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BP-10125ssssss:sssssssssssssss:s:ssssessssssss:aassasss::ssss:ssssasssssssssssssasassssss==s=s=sssssssssssssssss 1600 TO TAR APPMCANT/RRFRQQ A r _ A ivn ............ . Date of Plat Owner Owner mail address Owner phone # :xsxxszxsssss::ssssssssssssssssssssssssssssasssssssss=ss===::ssss=sss=s=sssaasssassss=sssssssssss;;;;sass OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACT TIEE M FOR REOIIIItgp SpBSSIONS_ N TAX COLLECTOR _ Approved _ HOLD By ❑3Board of Appeals = Approved By ❑ }Conservation Commission 1Z. Approved By ❑ D.P.W. Water _ Approved By ❑ D.P.W. Sewer _ Approved By__- ❑ D.P.W. Cross Connection _ Approved By Date Date Date Date Date ❑ Treasurer (Bond) ❑ Approved By Date ❑ D.P.W. Engineering - Approved By 7 Board of Health (well) _ Approved By Ooard of Health (septic) _ Approved By ❑ Board of Health (food service) _ Approved By Date Date Date Date ❑ Planning Board (parking) _ Approved By Date ® FIRE DISTRICT (I - II - fIl) _ Approved By Date BUILDING DEPARTMENT APPROVAL: ❑ ZONING ❑ BUILDING INSPECTOR/BUILDING COMbIISSIONER ❑ CONTROL CONSTRUCTION AFFIDAVIT :sssxsssssas:::s::ssss*xsssss;ass;s;s;s::ssxssxsss;s:::::::ssss:sss=:::ss=:ssss:::ss;:::ssss::::::ssss:: PROJECT SUl4LMARY: new constructions alterationidemo sewage disposal - public private [.Alter:add interior walls] [add rooms] [add footprint] water supply - pubiiciprivate well [pool] [garage shed/deck] [game court [food service] - - Describe :::ssss :s:ssssss:s.::s::ssssssssss:ssss:sssssssss��s:ssss,.sssssssssssssssssssss To the various depa eats: This notice has been forwarded to you for your information and any appropriate action. jPouid . /; dean have any questions please advise. If any reason to withhold the requested permit ' found/please advise. Your assistance d cooperation is appreciated. The Buildina Department - Date sent for review By TOWN OF DARTMOUTT1I-•BUILD1N I PAR NTT TELEPHONE 508-999-072O FAX> 508-999-0 i 38 APPLICATION FOR ZONING AND BUILDING PERMIT Instrnc6om . The applicant shall complete this application to the best of their ability prior to submission. leaving no item onanswered. They Department staff will be available during regular business hours to assist as necessary. N/A should be inserted for those sectiions which do not apply. A properly completed application will help avoid unnecessary delays. Nmhw FIF06 fee is rt Mfimmbfik­ (for ot5ee we only) Total Cost S 25 — Received By Less Application Fee S Total Permit Fee Ste= Permit 0# 100 LOCATION OF PROJECT Date Redd >ssaed Date TOTAL LAND AREA SQUARE FEET CURRENT ACCESSORS' PLAT z ` LOT � ZONING DISTRICT OTHER ZONING OVERLAY DISTRICTS , iff applicable NUMBER & STREET NEAREST CROSS STREET C' SUBDIVISION NAME & LOT # or BUSINESS NAME PREVIOUS TENANT / OWNER 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: _ - (%��\\\VN Z(� W -etach �Z Garage ttached to dwelling, dimensions L _ Carport - detached - attached to dwelling, dimensions L W ::Shed -dimensions L W _ Deck - dimensions L W _ Gazebo - dimensions L W _ Swimming pool above ground In ground Size _ Chimney - number of flues OPI Y _ Woodstove - used (will require inspection prior to installation new P� P 1, (provide manufacturers The following section for official use only. instructions). Location(s) (list) INSPECTORS, REVIEW = Fireplace(s) - (includes flue) List location(s) a ------------- 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 Code) 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 `AM 1'3999 Date" = Educational - structure for training including child day care for those over 2 years 9 months (see Code Section — Applicant informed of above - Date time staff (fax, phone, in •person) 304.0) _ .. i#fis#ssi sssssssssssi siisiiiissssissssiissisissssssissssitiiisss sssssssssssssssssssssassssssssssscs ssssss: — r - Factory :' Industrial _ (see Code Section 305.0) Over six months since approved for issue - DEED abandoned! MEticant. Advise a PP Hold 90 days for return then dispose if not picked up. _ Hi=h Hard - (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) :sss:ssssss:sssssssssss:s:s::::sssssssss:sssss:s:sssssssssssssss:s:ss:ssssssssssss::ssss:::sss::::::::::: 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 Total Sq. Ft. = tiew tenant for any of the above• indicate above (see Code Section 119.0 and Zoning By-law section 35) alteration Total Sq. Ft. - Tent or Trailer - temporary purpose? Permit is issued to = Other Desrn'be the ro P Poshbriefly, also existing condition O Comments/notes on permit 400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED 3 New Construction and/or Addition - total gross square feet 3 2 (For commercial only total gross cubic feet) - indicate It will be considered new construction if there an increase in square footage in addition to anv alteration(s). 