "
0
Architect/Enginei!r - project supervision and reports
- Furnace (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify)
- Boiler (heating)- Fuel gas (natural or propane) El
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 REQUIRED OFF-STREET PARKING - for ZONING & .Architectural Access
- NOT APPLICABLE
- Parking Plan submitted To - BuiIding Department - Planning Board Date submitted
Number of spaces - indoors outside total provided
Handicap spaces - required _ yes _no. If yes, how many as a part of the total required number.
Is Route 6 (State Road) Entrance permit required? ves - no -. If yes has it been issued yes - no
Submit copy of application and/or permit as soon as available.
190 IDENTTFICATTON sprint or type except as noted) *T) 7 z/� Z-
Current owner - name !°1/�. /I%pr yf oA•�v, / „ /l ii ti i'A , l
address J / -flm /Y�i .- r 11
phone 99 G - d r/r3 a /: �3 C - a2 s-3
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 tans, 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 Wi v/'oe A`�'r
Address /nee C 4 ✓r ..(1t✓q e° C, � ' /�/ S
Phone number (S vSto o/
Construction Supervisors license number e S
NOTE Signatures and seals on ail plans, affidavits and other documents SHALL BE originals and not
reproductions.
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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!
J
Remodel contractor name (please print) liter n� /'/ �ee a
Address
Registration number (if none state "none")
Phone number �S� �� C `% t ?
PERSONS CONTRACTING NVITH 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
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 requested he 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
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