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BP-09938800 MECHANIC -US & PREWARy FUEL • . Architect/Engineer - project supervision and reports Furaace (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify) Company name oiler (heating Fuel g atur °or propane), fuel oil, electricity,other s er (Pecify) Address I� HVAC (combined unit) -Prima fuel, Primarynatural gas, propane, electricity, other (specify) . - Phone number - = Air conditioning - (separate unit) Certified by State of Massachusetts as 77 None of the above to be provided Certification ficabon number - ,>�Hot Water Gas !L� Electric Oil Fuel Other NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE origin: is and not 900 SPRD4KLERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential reproductions. = Required, —Plans provided, -plans not provided, why? General Contractor (if Homeowner, state homeowner here then complete section 1300) Not required, not to be installed, Why? @ !t 2 .G .9 2 i Co a a e O t f C'o lap ay n m � /� s � r f S 1000 'ZEQUIRED OFF-STREET PARING - for ZONING `& Architectural Access Address y'P� Ala. _!Zt .g mot. s7� . �r4 • �10T APPLICABLE Phone number :Parking Plan submitted To = Building Department Z Planning Board Date submitted Construction Supervisors license number C S D C,tc Number of spaces -indoors P outside total provided NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originails and not reproductions: Handicap spaces - required yes _no. If yes, how many as a �rt of the to - p tat required number. ssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssassssssssssssssssmsssssssssssssss Is Route 6 (State Road) Entrance permit required? yes no --. If yes has it been issued ves = no 1200 FOR RESII)ENTTAI. REMODEL WORK ONLY - Submit copy of application and/or permit as soon as available. Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes — No _ If no g o to next section! 1100 IDENTIFICATION (print or type except as noted) Are you claiming exemption from the requirement? Yes No ®If yes,submit the requured affidavit: Current owner -name %i'h t 2 t 0 -N 'h It a f � eR j`1 l f k Ren_ ,)del contractor name iplease print) address 0 8 i9 (C C �it/ !Q . /' J o M 24^ Al phone # 5' ©f Address Registration number (if none state "none") If corporation. officer in charge lk-ll lo Phone number ArchitectJEngineer •for overall design / /_ / PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ArCCESS TO THE Company name — %�% e' k f 4 r 1 er-'P — /�� Q� '`o'�Cl� G Q !� �T�iQ GUARANTEE FUND! QUESTIONS OR COMPLAINTS call or write: , Home Improvement Contractors Registration Address One Ashburton Place - Room 1301 Boston MA 02108 Phone number (617) 727-8598 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. Owners name (print) t 2 f d yt of s Signature 1144 Date /1 / ovggz 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 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 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 00 / !% ?'f i-1 Q l� S" 7 Signature _ — ---, ­ --u Ay acc ana Ls siguea under ine pains and penalties of perjury. Date f " /0 y Who is authorized to pickup the ermit at the Building Department? � Tease oRnn Address er �O , /'k �d i � S Phone 1400 HOMEOWNER E 3MIEMON - 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 accords-ce with the rules and regulations promulgated by the BBRS entitled Rules and Regulations for Licensing Constmction 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 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 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 liability 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 1 sssssssssssssssss:#s#ssssssssssssslsslsss:!lssssss#ssssslss#!s#lsssssssssssssssslsss#s#sss!!s##!##ssssss 1500 COST Cost of Improvement g �' S G vv. Items to be installed but not included in the above cost: Electrical S Plumbing U vU. HVAC Other TOTAL S r3 3 o Uu, emu_ 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 Disposa� Declaration requizei. 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 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) for residential and Articl- 8 ft.. commercial) Temporary structure - includes when allowed, trailers, tents and the bike and only for limited periods 611 time. Describe 500 CONSTRUCTION PLANS None submitted. Why? ubmitted, usually three sets required. Four, sets for food serviceluses. Number of sets submitted .3 600 SITE PLAN ❑ Not regained, why? 56-ubmitted When? Previously, date 1th this application 700 UTMITIES Ii Water supply - required yes _ no, public ? _ yes /1 no, on site well' es no, existing? yes � no If required and not existing have necessary permits been issued? IL -no _ yes, date (M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a water supply, wwhen required, is available. See Code 780 CMR section 114.1.2) I Sewage disposal required �ves _ no, public sewer _ yes �o 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 instructions). Location(s) (list) u � Fireplace(s) - (includes flue) List location(s) i • = Game Court - describe (include overall dimensions) Tent, Trailer (Mobile Home) or Other - describe 300 COMMERCIAL --PROPOSED PROJECTIUSE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES THIS SECTION NOT APPLICABLE (The follocumgdescri des criptions are based on th e 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) = High Hazard - (see Code Section 306.0) I = Institutional hospital, nursing home, infant day care (see Code Section 307.0) N.Iercantile - 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? Y _ Other Describe the proposal briefly, INCLUDE -amber of dwelling units and bedrooms or occupant bad as applicable, also casting condition a 400 TYPE OIL CONSTRUCTION OR WORK TO BE PERFORMED k New Contraction and/or Addition - total gross square feet S (For commercial only total gross cubic feet) - indicate It will be considered new construction if there an increase in square footage in addition to anv aiteration(s). If project is an addition to existing structure —Total gross square feet of existing = FOR COM1ViERCI4L ONLY Wdi l this project be subject to CONSTRUCTION CONTROL (over 35,000 cu.ft.) `Yes No. (If ves sec 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 i The following section for official use only. 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 O_ _ HOLD Subject to Zoning Board of Appeals action Comments Inspectors signature r erO Date's = Applicant informed of a ove - Date time staff (fax, phone, in peerson) #*#######zs#*#*ssxsss##s#s#sszsz#sszzsxszsszssssssssaasassssssssssssssssssasassassasszszz*zzszszszz;sszzszs Over six months since approved for issue - DEEMED abandoned! Advise applicant. Hold 90 days for return then dispose if not picked up. u a h i Inspector Date Advised applicant Date Time staff (by phone, fax or in person) ss#*##ssss#*##ssszzasssss*#sssss#s#s##z#zs#**##zssazsssasa#aasasaazaas#sssaaass#ssa#sszssszsr..i##.x;�szazza OFFICEVNSPEGTORS W�OTFS TOTAL FE1: a Gross area - new construction Total Sq. Ft. cif alteration Total Sq. FL ./j Permit is issued to Comments/notes on permit _4 i-ew �Ll d� 67 #:::::sass::Y##iss##sill#ills##s#i#####YiY#siiii!#ii#ii#iiii#iY#ii#Y#i##iY*ssiss#sssisisssii#Yiisi*i##i -.-.-- MOO TO THE APPLICANrAMERRAL AND APPROVAL Date of Application submission Plat Lot Street Aquifer Zone Owner Owner mail address IAL Owner phone # '' Y#########t.##Y###Y##Y#Y#iiY#iiYiii#YiY###YY#tYii##iiY#YiiiiiYSYii###i#i#Yii##iii#iYYiiissiii$#iiiiiYY##i# OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your OAX proposed project. CONTACT ITEMFOR RFj)UEREDWRbft IONS. COLLECTOR = Approved HOLD By Date ® Board of Appeals Approved By Date conservation Commission CG Approved By Date ❑ D.P.W. Water roved B —;Approved y ❑ D.P.W. Sewer Approved "By- Date ri D.P.W. Cross Connection G Approved By Date ❑ Treasurer (Bond) ❑ Approved By Date ❑ D.P.W. Engineering . r Approved By Date arc! of Health (well) :1 Approved By Date ❑ Board of Health (septic) Approved By Date ❑ Board of Health (food service) Approved By Date ? ❑ Planning Board (parking) --'Approved By Dam; ®„ RE DISTRICT (I - II - II) — Approved By sssas islasscssssssssnsssasas#s#rsss Date ssassssssssssssssssssssssssssssssssssssssssssssssssssssssasss BUILDING DEPARTMENT APPROVAL: ❑ ZONING ❑ BUILDING INSPECTOR/BUILDING-CObINIISSIONER ❑ CONTROL CONSTRUCTION AFFIDAVIT : PROJECT SUMMARY: nevi construction" alteration/demo sewage disposal - P p ublic� rivate ter;add interior walls] [add rooms] [add footprint] water supply - public/private well [pool] [garage/shed/deck] [game court] [food service] Describe (. 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 ze, By TOWN OF DARTMOU M.. BU D DEPARlAlENT. TELEPHONE 508-999-0720 FAX:508-999-738 APPLICATION FOR ZONING AND BUILDING PERMIT The applicant shall complete this application to the best of their abifity prior to submission, leaving no item unanswered. the Department staff will be available during regular business 'hours to assist as necessary. N/A should be inserted for those sOActions which do not apply. A properly completed application will help avoid unnecessary delays. fiseasnot refiondObAr- (for office use only) �}❑3 FOUNDATION;(ONLY Total Cost Received By w Date Ree'd1ac" , Less Application Fee S Total Permit Fee Z Permit # Lwoed Daf 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET, t7�C7 CURRENT ACCESSORS' PLAT zi q LOT O if " Of? ZONING DISTRICT OTHER ZONING OVERLAY DISTRICTS if applicable NUMBER & STREET Z , � E /! NEAREST CROSS STREET _© cyo ., -it- /' SUBDIVISION NAME & LOT # t r 5;, 1,6 to S sVi t �' J or BUSINESS NIAIME PREVIOUS TENANT / OWNER �!d t S fi r y G C. C. 200 RESIDFNTIAL PROPOSED PROJECT - one & two family residence only . = THIS SECTION NOT APPLICABLE Single family number bedrooms 9 number baths Z Two familv number bedrooms unit 1 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 % O W /2 �e A 2 _ Gazebo dimensions L W - Swimming pool above ground in -ground Size = Chimney - number of flues /��"}