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800 MECHAANICALS & 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
)0 '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?
00 REQUIRED OFF-STREET PARKING- for ZONING & Architectural Access
= NOT APPLICABLE
Parking Plan submitted To Building Department Planning Board Date submitted
Number of spaces - indoors outside total provided
Handicap spaces - required _ yes —no. If yes, how many as a part of the total required number.
Is Route 6 (State Road) Entrance permit required? yes _ no =. If yes has it been issued yes no
Submit copy of application and/or permit as soon as available.
IDENTIFICATION (print or type except as noted)
Current owner - name
address -,,1 7I �� 7''�� / C�A10 i �J� � � °10C171-1
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/En&en er - 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 aind not
reproductions.
General Contractor (if Homeowner, state homeowner here then complete section 1300)
Company name '0 1�1 Al. �'�/�l'C r11V
Address 0111RA0 C /1 44,,S 7Ao,�? 1- 7 �'O
Phone number c 25
Construction Supervisors license number. 7
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals aind not
reproductions.
1200 FOR RESIDENTIAL REMODEL WORK ONLY
Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes No _ If no go toj next section!
Are you claiming exemption from the requirement? Yes _No _If yes, submit the requireed affidavit!
Remodel contractor name (please print)
Address
Registration number (if none state "none")
Phone number
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE AC47ZSS 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) /l-_�'i7D6
Signature
Date /f
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 pr=bvided 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 t€hree times by
5
ritten request- I understand that once the permit expires a new application may be required, including fees and current
her requirements (including Zoning).
Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required:
Demolition - describe structure
Name
Signature
The ab ve signature is my voluntary act and is signed under the pains and penalties of perjury.
Date
Who is authorized to pickup the permit at the Building Department? (please prints
Address Phone
•00 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
Section 127.0, effective July 1, 1982, no individual shall be engaged in directly supervising persons engaged in
ustruction, reconstruction, alteration, repair, removal or demolition involving the structural elements of buildings or
•uctures. unless he or she is licensed in accordance with the rules and regulations promulgated by the BBRS entitled
Iles and Regulations for Licensing Construction Supervisors.
Exception: Any Home Owner performing work for which a Building Permit is required shall be exempt from
provisions of this section; provides that if a Home Owner engages a person(s) for hire to do such work ,that such
>me Owner shall act as supervisor.
For the purposes of this section only, a "Home Owner" is defired as follows; Person(s) who owns a parcel of land
which heishe resides or intends to reside. on which there is, or is intended to be, a one or two family dwelling, attached
detached structures accessory to such use and/or farm structures. A person who constructs more than one home in
[).year period shall not be considered a Home Owner.
you are applying tender this section sign below:
;nature
Your signature carries certain responsibilities, including but not necessarily limited to, general liability
MCE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that any
!nsed Construction Supervisor, whether or not they have taken the permit are responsible for code compliance. (see
., of section 5)
oo COST
Cost of Improvement $
Items to be installed but not included in the above cost: Electrical S
' Plumbing
HVAC
Other
TOTAL $ 15 0 Q
following section for official use only.
INSPECTORS' REVIEW
Date plan reviewed NOV '1 1996
30 days to review period expires
Oh to issue date
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 (platilot 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 lavers when complete
A separate disposal declaration REQUIRED
= 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 will be
considered as an Alteration, otherwise will he included in new construction. (see Code section 3401.10 for
residential and Article 8 for commercial) l
Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods of time.
Describe
500 CONSTRUCTION PLANS
_ None submitted. Why?
= Submitted, usuallv three sets required. Four sets for food service uses. Number of sets submitted`
600 SITE PLAN
❑ Not required, why?
