BP-56501600 TO THE APPLIC Mr/REFERRAL AND APPROVAL
Date of Application submission ' 7 Ay
Plat Lot � Street 60 `
�t ,
Owner
Owner mail address
Aquifer
Aquifer Zone
Owner phone #
OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT' THEM FOR S'UBMLSSIONS-
® TAX COLLECTOR Approved HOLD By Date
❑ Board of Appeals Approved By
❑ Conservation Commission C. Approved By
13, D.P.W. Water Approved By ❑
❑ D.P.W. Cross Connection 7 A—
B /
Date
Date
Sewer Approved By Date
prov
Date
❑ Treasurer (Bond) ❑ Approved By
Date
❑ D.P.W. Engin/AIpDrVBy
Date
7 Board of Healed By
Date
❑ Board of Healved By
Date
❑ Board of Heal Approved By
Date
❑ Planning Board (parking) = Approved By
Date
® FIRE DISTRICT (I - II - 1I1) Approved By
Date
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BUILDING DEPARTMENT APPROVAL:
❑ ZONING
❑ BUILDING INSPECTORBUILDING COMMISSIONER
❑ CONTROL CONSTRUCTION AFFIDAVIT
PROJECT SUMMARY:
new construction/ alteration/demo sewage disposal - public/private
[Alter/add interior walls] [add rooms] [add footprint] water supply - public/private well
[pool] [garage/shed/deck] [game court] [food service]
Describe
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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 d
cooperation is appreciated. G
The Building Department - Date sent for review
By
TOWN OF DARTMOUTH' ".BUILDING DEPARIMENT
TELEPHONE 508-999-0720 FAX: 508 99970738
APPLICATION FOR ZONING AND BUILDING PERMIT
Insbruetiom
The applicant shall complete this application to the best of their ability prior to submission, leaving no item mtanswered. The
Department staff will be available during regular business hours to assist as necessary. N/A should be inserted for those sections
which do not apply. A properly completed application will help avoid unnecessary delays. Nair IEia fees me rd�
(for office use only) ON ONLY
Total Cost $ Received By Date Reed % ?T
Less Application Fee $ '
Total Permit Fee S Permit # Issued Date
100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET / 7
CURRENT ACCESSORS' PLAT LOT ZONING DISTRICT
O ER ZONING OVERLAY DISTRICTS, if applicable
NUMBER & STREETy�
NEAREST CROSS STREET
SUBDIVISION NAME & LOT #
BUSINESS NAME
PREVIOUS TENANT / OWNER
200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
THIS SECTION NOT APPLICABLE f
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:
J �
�y
(1 1
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 ins
( q inspection prior to installation), new (provide manufacturers The following section for official use only.
instructions). Location )
) (s) (list)
tl
C Fireplace(s) - (includes flue) List location(s) INSPECTORS' REVIEW
• Date plan reviewed j
C Game Court describe (include overall dimensions)
30 days toreview period expires
C Tent, Trailer (Mobile Home) or Other - describe
C OK to issue date
300 COMMERCIAL - PROPOSED PROJECT/USE - INCLUDING THREE FAMILY OR MORE AND E
THIS SECTION NOT APPLICABLE XEMPT USES :1 OK to issue subject to requested submittals (see project review worksheet) date
C
DENIED see project review worksheet date
(The following descriptions are based on the Massachusetts State Building Code Article 3, AS NOTED) (See the
Code) J HOLD reason
_ date
C Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe 77 HOLD Subject to Zoning Board of Appeals action
Comments
= Business - office, assembly with less than 50 occupants - indicate Medical or other professional (see Code
Section 303.0) Inspectors signature Date ppp�®� � .�99�
Educational - structure for training including child day care for those over 2 years 9 months (see Code Section Applicant informed of above - Date time L��e%f6
304.0) staff (fax, phone, in person)
_ Factory / Industrial - (see Code Section 305.0) — Over six months since approved for issue - DEEMED abandoned?
High Hazard - (see Code Section 30�.0) Advise applicant. Hold 90 days for return then dispose if not picked up.
_
C Institutional - hospital, nursing home, infant day care (see Code Section 307.0) Inspector
Date
Mercantile - retail stores (see Code 308.0) Advised applicant Date Time staff
(by phone, fax or in person)
Residential -three or more family, hotel (see Code Section 309.0)
OFFICEIINSPECTORS NOTES
_ Storage - includes garages (see Code Section 309.0) v
c
�- TOTAL FEE t�d L�
E Utility & Miscellaneous Structures - includes tents and _gricultural structures (see Code Section 311.0)
Gross area -new construction Total Sq. Ft.
