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F �., �„ .. , -. y. .. s . .. .,t... ,x ._. .s'.... , <. __�.i ._ ..._.,.., �..: .v,......... t m .., ,.. __ _.. _. _ ,.,__-�. _• - _ -. --.,. i .. ..._., .. .... ." .. ... ,,... _.. _...A... ,. ., v ...-.., h ...t,,. , 'i _.,.. .-.._. .... ...... .. ._..,. ._,, t_ .... .J„ _ _,.— . ,. ,. ., -- _. ._..,-, ,.....,.r .— . .1.+_ 1. _ _.. _, ..n. u„ ., -._. ,.. ., �.. ., _ ,,, .. .._ .. ._- ..__ _, . «.. .._ .-a .. _ . .. .. h ._ _., s. ,< .. _. _ ..d , 800 MECIIAN.'ICALS & PRIMARY FUEL, Furnace (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify) - i rBoiler (heating)- Fuel g (natu r 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',. �.2 g, P,u t l;l�Lt � 7 �v0 100�0 REQUIRED OFF�TREET PARKING - for ZONING & .Architectural Access /S SOT APPLICABLE U = Parking Plan submitted To Building Department = Planning Board Date submitted Number- of spaces - indoors outside total provided Handicap spaces - required yes _no. If ves, 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. I100 IDENTIFIC ILTION (print or type except as noted) Current owner - name Gy d4 r CJ Gc Q 11Q 6e4,-t-4- address l f U d !G lD on,±17-kal--nk r /� phone+ If corporation, officer in charge ArchitectlEngineer - for overcall design Company name .Address Phone :number C f tS 6"1:54 Cd.#,r j $-Q�'� 0e 'S �l v Certified by State of Massachusetts as Certification .number Acli J1 NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not reproductions. 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 reproductions. General Contractor (if Homeowner, state homeowner here then complete section 1300) C- Company name Address lub 11i1 /d e � 7 !� f f '/�� v2 �Q � • O Z� Phone number 001P 9 1�, r'9 ! � Construction Supervisors license number C S O Z/ Z/ Z 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 suction! Are you claiming exemption from the requirement? Yes _No _,If yes, submit the required affidaNit! Remodel contractor name lease tint) Address Registration number (if none state ..none") Phone number PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO, THE GUARANTEEFUND! QUESTIONS OR COMPLAINTS call or write: Home Improvement Contractors Registration One Ashburton Place - Room 1301 Boston.:MA 02108 (617) 727-8598 -- V t'7/JtG4j2/jQ Gc Owners name (print) Signature DateZ/ 1300 OWNER SIGN - OFF I, the undersigned, am the owner of record or authorized lessee (provide documentation) and I have re7�iewed the application herein submitted. I state that to the best of my knowledge and belief that the information provided' 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 beggun or six months after the last inspection if work has begun and that the permit may be extended for six months if no wwork is anticipated if I request such an extension in writing. I understand that the permit may be extended only three fumes 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 Signal The above signature is my voluntary act and is signed under the pains and penalties of perjury. Date' Who is authorized to pickup the permit at the Building Department? )please print) Address ��S'/t/G. s4i 51 Phone SteC'9/0 EXEMPTION - ONE & TWO I� I400 H011�OWN'�R FAMILY ONLY FOR HOME O'i NERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT 109.1.1 Licensing of Construction Superiors: 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. :.-env Home Owner performing w w it is required s ce lion. n work for which a Budding Perm hall be exempt Ez p p g r g eq 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: Persons) 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 dwelling, 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 you are applying under this section sign below: Signature four signature carries certain responsibilities, including but not necessarily.limited to, general liability z#izzizzisix###i####ii##############if##########i;###########i#######i#f#f############################## 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 2.1; .2 of section 55) 150U COST Cost of Improvement Items to he 'installed but not included in the above cost: Electrical 5 �'�'� _ 1,-5-V0 Plumbing S'ut� HVAC — o Other O TOTAL S p Z , U �. The following section for official use only. INSPECTORS' REVIEW Date plan reviewed 30 days to review period expires s OX to issue date are feet. A separate Refuse Disposal Declaration required. Alteration of existing, no increase in gross squ Demolition - describe structure Number of dwelling units Number of bedrooms A separate Refuse Disposal Declaration requaEd. 