BP-4015800 mEmANICALS & PRIMARY FUEL
e 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. Whv?
1000 REQUIRED OFF-STREET PARSING - for ZONING & Architectural Access
= NOT APPLICABLE
Plan submitted _ —
Parkin To _ g — Building Department _Planning Board Dat
e subm
itted
Number of spaces - `indoors outside total provided
Handicap paces - required _ ves _no. If ves, how many as a part of the total required number.
Is Route 6 (State Road) Entrance permit required? ves = no If yes has it been issued ves no =.
Submit copy of application and/or permit as soon as available.
1100 IDENTIFICATION (print or type except as noted)
w
Current owner - name C Jac �i f
address /� �� �'Jl�c /V/ Gi
7
phone#
If corporation. officer in charge
Architect/Engineer - for overall design
Company name
Address
Phone number
Certified by State of Massachusetts as ;
Certification number
NOTE Signatures and seals on all olans, affidavits and other' documentsSHALL BE originals and not
reproductions.
Certification number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals andl not
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,'not
reproductions.
1200 FOR RESIDENTIAL REMODEL WORK ONLY
Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes _ No _ If no go to acext section!
Are you claiming exemption from the requirement? Yes No If yes, submit the required aiffidavit'-
Rer,odel 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
Owners name (print)
Signature
Date
5
I, the undersigned, am the owner of record or authorized lessee (provide documeatation) 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
Signature_-- �--.
The abor�e signau ry ac du signed under the pains and penalties of perjury,
Date A57
`%'ho is authorized to pickup the permit at the Building Department? +P lease unnn
.address Phone
1400 HOMEOWNER EXEMPTION - ONE & TWO FAMII,Y ONLY
FOR HOME OWNERS WHO INTEND TO PERFORN,1 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 enti1ed
RLIes and Regulations for Licensing Coritrut cz Supervisors.
Esception:.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 personls) for hire to do such work ,that such
Home Owner shall act as supervisor.
For the purposes of this sectiOL -aly, 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 dwedin , attached
or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in
two -rear period shall not be considered a Home Owner.
If rou are apphing under this section sign below:
Signature
Your 7s��narure s B eerta, ponsibilities, including but not necessarily limited to, general liabilitti
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NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that any
Licensed Coristrucdon Supervisor, whether or not they have taken 2.15.2 of secrion 5the permit are responsible for code compliance. (see
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1500 COST
Cost .of Improvement 5
Items to be installed but not included in the above cost: Electrical 5
Plumbing
HV AC
Other
TOTAL S
Alteration of extstmq, .no increase in gross square lees. a separate mclusw. s•u -- �-- `�•��•
= Demolition - describe structure
Number of dwelling units Number of bedrooms A separate Refuse Dis1iosai
Declaration regnired.
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 -cooling - (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 will not be
enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwelliing will be
considered as an Alteration, otherwise will be included in new construction. (see Code section 34M1.10 for
residential and Article 8 for cormiercial)
Temporary structure - includes when allowed, trailers, tents and the like and only for limited perirods of time.
Describe
500 CONM UCTION PLANS
None submitted. Why.'
= Submitted. usually three sets required. Four sets for food serviceluses. Number of sets submit':ted
600 SITE, PLAN
Not required, why?
= Submitted When? Previously, date = With this application
700 LTTIIIT'IF.S
Water supply - required _ yes no, public ? yes _ no, on site well? _ yes mo,
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 suTpply, when
required, is available. See Code 780 CMR section 114.1.2)
Sewage disposal - required _ ves _ 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
P ) (Provide manufacturers
instructions). Location(s) (list)
Fireplaces) (includes flue) Lit 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 USE
THIS SECTION NOT APPLICABLE
(The following descriptions are based on the Massachusetts State Building Code Article 3
Code) , AS NOTED) (See the
- 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)
i
_ Educational • structure for training including child day care for those over 2 ye
304.0) ars 9 months (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)
j
Storage - includes garages (see Code Section 309.0)
- C;tWty & 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 - umber of dwelling units and bedrooms or
°O also Ming condition
load as applicable,
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 foo
alteration(s). q tage in addition to any
If project is an addition to existing structure - Total gross square feet of existing
FOR COMMERCIAL ONLY
W �ii this project be subject to CONSTRUCTION CONTROL (over 35,000 cu.ft.) Yes see Code section 127.0). Designer to submit Code Synopsis. No. (if yes
Will this project (
P J require Peer review over 400,000 cu.ft.) Yes No (see Code Appendix 1)
AFPLICANI' TO PROVIDE
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 woorksheet) date
DENIED see project review worksheet date
HOLD reason date
HOLD Subject to Zoning Board of Appeals action
Comments
Inspectors signature
DatPC"' 11997
Applicant in ed of above - Date time staff (fax,phone,, tin person)
= Over six months since approved for issue - DEEMED abandoned'
Advise applicant. ,Hold 90 &ys`fo return then dispose if not picked up.
