BP-00849• pr VEngnneer - projecs aur—
►ate 6-ran"ARY KULf - Company name
Furnace (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify)
Address
.'� oiler (hea )- Fue��ga�tural or propane), fuel oil, electricity, other (specify)
•Phone number
Primary fuel, natural gas, propane, electricity, other (specify)
HVAC (combined unit) Certified by State of Massachusetts as
Air conditioning - (separate unit) Certification number
Ca None of the above to be provided
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
Electric Fuel Oil Other reproductions.
Mot Water Gas'��
FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
900 SPIC]ifiKLERS - General Contractor (if Homeowner, state homeowner here then complete section 1300)
--plans provided, Jplans not provided, why? �Af
;� Required, `p P tt �ompany name 1
--#ot required, not to be installed, y redress
done number
p NG - for ZONING &Architectural Access / �` `�`�� ( o /
1000 RQUHtED OFFSTREET 1 `•-.]
X6nstruction Supervisors license number L �
NOT APPLICABLE
NOTE Signatures and seals on ate, affidavits and other, documents SHALL BE originals and not;
.= Parking Plan submitted To = Building Department ❑Planning Board Date submitted reproductions.
outside 2 total provided
N `L
umber of
es �,no. If yes, how many as a part of the total required number. REMODEL WORK ONLY � � V
Handicap spaces - required _ y 1200 FOR RESIDENTIAL
Are you a Home Improvement Contractor subject to (780CMR - 6) ? yes _ No _ If no go to next;et on!
Is Route 6 (State Road) Entrance permit required? yes no yes has rt been issued yes I—no
Submit copy of application and/or permit as soon as available. Are you claiming exemption from the requirement? Yes _No __If yes, submit the required affidlavit!
1100 IDENTIFICATION (print or type except as noted)
Ren_odel contractor name lease rint
`-Current owner - name t� r f
/ J �� I � J �r Address
f7 d e S /l'JP�c) /
address Registration number (if none state "none")
Phone number
one # RED CONTRACTORS DO NO ` T HAVE ACCESS o THE
If corporation, officer in charge PERSONS CONTRACTING WITH UNREGISTE
GUARANTEE FUND! QUESTIONS OR COMPLAINTS call or write:
� Architect/Engineer-for overall design e � Home Improvement Contractors Registration
One Ashburton Place - Room 1301
Company name
�c9 t r r S s� S'�`� �ju • �) Boston, MA 02108
�. etv I6 ) w ✓%k �-P .a A Z% (617) 727-8598 r�t� �r"A /�� tiS
Address 3 � � vc � � l
Owners name (print)
Phone number
Signature
Certified by State of Massachusetts as �" n
Date'Sd ^9 /
Certification numb
er
NOTE Sign
atures and seals on all clans, affidavits and other documents SHALL BE originals and not
reproductions.
5
i
Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required.,
I, the undersigned, am the owner. of record or authorized lessee (provide documentation) and I have reviewed Demolition describe structure
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. Number of dwelling units Number of bedrooms A separate Refuse Disposal
Further I understand that the permit will expire in six months, from the date of issue, if no work is begun or Declaration required.
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 ❑ Moving - (Provide copy of D.P.W. moving license) Type of structure
written request. I understand that once the permit expires a new application may be required, including fees and current
other requirements (including Zoning).
from where (plat/lot or address)
BtcS.NaQe I- •
/ to where (plat/lot or address)
`Signature '
Number of dwelling units ' Number of bedrooms per dwelling unit
The above signature is my voluntary act and is signed under the pains and penalties of perjury, ,
� Date 5 — 7—Re-roofing - (for existing only, is included in new construction)
•34 - 9 �
� 10 f 004 • Number of square feet Number of layers already existing
Who 'is authored to pickup the pe it at the Building De artm nt? lease riot
y� do .� ��,- 6
' /
Address Phone O C7 Number of layers when complete
1400 HOMEOWNER EXEMPTION -ONE &TWO FAMILY ONLY A separate disposal declaration REQUIRED
Replacement doors and windows - (for existing only) (only where doors and windows exist and will not be
FOR HOME OWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT
109.E_1 Licensing of Construction Supervisors: Except for those structures governed by Construction Control enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwelling will be
in Section 12e.0, effective July 1, 1982, no individual shall be engaged in directly supervising persons engaged in considered as an Alteration, otherwise will be included in new construction. see Code section 3401.10 for
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 residential and Article 8 for commercial)
R:,les and Regulatior-s for Licensing Construction Supervisors.
