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BP-2002-251061.7 ME OR FILE W i j / si l ,,, ;% '\ 1 IG!'�E - To !i ]%lf1Y- ' L' L' :, ,tc SST ---,is H1vD Ar: - L 1 +,!- CODES: mil! INDT ! ram ED E g_ 'I 7';� B}_�i_D N1G S J I }wm� Jzs) - - - Ilg - ��PPJlllYv iHS DUILINhU 941i gy' 3 THE THIRD P P iS rF �nif n.'v IVIA'IUF ACTt 3r:E rTO BUILD kf IN NI+- $ NUMB- OF tvIODUL AT, HOU�cS r C2 THE 1tdF+0i';vtal ON Cv„t?ILED; ;IN TH!3r ¢ 3 i, /� a j BUILDING S rS I EIASZ- Ps. APPROVAL ff tL: PoRvoem ON A THE BUICGING . ©Utt?fNG PlRQQRESS...OF THIS wor*Iy. n �r J. 1 1 Dk'171 10 U , -t TrrL,' DISTRICT' 2 2•--7Nb D- P F�TY"INSPEt:T,ON AGrNCY , y �! COPY 0 This EnL�.:`o see o �G`� � Tr11rZD PARTY � �G_;i RCF. l �e ONLY 3 f (!� Plan Must Be Kept On Site A) NAME FFS CCRPORdTlCx �+ � - 1SMS7- r; Dilfln Venst c flIt P-irAPPVL FOR T10N 13) AukTxf3RlZA71LW NUMBER : - m?a Paz �'q ( °j - 7O Ts6 CMR ART - PAS CO$! $eta`` i3 a da_fil,lit ia': tor'. �` ax,tsa.a .ae_s,il'4a`�'d#7a+R;0, $.�s�tv� UL 2 2UoL �3h4Fi sLOGSPROC. _ �j E:I'IkA770x DAZE OF AtJT1-ICRlZA?1Cx : `�' ��° " �' �" i II 3_ INDEX '� 4�rj_ c~ s znd regiaLans 7 T STATE 0¢ MA NO. DESOMPTION DATE PEVISION % DAl t - — t ?S1'?/S2 } Ala I - TYPF OF HEATING SYSTEM IN,--LUDtNC FUEL 1 MAY iL 914 l ? i COVER IH -1 - n i �Cl f 9 _ r NC . & SPECIFICsMoN i ?i%9?r'�2 ! R ,f �? Q I .•-�,- uc -r,- `'fir."' 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V w27 w27 w27 W27 w1 _ — t — 2%6 AWTK AWTK N o Tv. T. V �2} PCS 2x8 HEADER U t) PER SIDE SPF #2 T V z �� xl (3)2x3 SUPPORT STUDS SPF #2 " o w iv Q w 2/6 0 o o N 5/0 STATE SEAL v\m t'- 0 4I0 16'-5" FOYER rue:y Ib} orll_ O a P J8 JB I_ Z =1 L JB JB J r owl 4/0 BEDROOM 1. LIVING ROOM FAMILY ROOM o o 2' ARCH 2' ARCH z a0 (SEE DETAIL) , (SEE DETAIL} v p o t3'-6" Hi PHONE PHONE �d_i" PHONE o a m 3/0 #2 #2 #2 #2 #2 co 2'-1" - ro co� , ;1 a n1 4-1. ARCHWAY DETAIL #z APPRfOVED PFS. (LORP. JUN (f 2.00 Z APAROVAL lumlTeI T`I FACTORY SUIILT PORTl1 BUILDER AWASHONK SIZE 28XEd _ TYPE RANCH MODEL NCO15-3 STATE REP MA CK WORK DONE APP/PERMIT �0 Page 1 of 11 TL w 1,1"w3d -ins Au0ov 1 O?; ItAill IVAOUddV 20OZ 9 - Nib(` 6d=0' jryp a._0" Iva- - - 03AOUddV - — - — =y - * f i WAL D — � I J ANE,"t-GOL TS �3 1 i CCNCFN7RA LGA0 =5 rE0 94 MAX. 1173 (TYP ALL FOOTINGS) 1 1 I 6A i / I I 1 I t c" CONC. FLOOR { (351V T QNL Y) N0TE: PL.A GF SUPPORT COLLM44 JACYCS 12 APPROVED t i ' WITH HALF OF 70'02" SUPFGRT PLATE UNDER THE CENTER BEAM PFS. CORP. ' OF EACH UNIT. (TYPICAL ALL COLUMNS) ! UN 6 20 II ! F?aari(rGS PER SOIL ERC CONDITIONS P OVAL LIMIT CRAWL :SPACE VENTILATION FIzaN r I 1 sq tt OF V ENT PER 150 sq FT or CRAWL SPACE AREA RCOT. _ NofE; {2) WOKE PEft SOP. LOCATI!V NftE" Ssq Ft MIN. n'-8" �Arll� 1�lLilt IJ i3A5�N�J1' -l..0 �rli (DLO E# Q-11274 1&4PORTANT NOTE., NK WASHO m FOUNDATION NO