BP-7748-98800 MECHANICALS & 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)
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 SPRIN)G►'LERS - 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 gEQUIItED OFF-STREET PARKING for ZONING & Architectural Access
NOT APPLICABLE
Parking Plan submitted To = Building Department Planning Board Date submitted
Number of spaces -,indoors outside total provided
H-ndicap spaces - required _ yes _no. If yes, how many as a pirt 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 EDENTMCATION (print or type except as noted)
Current owner - name
address n Cr[
phone # 1 t _
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 plans, affidavits and other documents SHALL BE originals and not
reproductions.
ArchitectJEngmeer - 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 documents SHALL BE originals and not
reproductions.
General Contractor (if Homeowner, state homeowner here then complete section 1300) o
Company name U S�cQ (La
M Grp
Address
Phone number_
Construction Supervisors license number Cy O
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
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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_odel contractor name (pleaseyrint) -:
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
1. 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 requirements (including Zoning).
Name \ U
Signature A"J'
e above signature is my vol ry act and is n under the pains and penalties of perjury.
Date
Who is authorized to pickup the permit at the Building Depa artment? (please arinn
Address Phone'
1400 HOMEOWNER F.Ii3 3EMON - ONE & TWO FAMILY ONLY
FOR HOME OWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT
109.1.1 Licensing of Constriction 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 accorda-ce with the rules and regulations promulgated by the BBRS entitled
RLles 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 sectior. only, a "Home Owner" is defined as follows: Person(s) who owns a parcel of land
on which heishe 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.
f u are applying under this section sign below:
nature
Your signature carries certain responsibilities, including but not necessarily limited to, general liability
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)
1500 COST
Cost of Improvement S act o cio
Items to be installed but not included in the above cost: Electrical 5
Plumbing
HVAC
Other
TOTAL
G
Cif
_ 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 A separate Refuse Disposal
Declaration requhv&
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?
Submitted, usually three sets required. Four sets for food serviceluses. Number of sets submitted
600 SITE PLAN
❑ Not required, why?
ubmrtted When? ._ Previously, dateWith this application
700 ITI'IIXr ES
Water supplyrequired yes no, public ? eyes no, on site well? _Vyes no,
-
existing? Vyes _ 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 o no
private septic - on -site yes no. Submit copy of permit as soon as available.
800 MECHANICALS & 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)
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
goo SPRINICLERS - 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 OFFSTREET PARKING - for ZONING & Architectural Access
NOT APPLICABLE
Parking Plan submitted To Z Building Department a Planning Board Date submitted
Number of spaces - indoors outside total provided
Handicap spaces -'required _ yes _no. If yes, how many as a pirt of the total required number.
Is Route 6 (State Road) Entrance permit required? ves = no If ves has it been issued yes s no
Submit copy of application and/or permit as soon as available.
1100 IDENTIFICATION (print or type except as noted)
r
Current owner - name,
address 1,
phone #
If corporation. officer in charge
Architect/Engimmeer - for overall design
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.
Architect/Engmew - project supervision and reports
Company name
I
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.
I'
i
General Contractor (if Homeowner, state homeowner here then complete section 1300)
Company name
Address
Phone number C?9 �R-
Construction Supervisors license number C_ (i�
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!
Ren_odel contractor name (please print)
Address
Registration number (it 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�naame (print)
-Signature
/Date
6-0
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 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 andthat 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).
ame
'Sign
ature
The above signature is my voluntary act and is signed under the pains and penalties of perjury.
Date
Who is authorized to pickup the permit at the Building Department? please print)
Address Phone
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 accords-ce 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 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-vear 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
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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IfI501 COST
L) Cost of Improvement
Items to be installed but not included in the above cost: Electrical S
Plumbing
HVAC
Other
TOTAL
= Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required.
DenKlIfflon 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
I
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?
Submitted, usually three sets required. Four sets for food service uses. Number of sets submitted
600 SITE PLAN
0 Not required, why?
— Submitted When? - Previously, date With this application
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.
- Woodstove used (will require ins, ,:on prior to installation), new (provide manufacturers
The following section for official use only.
instructions). __.-AS) (list). �
INSPECTORS' REVIEW
V Fireplace(s) -(includes flue) List location(s)
Date plan reviewed
i
Game Court - describe (include overall dimensions)
30 days to review period expires
Tent, Trailer (Mobile Home) or Other -describe ,-
_ OK to issue date
300 COMMERCIAL - PROPOSED PROJECTIUSE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES
OK to i sue 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
Code) , AS NOTED) (See the
HOLD reason
date
Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe
— HOLD Subject to Zoning Board of Appeals action
Comments
_ Business - office, assembly with less than 50 occupants -indicate Medical or other professional (see Code
Section 303.0)
Inspectors signature �°�° �- 41998
Date
Educational - structure for training including child day care for those over 2 vears 9 months Code
_ Applicant informed of above - Date time staff (fax, phone, in person)
304.0)(see Section
--'Factory / Industrial - (see Code Section 305.0)
Over six months since approved for issue - DEEMED abandoned!
