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BP-85051600 TO THE APPLICANI'/REFERRAL AND APPROVAL Date of Application submission ©- Plat Lo Street JA Jtk � ( � Aquifer Zone Owner Owner mail address Owner phone # ssssss:sss::ss:sss:ss::sss::ssssss:sss:sss::s:::s:::sss::ssss:ss:+:::s:ss:s:::::::::s:s:sss:sass:ss:sss:ss OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACT THEM FOR REOi1iQED SUBMISSIONS. ® TAX COLLECTOR Approved Z HOLD By ❑ Board of Appeals = Approved By ❑ Conservation Commission r- Approved By ❑ D.P.W. WatI er Approved By ❑ D.P.W. Sewer = Approved By ❑ D.P.W. Cross Connection ` Approved By ❑ Treasurer (Bond) ❑ Approved By ❑ D.P.W. Engineering Z Approved By -1 Board of Health (well) = Approved By ❑ Board of Health (septic) = Approved By Date Date Date Date Date Date Date Date Date ❑ Board of Health (food service) = Approved By Date ❑ Planning Board (parking) - Approved By Date ® FIRE DISTRICT (I - II - IIn — Approved By Date ssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssasssssssssssssssssssssssssssss BUILDING DEPARTMENT APPROVAL: ❑ ZONING ❑ BUILDING INSPECTORBUILDING COMbIISSIONER ❑ CONTROL CONSTRUCTION AFFIDAVIT :ss:=:====s:ss::ss:::ssss:ssssss:ssss:s::ss::ss==:s:s:ssssssss::sssss:s:s:s::s:s:sss:*===*=*=#ssssssssss PROJECT SUMMARY: new construction/ alteration/demo sewage disposal - publiciprivate [.Mteradd interior walls) [add rooms] [add footprint] water supply - public/private well [pool] [garage/shed/deck] [game court] [food service] " Describe c_ Q_ct'un , AA I 1 3"LA "-, rvi 1-4 , - " 1 ? I ssssss:::s:sssssssssss:s:sss=====s*===sssssss:ssssssssssss sssssssssssss:ss::s:sss s ===ss=*ss:s:sssssssss 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 permit is found, 'please advise. Your assistance and cooperation is appreciated. The Building Department - Date sent for review ` �' t/�g B Y TOWN OF DARTMOUTH BUMDIN ,DEPARTMENT TELEPHONE 508-999-0720 FAX> 508-999-0738 APPLICATION FOR ZONING AND BUILDING PERMIT ImirneSona . The applicant shall complete this application to the best of their ability prior to submission, leaving no item ®answered. 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. Ne t Fig he in mot -effi— (for oTwe use only) 0 FOUNI)ATION ONLY Total Cost $ Received By _- Date Reed 16 -2 Less Application Fee $ Total Permit Fee $ Permit # Lvmed Date 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET 4Q, 7 oy CURRENT ACCESSORS' PLAT 0(t) LOT 4�_ ZONING DISTRICT OTHER ZONING OVERLAY DISTRICTS , if applicable � NUMBER & STREET _?7 S/yI11 Are f 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 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: - 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 _ Swimming pool above ground in -ground Size Chimney - number of flues _ Woodstove - used (will require inspection prior to installation new The following section for official use only. p ), (provide manufacturers ^� s instructions). Location(s) (list) _ ; . ` INSPECTORS' REVIEW Fireplace(s) - (includes flue) List location(s) Date plan reviewed - Game Court - describe (include overall dimensions) 30 days to review period expires Tent, Trailer (Mobile Home) or Other - describe = OK to issue date 300 COMl1ffitCIAL -PROPOSED PROJECT/USE _INCLUDING THREE FAMILY OR MORE AND EXEMPT USES OK to issue subject to requested submittals (see project review worksheet) date = THIS SECTION NOT APPLICABLE = DENIED see project review worksheet date (The following descriptions are based on the Massachusetts State Building Code Article 3, AS NOTED) (See the HOLD reason date Code) = HOLD Subject to Zoning Board of Appeals action _ .Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe Comments = 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 & I'discellaneous 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 Desmflbe the proposal briefly, INCLUDE - umber of dwelling units and bedrooms or occupant bad as applicable, w 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 aiteration(s). If project is an addition to existing structure - Total gross square feet of existing = FOR COMIKERCIAL 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 1) APPLICANT TO PROVIDE Inspectors signature Date©CT,2 0 1999 Applicant infWmed of above - Date - time staff (fax, phone, in person) sxz#z#z#Y#zs#s###z#sssslssssszssts!!#lsssz#zs#ssssassssssssssssss;sssssslsssslssstsslssssslYsss;slssszssss 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\JNSPECTORS NOTES 0 TOTAL FEE 30 Gross area - new construction ~� Total Sq. Ft. alteration Total Sq. FL Permit is issued to Comments/notes on permit NO �- lXq xiy �VL 2'Cl��t 1K?�i�i J 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 be 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 Signature The above sign re �myo ta act and is signed under the pains and penalties of perjury. Date D Z!> Who is authorized to picku the ermit at the Building De artment? (please arinn �1 h Address 3 � Z r-� TS t Phone - FIP F 33 F '7 1400 HOMEOWNER E7VTION - ONE & TWO FAMILY ONLY FOR HOME OWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT 109.1.1 Licensing of Construction Supn-risors: 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 accords-ce 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 defined as follows: Person(s) who owns a parcel of land on which hershe 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 sssssssssssssssssss:sssssssssssssssssssssssssssss:sssss::sssssssssssssss:ssss:::ssss:::::::::sssss:sssss 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) ::sssss::::sssss:sssssssssssssss:sss::::::sssss:sssss::sssss::::::::ssssssss:sss:::::sssss:ss::::sssss:: 1500 COST Cost of Improvement Items to be installed but not included in the above cost: s 7Z O EIectrical s Plumbing HVAC Other Alteration of existing, no increase in grossJ+• quare feet. A seI�arate Refuse Disposal Declaration required. f� slc�vz Mzv/0C PeXc J-�k,I — AQpfbx t3 = 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 — 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 Articl - 8 fL - commercial) = Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods of time. Describe 500 CONSTRUCTION PLANS v� None submitted. Why? ` � =Submitted, usually three sets required. Four sets for food ser•viceluses. Number of sets submitted 600 SITE PLAN ❑ Not required, why? = Submitted When? - Previously, date With this application 700 UTH,TTIFS Water supply - required _ yes _ no, public ? •_ yes _ 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 TOTAL / 2,5—, ®0 private septic - on -site _ yes — no. Submit copy of permit as soon as available. 800 MECHANICALS & PRIMARY FUEL Archihwt/Engmeer - 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 REQUIRED OFF-STREET PARE3NG - for ZONING & Architectural Access NOT APPLICABLE = Parking Plan submitted To = Building Department L—J Planning Board Date submitted Number of spaces - indoors outside total provided H-ndicap 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 1�Z address y3 % v►-,,, k rA phone # 99 7 - -2e) 5- `- 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 Contractor (if Homeowner, state homeowner here then complete section 1300) Company name Y� \�C -c�e,tiS� C�t��-r c-'�\ (CC«T 4�ct�c� i Address / 71-t Phone number 3-3 Construction Supervisors license number r7 NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not reproductions. sssssssxsx:ssxsxsxxss:xssssssssxssxss:xx:xxsssxxxsssxssxsssxxxxsxssssxxssssssssxssssssssssssssssssssssss 1200 FOR RESIDENTIAL REMODEL WORK ONLY Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes X No _ If no go to next section! Are you claiming exemption from the requirement? Yes No )<If yes, submit the required affidavit! Ren_,)del contractor name (Please print) t V" Address 3 5 t'-t W &A - Registration number (if none state "none") %D to % 2 2- Phone number l F� 9 3 92 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