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BP-11799:ssss:asssssssssssasssssasesssssfssssss�=sssesesssssssssssssssssessssssssssresssssssssssssssssssessssss 1600 TO THE APPUCANTIREFERRAL AND APPROVAL Date of Application submission Plat Lot Street Aquifer Zone Owner Owner mail address Owner phone # ::ssssss::sss::sss::sssssssss::::ssss:s*::sss::ssss:::::ssss::::sss:::s::::s::ss'ss":sssssssss::sss::sss OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional Proposed project. CONTACT 771M FOR REOZ�D permits or approval for your SUBMISSIONS. ® TAX COLLECTOR = Approved = HOLD By Date ❑ Board of Appeals = Approved By . Date ❑ Conservation Commission ` Approved By Date ❑ D.P.W. Water = Approved By ❑ D.P.W. Sewer _ 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 (well) = Approved By Date ❑ Board of Health (septic) = Approved By Date ❑ Board of Health (food service) = Approved By Date ❑ Planning Board (parking) = Approved By Date 2 FIRE DISTRICT (I - II - IIn _ Approved By sss:::sssssssssssssssssssssssssssssssssssssssssssssssssss:sss::sssssssss:::::sss:::ssssss Date :sssssssss::: BUILDING DEPARTMENT APPROVAL: ❑ ZONING ❑ BUILDING INSPECTOR/BUILDING C0:1LNIISSIONER ❑ CONTROL CONSTRUCTION AFFIDAVIT ::::ssss:::ssssssssssss:sss::sssssssss:::sss:sss:::::sssssssss::sss:ssss:::sss::::sss::ssssss*:sssssssss PROJECT SUMMARY: new constructions alteration/demo sewage disposal - publiciprivate [Alter add interior walls) [add rooms] [add footprint] water suppiv - publiciprivate well [pool] [garage'shed/deck] [game court] [food service] Describe ss:ssss:::sss::::sssssssss**ss:sss*ssssss:.::ssssssssssss"*:::sssssssss::s::s::::ssss:ssss:sssssssssssssssss 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 anv reason to withhold the requested permit is found, please advise. Your assistance and cooperation is appreciated. The Building Department - Date sent for review By Cn J Q n. Q 1L 0 [Y 0 co TOWN OF DARTMOUT3 tTILDING IEPFA7ENT. TELEPHONE 508-999-0720 FA> 508=999-0738 APPLICATION FOR ZONING AND BUILDING PERMIT Instroetiam •. The applicant shall complete this application to the best of their ability prior to submission. leaving no item umanswered.'Ile Department staff will be available during regular business hours to assist as necessary. NIA should be insertced for those sections which do not apply. A properly completed application will help avoid unnecessary delays. No t IEim lee irs, a t x (for OMM use only) FC11 !NIJl,9N ONLYTotal Cost $ Received By Bate Reed Less Application Fee $ Total Perm' Fee Z Permit # bsned Date_ 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET', t - '.,.' � ' CtRRENT ACCESSORS' PLAT LOT ONING DISTRICT OTHER ZONING OVERLAY DISTRICTS , if applicable PtMBER &STREET NEAREST CROSS STREET _ e%. S )IDIVISION NAME & LOT # ..... :ate or BUSINESS NAME Yi nYe1(4Cr3 e-% Mr t'CQ T5he PREVIOUS TENANT / OWNER 200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only THIS SECTION NOT APPLICABLE Single family - number bedrooms number baths = Two family - wymber bedrooms unit 1 number baths unit 1 number bedrooms unit 2 number baths unit 2 (3- _ Accessory apartment Total gross sq. ft. _ Accessory structure: = Garage - detached - attached to dwelling, dimensions L Cl) U= 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 = Woodstove - used (will require inspection prior to installation), new (provide manufacturers The following section for official use only. instructions). Locations) (list) .4 INSPECTORS' REVIEW = Fireplace(s) - (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 JUN 3 0 1999 300 CO-MMMCIAL - PROPOSED PROJECr/USE _ INCLUDING THREE FAMILY OR MORE AND EXEMPT USES - OK to issue subject to requested submittals (see project review worksheet) date - THIS SECTION NOT APPLICABLE = DENIED see project review worksheet date (The following descriptions are based on the Massachusetts State Building Code Article 3, AS NOTED) (See fire Code) r HOLD reason date = Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe = HOLD Subject to Zoning Board of Appeali action Comments = Business -office, assembly with less than 50 occupants - indicate Medical or other professional (see Code __ __' J�1N' 3 0 1999 Inspectors signature atLa Section 303.0) Educational - structure for training including child day care for those overt years 9 month = s (see Code Section = Applicant informed of above - ate time staff (fax, phmne, in person) 304.0) sssssssss:s::ssssssssssssss::ssssssssssssssss:ssssssssssssssssssssssssssssssssssssssssssssssmsssssss:sssss - 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 picked up. - High Hazard - (see Code Section 306.0) = Institutional - hospital, nursing home, infant day care (see Code Section 307.0) Inspector Dmte Mercantile - retail stores (see Code 308.0) Advised applicant Date Time staff (by phone, fax or in persom) _- Residential - three or more family, hotel (see Code Section 309.0) ssssssssssssss::::::::::ssssss::ssssssss:::sssss:ssssssss:::sssssssss:::ssssssssssssssssssstsssssssssssss OFFICEUNSPECTORS NOTES = Storage - includes garages (see Code Section 309.0) TOTAL FEE'�J = Utility & :1f➢scellaneous Structures - includes tents and agricultural structures (see Code Section 311.0) Gross area - new construction �-� Total Sq. Ft. = New tenant for any of the above, indicate above (see