Advise applicant. Hold 90 days for return then dispose if not picked up.
High Hazard -`(see Code Section 306.0)
Institutional - hospital, nursing home, infant day care (see Code Section 307.0)
Inspector Date
Mercantile •retail stores -(see Code 308.0)
Advised applicant Date Time staff (by phone, fax or in person)
- Residential -three or more family, hotel (see Code Section 309.0)
OFFICEUNSPECTORS NOTES
- Storage - includes garages (see Code Section 309.0)
TOTAL FEE �
= Utility & Miscellaneous Structures - includes tents and agricultural structures (see Code Section 311.0)
Gross area -new construction 3jj Total Sq. Ft.
- New tenant for any of the above, indicate above (see Code Section 119.0 and Zoning By-law
section 35)
alteration Total Sq. Ft.' li
Tent or Trailer - temporary purpose? '
- -----.
Permit is issued to
Other
z
Describe the proposal briefly, INCLUDE - umber of dwelling units and bedrooms or occupant
also existing condition Paatloadasapplicab�,
I
Comments/notes on permit
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
It will he considered new construction if there an increase in square foo
alteration(s). q tags in addition to any
_,
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
see Code section 127.0). Designer to submit Code Synopsis. No. (If yesWill
this project require Peer review over
l 400,000 cu.ft.) Yes ` No (see Code Appendix I)
APPLICANT TO PROVIDE
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1600 TO THE APPLICANTIRE IMAL AND APPROVAL f
Date of Application submission
Pla 1 PLot 4
Street
offer Zone
Owner
Owner mail address
Owner phone #
OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT THEM FOR REQUIRED S mpAM IONS.
® TAX COLLECTOR Approved HOLD By Date
❑ Board of Appeals Approved By Date
❑ onservation Commission t- Approved By Date
• 5
❑ D.P.W. Water Approved By 0 D.P.W. Sewer = Approved'By Date
❑ D.P.W. Cross Connection = Approved By Date
❑ Treasurer (Bond) ❑ Approved By Date
❑ D.P.W. Engineering Approved By Date
7 Boars' of Health (well) = Approved By Date
C13 oard of Health (septic) Approved By Date
j ❑ Board of Health (food service) = Approved By Date
❑ Planning Board (parking) _ Approved By Date
® FIRE DISTRICT (I - II - II1) _ Approved By Date
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BUILDING DEPARTMENT APPROVAL:
❑ ZONING
❑ BUILDING INSPECTOWBUILDING COMMISSIONER
❑ CONTROL CONSTRUCTION AFFIDAVIT
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PROJECT SUMMARY:
new constructions alteration/demo sewage disposal - public/private
[Alter add interior walls] [add rooms] [add footprint] water supply - public%private well
[pool] [garage/shed/dec ame court] [food service]
Describe'"'
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To the various departments:
This notice has been forwarded to you for your information and any appropriate action: Should you have° anv
questions please advise. If any reason to withhold the requested permit is found, please advise. Your assistancW=d
cooperation is appreciated.
The BuildingDepartment Date sent for review !, 1t Y
De p By
I
O u B } 17 _ tP E` S
TOWN OF DAR
TELEPHONE 508-999-0720 FAX: 508=999-0738
APPLICATION FOR ZONING AND BUILDING PERMIT
IasitoctioQs -
The applicant shall complete this application to the best of their ability prior to submission, leaving no item unanswered. The
nserted for those sections
Department staff will be available during regular business hours to assist as necessary. N/A should be i
which do not apply. A properly completed application will help avoid unnecessary delays. Nolen FNkff 60e=Mt
FO ON ONLY
(for ogee use mil)
Total Cost s Received By Date Reed
Less Application Fee
Total Permit Fee Permit # Lvmed Date
100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET
CURRENT ACCESSORS PLAT lLOT / ZONING DISTRICT
�
OTHER ZONING OVERLAY DISTRICTS , if applicable
NUMBER & STREET aQ<
NEAREST CROSS STREET
SUBDIVISION NAME & LOT #
or BUSINESS NAME
PREVIOUS TENANT / OWNER
200 RESIDEN\-fIAL - 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_detgc attachedAo dwelling, dimensions L W
= Carport - detached - ,attached to dwelling, dimensions L'
Shed -dimensions L W
Deck - dimensions L R'
= Gazebo - dimensions L R'
_ Swimming pool above ground in -ground Size
Chimney - number of flues