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BP-04159MWOM € .9..a A FA a m.a a. " a .a a 'A A .a .a A _L .a..d A A _" J-.f a _ • e� �y l�f ' ll SILTATION BARRIER LOT } 3 5# 4074 ,`l PLA T rya c r� ry :._ s l � U. 44 LOB` 44 hM '5Ri,108 1, ._TAU U 4 oft FULT TINCTLOCUS MAP SCALE: N.T.S. RZ' S'MrTrAMIT P.0mrElp l (01) 98.7 2* 98,6 (E WFINE SANDY LOAM 98.4 5" 98.4 a 0)FINE SANDY LOAD 97.3 30' 96f3 l0 rz 9�f1 s 44 � ____ 95f1 i rct�ARSE_ SAND - 89f8 I06° 9010 cC COARSE SAND I CQLATI®N RATES «r�ln=/Inf F'ERCCIL.ATiGN RATES, <2min./Ili, k DESIGN' DATA ,LOT �-� � � ' DESIGN PERCi mIt Jin, Clues 1 SOILS MIOTTLING _130 EL- 86,8 MFITTLING 130 EL= 87,5 ,, �. S Total Area �= 377,5fO �r�. Ft. y V DESIGN FLG' r 413Rf x 110 GPD/DR - 4 �!PD P R COLATION TEST l AI�EN4 03%5/97 I�ENNETH R. F ERI�.IRA ENGINEERING, INC, p.- LE'ACH AREA, e 4'x2 ' LEACH F'ZELD , FI'L EVALUATORr KEVIN J. SILVA 1 11 #I I CALCULATION& E4'x25'xO,74,o c /s,f, .=444 iw_) I�ECTFaR� CHRIS I�ICHAUD ¢ CALCULATIONS FOR RESERVE AREAf GENERAL NOTES. C _ 1 is ;.husetts Department nt f DESIGN F`LOWi 4DR, x 110 GPD/DR 4 .0,_�PD A work must be �n accordance w�tth the P.1as�c p o Environmental Protection i,00 & 15.00 Title V e of ,coon Regulations 310 CMR 1 ( ) a t LEACH AREA+ 1 x33 LEACH FIELD and any Local Beard ' of Health Modificaticans. 77 ,,sae 's without ride written PLAT �s PROPOSED PO MOB � , M , _ No modifications shall be made to this system p e «fl f 4. -, CALCULATICINS 18 x33 xt Y7 , /�f ', 4 , C LOT 7 AROUND E� ,'TIRE LOT. ' , � ,,� �. e Gi. C �� � � � 9 approval by the engineer and the local Board o Health 3,Engineer and the Board of Health must inspect the completed system ` NLITE prior to backfilling ,' ,' � ;" �' i � ,' r•, ` Cad tF . THERE ARE NO EXISTING !!ELLS 'MITI IIN 100' 4. Elevations shown an lair are based on an c sscm d datum. a c. ; TH _ p Z57.13' .FF „R ' c OF PROPOSED LEACHING FIELD, 5. Heavy equipment shal! not be run over the disc. 7sal system. `'t LOT SHOWN IS LOCATED WITHIN A AQUIFER 6. All unsuitable -soil is to be excavated from, the I-eaching Area w, _ l ,' °el or course sand c ajltc tic�n rr�et ' ,.;. ' A ° 7 7, fO .', Ff. F'RBTE CiICiN DISTRICT 7ONl� �, i�AXiMUN L LIT as shown on plan, and backfilled with clean grc / . -L L�. CY LITTLE FOAL t; � COVERAGE CIE 10°%_ as specified in 310 CMR 15.255(2). #//yy _ _ }, 7. leashed crushed stone shall be free of iron, fir`:=s and dust, Wd t, ' PERCENT CIF LOT COVERAGE o i t`°� 8. Septic tank, distribution box, etc. shall be mangy. actured by Rotondo MAXIMUM LOT COVERAGE - 37,71 S,F , .� P,� ire ', Sons Inc. or approved equal, and installed per , ,anufact�srer ,� specifications. HOUSE ,679 S,F', f c ° BARN _ 55 S,l , Grout shall be used to provide a water tight se�°l at all joints where pipe cz entn:rs or leaves a concrete structure. � PI�CIPCISED .T,' DRIVE = 1,221 S F � 2 9. Outlet distribution dines shall be level for a mir"num of the first two fee, TOTAL= i5C S.