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BP-697800 AiECHANICALS & PRIMARY FUEL s Architect/Engineer - project suFervision.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) s� - HVAC (combined unit) - Primary fuel, natural , propane, electricity, other (specify) Air conditioning - (separate unit) - None of the above to be provid . - Hot Water Gas Electric Fuel Oil Other 900 SPRINKLERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential f, - Required, plans provided, -plans not p ovided, why? - Not required, not to be installed , hy? 1000 REQUIRED OFF-SI'R.EEi' PARKING - for ZONING & Architectural Access - NOT APPLICABLE - Parking Plan submitted To - Building Number of spaces - indoors 'J Handicap spaces - required epartrdent - Planning Board Date submitted outside total provided 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. 1100 1DENTMCATTON (print or type except as noted) Current owner - name L 4 /\ / ©Cj 4Z 0 address phone ## V �� If corpbration, 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';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. s**z**zss*****s*sasszzszsxzxr^sszsszsszxsszsz*zzssx**ss*z�xssxssssssss*szssszsssssusszxsxsxsssaxssszsssss 1200 FOR RESIDEP.1711AL REMODEL WORK ONLY Are you a home Improvement Contractor subject to (780CI%IR - 6) ? Yes _ No ,_ If no go to nt-xt section! Are you claiming exemption from the requirement? Yes No _If yes, submit the required afffidavid 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 Owners name (print) Signature Date 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 proviided 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 ifs 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 thrcce 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). ' _ Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required. Name GA P, L 0 s C- O %� G Signature AL t& The above signature is my voluntary act and is signed under the pains and penalties of perjury. Date-2-3-26 Who is authorized to pickup the permit at the Building Department? (please print) �2) a w 11111- Q �� Address ,a ,CtiyKe Phone % 77 ,:9916, Ilea 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, 1992, 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 accordance with the rules and regulations promulgated by the BBRS entitled Rules and Regulations for Licensing Construction Supervisors. Exception: Any Horne 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 pl)rposes of this section only, a "Home Owner" is defined as folly.• Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwell, attach d 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 xs**s**x***xz*sz::**sssszssss*sss***sssssszsszssssszs**szxss*z*zzsssxs**ssssssxs*zssssssssxssssssxsxx*xz 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) s*z*x**x**xx*zsxzss*xs**s**zss*****ssssssssszsssssxsssxxsssxs*ssssxszs*xsssssssssssssxs*s*zzx**zxx*sxxxz 1500 COST' Cost of Improvement S Items to be installed but not included in the above cost: Electrical S The following section for official use only. INSPECTORS' REVIEW Date plan reviewed Plumbing HVAC Other TOTAL $ �© 6 MAY d 8 1996 30 days to review period expires _ Demolition - describe structure Number of dwelling units Number of bedrooms 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) !k separate Refuse Disposal Number of dwelling units Number of bedrooms per dweliling unit _ Re -roofing - (for existing only, is included in new construction) Number of square feet Number of layem already existing Number of layers when complete A separate disposal declaration REQUIRED Replacement doors and windows- (for existing only) (only where doors a)nd 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 be included in new construction.. (see Code section 3401.10 for residential and Article 8 foi commercial) Temporary structure- includes when allowed, trailers, tents and the like anid only for limited periods of time. Describe 500 CONSTRUCTION PLANS _ None submitted. Why? - submitted, usually three sets required. Four sets for food service uses. N- umber of sets submitted _o 600 SITE PLAN 0 Not required, why? _ Submitted When? _ Previously, date With this appliication 700 UTILITIES Water supply - required _ yes _ no, public ? _ yes _ no, on sitt;e, well? yes _ no, existing? _ yes _ no If required and not existing have necessary permits been issued? _ no _ yes, date (i41.G.L. Chapter 40, section 54 provides that no building permit may be issined unless a water supply, when required, is available. See Code 780 CMR section 114.1.2) Sewage disposal - required _ yes a no, public sewer _ yes _ no private septic - on -site Zyes _ no. Submit copy of permit as boon as available. OK to issue date U& to Isbuc �u �•.