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BP-09005800 MECHANICALS &'PRIMARY FUEL = 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) = 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? 1000 'LEQUIRED OFFSrREET PAREING - for ZONING & Architectural Access NOT APPLICABLE Parking Plan submitted To Z Building Department Planning Board Date submitted Number of spaces indoors outside ` total provided H-ndicap spaces - required ves no. If yes, how many as a pirt of the total required number. Is Route ti (State Road) Entrance permit required? ves no If yes has it been issued yes no Submit copy of application and/or permit as soon as available. 1100 IDENTWICATION (print or type except as noted) Current owner - name t v r i? I D address phone If corporation. officer in charge Architect/Fiagineer - for overall design 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 I reproductions. I _ Arceer - Proles 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) Company name N W A it T S ! G A1,9 T ly- Address Lip Ir(9 /2. 0 RzV 0 2 3- Y x Phone number /� q S Construction Supervisors license number r) NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not reproductions. sssssssssssssssssssssssssssssssssssssssssssssassssssssasssssssassssssssssssssssssssssssssssssssssss:sssas 1200 FOR RESIDENTIAL REMODEL WORK ONLY Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes _ No _ If no go to next seObon! Are you claiming exemption from the requirement? Yes _No ---If yes, submit the required affidavit! Rea ,)del contractor name (please print) Address Registration number (if none state *none') Phone number PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO 71= GUARANTEE FUND! QUESTIONS OR COMPLAINTS call or write: Home Improvement Conk -actors Registration One Ashburton Place - Room 1301 Boston, MA 02108 (617) 727-8598 Owners name (print) Signature Date i 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 Signatura� �!✓"_ The above signature is my voluntary act and is signed under the pains and penalties of e u P rJ ry. Date /0% 9 Z,2 Who is authorized to pickup the permit at the Building Department? (please arinn J N 1 1 Z Address i ACVS N T � 8, Phone 49k - % `� 7 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 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 accord2-ce with the rules and regulations promulgated by the BBRS enti!'ed Rules and Regulations for Licensing Constriction 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 hetshe resides or intends to reside, on which there is, or is intended to be, a one or two family dwellin , attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in two -tear 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 ssssssssssssssssssssssssssssssasssssssssssssss:assassssssssssssssssssssasassssssassssssssssssssssasssass 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 Z") sass:sssass::sssssssasssssss::sss:ssas::sssss:asssas:sssssssssass::::ssssasasssssssssssssss:sass::::sss: 1500 COST Cost of Improvement S Items to be installed but not included in the above cost: Electrical 5 Plumbing HVAC Other TOTAL, s '45v. Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration, rrequired. Demolition - describe structure Number of dwelling units Number of bedrooms A separate Refuse Dk,, Declaamton requhv& = Moving - (Provide copy of D.P.W. moving license) Type of structure from where (platllot 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 Twill not be enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwell1ing will be considered as an Alteration, otherwise will be included in new construction. (see Code section 340-1.10 for residential and Artich 8 it.. commercial) Temporary structure - includes when allowed, trailers, tents and the lice and only for limited periecils of time. Describe 500 CONSTRUCTION PLANS - NoI4 submitted. Why? Submitted, usually three sets required. Four sets for food service uses. Number of sets submittL..d C' 600 SITE PLAN ❑ Not required, why? Submitted When? - Previously, date ❑ With this application 700 UTELr IES - 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 (M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a water suplaly, when 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. Woodstove - used (will require inspection ptti: _- to installation), new (provide manufacturers instructions). Location(s) (list) Fireplace(s) (includes flue) List location(s) Game Court - describe (include overall dimensions) Tent, Trailer (Mobile Home) or Other - describe 300 CONWEtCIAL - PROPOSED PROJECT/USE 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) 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) i Educational - structure for training including child day care for those over 2 years 9 months (see Code Section Jz 04.0) s Factory / Industrial - (see Code Section 305.0) I-ligh Hazard - (see Code Section 306.0) 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) p } 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? - Other Describe the proposal briefly, INCLUDE - umber of dwelling unites and bedrooms or occupant load as applicable, also existing condition 1, 41S 7-19 L L- ��t� � f LL U/K(A), r,--�)c)X GN © LrL 1-�)/ /Uc- r /LJ t%ell C �. 