BP-27972COMMERCIAL
9. Inspector's Signature:
Applicant informed of above
Comments:
Total Permit Fee:
Gross Area - New Construction
Gross Area - Alteration
Permit Issued To:
c:Abl& Ibrms hlLlgapp.cotn
2000
Date: APR 0 4 2001
Clerk:
Reniainin2 Balance:
V ~�
llaae 4
rev. Januar, 20. ?00O
COMMERCIAL
$2S.00 APPLICATION FEE IS NON-RErONJABLE & NON -TRANSFERABLE
DARTMOUTH BUILDING DEPARTMENTDATE RECEIVED
_ 400 Slocum Road, P.O. Box 79399
Dartmouth, MA 02747
IM1n♦ ' S�
508-999-0720 FAX 508-999-0738 r < I r
APPLICATION TO CONST TA. REPAIR, RENOVATE OR DEMOLISH A COMMERCIAL BUILDING
(includes 3 or more family dwellings)
THIS SECTION FOR OFFICIAL USE ONLY
RECEIVED BY:
/'� BUILDING PERMIT NUMBER
DATE SENT FOR REVIEW: DATE ISSUED:
OK TO ISSUE - SIGNATURE: APR 0 4 6
DATE:
Buil _ffMMWIoner/Inspector of Buildings'
Zoning District: 6
Pro (ose/Use:__VPt)J
'� Zone:` ❑ C ❑ B 10 A ❑ V
; Aquifer Zone
THE FOLLOWIING AGENCIES SH(i - D BE NOTIFIED:
0 Board of ❑ Board of
❑ Con. 0 Demo ❑ DPW ❑ Elec'
❑ Energy Report
Appeals Health
Com Affidavit Card Sent Cut Off
Follow-up*
❑ Fire ❑Gas
Chief
0 Planning El Sewer Card 0 Water Card 0 Water Division
❑ Zoning ❑ Other
i
Cut Off
Board* / Cut Off / Cut Off Cross Connection
Review* "
* REQUIRES INSPECTOR'S REVIEW BEFORE THE ISSUANCE OF A`PERMIT
DEPARTMENTAL APPROVAL
Zoning Review:
Signature: 6 k
ABReQ 4 6,W
Energy Report:
Signature: dr
Date:
Fire Chief:
Signature:
Date:
Board of Health:
Signature:
Date:
Conservation Commission:
Signature: -
Date:
Other:
Signature:
Date:
Description of iI'ork Being
Performed.
SECTION 1- SITE INFORMATION
1.1 NUMBER OF PLANS SUBMITTED:
1.3 Property Address:
Nearest Cross Street:
Bus. Name:
Total Land Area Sq. Ft.:_
.5 Water Supply (MGL c 40 § 54):
2.1 Owner of Record:
Name (print)
)L SITE PLAN SUBMITTED: ❑ yes ❑ no
4 Assessors Plat & Lot Number:
Phone# I Plat 6 Lot ,jA_
i.o bewage Disposal System:
❑ Municipal ❑ Private Well ❑ Municipal 0 On Site Disposal System
SECTION 2 - PROPERTY OWNERSHIP / AUTHORIZED AGENT
rf�� /10T
Contact Address Telephone
2.2 Authorized Agent: —rl_me7e iye. -r /tavc,(4c
�
Name (print) Contact Address Tel
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c:Abldg. forms\bldgapp.com I rev_ Sentemher 7? 10l1n
COMMERCIAL
3.1 Licensed Construction Supervisor:
Name of Construction Supervisor.
Address
Signature
Telephone
Not Applicable ❑
License Number
Expiration Date_
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit I
L will result in the denial of the issuance of the building permit (MGL 152 Section 25A) Signed Affidavit Attached: ❑ yes ❑ no
❑ new construction ❑ addition ❑ alteration ❑ repairs ❑ accessory bldg. (shed/garage)
❑ other (specify Sec. 6): ❑ demolition ❑ sign ❑ replacement window/door no. of windows doors
The following descriptions are based on the Alassachusetts State Building 6th Edition, 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 303.00)
❑ Education - stricture 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)
f ❑"Mercantile - retail stores (see Code Section 308.0)
❑ Residential - three or more family, hotel (see Code Section 309.0)
❑ Storage - includes garage (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, please indicate (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 load as applicable, also existing
condition (if extra space is needed, attach an additional sheet):-1 o F_kec.t A Stun on Fte Deer-. 6-Rfcu;iy ; v
Iha02V�n FJaLJC or- t("noG,--, Feee nno be6e"L- Dcrr. t✓1F0
❑ New Construction and/or Addition (total gross cubic feet proposed) - indicate
If the project is an addition to existing structure - total gross square feet of existing:
Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration is required.
Will this project be subject to CONSTRUCTION CONTROL (over 35,000 cu. ft.) ❑ yes ❑ no
If yes, see Code Section 116.0. Designer to submit Code Synopsis in addition to original plans.
Will this project require Peer Review (over 400,000 cu. ft.) ❑ yes ❑ no (see 110.1 Code & Appendix I)
APPLICANT TO PROVIDE PEER REVIEW AT THEIR EXPENSE. SEE 780 CMR.
Demolition* - describe structure:
Moving* - (provide copy of DPW 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:
COMMERCIAL 2000
❑ 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 3603.21 for residential and Article 10 for commercial).
❑ Temporary stricture - includes, when allowed, trailers, tents and the like and only for limited periods of time. Describe:
SEC f14i + x.tifECHA1TCAlr:c� PTti14A#2Y F>Il�l<
❑ 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
_. ..... .... .......: ... .
SECTION. #o :- 9 5PRINKLETi ��'D, OR F#R>�:.iPR#J� E < TON ,>;:
❑ Required: plans provided plans not provided, why?
❑ Not required, not to be installed, why?
E 1Li\ ...1 RE ##RE13 FF- TI#EET P €tKI ' r nin h0oft, r [: t ss
❑ Parking plan submitted to: Building Dept. Planning Board date submitted
Number of spaces - indoors outside total 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.
. <:.... sl�crWIN - � i <tT)E�NTIFICA' T<3N ..
11.1 Architect/Engineer - for overall design
Company Name:
Address:
Phone #:
Certified by State of Massachusetts as:
Certification Number:
Note: Signatures and seals on all plans, affidavits, & other documents SHALL BE originals and not reproductions.
11.2 Architect/Engineer - project supervision and reports
Company Name:
Address:
Phone #:
Certified by State of Massachusetts as:
Certification Number:
Note: Signatures and seals on all plans, affidavits, & other documents SHALL BE originals and not reproductions.
11.3 General Contractor
Company Name: VOCT'MCQ-r I f(a 0+5T. "t2
Address: (SOD &v, A, A6 1--(tw's �D
Phone #: Sc1� (9 3 (a —
Construction Supervisors License Number
Note: Signatures and seals on all plans, affidavits, & other documents SHALL BE originals and not reproductions.
c:\blde. lbrmsbldgapp.com Pate 2 rev. January 20. 2000
c:,Nde. forms\bldaapp.com Page 3 rev. Januan• 20. 2000