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 lavers when complete A separate disposal declaration REQUIRED = Replacement doors and windows - (for existing only) (only where doors and windows exist and will not; the enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwelling will lbe considered as an Alteration, otherwise will be included in new construction. (see Code section 3401.10 for - residential and Article 8 for commercial) = Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods of tinne. Describe 500 CONSTRUCTION PLANS None submitted. Why'' ubmitted, usually three sets required.- Four sets for food service uses. Number of sets submitted 600 SITE PLAN ❑ Not required, why? 11�Submitted When? - Previously, date `With this application I 700 UTILTITES Water supply required yes no, public ? _ yes no, on site well? yes no. existing? ves _ no If required and not existing have necessary permits been issued? _ no �ff yes`, date yQI (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 _1;toyeS _ no, public sewer _ yes _ no private septic - on -site eyes _ 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) G Game Court - describe (include overall dimensions) Tent, Trailer (MobileHome) or Other - describe 300 COM 1MRCIAL PROPOSED PROJECT/USE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES XTMS 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 2 years 9 months (see Code Section 304.0) = Factory / Industrial - (see Code Section 305.0)4. ,t High Hazard - (see Code Section 306.0) k - 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 35) Y Tent or Trailer - temporary purpose? Other Describe the proposal briefly, INCLUDE number of dwelling units and bedrooms or occupant load as applicable, also existing condition 400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED -, New Construction and/or Addition - total gross square feet 11160 6Q (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). If project is an addition to existing structure Total gross square feet of existing = FOR COMIKERCIAL 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 OK to issue subject to req uested submittals (see project review worksheet) date DENIED see project review worksheet date L HOLD reason date HOLD Subject to Zoning Board of Appeals action Comments Inspectors signature 0 JA DateMAY (0 5 1998 Applicant informed of above - Date time staff (fax, phone, in peerson) I Over six months since approved for issue - DEEMED abandoned! Advise applicant. Hold 90 days for return then dispose if not picked up. Inspector Date I Advised applicant Date Time staff (by phone, fax or in person) OFFICEUNSPECI'ORS NOTES V 0 TOTAL FEE Gross area - new construction i � Doe Total Sq. Ft. /?/0 ,� S alteration Total Sq. Ft. I Permit is issued to Comments/notes on permit I 7 1600 TO THE APPLICANT' AND APPROVAL Date of Application submission Plat Lot Street Aquifer Zone Owner Owner mail address Owner phone # z::s:::::::::::saaaaasassa:saaastsss:*sssssasasssasssassssaasaaaaassassaassssssaassssssssssassass:sass:sa OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your Proposed project. CONTACT TmA FOR RE-OIIIR® SiIBMIS,SiONS. ® TAX COLLECTOR _ Approved — HOLD By Date ❑ Conservation Comm _ Approved By Date ❑ D.P.W. water ::Approved By Date ❑ D.P.W. sewer — Approved By Date ❑ D.P.W. cross connection _ ApprovedIff,2 Date ❑ D.P.W. engineering — Approved �> Date ❑ Board of Health well — Approved Date ❑ Board of Health septic _- Approved Date ❑ Board of Health fond service _ Approves Date 9 FIRE DISTRICT II - II - III) — Approved Date ❑ Planning Dept = Approved Date Other _ .Approved Date Other — Approved