BP-201— . _ ...._..-i.. .sue APPROVAL
Date of Application submission
Plat CL2- Lot street
Owner
Owner mail address
Aquifer Zone
Owner phone # C, c •� / �¢ I
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OTHER INN'OLVED AGENCIES - The following agencies require separate jurisdictional permits or or for your
proposed project. CONTACT THHM FOR REOUMM SUBMISSIONS. -
TAX COLLECTOR _ Approved _ HOLD By t Date
Q Conservation Comm = Approved By Date
a D.P.W. water _ Approved By Date
• D.P.W. sewer _ Approved By
Date
Q D.P.W. cross connection = Approved
t1 D.P.W. engineering _ Approved
Date
Date
Q Board of Health well = Approved
Date
17 Board of Health septic _ Approves Date
❑ Board of Health food service = Approved Date
S FIRE DISTRICT - IIIIII = Approved
Date
Q Planning Dept = Approved Date
Other _ Approved
Date
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TOWN OF DARTMOUTH BUILDING: DEPARTMENT
TELEPHONE 508-999-0720 FAX 508-999-0738
APPLICATION FOR ZONING AND BUILDING PERMIT
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The applicant shall cumpiete this application to the best of their ability prior tdAv no item unanswered. The
Department staff will be available during regular business hours to . It necessary. *A should be inserted for those sections
which do not apply. A properly completed application will help avoi idelutK��-
(for olrim use only)
Application fee $ received by Data 14t r /�
Total Permit Fee Permit # A
100 LOCATION OF PROJECT
CURRENT ACCESSORS' PLAT LOT 1 � ZONING DISTRICT
OTHER ZONING OVERLAY DISTRICTS , if applicable
NUMBER 3 STREET
NEAREST CROSS STREET
SUBDIVISION NAME & LOT #
or BUSINESS NAME
.PR€-T`TOUS-T'ENAN'T ; OWNER
Date 200 RESIDENTIAL - PROPOSED PROJECT - one & m1o�family residence only
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Prnject summary new constructioni alterntionidemo sewage disposal - puhliciprivate
[After.add interior walls] [add rooms] [add footprint) water supply - publiciprivate well
[pooh [garage -shed) [game court] [food ser•icel
Describe _ ;lh_
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To the various deaai-tmem
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This notice has been forwarded to you for }our 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 i .. d ,1, By a
__ 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 Z -
= Accessory apartment Total gross sq. ft..
= Accessory structure
Z Garage - detached - attached to dwelling, dimensions L W
Carport - detached - attached to dwelling, dimensions L r W
Shed - dimensions L W
= Gazebo - dimensions L W
= Swimming 001 above ground in -ground Size total square feet
Chim:&v - # of flues
u Woodstove - used (will require inspection prior to installation), new (provide manufacturers
instructions). Location(s) (list)
C Fireplace(s) - (includes flue) List location(s)
Game Court - describe (include overall dimensions)
Tent, Trailer (Mobile Home) or Other - describe
300 COMMERCIAL - PROPOSED PROJECTIUSE - 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 over 2 years 9 months (see Code Section
304.0)
_ Factory / Industrial - (see Code Section 305.0)
i
High Hazard - (see Code Section 306.0)
_ Institutional - hospital, nursjng home, infant day care (see Code Section 307.0)
_ Mercantile -retail stores/ (see Code 308.0)
= Residential - three of more family, hotel (see Code Section 309.0)
r
Storage - includes garages (see Code Section 309.0)
Utilih• & 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 bad as applicable,
also existing condition
A
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 t CONSTRUCTION CONTROL (over 35,000 cu.ft.) Yes 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 I)
APPLICANT TO PROVIDE
OK to issue subject to requested submittals (see project review worksheet) date
E: DENIED see project review worksheet date
HOLD reason date
HOLD Subject to Zoning Board of Appeals action
Comments
Inspectors signature �; � Date AUG 2 3 1996
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)
OFFICE\INSPECTORS NOTES
O
TOTAL FEE
Gross area - new construction Total Sq. Ft.
alteration
Permit is issued to
Total Sq. Ft.
Comments/notes on permit az���
written request I understand that once the permit expires a new application may be required, including fees and current
other requirements (including Zoning)
r
Name y.
Signature := �- '�
ML
(e,doove signature is my voluntary act and is signed under the pains and penalties of perjury.
Date J4 ^Cf4/1
«'ho is authorized to pickup the permit at the Building Department? ,please print, Address Phone
1400 HOMEOWNER EXEMPTION - ONE & TWO FAMILY ONLY
FOR HOIN1E OWNERS WHO INTEND TO PERFORDI AND BE RESPONSIBLE FOR THEIR OWN PROJECT
109.1.1 Licensing of Constrmction 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 he, a one or two family dweilin , 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
zizzizsziszzziifiiiifif#iff#ifi###iffiififfiiiiiifi#ii#i####;#ff#ffii#iiiiifiif##fi##iif##########fi#iif 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
2.1:.2 of section `)
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1501 i COST
Cost of Improvement S
Items to be installed but not included in the above cost:
TOTAL
he following section for official use only,
INSPECTORS, REVIEW
Date plan reviewed 3 1996
30 days to review period expires
OK to issue date
Electrical S
Plumbing
HVAC
Other
$ -A
_/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 lavers 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 Article 8 for commercial)
- Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods of time.
Describe '.f •-�w�t �t�t-6,� 11_� C -
500 CONSTRUCTION PLANS V e c d
— None submitted. Why?
P4uhmitted. usually three sets required. Four sets for food serviceluses. Number of sets submitted
600 SITE PLAN
CL Ot t equn ed, why?
- Submitted When? - Previously, date =With this application
700 UTILITIES
Water supply - required _ yes _ no, public ?'_ yes _ no, on site well?es _ no,
existing? _ yes _ no
If required and not existing have necessary permits been issued? _ no _yes? date
(AI.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 izyes _ 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 (hearing)- 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 PARKING - for ZONING & Architectural Access
— NOT .APPLICABLE
= Parking Plan submitted To — BuiIding Department = Planning Board Date submitted
Numher of spaces - indoors outside tots, 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.
1100 IDENTIFICATION i print or type except as noted) n ,,.,
Current owner - name
address
phone r �,
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 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
Address
Phone number
Construction Supervisors license number
lans. affidavits and other documents SHALL BE originals and not
NOTE Signatures and seals on al] p
reproductions.
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 leaseprint)
Address
Registration number (if none state 'none")
Phone number
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE
GUARANTEE FUND! Qi1ESTIONS OR HOMPLAINTS call or write:
ome Improvement Contractors Registration
One Ashburton Place - Room 1301
Boston..MA 02108
(617) 727-8598
Owners name (print)
Signature
Date
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.un or
Further I understand that the permit will expire in six months, from the date of issue, if no work is b work is
six months after the last inspection if work has begun and that the permit may he extended for six months if no
n writing. I understand that the permit may be extended only three times by
anticipated if I request such an extension i