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'i Ar4�+oric is Exdusive :Property of. G � �
a
Beaumont Name -[?ate - (� = - V Cj
$ildn Co., Inc. tee: NuTber.
200 North Street
New Bedford, Ma M740
508—M-17O1 1-800-474-1701 Fax 5O8-993-3230
800 MEC HAAIICALS & 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 5PRiNKLERS - 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 `tEQUIRED OFF-STREET PARKING - for ZONING & Architectural Access
NOT APPLICABLE
Parking Plan submitted To Z Building Department Z Planning Board Date submitted
Number of spaces - indoors outside total provided
Handicap spaces - required _ ves no. If ves, how many as a p?rt of the total required number.
Is Route 6 (State Road) Entrance permit r3 qu red? ves no =. If ves has it been issued yes = no
Submit copy of application and/or permit as soon as available.
1100 MEN i IFICATTON (print or type except as noted)
Current owner • name A L C—U v v @_,i
address
�(ra
phone #
If corporation. officer in charge
Architect/Engineer - 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
reproductions.
Architect/Engineer project 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 originaiis and not
reproductions.
General Contractor (if Homeowner, state homeowner here then complete section 1300)
Company name 14- C6
Address kJorr
Phone number �qo t 1( f
Construction Supervisors license number a�
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
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1200 FOR RESIDENTIAL REMODEL WORK ONLY
Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes _ No _ If no ger) to next section!
Are you claiming exemption from the requirement? Yes �No yes, submit the requiired affidavit!
Remodel contractor name (please print)
Address
Registration number (if none state "none")
Phone number
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE
GUARANTEE FUND! QUESTIONS OR COMPLAINTS call or write:
Home Improvement Contractors Registration
One Ashburton Place Room 1301
Boston, MA 02108
(617) 727-8598
i
Owners name (print)
Signature
Date
I
I
1300 OWNER SIGN - OFF
— Alteration of existing, no increase in gross square feet. A separate Refuse Disposal IT+acmration required: -
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 and
Demolition - describe structure
my knowledge 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
:Number of dwelling units Number of bedrooms A separate ll;,---fuse Disposal
Declaration
work is begun or
six months after the last inspection if work has begun the egu permit may be extended for six months ff
req�-
no work is
anticipated if Irequest such an extension in writing. I understand that the permit may be extended or y three times by
written request. I understand that once the permit expires a new
— Moving
— vmg - (Provide copy of D.P.W. moving license) Type of structure
application may be required, including fees and current other requirements (including Zoning),
Ai Cb
from where (plat/lot or address)
Name trV{
i
`�✓
to where (plat/lot or address)
Signature
'the a owe signature is my voluntary act and is signed under the pains and penalties of
Number of dwelling units Number of bedrooms per dwelling unit
perjury.
Date & / i f ,
= Re -roofing - (for existing only, is included in new construction)
Who is authorized to pickup the permit at the Bung Department? (please crintl
Building
Number of square feet Number of layers already existing
Address 4LW 1-`{'i+1 5 '1" Phone
Number of layers when complete
1-400 HOMEOWNER EXEMPTION - ONE & TWO FAMILY ONLY
A separate disposal declaration REQUIRED
;FOR HOME OWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT
- Replacement doors and windows - (for existing only) (only where doors and windows sexist and will not be
109.1.1 Licensing of Construction Supervisors: Except for those structures governed by Construction Control
enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an exisfting dwelling will be
in. Section 127.0, effective July 1, 1982, no individual shall be engaged in directly supervising persons engaged in
tea$
construction, reconstruction, alteration, repair, removal or demolition involving the structural elements buildings
considered as an Alteration otherwise will be included '
m new construction. (see Code s;ectton 3401.10 for
of or
structures, unless he or she is licensed in accord2-ce with the rules and regulations promulgated by the BBRS entitled R.les and Regulations for Licensing Constriction Supervisors.
residential and Artid� 8 fa: commercial)
Exception:Any Home Owner erform
p mg 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.
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.
Describe
For the purposes of this sectioc only, a "Home Owner" is defined as follows: Person(s) who owns
500 CONSTRUCTION PLANS
a
on - which hershe resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, a of land
dwelling,
or detached structures accessory to such use and/or farm
=None submitted. Why?
structures. A person who constructs more than one home in
two-year period shall not be considered a Home Owner.
