BP-79800 MECE ANICALS & 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 art of the total required
P q d number.
Is Rotate 6 (State Road) Entrance permit required? yes = no =.' If yes has it been issued yes = no
Submit copy of application and/or permit as soon as available.
1100 IDgNTIMC:ATION (print or a except as note )
4"f"t
owner.- name
I
!daress
phone # /a
If corporation. officer in charge
ArchiiectJEngineer - for overall design
Company name
Address
Phone number
Certified by State of Massachusetts as
Certification number-
NOTE Signatures and seals on all Tans, affidavits and other documents SHALL BE
reproductions. originals and not
Architect/Engineer 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 not
j
reproductions. —
General Contractor (if Homeowner, state homeowner It en complete section 1300)
I
o Company name
d
Address
` Phone number
Construction Supervisors license number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
i
1200 FOR RESIDENTIAL. REMODEL WORK ONLY
Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes _,No _ If no go to next sectiion!
Are you claiming exemption from the requirement? Yes _No _If yes, submit the required affidavit;!
Remodel contractor name (please print)
Address
I
Registration number (if none state "none')
i
Phone number
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO TZIE
GUARANTEE FUND! QUESTIONS OR COMPLAINTS call or write:
Home Improvement Contractors Registration,
One Ashburton Place - Room 1301
Boston. :MA 02108
(617) 727-8598
I
Owners name (print)
Signature
Date .
1300 OWNER SIGN - OFF
I, the undersigned, am the owner of record or authorized lessee (provide documentation) and I have reviewied
the application herein submitted. I state that to the best of my knowledge and belief that the information provided in tfhis
application is true and correct and ,that the permit requested he issued.
Further I understand that the permit will expire in six months, from the date of issue, if no work is begun -:for
six months after the last inspection if work has begun and that the permit maybe extended for six months if no works 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 requiremen (including Zoning).
1
JName
('�ru Af,
Signature
The above signature is my voluntary act and is signed under the pains and penalties of perjury.
i
1 Date`
Who is au dor'ze to picku jp� th permit at the Building De a nt1) L21ease_print) J'a /� l .G/ Va. 6, k
Address
_l/ 3 C Phone 1a d5
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 follows: Person(s) who owns a parcel of land
on which heishe 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 sign below:
Signature
Your signature carries certain responsibilities. including but not necessargy limited to, general liability
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NOTICE TO LICENSED CONTRACTORS: 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
of section 5)
1500 COT
Cast of Improvement $
Items to he installed but not included in the above cost: Electrical S
Plumbing
HVAC
Other
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] required,
Demolition - describe structure
Number of dwelling units Number of bedrooms A separate Refuse Dis�nosal
Declaration required.
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-roofmg - (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 dwelhing will be
considered as an Alteration, otherwise will he included in new construction. (see Code section 340Q.10 for
residential and Article 8 for commercial)
= Temporary structure - includes when allowed, trailers, tents and the like and only for limited periords of time.
Describe
500 CONSTRUCTION PLANS
None submitted. Why.,
- Submitted, usually three sets required. Four sets for food serviceluses. Number of sets submitted
600 SITE PLAN
❑ Not required, why?
_ Submitted When? _ Previously, date With this application -
E
700 UTILITIES
Water supply - required _ yes _ no, public ? _ yes _ no, on site well? Z
s _ no,,
existing? _ yes _ no
If required and not existing have necessary permits been issued? _ no _yes, k date
(N.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a water supplly, when
required, is available. See Code 780 CMR section 114.1.2)
Sewage disposal - required _ ve _ no, public sewer _ yes _ no
private septic - on -site yes _ no. Submit copy of permit as soon as available.
zm.
rt
r? Woodstove - used (win require inspection prior to installation), new (Provide r ,
vide manufacturers
instructions). Location(s) (list)
C Fireplace(s) - (includes flue) List location(s)
Game Court - describe (include overall dimensions)
Tent, Trailer (Mobile Home) or Other - describe
300 COMMERCIAL - PROPOSED PRO.IEC /IISE - 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 overt 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 3
Tent or Trailer - temporary purpose?
