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vvoo=ove - 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 e? 3
300 COb'1"IERCIAL - PROPOSED PROJECTIUSE _ INCLUDING THREE FAMILY OR MORE
AND EXEMPT USES
THIS SECTION NOT APPLICABLE
OK to issue subject to requested submittals (see project review worksheet) date
- DENIED see project review worksheet date
(The following descriptions are based on the Massachusetts State Building Code Article 3, AS NOTED)
Code)
(See e
th
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
Date
- Educational - structure for training
30 Educationalg 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)
_ Factory % Industrial
sssssssszssssssssssssssssssszssss:ssszssssssssssssssssssssssxssssssssssssssssssssssssssssszs:sxsss�zsxssszs
_ (see Code Section 305.0)
Over six months since approved for issue -DEEMED abandoned!
High Hazard - (,see ode�echon
Advise applicant. Hold 90 days for return then dispose if not picked up,
.0 306.0)PP
: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)
— Storage - includes garages (see Code Section 309.0)
OFFICEVNSPECTORS NOTES
_ Utility &Miscellaneous Structures
/73
TOTAL FEE Sa
-includes tents and agricultural structures (see Code Section 311.0)
® Gross area - new construction Total Sq. Ft.
— 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? 1
alteration Total Sq. Ft.
Permit is issued to------t- 1 ,.r•_ te..
Describe the proposal briefly, INCLUDE - amber of dw
also existing condition llingwand msoroocupantload asapplirable,
Comments/notes on permit
4, f0 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED
z
= 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
alteration(s).
If project is an addition to existings fracture -Total gross square feet of existing
= FOR COhU11ERCI4,L ONLY
Will this project be subject to CONSTRU
CTION CONTROL (over 35,000 cu.ft.) see Code section 127.0). y� Designer No,
(If yes
to submit Code Synopsis.
WRT this project require Peer review (over 400,000 cu.ft.) Yes
No (see Code Appendix n
APPLICANT TO PROVIDE
%
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1600 TO THE APPLICANIyREFERRAL AND APPROVAL
Date of Applicationsubmission
Plat ILot Street
&14q�ert It Zone
Owner l 1ll \>_'� 1%� f� i
O 1 ' '`- t
Owner mail address
Owner phone #
xxsssssxxx*ssssssssssxx"`*`***xx*****s•****x*:sssss:ssss*::::ssss:sssss:sssssssasssssssssssssssssssssss
OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional
proposed project. CONI'ACT'IT 'ITEM FOR REt?LiitQ��ttr °r approval for your
�D SOBNaMONS.
11 TAX COLLECTOR �_ Approved C HOLD By
Date
❑ Board of Appeals :_ Approved By
Date
❑ Conservation Commission C. Approved By
Date
❑ D.P.W. Water _ Approved By ❑ D.P.W. Sewer,--; ; Approved By -
Date
❑ D.P.W. Cross Connection C Approved By
Date
❑ Treasurer (Bond) ❑ Approved By
Date
❑ D.P.W. Engineering : Approved By
Date
7 Board of Health (well) :^ Approved By
Date
❑ Board of Health (septic) ;' � Approved By
Date
❑ Board of Health (food service) '_ Approved By
Date
❑ lanning Board (parking) _ Approved By
-
Date
®, RE DISTRICT (I - II - IIn — Approved By
:::$::as ::::asssa:asassssssassssasassss
Date
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BUILDING DEPARTMENT APPROVAL: ss
❑ Z,ONING
❑ BUILDING INSPECTORBUILDING COMMISSIONER
❑ CONTROL CONSTRUCTION AFFIDAVIT
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PROJECT SUMMARY:
new constructioni alteration/demo sewage disposal - public/private
[ALer add interior walls] [add rooms] [add footprint] water suppiv - public/private well
[pooh' [garage/shed/deck] [game court) [food service]
Describe
ssssssssss*sssssssssssssssssssssssssss:::xsssssssssssssssssssssssssssssssssssss sssssssssssssssssssssssssss
To the various departments:
This notice has been forwarded to you for your information and any appropriate action. Should you have any
questions please advise. If any reason to withhold the requested permit is f und, please advise. Your assistance and
cooperation is appreciated.
The Building Department - Date sent for review (�
By
8. .2—
TOWN OF DARTMOUTH INGDEPARIMONT
TELEPHONE 508-999-0720 FAX:= 508-999-07738:
APPLICATION FOR ZONING AND BUILDING PERMIT j
Insfrnetioas
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. N/A should be inserted for those sect ions
which do not apply. A properly completed application will help avoid unnecessary delays. blob FEkg he is =I avEmobilill
(for oboe e any) / N 01,gLY
L�4
age
Total Cost s Received By Date Rec'a
F
Less Application Fee $
Total Permit Fee $ Permit # �6 Lased Date
100 LOCATION OF P)it®`Ve-r TOTAL LAND AREA SQUARE FEET L/ /
CURRENT ACCESSORS' PLAT LOT ZONING DISTRICT
THER ZONING OVER' AY-JISTRICTS , if applicable,
NUMBER & STREET Z:2 C,1,4t -767 Q 0 r )JCe
NEAREST CROSS STREET
lor
BDIVISION NAME& L OT#
BUSINESS NAME t- ?/�C& 2 /IV r'"
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:
= Garage - detached - attached to dwelling, Limensions 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 ground in -ground Size
Chimnev - number of flues
1