�. 8of their length as _specified in 310 CMR 15.232i z) PERCENT CIE LOT COVERED : e it CMIR 1 5, 10. A Beard of Health certificate cif Compliance as qu -red by 310 L 021 ,�- L3;. < 10% OK must' be obtained by contractor upon cc npleticp of work. �F D _,�!1QE r TAKEN' M, C7 r. +:�P 11. Distribution dines to be capped at outlets. r _1=?"I�. �..t� � LINE T�`�K�P,_ FROM, . F-,t� ,. hx:., y ✓ i k:c+ ''�I'fi!' F'�'r�.F_L i;2r�.00'_5i 0020 C, MAP �, T�qy � e e 4s Ct CAS' `let l f � r �E A tE' n ,Cix a r a ga baggy' C�, ,, Y., f SEPTIC T , . P,V,C, PIPE SCHL 40 <TIGHT JDINTS,_ EE'. , ! 56 EXISTING CONTOURS -- W 1E X ,��}NING IS SR8 SINGLE RESIDENCE E , PROPOSED CCONTOURSDISTRIBUTION I l�___I MINIMUM LOT FRONTAGE 200.0 � E P RESERVE EA TEST IT - -MINIMUM TOTAL AREA r 80,000 L PROPOSED ? BC. ft. 1 l WATER FINE0VA�LllkG T.O,F. SETBACK REQUIREMENTS: -- WATER TABLE TEST _..,w,4 , ELEV. 101. 1 r MINIMUM FRONT YARD ®.oa j , MARK ; .. ,•--- ,. ; ; Y_ - - MINIMUM SIDE YARD 20.00 v� _._:_ MINIMUM REAR YARD 20.00 BOARD OF HEALTH STAMPS \� 0 a s° °.s� :,0 0 0 r a O 3 G Q H EY CKi6 Ell STu VE 3 � '! #'-f' �1 �'C` O G 3' a -co 0 s .- I®CDp-1 CD _ CD� z �c S ca rn i i i i i i i} } Ir I � "xDETECTORS le" 5T(1D5 ZQ r- // 8'. p" �IZ/-\DC LINE/ loft �f ,k � I t / ' 5eF �X Z"x Ing ar ion inspectian LIM I�-TI D I\J. �-ri'o1� 1 L=�r •onstruttion 6 rn a � \I QI IJ I q -- �-7' �'' ,— % r� I'—L7 3'—!�;a r-rur cr _ MUReepp_�r� ` �r¢rtr�� IMIL LEV-L ? i Sid"fir a E j t �4� - Tn1a ©► f.[yn 9 e4r t y s - tll aCs�� � C � ��� - /w'roqui�t. •v t cy AI (1') ACT 1\11 t 3:2 G'1�1 t L.I hQ Ca 215E THIS \lVnLL FROM TDP 01-- 1`vl1>v1,11`r►01v W/L L i a u_G / r -7 i 4f.$'/ t 8„ C n1z/,N (i-T1=__. `` 9,S "STEM (TVP) 17 C 12'' STQ_i NenG ;j)_ 1/) sil�,13 Tll_.! YOUR Dix AT THE BUILDING �' , ,� r �.�w � SCJ�I_l� r/tl'/ = I ! t,?1i FiiOORESS O THIS a } Town of Dri-r raoi-at � MUDTE.S ILE, ! N U S L CJ L� 152 '' O _ . . �k _ ; PS Ls::-0 Ls::-U _s - 4 u t\Lb 1"i... P/S I" L LA_ 9 G/N1"�1 a 1 rt1 ¢ rc i I r t'1 { o ti,� . DUcT ��LL� � /aW Tc� ►�.' T i=12.1 i'2� F-0 lam TAP Zy , zr,. :,S ' SFL U IZL G I) V�, X 43 LO Ni1U LN 0 12 ...En t-7..S � �i n l A Cope Of This End'ersQd �� � 2 4'' , E. n;� �l/SC t= Z- Z'`�€ ► Q'' f �-4 - ►- h1 /fit L L Flan'rust BeOKept On Site C/�� _IZS C) • 18 _. �` _ Oe s rt t", t��►U 11v CnS 1=U►Z -DcY-) i'L /_'NN a Zy \ b GAL SEP D 0� v P In Pns F� ZE S+D 1 m. c� co 1v� 1 s Ts n r s, : n o S q)U�r N2_ i_ (t. G.