The URL can be used to link to this page

BP-9959s#ssss=sssssssssssss#ssss#is#ssfffsss#fs#ssfs#ssiif#ssssfss#ssfsfsssfsss##ss#s#sisfsfss##sts#ss#s##st### 1600 TO THE APPLICANT/REFERRAL AND APPROVAL Date of Application submission Plat t-1� Lot Street Owner a_t Aquifer Zone Owner mail address y Owner phone # L ( sii=i=sisis=izsiisssii#fsss#sf##sfs###s#ssisssis##s#isssf#ss#ssss##fssssssssssss#ssss##s##sss#ssssssis#si OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACT TEEM FOR REQUIRED SUBMISSIONS. /( ®)TAX COLLECTOR —Approved HOLD By ❑ Board of Appeals = Approved By ❑ Conservation Commission ` Approved By Date Date Date ❑ D.P.W. Water - Approved By t] 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 7 Board of Health (well) = Approved By Date ❑ Board of Health (septic) Z Approved By ❑ Board of Health (food service) = Approved By Date Date ❑ Planning Board (parking) = Approved By Date ® RE DISTRI (I II - III) — Approved.By TDate s::#sf ______________#_====s==s=====___====#sssss:====s=====_====s=====_____•====ss:::==___#______ BUILDING DEPARTMENT APPROVAL: ❑ ZOtiING ❑ BL;ILDING INSPECTORBUILDING COMMISSIONER ❑ CONTROL CONSTRUCTION AFFIDAVIT ____=====izi==li==fifists#sssfsif#f#=iii==='ii====*==sssii#iiiiiii#=i=i==i====i====zffii#s###=is#i##siss PROJECT SUMMARY. new constructioni teratio \ demo sewage disposal - public private [Alter:add interior walls] [add rooms] [add footprint] water supply - publiciprivate well [pool] [garage shed/deck] [game court] [food service] r Describe S:L isiii=z=zzzif=iisii ziiffif#####i!i#fii#ii#i=i iiiif#ii#ff##iii#i=#ii=iifii=i iiifiiif##fff#f##i#iii =##ii To the various departments: This notice has been forwarded to You for your information and any appropriate action. Should you have anv questions please advise. If any reason to withhold the requested permit is found. please advise. Your assistance and cooperation is appreciated. The Buiidinc Department - Date sent for review dc// By C OUTH: BUILDING DE .. .. DE TOWN OF DARTMNT F 508-999-0738 TELEPHONE 508-999-0720 APPLICATION FOR ZONING AND BUILDING PERMIT Instruefions ' no item ®answered. The The applicant shall complete this application to the best of their ability prior to submission. lnvmg Department staff will be available during regular business hours to assist as necessary. NIA should be inserted for those sections avoid unnec delays. P616M FEW flees tit �` which do not apply. A properly completed application will help essary 5 PD ON ONLY i (far ofLce use only) Date Reed 7 Total Cost S Received By Less Application Fee $ j�d Date Total Permit Fee Permit # i 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET `� LOT Jd ZONING DISTRICT � E-� CURRENT ACCESSORS' PLAT OTHER ZONING OVERLAY DISTRICTS , if applicable NUMBER & STREET Z t;L_ NEAREST CROSS STREET U t ✓�—� SUBDIVISION NAME & LOT # e5�, v L- Zr t7� 4—e— or BUSINESS NAME " PREVIOUS TENANT / OWNER 200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only �p ws �T✓�UL"T! C�\S c� t= ��7 � w' (i L:.� = THIS SECTION NOTAPPLICABLE ' /"�Z`� � � C��1 ✓�� = Single family - number bedrooms uu Ler baths = Two family_ - number bedrooms unit 1 number baths unit I 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 = Chimnev - number of flues = Woodstove - used (will require inspeelon prior to installation), new (provide manufacturers instructions). Location(s) (list) — Fireplace(s) - (includes flue) List location(s) = Game Court - describe (include overall dimensions) — Tent, Trailer (Mobile Home) or Other - describe 300 COM =CIAL - PROPOSED PROJECTIUSE - INCLUDING THREE FA1%1ILY OR MORE AND EMNIPT 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 304.01 (see Code Section _ 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) = Ctilit-& 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 Desmbe the proposal briefly, INCLUDE -umber of dwelling units and bedrooms or occupant load asapplicable, 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 alterationis). 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 ves see Code section 127.0). Designer to submit Code Synopsis. WiH tLis project require Peer review (over 400.000 cu.ft_1 Yes Nn rc� 1--i. The following section for official use only. INSPECTORS' REVIEW 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 DENIED see project review worksheet date HOLD reason date HOLD Subject to Zoning Board of Appeals action Comments FES Inspectors signature Date "1 •` Applicant informed of above - Date time staff (fax, phone, in person) ss:s:::ssssss:sssssssss;ss#;issss#sssssssssssis;s#ss;i#;;;;ssssss#sssss#;sss;#s##s#sssssissss;ssi#i<i:s:sss 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) OFFICEUNSPECTORS NOTES TOTAL FEE , 0 Gross area -new construction s-/ Total Sq. Ft. alteration Total Sq. Ft. ----— Permit is issued to T 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 information provided 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 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 t!I�iZCilf� l« ILA I-r T �C 1- D / Signature �i'!'