Ezception:.Any Home Owner performing work for which a Building Permit is required shall be exempt from Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods of time.,
I
the provisions of this section; provides that if a Home Owner engages a person(s) for hire to do such work ,that such Describe
Home Owner shall act as supervisor.
500 CONSTRUCTION PLANS
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 familv dweilin ,attached _None submitted. Why?
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.... "f -S
Submitted usual
ly il three sets required. our sets for
r food e s rvn ce uses. 3 !, 3 Y q 1 Number of sets submitted
If you are applying under this section sign below: 600 SITE PLAN
Signature ❑ Not required, why?
Your signature carries certain responsibilities, including but not necessarily limited to, general liability
sssssssss*ssssxsssssssssxsssssssssssxsssssssssss*****s*s*s*s*sss*ss*s*sssssmssss*****s*#***ss*sssmssssss J/ubmitted When? = Previously, date W
A,,/\ith this application
NOTICE TO INCENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that any
A
licensed Construction Supervisor, whether or not they have taken the permit are responsible for code compliance. (see
2.15.2 of section 5)
700 UTELrITE,S
sssssssssssss�ssss:sssssssssssssssssss:ssssssssssss*:*ssxssssssssssssssssss:s::ssssssssssssssss:ssssssss
1500 COST
i Water supply - required V yes no, public 7 yes _ no, on site well? yes no,
Cost of Improvement $ 17 O O U
existing.,
yes no
Items to, be installed -tot included in the above cost: Electrical $ 3 OOU ,
If required and not existing have necessary permits been issued? no yes, date
Plumbing D 000. (M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a water supply, when
HVAC ,,0111/1/1
e
r quu-ed, is available. See Code 780 CMR section 1141.2)
Other Sewage disposal - required yes _ no, public sewer yes no
TOTAL
private septic - on -site Yyes no. Submit copy,of permit as soon as available.
6 •
. 3
- -
L„c, ,,-m-, ezq�mre�mspecuon-prior —to mstatianon),- new (provide manufacturers
1'he mowmg section For official use only.
INSPECTORS' REVIEW
instructions). Location(s) (list)
`
Date plan reviewed
C Fireplace(s) - (includes flue) List location(s)
30 days to review period expires
Game Court - describe (include overall dimensions)__V
S D`� S�`�'�'�`
-, OK to issue date
Tent, Trailer (Mobile Home) or Other - describe LtyC�
a
OK to issue subject to requested submittals (see project review worksheet) date
300 CO CIAL - PROPOSED PROJECT/USE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES
DEN® see project review worksheet date
THIS SECTION NOT APPLICABLE
(The following descriptions are based on the Massachusetts State Building Code Article 3, AS NOTED) (See the
:1 HOLD reason u'iate
Code)
= HOLD Subject to Zoning Board of Appeals action
Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe
Comments
Business - office, assembly with lessthan 50 occupants - indicate Medical or other professional (see Code
Inspectors signature Dane
Section 303.0)
Applicant informed of above - Date time staff (fax, ph(ane, in person)
Educational -structure for training including child day care for those over 2 years 9 months (see Code Section
**ssss*sssszzsssszzssszsssxzszssssz**sssssssssz*s*ss*zsxts*sssssssssss**sssss*sss*zsssssszs�;ssss*sss*zssss
304.0)
Over six months since approved for issue -DEEMED abandoned!
- Advise applicant. Hold 90 days for return then dispose if not picked up.
Factory /Industrial - (see Code Section 305.0)
High Hazard - (see Code Section 306.0)
Inspector _Date
_ Institutional - hospital, nursing home, infant day care (see Code Section 307.0)
i J
� Advised applicant Date Time staff (by phone, fax or in persoon)
Mercantile - retail stores (see Code 308.0)
msz***sssszzsss**sssss*ssssszszzss*sszs*ss*ssssssssss*ssssssszsssssszs**s*s*sss*sssmssss*Fxsssss�szz*ssss
Residential - three or more family, hotel (see Code Section 309.0)
OFFICE\INSPECTORS NOTES
Storage - includes garages (see Code Section 309.0)
TOTAL FEE
Utility & Miscellaneous Structures - includes tents and agricultural structures (see Code Section 311.0)
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.
