BP-26800 MECIIANICALS & 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 SPRINKLERS 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 PARKING- 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 yes, how many as a part of the total required number.
Is Route 6 State Road - — —
( )Entrance permit required? es no a as 't b � _ _. If r s h � been ' P q n 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 M kG AIR , iZ a S`S 1
I f
address ! t �J.! !`� /
I
phone #
If corporation. officer in charge
AxchitectlEngineer - for overall design
I,
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.
G
ArcWtectlEngineer 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 snot
reproductions.
General Contractor (if Homeowner, state homeowner here then complete section 1300)
Company name -
Address
Phone number
Construction Supervisors license number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and; rnot
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 nesxt section!
Are you claiming exemption from the requirement? Yes _No _Ir yes, submit the required affidavit!
Remodel 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 writer
Home Improvement Contractors Registration
One Ashburton Place - Room 1301
Boston.:MA 02108
(617) 727-8598
Owners name (print)
Signature
Date
1300 OWNER SIGN - OFF
I, the undersigned, am the owner of record or authorized lessee (provide documentation) and I havfe reviewed
the application herein submitted. I state that to the best of my knowledge and belief that the information proviied 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 ifs begun or
six months after the last inspection if work has begun and that the permit may be extended for six months if rno work is
anticipated if I request such an extension in writing. I understand that the permit may be extended only throe times by
understand that once the permit expires a new application may be required, including fees and current
e u est. I
written r P P PP
q
other requirements (including Zoning).
Name i1'1 \ C �\410k Z 11 l� f V110 s',S'
Signature J tn,�✓"'�C ��.
The above signature is my voluntary act and is signed under the pains and penalties of perjury.
Date / A7 _ -o
(�
Who is authorized to pickup the permit at the Building Department? (please arintt
:Address Phone —7 q z✓ ? cl y el ct 4 q (7
1400 HOMEOWNER EXEMPTION - 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 accordance with the rules and regulations promulgated by the BBRS entitled
Rules and Regulations for Licensing Construction 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 forlows: Person(s) 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
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.
If cou are applying under this section sign below:
Signature
Your signature carries certain responsibilities, including but not necessar4y Limited to, general liability
NOTICE TO LICENSED CONTRACTORS: The Building' Code provides in the Rules and Regulations section that any
Construction Supervisor, whether or not thev have taken the permit are responsible for code compliance. (see
' ensEd
tic P
1.1 ' of .section 5)
1500 COST _
Cost of Improvement 5too
Items to he installed but not included in the above cost: Electrical 5
Plumbing
HVAC
Other
s i( i6
TOTAL
The following section for official use only.
INSPECTORS' REVIEW
Date plan reviewed
30 days to review period expires
— OK to issue date
Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration irequired.
Demolition - describe structure
Number of dwelling units Number of bedrooms A separate Refuse Disgicasal
Declaaation requh-ed.
Moving - (Provide copy of D.P.W. moving license) Type of structure
from where (plat/lot or address)
to where (platilot 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 lavers when complete
A separate disposal declaration REQUIRED
_ Replacement doors and windows - (for existing only) (only where doors and windows exist and swill not be
enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwelliing will be
considered as an Alteration, otherwise will he included in new construction. (see Code section 340;71.10 for
residential and Article 8 for commercial)
Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods of time.
Describe
500 CONSTRUCTION PLANS
_ None submitted. why''
Submitted. usually three sets required. Four sets for food service uses. Number of sets submim,: d
600 SITE PLAN
0 Not required, why?
Submitted When? — Previously, date _ With this application
700 UTILITIES
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 supiply, 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 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)
E 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 / 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 number 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
OK to issue subject to requested submittals (see project review worksheet) date
DENIED see project review worksheet date
HOLD reason date,,-.
77 HOLD Subject to Zoning Board of Appeals action
Comments
Inspectors signature Date
Applicant informed of above Date time staff (fax, phone,; yin person)
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)
OFFICE\INSPECTORS NOTES
TOTAL FEE
Gross area - new construction Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit
1600 TO THE APPLICANT/BEFERItAL AND APPROVAL
Date of Application submission wz
e
----------------
Plat Z. _ Lot
J�'
ug fifer_ Zone
'Street
Owner
-------------
Owner mail address
Owner phone #e9 of �%Cc/
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OTIiER INVOLVED .-AGENCIES - The following agencies requireseparate jurisdictional permits or approval for vour
proposed project. CONTACT MEM R UIRED SLBhumo NS.
TAX COLLECTOR _ Approved _ HOLD By 1 c �
Date
0 Conservation Comm = Approved By
Date
a D.P.W. water — Approved By
Date
E3 D.P.W. sewer: — Approved By
Date
11 D.P.W. cross connection _ Appmved
Date
❑ D.P.W. engineering — Approved
Date
Q Board of Health well — Approved ---
Date
is Board of Health septic - Approves
Date
Q Board of Health food service _ Approved
Date
-`F RE DISTRICT (I - II -III) _ Approved
Date
tI Pldnninz Dept — Approved :
Date
Other — Approved
Date
Other — Apppoved
Date
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Prnject summary new constructioni alterationidetno sewage disposal - publiciprivate
[Altzr.•add interior walls] [add rooms] [add footprints water supply publiciprivate well
1poals [garnge.,shed] (game courts (food services
Descrtbe�(" 1
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To the various departments:
This notice has been forwarded to you for vour 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 an By
APPLICATION FOR ZONING AND BUELDING VERMIT
ins"McbOu4
The applicant shall complete this application to the best of their ability prior to submissiou.-lesviag no item tmats1"'red. The
Department staff will be available durim_ regular business hours to assist as necessary. MA should be inserted fordihose sections
which do not appiv. A properly completed application will help avoid unnecessary delays. 1� i�istnt�
(for office use only) R ✓�� '
Application fee $ received by Bate 0
Cr
Total Permit Fee $36 l'j PermA #
100 LOCATION OF PROJECT pp
CURRENT ACCESSORS' PLAT -3 S LOT 0 ZONING DISTRICT
OTHER ZONING OVERLAY DISTRICTS ,.if applicable
NUMBER 3 STREET ! Au s mi LL9. t, b
NEAREST CROSS STREET
SUBDIVISION NAME & LOT #
or BUSINESS NAME
PREVIOUS TENANT ONVNER
200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
THIS SECTION NOT APPLICABLE
Sinzle famih• - number bedrooms number baths
Two family number bedrooms unit 1 number baths unit 1
number bedrooms unit:: number baths unit 2
_ Accessory apartment
_ Accessory structure
Total gross sq. ft.
Garage detached - attached to dwelling, dimensions L W
= Carport - detached - attached to dwelling, dimensions L W
_ Shed - dimensions L W
= Gazebo - dimensions L W
_ Swimming pool above ground in -ground Size total square feet
= Chimney - # of flues