IRS DNANWC IS RROVIDED FOR t' 10570NAL FOI)NDA T10N PLAN 2$X64 H1 `` t0A0 PURPASES C1 Y WALL AND FQbi StZfS RE -in ORC/NG FOR THE SAAIC Pltt}V iED OTHERS. RANCH VFW FRA AUII nINS SYSTFNS THE FINAL DESIGN FOR ALL PRE— 51TE P.C.E*X2n �A! LE IENT , IOOE S_MOPENWG DENOTES ADDITIONAL 17,00 CS WORK REL?UIRED WITH THE SET —UPI N0015-3 .aasCtrH2FNAVE. NOTE: LENGTH AIu11 tD;ti rvraL rc'GH' FROM it)P M PCOLUMNS I REWIRED FOR _LARGE INSTALLATION OF THE UNIT5 5HALL UE I-IAII �L�' RICK SMAI A�%All1.JA 1_?i.6 DAI>_NSICNS u 5R); JI�LY �F- C vG fIE SLAB TOP C1 SILL PLATE" = 89 1112" IN MARRIAGE WALE PREPARED BY A P.E. OR R.A. MA ;;i�Klrl�i 5vALE 3/1E"=1' anit 6/3J02 A PP/P ERMIT nF w - C.H. NO ■ NOTES: 1. EXTERIOR LIGHTS ARE SHIPPED LOOSE FOR FIELD 3. STOOPS, STAIRS, BANORAILS, GUTTERS, DOWNSPOUTS 5. SHUTTERS ARE OPTIONAL 8. BOTTOM ROW OF SIDING IS SHIPPED LOOSE AND INSTALLATION BY OTHERS TO PRE -WIRED BOX. AND SPLASH BLOCKS ARE FURNISHED AND INSTALLED BY 6. THE NUMBER OF WINDOWS WILL VARY ACCORDING TO INSTALLED BY BUILDER ON SITE 2. SIDING FOR ENDS IS SHIPPED LOOSE FOR FIELD OTHERS IN ACCORDANCE WITH STATE AND LOCAL CODES. INDINDUAL FLOOR PLAN. INSTALLATION BY OTHERS. 4. SIDING SHOWN -IS 414 VINYL OTHER SIDINGS ARE 7. MASONRY VENEER OR OTHER FOUNDATION SIDING IS AVAILABLE FURNISHED AND INSTALLED BY OTHERS. =�- =fit• IN �'' =_ -� ® �_- �s I ELEVATIONS FOR ILLUSTRATION ONLY NOT TO BE SCALED BUILDER AWASHONK C SIZE 28x64 TYPE RANCH MODEL NCO15-3 STATE REP MA R CK WORK DONE SL LAPP/PEERMIT D� APPROVED PFS. CORP. PROVAL t l!AlTF_Q)_TiO rtfllt "lN al r • FASTEN RIDGE TO RAFTER, WITH (3) 16d NAILS EACH 225# FIBERGLASS SHINGLES OR ASPHALT SHINGLES OVER 15# ASPHALT FELT (6) FASTNERS PER SHINGLE R-30 F.G. INSUL. W/ V.B.(STD.) PRE -FINISHED ALUM. DRIP & FASCIA \\-5/8" 2X6 SUB -FASCIA 2X6 TOP PLATE GYP. BD PRE -FINISHED ALUM. - SPF112 PERF. SOFFIT 2X6 STUDS 0 24"0.C_ SPFj72 7/16" O.S.B. SHT'G (Ico- C. OPT.) APA RATED OR PLYWOOD R-19 F.G. INSUL. W/V.B, BUILDING WRAP 2X6 BOTTOM PLATE SPF#2 3/4" O. S. B. OR PL > T&G APA RATED 0 0cr � Q3 LOCAL REQUIREMENTS 11 VERTICAL COURSES MAS. BY BUILDER I FOR BSMT. MODELS MAS. COURSES FOR CRAWL SPACE TO SUIT LOCAL FROST CONDITIONS CONC. FOOTINGS BY BUILDER (23'-8") (26'-0") RIDGE VENT SHIP -LOOSE & INSTALLED BY L7UILDER (MUST COVER 607. OF RIDGE) RIDGE 1,SSEMBL Y (FIELD INSTALLED) 7 iPLYWOOD R P / o" O.S.B.G S B 0 � UOD APA I RATED 24"O.C. @ 40# L_L, PRE -MANUFACTURED ROOF TRUSS --@ 24"O.C.