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BP-9424_#.#■•isssssssssssssssssss#ssssss#ssssisisssss#s#ssssssss#sssssssss#sssssissss#ssssssssessssssssssssss#s 1600 TO THE APPLICANT/REFERRAL AND APPROVAL Date of Application submission Plat t� �_ Lot e? Street - Aquifer Zone_ Owner i Owner mail addr s Owner phone # :#i###ifi##ffilffsifs:##:#s:ss####s#ss#:!!ii#ft##i##issis##i#is#is###s;i##i#lsiisi!#i###iii!!#i#!s#:ii#si OTHER INVOLVED AGENCIES -The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACT THEM FOR REQUIRED I=ONS- s TAX COLLECTOR L- Approved Z HOLD By Date ❑ Board of Appeals = Approved By Date ❑ Conservation Commission ` Approved By Date ❑ D.P.W. Water - Approved By ❑ D..W. Sewer = Approved By__ Date ❑ D.P.W. Cross Connection = Approved By v ❑ Treasurer (Bond) ❑ Approved By Date ❑ D.P.W. Engineering g g :- Approved B Date 7 Board of Health (well) = Approv By �- Date ❑ Board of Health (septic) =Approved By I ( Date Lam' ❑ Board of Health (food service) - Approved g � - APP y � I 1 ate ❑ Planning Board (parking) _ Approved By Date ei ® FIRE DISTRICT (I - II -III) - Approved By Date BUILDING DEPAR7 4 ENT APPROVAL: ❑ ZONING ❑ BUILDING INSPECTOR/BUILDING COMMISSIONER ❑ CONTROL CONSTRUCTION AFFIDAVIT fffiiiiisiitllit#iilfffiif####fftfff###f#;i#ii#ff#flfffiifii#i#iiiifi#fiiifii#fiii#!i!i##i##########!#!f PROTECT SUMMARY. new constructions alterationidemo [Alteradd interior walls] {add rooms] [add footprint] sewage disposal - publiciprivate [pool] [garage/shed/deck] [game court] [food service] water supply - publiciprivate well Describe hisszszzsssf#ff#f#fflff#!ff##i#fffifsfzf!#Rfssifisiffi#f!!!i##sflfizsszfziifsflziiflfiilf#####!s#f#f#!!!### 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. TOE OF DARTMOUT�I •BUHDWG DE ARI ENT TELEPHONE 508-999-0720 FAX508-999-0738 APPLICATION FOR ZONING AND BUILDING PERMIT Instructions 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. Neft F21ing fee is met R dbud ti ([or office we only) ON ONLY Total Cost $ f� Received By .-� Date Reed t Less Application Fee $ Total Permit Fee SJ / Permit # Lssaed Date �l 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET - CURRENT ACCESSORS' PLAT _Cx)0 _ LOT ZONING DISTRICT O R ZONING OVERLAY DISTRICTS , if applicable UMBER & STREET S E'-A Af --- C-OR IRI-2 ' S �211'P� 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 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 in -ground Size The Building Department - Date sent for review By _ Chimney - number of flues _ Woodstove - used (will require inspectitm priu'r 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) o 60th ' - describe 300 COMMERCIAL - PROPOSED PROJECT/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) (Sea 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) - Factors 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 load as appiic:able, also existing 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 alteration(s). If project is an addition to existing structure - Total gross square feet of existing - FOR C011IVIERCI4LL 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 lover 400.000 cu.ft.) yes No (see Code Appendix I) APPLICANT TO PROVIDE The following section for official use oniv. 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 DatPEC 2 9 19 Applicant informed of above - Date time staff (fax, phone, in person) :sssssssss:::s::s:s:::::::::::::s:sssss:::ssssss:::sssssss::ssssssssss:::::::sssssss:sssssss:::::::sass::: 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) ::ssssssssss::::sssssss:s:s::::::::s:sss:sssssss::sssssss:sssssss::::::sssssss:sss:sssss:::sss:sssssss:: OFFICEUNSPECTORS NOTES TOTAL FEE Gross area - new construction Total Sq. Ft. alterai Permit is issued to Comments/notes on permit 1300 OWNER SIGN - OFF -- - - Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required. I. the undersigned, am the ownerof 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 requestedbe 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 ..// ignature Date signature is my voluntary act and is signed under the pains and penalties of perjury. Who is authorized to pickup the permit at the Building Department? (please orfnn Address Phone 1400 HOMEOWNER E 311MON - ONE & TWO FAMILY ONLy FOR HOME OWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT 109.1.1 Licensing of Construction Superiors: 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 accor&a ce with the rules and regulations promulgated by the BBRS enti!led RLIis 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 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 XX Your signatur carries certain responsibilities, including but not necessarily limited to, ss:sss NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that any licensed Construction Supervisor, whether or not thev have taken the permit are responsible for code compliance. (see 2.15 2 of section 5) s:ssssss:sss:ssssssssssss*ssssssssss==s==ss==ssssssssssssssssssssssssssssss::ssssssssss=ss*=s==*ss*sssss 1500 COST Cost of Improvement Items to be installed but not included in the above cost: TOTAL Electrical S Plumbing HVAC V% Other __------- ---_.. _ - 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 ArticI- 8 ft- commercial) Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods of time. Describe 500 CONSTRUCTION PLANS` dl-� - None submitted. Why? - Submitted, usually three sets required. Four sets for food serviceluses. Number of sets submitted 600 SITE PLAN 0 Not requir-ed, why? - Submitted When? - Previously, date I With this application 700 UTILPTIES Water supply - required — Yes _no public ? _yes _ no, on site we? _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 SPRUgKLERS - 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 IEQUIRED OFF-STREET PAR]MG - 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 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 ID CATION (print or type except as noted) at owner - name J (�� � 7r p ad Tess L �G�4//l hone #t 3C �� 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 (omeowner to homeowner here then complete section 1300) Company name Address Phone number Construction Supervisors license number NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not reproductions. ssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssxs 1200 FOR RESIDENTIAL REMODEL WORK ONLY Are you a Home Improvement Contractor subject to (780CMR - 6)' ? Yes No _ I" f 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) \1 0(/() / ' / . C, Signature F Date