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SEP 17 1995
�# �o
A
TOWr
OF
S/F NON -ILLUMINATED WALL SIGN.
}F..
.040 ALUM. FACE OVER 2E£ ALUM. A copy Of -`This El-iFv
ANGLE FRAME. Plan rilust Be Kept of 5 .
HI-PERF VINYL GRAPHICS APPLIED Date
DuringCasSdU�O
TO FACE PER CORP LOGO & COLORS,
iH6 is AN WrmisiRD D:7AM71G, tf NAs OEEN
GT.E/1F9 :9R YDUR rJSONAL USE It COwSTTON WITH -
,, PR0.1f.C1 DERJi' ,,.N1NED f-0R YOJ/-6Y rCgMT eYONa RJC.
AS SUM IT G rROTECTED UNDER F.xiRSriNG � $ j
LAWS AHD EXCErTRiG REGBTFAID r* wRra dwt a
RIINH iNE EaLIENE IROrERTY O`:i PY/ncf 9Aq RIG
UN 5 A UrVb: ALTOKY TURLHAEE ACr. ,(g�(6 MADE
tE IB NOf W DE 91oMY TV ANYONE ({�YT<gq WIT ORGANIZAIIQ(,
NOR S R TO DE USED. REF%=C®.i'C4, m EAtltNTED
N ANY FORM DR MANNER WYWSiOEY'1'EX. A.^-'8W1LE Of TM
DRWW, sHAL1 M DEEMED ACXItlPttTiTs, 0A3l tT AND
ACCEf NCE DP THESE TE MB AND C{DNDP(tiiS
ACCETTED DT W7E
ArehitectJEnginerr - project supervision and reports
800 NWCELANICAI.S & PRIMARY FUEL
Furnace (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify)
Company name
Boiler (heating)- Fuel gas (natural or propane), fuel oil, electricity, other (specify)
Address
HVAC (combined unit) - Primary fuel, natural gas, propane, electricity, other (specify)
Phone number
I
Air conditioning - (separate unit)
Certified by State of Massachusetts as
None of the above to be provided
Certification number
Hot Water Gas Electric Fuel Oil Other
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and mot
_
reproductions. -
-r
900 SPRffiYKLF.RS -FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
—
Required, —Plans provided, 7-,plans not provided, why?
General Contractor (if Homeowner, state homeowner here then complete section 1300)
Not required, not to be installed, Why?
Company name -S �__'/C-
Address - /A 'l C- (-/IV e-7 /�✓ A1JrCt1 /��1�/-y/�/.)
1000.REQUIRM OFF-STREET PARKING - for ZONING &Architectural Access
Phone number
NOT APPLICABLE
Construction Supervisors license number a ZZ-Gft/�:K
= Parking Plan submitted To -- Building Department L Planning Board Date submitted
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and mot
Y
I Dumber of spaces - Indoors outside total provided
reproductions.
P � -
H-ndicap spaces - required _ yes _no. If yes, how many as a pirt of the total required number.
Is Route 6 (State Road) Entrance permit required? yes77 no —. If yes has it been issued yes no _ .
1200 FOR RESIDENTIAL 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 go to neat section!
1100 IDENTIFICATION (print or type except as noted)
Are you claiming exemption from the requirement? Yes No _If yes, submit the required affudavit!
Current owner -name -5 c) L e pl ,91V (� %��O >� iQ �J �j ///
i
Ren_odel contractor name (please print)
address a3y 1 ! L (r— e9 SA /V i ..Sr /t/,ea-) 43 cbl ` 0 L'�' d
Address
phone #� Ff� - �.�/
Registration number (if none state "none")
l
�( If corporation, officer in charge 4 (pt- >��a l ,:j „4 a
Phone number
Architect/'Engineer - for overall design
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS'`TO THE
GUARANTEE FUND! QUESTIONS OR COMPLAINTS call or write:
I Company name
Home Improvement Contractors Registration
One Ashburton Place - Room 1301
Address
Boston, MA 02108
(617) 727-8598
Phone number _
Owners name (print)
Certified by State of Massachusetts as
Signature
L Certification number
Date
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
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
iss
ue,
six months after the last inspection if work has begun andthat the permit may be extended for six months if nbegun
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 L-
�( Signature
The above s' ature is my voluntary act and is signed under the pains and penalties of perjury.
Date
Who is authorized to pickup the perm�i; at the Building Department? lease grim) 44'17-4 Z.
,
Address ! C u Phone
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 accordarce wit;i the rules and regulations promulgated by the BBRS entitled
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 helshe 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 tos#g###ssbility ##ss##
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 ermit are res
2.15.2 of section 51 p ponsibie for code compliance. (see
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1500 COST
Cost of Improvement
Items to be installed but not included in the above cost: Electrical S -
Plumbing
HVAC
Other
TOTAL
_ Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaraition required.
_ Demolition - describe structure
Number of dwelling units Number of bedrooms A separate Refuse'Disposal
Declaration required.
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 -rooting - (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 aind will not be
enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing divielling will be
considered as an Alteration, otherwise will be included in new construction. (see Code section 3401.10 for
residential and Articl- 8 fL_ commercial) _
Temporary structum - includes when allowed, trailers, tents and the like and only for limited pf:,riods of time.
Describe
I
500 CONSTRUCTION PLANS
_ None submitted. Why?
= Submitted, usually three sets required. Four sets for food service uses. Number of sets submmitted
600 SITE PLAN
El Not required, why?
= Submitted When? = Previously, date C With this application
700 UrU I71ES
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 ss)upply, when
required, is available. See Code 780 CMR section 114.1.2)
Sewage disposal - required _ ves _ no, public sewer _ yes _ no
private septic - on -site _ yes _ no. Submit copy of permit as soon as available.