Code Section 119.0 and Zoning By-law section 35) alteXtion Total Sq. FL = Tent or Trailer - temporary purpose? Permit is issued to 10, 0�,h - -t��/ �Q - Other t^,f Describe the proposal briefly, INCLUDE -umber of dwelling units and bedrooms or occupant load as applicable, also existing condition Comments/notes on permit 80ARD 400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORM OFED APP _ New Construction and/or Addition - totaI gross square feet Casa # FAILS Q ® (For commercial only total gross cubic feet) -indicate V 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 COMN[ERCIAL 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. Will this project require Peer review (over 400.000 cu.ft.) Yes No (see Code Appendix I) APPLICANT TO PROVIDE 1300 OWNER SIGN -OFF = Alteration of existin no increase in gross square feet. A separate Refuse Disposal requuired. g, g q p posit Declaration 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 sic 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 1� iQ,n Lt� The above signature is my voluntary act and is Date under the pains and penalties of perjury. Who is authorized to pickup the permit at the Building Department? (please printl 91 j Address �'i'��7i' Y4 Mne4q[' '1r/f � 1 1400 HOMEOWNER ERF.MPTTON - ONE & TWO FAMILY ONLY FOR HOME OWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT 109.1.1 Licensing of Conshmcdon 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 r^ t:ction, reconstruction, alteration, repair, removal or demolition involving the structural elements of buildings or ~sres, unless he or she is licensed in accord2-.ce with the rules and regulations promulgated by the BBRS e ati!'ed kLies 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 heishe 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 to, general liability ssssssssssssssssssssssssssssssssssssssssssssssssssssss*ssssssssssssssssssssssssssssss*sss*asses*ssssssss 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 5) =*==ass*ss**_*•**__****=**ssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss 1500 COST Cost of Improvement (? bo Items to be installed but not included in the above cost: TOTAL Electrical S Plumbing HVAC Other = Demolition - describe structure Number of dwelling units Number of bedrooms A separate Refuse Disposa,'1 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 -roofing - (for existing only, is included in new construction) Number of square feet Number of layers when complete A separate disposal declaration REQUIRED Number of layers already existing = Replacement doors and windows - (for existing only) (only where doors and windows exist and will'. .not be enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwelling wrill be considered as an Alteration, otherwise will be included in new construction. (see Code section 3401.10) for residential and Articl- 8 fL commercial) C Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods oif time. Describe 500 CONSTRUCTION PLANS 0 e44ar o n Nq X, l S`('� rn(�� j (�� Q`Z'q n . = None submitted. Why? = Submitted, usually three sets required. Four sets for food serviceluses. Number of sets submitted 600 SITE PLAN ❑ Not requir-ed, why? = Submitted When? = Previously, date C With this application 700 VTH.ITIES 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 supply,,,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. 800 I CECHANICALS & PRIMARY FUEL Archite4(Engineer - project supervision and reports = 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 SPMKLERS - 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 REQUIRED OFFSTRI= PARSING - for ZONING &Architectural Access = NOT APPLICABLE = Parking Plan submitted To =Building Department Planning Board Date submitted Number of spaces - indoors outside total provided H-ndicap spaces - required _ yes _no. If yes, how many as a p?rt of the total required number. Is Route 6 (State Road) Entrance permit required? yes no If yes has it been issued yes = no 7. Submit copy of application and/or permit as soon as available. 1100 IDEN MCATION (print or type except as noted) Current owner - name Al CC h S07- 10r SQL (f address 17 h-CACift-t-12a::L 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. 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 n(bt reproductions. General Contractor (if Homeowner, state homeowner here then complete section 1300) Company name ? ny) f S, 9 C o Address---) OU N k `i-h y Nf-c.� . W 0-- O -D 9 4C) Phone number ' C)4d—ft j Construction Supervisors license number (221 '7 6 0'-- NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and nmt reproductions. sssssssssssssssssssssssssssssssssssss:sss:sssssssssssssssssssssssssssssssssssssssssssssssssssssstssssssss 1200 FOR RESIDENTIAL REMODEL WORK ONLY Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes _ No ,_ If no go to nex'.; section! Are you claiming exemption from the requirement? Yes NO _If yes, submit the required affidavit! Ren_,)del contractor name (please print) Address Registration number (if none state "none") i Phone number PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS IrO THE GUARANTEE FUND! QUESTIONS OR COMPLAINTS can or write: Home Improvement Contractors Registration One Ashburton Place - Room 1301 Boston, MA 02108 (617) 727-8598 Owners name (print) Signature Date i 7