(16"O.C. OPT) SEE TRUSS DETAILS H2 SIMPSON STRAP (PER TRUSS) ICE SHEILD (BOTH SIDES) - 10" FLIPPED OVERHANG GUTTERS & DOWNSPOUTS BY BUILDER/CONTRACTOR — 7/16" O. S. B. OR PL YWOOD —DBL. 4" VWYL SIDING OR TEXTURED T1-11 WOOD SIDING OR BRICK/MASONRY VENEER (BY BUILDER) I,I-DBL. 2X10 PERIMETER BAND SILL PLATE & ANCHOR BOLT BY BUILDER/CONTRACTOR BUILDER AWASHONK CROW RANCH MODEL NC015-3 — STATE REP MA -� RICK WORK DONE APP/PERMIT 171 PPROVED) PFS. CORP). JUN - 6 20(2 APPROVAL LIMITED TO E � ILT PORTION SEE NOTE#2 SEE NOTE #2 SEE NOTE #2 1 1/2" 90 STREET ELL 2„D X E co 1 1/2"x2" RED. 1 114" MIN. TAIL PIECE FIXTURE TAIL PIECE Z f 1 1/2' 1 1/2" eo 1 1/4"x1 1/2" ADAPTER 1 1/2" SANI-TEE 1'1/2" P-TRAP 1 1/2"YE+STREET 45 2„ SANI-T W \ TYPICAL 1 IJCS/SI-IO�1r�11ER 2" P-TRAP � 1 1/2"P-TRAP 2" 90 STREET ELL 1 1/2" 90 STREET ELL 11 - WASHER STANDPIPE_ TYPICAL SINGLE LAV. -,:•,,. FLOOR DECKINC :.. SEE NOTE#2 NOTES: TOIl TO DISHWASHER 1.) ONE 2" DIA. FUTURE VENT REO'D AND MUST BE TAGGED & PLUGGED. 11/2"CONTINUOUS WASTE � ' 2"SANI-TEE VENT WITH 3x3x1 1/2" TEE /� 3.) ANTI -SCALD DEVICES MUST BE 2"P-TRAP) , 2"DIA- INSTALLED ON ALL TUBS & SHOWERS BUILDER 2"DIa PER STATE CODE. AWASHONK 4.` FIRESTOPPING PROVIDED AROUND ALL 28x64 TYPE TYPICAL KITCHEN SINK VENTS, PI„PES, DUCTS, CHIMNEYS ANDRANCH MODEL w/OPT. DISHWASHER FIREPLACES AT CEILING/FLOOR LEVELS NCO15-3 STATE REP MA RICK WORK DONE APP/PERMIT VENT \BQWE ROOF TO) FLOOR w/NON COROSIV✓E SCREWS APPROVED 1— JUN 6' 1002 I' i i f— - 1 - } t + niil .3� f '1 7 TT 1 % 1 1 t i I_V_ i_ \ y NP GRC6`ti :4hfF A4YG =_ CL?LXJiT .4MF Sfiu UVN9 POW ' 75 14 2 20 s 12 34TH aE�r LIoM ! 3 20 12 :1 4- 40 i & BcDPCrDV 2 S 1 S 14 6 40 1 riANGE REDRGOW 3 7 15 74 `` & 20 s 2 .SWLL Arp FAMILY POW 9 i5 14 10 26 ' 12 . SMALL APP p�W 7;.,.: 15. _:i4 12,. 2I]. 12 ;N141?-NOt317 9E'NERAL LltrHi;NG 73 75 14 74 20 = 12 44K9TCP (tr7f BASEA/C4fr 15 7 1 1 �, iz 17 ! 1@ Q { 21 24 I file://C:1My% o2ODocuments\Q-11274A-Model.dwf 6/6M2 WINDOW SCHEDULE DOOR SCHEDULE R HO ID 'SIZE E"H" ID ,,W" X DESCRIPTION LIGHT VENT MANUFACTURER DESCRIPTION LIGHT VENT MANUFACTURER 1 30"X37" 4 BARRIER 3/0 3'X6'-8" STEEL ANDERSEN, 2 38"X59" OUBLE HUNG 1.1.8 6.1 BARRIER SIDE HINGED — — MALTA, PDI 4 DOUBLE H.,NG, 3.386 5.83 BARRIER 3/0 3 X6 —8" STEEL SNGL SIDELIGHT ANDERSEN, 5 "X41" DOUBLE HUNG 7.678 3.582 BARRIER SL SIDE HINGED 2 3 — MALTA, PDI 6 38"X37"DOUBLE _HUNG 6.712 3.095 BARRIER 3/0. 3 X6 —8 STEEL �IDE NGED SIT 4.6 - ANDERSEN, 1 30"X37" DOUBLE HUNG 5.068 2.343 ANDERSEN DBL MALTA, PDI 2 38"X57" DOUBLE HUNG 1.26 5.374 ANDERSEN 2/8 2'811X6'8" STEEL _ ANDERSEN, 4 38"X69" DOUBLE- HUNG 13.38 5.374 ANDERSEN SIDE HINGED - MALTA, PI71 ': PIC 72",X57" 6' PICTURE 19.49 6.40 CAPITOL 6/0 6'X6 -8" VINYL SLIDER 32.4 — ANDERSEN, PIC 95"X57" 8' PICTURE 27.34 8.98 CAPITOL PATIO DOOR MALTA, PDI 80 96"X62" 8'BOW CASMT 28.46 6.76 CAPITOL 6 0 6'X6'—g" VINYL SWINGER 32 4 _ ANDERSEN, BAY 96"X62" DBL HNG BAY 29.06 4.96 CAPITOL PATIO DOOR MALTA, PDI 42"X71 " 6' B Q W 12.48 7.74 CAPITOL OCT 24"X24" OCTOGON 3.33 1.67 BARRIER C15 24"X59 2' CASEMENT 7.5 6.9 ANDERSEN 2JJ5 28 X40 CASEMENT 5,0 5.49 BARRIER EGRESS NOTE: NET CLEAR OPENING OF #2 