BP-911800 MECHANICALS & PRIMARY FUEL
= Furnace (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify)
Boiler (heating)- Fuel gas (natural or propan , fuel oil, electricity, other (specify)
� HVAC (combined unit) -primary fuel, n1ra g opane, electricity, other (specify)
Air conditioning (separate unit)
i
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 prod e, w
- Not required, not to be installed, Why?
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1000 REQUIRED OFF-STRELrT PARiKING - for ZONING & Architectural Access
= NOT .-APPLICABLE
Parking Plan submitted To = Building Department _.lann' g Board Date submitted
Number of spaces - indoors outsidet provided
H%ndicap spaces - required ves no. If ves w ma y s a art )f the total required number.
Is Route 6 (State Road) Entrance permit required yes no If yes has it been issued yes no 7.
'a
Submit copy of application and/or permit as soon as available.
1100 IDENTIFICATION (print or type except as noted)
Current owner - name e-,
i
address r j C OV�
1 phone #�
If corporation, officer in charge
Architect/Engineer - for overall design
Company name
Address
i
li 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.
i
i
ArchitectJEagineer - 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 originals and not
reproductions.
General Contractor (if Homeowner, state homeowner here then complete section 1300)
Company name
Address
Phone number
Construction Supervisors license number
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 _ IL':no go to next section!
Are you claiming exemption from the requirement? Yes —No _If yes, submit the, `required affidavit!
Ren_odel contractor name (please print)
Address
Registration number (if none state 'none")
Phone number
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVIE 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
Owners name (print)
Signature
Date
1300 OWNER SIGN - OFF
I, the undersigned, am the owner
_ Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaraition required -
of record or authorized lessee (provide documentation) and I have review ed
the application herein submitted. I state that � the best of my knowledge and belief that the information
-
_ Demolition describe structure
provided '
application is true -and correct and that the permit requested_be issued. m this
Further I understand that the permit will expire in six months, from the dale of issue,Number
if no work is begun or
sip months after the last inspection if work has begun and•that the
of dwelling units Number of bedrooms A separate Refuse IDis posai
Declaration required.
permit may be extended for six months if no work is
anticipated if I request such an extension in writin g. I understand that the permit may be
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written request.extended only three times b y
understand that once the permit expires a new application may be required, including fees and
other requirements (including Zoning).
— Moving - (Provide copy of D.P.W, moving license) Type of structure
curie at
Names C {' `' ��
from where (plat/lot or address)
+ f
Signature
to where (plat/lot or address)
The above signa r is v.y luntary act and is signed under the pains and penalties of perjury,DateRe-roofing
Number of dwelling units N� mbIro brooms per dwelling unit
- (for existing only, is includ in ewtru tion)
Who is autho i d to picku the rm't t the Buildl De artment. r ire ii,int�
g $��
Address t 1�� 5
Number of square feet Number of layers already existing
Phone
Number of
layers when complete
1400 HOMEOWNER EXEMPTION -ONE & TWO FAMELY 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 exist amd will not be
109.1.1 Licensing of Construction Supervisor,: Exce t for those
p
� in Section 127.0, effective July 1 1982 se structures governed by Construction Control
+ , no individual shall be
enlarged) EGRESS dimensions must be maintained. .
Enlarged or new windows in as existing dw�ellmg will be
engaged in -directly supervising persons engaged in
construction, reconstruction, alteration, repair, removal or demolition involving the structural elemen
struct:res, unless he or she is licensed in ts of buildings
�
considered as an Alteration, otherwise will be included in new construction. (see Code section 401.10 for
or
accordance wit'r therulesand regulations promulgated by the BBRS entitled
RL1es .and Regulations for Licensing Construction Supervisors.
residential and Artici.- 8 fo_ commercial)
,Ezception: Any Home Owner performing work for whit h a Building Permit is
the provisions of this section; provides that
$ required :hail be exempt from
- Temporary _ � •
porary structure includes when allowed, trailers, tents and the like and only for limited pr nods of time.
if a Home Owner engages a person(:) for hire to do such work ,that such
Home 'Owner shall act as supervisor.
Describe
i. svi71 rse .usn
For the purposes of this section only, a "Home Owner" '
is defined as follows: Person "s who 0
on which he; she resides or intends to reside,' �) owns a parcel of land
which there is, is
500 CONSTRUCTION PLANS 0 5th Edition
or :intended to be, a one or two family dweilin
or detached structures accessory to such use and/or farm structures. A person who constructs more th
two-year period shall not be
06th Edition
— None submitted. Why?
an one homce in
considered a Home Owner.of
+
If you are applying under this section sign below:
the State Bus.,
lding _Code
- Submitted, usually three sets required. Four sets for food service uses. Number of sets submaitted
Signature
600 SITE PLAN
Your signature carries certain responsibilities, including but not necessarily limited to
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❑Not required, why?
NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section
licensed {Construction Supervisor.