/—Submitted When? — Previously, date _ With this application
700 UTILITIES
Water sn - required _ yes _ no, public ? _ yes _ no, on site well? = yes _ no,
ply q
existing? _ yes _ no
If required and not existing have necessary permits been issued? _ no _ yes,, sdate
(M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a water suppiv, when
required, is available. See Code 780 CMR section 114.1.2)
Sewage disposal - required veS z no, public sewer _ yes _ no
private septic - n ye
s es no. Submit copy of permit as soon as available.
o._
— ---- ---- -
- - w.ouwve = used (will require inspection prior to installation), new (provide manufacturers
instructions). Location(s) (list)
! � Fireplace(s) - (includes flue) List location(s) -
u Game Court - describe (include overall dimensions)
Tent, Trailer (Mobile Home) Other - describe
300 COMMERCIAL 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 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)
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 number of dweWmg units and bedrooms or occupant load as applicable,
aPso existing condition
400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED
Wew 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 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
OK to issue subject to requested submittals (see project review worksheet) date
- DENIED see project review worksheet date
HOLD reason date
:E HOLD Subject to Zoning Board of Appeals action
Comments
Inspectors signature lid /t DatV0 �.' e94 1996
r .
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)
OFFICEUNSPECTORS NOTES
TOTAL FEE
Gross area - new construction iC _ Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit
0
7
7
1600 TO TZIE-APPLICANTAUUMMAL AND `APPROVAL
Date of Application submissionA�-�
` ��� Plat LoYl
Cuifer
Zone
Gr t
Owner
� �
Owner mail address
Owner phone # % � .-,5 sr
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OTIiER INVOLVED AGENCIES - The following agencies require separate jurisdictional
permits or approval for your
proposed project. CONTACT THEM FOR REQUIRED
SUBW11MONS.
a TAsx COLLECTOR — Approved = HOLD By
Date
Conservation Comm = Approved By
C-7)
Date
• D.P.W. water Z Approved By
Date
• D.P.W. sewer _ Approved Ev
Date
Q D.P.W. cross connection — Approved
Date
a D.P.W. engineering _ Approved
Date
)ard of Health well Approved1.
Date
_
A
bO
#
bard -f Health septic - Approved
Date
o Board of Health food service = Approved
Date
$ FIRE DISTRICT' -III) =Approved
Date
Q Planning Dept _ Approved
Date
Other _ Approved
Date
(Other _ Approved
Date
(.,mments
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Prnject summary new constructioni alterstionidemo
sewage disposal - puhliciprivate
[After:add interior walls] [add rooms] [add footprint]
water supply - puhliciprivate well
(pool] [garngershed] [game courtJ [food service]
Describe
I
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To the carious 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
®� BUILDING .a `
TOWN OF >AR
.T ARTAO
v-T%TYr%.TV CnQ n00_110701n FAX 508-999-CM8
APPLICATIPN FOR ZONING AND BU LDING PERMIT
,.Fu 15 Vill
The apphcant shall rompiete this'ap rlication to the. best of their ability prior to snbmispoti.-Imvmg no Item tmaor tho d. "his
Dep�icr � tt5UMV6ll he Ia h a e�i 4AI! regular business hours to assist as necessary: N/A should be inserted for those sc•ctioas
which do not apply.. properly completed application will help avoid unnecessary delays- � fee is no'
(ror once use only)
Application fee $ '' received by Date
Total Permit Fee S Permit #
100 LOCATION OF PROJECT
CURRENT ACCESSORS' PLAT LOT 00' ZONING DISTRICT '
OTHER ZONING OVERLAY DISTRICTS if applicable
NUMBER 3 STREET
NEAREST CROSS STREET
f
SUBDIVISION NAME & LOT #
S j"h'/raf= 2 C pie O 04
or BUSINESS NAME
PREVIOUS TENANT i ONVNER
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
w
= Garage'- detached - attached to dwelling, dimensions L
Carport - detached -'attached to dwelling, dimensions L
W
= Shed - dimensions L W
= Gazebo; dimensions L W
-__�-
= Swimming pool above ground in -ground Size total square fe`"t
= Chimney - # of flues