Inspector Date
Advised applicant Date Time staff (by phone, fax or in person)'
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OFFICEUNISPECTORS NOTES
TOTAL FEE
Gross area -new construction Total S q• Ft.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit
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1600 TO THE APPLICANT AND APPROVAL
Date of Application submission
Plat Lot Street
. Aguilar Zone
Owner
Owner mail address
Owner phone #
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OTHER IlWOLVED AGENCD?S - The following agencies require separate jurisdictional permits or approval for your
Proposed project. CONTACT THEM FOR REQUIREDSQ>tnxc
a TAX COLLECTOR ` Approved HOLD By
Date
0 Board of Appeals := Approved By
Date
❑ Conservation Commission C Approved By
Date
❑ D.P.W. Water _—_;Approved By __ ❑ D.P.W. Sewer = Approved Bye_ Date
❑ D.P.W. Cross Connection _; Approved By
Date
❑ Treasurer (Bond) t7 Approved By
Date
❑ D.P.W. Engineering , r Approved By
Date
7 Board of Health (well) C Approved By
Date
❑ Board of Health (septic) Approved By
Date
❑ Board of Health (food service) _ Approved By
Date
❑ Planning Board (parking) _ Approved By
Date
M FIRE DISTRICT (I II Approved By
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BUILDING DEPARTMENT APPROVAL:
❑ ZONING
❑ BUILDING INSPECTORBUILDING COMMISSIONER
❑ CON'TROL CONSTRUCTION AFFIDAVIT
PROJECT SWYEKARY:
new constructioni alteration/demo sewage disposal = publiciprivate
[Alter;a.dd interior walls] [add rooms] [add footprint]
water supply -public/private well
[pool] (garage/shed/deck) [game court] [food service]
Describe
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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
-ooperation is appreciated.
the Building Department - Date sent for review
z By
TOVM. OF DARTMOi7TH NT
TELEPHONE 508-999-0720 FAX.' 50=999-038
APPLICATION
s's, • a ZONING AND BUELDING PERMIT
The applicant shall complete this application to the best of their ability prior to submission. leaving no item unanswered. 'the
Department staff will be available during regular business hours to assist as necessary. NIA should be inserted for those se -.-,dons
which do not apply. A properly completed application will help avoid unnecessary delays. Neft F816M Sm in mot
(for ofee use Daly) ❑ FOUNDATION (ONLY
Total Cost $ �`" v Received By Date Reed
Less Appfmtion Fee S ! _
Total Permit Fee S s Permit #
100 LOCATION OF PROJECT
TOTAL LAND AREA SQUARE .p
CURRENT ACCESSORS' PLAT 4/P LOT/ ---:S ZONING DISTRICT
OTHER ZONING GIJERLAY DISTRICTS , if applicable
NUMBER & STREET S n7lk'C c-19 =210 IS
NEAREST CROSS STREET
SUBDIVISION NAME & LOT #
or BUSINESS NAME
P1r 1/
It,.Jt7i1�- � �-..OWNER ,
200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
= THIS SECTION NOT APPLICABLE
. T r �
Single family - number bedrooms �3 number baths
= Two family - number bedrooms unit 1 number baths unit 1 tip} --1
number bedrooms unit 2 number baths unit 2
Accessory apartment Total gross sq. ft.
= Accessory structure:
!,Garage - detached - attached dwelling, cimensions L W
= Carport - detached - attached to dwelling, dimensions L W
Shed - dimensions L W
= Deck, dimensions L W
U
�-Gazebo -dimensions L W
= Swimming pool above ground in -ground Size
= Chimney- number of flues
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