-T //1 iN P Qxn'\ 1= go- I lof L2 Ll V I Nj ii G — % TOWN OF DARTMOUTH BUILDING DEPARTMENT This plan has beer%IFXiahMccepted as a record copy of work proposed to be performed in compliance with ICO N 780 CMR 5th Edition- The owner, applicant/agent and/or architect/engineer is responsible for insuring final ` compHance with the above —mentioned code notwithstanding ZOW� y . Scrag- I any errors or omissions in the record plan. Any change in owner, license contractor or engineer mustbe /< reported to this office immediately. Any change in plan ' must be subm ted to th' off in a imely manner. C"� _._• id'i '� /r c .� Signature M �, M LI ILL - �V y'' �12/wEL 7-- L UL-Li-TLE-- a?-n.t MA i / Lo � Tpq 1\,1 n iLT 1-1 1\/1nU71-1 ��Jt SR ell, ID 11A VV h_.1 .$ `°l . G ► 4o I Z.,6 l P/a j4 t �. D/sr SCE t.,. l_ : 1 /U"!-— • �54 L►3 31 1Iw�HO�1 n Ih1 _..! _Lnjoom Ic' U O a X J�-'T1 d /YC S ` �l `, GLtt15ETf i I �� r) TILE FL6011 t 8=2 ''i 00 ►L is IL \ E_ ZL7. EI�1Cr. 1zno1= 1260E TlbJSSES � 2. - a a � L • Vi P 1 (TYI�' r� 2-v t��G.(?`IP) SuPPOIL�f"ih1G, I�UU�Ll�TiUty l/v/� LLB @ 16 L • �7 \ (CtIV r-- LNLY CNLi{1 � Z''x If lzLDCE 1 RDC)= Tt2 - I`1-SSt.S C Z'-v ASPH/ELT 5HINL-,LF_5 5hLF SI_6LI1\lL-r ON #15 1=1=L_-T PIYEIZ 7- 5''STEP SHELET1 NG uL 2=-15 'TYt, I l=('- "T I L.) NJ �Ll�L1� r/L , I'/aSCil� 112''G,Yp Vv/l\LL.. Ll*lV 12_b i "x 3" r--.LJ IZIZIt A L% PLYWCY-\,D /� ,L . L Z 1 z"x y y '-�'�o P[ �-raS XT /_ t� /I .50 F IT -7, S E-mrs. CP'FLANL TIZus5E. 2 1--/)" /l . r (T`/ ;> ) i LLLSSl_S vY�auT '-CTIC Ill 3-S L/) L E Yz 1 '-D', DTI a Iu ell Uv � IL /a tL S U Lzi ►-I1 (TY P� 1 SJll-�..O S 11)1 Iv U aC• q�, LXTE121(V /\)\I I Iv i t IL1L IL VVA LL STL-.Lbs LJ I'LUvt2 8 ' ftLD IL SU IST -i OLlJSS Z" f� �� Tv r' ---) � Iv�e Utv 'I' \\I N\ Z- Z"X6 SILL (tit S�8 ` 1� - 18'' trs ►.►� 1�tiiC 12 -S OLT-S\l �1 o_v co d b �. • f 6v If i �Ll� a�i x G q r_0 PL)S I b � 1 E t�1 C, RL� i Mr E, rs * Iv LU �y L1-rr LIB ►-r.� " � LOT -ff w Y a�N SELF .Sl.l.�UNC, Lim It. IS Ft a R/APr t-L 6 to -lY" lou M PjnDF TD-IJSSI=S 2.161Ci �-- cTY tall.. bb p Y=- LUM, 6um_ns I T� .SGRc�I v�►,1 2-- Z.,x `' -r o t> PL/N-rc—S LOT 4 1-1 Z"A6`'STUbCI6;'bf-, � a M/�P #� sty 6„ REEIZ» IN5UL1 0 5/a'x 18" LUivc /\iNLH v oL 13vLTS� Z- Z"x 6 " S1LL P'IAI LS ; Y7-" IN SUL a U1,LbM- q/NTW--S. `Q FLESi D t= N C f!,-« j y tr�Nc. SL/� ` i `' •` � � A L!i-.,it / LU (-`f LI-1 LF \16� b 8" 66 1\1 C W/-� LL P LZ) -T Z„ x y,• KLCV Sr1-�s L-C - t A tUh► a N , a L CJ , I LULJ r -r�Zu ss (Ty f>) I �ic7u�t'��Ivci Ira.,a.3•'iy'Jx3Z y8` Zoe 1G Z1 r _ Li?nSS SG TIONI - _V-/a L� v NU`i" USE U�.1Lu .1���n• 5>�►E�w���.C-,, i Z • _5LCu0-i= WITH S/8'� I /a x t 8Lt)1\1 c-x I I+ I)Z)M L) ILA., I=115, I I A. ALL 61—)EQN< S FYL s6611— /\SkI-1) w�tiw���5a t sT s OF 75r 5-IqUlYl r'GC-r a T THE BUILDING DURING THE 'RO RESS OF THIS `Al-O K. RUrg p g P4-`..a `. f' 1 �ti/ t IVY L S! DIwL, �rt / h o":z"'m 01, "'Dart out Ell ZT LEE IZI C,H-T '�1I)1- ME -\A/ c-IC._ vt E-W LEFT ;1 1 R JA COPY Of This Endorse Elan Must BeKept On Site D Sri P �n tr ct Date 1= 0 - Iv11' NI -Is IVI /S l\-1 L L— L -FI=yL=S T-W L- I ,uI /- v -w- y T b 11/a 1n/lu 8 y i ..Pik-t