BP-24311600 TO THE APPLICANT/REFERRAL AND APPR
//OVAL
Date of Application submission C112- Lc
Plat 2� Lot-1 Street ' - � le216 .r,�1x�� E- C-_ Aquifer Zone
Owner
Owner mail address �`--11
Owner phone # j
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OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your
Proposed project. CONTACT THEM FOR RE<)1jIR1M SUBMISSIONS.
® TAX COLLECTOR ❑ Approved ^ HOLD By Date
❑ Board of Appeals ;3 Approved By
❑ Conservation Commission El Approved By
Date
Date
❑
D.P.W. Water J Approved By ❑ D.P.W. Sewer Approved By
Date
❑
D.P.W. Cross Connection El Approved By
Date
❑
Treasurer (Bond) ❑ Approved By
Date
❑
D.P.W. Engineering ❑ Approved By
Date
7
Board of Health (well) 2 Approved By
Date
❑
Board of Health (septic) : r Approved By
Date
❑
Board of Health (food service) ' Approved By
Date
❑ Planning Board (parking) _ Approved By Date
® FIRE DISTRICT (1 - II - III) Approved By Date
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BUILDING DEPARTMENT APPROVAL:
❑ ZONING
❑ BUILDING INSPECTORBUILDING COMMISSIONER
❑ CONTROL CONSTRUCTION AFFIDAVIT
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PROJECT SUMMARY -
new construction/ alteration/demo
[Alter/add interior walls] [add rooms] [add footprint]
sewage disposal - public/private
[pool] [garage/shed/deck] [game court] [food service]
water supply - public/private well
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 and
cooperation is appreciated.
The Building Department - Date sent for review
By
TOWN OF -DARTMOUTH BUR DING D PARTNIE TT
TELEPHONE 508-999-0720 FAX508-999-4738
APPLICATION FOR ZONING AND BUILDING PERMIT
The applicant shall complete this application to the best of their ability prior to submission, leaving no item unanswered. 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. N@6m its ices sst 1rr&
(for office use only) 0 FOUNDATION ONLY
Total Cost s Received By z2kk�-'-- Date Reed
Less Application Fees ✓ - r
Total Permit Fee s Permit # Issued Date
\' 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET
CURRENT ACCESSORS' PLAT LOT ZONING DISTRICT J "'
OTHER ZONING OVERLAY DISTRICTS , if applicable
NUMBER & STREET
NEAREST CROSS STREET
SUBDIVISION NAME & LOT #
or BUSINESS NAME C�✓1 '�/� 1 %/ l
/ OWNER
200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
T'HHIIS SECTION NOT APPLICABLE
Single family - number bedrooms number baths C
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
Z Carport - detached - attached to dwelling, dimensions L W
Shed - dimensions L W
Deck - dimensions . L W
Gazebo - dimensions L W
E Swimming pool above ground in -ground Size
Chimney - number of flues
..uuubwve - usea (wW require inspection prior to installation), new (provide manufacturers
The following section for official use only.
instructions). Location(s) (list)
C Fireplace(s) - (includes flue) List location(s) '
C Game Court -describe (include overall dimensions)
P/Tent, Trailer (Mobile Home) or Other - describe
300 COMMERCIAL - PROPOSED PROJECTIUSE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES
C THIS SECTION NOT APPLICABLE
(The following descriptions are based on the Massachusetts State Building Code Article 3, AS NOTED) (See the
Code)
C' 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)
E Institutional - hospital, nursm"J home infant day care (see Code Section 307.0)
" Mercantile - retail stores (see Code 308.0) (.
��r I
Residential - three or more family, hotel (see CodeSection 309.0)
C Storage - includes garages (see Code Section 309.0)
C Utility & Miscellaneous Structures - includes tents and _ gricultural structures (see Code Section 311.0)
C. New tenant for any of the above, indicate above (see Code Section 119.0 and Zoning By-law section 35)
C Tent or Trailer - temporary purpose?
Other
Describe the proposal briefly, INCLUDE r umber of dwelling emits and bedrooms or occupant load as applicable,
also existing condition
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
C! 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 I)
APPLICANT i.^. PRPVIDE -
INSPECTORS' REVIEW
Date plan reviewed %
30 days to review period expires
C OK to issue date
J OK to issue subject to requested submittals (see project review worksheet) date
DENIED see project review worksheet date
J HOLD reason
date
77 HOLD Subject to Zoning Board of Appeals action
Comments
Inspectors signature
Date
C Applicant informed of above - Date time staff (fax, phone, in person
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 __ Coy phone, fax or in person)
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OFFICEWVSPECTORS 1VOTES
TOTAL FEE
Gross area - new construction - Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit
2
\1300 OWNER SIGN - OFF
Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required.
0
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 V '
The above sig ture is my voluntary act and is signed under the pains and penalties of perjury.
Date
__�,h5Y27
Who is authorized to pickup the permit at the Building Department? (please prints 1
Address ZS—1 PLO' T)08 d - Phone ( Or3) q /
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 promu';atea 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 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
Your signature carries certain responsibilities, including but not necessarily limited to, general liability
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)
1500 COST $ 5AA
Cost of Improvement ' 6 O
Items to be installed but not included in the above cost: Electrical 5
Plumbing
HVAC
Other
TOTAL �• o C)
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 Articlo 8 fu- commercial)
Temporary structure - includes when allowed, trailers, tents and the lira and only for limited periods of time.
Describe I will be using the
500 CONSTRUCTION PLANS
5jc r L�t"" h kc_ ❑ 5th Edition
❑6th Edition
None submitted. Why?
of the State 'Building -Code -
= Submitted, usually three sets required. Four sets for food service uses. Number of sets submitted
�00 SITE PLAN V\encvr+^ K_4-S
❑ Not required, why?
Submitted When? = Previously, date C With this application
700 UT LXIIFES
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 MECHANICALS & 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)
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 PARIONG - for ZONING &Architectural Access
NOT APPLICABLE
Parking Plan submitted To _ Building Department a Planning Board Date submitted
- Number of spaces - indoors outside total provided
H-ndicap spaces - required _ yes _no. If yes, how many as a pL rt 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.
b1100 IDENTIFICATION (print or type except as noted)
Current owner - name L ) M t-A+rp I , + (7-5 ) 6I)
address
phone # LOUc-5 ) `1 b L/ -
If corporation, officer in charge
Architect/Engineer - for overall design
Company name
Address
Phone number
Certified by State of Massachusetts as
Certification number
O
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.
0W/1'P-('—
General Contractor. if Homeowner state homeowner here then complete section1300)
Company name Q j/ �CAY Vl I I n 1 "I n l nrut
t
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!
Reaodel contractor name (please print)
Address
Registration number (it 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
4