Date t','mments ......zzzzzzzz z zs zsssazsszsassssssss:zsssssssss=szsssaazzs:ssss::zsaszsssssssassssss ssssssssssssssssszs Project summary new constructioni alterntionidemo sewage disposal - puhliciprivate [After -add interior wallsl [add rooms] [add footprint] water supply - puhliciprivate well (pool] [garagershedj [game court] [food service]' Describe z::::::z:::::sssssss:ssssssss:sssssssszsszazaa:sss:sszzsszzsssasszsssszzssasssasssss:ssssssssss:ssssszzzzzs To the various departments: This notice has heen forvurded to you for your information and a v appropriate nactin • _n. Should sibs have any questions please advise. If any reason to withhold the req uested permit is found, please advise. Your assistance and Lrouperstion is appreciated. The Building Department Date sent for review � By TOWN OF DARTMOUTH BIDING DEPARTAEANT TELEPHONE 508-999-0720 FAX 508-999-0738 APPLICATION FOR ZONING AND D I�stractions 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. MA should be inserted for those sections which do not apply. A properly completed application will help avoid unnecessary delays. 16oft &Estmi (for office use only) Application fee $ received by I}ate l Total Permit Fee $ Permit # 100 LOqNON OF PROJECT,. CURRENT ACCESSORS' PLAT yq LOTOF-1�4 ZONING DISTRICT OTHER ZONING OVERLAY DIS CTS ,•if applicable *44, NUMBER 3 STREET t! l Z NEAREST CROSS STREET 0 SIiBDIVISION NAME & LOT S �/ T /� 5 r� �Q $• or BUSINESS NAME p PREVIOUS TENANT ; ONIMER /'4 15 � 2 �. C c1 w.�r ct �� • j,%�s %Z1o191 t � 200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only _ THIS SECTION NOT .-APPLICABLE F SingIe famih• - number bedrooms 3 number baths _ Two famih• number bedrooms unit 1 number baths unit 1 number bedrooms unit 2 number baths unit 2 Accessory apartment Total gross sq. ft. = Accessory structure r/ 0 A16- Garage - detached -- attached to dwelling, dimensions L W Carport - detached attached to dwelling, dimensions L W Shed - dimensions L W Gazebo dimensions L W ool above ground in round Size total square feet = Swimming p S -g Chimney - # of flues 800 MECHANICALS & PRIMARY FUEL - Furnace (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify) —iler (heating)- Fuel (natura r 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 Water Gas r v 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? /,,,,� Syr � fyu 7 z J 10l30 RE OFF-STREET PARKING - for ZONING &Architectural Access NOT APPLICABLE Parking Plan submitted To = Building Department LE Planning Board Date submitted Number of spaces - indoors outside total provided H-ndicap spaces - required ves no. If yes, how many as a p?rt of the total required number. Is Route 6 (State Road) Entrance permit required? es no If es h q Y y as it been issued yesno�. Submit copy of application and/or permit as soon as available. 1100 IDENTIFICATION (print or type except as noted) Current owner name ` Cr Gti d /* t G C address phone # J " f 6 ' J 1 / ,/ If corporation, officer in charge Architect/Engineer - for overall design Company name !/Lo Ct G• f" . Address !� .L t ,• i-P pig. % �J Phone number Certified by State of Massachusetts as T Certification number Al C # /Z / NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not reproductions. Archkect;/Engineer - project supervision and reports Company name lip 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 Contractor (if Homeowner, ' state homeowner here then complete section 1300) IC - _ EIS. Company name Address '5 Ayze Phone number 4 ' l �✓'� l' Q Construction Supervisors license number r NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals =nd not reproductions. 