P
Submitted When? - Previously, date YWith this application
whether or not they have taken the that any
2.15.2 of section 5i Permit are responsible for code compliance. (see
700 UTILITIES
1500 COS T
Water supply V/no,
Cost of Improvement
- required _ yes public,? _ yes no, on site well? _-no,
I�
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Items to be installed but not included in the above cost: Electrical 5
existing yes � no
�
k
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 be issued unless a water supply, when
HVAC
r
required, is available. See Code 780 CMR section 114.1.2)
Other
disposal - required — yes V/no, public sewer s yes V/ no
V/no
TOT AL
private -site
I
septic - on V ves no. Submit copy of permit as soon as available.
(P
prior w�asrauanon new rovide manufacturers
instructions). Location(s) (list)
C Fireplace(s) - includes flue List location(s)
t- Game Court -.describe (include overall dimensions)
u Tent, Trailer (Mobile Home) or Other describe
3W CO CIAL - PROPOSED PROJECTIUSE - 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 ref ose over 2 years 9 months (see Code Section
304.0)
I
Factory / Industrial - (see Code Section 3 0)
High 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)
C Utility & Miscellaneous Structures - includes tents and __gricultural 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)
Tent or Trailer - temporary purpose?
C Other
Describe the proposal briefly, INCLUDE r umber of dweflhg units and bedrooms or occupant bad as applicable,
also existing condition
4() TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED
New Construction and/or Addition - total gross quare feet
(For commercial only total gross cubic fee is to
It will be considered new cons ctioy if the ` increase in square footage in addition to any
alteration(s).
If project is an addition to exis . stru T tal ross square feet of existing
u FOR COMMERCIAL ONLY
Will this project be subject to CONSTRUCTION VTROL (over 35,000 cu.fL) Yes No. (If yes
see Code section 127.0). Designer to submit Code Synopsis.
Will this project require Pem-.view (over 400,000 cu.fL) Yes No (see Code Appendix 1)
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 ,nxcct to requested submittals (see project review worksheet) date
DENIED see project review wor i st-eet date
HOLD reason date
HOLD Subject to Zoning Board of Appeals action
Comments
Inspectors signature )Date`UN 19 1997
Applicant informed of above - Date time staff (fax, Inhone, in person)
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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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OFFICEVNSPECTORS NOTES
TOTAL FEE c
Gross area - new construction Total Sq. Ft.
alteration Total Sq. FL
Permit is issued to
Comments/notes on permit
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-
1600 TO THE APPLICANIT/REF1MRAL AND APPROVAL
Date of Application submission
Plat 4 1-f Lot /�'Street C
��r .,. - f -_ Aquifer Zone
Owner
Owner mail address
Owner phone # `7 '2— 6q)
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OTTER`INVOLVED AGENCIES -The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT THEM FOR RE(NIIRED S'UBMLSSIONS.
® TAX COLLECTOR a Approved C HOLD By Date
❑ Board of Appeals C Approved By Date
❑ Conservation Commission C Approved By ( Date
❑ D.P.W. Water 'C Approved By ❑ D.P.W. Sewer = Approved $y Date
❑ D.P.W. Cross Connection Z Approved By Date
❑ Treasurer (Bond) ❑ Approved By Date
❑ D.P.W. Engineering C Approved By Date
-] Board of Health (well) Approved By Date
Board of Health (septic) Approved By Date
p Board of Health (food service) '_ Approved By Date
❑ Planning Board (parking) _ Approved By Date
® FIRE DISTRICT (I II = III) Approved By Date
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BUILDING DEPARTMENT APPROVAL:
❑ ZONING
❑ BUILDING INSPECTORBUILDING COMMISSIONER
❑ CONTROL CONSTRUCTION AFFIDAVIT
PROJECT SUMMARY:
new constructions alteration/demo sewage disposal - public/private
[Alter/add interior walls] [add rooms] [add footprint] water supply - public/private well
'[pool] [garage/shed/deck] [game court] [food service]
Describe
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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 �Zl i By
APPLICATION e. I. D BUILDING PERMIT
Instrnctiom -
The applicant shall complete this application to the best of their ability prior to submission, leaving no item tmansweved. The
Department staff will be available during regular business hours to assist as necessary. NIA should be inserted for thome sections
which do not apply. A properly completed application will help avoid unnecessary. delays. Mete: ]EEing fee in Brat
IMEMOdOblir-
(for office we only) ❑ FOUNIDA17ON ONLY
Total Cost $ Received By __ Date Reed 611 `'
Less
pucauun Fees 4Z k v
Total Permit Fee $ Perzait # Lssned Date
100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET
CURRENT ACCESSORS' PLAT LOT ZONING DISTRICT
f
OTHER ZONING OVERLAY DISTRICTS , if applicable
NUMBER & STREET ( [ I� lei Cf t l 1l
t R04J
NEAREST CROSS STREET !b
SUBDIVISION NAME & LOT#
or BUSINESS NAME
PREVIOUS-TEAI�FI-/ OWNER 1✓ l /'� 1 �}
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 =
C Accessory apartment Total gross sq. ft.
Accessory structure:
Garage - detached - attached to dwelling, dimensions L W
C Carport - detached attached to dwelling, dimensions L W
V.t
Shed - dimensions L U WA
C Deck -dimensions L W
= Gazebo - dimensions L R'
Swimming pool above ground in -ground Size {
C Chimney - number of flues >>