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BP-8051sfiiiffiffii##!f!#!!!i#!!#i##!R!##Rii#fitRiR#RiR#liiRRRRiiiiR=sfRfsi��s!#if=Riiiii#!!f#!i#!:fill!##i!#ii 1600 TO THE APPLICANT/RH, AHD APPROVAL Date of Plat a Owner Owner Owner phone /# :sss=s:ssssssifsifif#=f*#ssRflfss*#=f#i*i*R!lsiiRiiiiRllifl===ffifiRiiiiRfii**i=RsisiRiisliifRiiiffRiliif OTHER INVOLVED AGENCIES -The following agencies require separate jurisdictional permits or approval for your Proposed project. CONTACT THEM FOR 1t MBNOMONS. 0 TAX COLLECTOR = Approved HOLD By ❑ Board of Appeals = Approved By nervation Commission Approved By ❑ D.P.W. Water Approved By ❑ D.P.W. Sewer = Approved By ❑ D.P.W. Cross Connection a Approved By ❑ Treasurer (Bond) ❑ Approved By ❑ D.P.W. Engineering Z Approved By 7 ! oard of e, ih (w � A roved By PPa' d ealth (septic) _Approved By ❑ Board of Health (food service) — Approved By ❑ Planning Board (parking) = Approved By Date Date / Date Date Date Date Date Date Date Date Date ® FIRE DISTRICT (I - II -III) _ Approved By ss:::sssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss:::sss::ssssssssDate sssssss:ssssss BUILDING DEPARTMENT APPROVAL: ❑ ZONING ❑ BUILDING INSPECTORBUILDING COMMISSIONER ❑ CONTROL CONSTRUCTION AFFIDAVIT s====s*===*==*=ifiis#ifiiiiisRRiiRiiR#s=#ss=s=sss#==ifiiff======f===i=====sss*=iii**iiffRiiif=fff=fsffRf PROJECT SUMMARY: new constructions alteration/demo [Alterradd interior walls] [add rooms] [add footprint] sewage disposal - public/private [pool [garage/shed/deck] [game court] [food service] Describe i=i=ff=sssfiisff#f=issifiR**=*==iRfffi#sffRsisisiiisii! fflRsy To the various departments: water supply - public/private well sssssssissssisssR*=*=**s*****=ssf#isf 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 ? e By TOWN OF DARTMOUTH -BUILDING DEPARTZVIENT' TELEPHONE 508-999-0720 FAX508-999-0738" APPLICATION FOR ZONING AND BUILDING PERMIT Iav4ve6om . The applicant shall complete this application to the best of their ability prior to submission, leavJ. no item ®answered. The Department staff will be available during regular business homy 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. Nailfling timia me 1; 1 11e. (for OMM use only) ❑ FOUNDATIQOHI Y Total Cost $ Received By ��� Date Reed C __ Less Application Fees S :7__ Total Permit Fee $ Permit # Lvmed Date t 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET CURRENT ACCESSORS' PLAT 957 LOT I OTHER ZONING OVERLAY DISTRICTS , if applicable NUMBER & STREET W)_ NEAREST CROSS STREET - SUBDIVISION NAME &, LOT ## -1 or BUSINESS NAME ZONING DISTRICT 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 tn-ground Size 4 x: ,g,/ Chimney - number of flues S 6 _ Woodstove - used (will require inspectmn 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 3%r0 COMMERI' A - PROPOSED PRQIECT/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) (Seethe Code) ` _ Assembly - restaurant, lounge, theater, school, etc. (see Code Section 2.0) Describe = Business - office, assembly with less than 50 occupants - indi to Medical or other professional (see Code Section 303.0) _ Educational - structure for training including child day re 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, ' ant day care (see Code Section 307.0) . . = Mercantile - retail stores (see Code 08.0) _ Residential - three or more fam' v, hotel (see Code Section 309.0) L _ Storage - includes garages ( e Code Section 309.0) _ Utility & Miscellaneous tructures - includes tents and agricultural structures (see Code Section 311.0) = New tenant for anv f the above, indicate above (see Code Section 119.0 and Zoning By-law section 35) = Tent or Trailer temporary purpose? _ Other DescaJso eri'be proposacondition ��r INCLUDE -umber of dwelling mots and bedrooms or occupant bad as appt�b 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 see Code section 127.0). Designer to submit Code Synopsis. No. (If yes Will this project require Peer review (over 400,000 cu,ft,) Yes No (see Code Appendix 1) APPLICANT TO PROVIDE The following section for official use only. INSPECTORS, REVIEW Date plan reviewed 30 days to review period expires OK to issue date 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 t Date Applicant informed of above -Date staff (fax, phone, in person) ssssssssssss:ssssssssssssss:ss:::ssssss:ssssss:sssssssssssssssssssssssssssssssssssssssssss:::::*ssssssssss 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) ssssssssssssssssssssssssssssssssssssssssss*ss*s*ss*ssssssssisssssssssssssssssssss*si:sssss**ssssssssssss OFFICEUNSPECTORS NOTES TOTAL FEE pC �-'•� Gross area - new construction Total Sq. Ft. alteration Permit is issued to Total Sq. Ft. Comments/notes on permit ` 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 extend n)y three times b written request. I understand that once the permit expires a new application may be required, cludin fees and currecurrentother requirements (including Zoning). Name Signature The above signature (s }� v 1untary act d is'si he under the pains and penalties of perjury. tt J Date Who is authorized to pickup the permit at the Building Department? (lease 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 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 accords"ce with the rules and regulations promulgated by the BBRS entitled R:.les 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 heishe resides or intends to reside, on which there is, or is intended to be, a one or two family dwellin , 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 ssssssss::::ssssssssssssssssssssssssssssssssssssssssssssssssssssssss:::::ssssssss::::sssss::ssssssssssss 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) ssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss*ssss**::sssss 1500 COST Cost of Improvement UC: i) Items to be installed but not included in the above cost: TOTAL S EIectrical S Plumbing HVAC Other _ Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required. = 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 already existing Number of layers 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 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 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 0 Not required, why? = Submitted When? = Previously, date With this application 700 iTTIXrM Water supply - required K--yes _ no, public ? _ yes _ no, -on site well? III yes _ no, existing? k-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 _ ves ' no, public sewer _ yes � no private septic - on -site yes _ no. Submit copy of permit as soon as available. 800 MECHANICAIS & PRIMARY FUEL Architect/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) 71 None of the above to be provided Hot Water Gas Electric Fuel Oil Other 900 SPRE4ELERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential Required, --plans provided,pians not provided, why? = Not required, not to be installed, Why? 1000 REQUIRED OFF-STREET PARMG - for ZONING &Architectural Access NOT APPLICABLE = Parking Plan submitted To = Building Department LZ Planning Board Date submitted Number of spaces - indoors outside total provided Handicap 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 ves 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 M A,, - & Qcz e .1 w c-, c� address cc_v- a % N . phone # ) `/ L% - 1.2 & U If corporation, officer in charge Architect(Engmeer - 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 An 7c;J Lc z SPA Address A) i ✓ its- r Phone number ��f C, ' -';' L (, Construction Supervisors license number .41, S 2i-25 NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not reproductions. sss:sssssss::sssssssssssssssssss:ssssssssssssssssssssssssssss:ssssssssssssssssssssssssssssssssssss:sssss 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 (ir 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 Date