BP-431600 To TZIE AppUCAN MEFRR"L - --- - -___ •�:...
AND APlROVAL
Date of Applications mission
Plat � Lot Street Aquifer l G+G1 r
Owner (%CM/� '� Zone_
Owner mail address
r/
Owner phone # S
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OTHER INVOLS'ED AGENCIES - The followinga encies sssssissses:sssssssisssi=su
3 require separate jurisdictional permits or approval for your
Proposed project. co
XTACr ZTIEM FOR REQUIRED SMRM?rMONS.
�Ax Approved = HOLD By COLLECTOR = /C e.
Date
t7 ('onserration Comm _Approved By
Date
❑ D.P.W. water -
- Approved B}•
Date
a D.P.W. sewer _ Approved Bs
Date
Q D.P.W. cross connection — Approves
Date
0 D.P.W. engineering _ Approved
Date
Q Board of Health well = Approved
Date
tI oard of Heaith septic _ " Approve�`C.r
Date _
C1 Board of Health food service = Approved
Date
�RE DISTRICT (I - II - III) = Approved
Date
Planning Dept _ Approved
Date
c) t r c r Approved
Date
Other —Approved
Date
� •••mrtents
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Prnlect summary new• construction/ alterationrdemo
sewage deposal - pubiiciprivate
;.Alter. add interior walls] [add rooms] [add footprintl water supply - publiciprivate ,veil
1pooil
Descr:be
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' arious departments:
[garsge.shedj [game courtl [food ser•vicei
This notice has been forwarded to you for your information s 'ons please advise. I say reason to wad any appropriate action. Should you have any
rstion is appreciated..ithhold the requested permit is found. please advise. Your assistance and
uilding Department
TOWN OF DARTMOUTH BUI_ LDING• jjEPARTMENT
TELEPHONE 508-999-0720 FAX 508-999-0738
APPLICATION FOR ZONING AND BUILDING PERMIT
Iasa 3c ions
Tie applicant shall complete this application to the best of their ahility prior to submission, le"ing no Iola ttttaaswe'ed• The
Department staff wiil he available durias regular business hoots to assist as necessary. MA should be inserted for those sections
which do not apply. A properly completed application will help avoid ulmecessuT delays. NMW ills fees tat nei,a•biie-
(for ohm we only)
Application fee S ✓ ''Vrwened Date
Total Permit Fee S Permit #
100 LOCATION OF PROTECT
CURRENT ACCESSORS' PLAT LOT ZONING DISTRICT __'5 R — 6
ZONING OVERLAY DISTRICTS ;_if applicabPt
ITHER
I;IIBER & STREET �/ Gc' � C�.�%Iz —
NE. -REST CROSS STREET
SUBDIVISION NAME & LOT #
12,.4
or BUSINESS NAME
'
rn
PREVIOUS TENANT ; O«'NER
==
C
200 RESIDENTIAL - PROPOSED PROJECT - one & two family, residence only
s
ti1
M
r
e:
M
= THIS SECTION' NOT APPLIC- BLE
<
Z3
c
= Single famih• - number bedrooms number maths
Lo
= Two family - number bedrooms unit I number baths unit 1
number bedrooms unit:: number baths unit Z
--i
.Y
= Accessory apartment Total gross sq. fL*
Accessory structure
= Garage . detached - attached to dwelling, dimensions L W
_ Carport - detached - attached to dwelling, dimensions L W
Z Shed - dimensions L W
- Gazebo -dimensions L W
= Swimming pool above ground in -ground Size total square feet
Date sent for review
By
= Chimney - # of flues
t:; Woodstove -used (will requmns
pection prior to installation), new (provide manufacturers
OK to issue subject to requested submittals (see project review worksheet) date
instructions). Locations) (list)
Fireplaces) - (includes flue) Lit locations)
Game Court - describe (include overall dimensions)
Tent, Trailer (Mobile Home) or Other - describe
300 COMMERCIAL - PROPOSED PROJECr/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 overt 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 COM 1ERCIAL ONLY
Will this project be subject to CONSTRUCTION CONTROL (over 35,000 cu.ft.) __yam 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 n
APPLICANT TO PROVIDE
DEN® see project review worksheet date
HOLD reason
HOLD Subject to Zoning Board of Appeals action
Comments
date
Inspectors signature Qde�_Dl�ILSLJ;21D
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)
OFFICEIINSPECTORS NOTES
TOTAL FEE % ;�-
Gross area - new construction
Total Sq. Ft.
