BP-4454800 MIECIIANICAIS & 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)
.fir conditioning - (separate unit)
= one of the above to be provided
Hot Water Gas Electric Fuel Oil Other
900 SPRINILERS - 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 PARENG 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 _ ves no. If ves, how many as a partof the total required number.
Is Route 6 (State Road) Entrance permit required? ves - no =. If yes 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
address !g Le
J
phone #
If corporation, officer in charge
ArchitectTmgmeer for overall design
Company name
Address
s
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/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 andl'not
reproductions.
General Contractor (if Homeowner, state homeowner here then complete section 1300)
Company name ii t7 � {'U1
Address
Phone number,
�77
Construction Supervisors license number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals andl'not
reproductions.
1200 FOR RESEDENTIAL 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 agffidavit! ,
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
Alteration of existing,;no increase in gross square feet. A separate Refuse Disposal Declaration requ fired.
1. the undersigned, am the owner of record or authorized lessee (provide documentation) and I have reviewed
— Demolition - describe structure
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.
Number of dwelling units Number of bedrooms A separate Reface Disposal;
g
Further I understand that the permit will expire in six months, from the date of issue, if no work is begun or
Declaration required.
six months rafter the last inspection if work has begun and that the permit may extended for six months if no work is
ted if I request such an extension
anticipated nsion w
q in writing. I understand that the permit may be extended
P y nded only
g P y three tunes by
— Moving - v' co of D.P.W. moving license Type of structure
_ M (Provide g ) YP
�-g ( PY
written request. I understand that once the permit expires a new application may be required, including fees and current
other requirements (including Zoning).
from where (plat/lot or address)
amet9�s1 �t ° l�s�
to where (plat lot or address) ,
K' Signature P
Number of dwelling units Number of bedrooms per dwelling unit
The above signature is my voluntary act and is signed under the pains and penalties of perjury. P p tj ry.
Re -roofing - (for existing only, is included in new construction)
Date _I(
`
Number of square feet Number of layers already existing
Who is authorized to pickup the permit at the Building Department? iplease or;nt)
Address Phone
Number of lavers when complete
A separate disposal declaration REQUIRED
1400 HOMEOWNER EXEMIMON - ONE & TWO FAMILY ONLY
- Replacement doors and windows - (for existing only) (only where doors and windows exist and will,anot be
FOR HOME ON;OiERS WHO INTEND TO PERFOR,11 AND BE RESPONSIBLE FOR THEIR OWN PROJECT
li
enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwelling will be
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
considered as an Alteration. otherwise will be included innew construction. (see Code section 3401.10 for
construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of buildings or
structures, eanless he or she is licensed in accordance with the rules and regulations promulgated by the BBRS entitled
residential and Article 8 for commercial)
RLIes and F egu' itions for Licensing Corstruction Supervisors.
= Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods aif time.
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 'Ownerengages a persons) for hire to do such work .that such
Describe
Hone Owner shall act as supervisor.
500 CONSTRUCTION PLANS
j For the purposes of this section niv, 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 family dwelling, attached
—None submitted. Why?
- or detached structures accessory to °such use and/or farm structures. A person who constructs more than one home in
two -rear period shall not be considered a Home Owner.
_ Submitted, usuailv three sets required. Four sets for food service 1 uses. Number of sets submitted
If you are applying under this section sign below:
600 SITE PLAN
Signature
1] Not required, why?
Your signature carries certain responsibilities, including but not necessarily limited to, general liability
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— Submitted When? - Previously, dater With this application
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)
700 UITLITIFS
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Water supply - required _ yes _ no, public ? _ yes _ no, on site well? _ yes _ no,
1500 COST
Cost of Improvement 5
existing? yes _ no
I
Items to be installed but not included in the above cost: - Electrical -5
If required and not existing have necessary permits been issued? — no _ yes, date
i Plumbing
(M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a water supply3, when
HVAC
required, is available. See Code 780 CMR section 114.1.2)
ther
Sewage disposal - required _ yes _ no, public sewer yes _ no
TOTAL S
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 COM[MERCiAL - PROPOSED PROJECTIUSE - 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 / 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 - amber of dwelling units and bedrooms or occupant load as applicable,
also existing condition
404 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 be considered new construction if there an increase in square footage in addition to any
aiteration(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 1)
APPLICANT TO PROVIDE
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 date,
HOLD Subject to Zoning Board of Appeals action
Comments
.Inspectors signature
Applicant informed of above - Date time staff (fax, phone;, in person)
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Over six months since approved for issue - DEEMED abandoned!
Advfse 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))
OFFICE\INSPECTORS NOTES
TOTAL FEE ,
Gross area new construction �.`�� Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit
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1600 TO THE APPLICANTMEFERRAL''AND APPROVAL
Mate of Application submission
9
Plat Lqt-21 Street quifer Zone
Owner
Owner mail address
Owner phone #
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OTHER INVOLVED AGENCIES The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT 771M FOR RFOiIIRED SUBMISSIONS.
to TAX COLLECTOR Approved HOLD By Date
13 Board of Appeals Approved By Date
❑ Conservation Commission C Approved By Date
❑ D.P.W. Water Approved By t] D.P.W. Sewer Approved By Date
❑ D.P.W. Cross Connection E roved
APP By Date
13 Treasurer (Bond) ❑ Approved By Date
❑ D.P.W. Engineering C Approved By 'late
'7 Board of Health (well) C Approved By Date 'n
r[3,Aoard of Health, (septic) pp y Date
C Approved B
❑ Board of Health (food service) Approved By Date
❑ Planning Board (parking) _ Approved By Date
® FIRE DISTRICT (I - II - III) , = Approved By Date
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BUILDING DEPARTMENT APPROVAL:
❑ ZONING
❑ BUILDING INSPEC'TORBUILDING COMMISSIONER
❑ CONTROL CONSTRUCTION AFFIDAVIT
PROJECT SUMIYiARY:
I
new construction/ alteration/demo sewage disposal - public/private
[Alter/add interior walls] [add rooms] [add footprint] water supply - public/private well
[pool] [garage/shed/deck] [game court] [food service]
Describerl &
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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 assistance and
cooperation is appreciated.
The Building Department - Date sent for review By
2.
TOWN OF-DARTMOUTH BUILDING DEP'AR
TELEPHONE 508-999-0720 FAX: 508-999-0738
APPLICATION FOR ZONING AND BUILDING PERMIT
Instrnetions
The applicant shall complete this application to the best of their ability prior to submission, leaving no item —answered- Th-g
Department staff will be available during regular business hours to assist as necessary NIA should be inserted for those sectlions
which do not apply. A properly completed application will help avoid unnecessary delays. Neft FRiEg free is ad
(for ocam me only) 4 O?rgo T7N C)NLY
Total Cost $ Received By Date Reed I /J
Less Applicatiion Fee $
T tal Fee Permit # Lsned Date
o Permit
100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET
CURRENT ACCESSORS' PLAT LOT ZONING DISTRICT
VERI,AY DISTRICTS if applicable
OTLIER ZONING O
NUMBER & STREET ��
Ile- AAII�
NEAREST CROSS STREET
SUBDIVISION NAME & LOT #
or BUSINESS NAME
PREVIOUS TENANT / OWNERT, -
200 RESIDENTIAL - PROPOSED PROJEC: one & two family'residence only
THIS SECTION NOT Aim—riICABLE
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:
C Garage detached attached to dwelling, dimensions L Wi
Carport - detached - attached to dwelling, dimensions L W
Shed - dimensions L W
�__JDeck - dimensions L7 e W
Gazebo - dimensions L W
Swimming pool above ground in -ground Size
Chimney - number of flues