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BP-2988xssssssssss�,:sssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss 1600 TO TAM APPLICANT/REFERRAL AND APPROVAL Date of Application submission X10 Pla Lot` / Street quiff Zope J r Owner Owner mail address e� Owner phone #, ssssssssssssssssssssssssssssssssssssssssssssssssssssss::::::s::ssssssssssssssssssssssssssssssssssssssssss OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACT THEM FOR REOCT RED RIBMISSIONS- ® TAX COLLECTOR Approved _— HOLD By Date ❑ Board of Appeals C Approved By Date C13Conservation Commission C Approved ByA ❑ D.P.W. Water C Approved By ❑ D.P.W. Sewer _ Approved By Date ❑ D.P.W. Cross Connection C Approved By ❑ Treasurer (Bond) ❑ Approved By Date Date ❑ D.P.W. Engineering C Approved By Date Dare; of Healtu (well) C Approved By A- p ' It?66 d 44 _ Date LP 'Board of Health (septic) C Approved By Date ❑ Board of Health (food service) C Approved By Date ❑ Planning Board (parking) 1 Approved By Date ® FIRE DISTRICT (I - II - III) Approved By Date s::::ss:::ssss:::::ssss:::ss:sssssss:ssssssss:ssssss:ss::ssssss:sssss:::s:s:sss:ss::sss:sssss:s:s::s:sss BUILDING DEPARTMENT APPROVAL: ❑ ZONING ❑ BUILDING INSPECTORBUILDING COMMISSIONER ❑ CONTROL CONSTRUCTION AFFIDAVIT sssssssss::s::sssssssssssssss:sssssssss:sssssss:ssss:ssssssssssssssssssss:s::s::ssssssssssssssssssssssss PROJECT SUMMARY: new construction/ alteration/demo [Alteriadd interior walls] [add rooms] [add footprint] sewage disposal - public/private water supply - public/private well [pool] [garage/she d /deck] 4aibe court] food service] Describe ssssssssssssssfsi:sssssssssssssss:ssssssssRssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss To the various departments: This notice has been forwarded to you for your information and any appropriate action. Should you have any m questions please advise. If any reason to withhold the requested perit is found, please advise. Your assistance and cooperation is appreciated. � �. �� The Building Department - Date sent for review B y�//2L TOWN OF DARTMOUTH :BDILDING DEPARTMENT TELEPHONE ;.5Q8-999-0720 FAX: 508-999-0738` APPL.IgA, ON FOR5ZONING AND BUILDING PERMIT Iastroetions The applicant shall complete this application to the best of their ability prior to submission, leaving no item unanswered. The ill Department staff wbe 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. Nsie FM6g fee is ssrt - 16 A " (for office we only) ❑ FOUNDAITON ONLY Total Cost $ —��— Received By. /' 9e — Date Reed Less Application Fee $ r► Total Permit Fee Permit # Usped Date c � �'' l7 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET C1 t La CURRENT ACCESSORS' PLAT .4 cl LOT eX©1 ZONING DISTRICT OTHER ZONING OVERLAY DISTRICTS , if applicable NUMBER & STREET -7-00 '3,A1kJ-S?_V Il L E VctI> NEAREST CROSS STREET 6y-m 4 tokN> SUBDIVISION NAME & LOT # or BUSINESS NAME 1OWNER V _ex_0_4/ 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 _ L' Carport -detached -attached to dwelling, dimensions L W =Shed -dimensions L W Deck - dimensions L W Gazebo - dimensions L W ' E Swimming pool above ground in -ground Size Chimney - number of flues 9 - Woodstove - used (will require inspection prior to installation), new (provide manufacturers The following section for official use only. instructions). Location(s) (list) INSPECTORS' REVIEW Fireplace(s) - (includes flue) List location(s) 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 COMMERCIAL -PROPOSED PROJECT/USE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES OK to issue 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 Code) - 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) - Educational - structure for training including child day care for those over 2 years 9 months ( 304.0) see Code Section - 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 dweWngg units and bedrooms or occupant load as applicable, also existing condition 400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED New Construction and/or Addition - total gross square feet Ct © +� (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 s FOR COM34ERCIAL ONLY Will this project be subject to CONSTRUCTION CONTROL (over 35,000 cu.ft.) Yes No. (if es see Code section 127.0). Designer to submit Code Synopsis. y Will this project require Peer review (over 400.000 cu.ft.) Yes APPLICANT TO PROVIDE No (see Code Appendix I) Inspectors signature date DaJUL 'I 9,7 - Applicant informed of above - Date time staff (fax, phone, in person) *s#z#zsssss#s:ssss#:sssszzssss#:sszssssssssssssssssssssss##s#ssssssssisssi#sssssis#ssssi###sssssszsiz#sss# - 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) OFFICEWVSPECTORS NOTES TOTAL FEE Gross area - new construction 114'9 Total Sq. Ft. alteration Permit is issued to Comments/notes on permit Total Sq. Ft. 