BP-9577:::ssss;s;sssssssssssssssfsss:ssssssssass:sssesssssssssssssssssssssasssssssssssssessssstssssfsss=:::ssss 1600 TO THE APPLICANTIREF ntRAL AND APPROVAL
Date of Application submission
Plat KK Lot -�z Street � 0
Owner /LI/ (7.f] %i /i) rY
Owner mail address l'� 1
Owner phone #
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OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional
Proposed project. CONTACT THEM FOR�permtts or approval for your
- D SURMLSSIONS.
0 TAX COLLECTOR = Approved Z HOLD By
Date
❑ Board of appeals = Approved By
Date
onservation Commission ` Approved By
P /1, —'L r1l Date
❑ D.P.W. Water _ Approved By 0 D.P.W. Sewer _ A�proved By Date
❑ D.P.V. Cross Connection Approved By
Date
❑ Treasurer (Bond) ❑ Approved By
Date
❑ D.P.W. Engineering _ Approved By
Date
oard of Health (well) = Approved By
C133
Date
of Health (septic) = Approved By
Date
❑ Board of Health (food service) = Approved By
Date
❑ Planning Board (Parkin.. _ Approved By
Date
RE DISTRICT (I II -III) _ Approves By
Date
BUILDING DEPARTMENT APPROVAL:
❑ ZOtiING
❑ BUILDItiG INSPECTORBUILDItiG COMMISSIONER
❑ CONTROL CONSTRUCTION AFFIDAVIT
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PROJECT SUMMARY:
new construction: aiterationidemo
[Alter:add interior walls] [add rooms] [add footprint]
[pool] (garageshed/deck) [game
Describe
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To the various departments:
] [food
-•4 V
sewage disposal - public private
water supply - publiciprivate well
1
This notice has been forwarded to you for your information and any appropriate action. Should you have any
Iuestions please advise. If any reason to withhold the requested permit is found. please advise. Your assistanc and
:ooperation is appreciated.
fhe Buiidinz Department - Date sent for reviewoil By
TOWN OF DARTNIOUTH .BUI1LDWG DEPARTMENT'
TELEPHONE 508-999-0720 F - X.508-999-0738
CATION FOR ZONING AND BUILDING PERMIT
loom ..
The applicant shall complete this application to the best of their ability prior to submission, leaving no item ®answered. 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. Nsft fib lee in tit zdaid:�
(for office we only) Y2A Q FouNIDATION ONLY
Total Cost f L Received By Datie Reed
Less Application Fee $
Total Permit Fee Permit # Lwoed Date
100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET
CURRENT ACCESSORS PLAT �S LOT ZONING DISTRICT
ER ZONING OVERLAY DISTRICTS , if applicable
NUMBER & STREET��/'
rUBDIV
STCROSSSTREETnISION NAME & LOT # �:Tip a C � €�,114 &?D 0
or BUSINESS NAME
PREVIOUS TENANT / OWNER Af tC• ZaL' cF J
200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
- THIS SECTION NOT APPLICABLE
YSmgle 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. fL `
_ Accessory structure:
arage - detached atta__ched to dwellin dimensions L 3 W
= Carport - detached - attached to dwelling, dimensions L W
_ Shed - dimensions L //W
4'eck - dimensions L 7 C,05 `W ?? f`T
_ Gazebo - dimensions L W
_ Swimming pool above ground in -ground Size
Ogd 0, 0.1
_ Chimney - number of flues ''�
= Woodstove - used (will require inspection prior to installation), new The following section for official use only.
pec p ) (provide manufacturers
instructions). Location(s) (list) J x INSPECTORS' REVIEW
�F replace(s) - (includes flue) List location(s) � n•�i! I/` Co rst1 Date plan reviewed
= Game Court -describe (include overall dimensions)
30 days to review period expires
= Tent. Trailer (Mobile Home) or Other - describe = OK to issue date
300 COM 1ERCIAL - PROPOSED PROJECTNSE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES - OK to taste subject to requested submittals (see project review worksheet) date
= THIS SECTION NOT APPLICABLE = DENIED see project review worksheet date
(The following descriptions are based on the Massachusetts State Building Code Article 3, AS NOTED) (See the —
HOLD reason date
Code)
- HOLD Subject to Zoning Board of Appeals action
= Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe
Comments
= 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
f
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 -umber of dweIImg touts and bedrooms or occupant load as applicable,
also existing condition
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
alterationts).