� •' o i -,/
- Submitted, usually three sets required. Four sets for food serviceiuses. Number of seas submitted
If s-ou are applying under this section sign below:
600 SITE PLAN
Signature
Your signature carries certain responsibilities, including but not necessarily limited to general liability
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❑Not required, why?
NOVICE TO LICENSED CONTRACTORS: The Building Code
—Submitted When? Previously, date ^With this application
provides in the Rules and Regulations section that any
licensed Construction Supervisor, whether or not they have taken the permit are responsible for
2.15.2 of section5) code compliance. (see
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700 VTLIMIE.g
- ,.
1500 COST
Water supply - required yes no, public ? yes _ no, . on site well? _ yl� no,
Cost of Improvement
_
existing? _yes _ no
Items to be installed but not included in the above cost: Electrical 5
If required and not existing have necessary permits been issued? _ no _ yes, date.
Plumbing
(M.G.L. Chapter 40, section 54 provides that no building permit may he issued unless a (water supply, when
HVAC
required, is available. See Code 780 CMR section 114.1.2)
Other_
Sewage disposal - required _ yes _ no, public sewer _ yes _ no
TOTAL S OJ 00 f3�
private septic - on -site _ yes — no. Submit copy of permit as soon as available.
= Woodstove - used (will require inspect; a -prior 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 COMIITERCIAL`- 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)
Educational - 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 daycare (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)
New tenant for any of the above, indicate above (see Code Section 119.0 and Zoning By-law section 35)
Teat or Trailer- temporary purpose?
Other 13
Dcscrii)e the proposal briefly, INCLUDE -umber of dwelling units and bedrooms or occupant load as applicable,
,also existing condition -
-100 'YPE OF CONSTRUCTION OR WORK TO BE PERFORMED
i 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.ft.) -Yes No. (If ves
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
The following section for official use only.
INSPECTORS' REVIEW
Date plan reviewed
30 days to review period expires
OK to issue date
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 Dane
Applicant informed of above - Date time staff (fax, phone, in person)
= 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)
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OFFICE\INSPECTORS NOTES
TOTAL FEE
Gross area - new construction Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit
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1600 TO THE APPLICANTMWERRAL AND APPROV
p
Date of Application submission' 1
Plat a Lot Street 9 7
J' v
Aq
uifer Zone
Owner
Owner mail address
Owner phone #
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OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits
or approval for your
proposed project.. CONTACT 7TEM MIONS.
o TAX COLLECTOR = `Approved HOLD By
77=M
Date
❑ Board of Appeals — Approved By
Date
p Conservation Commission I Approved By
Date
❑ D.P.V. Water —'Approved By O D.P.W. wer _Approved By
Date
❑ D.P.W. Cross Connection . _ Approved By
Date
❑ Treasurer (Bond) ❑ Approved By
'
Date
❑ D.P.W. Engineering = Approved By
Date
7 Board of Health (weir App ed By
Date
o Board of Health (septic) — pproved By
Date
❑ Board of Health (food ervice1 _ Appmo By
Date
❑ Planning Board (parking) - Approved By
Date
® FIRE DISTRICT (I - II - III) — Approved By
Date
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BUILDINGDEPARTMENT APPROVAL:
❑' ZONING
❑ BUILDING INSPECTORBUILDING COMMIISSIONER
CONTROL CONSTRUCTION AFFIDAVIT
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PROJECT SUMMARY:
new construction/ alteration/demo sewage disposal - pubhciprivate
[Alter add interior walls] [add roomsj' [add footprint] water supply -
publiciprivate well
[pool] [garage/shed/deck] [game court] [food service]
Describe
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 Buiidina Department - Date sent for review %
By
(for oSim ooe aaiy) ❑ f :ONL]Y
Total Cost S "�+ Received Date Reed 7
Less Application Fee $
Total Permit Fee f Permit # Date r
100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET
f � ,
CURRENT ACCES SORS' PLAT LOT / ZONING DISTRICT
OTHER ZONING OVERLAY DISTRICTS , if applicable
NUMBER & STREET'Rl'I
NEAREST CROSS STREET
- SUBDIVISION NAME & LOT # or BUSINESS NAME
p
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 l
number bedrooms unit 2 number baths unit 2
= Accessorypar apartment Total gross sq. ft. j
— i
— Accessory structure:
Garage detached - attached to dwelling, dimensions L W
Carport - detached - attached to dwelling, dimensions L W
Shed - dimensions L R'
- Deck - dimensions L W
- Gazebo dimensions L W
_ Swimming pool above ground in -ground Size
= Chimney number of flues
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