ijZjS �/aT S �/� L-L I� I U `f"►:1� S t ti_ I `T t CJ I= I ' .L .L..i .L rA .L W J Yd _1 b J A .i .L-M b .ri.i .Lml d 9 U . \ \.... P-LAT F4 SIB/ W UAT r8v i LOT f f c ti # I $ on ICE= 5` 4Jv Y � p .' ' . G4` LOB' 4 N p,,r � t � �, S ill u 4 = I� sTor 1y " (O�) (O/A)FINE SANDY LOAM (B)FINE (SANDY LOAM - -(C i) - - COARSE SAND (C 2 COARSE SAND 7Ct0 U '0i> ✓r✓aw 98.7 8* 98.6 (O.!A)FINE SANDY LOAM 98.4 58, 98.4 0)FINE SANDY LOAM 97.3 30' 96.3 C 1) 95.1 44` - 95.1 COARSE~ SAND 89.8 106# 9010 (C ClIARSE NAND 86 8 136° 87 5 ` rnn.t �y int '. �. DESIGN DATA - PEi�cOLATI�rs. RATES O�F"i14 il Ine LOT t� ` . :v PERCOLATION RATES, Ql/inMOTTLING 130' EL= 86,8 MOTTLING 130�' EL = 87.5 LOTk -f ,' DESIGN PERC$ Qmint/Int Cla s I SOILS Total Arco. S77,510 q. Fit y� t; DESIGN FLOW, 4BRt x 110 GPD/BR = 440;PD PERC®CATION TEST TAKEN 03/5/97 KENNEfiN R. FERR6"`IRA ENGINEERING, INC. LEACH AREAS 24'x25' LEACH FIELD SDIL EVALUATORS KEVIN J. SILVA d / 1 INSPECTOR$ Cl-IRIS MICHAUD CALCULATIONS$ 84 85'xO.740pci/stf .=444C ,-, ilE CALCULATIONS FOR RESERVE AREA:GENERAL rlo .- r', 1. All work must be in accordance with the Massc.-husetts Department ` of ,. DESIGN FLO i 4DRt x 110 GPD/BR 440�_.PD ` , Environmental Protection Regulations 310 CMR 1 ;.Ofl & `15.00 (Title ,V) !. LEARN AREAS 18 x33 LEACH FIELD +T . and any loco! Board of Health Modifications. a without prior. written , 4 2. No modifications shall be made to this system P STED MOD FENCE r - CALCULATIONS, 18 3 0t74 Fed/stft=440 pd approval b the engineer and the local Board a: Health. LOT PLACED Ar�our#D EI411RF LOT. _,PROPOS 1 T , r C PP y i 3: Engineer. and thec Board of Health must inspect thee.. completed systerx� l ?` prior to backfil €li ng THERE ( 4. Elevations shown on plan are based on on a sr) Pd datum. t I r �s_.=�r' , HERE ARE NO EXISTING WELLS Wl"THIN 100 257.13' � #� � OF PROPOSED LEACHING FIELD, 5. Heavy equipment shall not be run over the disrDsal system. N54n3 24 V1. ' LOT SHOWN IS LOCATED WITHIN A AQUIFER 6. All unsuitabl _ soil $s to be exca,�ated from the a Area ,{ Total ., r" em , 1 Ft. � EE as shown on plant and backfilled with clean grcN,el or coarse: sand ,, Siltation Orr, F'ROTECTIGIN DISTRICT ZCIS� �, MfikIMLlN LOT LUC LI L F'OAD �c, � as s ecified in 310 CMIR 15.255(2). i CE11tElt�GE LIl~ 1Q/., P 7. Washed crushed stone shall be free ` of Iron,fir„ tss and dust. 100 PERCENT OF LOT COVERAGE :� 8. Septic tank, distribution box, otc. shall be man$ #actured by Rotondo Qc' MAXIMUM LOT COVERAGE 37,751 S,F. ..sanufacturer s specifications, S�!, � _ HOUSE = 2,679 yF Sons lnc: or approved equal, and (nstalfed per � p L ��� i S Grout !l b e provide � =1 at all 'aims �rhere pipe �y - DAPN `- 855 S,. , G ut shall e used to p o (de a water tight se 1 P p J - enters or leave. a concrete structure, ''� PROPOSED B.T; DRIVE - 1,c S,F , 9. Outlet distribution lines shall be level for a mir, ,num of the first two fret TOTAL = 4,755 S,F-. of their length as specified in 310 CMR 5,232t3}• �. PEPCENT 01F l_OT COVEREI) 10, A Board a# Health certificate of Compliance as .required by 310 CMR 15.021 1,3r: < 10;: ❑.K, m$st be obtained by contractor upon completion of work. r1 1. Distribution lines to :be topped at outlets. f l-_JO!t �E�;t� !