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Afteiration to
A-� V--'N PLAN Z, �71
LO FOUMATEn Ckerwatznr Archit^cts fST
4�1 Store
(� ELEVA7014 & 1228 Russells hAffis Road, Dartmouth MA
50 Cross Rd. Westport MA
tel & fax 508-636-3009 Contactor. Re-i9d W. SmaR
WALL SECnOK
Westporl LIA-i 508-636-8308
Iva
800 MEi'gANICALS & PRIMARY FUEL
ArchitecVEngineer - 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 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-SSTREET PARKING - for ZONING & Architectural Access
- NOT APPLICABLE
- Parking Plan submitted To = BuiIding Department = Planning Board Date
Number of spaces - indoors outside total nrovried
Handicap spaces - required s 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 (print or type except as noted)
Current owner - name ''pry o f ry V _ ,, /
address
phone#�i�_ `1� /_ <:Z
If corporation, officer in charge
Architeet/Engineer - for overall design
Company name
Address
Fhone 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.
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14
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
Compaw.
Address
Phone number�j
Construction Supervisors license number -a A
1300)
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
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 (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
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 requirements (including Zoning).
Name
Signature
Date
L q :,t•
above signature is my voluntary act and is signed under the sins and penalties ofperjury.ti<
P P
Who is authorized to pickup the permit at the Building Department?
Address gJ . Phone GA ', 1
1400 HOMEOWNER EXEMPTION - ONE & TWO FAMILY ONLY
FOR HOIN1E 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 deli -ed 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
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 anv
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
Items to he installed but not included in the above cost:
TOTAL
The following section for official use only.
INSPECTORS' REVIEW
Date plan reviewed
I
Electrical S
Plumbing
HVAC
Other
----l—a'a�,
Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required.
describe structure
Demolifon -
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/1ot 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
Number of layers already existing
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 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. Whv?
Submitted, usually three sets required. Four sets for food serviceluses. Number of sets submitted_
600 SITE PLAN _
❑ Not required, why?
_ Submitted When? = Previously, date = With this application
700 UTILITIES
Water supply - required _ ves •, no, public ? _ ves no, on site well? _ yes _ no,
existing? _ yes _ no
If required and not existing have necessary permits been issued? _ no _ yes; date
1
(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 V no, public sewer _ yes no
30 days to review period expires
OK to issue date
private septic - on -site _ yes _ no. Submit copy of permit as soon as available.
Woodstove - used (will require inspection prior to installation), new
instructions). Location(s) (list)
J Fireplace(s) - (includes flue) List location(s)
Game Court - describe (include overall
Tent, Trailer (Mobile Home) or Other - describe
rovide manufacturers — OK to issue subject to requested submittals (see project review worksheet) date
DENIED see project review worksheet date
HOLD reason
HOLD Subject to Zoning Board of Appeals action
300 COMMERCIAL - PROPOSED PROJEC IUSE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES
THIS SECTION NOT APPLICABLE
- — I
(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)
- High Hazard - (see Code Section 306.0)
�t
- Institutional - hospital;"nursing home, infant day care (see Code Section 307.0)
- Mercantile - retaiI stores (see Code 308.0) 4
- 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)
I
- 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 nn
c<
also existing condition
units and bedrooms or Occupant load as applicable,
)0 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED
- New Contraction 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,,
alteration(s).
If project is an addition to existing structure - Total gross square
e in addition to any
- FOR COMMERCIAL ONLY
Will this project be subject to 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
Comments
date
Inspectors signature Date
Applicant informed of above - Date time staff (fax, phone, in person)
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
TOTAL FEE
Gross area - new construction
alteration s
Permit is issued to
Comments/notes on permit
Total Sq. Ft.
Total Sq. Ft.
1
7
1600 TO THE APPLIt^AMyB�tAL AND APPROVAL
Date of Application submission
Plat Lot Street
Owner
Owner mail address
Aquifer Zone
Owner phone #
I
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OTHER INI'OLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your
Proposed project. CONTACT' THEM FOR REOUIRED Si mv,-crnura -
a TAX COLLECTOR _ Approved =HOLD By Date
Q Conservation Comm = Approved By Date
a D.P.W. water a Approved By Date
Q D.P.W. sewer _ Approved By
Date
17 D.P.W. cross connection _ Approved
Date
II D.P.W. engineering _ Approved
Date
a Board of Health well = Approved
Date
• Board of Health septic - Approved
Date
• Board of Health food service = Approved
Date
a FIRE DISTRICT iI - II - III/ = Approved
Date
• Planning Dept — Approved
Date
Other — Approved
O,hcr _ Approved
c Mment_s
Date
Date
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Prnject summary new construction/ alteration rdemo sewage disposal - puhliciprivate
(Alter.add interior walls] [add rooms] [add footprint] water''suppiv - publicrprivate well
(Pool] [garagershedl [game courtl [food service]
Describe
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i
To the � arious 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.
The Building Department
TOWN OF DARTMOUTH BUILDING DEPARTIVIE1vT
TELEPHONE 508-999-0720 FAX 508-999-0738
APPLICATION FOR ZONING AND BUILDING PERMIT
Insu acdoas
The applicant shall complete this application to the best of their ability prior to submis0oni.•leavimg no item tmanswered' The
Department staff ..ill he available durin- regular business homy to assist as necessary.'.MA should be inserted for those sections
which do not apply. . properly completed application wM help avoid unnecessary delays. Pin �5 i<ee m mi.
([or ogee use Daly) Application fee $ received by Date 1
r
Total Permit Fee Permit # Z5 .- 1
100 LOCATION OF PROJECT
CURRENT ACCESSORS, PLAT LOT ZONING DISTRICT _
OTHER ZONING OVERLAY DISTRICTS , if applicable f
NUMBER 3 STREET��
NE.-!LREST CROSS STREET
SUBDIVISION NAME & LOT # �
or BUSINESS NAME
PRE/'IOUS TENANT ; 0 WNER L, �L 11+ b/ p l ` i � c • `6_ .
200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
THIS SECTION NOT APPLICABLE
_ Single famih• - 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
_ - attached to dwelling, dimensions L W
Carport -detached
= Shed - dimensions L W
- Gazebo - dimensions L W
- Swimming pool above ground in -ground Size .e_ total square feet
Date sent for review
By
I
= Chimney - # of flues