BP-915euu MECHANICM.S & PREMARY 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
HVAC (combined unit) - Primary fuel, natural gas, propane, electricity,
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
Required, --plans provided, 7plans 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 - Building Department �E Planning Board Date
Number of spaces - indoors outside
total provided
P-ndicap spaces - required _ yes _no. If yes, how many as a_.)art of the tots
Is Route 6 (State Road) Entrance permit required? yes t� no If yes has it bef
Submit copy of application and/or permit as soon as available.
1100 [DrN IFICATION (print or type except as noted)
Current rrent owner - name _ �e_J 3 7 � Le 411)
°' a ddress
l
Phone #—�
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 fans, affidavits and other documents SHALL BE
reproductions.
(specify)
residential
required number.
issued yes no 7.
and not
Architcct/Eugur- project supervision and reports
Company name
Address
Phone number
Certified by State of Massachusetts as
Certification number
NOTE Signatures and'seals on all tans, affidavits and
reproductions. other documents SHALL BE originals and not
General
Company name
Address
homeowner here then complete section 1300)
Phone number
Construction Supervisors license number
NOTE Signatures and seals on all Plans, affidavits and other documents SIIALL BE originals riginals and not
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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!
Ren_,)del 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)
Signature
Date
1300 OWNER 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 docume
the application herein submitted. I state that to the best of my knowledge and belief that the
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 i
six months after the last inspection if work has begun and that the permit may be extended
anticipated if I request such an extension in writing. I understand that the permit may be E
written request. I understand that once the permit expires a new application may be requires
other r'equirements (including Zoning).
'Name
Signature
The alMve signature is my voluntary act and is signed under the pains
=` Date9 Z
and I have reviewed
tion provided in this
ue, if no work is begun or
w six months if no work is
tended only three times by
including fees and current
Penalties of perjury.
Who is authorized to pickup the permit at the Building Department?
Address Phone
1400 HOMEOWNER EX'ITON - ONE & TWO FAMILY ONLY
FOR HONIE 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 regui lions promulgated by the BBRS entitled
Rules aid 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 sign below: ,
Signature
Your signature carries certain responsibilities, 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)
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1500 COST
Cost of Improvement
Items to be installed but not included in the above cost:
Electrical S
Plumbing
HVAC
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 Article. 8 fir 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 required, why?
_ Submitted When? Previously, date ❑ With this application
700 U THXITES
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.
Ic
— woodstove used (will require inspection prior to installation), new (provide manufacturers
instructions). Location(s) (list)
❑ Fireplace(s) - (includes flue) List location(s) j
C Game Court -describe (include overall dimensions)
❑ Tent, Trailer (Mobile Home) or Other - describe
300 COMMERCIAL - PROPOSED PROJEGT/tiw - INCLUDING THREE FAMILY
THIS SECTION NOT APPLICABLE
(The following descriptions are based on the Massachusetts State Building Code
Code)
Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0)
Business - office, assembly with less than 50 occupants - indicate Medical or
Section 303.0)
C Educational - structure for training including child day care for those over 2 ye,
304.0)
Factory / Industrial - (see Code Section 305.0)
High Hazard - (see Code Section 306.0)
C Institutional - hospital, nursing home, infant day care (see Code Section 307.1
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)
AND EXEMPT USES
3, AS NOTED) (See the
Professional (see Code
9 months (see Code Section
Utility & Miscellaneous Structures - includes tents and <gricultural structures (see Code Section 311.0)
INew tenant for any of the above, indicate above (see Code Section 119.0 and 'oning By-law section 35)
Tent or Trailer - temporary purpose?.4-L
Other ; e-;
Describe the proposal briefly, INCLUDE number of dweWng units and bedrooms or
also existing condition pant bad as app&Mble,
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400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED
New Constriction 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
u 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.
APPLICANT TO PROVIDE ) yes Noj (see Code Appendix I)
I
I
2
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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
DENIED see project review worksheet date
J HOLD reason
_ date
HOLD Subject to Zoning Board of Appeals action
Comments
Inspectors signature L
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
Date
Advised applicant Date Time staff (by phone, fax or in person)
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TOTAL FEE
Gross area - new construction - Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit
1600 TO THE APPLICANT/REFERRAL AND APPROVAL
Date of ADDficationissioa/
Plat Lot Street 24
r�
i2luifer Zone
Owner '� �
l
Owner mail a dress
i
Owner phone #
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OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT TEEM FOR REt UMM WBMISSr[Wq_
® TAX COLLECTOR ::Approved HOLD By
❑ Board of Appeals _— Approved By
❑ Conservation Commission ❑ Approved By
❑ D.P.W. Water 7 Approved By
❑ D.P.W. Cross Connection a Approved By
❑ Treasurer (Bond) ❑ Approved By
❑ D.P.W. Sewer = Approved By
Date
Date
Date
Date
Date
Date
❑ D.P.W. Engineering �i Approved By Date
Board of Health (well) Approved By Date
❑ Booa��rd of Health (septic) J Approved By Date
❑ Bi3ard of Health (food service) � Approved By i Date
nning Board (parking) _� Approved By Date
' RE DISTRICT (I - II -III) Approved By Date
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BUILDING DEPARTMENT APPROVAL:
❑ ZONING
❑ BUILDING INSPECTORBUILDING COMMISSIONER
❑ CONTROL CONSTRUCTION AFFIDAVIT
PROJECT SUMMARY:
new construction/ alteration/demo sewage .disposal - public/private
[Alter/add interior walls] [add rooms] [add footprint] water supply - public/private well
[pool] [garage/shed/deck] [game co rt] [food service]
Describe`
To the various departments: l
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.
9
The Building Department -Date sent for review
TOWN OF DARTMOUTH . BI�DIl'NG DEPART 1NT``
TELEPHONE 508-999-0720 FAX 508-999-0738
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 tmanswered. 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. R.te Fiif fees mot
(for oface use only) ('� �' ❑ FOUNDATION ONLY
Total Cost J Received By Date Rec'd
Less Application Fee S
Total Permit Fee S Permit # Issued Date
100 LOCATION OF PROJECT
TOTAL LAND AREA SQUARE FEET "p _ j
CURRENT ACCESSORS' PLAT I LOT �� ZONING DISTRICT
OTHER ZONING OVERLAY DISTRICTS , if applicable
`
'AUMBER & STREET /Z 'c % ' d �, ,
NEAREST CROSS STREET
UBDIVISION NAME & LOT A
r 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
Chimney - number of flues