_IN;�. I TAKEN F"E�i�r�l F,E��' A, MAP pp s. v r,1. �JN4TY PANEL +`27l�1 liC r; (12, $-{e" fi�rteirot designed for a . a C r'r r JULY r 1, r_LL PROPOSED 4 BED. e>' DAELLING T.0.F. I _ ........ __.. ... ELEV. - 101.5 fL t�'Lo 5' 0 D >G_ „p < 99x5 4' P,V,C, PIPE SCHL, 40 (TIGHT JOINTS 7 � 1,) 1 SEG T T ' Tit<NK� 56 EXISTING ING CONTOURS _ LLB - PROPOSED CONTOURS � DISTRIBUTION BOX RESERVELEACH AREA ; TEST PIT W WATER LINE MWATER TABLE TEST ow WELL B,M, r ': BENCH MARE BOARD OF HEALTH STAMPS Nt BDO { C l--_- F= Z I- L___ 1.--- �- .t`,�.... .IG:"7 �} {� j j".y �'�('jp} s r ! q Y` r,...�..�.Q�,3.Q- , £i � Q � Ono ® f� ® � lY��t „«� �R�Jt�t�L J i i,liY� 1/ � '1 Q Z% L) d.7,''b o" ,p s uu0Cgg_�� (J.ta+Fcp��,� Aw�^L>�U�UQ�_. `AJJi;7("du_ � G 'tl fl lJ a}TLIF Yb.. %'?r-t %P 0 0 C5 a ? ,. .. u {? .ram .� 0 , o ,., C 3` J 814 ' T ]TOP OF FOUNDATION • 4 53 2 r 11 . BOAR ❑E H A T T _. _ D E L H S AMi ._ } „y LUCY TLE ROAD OF DARTMOUTH 99,5 9911 9810 ` 98t0 MIN. Arr E -PORT E RE 14 r, , i Dated Roviaw z/ Z,- P ill e * -; ., € (� / 7 i,o>r r _ a 1 1 2 l ASHEi STCNt 6 ,1AOd 97,00 _ ""_,. 4 SC LF. 40 PVC H .. � � � � � .� .. t,r , RE, TA LYJ).� LEY{ _ �^ _ fir �e y^� r _ �, t �o -EWERA5, DISPOSAL SYSTEM , u { t l l�V 11 : 96,5�i - �T 4 v �_ SEMENSUBSURFACE S P O BASEMENT. l ,. HL O , , , l 9 4. tI { f $ , r , . .i , , .,�. ..-.--- �, � 1 WASHED STONE k r� 1 � CT PICAL) ,, t _-__i l : b do .-. � � v u 931 . FLOOR l , . t--1 { � _ 7 .._ ,._...- 4 i=._.. 5 l $ � x ,J ^-<. �' a... 4 P.V.C.\Gsps�lt,a� TIES Q Q Q Q C.} ,. .w, . ,_ ,, �i Q c� Q �} � v ia1 ��. Q a. a , ❑��NER MANUEL TEVES m,(t �+, ! '/�q$#.� /yy�: Q.: Q' Q i:.r __ rl Q} Q Q ,,, ,,.✓ Q Q Q Q 4`� (f l,s:Ce .�3. 6t..i7% 7t81 _ � ; Q Q Q � ca Q Q ' � c� ._ .� � Q Q Q Q �. �, � Q Q , Q � Q �. ..-.•-,�4,. -tea Ay] 9... � •f �..., : ( d 'l "" ("'._ f t "' w., /� : _ . �5^i � N C}_C Q C Q G Cl Q Q t U C) 9 Q Q Q' Q 15�3 GALLON 96,89 - �_ :.�.- _ Q Q ,� Q 96.00 , �6.63 ram_ . �� F�tATI���l4 T � _ � � LQ 1 I. .4 , t E CO'NCRETE a. _ Pr � BEET LOCATIO~$ LUCY c5 LTTLE ROAD ARTM lT� DISTRIBUTION `r' ,6 _ • � t €1 _ �.ff LEVEL EL El�_I I {s . , 1:-_ WIT ' w er� Inc. -�95t5 51P#108) tCRUSHED STONE ON SMAIsrM� ,. P,LS� � COMPACTED LEVEL STABLE EJ;., _ South Dart ,outs' .� A. -ter �. 5 10 �, .�r7-pprvrsr0rr,� : ,�r� F S to A S WAGE. t- ., ��, . ,F- Yam,. � j�.y�;.(,508) �•/f�p /'� I C A IaOF[ LE .<, , <.:. iogep�i r es, Joseph T. Correia IV VIP.: NO TE, _, D TFD �0.. 