BP-50959�n�RnR�uf"TAT
COMMERCIAL
3.1 Licensed Construction Supervisor: pp
Not Applicable ❑
Name of Construction Sup ervisor )'w` 1,A_ y `y t 5 License Number
Address J 1" �- c`'� Expiration DateSignatur
Telephone (0��
new construction ❑ addition ❑ ❑ repairs ❑ accessory bldg. (shed/garage)
other (specify Sec. 6): ❑demolition ❑ sign . ❑ replacement window/door no. of windows doors
The following descriptions are based on the Massachusetts State Building 6th Edition, Code Article 3, as noted Seethe ode
❑ Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0)
Dribe:
r�Business - office, assembly with less than 50 occupants - indicate Medical or other professional (see Code Section 303.00)
❑ Education - 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)
❑ Institutional -hospital, nursing home, infant day care (see Code Section 307.0)
❑ Mercantile - retail stores (see Code Section 308.0)
❑ Residential - three or more family, hotel (see Code Section 309.0)
❑ Storage -includes garage (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, please indicate (see Code Section 119.0 and Zoning By -Law Section 35)
❑ 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 (if extra space is needed, attach an additional sheet):
IYI tN� owl `�-E�'i�G 6!�►N�t drat ct�► n� .
vim-- w,a_kXX5A&1 1 &00 1 T cw or 7VIV8um,
Iv w Construction and/or Addition (total gross cubic feet proposed) - indicate
If tl�4roiect is an addition to existing structure - total gross square feet of existing: -
Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration is required.
Will this project be subject to CONSTRUCTION CONTROL (over 35,000 cu. ft.) Wyes ❑ no
If yes, see Code Section 116.0. Designer to submit Code Synopsis in addition to original plans.
Will this project require Peer Review (over 400,000 cu. ft.) o yes ❑ no (see 110.1 Code & Appendix I) `
APPLICANT TO PROVIDE PEER REVIEW AT THEIR EXPENSE. SEE 780 CMR
❑ Demolition* - describe 'structure:
❑ Moving* - (provide copy of DPW 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:
❑ Replacement doors and windows - (for existing only) (only where doors and windows exist and will not be emlarged) 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 3603.21 for residential and Article 10 for commercial).
❑ Temporary structure - includes, when allowed, trailers, tents and the like and only for limited periods of time.. Describe:
❑ Furnace (hot air) -fuel gas (natural or propane), fuel oil, electricity, other (specify):
❑ Boiler (heating) - fuel gas (natural or propane), fuel oil, electricity, other (specify):
❑ HVAC (combined unit) - primary fuel, natural gas, propane, electricity, other (specify):
❑ conditioning - (separate unit)
9 None of the above to be provided M*l NTAl N *Ctf Cs
❑ Hot Water: Gas Electric Fuel Oil Other
❑ ired: plans provided plans not provided, why? (vi¢ll NR1 tJ'I'
'Not required, not to be installed, why?z�C� cS�-'� h'►ar�C� �l�' g '�
❑ Parking plan submitted to: Building Dept. Planning Board date submiitted
Number of spaces - indoors outside total provided
Handicap spaces - required yes no if yes, how many as a part of the total requitedl
number
Is Route 6 (State Road) entrance permit required? yes no ---'if yes, has it been issued? ,yes no
Submit copy of application and/or permit as soon as available. � Nb pLA 4 `>° aYl,�! nor ►{nr
11.1 Architect/Engineer - for overall design
Company Name: R .1� VAtt7/� 7 �. �N e
Address: c3m�YIYC',
Phone #: �t9 cl? It-49_L�;V
Certified by State of Massachusetts as:
Certification Number:
Note: Signatures and seals on all plans affidavits, & other documents SHALL BE originals and not reproductions.
11.2 Architect/Engineer - project supervision and reports
Company Name: R . A. V 4 ?515 ®Cl
Address: per- � a&-&7Drd m� ? Z.,
Phone #: ��l . ZQ'7. O �6
Certified by State of Massachusetts as: ZC);z B%&l T,-MP'
Certification Number:
Note: Signatures and seals on all plans affidavits, & other documents SHALL BE originals and nrot reproductions.