WINDOWS EQUALS 32 11/16" WIDE 25 11/16" HIGH i SYMBOL SCHEDULE (GENERAL NOTES CON'T) DUPLEX OUTLET // 15A 1 15V l ) >HFuo THERMOSTAT 5. FLOOR A MIRROR PLANS MAY BE IMAGE OF THAT CONSTRUCTED AS SHOWN ON THE Q DUPLEX OUTLET (20A/115V) ® SUPPLY AIR RETURN GRILLS APPROVED PLAN (END FOR END/SIDE TO GFi � DUPLEX OUTLET (15A%1 15V) GFI PROTECTED WP SIDE) 6. TOILET COMPARTMENTS TO BE 30" MIN) WEATHER PROOF FIXTURE IN WIDTH WITH 1 5" FROM CENTERLINE OF 0 CEILING MOUNTED LIGHT JUNCTION BOX STOOL TO NEAREST EDGE OF ENCLOSURE, TUB SIDE, ETC. I -01 EXTERIOR EIGHT sD SMOKE DETECTOR 7. HALLS TO BE 36"(MIN) IN WIDTH II (WEATHER PROOF) ® MAIN DISTRIBUTION PANEL 1 ® CEILING EXHAUST FAN S WALL SWITCH ® FIREPLACE BLOWER S3 WALL SWITCH (3-WAY) 2' OF HOT WATER HEAT RANGE EXHAUST FAN 2' OF ELECTRIC HEAT RECESSED LIGHT "IC" LABELED GENERAL NOTES 1. APPLIANCE ELECTRICAL CIRCUIT SCHEDULE IS FOR REFERENCE ONLY. APPLIANCE MANUFACTURER'S SPECIFICATION REQUIREMENTS MAY PREEMPT THE -SCHEDULE. 2. LIGHT AND VENTILATION CALCULATIONS ARE BASED ON MINIMUM WINDOW AND DOOR AREAS OFFERED. 3. TOTAL WINDOW AND DOOR AREA INCLUDING ANY OPTIONAL WINDOW AND DOORS ADDED MUST NOT EXCEED THE MAXIMUM ALLOWABLE FOR COMPLIANCE WITH THE HEAT LOSS REQUIREMENTS. 4. WHEN A GAS RANGE IS INSTALLED, THE RECEPTACLE BEHIND THE RANGE MAYBE ON A GENERAL LIGHTING OR PORTABLE APPLIANCE CIRCUIT. BUILDER AWASHONK SIZE 28x64 TYPE RANCH MODEL NCO15-3 STATE REP MA — CK WORK DONE APP/PERMIT APPROVED PIPS. CORP. JUN - 6 ZU1' APPROVAL L1N!iT�D�"TO � 1 ly S�1IItT II N QUOTE# 0-11274 WINDOW/DOOR a�CHD. NEv'1r' ERA BLIILDIM31 SYrSTEMS P.O. BOX 269 451 SOUTHERN AVE. STRATTANVILLE, PA. 1625t SCALE: 3/16"=1' DATE: E�'/3/02 DR. BY: C.H. NO. SECTION 2 - PROPERTY OWNERSHIP / AUTHORIZED AGENT 2.1 Owner of Record: 41116 PYZ i' /1 , ROSS ; ��f� �C �se!/.i` &p��s �1 Name (print) Contact Address Phone Number 2.2 Authorized Agent: ,may Name (print) "bW Contact Address Pho "a` `. ^. f a SECTION 3 -CONSTRUCTION' SERViHS 3.1 Licensed Construction Supervisor: V441�6 R. Not Applicable ❑ Licensed Construction Supervisor License Number �Q.ef Address 7D p _\> Expiration bate 031la Signature Telephone&>1,—`i 3.2 Registered Home Improvement Contractor: Not Applicable 0 Are you a Home Improvement Contractor subject to (780 CMR-6)? ❑ yes Q no If no, go to the next section! Are you claiming exemption from the requirement? ❑ yes Lilo If yes, submit the required affidavit! Company Name )7/ UC/-,� ' > 6 Registration Number (if none, state "none") Address /iLi %6�1G?JU+-L -tea Signatur �1--'TelephoneExpiration Date 3.3 For Residential Remodel Work Only PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND: QUESTIONS OR COMPLAINTS call or write: Home Improvement Contractors Registration, One Ashburton Place - Room 1301, Boston, ILIA 02108, (617), 