BP-4019800 MECIIANICALS & PRIMARY FUEL
ArchitEc�ieer - 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 SPRINKLERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
- Required, —plans provided, :—_plans not provided, whv?
= Not required, not to be installed. Why?
1000 REQUIRED OFF-STREET PARSING - 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 _ ves _no. If ves, 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 ves = no =.
Submit copy of application and/or permit as soon as available
1100 IDENTIFICATION (print or type except as noted)
/Current owner - name lmv-70 A)
/address / l 1TIa lyL`
Yhone # .57VC — 0 3- C)()P
If corporation, officer in charge
ArchitectTrigineer - for overall design
Company name
Address
Phone number
Certified by State of Massachusetts as
Certification number
NOTE Signatures and seals on all nlans, 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'.�not
reproductions.
General Contractor
ontra (if Homeowner, to homeowner ere then complete section 1300)
xjo�
Company name. ff �
Address �7' / j
Phone number
Construction Supervisors license number R4
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 mext section!
Are you claiming exemption from the requirement? Yes _No _If yes, submit the required aiffidavit!
Ren--)del contractor name (please 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
5
I, the undersigned, am the owner of record or authorized lessee (provide documentations 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 In is
onths if no work
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).
W e
i2nature
% The above signature is my voluntary act and is signed under the pains and penalties of perjury.
f/Date �(%
Who is authorized.tP pickup the pe in'l�y the Building Department? r teaseonnn j-},�puj
Address ��1 % fsi l Phone 1� — i// �'4� C �✓
1400 HOMEOWNER EXEEMPIZON - ONE & TWO FAMILY ONLY
FOR HOME OWNERS IN'HO I.NTEND TO PERFOILNI AND BE RESPONSIBLE FOR THEIR OWN PROJECT
109.1.1 Licensing of Construction Super sora: Except for those structures governed by Construction Control
in Section 127.0, effective July 1, 1982, no individual shall be engaged in directly supervisin
construction, reconstruction, alteration, repair., removal or demolition involvingthe structu g persons engaged in
structures. unless he or she is licensed in accordance with the rules and regulations promulgated by he BBRS enements of gtl d
R:.les and Regulations for Licensing Co-strt ^tic1 Busier; lk'
Exccption: 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 personts) for hire to do such work ,that such
Home Owner shall act as supervisor.
For the purposes of this sectiot:..aiv, a "Home Owner' is defined as follows: Petson(s) who owns a parcel of on which he:she resides or intends to reside, on which there is, or is intended to be. a one or two family dwellingIan
,
or detached structures accessory to such use and/or farm structures. A person who consached
tructatts more than one home in
M-o-rear period shall not be considered a Home Owner.
_ ANeranon ui extsnnR,:no increase in gross square feet. A separate Refuse Disposal Declaratiion required_
- Demolition - describe structure
Number of dwelling units Number of bedrooms A separate Refuse Tnisposal
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-rvor g - (for existing only, is included in new construction)
Number of square feet
Number of layers when complete
Number of layers already existing
A separate disposal declaration REQUIRED
- Replacement doors and windows - (for existing only) (only where doors and windows exist amd will not be
enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dweelling will be
considered as an Alteration, otherwise will be included in new construction. (see Code section Z401.10 for
residential and ,!L-ticle 8 for comi tercial)
_ Temporary structure - includes when allowed, trailers, tents and the like and only for limited pemods of time.
Describe
500 CONSTRUCTION PLANS
- None submitted. 17,hy?
- Submitted, usually three sets required. Four sets for food serviceluses. Number of sets submitted
If you are apphins; under this section Sig below:
G�-
600 SM PLAN
Si2nature
four signature carries certain responsibilities, including but not necessarily limited ❑ Not requird, why?
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to, genera! liability
NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that am — Submitted When? - Previously, date With this application
licensed Construction Supervisor, whether or not they have taken the e 2.15.= of section � i p rmit are responsible for code compliance. (see
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1 500 COST '
Cost of Improvement _ wares supply -required _yes _ no, public ^ _yes _ no, on site well? _ yes no,
existing? _ yes _ no
Items to be installed but not included in the above cost: Electrical S
` 00 If required and not existing have necessary permits been issued? _ no _ yes, date
Plumbing
(M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a water smpply, when
HN .kC
W*N
required, is available. See Code 780 CMR section 114.1.2)
Other �l1 i t0()
Sewage disposal - required _ yes no, public sewer _ yes _ no
TOTAL S � (, � � Q
private septic - on -site yes _ no. Submit copy of permit as soon as available.
