BP-51436COMMERCIAL;
::. ::.::::.:<.;:..:...:::::..::
3.1 Licensed Construction Supervisor: Not Applicable ❑
Name of C--o a*i€�ieor License Number
Address (Y Atka- 11,J17- VP M"!`��rPa(fODdWg Expiration Date
...S. i atu..............
Telephone
e hone
�6
9g
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit (MGL 152 Section 25A)Signed Affidavit Attached: f`�yes ❑ no
..:.:.::.;:.:
❑ new construction ❑ addition ❑ ❑ repairs ❑ accesso
ry Dbld . (
shed/g
ara e)
❑ h of er (specify Sec. 6): ❑ demolition 'sign ❑ replacement window/door no. of windows doors
Thefollowing
llowin de
scriptions scri do ns ar
e ba
sed on th
e
./� Massachu sett g P s State
CodeABuilding
6 th Edition Code Artic
le 3 as , noted See the
ssembl - restaurant, e theater, sch0leto: (see Code
e S crion 302.0
Describe: ��M111', P17ef T'e' 00 � )
❑ Business - office, assembly with less than 50 occupants - indicate Medical or other professional (see Code Section 303.00)
El 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)
❑Me
rcantile - re
tail stores
(see Code
Section 308.
0)
• Residential - three or more family, ho
tel see Code
Section 30 9.0
❑ 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 bedroom�s r occupant load as applicable, also existing
condition (if extra space is needed, attach an additional sheet): j�/!/"�79f� C' 3 `X(� ` J%U�G0_ f 14
I C• 2_ tX ISI%U&- P60 144-LA/W&7—t- 1YM&b1YV& rl&,Kj
..........::::::.::::::::::::
::...<.;;;;:.;:.;..::::::::::.:::::::::.:.::.::::.;:.:,>;.;
....:............. Y71..�T 1bRT.'Ti?.13E:.P ::::::::::..:::::::.:::::::::. E :.:::............:
New Construction and/or Addition (total gross cubic feet proposed) - indicate V A J7�N! / �t^g t f 1 / . y/W
1"If die project 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.) ❑ yes ❑ 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.) ❑ 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:
c:\bldg. forms\bldgapp.com Page 2 rev. March 12, 2004
COMMERCIAL
❑
Replacement
cement doors andwmd windows
(for existing only) (only where doors and windows exist and will not 1=ae enlarged) EGRESS
dimensions must be maintained. Enlarged or new windows in an existing dwelling will be considered as3'an alteration, otherwise will
be included in new construction. (see Code Section 3603.21 for residential and Article 10 for commerciall)_
❑ Temporary structure - includes, when allowed, trailers, tents and the like and only for limited periods of time. Describe:
Furna
ce(hot
air - fuel gas (natural
tural or pro
pane),ane
), fuel oil electricity,
other (specify):
3)
11 Boiler (heating) -fuel gas (natural or propane), fuel oil, electricity, other (specify):
❑ HVAC (combined unit) - primary fuel, natural gas, propane, electricity, other (specify):
❑ Air conditioning - (separate unit)
11 Non f e o the above to be provided
❑ Hot Water: Gas Electric Fuel Oil Other
❑ Required: plans provided plans no
t provided
wh
El Not required, Y•
n 9
of to be in
stalled,
dwh.
> Y
❑ Parking plan submitted to: Building Dept. Planning Board date-sulbmitted
Number of spaces - indoors outside total provided
Handicap spaces - required yes no if yes, how many as a part of the total requireed
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.
{
11.1 Architect/Engineer - for overall design
Company Name:
Address:
Phone #:
Certified by State of Massachusetts as:
Certification Number:
Note: Signatures and seals on all plans, affidavits & other documents SHALL BE originals and nrot reproductions.
11.2 Architect/Engineer - project supervision and reports
Company Name:
p Y
Addre
ss:
Phone #:
Certified by State of Massachusetts as:
Certification Number:
Note: Signatures and seals on all plans, affidavits, & other documents SHALL BE originals and nit reproductions.
11.33 General Contractor
" Company Name: J
r
Address:_ 13 %Jb k- 14G- AV tl/% l M40r.'E7
(�dnstruction Supervisors License Number �S 9
Note: Signatures and seals on all plans, aTdavits & other documents SHALL BE originals and n(pt reproductions.
i
c:\bldg. forms\bldgapp.com Pnve _
COMMERCIAL
c:\bldg. forms\bldgapp.com Page 4
rev. March 12, 2004
COMMERCIAL
$25.00 APPLICATION FEE IS NON' -REFUNDABLE & NON -TRANSFERABLE',
,DATE.REC21VED
."C/"THE/yam DARTMOUTH BUILDING DEPARTMENT
t
'o 400 Slocum Road, P.O. Box 79399
K Dartmouth, MA 02747
508-910-1820 FAX 508-910-1838
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A COMMERCIAL BUILDING (includes 3 orf more family dwellings)
Zoning Review: Signature: 'e-71'` ZDate: DEC 0 7 2007
Energy Report: Signature: � Date:
Fire Chief- Signature: Date:
Board of Health: Signature: Date:
Conservation Commission: Signature: Date:
Other: Signature: Date:
Description of Work Being Performed:
1.1 NUMBER OF PLANS SUBMITTED:: / 1.2 SITE PLAN SUBMITTED: ❑ yes 10 no
1.3 Property Address: c t%r /U� 1.4 Assessors Plat & Lot Number:
Nearest Cross Street: &Janc 0,01WW- PAD % p
Bus. Name: ��1� fr��F�d��`Phone#�''%g�°Y� Plat Lot
3�[
Total Land Area Sq. Ft.:
1.5 Water Supply (MGL c 40 § 54): 1.6 Sewage Disposal System:
,Municipal ❑ Private Well aMunicipal ❑ On bite Disposal System
2.1 Owner of Recor � � / % r— &
Name (print) hZ Contact Address Telephone
Ij
2.2 Authorized Agent:
ey salm- h&wq- 16w awnm) bew&,-1
Name (print) Contact Address4 avf Telephone
� (W;6 1
c.-Wda fnrTnc\h1daann r.nm Pace 1 rev. March 12. 2004