1200 FOR RESIDENTIAL REMODEL WORK ONLYf Are you a Home Improvement Contractor subject to (78_0CMR - 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_adel contractor name (please print) Address Registration number (if none state "none") Phone number PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCSS 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) F Signature Date 1300 OWNER SIGN - OFF I, 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 m knowledge and belief that the information Y d$ provided in this application is true and correct and that the permitrequested 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 above sign re is my'Voluntary act and is signed under the pains and penalties of perjury. Date Who is authorized to pickup the permit at the Building Department? {please print) Address YYs .va, yrt At I S tf Phone o ri.' S -p 7 0 rt r 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 he engaged in directly supervising persons engaged in construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of buildings or structures, unless I i or she is licensed in accorda-.ce with the rules and regulations ro u �ated b the BBRS e nhtt ed Rules and Regulations for Licensing Constriction Supervisors. Exception: Any Home Owner performing work for which a BuildingPermit is required shall be e eq 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 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 structures accessory to such use and/or farm structures. A person who constructs more than one home in two-year periodd shall not be considered a Home Owner. If you are applying under this section sign below: Signature f' / Your signature carries certain responsibilities, including but not necessarily limited to, general liability szszzzszssssss�ssssssssszssszsszsssssszsssssssssssssssssssxsssssssssssszsszszsssssssssssssssszsszssszsss 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 2.15.2 of section, 5) sszszsssssszszsssxsssszszssssxzsszzsssssszszssszsszzxszsxsssssssszzzsssssssssssss*sszsssssssxsssssssssss 1500 COST Cost of Improvement V. Items to be installed but not included in the above cost: Electrical 5 Plumbing HVAC Other 'r TOTAL L� ��• '_ 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 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 not bfe 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 3401.10 for residential and Articl 8 fo_ commercial) Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods of time;. Describe 500 CONSTRUCTION PLANS (None submitted. Why? = Submitted, usually three sets required. Four sets for food service uses. Number of sets submitted 600 SITE PLAN ❑ Not required, why? Submitted When? Previously, date' "7V ❑ With this application 700 UTILITIES Water supply - required yes _ no, public ? _ yes no, on site well? yes no, existing? yes _ no If required and not existing have necessary permits been issued? no yes, date 2 O - `"' (M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a water supply, whem required, is available. See Code 780 CMR section 114.1.2) Sewage disposal - required yes _ no, public sewer _yes _ no private septic - on -site yes _ no. Submit copy of permit as soon as available. _ wooustove used (will require inspection prior to installation), new (provide manufacturers instructions). Location(s) (list) ❑ Fireplace(s) - (includes flue) List location(s) Z Game Court describe (include overall dimensions) Tent, Trailer (Mobile Home) or Other- describe 300 CO CIAL - PROPOSED PROJECr/[JSE - 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) 2 '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) J 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`. El Institutional - hospital, nursing home, infant day care (see Code Section 307.0) Mercantile - retail stores (see Code 308.0) J Residential - three or more family, hotel (see Code Section 309.0) Storage - includes garages (see Code Section 309.0) ' J Utility & Miscellaneous Structures - includes tents and _,griculturaI 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) E Tent or Trailer - temporary purpose? Other Describe the proposal briefly, INCLUDE number of dwelling nails and bedrooms or occupant load as applicable, also eristing condition r 400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED �Newnstruction and/or Addition - total gross square feet ! ' / [n (For commercial only total gross cubic feet) - indicate It will be considered new construction if, there an increase in square footage in additionto any alteration(s). If project is an addition to existing structure - Total gross