If project is an addition to existing structure - Total gross square feet of existing
= FOR COMMERCIAL ONLY
Will this project be subject to CONSTRUCTION CONTROL (over 35.000 cu.ft.) Yes No. (If v_ es
--- rode section 127.0). Designer to submit Code Synopsis.
Dom,. -review (over 400.000 cu.ft.) Yes No isee Code Appendix it
Inspectors signature (/k����5' 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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OFFICEUNSPECTORS NOTES �{ �FLZ
�
' V
TOTAL FEE (Do �Q d z�
Gross area - new construction I _ Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit
1 9/K36W
/ 1�7
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 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 be 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 4irements (including Zoning). `
ame
ignature A4
The above signature is my voluntary act and is s ned under the pains and pen ties of perjury.
Date
Who is authorized to pickup the permit at the Building Department? r lease rind
Address / All lrs7 P IyJ/1 Phone fn -Reg b !�_
1400 HOMEOWNER F•XEM[PTION - ONE & TWO FAMH.Y 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
R:aes and Regulations for Licensing Constriction 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:
Signaturer�-� _ e+
Your signature carries certain responsibilities, including but not necessarily limited to, general liability
tiff#i#filfi#!!i!!!iilifi#fit#!!s!#!silili!liii#ilssi!!!lrill!#isifsli#iris#ifiiiilifiis!#!!###s#!##!#f!
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 51
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1500 COST
Cost of Improvement S
Items to be installed but not included in the above cost: Electrical S
Plumbing
HVAC
Other
TOTAL S U
- 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 already existing
Number of layers when complete
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 be included in new construction. (see Code section 3401.10 for
residential and Articl- 8 ft- 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? -�
f
Submitted, usually three sets required. Four sets for food serviceluses. Number of sets submitted
600 SITE PLAN
❑ Not required, why?
- Submitted When? - Previously, date C With this application
700 UTH,TTIES
Water supply - required _ yes _ no, public ? _ yes _ no, on site well? V 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 �o. Submit copy of permit as soon as available.
buu ME(MAMCALS & PRIMARY FUEL
-Furnace (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify)
Z" Boiler (heating)- Fuel gas (natural or propane) fuel 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 BPRuiKKKK FOR STRU
LTURES OVER 7500 SQUARE FEET and certain multifamily residential
Required, —plans provided, 7Plaus not provided, why?
= Not required, not to be installed, Why?
/ AAA T7f
-���-�•.��•��-•• yr"'t-KEEr PARKING - for ZONING &Architectural Access
NOT APPLICABLE
= Parking Plan submitted To = Building Department Planning Board Date submitted
Number of spaces -indoors �—
outside total provided
Handicap spaces - required yes _no. If yes, how many as a p rt 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.