16/ 97Gr construction.the-contract C��t^�C ¢a tv�rl.yatt aloen�for�Ti� � taIt� prior ahv Wh$.e everY attempt to avoid mistakes, maker cannot C.,-rUt L a � err C^ � Aycanfl ts whntt VW r 9ht �o the ater�tlon of C❑RREIAS EN ICERi w{. ♦ ictlCC r-'xca�a excavation., , REVISION, FLOOD ZO,� LINE 7C I1 . � , .: »p , jj i ! 800 MECRANICALS & PRIMARY FUEL Furnace (hot air) Fuel gas (natural or propane), f el oil, electricity, other (specify) Boiler (heating) Fuel gas (natural or propane), uel oil lectricity, other (specify) HVAC (combined unit) - Primary fuel, natural gas, propane, electricity, other (specify) i Air conditioning - (separate unit) one of the above to be provided �� ,✓H� iL Hot Water Gas Electric Fuel Oil Other 900 SPRIN'I<LERS FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential i _ Required, --plans provided, .—plans not provided, why? I, - Not required, not to be installed, Why? 1000 REQUIRED OFF-STREET PA RKING -for ZONING &Arch itectural Access - NOT APPLICABLE I Parking Plan submitted To Build ing Department Planning Board Date_ submitted j Number of spaces - indoors outside total provided i Handicap -paces -required yes _^+o. I_ 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 yes no �. Submit copy of application and/or permit as soon as available. 1100 IDENTIFICATION (print or type except as noted) OPI Cuazent owner -name address ;L / phone # ff corporation.officer in charge II Arch tecVEr gineer - 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. Archit_ect(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 reproductions. General Contracto (' Homeowner, s to 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 next sect<ion'. Are you claiming exemption from the requirement? Yes No ,_If yes, submit the required affidavit! Ren_idel contractor name (please print) Address Registration number (if none state "none") Phone number PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO TINE 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 (prin Signature Date �C/- 1, 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 rt 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 req irements (including Zoning). IYm e .�tgnature T above signature is m voluntar?act d is signed under the pains and penalties of perjury. 4te<-7, l 'ho is authorized to pickup the permit at the Building Department? r lease print) Address d�i� - Phone < i ------------- 1400 HONMOWNER 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 R:.les and Regulations for Licensing Construction Supervisors. Exception: Any Home Owner performing work for which a Building Permit is required shall he 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 hershe resides or intends to reside, on which there is, or is intended to be, a one or two family dwellia ,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 necessarily limited to, general liabilih- NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that any licensed Construction Supe-visor, whether or not they have taken the permit are responsible for code compliance. (see 2.15.2 of section 1500 COST Cost of Improvement $ Items to be installed but not included in the above cost: Electrical 5 Plumbing _ HVAC Other TOTAL Gd .� Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration regniired_ _ 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 mot be enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwelling wiill be considered as an Alteration, otherwise will be included in new construction. (see Code section 3401.10 ffor residential and Article 8 for commercial) Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods of1time. Describe 500 CONSTRUCTION PLANS None submitted. Why? = Submitted, usually three sets required. Four sets for food serviceluses. Number of sets submitted 600 SITE PLAN 11 Not required, why? / Submitted When? = Previously, date _ With this application 700 LTI UXr E,g Water supply required _ yes no, public ? yes _ no, on site well?; V 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, wlhen required, is available. See Code 780 CMR section 114.1.2) Sewage disposal - required s _ no, public sewer _ yes _ no — private septic _ yes _ no. Submit copy of permit as soon as available. 1 The following section for official use only. S�oodstove - used (will require mspechon prior to mstallahon), new (provide manufacturers I ( instructions). Location(s) (list) Fireplace(s) - (includes flue) List location(s) Game Court describe (include overall dimensions) E Tent, Trailer (Mobile Home) or Other - describe 300 COMMERCIAL - PROPOSED PROJECT/USE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES it 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 assemblywith less than 50 occupants - indicate Medical or other professional see Code P Section 303.0) Educational - structure for training including child day care for those over 2 years 9 months (see Code Section 304.0) Factory / Industrial (see Code Section 305.0) - High Hazard - (see Code Section 306.0) i .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) Ii 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 - umber of dwelling units and bedrooms or occupant load as apptimble, 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 alteration(s). x 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 yes see Code section 127.0). Designer to submit Code Synopsis. Will this project require Peer review (over 400,000 cu.ft.) Yes No (see Code Appendix 1) APPLICANT TO PROVIDE 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 Inspectors signature Dats l l 97 Applicant informed of above - Date time staff (fax, phone, in person) szzzzzzzzs*zsssssss***sszsssx*zzzzss*z*s*sszs*ssssssssszsssssss*ssssssssss*sssss*ssszssssss*sssszzsz*�ssssz 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) sssss�sssss**sssssss**ss*sss**sssssss**ss*sszs*sssssssssss ssssss***sssss**ssssssz*ssssz*ssss*szs`*tzss OFFICE\INSPECTORS NOTES TOTAL FEE n Gross area - new construction Total Sq. Ft.