727-8598 - t Owners Name (print) Signature by signing the above, the homeowner acknowledges that there will be no eligibilty to the Guaranty Fund Date 3.4 Homeowner Exemption - One & Two Family Only FOR HOMEOWNERS 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 116.0, 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 Homeowner performing work for which a Building Permit is required shall be exempt from the provisions of this section; provides that if a Homeowner engages a person(s) for hire to do such work, that such Homeowner shall act as supervisor. For the purposes of this section only, a "Homeowner' is defined as follows: 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 a two-year period shall not be considered a Homeowner. If you are applying under this section sign below: Signature: Your signature carriescertain responsibilities, including but not necessarily limited to, general liability RESIDENTIAL 2002 RESIDENTIAL 2002 a C: bldg.forms [3ldgapp.ecs. pd Page 2 Rev. January 19, 2001 NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that any licensed ConstructioTn Supervisor, whether or not they have taken the permit are responsible for code compliance. (see Appendix of 780 CMR R5.2.15) SECTION 4 - WORKER'S COMPENSATION INSURANCE AFFIDAVIT (MGL' C 152.§ 25) ---------------- Workers Compensation Insurance affidavit must be completed and submitted with this application. Faiiluu to provide this affidavit will result in the denial the issuance of of the building permit. Signed Affidavit Attached: ©'yes ❑ no L SECTION - DESCRIPTION OF PROPOSED WORK (check all applicable) new construction* ,' ❑ addition ❑ alteration ❑ repairs ❑ chimney/ ❑ wooc?lstove (energy report required) (energy report required) fireplace ❑ deck ❑ pool ❑ accessory bldg. ❑ replacement window/door ❑ other ❑ dem6lition ' (shed/garage) no. of windows doors (specify below): (specify,lbelow): * If new construction, please complete the following: Single Familv: no. of bedrooms 3no. of baths Two Family: no. of bedrooms unit 1 no. of baths unit 1 no. of bedrooms unit 2 no. of baths unit 2 ❑ 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 Brief Description of Proposed Work: r� , SECTION - 6 ESTIMATED CONSTRUCTION COSTS Item' Estimated Cost (S) to be completed by permit applicant 1. Building C,6c�, r 2. Electricals 3. Plumbing �3 < 4. Mechanical (HVAC) ,5"-ZOO 5. Total = (1 + 2 + 3 + 4) *Estimated Total $ 70 ,iio SECTION 7A - OWNER AUTHORIZATION _ (to be completed when owner's agent or contractor applies for building permit) (please print) ' 1� -I, M N t-71. �s as Owner of the subject property her authorize to act on my behalf, in all matters relative to work authorized by this building permit application. da Signature of Owner Date SECTION 7B - OWNER/AUTHORiZED AGENT DECLARATION as Owner/Authorized Agent hereby declare that the statements and infornnation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. --} Signature of Owner/Authorized Agent Date C-\bld".fnniic`,Rl�iaann SECTION 8 - INSPECTOR'S REVIEW/COMMENTS 1. Date plan reviewed: 2. 