BP-6071600 TO TITS APPLTCANTIREBERRAL AND AppROVAL
Date of Application submission
Plat 10 Lot 2� Sty
Owner
Owner mail address
/s7
6'�quifer Zone
Owner phone #
OTIiER INVOLVED .-AGENCIES - The following agencies require separate jurisdictional permits or approval for your
Proposed project. CONTACr THEIR! FOR REQUIRED SDBMI8.4i<ONS. _
® TAX COLLECTOR __ Approved = HOLD By
Date
❑ Conservation Comm = Approved By
Date
❑ D.P.SV. water = Approved By
Date
❑ D.P.W. sewer ::Approved By
Date
❑ D.P.W. cross connection — Approved
Date
❑ D.P.IV. engineering _ Approved
Date
❑ Bo rd of Health well = Approved
Date
❑ oard of Health septic _ Approv 1
Date
❑ Board of Health food service = Approved
Date
9 FIRE DISTRICT J - II . IIII = Approved
Date
0 PlanninQ Dept _ Approved
Date
_,l
Other _ Approved
Date
Uthcr — Approved`:, ._
Date
Cmrnents
Prnlect summary new construction/ alteration, demo sewage disposal - puhiiciprivate
falter -add interior walls] [add roomsl [add footprint) water suppiv - publicrprivate well
1pooll [garngershedl [game cou I [food service]
Describe ��If I
To the various departments:
This notice has been forwarded to you for vour information and any 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.
The BuiIdin_ Department
Date sent for review 2 2
-je-2: By
3
TOWN OF DARTMGUTS BUILDING: jkPARTNENT
TELEPHONE 508-999-0720 FAX 508-999-0738
APPLICATION FOR ZONING AND BUILDING PERMIT
Ins"oetions
The applicant shall complete this application to the best of their ability prior to submis;ioti.'leaviag no item unanswered. The
Department staff µiu he available during regular business hours to assist as necessary: MA should be inserted for those sections
which do not apply. A prnperly completed application will help avoid unnecessary delays. Irate film fees apt wr& is,
(for ot$ce use only)
Application fee $ received by Date
Total Permii Fee $ Permiit #
V
n
100 LOCATION OF PROJECT
CURRENT ACCESSORS' PLAT . LOT ZONING DISTRICT S (C— -
OTHER ZONING OVERLAY DISTRICTS , if applicable
NUMBER 3 STREET 21
NEAREST CROSS STREET 0 I Jf1n�P �
SUBDIVISION NAME & LOT #
or BUSINESS NAME
PREVIOUS TENANT ; OWNER �� LWr f c)Gl r fit°,
200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
= THIS SECTION NOT APPLICABLE
Sinzie famih' - number bedrooms number baths `�'
= Two family - number bedrooms unit 1 number baths unit 1
number bedrooms unit 2 number baths unit 2 -
= Accessory apartment Total gross sq. ft.'
= Accessory structure
= - attached to dwelling, dimensions L W
Garage -detached
= Carport -detached - attached to dwelling. dimensions L W
= Shed - dimensions L W
= Gazebo - dimensions L W
Swimming pool above round in - ground Size total square feet
= g
= Chimney - # 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 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 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 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 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.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 I)
APPLICANT TO PROVIDE
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
Inspectors signature
DateMAR ® 41997
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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OFFICEVNSPECI'ORS NOTES
TOTAL FEE I % ��La
Gross area - new construction l9 aD Total Sq. Ft. j a'.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit �� a S^ 00
written request. I understand that once the permit expires a new application may be required, including fees and current
other requirements (including Zoning).
Name L'22a },/ �CL_�
Signature
The above signatt le is my voluntary act and is signed under the pains and penalties of perjury.
Date?YY
Who is authorized to pickup the permit at the Building Department? iplease printi
.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 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
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 deli:.ed 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 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 signature carries certain responsibilities, including but not necessarily Limited to, general liability
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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
2.1_.2 of section 5)
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1500 COST
Cost of Improvement
Items to he installed but not included in the above cost: Electrical 5
Plumbing
HVAC
Other
TOTAL S
The following section for official use only.
INSPECTORS' REVIEW
Date plan reviewed
Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required.
Demolition - describe structure e�� / ` G^U H-� f '5�
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 already existing
Number of lavers when complete
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 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
_ one submitted. Why".
Submitted, usually three sets required. Four sets for food service uses. Number of sets submitted
600 SITE PLAN
Not requued, why?
_ Submitted When? - Previously, date _ With this application
700 UTILITIES
Water supply - required _ yes ,_ no, public ? 3zves _ no, on site well? _ yes _ no,
existing? eyes _ no
If required and not existing have necessary permits been issued? _ no _ yeso 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 X yes _ no. Submit copy of permit as soon as available.
30 days to review period expires
OK to issue date
800 MECHANICALS & PRIMARY FUEL
Architect/EngWeer - 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, whv?
— Not required, not to be installed, Why?
1000 REQUIRED OFF-STREET PARKING - for ZONING & Architectural Access
= NOT .-APPLICABLE
= Parking Plan submitted To = Building Department = Planning Board Date submitted _
Number of spaces - indoors onside 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? yes = no _. If yes has it been issued ves = no
Submit copy of application and/or permit as soon as available.
1100 IDENTIFICATION (print or type except as noted)
Current ov
address
phone #
If corporation, officer in charge
Architect/Engineer - for overall design
Company name
Address _LI 6 , V1 h e
Phone number
Certified by State of Massachusetts as
Certification number
eo l J oA n Ma hr�
NOTE Signatures and seals on all cans, affidavits and other documents SHALL BE originals and not
reproductions.
cf
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 N I're d #//q -eo --�'1
Address
Phone number (,6 � 9) �La
Construction Supervisors license number (� 5
914 6a32..(
NOTE Signatures and seals on all 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 _I/No _ If no go to next section!
Are you claiming exemption from the requirement? Yes _No V?If yes, submit the required affidavit!
Remodel contractor name (please print)
Address E /1 �`iA �%Y7 G�� CQ�Q l/L 1W
Registration numbe (ir none state "none")
Phone number 3-
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
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
c-