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BP-7518- - 800 ME CHANI CALS & PRIMARY FUEL Architect/Engineer -I, project supervision and reports = Furmace (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify) Company name = Boiler (heating)- Fuel gas (natural or propane), fuel oil, electricity, other (specify) Address _ HVAC (combined unit) - Primary fuel, natural gas, propane, electricity, other (specify) Phone number Air conditioning - (separate unit) Certified by State of Massachusetts as None of the above to be provided Certification number Hot Water Gas Electric Fuel Oil Other NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals mnd not reproductions. 900 SP1LIIWGYM - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential Required, --plans provided, plans not provided, why? General Contractor (if Homeowner, state homeowner here then complete section 1300) � L U Not required, not to be installed, Why? Company name ,� Address 1000 !tEQUMED OFF-T RE PARKING - for ZONING & Architectural Access Phone number NOT APPLICABLE Construction Supervisors license number Parking Plan submitted To _ Building Department ` Planning Board Date submitted NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals mnd not Number of spaces - indoors outside total provided reproductions. Handicap spaces - required _ yes _no. If yes, how many as a pirt of the total required number. s::s::::s::::::::::::xss****ss::ssss:s:::s:s:ass:::s:s:ss::s:s:as:sss::ss:s:sssssssssssssss:s:s:ssasss::s Is Route 6 (State Road) Entrance permit required? yes = no _. If yes has it been issued yes = no 7:. 1200 FOR RESIDENTIAL REMODEL WORK ONLY Submit copy of application and/or permit as soon as available. Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes s No _ If no go Yto next section! 1100 IDENTIFICATION (print or type except as noted) Are you claiming exemption from the requirement? Yes _No _If yes, submit the requir-ed affidavit! Current owner - name ,�e teei Ren_odel contractor name (please print) address L3 uJo(-J � ooC Address G �t �i phone # � ©— s 6 ^� l Q C? Registration number (if none state "none") If corporation. officer in charge Phone number ArchitectJEngineer - for overall design PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTEE FUND! QUESTIONS OR COMPLAINTS call or write: Company name Home Improvement Contractors Registration One Ashburton Place - Room 1301 Address Boston, MA'02108 (617) 727-8598 Phone number Owners name (print) Certified by State of Massachusetts as Signature Certification number Date NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not reproductions. n 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 it tree -and correct and that the permit requested be issued. Further Iunderstand 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). Name 116( Signature V c.te The above signature is my voluntary act and is signed under the pains and penalties of perjury. Date 7 bf / fd Who is authorized to ickup the permit at the Building Department? [please jinn fl/1(% �' Address % 7 C 0 e_(C_ 'J. Phone 14 HOMEOWNER ERLt 11MON ONE & TWO FAMILY 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 enti"ed R:.les and Regulations for Licensing Constriction 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 only, a "Home Owner" is defined as follows: Person(s) who owns a parcel of land on which hershe 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. c If you are appll°ing under this section sign below: Signature f Your signature carries certain responsibilities, including but not necessarily limited to, general liability NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that any licensed Construction Supervisor, whether or not thev have taken the permit are responsible for code compliance. (see 2.15.2 of section 5) ass##asssssssss;ssss#sass;ssss##iss:ls#iss#s;ssssissssssssssss#ss#ssss:###ass#sssssssssssssssss#;ssss##ss 1500 COST Cost of Improvement S Items to be installed but not included in the above cost: Electrical 5 Plumbing HVAC Other TOTAL $ = Altom ion of existing, no increase in gross square feet. A separate Refuse Disposal Declaration rer wired. = Demolition - describe structure Number of dwelling units Number of bedrooms A separate Refuse Disposail Declaration required. = Moving (Provide copy of D.P.W. moving license) Type of structure from where (plat/lot or address) to where (p12tAOt 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 C 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 mill be considered as an Alteration, otherwise will be included in new construction. (see Code section 3401.1f9 for residential and Articl- 8 ft..