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BP-69851600 TO THE APPLICANTIREFERRAL AND APPROVAL Date of Application submission Plat Lo Street %" ,k LLe -Aquifer Q Zone OwnerLu_ 9 .h ID Owner mail address Owner phone # OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your Proposed project. CONTACT THEM FOR REtAIitQ RD MBMLSSIONS. ® TAX COLLECTOR = Approved = HOLD By ❑ Board of Appeals Approved By Date O Conservation Commission G Approved By Date ❑ D.P.W. Water _ Approved By ❑ D.O.W. Sewer '-Approved By Date ❑ D.P.W. Cross Connection Z Approved By/ Date ❑ Treasurer (Bond) ❑ Approved By ❑ D.P.W. Engineering ; 7 Board of Health (well) Date Date By Date ❑ Board of Health (septic) :;/Approved By ❑ Board of Health (food service) = Approved By Date Date ❑ Planning Board (parking) = Approved By Date ® FIRE DISTRICT (I - II -III) _ Approved By Date sssssssssssssssssssssssssssssssssssssssssssss::sss:ssssssasssssssssss::::sssssssssssssssssssssssssssssss BUILDING DEPARTMENT APPROVAL: ❑ ZONING ❑ BUILDING INSPECTORBUILDING COMMISSIONER ❑ CONTROL CONSTRUCTION AFFIDAVIT ssss::ss#ssssisss#sssisssi:sissisiss:::::::ssssss##iisss::ssss:::ssss:s##s#:ss::::sssssiiii###ss#isiissi PROJECT SUMMARY: new --onstrucrioni alteration/demo sewage disposal - public/private [.Mter;add interior walls] [add rooms] [add footprint] [pool] [garageished/deck] [game court] [food Describe _ I ss#:ssssss#fsfssssssssfs�s To the various departments: water supply - public/private well :ssssssssssss::ssss'"s:ssssss:::::�fsssss�sssss::ss:sssssssssssss''sssssssss 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 found, please advise. Your assistance and, cooperation is appreciated. The Building Department - Date sent for review% (`j By Q TOWN OF DARTMOUTH BUILDING DEPARTIVIEI�T': TELEPHONE 508-999-0720 'FAX:508499-0 i 38 APPLICATION FOR ZONING AND BUILDING PERM -TT Instrnrba�m The applicant shall complete this application to the best of their ability prior to submission. leaving no item tmanswered. The' 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. Pink-- ilk lee in =I re&iilee. (for office me oely) Total Cost $ -! a/ Received By Less Application Fee $ Total Permit Fee — Permit # N OPILY Date Ree'd Luned Date C' f f 9sr ,ra 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET -171e/ CURRENT ACCESSORS' PLAT LOT �` ZONING DISTRICT OTHER ZONING ')VE1d AY DISTIVCTS , if applicable NUMBER & STREET ✓ 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: = 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 ground in -ground Size = Chimney - number of flues - Woodstove - used (will require inspection prior to irctallation), new (provide manufactui-ars - instructions). Location(s) (list) The following section for official use only. INSPECTORS' REVIEW - 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 years 9 months (see Code Section 304.0) - Factory / Industrial - (see Code Section 305.0) - High Hazard - (see Code Section 306.0) Insrtutional - 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) r - 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 -umber of dwelling units and bedrooms or occupant load as applicable, also existing condition 400 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 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 1) APPLICANT TO PROVIDE 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 - DEN® see project review worksheet date HOLD reason date - HOLD Subject to Zoning Board of Appeals action Comments Inspectors signature Applicant informed of staff (fax, phone, in person) sssszs:zs:s:zssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssscssss - 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) ssssssssssssssssssssssss:sssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss:ssss OFFICEVNSPECTORS N07V TOTAL FEE 4 `Jv Gross area - new construction ✓ Total Sq. Ft. alteration Total Sq. Ft. Permit is issued to Comments/notes on permit 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 informati application is true -and correct and that the permit requested be issued. on provided in this 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 onI written request. I understand that once the permit expires a new application may be required, including y three tunes by other requirements/(including Zoning), ing fees and current Name .J . c I Signature � u= �b�.