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 requirements (including Zoning). dame Signature The above signature is my voluntary act and is signed under the pains and penalties of perjury. Date 4,,3"7 �`LG I ci7 Who is authorized to pickup the permit at the Building Department? (lease mina C Address t_,+.f , Phone 7�—S-3�i1L �lLC1NLt= 1400 HOMEOWNER EXEMPTION - ONE & TWO FAMILY ONLy FOR HOME O�NNERS 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 reg nations promulgated by the BBRS entitled 2:.les and Regulations for Licensing Construction Supervisors. Exception: -knv 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 , Home Owner shall act as supervisor. that such For the purposes of this section only, a "Home Owner" is defined as follows: Persons) 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 famin ,attached ily dwell 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 ssssss:s:sssssssssssss:sssssssssssssssssssssss:sssssssssssssssssssssssssssss twit , general *�*bili*** ***s 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) ssssssss:s:sss:sssssssssssssssssssssssssss*ssssssssssssssssssssssssssssss***ssssssssssss*z**s***ssssssss 1500 COST 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. - 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 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. Why? !?"Submitted, usually three sets required. Four sets for food servicekuses. Number of sets submitted 600 SITE PLAN El Not required, why? ubmitted When? =Previously, date yWith this application 700 UTH,ITIES Water supply - required _ yes ✓no, public 7 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 �o private septic - on -site —Zyes — no. Submit copy of permit as soon as available. S r 6 800 MECHANICALS & PRIMARY FUEL /Furnace (hot air) - Fuel gas (natural or propane), fuel o' , 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 SPRINKI,F.RS - 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-STREET PARE3NG - for ZONING & Architectural Access - NOT APPLICABLE - Parking Plan submitted To - Building Department - Planning Board Date submitted Number of spaces - indoors outside total provided Handicap paces - 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 ves 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 a7SQQ address 'Zb0 phone # C,G'L - yr L-LQ If corporation, officer in charge _ Architect/Engineer - for overall design Company name Address Phone number Certified by State of Massachusetts as Certification number Architect/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 documents SHALL BE originals and not reproductions. General Contractor (if Homeowner, state homeowner here then complete section 1300) Company name sc-tk 'V L pp'x to t- 4b H Address 6 '-(ZtSC�EL UA- N AEMAO MIORT'r PA- C 2 739 Phone numberConstruction Supervisors Supervisors license number NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not reproductions. *assxsaoxxxxsssssxsssssssxxsxsxxssxxxxssxsxssssxxsssssssssssssssassssssssssssssssssssxsssxssssssxssssxss 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) Sot kr-- Address Registration number (if nonestate "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 (prin Signature Date NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not reproductions. )e i I I ; SUN "F- A i�0 tom- S, 7�RTMW7' k x�4 'PA N a�E-t>SE t--XtSTtµG �A-R��t� �v►tir �a�i SONO-TULE SIZE AND DEPTH INSPECTION 110; RECU!RED 2EPORE _ THE C0NON, , ETC IS POURED. BUILDING DEPARTMISN, Town of Daftrrouih 1 o- 3 - C•tnzo SZv - t3D �2m=- wi�.tc?��/ -v_ q' - �'14" r��tGz•��.L. _ - 2o-ro5-Lv - k3D Ana+- ��/l�.{ 17fl�y —� k�� u 1 f r + 1+ r , - DART. jai ON PLC is A Copy Of This Endorsed Plan "Aust Be Kept On Site During ConstructioL—),- Date JUL 311997 f - 1 5AST S LF_V A-rj tN j4" I I I I I I I ( I I I I I� o�aSt✓ \� ' I I I I `4 � 1 I I q1-�11 t- by�7A`t\ o L v 2, x 4 cTvT25 C) 2x c� P., . Stu gxaXl� �2� 1-0 c1 tit (� C.1Zoss SCGC\pN 2 X(a �ZA=t-7SQQ> 0, c . Cn x PLY _