= Woodstove - used (will require inspection prior to installation new
F )+ (provide manufacturers
The following section for official use only)
instructions). Location(s) (list)
INSPECTORS' REVIEW
Fireplaces) - (includes flue) List location(s)
Date plan reviewed
'Game Court - describe (include overall dimensions)
30 days to review period expires
Tent, Trailer (Mobile Home) or Other - describe
OK to issue date SFp 17 1998
300 COMMERCIAL - PROPOSED PROJEC IUSE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES
OK to issue subject to requested submittals (see project review worksheet) c£late
THIS SECTION NOT APPLICABLE
— DENIM see prole . rL%`cvr yerslzcnu data
(The following descriptions are based on the Massachusetts State Building Code Article 3, AS NOTED) (See the
Code)
— HOLD reason date
Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe
HOLD Subject to Zoning Board of Appeals action
Comments
_ Business - office, assembly with less than 50 occupants - indicate Medical or other professional (see Code
Inspectors signature L..-'-� Date sEP ;
Section 303.0)
_ Educational -structure for training including child day care for those over 2 years 9 months
-
Applicant informed of above - Date time staff ((fax, phone, in person)
304.0) , (see Code Section
i
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a
Factory ;: Industrial : (see Code Section 305.0)
= Over six months since approved for issue - DEEMED abandoned!
Advise applicant. Hold 90 days for return then dispose if not pp Po picked up.
- High Hazard - (see Code Section 306.0)
Institutional - hospital, nursing home, infant day care (see Code Section 307.0)
Inspector Date
_ Mercantile - retail stores (see Code 308.0)"
- Advised applicant Date Time staff (by phone, fax or, "in person)
- Residential - three or more family, hotel (see Code Section 309.0)
(
f
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OFFICEUNSPECTORS NOTES
_ Storage - includes garages (see Code Section 309.0)
..
TOTAL FEE t J�
r Utility & Miscellaneous Structures _ includes tents and agricultural structures (see Code Section 311.0)
Gross area - new construction Total Sq. Ft.
- New tenant for and 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
Other .S l�si✓ /� /5 ftLL rtPefAZ�&`
Describe the proposal brie
P P fly, INCLUDE -umber of dwelling units and bedrooms or occupant bad as applicable,
also ezisting condition
Comments/notes on permit
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 any
alteration(s).
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.fL) Yes No. (If
yes
see 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
ss��ss•sss:sssssssssssssssssssssssssssss*ssss*sssssssssssssssssssssssssssss:ssssssssasssssss:ssssssIssas
1600 TO THE APPLICANTIREFER tAL AND APPROVAL
Date of Application submissions
Plat Lot Street 1N t Aquifer Zone
Owner 30 l /= R 0 0�b
Owner mail address
Owner phone # �cl i 99) < ,mot ;571
xx::ss::=:ss:sx::ssssx::s:sssss:ssssxs:ss:sxssss:s:ss:sss:s:::::ss:ssssx:ss::s::::sssssss:ss:s::sss::s:
OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional
Proposed project. CONTACT THEM FOR REOLii>Q permits or approval for your
-ED STBMIS.SIONS.
® TAX COLLECTOR:: Approved:: HOLD By Date
❑ Board of Appeals - Approved By Date
❑ Conservation Commission C Approved By
Date
❑ D.P.W. Water - Approved By p D.P.W. Sewer — APProved By Date
O D.P.W. CrossConnection Z Approved By Date
❑ Treasurer (Bond) ❑ Approved By Date
❑ D.P.W.' Engineering .- Approved By
Date
-3 Board of Health (well) :1 Approved By Date
❑ Board of Health (septic) Approved By Date
❑ Board of Health (food service) Approved By Date
❑ P➢`tinning Board (parking) - Approved By Date
® FAZE DISTRICT (I - II IIn — Approved By ' Date
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BUILDING DEPARTMENT ENT APPROVAL:
❑ ZONING
❑ BUILDING INSPECTORBUILDING COMMISSIONER
❑ CONTROL CONSTRUCTION AFFIDAVIT
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PROJECT SUAEMARY:
new construction/ alteration/demo sewage disposal - publiciprivate
[Alter,^add interior walls] [add rooms] [add footprint] water supply - public/private well
[pool] [garageshed/deck] [game court] [food service]
Describe 1 ,
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To the various departments:
This notice has been forwarded to you for your information and any se. Your
appropriate action. Should you have any
questions please advise. If any reason to withhold the requested permit is found, please adviassistance and
cooperation is appreciated.
The Building Department - Date sent for review `� r By
M�
Iasitvetiom
The applicant shall complete this application to the best of their ability prior to submission. leaving no item unanswered. "Me
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. Nth FFog fi e is not rdaiei�e-
(for owke use only) Fp Ohl; ONLY
Total Cost $ Received By Date Rec'd_
IA= Application Fee $ �_ k l/
Total Permit Fee $ A<aa�- Per & # � Isned Daft
100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET
G
CURRENT ACCESSORS PLAT LOT � ZO
NING DISTRICT
OTHER ZONING <)VEkLAiY DISTRICTS , if applicable
NUMBER & STREET V-Cev
NEAREST CROSS STREET
SUBDIVISION NAME & LOT #
or BUSINESS NAME 0 t
i
PREVIOUS TENANT / OWNER
200 RESIDENTIAL - PROPOSED PROJECT - one & two family'residence only
- THIS SECTION NOT APPLICABLE
= Single family -number bedrooms number baths
- Two family - 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, c:➢mensions L W
- 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