� signature is MY voluntary act and is signed under the pains and penalties of perjury. Date ,� Who is authorized to pickup the permit at the Building Department? {please orinn Address Phone 1400 HOMEOWNER EJMKpTION - 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 b in Section 127.0, effective July 1, 1982, no individual shall be engaged in directly supervising Construction Control construction, reconstruction, alteration, repair, removal or demolition involving the structuralpersons engaged it structures, unless he or she is licensed in accord2rce wit: the rules and regulat ons promulgated bents B buildings or R:.les and Regulations for Licensing Construction Supervisors. Y the buildings entitled 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 sectiot: only, a "Home Owner" is defined as follows: Person(s) who owns a parcel of land on which heishe resides or intends to reside, on which there is, or is intended to be, a one or two family dwellin , attached or detached structures accessory to such use and/or farm structures. A person wh two-year period shall not be considered a Home Owner. o constructs more than one home in If you are applying under this section sign below: Signature T,1 r signature carries certain responsibilities, including but not necessarily limited ssssss+ssssssssssssss:sssssss*:sssss:lssssssssssss to, general liability sss:ii!!!!#i!#slif#iss:lsssili*iisss!!ii!lsii:#!!!#i 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 a-1 iliYiYii#f#iifiii#i#iiif##filifisii##!#fii##YisiiY!!!sliiiiiliiiiiiYfYiili#YYiifiiiii!!ii!!#i##!Y####!#i 1500 COST Cost of Improvement Items to be installed but not included in the above cost: S Electrical S Plumbing HVAC Other TOTAL = Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration tquired, - Demolition - describe structure Number of dwelling units Number of bedrooms A separate Refuse Dispos;al Declaration rewired. = 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 - M 1 — 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 = 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 wvill be considered as an Alteration, otherwise will be included in new construction. (see Code section 3401.10) for residential and Articl, 8 fi.: commercial) Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods off time. Describe 500 CONSTRUCTION PLANS _ None submitted. Why? _ Submitted, usually three sets required. Four sets for food service uses. Number of sets submitted 600 SITE PLAN ❑ Not required, why? = Submitted When? = Previously, date C With this application 00 UI'II.PIIES Water supply - requ ired red es no q — Y _ , 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, w+hen required, is available. See Code 780 CMR section 114.1.2) Sewage disposal - required _ yes no, public sewer _yes _ no Private septic - on -site _ yes _ no. Submit copy of permit as soon as available. 800 ME(E[AANICAIS & 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) Air conditioning - (separate unit) None of the above to be provided Hot Water Gas Electric Fuel Oil Other 900 SPRINT LERS - 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.REQUIREI) OFF-STREET PARE3NG - for ZONING & Architectural Access — NOT APPLICABLE = Parking Plan submitted To = Building Department Planning Board Date submitted Number of spaces - indoors outside total provided H-ndicap spaces - required _ yes _no. If yes, how many as a p?rt of the total required number. Is Route 6 (State Road) Entrance permit required? yes no If yes has it been issued yes no Suhmit copy of application and/or permit as soon as available. 1100 ID CATION (print or type except as noted) Current owner - name n�(/ ��/% /14�40� phone # ol If corporation, officer in charge ArchitewFjq veer - for overall design 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. Architect;WAieneer - 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 and nalt reproductions. - .r . General Contra (if Homeowner to homeowner here then complete section 1300) tI ompany name I/10 S C R � ' ddress '% �`h f� i-c / �nenumber Construction Supervisors license number NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not; reproductions. ssssssssss:ssssssssssssssssssssssssss:sss:ssssssssssssssssssssssssssssssssssssssssssssssssss:ssss:sss:ss: 1200 FOR RESIDENTIAL REMODEL WORK ONLY Z-if Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes _ No o 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 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 Ownefs name (print) Signature -y Date's .