UJN (print or type except as noted)
Current owner • name .-
address ,� C< 0
hone #
If corporation, officer in charge
"hitectMELgineer - for overall design
Company name
Address
Phone number
Certified by State of Massachusetts as
Certification number
NOTE Signatures and seals on all plans, aff and other documents SHALL HALL BE originals and not
engineer - Project supervision and reports
Company name
Address
Phone number
Certified by State of Massachusetts as
Certification number
NOTE Signatures and seals on all plans, affidavits and other reproductions. documents SHALL BE originals and not
General Contra (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 reproductions.documents SHALL BE originals and not
sssssssssssssssssss:ssssssss:sss:ssssssss:*sssssssssssssssssssssssssssssssssssssssss**ssssssssssss:sssss
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 Tease 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
4 -
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At
FMZ2 mp;jma nnouim r ME. I I T
hru rated v;allls and floors *,,hall be
Pere try t' N T 11 C IH-ij
CC. ff-Ale of preventing tho must be
zes wi,4n. s-A);P_ctGd s
P sso�So of, 11"Mc a and hot gas An AEaUt o
to the requ;fements of tho Test Sicw-,%ii-Afrd speCific -:Mittea to the Mil ing
v sire Stops ASITP,-E-814. Dept - Py' or to for
a foundation in:pection or
f'Cr-,b.er
PIECOF110 FUIL!" %i NOUq DFW-,V',,10 DUST BE KEPT
AT THE BUILDING DURING THE
A Ccry Of TTht Em.'orred PnmR-,:Ss oFn worui.
plen VUl.. ro rx-fit On sit'.% BUILDING DEMMMENT
0,-, rl r, 9 Ca rtm r! if c 04 T=111 Of Dartmouth.
Onto
to-,10.TME SIZE A413 DEPTH
e% jpjt,-r-ECTI0,j IS REQUIRED krom
THC COINCRETE IS POURED.
bur CUILDIN'S DEPARTMENT
TaNn e� DarbnotAh
TOWN OF DARTMOUTH BUILDING DEPARTMENT
A
This plan has been reviewed and accepted as a record copy of work proposed
rTAP 6TH Edition. The owner,
to be performed in compliance w ri final
applicant/agent and/or architect/engineer is responsible for insuring f
compliance with the above -mentioned code notwithstanding any errors or
omissions in the record plan. Any change in owner, license contractor
or engineer must be
reported to this office immediately. Any change in
&,ce
plan must Ibbe submitte�49qhts ?off, ffl�a timely rn ner.
Signature
Date ii
j—
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APPROVE BY tMj, —P� G
SCALE:
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F 'ROOF MASTER FORM
.
MQUIREMENT
PRE STOPPING r
Penetrations thru rated wails and floors zhet9 be
sealed with a material
of preventing the
}
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p s
a the requirements of the Vest Standard specific
-------- . f r , t ` '71,1
AND DEPTH
. , _ .. _. TUBE SIZE
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> � !�.RECTIOH IS RE
g'�FOR:
An �� F,tiilt S�:�`ve;� mustt�'
,t � THE CONCRETE IS PO.IF��•
+ i s omitted to the M:iydin�;
BUILDING DEFAMMElff
i 3 - ! Dept prior to chiis for t
! ; - p p Town of Dartmotte
a foundation in-► or
c:
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' 'YOUR DRAWING MUST BE KEPT
�..�t�h 1�`�F, 3-� .,1 0 2-e , Co -Co
_: _ rw { ►=� — CO Of Thl Eiil �I 1 AT THE BUILDING DURtldti THE
Plan Vast Ce r%er.t On R*% PROGR'SS OF TI iIS WORK
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Town of Dartmouth
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DRAWING NUMUR
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ti.
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- , . , L ' r An As Built Susv a
Penetrations thru rated walls an s 5h ,
T •.__::' - i sealed with a material capable of preventing the -.Vey must b ;
i assa«e of flames and hot sasses when subjected submitted to the Building
to the requirements of the Test t • n
st Standard specific
Dept. prior to calinag for �4
! /l_:-._...._. -�._-1 l..___----.5.� r ,,.y.1` `-• �,.,.•a_. a foundation i n�itlonOTfor �ire Stops STM-E-81•. L,v4f
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S OUIRED BEFORE Ca Tf' CONCRETE IS POURED. p�
'�is Er�c��rr
-r > TMECTiON BUILDING DEPARTMENT C4
r-' 7 ", .( T Of Dartmovtll pZcli {1cI", on site
BUILDING DEPARTMENT
Must C3
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ajoundation inspection or �0 AT THE f UtLDING DJM!'fl
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IMEN
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