_ New tenant for any of the above, indicate above (see Code Section 119.0 and Zoning By-law section 35)
alteration Total Sq. Ft.
_ Tent or Trailer - temporary purpose?
_ Other Permit is issued to
Describe the proposal briefly, INCLUDE r umber of dwelling units and bedrooms or
also existing condition occupantloadasapplirabk, Comments/notes on permit
400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED
C 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
Wit"' this project be subject to CONSTRUCTION CONTROL (over 35,000 cu.fL yes
see Code section 127.0). Designer to submit Code Synopsis. No. (If yes
Will this project require Peer review (over 400,000 cu.ft.
APPLICANT TO PROVIDE ) Yes No (see Code Appendix I)
1300 OWNER SIGN - OFF
Alteration of existing; no increase in gross square feet. A separate Refuse Disposal Declaration required.
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).
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�ame ,�C 15 t f� ;(r (�� 0i
Signature rz�'—
�Thhe abovissignature is my Qtary act and is signed under the pains and penalties of perjury.
Date
1 {��
Who is authorized to pickup the permit at the Building Department? (please print)
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 he engaged in directly supervising persons engaged in
construction, reconstruction, alteration, renair, removal or demolition involving the structural elements of b-ildings or
structures, unless he or she is licensed in accordance with the rules and regulations promulgated by the BBRS entitled
RLIis and Regulations for Licensing Constmction 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 Ian
on which helshe resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attach d
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:
)Z
Signature f/
Your signature carries certain responsibilities, j&cluding 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 anv
licensed Construction Supervisor, whether or not they have taken the permit are responsible for code compliance. (see
2.15.2 of section 5)
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1500 COST
Cost of Improvement $
Items to be installed but not included in the above cost: Electrical S
Plumbing
HVAC
Other
TOTAL "/� LIZ
= 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 he included in new construction. (see Code section 3401.10 for
residential and Articl- 8 ft.-- 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 service\uses. Number of sets submitted
600 SITE PLAN
❑ Not required, why?
Submitted When? = Previously, date C With this application
700 LITHdTIF,S
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
private septic - on -site _ yes — no. Submit copy of permit as soon as available.
800 MECHANICAIS & PRIMARY FUEL.
= 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)
7.1 None of the above to be provided
= Hot Water Gas Electric Fuel Oil Other
900 SPREiELERS - 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 = Building Department a Planning Board Date submitted
Number of spaces - indoors outside total provided
Handicap spates - required _ yes _no. If yes, how many as a p?rt of the total required number.
Is Route 6 (State Road) Entrance permit required? yes C no If yes has it been issued yes no --.
Submit copy of application and/or permit as soon as available
1100 IDENTIFICATION (print or ty�p/e except as noted
Current owner - name ! Zvr 1? �i, �,�
Y dress V �t% ( �1 �/yt Gfet.
hone #
If corporation, officer in charge
Architect/Engi mer - 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.
Architect/Engineer - project supervision and reports
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
k/eompany name
met, state homeowner here then complete section 1300)
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Phone number �' / L4
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!
Ren-odel contractor name (please print)
Address
Registration number (if none state "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) 727-8598
Owners name (print)' �`�
Signature A�/<'/
C F� -
Date �//
BUILDING PERMIT 4/ill
FIELD INSPECTION
Dartmouth Building Department Plat: 24
400 Slocum Road P.O. Box 79399fo rim Lot(s) : 74
Dartmouth, MA 02747 i�l�l�1! Lot Size: 39, 748
Telephone (508 ) 999-0720 Zone Dist. :SRB
Issued Date //f / 9t Permit No: ( 9,6
Project Location: 506 Rock-O-Dundee Road
Number Street
Subdivision Name:
Nearest Cross Street:
Applicant/Agent: Roger Cabot
Contact Person Phone #: (508) 636-4943
Proposed Use: Residential
Residential, Commercial,Industrial,etc.
Permit Issued To: To Install
Type of Improvement,Add,Alter,New Const.,Demo,Land/Move,etc.
Woodstove and chimney
Indicate no. of bedrooms and bathrooms and other rooms
Owner(s) of Record: Roger Cabot
Address: 506 Rock-O-Dundee Road, Dartmouth, MA 02748
DATE TIME TYPE OF INSPECTION REMARKS INITIAL
3- 93—9 — c132),a-- oa /. / a4c S it
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