•. Woodst<�ve - used (will require inspection prior to installation), new (provide rr" ."mcturers —_ DENIED see project review worksheet date ' 'date instructions). Location(s) (list) —_ HOLD reason Fireplace(s) - (includes flue) List location(s) _ HOLD Subject to Zoning Board of Appeals action Game Court - describe (include overall dimensions) Comments Tent, Trailer (Mobile Home) or Other - describe I))ate 1996 300 COMMERCIAL - PROPOSED, PROJECr/USE - INCLUDING THREE FAMILYI OR MORE AND EXEMPT USES Inspectors signature staff (fax, Inhone, in person) _ Applicant informe of above -Date time = THIS SECTION NOT APPLICABLE ' the Massachusetts State Building Code .Article 3, AS NOTED) (See ffie following descriptions are based on = Over six months since approved for issue - DEEMED abandoned! up. (The Hold 90 days for return then dispose if not picked Code) Advise applicant. _ Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe Date_______ Inspector indicate Medical or other professional (see Code = Advised applicant Date Time staff (by phone, fax or in petrson) = Business - office, assembly with less than 50 occupants - Section 303.0) *zzzzzzzzzzzzz*zzz*zzzszzz*zzzz*zzzzzz***sszszszxzsszzzzz*szz*zzzzzzsszzzzzzzzzsszxszzz:zzzzzzszzzx:*zzzz for training including child day care for those over 2 years 9 months (see Code Section ONCE\INSPECTORS NOTES = Educational - structure �0�52 304.0) TOTAL FEE ` =ry / Industrial - (see Code Section 305.0) ''�_ Facto Gross area - new constructior Total Sq. Ft. JZ ` - High Hazard - (see Code Section 306.0) alteration Total Sq. Ft. infant'day care (see Code Section 307.0) = Institutional -hospital, nursing home, Permit is issued to stores (see Code 308:0) _ Mercantile - retail family,Jhotel (see Code Section 309.0) = Residential - three or more f' Comments/notes on permit = Storage - includes garages (see/Code Section 309.0) Structures - includes tents and agricultural structures (see Code Section 311.0) Utility & Miscellaneous for any of'the above, indicate above (see Code Section 119.0 and Zoning By-law section 35) New tenant = Tent or Trailer - temporary purpose? — Other briefly, Describe the proposal brie INCLUDE number of dwelling units and bedrooms or occupant load as applicable, also existing condition 40.) TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED New Construction and/or Addition - total gross square feet a ` (For commercial only total gross cubic feet) indicate It will be considered new construction.4 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 CONUAERCIAL 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. Yes No (see Code Appendix I) Will this project require Peer review (over 400,000 cu.ft.) APPLICANT TO PROVIDE 1600 TO THE APPLICANIT/REFERR&, ANIJ APPROVAL Date of Application submission (o Plat Lot /G 0 Street /� Aquifer Zone Owner C- © Owner mail address // Owner phone # 7 s*x:#s##x:xsxxszsasssssssssssszsssxsxs*sxsxsss##ssssssxsszszsssssxxsssssssxss#xsssssssssssssssssss#s#s#ss OTHER INN'OLN'ED AGENCIES - The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACT ITIE74 FOR REOW E SITUME l I.S.SIOIoiS. COLLECTOR -- Approved -- HOLD ByL8�V 6-1 Date onservation Comm -- Approved By Date ❑ D.PAV. water — Approved By Date ❑ i .P.�i'. sewer — Approved By Date ❑ D.P.W. cross connection _ Approved Date ❑ D.P.W. engineering -- Approved Date ❑ Board of Health well -- Approved Date ❑ Board of Health septic -- Approved Date ❑ Board of Health food service -- Approved Date DIRE DISTRICT lI - II - III) -- Approved ❑3Planning Dept -- Approved Other _ Approved Other C.,mments = Approved _ V Date Date Date Date / 419al­ � a-1)1: 5� Q10 ............. Project summary new construction/ alteration/demo sewage disposal - publiciprivate [Alter add interior walls] [add rooms] [add footprint] [pool] [garage shed] [game court] [food service] Describe To the .arious departments: water supply - publiciprivate well This notice has been forwarded to you for your information and any appropriate action. Should you have anv 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 v j B, —D) TOWN OF 4Y DEJ •. r TELEPHONE 508-999-0720 FAX 508-999-073 APPk 0N FOR ZONING AND LUILWIENG PERMIT ffj . uJI The applicant sha c nx'pj`eD t application to the best of their ability prior to submission. leaving nio item unanswered. The Department staff µill he ava1 a to f regular business hours to assist as necessary. NJA should bee inserted for those sections which do not apply. A properly comp a A application will help avoid unnecessary delays. g &e iac r (for office use only) Application fee received by -- Total Permit Fee l Permit # 100 LOCATION OF PROTECT CURRENT ACCESSORS' PLAT _ LOT l Q ZONING DISTRICT Date < — -3 — 0,5; 6 OTHER ZONING OVERLAY DISTRICTS , if applicable NUMBER & STREET NEAREST CROSS STREET SUBDICISION NAINIE & LOT # or BUSINESS NAME OWNER /�- L O S G O R I R Q 200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only THIS SECTION NOT APPLICABLE - SingIe 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, dimensions L W _ 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 feet _ Chimnev - # of flues k. 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