400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED = New Construction and/or Addition - total gross square feet (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 alterationis). If project is an addition to existing structure Total gross square feet of existing ' FOR COMMERCIAL 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. «'ill this project require Peer review (over 400,000 cu.ft.) Yes No (see Code Appendix I) i i The following section for official use only. INSPECTORS' REVIEW Date plan reviewed 1 30 days to review period expires u OK to issue date Noy '� MR OK to issue subject to requested submittals (see project review worksheet) date DENIED see project review worksheet date HOLD reason date HOLD Subject to Zoning Board of Appeals action Comments Inspectors signature I) 6 , 199 Applicant informed of above - Date time staff (fax, phone, in person) s*zszzzzzsss:sssss*sssssszz*ssssssss**sxs*sssssssszssssssssssssssssssssss*sssss*ssssssssszzssssssss;ssssszs Over six months since approved for issue - DEEMED abandoned! Advise applicant. Hold 90 days for return then dispose if not picked up. Inspector Date Advised applicant Date Time staff (by phone, fax or in person) sssss*sssssssssssssz****ssssssszsssssssss*sss*szss*sssssssssssssssssssssssssasssssss*ss*s**ssssszs'ss*sszs OFFICEWVSPECTORS NOTES TOTAL FEE 7 Gross area - new construction .- Total Sq. Ft. alteration Total Sq. Ft. Permit is issued to Comments/notes on permit sss#sC;ass###siissfifs##issfssf#fsfiff##ssstii#is#ffissif#!f#f#iff#ifif#!ff#ff##is#sfiff##fff#fff#ifs###f 1600 TO THE APPLICArTIyREFERRAL AND APPROVAL Date of Application submission J Plat Lot Street Aquifer Zone Owner Owner mail address Owner phone # l' U ##z#z##szzzzz##xxx#s#xxsss#sssss#ss#s#sssfs#s#ssssssssiizsss#ssfax#sfsszsss#::::sssss#ssffssfsssssssizsxz OTHER INVOLVED AGENCIES The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACT THEM FOR RF�1itQtgp SpgMONS. s TAX COLLECTOR 7 Approved - HOLD By Date ❑ Board of Appeals ,- Approved By Date ❑ Conservation Commission C Approved By Date ❑ D.P.W. Water - roved B Approved y.___ ❑ D.P.W. Sewer —Approved By Date ❑ D.P.W. Cross Connection E: Approved By Date Q Treasurer (Bond) ❑ Approved By Date D.P.W. Engineering - Approved By Date Board of Health (well) -� ,Approved By Date t] Board of Health (septic) - Approved By Date ❑ Board of Health (food service) Approved By Date © Planning Board (parking) Approved By Date is FIRE DISTRICT (I - II`- III) - Approved By ssss#ssssasss�sssssssssssss::assssssssssssssssssssassssasssssssssssfssssssssssssssssssssDate ssssssssssssss BUILDING DEPARTMENT APPROVAL: n ZONING r3 BUILDING INSPECTORBUILDING COMMISSIONER ❑ CONTROL CONSTRUCTION AFFIDAVIT #z#xzzxzxx#zzssszxz#ssxx#sssssss#xsszsz#ss#:zszx#z#xzzxsz#szszz#zz#zzzzxzz#s*z*sxzzx#sx#ss#zxzz#zzxz#xz# PROJECT SUMMARY: new constructioni alteration/demo sewage disposal public/private [4lter)add interior walls] [add rooms] [add footprint] � ] water supply -public/private well [pool] [garage/shed/deck] [game court] [food service] � Describe_'-ILLS n C-1A 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 By TOWN OF DARTIVIOUTH' BULL ING DEPAR ANT TELEPHONE 508-999-0720 FAX: 508=999�.0738 APPLICATION FOR ZONING AND BU LDING PERMIT Iaatroetiona The applicant shall complete this application to the best of their ability prior to submission, leaving no item ®answered'. 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 lEVoc Em in ad (for oWme use only) ❑ 1 TIC'1N ONLY Total Cost C]'---Received By 6 to Reed Less Application Fee $f l Total Permit Fee — Permit # Date ja 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET cc CURRENT ACCESSORS' PLAT LOT ZONING DISTRICT OTHER ZONING OVERLAY DISTRICTS , if applicable NUMBER & STREET V 10A l U l'Z A t 1 I? NEAREST CROSS STREET SUBDIVISION NAME & LOT # or BUSINESS NAME _ CM PREVIOUS TENANT / OIVNER 200 RESIDENTIAL - PROPOSI,.D PROJECT - orw & two family residence only THIS SECTION NO x° APPLICABI = Single family - number b.Arooms number baths _ Two family - number bedrooms unit 1 number baths unit 1 number bed-;joms unit 2 number baths unit 2 I - Accessory apartment Total gross rq. i . Accessory structure: - Garage - detached - attached to dwelling, dimensions L W I I - Carport - detached - attached to dwelling, dimensions L W Shed dimensions L W Deck dimensions L W Gazebo - dimensions L W —,Swimming pool above ground in -ground Size Chimney - number of flues