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BP-5226S00 MECHANICALS & PRIMARY FUEL 'Furnace (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify) - Boiler (heating)- Fuel gas (natural or propane), CueloH,,'electricity, other (specify) J - 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 �,f Other 900 SPRINKLERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential Required, -plans provided, - plans not provided, why? ONot required, not to be installed. Why? 1000 REQUIRED OFFSTREET PARE3NG - for ZONING & Architectural Access &7410T APPLICABLE - Parking Plan submitted To - Building Department - Planning Board Date submitted Number of spaces indoors outside total provided Handicap spaces required e yes no. If yes, howmany as a part of the total required number. Is Route 6 (State Road) Entrance permit required? ves - no -. If yes has it been issued yes - no -. Submit copy of application and/or permit as soon as available. 1100 IDENTIFICATION (print or type except as noted) Current owner -name e/ address I phone If corporation, officer in charge Architect/Engineer meer - for ove r-all design m Company name D L� \ t~`r� )� C t' iif t Address(I � 1 2- G Y L E F— 11 l i Phone number Certified by State of Massachusetts as Certification number NOTE Signatures and seals on all pians, affidavits and other documents SHALL BE originals and not reproductions. Architect/Engineer -_project supervision and reports Company name i,1_n 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 amd not reproductions. General Contractor (if Homeowner, state homeowner here then complete section 1300) Company name Address Phone number 6 70CI Construction Supervisors license number T Q / NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals avid 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! Ren_,)del 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 OneAshburton Place - Room 1301 Boston, MA 02108 (617) 727-8598 Owners name (print) _ Signature Date I. the undersigned, am the owner of record or authorized lessee (ProvidoF»� entatio n the application herein submitted. I state � ) and I have reviewed that to the be st o • f y 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 wor is k 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, itteI understand that the permit may be extended only three times by wrn request.I understand that once the permit expires a new application may be required, q d, including other requirements (including Zoning), fees and current dame /l ftC� r✓» r' ; e � e Signature The a ove sign lre is my voluntary act and is 'signed under the pains and penalties es of perjury. Date 9 Who is author' ed toP pick up he per mit th e Building Department? ., e lease - .-address � orintl I, Phone i 1400 HOMEOWNER EXEMPTION - ONE & TWO FAMILY ONLY FOR IIOME 014-1ERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT 109.1.1 Licensing of Construction Supervisors: Except for those structures ove ed in Section 127.0. effective July 1,, 1982. no individual shall be engaged in directly supervising by Control construction, reconstruction, alteration, repair, removal or demolition involving the structural elementsg eons engaged in structures, unless he or she is licensed in accordance with the rules and regulations promulgated b he BB S entitled or R:.les and Regulation. for Licensing Co^structicn Supervisors. y RS entitled Exception: Any Home Owner performing work for which a Building'Permit is re the provisions of this section; provides that i required shall be exempt from faH Ho me Owner en gages es a e Home Owner shall act as supervisor. g g P rtonls) for hire to do such work ,that such For the purposes of this section �nlv, a "Home Owner" is defined as follows: Person(s) who owns a parcel on which he;she resides or intends to reside, on which there is, or is intended to be, a one or two family dweln, 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 apphving under this section sign below; Signature four siQ_nature carries certain responsibilities, including but not necessarily limited t0 _ general ' zs*ssacszxsss h3 g liability #s:ssssssssssssss:*ssszsss#zzssszsss*ss***ssss*sssz:zs*ssxss NOTICE TO LICENSED CONTRACTORS: The Building m Co de roved . • es .. in licensed Construction Supervisor,' whether or not they have taken the permit are and Regulations section that any P responsible � c � _ -for _.1.,._ of section �� Po r code compliance. (see ##sssss::sssr#sss#mxzstss:sssssszsssisssszzzss#szss:ssssssssssasssxzzsszszz##sssssssssssszs#sx#xssz###s# 1500 COST Cost of Improvement Iteir+.s to be installed but not included in the above cost: Electrical 5� Plumbing e-:enr-y e E HVAC r �� Other TOTAL $ Atteranon of existing;' no increase in gross square feet. A separate Refuse Disposal Deciarationjirequired. 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 I — Reroofing - (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 34011.10 for j • I residential and Article 8 for commercial) Temporary structure - includes when allowed, trailers, tents and the like and only for limited period's of time. Describe 500 CONSTRUCTION PLANS None submitted. Why' uSuff�mitted, usually three sets required. Four sets for food serviceluses. Number of sets submittePn :2�' 600 STTE PLAN ❑ Not required, why? j I _ Submitted '"hen? - Previously, date tin this application 700 LTTUXITES Water supply -required I-- yes no, public ? yes _ no, on site Weil? _yes no,, existing? Zves _ 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 suppily, when required, is available. See Codee 780 CMR section 114.1.2) Sewage disposal - required id yes no, public sewer yes _ no