BP-6829$00 MEC ANICAI.S & 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)
None of the above to be provided
Hot Water Gas Electric
Fuel Oil Other _
900 SP RINKLERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
Required, —Plans provided, :7P)a2s not provided, why?
_ Not required, not to be installed, W ;y? N............
--
1000.REQUIRED OFF-STREET PAgKNG - for ZONING & Architectural Access
- NOT APPLICABLE
- Parking Plan submitted To - Building Department 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 q u'ed 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 noted)
oted)
Cement owner - name q t.. I g Kn
address l C/ A i J � _ .-
phone ##
If corporation. officer in charge
ArchitectJEng veer - for overall design
Company name _ , r P o
Address A4, -i 9 v -i
Phone number
Certified by State of Massachusetts as
Certification number
NOTE Signatures and seals on all lans, aff�dav=ts and other documents S reproductions. Imo. BE originals and not
- Pmjea scion 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 d
reproductions. ocuments SHALL BE originals and not
General Contractor (if Homeowner, state homeowner here then complete section 1300)
Company name A, ►-o n Po, I s
Address
Phone number 9 g (�-
Construction Supervisors license number 0 / -1
NOTE Signatures and seals on all plans, affidavits and other reproductions. documents SHALL BE originals and not
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1200 FOR RESIDENTIAL REMODEL WORK ONLY
Are you a Home Improvement Contractor subject to (780CMR _ ? Y�
� _ No Zif no go to next section!
Are you claiming exemption from the requirement? Yes _NloLIf es, submit the required affidavit!
Reb odes 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
Ow ers name (print)
Signature
Date C .
1300 OWT41M 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).
j v �/
�+'J Name x'i. i
Signature
The above
Date S- a1-4V)
act and is signed under the pains and penalties of perjury.
Who is authorized to pickup the permit at the Building Department? (pleaseprint)
Address 1q 5)Q Je Phone C :3 [, tl L
1400 HOMEOWNER E%EMP'I ION - 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
structures, unless he or she is licensed in accord2?'ce wit1 the rules and regulations promulgated by the BBRS
construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of buildings or
R41es and Regulations for Licensing Construction Supervisors. enti!'ed
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 helshe 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:
`JF Signature k cr^it-i
Your signature carrre res nsibilities, including 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 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
Cost of Improvement S
Items to be installed but not included in the above cost:
TOTAL
Electrical S
Plumbing
HVAC
Other
00
- Demolition - describe structure
Number of dwelling units Number of bedrooms A separate Refuse Disposal
Declaration requited.
- Moving - (Provide copy of D.P.W. moving license) Type of structure
from where (platilot or address)
to where (plat/lot or address)
Number of dwelling units Number of bedrooms per dwelling unit
- Re-roofmg - (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 he included in new construction. (see Code section 3401.10 for
residential and Articl- 8 fs,- - 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 requkvd, why?
!!"Submitted When? - Previously, date ^ With this application
Water supplyrequired _ es _ no public ? ? v
- q Y P _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 he 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 es p _ y _ no. Submit copy of permit as soon as available.
- Woodstove - used (will require inspection 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
300 COMMERCIAL - PROPOSED PROJECT/USE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES
12 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 over 2 years 9 months (see Code Section
304.0)
- Factory i 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 -umber of dwelling units and bedrooms or occupant bad as applicable,
also eristing 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
alterationt 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 No. (If yes
see Code section 127.01). 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
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
- DENUM see project review worksheet di:ae
HOLD reason date
- HOLD Subject to Zoning Board of Appeals action
,
Comments
Date ,
Inspectors signature
- 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)
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OFFICEVNSPECTORS NOTES
TOTAL FEE L
Gross area - new construction Total Sq. Ft.
alteration Total Sq. FL
Permit is issued to
Comments/notes on permit ,�
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1600 TO THE APPLICANTTIMUPERRAL AND APPROVAL
Date of Application submission f 1 f
Plat .27 Lot �Z Street
� `l `� /�'� Aquifer Zone
Owner
Owner mail address, r/ ;
Owner phone # (- " v
OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional
Proposed project. CONTACT 711M FOR �permtts or approval for your
-ED RMQS.SIONS.
® TAX COLLECTOR - Approved:: HOLD By Date
❑ Board of Appeals ° = Approved By 4 Date
❑ Conservation Commission i6,pproved By Date %'-;[ --`
❑ D.P.W. Water — Approved By ❑ D.P.W. Sewer - Approved By Date
❑ D.P.W. Cross Connection - Approved By Date
❑ Treasurer (Bond) ❑ Approved By
Date
❑ D.P.W. Engineering : r Approved By
to _
7 Soard of Health (well) - Approved By
Date
❑ Board of Health (septic) -Approved By
Date
❑ Board of Health (food service) - Approved By
Date
❑ Planning Board (parking) - Approved By
Date
® FIRE DISTRICT (I - II -III) _ Approved By
D te
BUILDING DF.PAR17MKNT APPROVAL:
❑ ZONING
❑ BUILDING INSPECTORBUILDING COMMISSIONER
❑ CONTROL CONSTRUCTION AFFIDAVIT
PROJECT SUMMARY:
new construction/ alteration/demo
[Ater; add interior walls] [add rooms] [add footprint]
[pool] (garage shed/deck] [gatfte court) (food s
sewage disposal - public/private
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 requestedp4rmi is ound, please advise. Your assistance and
cooperation is appreciated.
The Building Department - Date sent for review
By �
P
TOWN OF DARTMOUrvy BUMDING DEPARTlONT
TELEPHONE 508-999-0720 FAX:508-999-0738
APPLICATION FOR ZONING AND BUILDING PERMIT
Instruction - .
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 daring 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 Pig fees not alma/"
(for oface one mly)
Total Cost
Less Application Fee $
Total Permit Fee
ONLY
Received By Date Rec'd
Permit #
Issued Date
100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET 7 A,
CURRENT ACCESSORS' PLAT r27 _ LOT ZONING DISTRICT
OTHER ZONING JVEKLAY DISTRICTS , if applicable
NUMBER & STREET
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 I number baths unit i
number bedrooms unit 2 number baths unit 2
- Accessory apartment Total gross sq. M
- Accessory structure:
- Garage - detached - attached to dwelling, timensions 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 grounds in -ground Size .27 ,
- Chimnev - number of flues