11.3 General Contractor
Company Name:
Address: �/h!N t' C auT�E r #"A- C- `F)
Phone #: ,fig (05040
Construction Supervisors License Number
Note: Signatures and seals on all plans affidavits & other documents SHALL BE originals and mot reproductions.
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Page 3 rev. March 12.2004
COMMERCIAL
Item Estimated Cost ($) to nearest dollar. To be completed by permit applicant
1. BuildingO Do O
2. Electrical 066
3. Plumbing O0 0
4. Mechanical (HVAC)
5. Total = (1 + 2 + 3 + 4) Estimated Total Cost Including Labor: $ L% d� 600
I, 1*4V. \rt as Ownerof the subje property hereby authorize !Rc�. l }� >JCi► V 10� 5
to act on my behalf, in all m tters relative to ' rk th 'zed b s building permit application.
v Wbiv tb�o ` �'�
VN�
Signatu of Owner - Date
I, 't O\ S as Owner/Authorized Agent hereby declare that the statements and information
on the foregoing application are true and accurate, to the best of my knowledge and belief.
0
rgn7unde ea' d al 'es of perjury.
10 % "off f 7
Sign e of Owner/Agent Date
1. Date plan reviewed: 5. DENIED '(see project review worksheet):
2. 30 days to review period expires: Date:
3. OK to issue date: 6. HOLD reason:
4. OK to issue subject to requested submittals (see project Date:
review worksheet): Date: 7. HOLD subject to Zoning Board of Appeals action:
8. Comments:
9. Inspector's Signature: Date:
Applicant informe o o e Date: / Time: Clerk) at
Comments: ( c�
Total Permit Fee: ze?v' Less Application Fee: $ 25.00 Remaining Balance:
Gross Area - New Construction
Gross Area - Alteration_
Permit Issued To:
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COMMERCIAL
$25.00 APPLICATION FEE IS NON-REFUNDABLE & NON-TRANSFE BLE
DA;-TE RECEIVED
DARTMOUTH BUILDING DEPARTMENT
ti
z$ 400 Slocum Road, P.O. Box 79399 a ..
Z
34 :: Dartmouth, MA 02747
508-910-1820 FAX 508-910-1838 4'
APPLICATION TO CONSTRUCT, REPAIRRENOVATE OR DEMOLISH A COMMERCIAL BUILDING (im-61udes 3 or more family dwellings)
Zoning Review:
Energy Report:
Fire Chief:
Board of Health:
Conservation Commission:
Other:
Work
Signature: 62 K/ `- Late: Vk1 1 4' 0 cuur
Signature: Late:
Signatur
Signature: Late:
eoe-
Signature: late:
Signature: Date:
'erformed: M / A16P- W r * McN ?'b ie)qQS r1.v& 6YN 25W. ne-
1.1 NUMBER OF PLANS SUBMITTED: 1.2 SITE PLAN SUBMITTED: ❑ yes ❑ no
1.3 Property Address: -.2f Vrnl-i2tt- 1.4 Assessors Plat & Lot Number:,
M
Nearest Cros Street:
Bus. Name: 1 Plat c3 Lot -
Total Land Area Sq. Ft.:
1.5 Water Supply (MGL c 40 § 54): / 1.6 Sewage Disposal System:
12' icipal ❑ Private Well �'Municipal 10 On Site Disposal System
2.1 Owner of Record -LRl �Ji9 N
->$ V �N"N /�°i J�f 11�-
Name
Name (print)
Contact Address Telephone
2.2 Authorized Agent:
�3Co �wNC� �- �
lS
MIVIO
R • P cam
1-& - -- leV-
, f5re&-Q�yp
Name (print)
Contact Address Telephone
c•\hlda fnrmc\hldaann r ®paved rev. March 12. 2004