l private septic - on -site yes no. Submit copy of permit as soon as available. = Woodstove - used (will require inspection prior to installation), )+ new (provide manufacturers The following section for official use only. instructions). Location(s) (list) L INSPECTORS' REVIEW E/Fireplace(s) - (includes flue) List location(s) — ,ti.L, Date plan reviewed _ Game Court - describe (include overall dimensions) - 30 days to review period expires - L Tent, Trailer (Mobile Home) or Other - describe _ _ OK to issue date 300 CONURE tCIAL PROPOSED PR _ - OJEC IUSE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES i = T%IiIS SECTION NOT APPLICABLE OK to issue subject to requested submittals — J q (see Project review w J orksheet) date DENIED see project review worksheet date (The following descriptions are based on the Massachusetts State BuildiCode)ng Code Article 3, AS NOTED) (See the _. HOLD reason date Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe HOLD Subject to Zoning Board of Appeals action Comments Business - office, assembly with less than 50 occupants - indicate Medical or other professional (see Code I Section 303.0) 66 p Inspectors signature Date"��gt,' 16� - Educational- structure for training including child day care for those over 2 years 9 months (see Code Section 304.0) _ Applicant informed of above - Date time staff (fax, phone, im person) - Factor/Industrial y _ (see Code Section 305.0) — Over six months since approved for issue -DEEMED abandoned! _ High Hazard - (see Code Section 306.0) Advise applicant. Hold 90 days for return then dispose'lf not picked up. Institutional - hospital, nursing home, infant day care (see Code Section 307.0) Inspector r Date . .Mercantile - retail stores (see Code 308.0) - Advised applicant Date Time staff (by phone, fax or in person) ' _ 'Residential -three or more family, hotel (see Code Section 309.0) OFFICEIINSPECTORS NOTES Storage - includes garages (see Code Section 309.0) TOTAL FEE �/ �- _ Utility & Miscellaneous Structures - includes tents and agricultural structures (see Code Section 311.0} d r, Gross area new construction � ��� Total Sq. Ft. _ — New tenant for any of the above, indicate above (see Code Section 119.0 and Zoning By-law section 35) alteration Total Sq.-Ft. Vent or Trailer - temporary; purpose? Other Permit is issued to Describe the proposal briefly, INCLUDE - •,amber of dwelling undo and bedrooms or Occupant also existing condition pant load as applicable, Comments/notes on permit n 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 lteration(s). aq tage in addition to any If project is an addition to existing structure - Total gross square feet of existing FOR COMMERCIAL. ONLY iYl this project be subject to CONSTRUCTION CONTROL (over 35,000 tuft.) y see Code section 127.0). Designer to submit Code Synopsis. es No. (If yes Will this project require Peer review (over 400,000 cu.ft. AP'PLLCANT TO PROVIDE ) YesNo (see Code Appendix n V3 , 1600 TO THE APPLICANTIREMERRAh AND Date of Application submission — Plat Lot A3 Street - Aquifer Zone Owner Owner mail address Owner phone # *##x#xmxxxsssssssxxx#ssssssssss#ss#s#sx#ss#ssss#xs#xssss#sss##s#ss#ss#xxs#ssss#sssss####sssss#ssssssss#ss OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACr THEM FOR RFQUHtED OWN MWONS. ® TAX COLLECTOR Approved HOLD By Date ❑ Board of Appeals Approved By Date ❑ Conservation Commission G Approved By Date ❑ D.P.W. Water Approved By ❑ D.P.W. Sewer Approved By Date ❑ D.P.W. Cross Connection Li Approved By Date ❑ Treasurer (Bond) ❑ Approved By Date ❑ D.P.W. Engineering Approved By Date -1 Board of Health (well) , j Approved By Date ❑ Board of Health (septic) Approved By Date ❑ Board of Health (food service) Approved By Date ❑ Planning Board (parking) = Approved By Date ® FIRE DISTRICT (I - II IIn Approved By sssssssssssssx sssssssssssssssssssssssassssssssssssssssssssssssssssssssssssssssssssssssssssate sssssssssssss BUILDING DEPARTMENT APPROVAL: ❑ ZONING ❑ BUILDING INSPECTORBUILDING COMMISSIONER ❑ CONTROL CONSTRUCTION AFFIDAVIT s#xxxx:xxxs#sssssxssxsssxsssss#xsssssssssssxsxsxsxsss#s;#sxxsxsxxsss#*xxss#s#xsssssxs#x#*s*x*#xs**xssxss PROJECT SUMMARY: new constructions alteration/demo sewage disposal- public/private [.-lter;add interior walls] [add rooms] [add footprint] tP ] water supply -public/private well [pool] [garage,ished/deck] [game court] [food service] Describes #xx##*xx##x##xx# sssxsx#x##x#xx#R#Y##x###xxx##x##x####xxxxxxxx##xxs#x#xx##xxsx##xx####x*#x#xx#x#x. To the various departments. This notice has been forwarded to you for your information and any appropriate action. Should you have any questions please advise. If any reason to withhold the requested permit is found, please advise. Your assistance and cooperation is appreciated. The Building Department - Date sent for review 2. By iAPPLICATION FOR ZONING AND BUILDING PERMIT (for office um only) ❑ FOUNDATION ON> Y Total Cost $ Received By Dam Reed Less Application Fee $ z(m `�- Total Permit Fee Perm t ## Lwoued Date 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET i 1,3 — Z CURRENT ACCESSORS' PLAT LOT ZONING DISTRICT OTHER ZONING OVERLAY DISTRICTS , if applicable - .,. NUMBER & STREET' NEAREST CROSS STREET SUBDIVISION NAME & LOT # �717�F or BUSINESS NAME y PREVIOUS TENANT / OWNERZ2xZ1_1L1 /V 200 RESIDENTL&L - PROPOSED PROJECT - one & two family residence on - = THIS SECTION NOT APPLICABLE Single family - number bedrooms number baths _ Two family - number bedrooms unit I _ number baths unit 1 } 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 A>1_ W = Gazebo - dimensions L W Swimming pool above ground in -ground Size Chimnev - number of flues