alteration %G/' / Total Sq. Ft.
Permit is issued to
Comments/notes on permit
written request. I understand that once the permit expires a new application may be required, including fees and current
other 4quiremen4-(alluding Zoning).
! ame Get t
Signature _ 2�
The a dove signature is mywolunt
ate % I �7Z
and is signed under the pains and penalties of perjury.
Who is authorized to pickup the permit at the Building Department? ipfease print"--7eeF.l�ii/ <' (.Gs4 1
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 Constriction 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: 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: 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 famiiv 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 necessarijy 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
of section 5)
1500 COST
Cost of Improvement 5
Items to he installed but not included in the above cost: Electrical 5
Plumbing
HVAC
Other
1
TOTAL
The following section for official use only.
INSPECTORS' REVIEW
Date plan reviewed JUL 0 9 1996
30 days to review period expires e �'
CT
OK to issue date
- Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required.
G'�—)Iernolition - describe structure
Number of dwelling units Number of bedrooms A separate Refuse Disposal
Declaration requaEd.
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 oniv, is included in new construction)
Number of square feet Number of layers already existing
Number of layers when complete
A separate disposal declaration REQUIRED
X- Replacement doors 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
pl considered as an Alteration, otherwise will be included in new corstruction. (see Code section 3401.10 for
LL
re 'dentiai 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. I`'hv? f2Z`' /�/—�/'✓fG'�f%/Oi/ i�� /J��i'r/ G"�/"'
- Submitted. usually three sets required. Four sets for food serviceluses. Number of sets submitted
600 SITE PLAN
❑ Not required, why?
- Submitted When? - Previously, date = With this application
700 UTILITIES /
Water supply - required _ ves _ no, public ? V yes _ no, on site well? _ yes _ no.
existing? _ yes _ no
If required and not existing have necessary permits been issued? _ no _ yes,. date
(i11.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a water supply, when
required, is available. See Code 790 CMR section 114.1.2)
Sewage disposal - required _Is _ no, public sewer _ yes _ no
private septic - on -site _ yes _, no. Submit copy of permit as soon as available.
800 MECMANICAiS & PRIMARY FUM
Archit.:t Engineer - 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 EIectric Fuel Oil Other
900 SPRINKLERS - FOR STRUCTURES OVER 7S00 SQUARE FEET and certain multifamily residential
= Required, ::Plans provided, =plans not provided, why?
— Not required, not to be installed, Why?
1000 REQUIRED OFFSTREET 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? yes = no _. If yes has it been issued yes = no —.
Submit copy of application and/or permit as soon as available.
lli)() IDENTIFICATION (print or type except as noted
at owner - name C' /CCC"/ (/
ddress 1/J GL� eq/ �!/�%!� y
p3��//�/rT sZ//L✓ i�/j��J'
hone` �f�" �, ���
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 allplans, affidavits and other documents SHALL BE originals and not
reproductions.___�.�
General Contractor Homeowner, s ! to homeowner here then complete section 1300)
Company name
Address
Phone number
Construction Supervisors license number
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 _ No _ If no go to next section!
Are you claiming exemption from the requirement? Yes _No _If yes, submit the required affidavit!
Remodel contractor name lease Tint)
Address
Registration number (if none state "none")
Phone number
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 (pri
Signature
Date • y/ —��
I
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
be extended only three times by
anticipated if I request such an extension in writing. I understand that the permit may