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BP-77290 • f } i 5 f 4-1 a x l� { f �i !Gt � fifE �11 �€E e I E I i t i !i F ,�.�--sue. ..- —' _•_'•--• � _—.._--__� _.. ___�.__�___.._—.—__...__. _�_.���_-��.�—�_�__�. f � '__ f i a 4. ILI i�.. .�..�..�E. i del i� E ! , -4a 800 MECHANICM. S & PRIMARY FUEL V 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 re quired, uired not to be in stalled, • q Wht . 1000 REQUIRED OFF-MWET PARKING for ZONING & Architectural Access — NOT .A.PPLICABLE — Parking 'Plan submitted To Building Department = Planning Board Date submitted Number of spaces - indoors outside total provided handicap spaces - required yes _no. If yes, how many as a part of the total required number. Is Route 6 (State Road) Entrance permit required? yes no If ves 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) Current owner - nameV s add- ess� `1A LIU2-A 1 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 plans, affidavits and other documents SHALL BE originals and not reproductions. Architect/Engmeer - project supervision and reports Company name Address Phone number Certified by State of Massachusetts as Certificationnumber, NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and nott reproductions. General Contractor (if Homeowner, state homeowner here then complete section 1300) Company name�'��-1�57 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 next section! Are you claiming exemption from the requirement? Yes No If yes, submit the required affidavit! Remodel contractor name lease rind Address Registration number-. (it none state "none") Phone number PERSONS CONTRACTING IVITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS T'O THE GUARANTEE FUND! QUESTIONS OR COMPLAINTS call or write: Home Improvement Contractors Registration tt J, Ashburton Place - Room 1301 oln.:: 8 a._. 59 Owners name (print) . Signature o C�- Date 1 I 1300 OWNER SIGN - OFF I, the undersigned, am the owner of record or authorized lessee (provide documentation) and I have r°aviewed 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 rbegun or r six months after the last inspection if work has begun and that the permit may he extended for six months if no work is J anticipated if I request such an extension in writing. I understand that the permit may be extended only three tames 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 above sig au is v /oluntary act and is signed under the pains and penalties of perjury. Date VZ710 is authorized to pickup the permit at the Building 'Department? iaiease pnntt Address Phone 1400 IiOMEOWNER'EXEMPTION - ONE & TWO FAMILY ONLY FOR HOME OWNERS WHO INTEND TO PERFORi1I 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 directlysupervising 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 -)nh•, a 'Home Ownt:r" is defi;-ed 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 srli uctures 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 yououre applying under this c ' n''s' e i ure Your signature c rrie rtai red onsibilities, including but not necessarily limited to, general liability N CE TO LICENSED NTRAC RS: 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 5) 1500 COST Cost of improvement S . Items to he installed but not included in the above cost: Electrical S Plumbing HVAC Other TOTAL The folloµinz 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 required. `Demolition - describe structure Number of dwelling units Number of bedrooms A separate Refuse Dispogal 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) I 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 willl not be enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dweiling7.will be considered as an Alteration, otherwise will he included in new construction. (see_Code section 340I.1.'o for residential and Article 8 for commercial) _ Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods ®f time. Describe 500 CONSTRUCTION PLANS I No ne submitted. Whv" �1' Submitted, usually three sets required. Four sets for food serviceluses. Number of sets submitted 600 SITE PLAN ❑ Not uired, why? _. Submitted When? _ Previously, date _ With this application 700 UTILITIES Water supply -required _ ves no, public ? /Ves _ 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, '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 V 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) CJame Court - describe (include overall dimensions) Tent, Trailer Trailer (Mobile Home) r