- commercial) C Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods o3 f time. Describe 500 CONSTRUCTION PLANS C None submitted. Why? _ Submitted, usually three sets required. Four sets for food serviceluses. Number of sets submitted' 600 SITE PLAN ❑ Not required, why? = Submitted When? Previousiv, date C With this application 700 VTUZrEES Water supply required _ yes _ no, public ? � 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 _ no private septic - on -site �! -ves 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) 6110 101.1 A -CI P j t 11_9 Tent, Trailer (Mobile Home) Other describe 1 a; -,� z w 1rP 300 COMMMCIAL - PROPOSED PROJECTIUSE - INCLUDING THREE FAMILY OR. MORE AND EXEMPT USES cm- fop_-` P3 I = THIS SECTION NOT APPLICABLE (The following descriptions are based on the Massachusetts State Building Code Article 3, AS NOTED the Code) _'Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describ = Business - office, assembly with lessZcare ts indicate Me ' I or other professional (see Code Section 303.0) Educational -structure for training iy care r those over 2 years 9 months (see Code Section 304.0) = Factory / Industrial . (see Code SecHigh Hazard - (see Code Section 30Institutional - hospital, nursing home (see Code Section 307.0) Mercantile - retail stores (see ode 308.0) = Residential - three or m e family, hotel (see Code Section 309.0) = Storage - includes rages (see Code Section 309.0) Utility & Misc aneous Structures includes tents and agricultural structures (see Code Section 311.0) New tena for any of the above, indicate above (see Code Section 119.0 and Zoning By-law section 35) = Tent r Trailer - temporary purpose? her I - Desrnbe the proposal briefly, INCLUDE - umber of dweiling tmits and bedrooms or occupant load as applicable, also existing condition 400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED New Constracdon 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 existing structure Total gross square feet of existing = FOR COAUVIERCIAL 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 Tn Ponvmi? u The following section for official use only. INSPECTORS' REVIEW Date plan reviewed 30 days to review period expires 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 1DaJUL 21 199 Applicant informed of above - Date time staff (fax, pphone, in person) i##i#######iiiiii#i#iiiffifiii#ii####!t#if#iifi#fi#ifii#i##iff#ff#ifi#flfffif#f#fff$###f$fsBii#i#f#iifiiifii 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) ######i#####f##iiiii###i##iitiiiii##f#fi###ii#ii##ii#ii#!fff#ff###f##i##i#fffifff#####f:s3fitiffi##iiiii#i OFFICEUNSPECTORS NOTES TOTAL FEE Gross area - new construction �� Total Sq. Ft. alteration Total Sq. Ft. Permit is issued to Comments/notes on permit xsss�s#ssssssssssssssssssssss:ssssssssasssslss!#:ssss:sasses#ssssssssslsss:sssssssssssssssssssssssssssss 1600 TO THE APPLICANT/REFERRAL AND APPROVAL Date of Application submission Plat 33 Lot _�__ Street 3 .Owner 6 Aquifer Zone - Owner Owner mail address Owner phone # Y#######sf#ss##i#sisssss!##ssiss!!ss#!!s##iss##ifiif!lsisfsls!!lssssis#is#liiisiilfsiifis:ss###si:ssfss#f i OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your Proposed project. CONTACT THEM FOR REOiT>r>QJKD mlmnW IONS. PAX COLLECTOR Z Approved Z HOLD By Date ❑ ' Board of Appeals _ Approved By Date ❑ Conservation Commission ` Approved By Date ❑ D.P.W. Water Approved By ❑ D.P.W. Sewer _Approved By Date ❑ D.P.W. Cross Connection Approved By Date ❑ Treasurer (Bond) ❑ Approved By Date ❑ D.P.W. Engineering _ Approved By Date -1 Board of Health (well) = Approved By Date ❑ Board of Health (septic) Approved By Date ❑ Board of Health (food service) Approved By Date 13 Planning Board (parking) Approved By Date FIRE DISTRICT' (I II -III) = Approved By Date ssss: s ssssssssssss::sssssssssss::::ssss::ssss::ssss:ass:::ssss:::::sssssssssssssssssssssssssssssss BUILD G DEPARTMENT APPROVALc C2 _ZONING ❑ BUILDING INSPECTOR/BUILDING COMMISSIONER ® CONTROL CONSTRUCTION AFFIDAVIT PROJECT SUMMARY: new construction aeration demo sewage disposal - publiciprivate 1, L-Iter;add interior walls] [add rooms] [add footprint] water supply - publiciprivate well [pool] [garage/shed/deck] [game court] [food service] Describe - i To the various departments: a� This notice has been forwarded to you for your information and any appropriate .action. Should you have I any questions please advise. If any reason to withhold the requested permit is found, please advise. Your assistance and cooperation is appreciated. !The Buildi2g Department - Date sent for review e BY TOWN OF DARTMOUTH: B REP. TELEPHONE 508-999-072Q :FAX>'SOS-! 9-0738: APPLICATION • 1 BUILDINGPERMIT Imtroetiom -. The applicant shall complete this application to the best of their ability prior to submission, leav&g no item unanswered. The Department staff will be available during regular business hours to assist as necessary. Na should be inserted for dhose sections which do not apply. A properly completed application will help avoid unnecessary delays. %Gs ■ i (for office um oily) M,? ONONLY Total Cost $ Reeeived By 3 Date Reed Less Application Fee Total Permit Fee Permit # Lmmed Date 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET / CURRENT PLAT V LOT 0 ZONING DISTRICT ACCESSORS' OTHER ZONING OVERLAY DISTRICT��S��, if applicable NUMBER & STREET NEAREST CROSS STREET SUBDIVISION NAME & LOT # or BUSINESS NAME PREVIOUS TENANT / OWNER 200 RESIDENITAL - 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 = 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 v , b l