BP-21800 MECHAINICA 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)
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- HVAC (combined unit) - Primary fuel, natural gas, propane, electricity, other (specify)
- Air conditioning - (separate unit)
Architect/Engineer - project supervision and reports
Company name
Address
Phone number
Certified by State of Massachusetts as
- None of the above to be provided
Certification number
- Hot Water Gas Electric Fuel Oil Other
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
900 SPRINKLERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
reproductions.
- Required, --plans provided, _plans not provided why?
_
General Contractor (if Homeowner, state homeowner here then complete section 1300)
- Not required, not to be installed, Why?
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Company nameYw PfzGG _! ELI
Address G fJ Q i� 4 I��% /!'yt ll—ld, /d 't I LZ
1000 REQUIRED OFF-STREET PARKING _for ZONING & .Architectural Access
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Phone � � � �
/J 7
_ NOT APPLICABLE
number
_
Construction Supervisors license number
_ Parking Plan submitted To - Building Department - Planning Board Date submitted
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
Number of spaces -indoors ® outside total provided
reproductions.
Handicapspaces required
P q 0 yes _no. If yes, how many as a part of the total required number.
Is Route 6 (State Road) Entrance permit required? ves - no =. If ves has it been issued yes = no
1200 FOR RESIDENTIAL REMODEL WORK ONLY
Submit copy of application and/or permit as soon as available.
Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes _ No _ If no go to next section!
1100 ID' (print or type except as noted)Are
you claiming exemption from the requirement? Yes No If yes, submit the required affidavit!
;NUFTCAUON
nt owner- name r- -
aw{ ��
Remodel contractor name (please print)
ddress /LL"tii /f ,f
C � �.�
Address
phone #j %""�
Registration number (if none state "none")
If corporation, officer in charge
Phone number
Architect/Engineer - for overall design
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE
GUARANTEE FUND! QUESTIONS OR COMPLAINTS call or write:
Company name
Home Improvement Contractors Registration
One .Ashburton Place - Room 1301
Address
Boston, :MA 02108
(617) 727-8598
Phone number
Owners name (print)
Certified by State of Massachusetts as
Signature
Certification number
Date
NOTE Signatures and seals on ail tans, affidavits and other documents SHALL BE originals and
not reproductions.
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 he 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 re uirements (including Zoning).
j �me
St ature
Tagb a signature is my voluntary act and is signed under the pains and penalties of perjury.
ate /'
Who is authorized to pickup the permit at the Buildings Department! (please print) )fir u`', 1�/1� ✓'t �+J�t�%�`
w
Address �' '% S _eta `€= " r`�d_ L i; Phone Z-
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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 promulgated 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 follews: Person(s) who owns a parcel of land
on which hershe resides or intends to reside. on which there is, or is intended to be, a one or two familv 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:
Signature
Your signature carries certain responsibilities, including but not necessar4y Waited to,1 general liability
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NOTICF, TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that anv
licensed Construction Supervisor, whether or not they have taken the permit are responsible for code compliance. (see
2.15.1 of section 5)
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150o COST
Cost of Improvement S
Items to he installed but not included in the above cost:
The following section for official use only.
Date plan reviewed
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
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)
A separate Refuse Disposal
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 lavers 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 Article 8 for 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, usual►v three sets required. Four sets for food service\uses. Number of sets submitted
600 SITE PLAN
❑ Not required, why?
Submitted When? � Previously, date - With this application
700 UTILITIES
Water supply - required e ves _ 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 s yes no. Submit copy of permit as soon as available.
30 days to review period expires
OK to issue date
Woodstove - used (will require inspection prior to installation), new (provide manufacturers
OK to issue subject to requested submittals (see project review worksheet) date
DENIED see project review worksheet date
instructions). Location(s) (list)
! Fireplace(s) - (includes flue) List location(s)
Game Court - describe (include overall dimensions)
Tent, Trailer (Mobile Home) or Other - describe
1
300 COMMERCIAL - PROPOSED PROJECIyUSE - 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
i
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)
I
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)
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 number of dwelling units and bedrooms or
also existing condition
as applicable,
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
considered w t ere an increase in are footage in ddition to any
It will benew construction if h q g a
alteration(s).
If project is an addition to existing structure - Total gross square feet of ex'iisting
= FOR COMMERCIAL ONLY
Will this project be subject to CONSTRUCTION CONTROL (over 35,000 cu.ft.) 1 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
HOLD reason date
HOLD Subject to Zoning Board of Appeals action
Comments
Inspectors signature Date
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
— Advised applicant Date - Time
Date
staff (by phone, fax or in person)
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OFFICEVNSPECTORS NOTES
TOTAL FEE
Gross area - new construction Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit
1600 TO TI1 E APPLIC&W AND APPROVAL
Date of Application submission
Plat Lot Street
Zone
Owner
Owner mail
Owner phone #
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OTHER INI'OLN'ED AGENCIES - The following agencies require separate, jurisdictional permits or approval for your
proposed project. CONTACrNTIEM FOR REOLTIRM S,pgbUMONS.
TA,1 COLLECTOR _ Approved — HOLD By Date
❑ Conservation Comm = Approved By Date
❑ D.P.W. water _ APPraved By
❑ D.P.W. sewer _ Approved By
❑ D.P.W. cross connection = App
Date
Date
Date
u u. r. titi . engineering — Approved
Date
❑ Board of Health well = Approved
Date
❑ Board of Health septic - Approved
Date
❑ Board of Health food service = Approved
Date
I
CSIRE DISTRICT lI II _ IIh _ Approved`
Date
❑ Planning Dept _ Approved
Date
Others —Approved
Date
)thcr _ Approved
Date
('„mments (.` ' ✓
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Project summary new constructioni alterationidemo sewage disposal - publiciprivate
[After. -odd interior walls] [add rooms] [add footprint) water supply - pubiiciprivate well
[pool] [garage shed) [game court] [food service]
Describe
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.1 Your assistance and cooperation is appreciated.
The Building Department
I
i
Date sent for review
By
TOWN OF DARTMOUTH BUII:DING DEPARTMENT
TELEPHONE 508-999-0720 FAX 508-999-0738
APPLICATION FOR ZONING AND BUILDING PERMIT
InstrUcemms
The appikant shall complete this application to the best of their ability prior to snbtnission.-leaving no item unanswered. The
Department staff µill he available dnring regular business hours to assist as necessary. N/A should be inserted for those sections
which do not appiv. A properly completed application will help avoid unnecessary delays. P6 iat: }wars fee is not v 61 " "
(for office use Daly)
Application fee $ '30, n received by Date 6 — 2 % --q&
Total Permit Fee $ Permiit #
100 LOCATION OF PROJECT
CURRENT ACCESSORS' PLAT iz)lo LOT ZONING DISTRICT
OTHER ZONING OVERLAY DISTRICTS , if applicable
NUMBER & STREET
v
NEAREST CROSS STREET
SUBDIVISION NAME
or BUSINESS NAME
PREVIOUS TENAl\'T ; O« NER
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 I
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
- Gazebo - dimensions L W
- Swimming pool above ground in -ground
- Chimney - # of flues
Size total square feet
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