Othe -describe( 300 COMMERCIAL - PROPOSED PROJEC IUSE - 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) - Institutional - hospital' 'nursing home, infant day care (see Code Section 307.0) 9 _ 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 also ex st g condition and bedrooms or occupant bad as applicable, 400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED New Construction an /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 a.lteration(s). If project is an addition to existing structure - Total gross square feet of existing — FOR COMMERCIAL ONLY Will this project be subject to see -Code section 127.0). DesigCONSTRUCTION CONTROL (over 35,000 cu.ft.) yes Noner to submit Code Synopsis. (If yes Will this project require Peer review (over 400,000 cu.ft.) YesAPPLICANT TO PROVIDE No (see Code Appendix I) OK to issne subject to requested submittals (see project review worksheet) date DENIED see project review worksheet date HOLD reasondate HOLD Subject to Zoning Board of Appeals action Comments Inspectors signature Date — Applicant informed of above - Date time staff (fax, phone, in [person) sssss********#*s*****#****s*ss*ss*ss*ssssssssss:ssss**ssssssssssssssssssssssss*ssssxsssssssssssssss::sssssss 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) s*s=sssss*s:s*ssssssssssssss*ssssssssssasxssass:sss*ssssssss*sssssssssss*sssssssssssssssss#ssssssayssmssm OFFICEIINSPECTORS NOTES TOTAL FEE _ • l® Gross area - new construction Total Sq. Ft. alteration Total Sq. Ft. q G . �© Permit is issued to Comments/notes on permit i i 1600 TO TIM APPumiqrvREPERRAL AND APPROVAL Date of Application submWioa Plat ` Lot �-� Street / Aquifer Zone f I � Owner �l 0 /„� .(^�' r^i, 4 Owner mail address Owner phone # zs:::z:z:asz#sissssssss##sssssssasss:#sssssassa:#!s#ssss:::#::!sssssssssssssssesssesssssssss#sasa:: OTITER I.WOLS'E.D AGENCIES - The following agencies require separate jurisdictional permits or approval for proposed project. CONTACT THEM FOR your REOUMED S'OBMISS>;ONS- (® COLLECTOR _ roved APP HOLD By �-' Date SC'onservation Comm _ Approved By t-,' Date ❑ D-P.W. water _ Approved B} Date ❑ D.P.ZN'. sewer _ Approved By Date ❑ D.P.W. cross connection = Approved Date Q D.P.W. engineering- Approved Date Beard of health well = Approved s Dace of Health septic - ApprovedDateBord q§oi,�dr of Health food service -Approved I g FIRE DISTRICT' I II -III) =Approved Date � Date (L% ❑ Planning Dept - Approved Date Other Approved — Date O;hcr _ Approved Date C,mmentS ::.z:::::z:::z:::::::::ssss:silss:s:::se#s:!#ssss:is:::ss:s::::isszzzszi:ss::z:s#:sssssssssfs:iissss:#zi I Prnlect summa^y new construction/ alteration/demo sewage disposal - publicrprivate [Alter. -acid interior wails] [add rooms ] [add footprintl water supply PubliclPn•v ate well elI (pool] A�arnge shed] [game court l [food service] Describe �IM, Alik 1 6 v i (J (,ram t:zzzz:szs::::i#!#!!!s'i!#ii##i!!#;#i!#i#sits###s#!s#ss#ssss:lz#!i##izszzzz!#ii#i#iiilislfiffif######s##fits o the various departments: This notice has been forwarded to you for your information and any appropriate action. Should you have any uper- ri n is a advise. I 'any reason to withhold the requested permit is found. please advise. Your assistance and ��aoerstion is appreciated. he Building Department Date sent for review By F ' • is '" 1 1 �; ttt 1 APPLICATION•R ZONING AND BUILDING� the applicant shall complete this appication to the best of their ability prior to snbmispolui 1esviag no item utnaaswered- e Department staff will he available during regular business hours to assist as necessary:.MA should be inserted for those see`iions which do not appiv. A properiv completed application will help avoid 'unnecessary delays. i!irt� irt+estt't - (for office use oily) 7. Application fee $ �✓ received by 3 Date " Tout Permit Fee $ . Permit # 100 LOCATION OF PROJECT CURRENT ACCESSORS' PLAT LOT _ ZONING DISTRICT OTTER ZONING OVERLAY DISTRICTS ,)f applicable NU'IBER 3 STREET Mz NE--3REST CROSS STREET - -- SUBDIVISION NAME & LOT # - =g s or BUSINESS NAME c PREVIOUS TENANT ; O«'NER 200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only = THIS SECTION NOT APPLICABLE Sinele famih• - number bedrooms number baths WIM = Two famih• - number bedrooms unit 1 number baths unit 1 number bedrooms unit:! number baths unit Z 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 - Gazebo - dimensions L W _ Swimming pool above ground in -ground Size total square feet = Chimney - # of flues 7X