_ Other
Describe the proposal briefly, INCLUDE n
also existing condition umber of dwe ' units and be or occupant load as a
PPlicable,
y
400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED
= New Construction and/or Add,:flon . 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 is addition to any
y
— If project is an addition to existing structure - Total gross square feet of existing_
FOR COMMERCIAL ONLY
Will this project be subject to CoNSTRUC
see Code section 127.0). Designer to submit Codt Cod CONTROL (over 35,000 cu.ft.) Yes
e Synopsis. No. (If yes
Will this project require Peer review (over 400,000 cu.ft.) Yes APPLICANT TO PROVIDE No (see Code Appendix I)
1
— OK to issue subject to requested submittals (see project review worksheet) date
DENIED see project review worksheet date
J HOLD reason
da(te
HOLD Subject to Zoning Board of Appeals action
Comments
Inspectors signature
Dates . Q 9 19
Applicant informed of above - Date time '
staff (fax, phone
in person)
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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)
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OFFICEXINSPECTORS NOTES
TOTAL FEE 69�57,-
i
Gross area - new construction Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Com men is/notes on permit
1600 TO TM APPUCANTIREFERRAL AND APIPROV
Date of Application submission
Plat Lot Street L✓�� Aquifer Zone
Owner 0 12 6/ Z,
Owner mail address /-
Owner phone # 6 3 6
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OTHER INVOLVED .-AGENCIES - The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT THEM FOR REOUIRED SUBMISSIONS.
0 'COLLECTOR Approved -- HOLD By Date
❑ (' nservation Comm = Approved By Date
❑ D.P.W. water = Approved By Date
❑ D.PAV. sewer — Approved By Date
❑ D.P.W. cross connection = Approved Date
it
❑ D.P.V. engineering — Approved Date
❑ Boa d of Health well = Approved Date
rd of Health septic - Approved Date
❑ Board of Health food service = Approved Date
-IRE DISTRICT (I - II - III) = Approved / �( t� Date
❑ Planninz Dept _ Approved Date
i
t)thcr _ Approved Date
Other _ Approved Date
t "„mmenu
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Prniect summary new constructioni alterationidemo sewage disposal publiciprivate
[Alter.•add interior walls] [add roomsi [add footprint] water supply - publiciprivate well
[pool] [garage shed] [game court] Jfood se ice]
Describe
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To the various departments:
This notice has been forwarded to you for your information and any appropriate action. Should you have any
tluesdons please advise. If any reason to withhold the
requested permit is found. please advise. Your assistance and
cooper -anion is appreciated.
I�
The Building Department
Date sent for review 4Z,:�2-` By
r
TOWN OF , DARTMOUFAX SCI-999-0738
TELEPHONE 508-999-0720
ZONING AND BUILDING- PERMIT
APPLICATION FOR
no item e1maaswered. The
The applicant shall complete this application to the best of their ability prior to sabmissioa.'leavm8
a rewIar business hours to assist as necessary. MA should be insert
for those: s� ons
Department staff will be available durin, g lfeeesieeeat
which do not apply. A properly completed application will help avoid unnecessary delays- N =
([or ohm me only) ) D2te --
Application fee �
received by ��.=_—
Total Permit Fee s Permit #
100 LOCATION OF PROJECT
. CURRENT ' SORS' PLAT LOT � ZONING DISTRICT'
ACCES
ZONING OVERLAY DISTRICTS ,.if applicable
STHER
UMBER 3 STREET
NEAREST CROSS STREET
SUBDIVISION NAME Sc LOT #
or BUSINESS NAME
PREVIOUS TENANT ; OWNER
200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
THIS SECTION NOT APPLICABLE
= Single family number bedrooms o___ number baths
Two family - numberr bedrooms unit 1 number baths unit 1number baths unit Z
number bedrooms unit 2
= Accessory apartment Total gross sq.' ft.
= Accessory structure
= Garage- detached - attached to dwelling, dimensions L
aa Val
d - attached to dwelling.
Carport -detachedimensions L `
�W`2
— Shed dimensions L
= Gazebo dimensions L
W
Size to;� square feet
= Swimming pool above ground in -ground
= Chimney - # of flues