square feet of existing FOR COMPdERCIAL 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 I) APPLICANT TO PROVIDE The following section for official use only. INSPECTORS' REVIEW Date plan reviewed % 30 days to review period expires OK to issue date :J OK to issue subject to requested submittals (see project review worksheet) date DENIED see project review worksheet date J HOLD reason date HOLD Subject to Zoning Board of Appeals action Comments Inspectors signature ITjate MAY ® 8 199 J Applicant informed of above - Date time staff (fax, phone, in person) Over six months since approved for issue - DEEMED abandoned! Advise applicant. Hold 90 days for return then dispose if not picked up. Inspector Wate J Advised applicant Date Time staff (by phone, fax or in per-;on) #s*#*zs*#s#szss#*ssz#sz*#s*s**ss####ss*##s*#s*sss**ssss*sss#s#ssasss#*ssss*s#az**s*##s**zrzz#s*###xs#s##s III OFFICEVNSPECTORS NOTES TOTAL FEE III Gross area - new construction Total Sq. Ft. alteration Total Sq. Ft. Permit is issued to I Comments/notes on permit --�- #_*�__#__:=***xx******#*:*•#s*x*ssx:s*::sss:s:ss*s:s:**:sxsss*ss*ss**s::ssssss:ss*:ss:*sssx:*s**::*::ss 1600 TO THE APPLICANT/REFERRAL AND APPROVAL �] Date of Application submission j ' Plat Lot Atreet kJ/ Aquifer Zone OwnerLAO Owner mail address Owner phone # OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACT THEM FOR REOUnm SOBI4 INMONS- ® TAX COLLECTOR Approved HOLD By Date ❑ Board of Appeals El Approved By Date ❑ Conservation Commission C Approved By Date ❑ D.P.W. Water Approved By o D.P.W. Sewer _ Approved By bate ❑ D.P.W. Cross Connection El Approved By Date ❑ Treasurer (Bond) ❑ Approved By n Date ❑ D.P.W. Engineering ^', Approved By t Da Board of Health (well) 77 Approved By AnDate ❑ Board of Health ti se c ( P ) =Approved By Date ❑ Board of Health (food service) _ Approved By Date ❑ Planning Board (parking) _ Approved By Date a FIRE DISTRICT (I II - III) Approved By Date sssssmsssssssssssssssssssssasssssssssassasssssssssssssssasssssssssassssssssssssssssssssssssssssssssssss BUTMING DEPARTMENT APPROVAL: ❑ ZONING ❑ BUILDING INSPECTORBUILDING COMMISSIONER ❑ CONTROL CONSTRUCTION AFFIDAVIT PROJECT SUMMARY: new construction/ alteration/demo sewage disposal - public/private [Alter/add interior walls] [add rooms] [add footprint] water supply _ public/private well [pool] [garage/shed/deck] [game court] [foodiservice] Describe *s*Y s***s*x*s* 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 cooperation is appreciated. , please advise. Your assistance and The BuDding Department - Date sent for review B t By D� Q TOWN OF DART7VIO TTH.:.. UHMING DEPARTAI NT TELEPHONE 508-999-0720 FAX 508 999,0738 APPLICATION FOR ZONING AND L Insirnction9 The applicant shall complete this application to the best of their ability prior to submission, leaving no item unansweredl. The Department staff will be available during regular business hours to assist as necessary. N/A should be inserted for those sections which do not apply. A properly completed application will help avoid unnecessary delays. Neil i13g llime in not rellinnikiie. (for office ine only) Q FOIINDATTC•)N ONLY Total Cost S � Received By Date Rec'd + lX 1 ' Less Application Fee f Total Permit Fee S i / Permit # Lssaed Date i 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET t� CURRENT ACCESSORS' PLAT LOT ZONING DISTRICT OTHER ZONING OVERLAY DIST CTS , if applicable NUMBER & STREET NEAREST CROSS STREET 0 Cr Q SUBDIVISION NAME & LOT # S > A 2 t 5 Xe i or BUSINESS NAME PREVIOUS TENANT / OWNER f)A / 200 RF.SIDEN'TIAL - PROPOSED PROJECT - one & two family residence only i THIS SECTION NOT APPLICABLE Single family - number bedrooms 3 number baths r Two family number bedrooms unit 1 number baths unit 1 number bedrooms unit 2 number baths unit Z c Accessory apartment Total gross sq. ft. Accessory structure: = Garage - detached - attached to dwelling, dimensions L W � a Carport - detached - attached to dwelling, dimensions L W b M p ed - dimensions L W aV II Deck - dimensions L W Gazebo - dimensions L W Swimming pool above ground in -ground Size �I Chimney - number of flues