� alteration Total Sq. Ft. Permit is issued to Comments/notes on permit Owner phone # *x****xzxxxsssxss*sssssssssssssssssxasxssxssxssssssmsssssssssssssxssssssxssssx*s**s**sss*sssssssssxssssss OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACT THEM FOR MED SUBMIMONS. ® TAX COLLECTOR E: Approved r-° HOLD B G y Date ❑ Board of Appeals - Approved By Date ❑ Conservation Commission ❑ Approved By Date ❑ D.P.W. Water 7 Approved By ❑ D.P.W. Sewer Approved By Date ❑ D.P.«'. Cross Connection u Approved By Date 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET ❑ Treasurer (Bond) ❑ Approved By Date CURRENT ACCESSORS' PLAT LOT _�� ZONING DISTRICT' ❑ D.P.W. Engineering 71 Approved By Date e HER ZONING OVERLAY DISTRICTS , if applicable 7 Board of Health (well) :1 Approved By Date NUMBER & STREET ❑ Board of Health (septic) E Approved By Date NEAREST CROSS STREET ❑ Board of Health (food service) _ Approved By Date SUBDIVISION NAME & LOT # ❑ Planning Board (Parking) Approved By Date or BUSINESS NAME ® FIRH DISTRICT (I - II - IIn "Approved By Date ' , :sass::::ass: sssass::assasssssssassasaasass::aassas::ass:a::aaa::aass:a:::assssssss PREVIOUS TENANT /OWNER BUILDING DEPARTMENT APPROVAL: 200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only ❑ ZONING ; THIS SECTION NOT APPLICABLE ...... rr. ❑ BUILDING INSPECTOR/BUILDING COMMISSIONER �ingle family bedrooms number baths r - number ❑ CONTROL CONSTRUCTION AFFIDAVIT *ss******t****ssrssssssssssmsss*sssssssssk*ss*#ssssssssssss:ssssssssssssssssssssssssssssssssxss*:sssssss Two family - number bedrooms unit 1 number baths unit 1 i PROJECT SUMINIARY: number bedrooms unit 2 number baths unit 2 new construction! alteration/demo di sewage sposal -public%private Accessory apartment Total gross sq. ft. • ` Accessory structure:,, [Alter/add interior walls] [add rooms] [add footprint] water supply - public/private well eGarage v3 C.tea' - detached - attached to dwelling, dimensions L W [pool] [garage/shed/deck] [game court] [food service] ` Carport - detached - attached to dwelling, dimensions L W Describe 'tL Shed - dimensions L W sssssss:Descrisssssssss:ssss:sssssss::::sssss sssssssssssssssssssssssssssssssssssssssssssssssssssssssss:sss To the various departments: ------ -� V Seck -dimensions L W 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 `Gazebo -dimensions L W cooperation is appreciated. Swimming pool above ground in -ground Size The Building Department - Date sent for review By Chimney - number of flues