/j/u.�J v The ove signature is my voluntary act and is signed under the pains and penalties of perjury. Date L Who is authorized to pickup the permit at the Building Depa tment? fvilease nriet► Address I fIFob Phone 9,75-5344 1400 HOMEOWNER EREM MON - 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 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,we with the rules and regulations promulgated by the BBRS enti"ed 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 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 two-year period shall not be considered a Home Owner. - If you are applying under this section Signature ; Your signature carry certain responsibilities, including but not n ecelsarily limited to, general liability ii*:i****lisii#ii!!:!i**i =!ii!liif!!i!i!!itiii#isfii!liiiiiliti#fisf#iiil:#:::::li#!!!##::i!!!###i!i#* NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that anv licensed Construction Supervisor, whether or not they have taken the permit are responsible for code compliance. (see 2.15.2 of section 5) fi#f#!f#iifis#itffiiiitii#i!!f!i!i!i#f#*ii#!if#i!#liiiliii!#f!#ii#ifffiii#iii#!iilfii!!##!!#!#!##i#iltif 1500 COST Cost of Improvement S Items to be installed but not included in the above cost: Electrical 5 Plumbing HVAC Other TOTAL $ Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required.. = Demolition - describe structure Number of dwelling units Number of bedrooms A separate Refuse Disposal Declaration required. = 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 = 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 will be considered as an Alteration, otherwise will be included in new construction. (see Code section 3401.10 for residential and Articl- 8 fL_ 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 submitted 600 SITE PLAN INot regained, why? No e_- 4 f}-N 6E- / � ``— Submitted When? = Previously, date ^ With this application 700 UITLPI'IES Water supply - required _ yes 1_4 no, public ? ) yes _ no, on site well? _yes _ no, existing? I 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 _ yes _ no. Submit copy of permit as soon as available. 800 MIECHAIIIICAIS & PREWARY FUEL Architeet(Engineer - project supervision and reports = 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 SPn1NKLFM - 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 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 7. Submit copy of application and/or permit as soon as available 1100 IDENTIFICATION (print or type except as noted) Curreat owner - name U F— G-t C---Vl� address tGr UL-i�--:- tjj t--L opz phone # S-0 Uf `� 4- -- l 22- 1 2— If corporation, officer in charge Architect/Eng 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. 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. General Contractor (if Homeowner, state homeowner here then complete section 1300) Company name �� (� 1�'`� V%—! Address 1 6 Z',Ul-) —rc--� , f�� `� �t4 Phone number E5-0v / `i' % ` ' � Z-4 -2— Construction Supervisors license number S C ' Z ®% `� NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not reproductions. 1200 FOR RESMEN 7AL REMODEL WORK ONLY Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes/L.No — If no go to next secition! Are you claiming exemption from the requirement? Yes _No )i If yes, submit the required affidavit:! Ren_odel contractor name (please print)'�� Address IL E-0X r2-0.Q Registration number (if none state "none") Phone number 'G�9 e� S — JrZ PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO TWE GUARANTEE FUND! QUESTIONS OR COMPLAINTS call or write: Home Improvement Contractors Registration One Ashburton Place - Room 1301 Boston, MA 02108 (617) 727-8598 Owners name (print) Signature Date h r?—C FLHLC E74I ts-rt Q -7Z'-t4- I S-n CO SC-AL-E: � /Z ,n AZ -A C - w � s-ra� 2wA�( . . - � . I/ - . -.-, r--- I � /IN �-% C_;=-j ---I -_ f -1--% 1--7 _-- 1,, V / 0, G:, C-WLIJING DEPAWMENT T DatIrmth! &, 10', 2�1Nfi 12- )UR DRAWING MUST BE KEPT 'HE BUILDING DURING THE RESS OF THIS WORK. TILDINle, DEPART11MTT Town of Dartmouth if HLE P", !Ljj! UTI Fill A, copy 7-N Endorsed PiGn Illiust L-P-1 'i"Opt On Site PU riq Construction