Tent or Trailer - temporary purpose?
Permit is issued to
. E Other
Dessm'be the proposal briefly, INCLUDE r umber of dwelling units and bedrooms or occupant load as appEr.able,
Comments/notes on permit
also eusting condition'
400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED
New Construction and/or Addition - total gross square feet ! tD
(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 COWMIERCIAL ONLY
Will this project be subject to CONSTRUCTION CONTROL (over 35,000 cu.ft.) Yes Na (If yes
see Code section 127.0). Designer to submit Code Synopsis.
Will this project require Peer review (over 400,000 cu.ft.j _._ Yes No (see Code Appendix n
APPLICANT TO PROVIDE
2
1600 TO THE APPLICANT/REFERRAL AND APPROVAL
Date of Application submission
��SPlat q-z/-- Lot treet C rr -9-- A uifer Zone q '
Owner JT rf',1 -,X4 ,::M, ' C %'t.� .� r
%a ��I/dv 1IhS
Owner mail address J �/'�C K' �C F)� S� ` Tv, 1el x
Owner phone # / 50 1% etlZ
OTHER INVOLVED AGENCIES -The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT THEM FOR RF-OL1IM SUBMISSIONS.
® TAX COLLECTOR L—_� Approved HOLD By Date
❑ Board o ppeals -0 Approved By Date
❑ Consery on¢Commission ❑ Approved By
Date
❑ D. . W Water 7 roved B ❑
D.P. W Approved Y ewer � Approved � By Date
D.P.W. Cross _ . Connection u roved APP By
Date _
Treasurer (Bond) 0 Approved By Date _
❑ D.P.W. Engineering El roved'B g g AP P
y
Da
te
to
7 ^
o rd o a f Health we
rov
(, DPP � BY Date
❑ Board of Health (sep c) J Approved By
Date
❑ Board of Health'(food service) _ Approved By
Date
f
❑ Planning 'o' and (parking) ] Approved By
Date
® FIRE DISTRICT (I II - III) Approved By Date
sssssua:as::as:::as:asasassssasa:a::aaassssssassass:a:::a::a::aasssas:::a:as:a
BUILDING DEPARTMENT APPROVAL:
J ❑ ZONING
❑ BUILDING INSPEZTOR/BUILDING COMMISSIONER
❑ CONTROL CONSTRUCTION AFFIDAVIT
PROJECT SUMMARY:
i
new construction/ alteration/demo sewage disposal public/private
[Alter/add interior walls][add rooms] [add footprint] water supply public/private riva
PP Y P / to well
P
[pool] (garage/s4e/,,2ckJ [game court] [food servicDescribe � 1 .
#
To � the various departmen
This notice has been forwarded to you for your information and an appropriate action. Should ou
Yhave
Y any
y
questions lease advise. If an reason .
P y as n to withhold the requested pe � rt is found, please advise. Your assistance and
cooperation is appreciated.
The Building Department- Date sent for review f�
BY
8
Iastraetions
The applicant shall complete this application to the best of their ability prior to submission, leaving no item mianswep%d. 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. Neft FiiFog fees not
(for office use only) ❑ FOUNDAT17ON ONLY
Total Cost Received By Date Rec'd
Leers Application Fee $
Total Permit Fee Permit # Lssued Dam
100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET
s
' y `7 , LOT / ZONING DISTRICT
CURRENT ACCESSORS PLAT
O HER ZONING OVERLAY DISTRICTS , if applicable
NUMBER & STREET :3 3
NEAREST CROSS STREET O S ! /t�O T J IZU
SUBDIVISION NAME & LOT # (.5 Al
or BUSINESS NAME
PREVIOUS TENANT (OWNER 1>415y
200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
THIS SECTION NOT APPLICABLE
t/
' Single family - number bedrooms 3 number baths 2 `Z
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
u Carport - detached attached to dwelling, dimensions L W
E Shed dimensions L W -
Deck - dimensions L % W %CJ
Gazebo - dimensions L W
Swimming pool above ground in -ground Size
LE Chimney - number of flues
10DW