_ woodstove - used (will require inspection prior to installation), new (provide manufacturers
instructions). Location(s) (list)
- Fireplace(s) - (includes flue) List location(s)
- Game Court - describe (include overall dimensions)
- Tent, Trailer (Mobile Home) or Other - describe
300 COMMERCIAL - PROPOSED PROJECT/USE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES
- THIS SECTION NOT APPLICABLE
(The following descriptions are based on the Massachusetts State Building 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 303.0)
- Educational - structure for training including child day care for those over 2 years 9 months (see Code Section
304.0)
- Factory i Industrial - (see Code Section 305.0)
- H;qh Razard - (see Code Section 306.0)
- Institutiona► - 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 pr+opaaal briefly, INCLUDE —umber of dwelling twits and bedrooms or occupant load as appbcable,
also existing condition
40C, TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED
-1. New Construction 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 anv
alteration(s).
If project is an addition to existing structure - Total gross square feet of existing
- FOR COhUKMCIAL ONLY
Will this project be subjecf 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 1)
APPLICANT TO PROVmF
The following section for official use only.
INSPECTORS' REVIEW
Date plan reviewed
30 days to review period expires
- OK to issue date
- OK to issue subject to requested submittals (see project review worksheet) date
DENIED see project review worksheet date
- HOLD reason dam'
- HOLD Subject to Zoning Board of Appeals action
Comments
Inspectors signature Date 'OCT 2 0 1997
- 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 duose if not picked up.
Inspector Datee
- Advised applicant Date Time staff (by phone, fax or in person)
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OFFICEUNSPECTORS NOTES
TOTAL FEE��,
Gross area - new construction Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Commentsinotes on permit ,.e
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1600 TO T>M APPLICAN AMFF:RgAL AND APPROVAL
Date ofApplicationppGcatiomission
Plat Lot _Street _
Owner
Owner mail address
Zone
Owner phone #
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OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT 711M FOR RF.(?Lg t SB11sLSSIONS.
9 TAX COLLECTOR = Approved = HOLD By
❑ Board of Appeals , = Approved By
013onservation Commission r Approved By
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❑ D.P.W. Water = Approved By ❑ D.P.W. Sewer = Approved By
❑ D.P.W. Cross Connection a Approved By
❑ Treasurer (Bund) ❑ Approved By
❑ D.P.W. Engineering = Approved By
oarcl of Health (well) _11! Approved By
Board of Health (septic) = Approved By
❑ Board of Health (food se: vice) = Approved By
Date
Date
Date
Date
Date
Date
Date
Date
Date
Date
❑ Planning Board (parking) = Approved By
_ Date
® FIRE DISTRICT (I - II -III) _ Approved By
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BUILDING DEPARTMENT APPROVAL:
❑ ZONING
❑ BUILDING INSPECTORBUILDING COMMISSIONER
❑ CONTROL CONSTRUCTION AFFIDAVIT
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PROJECT SUKMARY:
new constructioni alteration/demo
sewage disposal - public/private
[Alterad.d interior walls] [add rooms) [add footprint)
OD
(garageished/deck) ,�-[game
Dcourt] [food service]
Describe
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ro the various departments:
water suppiv - public/private well
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This notice has been forwarded to you for your information and any appropriate action. Should you have any
luestions please advise. If any reason•to withhold the requested permit is found, please advise. Your assistance and
ooperation is appreciated.
be Building Department - Date sent for review
sy
TOWN OF DARTMOUTH •B IDING I PAR ME T
TELEPHONE 508-999-0720 FAX508=999-038
APPLICATION FOR ZONING AND BUILDING PERMIT
Instrnetiom
The applicant shall complete this application to the beet of their ability prior to submission. leaving no item unanswered• Thte
Department staff will be available during regular business hours to assist as necessary. NIA should be inserted for those sections
which do not apply. A properly completed application will help avoid unnecessary delays. Nett Mog (ee is.at -
(for oNim ose ooiy)
Total Cost $ 4 r Remixed By Date
Less A.pp&=tion Fee $
Total Permit Fee S Permit # Iss:=
100 LOCATION OF PROJECT
TOTAL LAND AREA SQUARE FEET
_� Cf
CURRENT ACCESSORS' PLAT =_t- LOT ZONING DISTRICT ,fir
OTHER ZONING GMWLAY DISTRACTS , if applicable
DUMBER & STREET l l I / ��o"t� �t /K
NEAREST CROSS STREET
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:
Q T
1
b
= Garage - detached - attached to dwelling, cimensions L W
= Carport - detached - attached to dwelling, dimensions L W
= Shed - dimensions L W
= Deck - dimensions. L W
= Gazebo - dimensions L W
Swimming pool above groin-ground Size
und
= Chimney - number of flues
a
uOi�,