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 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 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 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). t Name Signature I � �l \ The above signature is m voluntary act cz z � C1 Date is signed under the pains and penalties of perjury. Who is authorized to pickup the permit at the Building Department? (please orinn `\ a' R, � �a1c�t5 Address Phone 1400 HOMEOWNER EXEMPTION - ONE & TWO FAMMy 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 RLIes 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 )nly, a "Home Owner" is defined as follows: Person(s) who owns a parcel of land on which helshe 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., If you are applying under this section sign below: Signature Your signature carries certain responsibilities, including but not necessarily limited to, general liability ssssssssssssssssssssssssssssssssssssssssssssssss:sssssssssss:s*:sss:sssssssssssssssss:ssss*sssssssssssss 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 sssssss:ssssssss:ssssssssssssssssssssssssssssss:ssssssssssssssssssssssssssssssssssssssssssssssssssssssss 1500 COST Cost of Improvement Items to be installed but not included in the above cost: Electrical S Plumbing HVAC �` Other �l FC1`+ ��Pr l O sit{ _ " z . TOTAL s �', C5 ` r 6U = Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration requiredi. = 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-rooling - (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 The enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwelling will bte considered as an Alteration, otherwise will be included in new construction. (see Code section 3401.10 for - residential and Articl- 8 fo: commercial) Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods of timie. Describe 500 CONSTRUCTION PLANS None submitted. Why? ±"S"ubmitted, 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 UIU I TIES Water supply - required _ yes k no, public ? yes _ no, on site well? _, yes _ no, existing? _ yes _ no If required and not existing have necessary permits been issued? — no _ yft, date (M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a water supply, whew required, is available. See Code 780 CMR section 114.1.2) Sewage disposal - required _ y no, public sewer _ yes _ no private septic - on -site yes _ no. Submit copy of permit as soon as available. 800 MECHANICAIS & PRIMARY FUEL, Architect/Engineer - 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 SPRr*aERS - 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 OFFSPREET PARMC. - for ZONING &Architectural Access SNOT APPLICABLE = Parking Plan submitted To = Building Department L Planning Board Date submitted Number of spaces - indoors outside total provided H-ndicap spaces - required _ yes _no. If yes, how many as a p-irt of the total required number. Is Route 6 (State Road) Entrance permit required? yes no If yes has it been issued yes = no 7. Submit copy of application and/or permit as soon as available. 1100 IDENTIFICATION (print or type\ except as noted) Current owner - name address [ L( 6 {4-- i\ phone # / 7g " If corporation, officer in charge Architect/Engineer - for overall design Company name Address CF �t- pJ 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. 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 noft reproductions. General Contractor (if Homeowner, state homeowner here then complete section 1300) Company name Address Phone number d Construction Supervisors license number NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not; reproductions. ::ssssssss:ssssssssssssssss:ss::ssssssss:s:sssssssssssss:ssss:sssssssssssssssss*sssssssssssssss:sanssssss 1200 FOR RESIDENTIAL REMODEL WORK ONLY Are you a Home Improvement Contractor subject to (780CMR _ 6) ?yes fo _ 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 (please print) Address Registration number (if none since "none") Phone number PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TOE 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 NEW GONSTRUGTION EX1511NG BUILDING EXISTING BUILDING NEW GONSTRUCTION 0_SOIJT _ELVATION -GARAGE 0 5 - 10, NEW GONSTRUGTION EXISTING BUILDING : r ----------------------- ---------- , , , I� , , , , f , , , , , , , , m NEW WINDOWS NEW GARAi EAST ELEVATION - GARAGE 0 5' 10, NEW GONSTRUG710N EXISTING BUILDING 101 1 Q_N _Ol 11 ELEVATION - GARAGE WEST ELEVATION - GARAGE 4 0 5' 1a 0 la FIRST FLOOR PLAN o i -)P3ERT`r LINE DRIVE WAY NDOW a r� s MAIN HOUSE , GARAGE ADD!110N - DOOR NEW DRIVE J , 0 - - - - - - - - WETLANDS BUFFER EXC7 DOOR FILE COP YOUR DRAWING MUST BE 'KEPT- _ AT THE BUILDING DURING THE PROGRESS OF THIS WORK. PRpp_` Ems' L►NIC BU;LD1LaG DEPARTMErrr Dartmouth 1` P-)APTIAL —s TE PLAN C� 5' 1a 2a 30 501 a 0 z 9 13 TOW 11 G P.A. R T!l 0 U T H RE PLAN A Copy O a his Endorsed Ply, n Must Ee Kept On Site During Construction —3