30 clays to review period expires: 3. OK to issue date: 4. OIL to issue subject to requested submittals(see project review worksheet): Date: 5. DENIED (see project review ,, orksheet): Date: 6. HOLD reason: 7. HOLD subject to Zoning Board of Appeals action: S. Comments: Ae:2 2 2002 9. Inspector's Signature: SECTION 9 - APPLICANT NOTIFICATION Applicant informed of above Date: Time: Clerk: Comments: SECTION 10- OFFICEVNSPECTOR'S NOTES Total Permit Fee: S Less Application Fee: S 25.00 Remaining Balance: S TOTAL FEE: 3�r} �� Gross Area - New Construction total sq. ft. 3,S gd:;, Gross Area - Alteration total sq. ft. Permit Issued To - SECTION 11 - ADDITIONAL COMMENTS/SKETCHES Li U(J1V�lLY $25.00 APPLICATION FEE IS NON-REFUNDABLE & NON -TRANSFERABLE DATE RECEIYVED DARTMOUTH BUILDING DEPARTMENT 400 Slocum Road P.O. Box 79399 Dartmouth, MA 02747 n .4 508-910-1820 FAX 508-910-1838 APPLICATION TO CONSTRUCh REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING THIS SECTION FOR OFFICIAL USE ONLY RECEIVED BY: BUILDING P DATE SENT FOR REVIEW: s NUMBER: e. DATE ISSUED: �UL 2 2 2002 OK TO ISSUE - SIGNATURE: DATE uilding Commissioner Inspector Buildings Zoning District: Proposed a:_L1� Zone: a-6111 B ❑ A ❑ V Outside Flood Zone ❑ Aquilfer Zone THE FOLLOWING GENCIES SHOULD BE NOTIFIED: %J" ❑ Board of Board of ❑Con. Com. ❑ Demo ❑ DPW lee ❑]Energy Report Appeals Health Affidavit Card -.Sent, Cutoff F'61low-up* Zoning 01 Other ❑ Fire ❑ Gas ❑ Planning Board* ❑ Sewer Ca d ❑ Water C 7APERMIT. Chief Cut Off / Cut Off / Cueview* (BI REQUIRES INSPECTOR'S REVIEW FORETHE 'CE OF DEPARTMENTAL APPROVAL Zoning Review: Signature:; Date: 55—_2-- _ Energy Report: Signature: /!gK `���-Oy- Date: Fire Chief: Signature: 4 W Date: C9 - Gee= ` 3 Signature: ix Date: 7_ Board of Health: zo �t! Conservation Commission: Signature : Date: Other: Signature:Az-_, — te: Deseription of work being peifornzed: SECTION 1 - SITE INFORMATION NUMBER OF PLANS SUBMITTED: SITE PLAN SUBMITTED: 2fyes ❑l no 1.2 Assessors Plat & Lot Number: _ 1.1 Property Address: U, Plat Lot Nearest Cross Street: �� Rt% Subdivision Name: 1.3 Historical District ❑ yes no Has application bee submitted to the His_',toric Commission? Total Land Area Sq. Ft.: �,2 � 2�-,� �, yes Vno , Date: 1.4 Water Supply (MGL c 40 § 54): 1.5 Sewage Disposal System: C 1 Iunicipal❑ Private Well ❑ Municipal M On Sitrt Disposal System I, C:,,bld .Furms,Bldgapp.ies.wpd Page 4 Rec. January 19, 2001 C `b1dc.!'ouns�B1duapp.res.wpd Page 1 Rev. January 19, 2001