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A LC LE v r � CA" DFTZ,�EN NO !?- e,'FAGP PPOOr MV3TFR FORM T- t Ir. L ti H .7 �rr7 OCT 2 7 1997 0 date BUILDING DEPARTMENT TWN OF DARTMOUTH S TSO This plan has been reviewed and accepted as a record copy of work proposed to be performed in compLiance wit? all *j;- 780 CMR 5th Edition. The owner, applicant/agent and/or architect/engineer is responsible for insuring final , I "Ib s� iian compliance with the above -mentioned code notwithstanding Carat any errors or omissions in the record plan. Any change in owner, License contractor or engineer must be reported to this office immediately. Any change in pLai Date must be submitted to this office in a timely manner. CUlil Signatu,`��l a LOT L, CeDr'P'P'Iz � P I) eo j CAH �T- C n ui E. V, 00- Sr 56 31: Ij ELILN), LE"j zi J��o J sw) a L, 'IT PIT 9'r Dp"SLr' 424 ji I f f-i tt I'N LE '20' 20 Z-7i 0- E T rtrlr T Y, C r, u fl-ri T f IS II u �11 L C C, q, /5' 91 fr I'LL f jF y ` -4 - -1 - 6K III C) ir, I Z L:) )AI AT E It E Li It, T i P-1 C LA DP iuC- w t L. E t, o lot Lf Z x rT 14 G �4 L5 ?LCT-7Dr, 62W W /C)PjLt?Ee�L�)j(ZCij LI 4 P�ZOL) l0f--(� 7 400 _fC ST PR o ip t- Tc i_s x I I xj'C. '"I E P1. 'T M j 1-., 0, Fp-zn EXIST)M' WELL. Mc, art) Ec_ YNbW*4 WELLS ,(�o Leq,�� Ar iL tiv 0 X I'W- T 1 -T 0 otzs -'� c, -r" , C),� 'Se P-n W� (_IA5 P_10,'rLE 't I NJ JS 14 ALI r�A E 0 Ly I 511CIT ENuii- 71 T Lt-_ I C�D f-�\ w-'Ll C C) I THE APPROVAL BY THIS OFFICE DOES NOT GUARANTEE THE EFFECTIVENESS OF ANY INSTALLATION. f�,, DARITOUTH BOARD OF HEALTH N E TN I CW Atq r-\�Ii toC_ PL V4 V iD o L OF HEtALTK �i L,, BOARD OF HEA' I JH jji0i=LLI 1 REQUIRED WHEN EXCAVATED ENGINEERS AS -BUILT PLAN" A CERTIFICATION ELEWAITIONS MUST NOT CE OF HEAL11i Ah"i"ibyt"IL t 0 � FMAV I A IQQ7 STAT'EIVIENT REQUIRED BY. - 4- TOW OF DARTMOUTH (,StUTH CONSTRUCTION OF THIS SEP IC SYSTEM BOARD OF HEALTH MUST BE COMPLETED WITHTHREE (3) This S o YEARS OF THE DATE OF APPROVAL For Garbage Grinderf Whirlpool Or -Other High Water Use Devices. ,� S _P E, E hoc -T F) e \ c PR s LA 0 0 .5--P_EGT Lc)(,07_100STRIPER- C1Q(_LE,�f't1Z_T11DU_t I E ST P,0 fi- Cr'ju lfOf.) r APPROVED By DRAWN BY IL- <- SM',E: I -- �)C) DATI, R E C L cA, v "7, AT e,-) VO T-T 0 0 f - IL D AWING NUMBER I I- WUZIMOUTF I DIETZGEN NO. 198-MF AGEPROOF MASTER FORM n S E H E � JT L4)0 P. VJ A T C C- TA 6'-E F—LF-V- 2 13. 6q I Ki v c r, — Eu v - 22 -',.'qO 1600C,Q L EPTIL TAWr 7- Z'3. 1" Zz3.14 171 NA i i4 2 L4, e�rti E LE t4 E f i-T LC V: E L F-V. z z ?-. tL IL i Gh t Fl Y H CA) Tb o J, p 514 c f) ST-C) C- j L 2 2 I Y-z :-I� i A L L 7) LE V, Le o (-}i a I Os P 2- DIETZGEN No. 198-MF AGEPROOF MASTER FORM J. I cc u-C J-) A 6"01A, oT TrJ LJE T A t T L E r IV -fr-'LLT L L5 LET t Z z q LLEV. 3" Z Z Ljo ot 1q, A u-i CLLV I 4 o c TI4 .1 ;,' - -f, -; SCALE: N, T, APPROVED BY DRAWN BY )�-LL DATE: Ll DI 4Wl3 NUMBER _1,757 EALTH L Ill 800 MECHANICALS & PRIMARY FUEL Furnace (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify)25Ud (j t•G Al oiler (heating)- Fuel gas (natural or propane), fuel oil, electricity, other (specify)1kL1t-L 6114 HVAC (combined unit) - Primary fuel, natural gas, propane, electricity, other (specify) Air conditioning - (separate unit) ❑l None of the above to be provided L Hot Water Gas - Electric Fuel Oil Other 900 SPR NII LERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential Required, `plans provided, 7--iplans not provided, why? Not required, not to be installed, Why? 1000 REQUIRED OFF-STREET PARKING - for ZONING &Architectural Access NOT APPLICABLE Parking Plan submitted To = Building Department a Planning Board Date submitted Number of spaces - indoors outside total provided ."[and. ap spaces - required _ yes _no. If yes, how many as a part,( f the total required number. Is Route 6 (State Road) Entrance permit required? yes r' no. If yes has it been issued yes ❑ no ❑. Submit copy of application and/or permit as soon as available. 1100 ID NTIFICAT ON (print or type except as noted) at owner- name UGC, /l Tdd �/ one If corporation, officer in charge ArchitectJEngineer - 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 originals and nrot reproductions. General Contractor (if Homeowner, state homeowner here then complete section 1300) J e JCompany name �n (5 00%f _ IA19 �ddress 'hone number VConstruction Supervisors license number p NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not reproductions. sxxxssx****sxxx***ssxx**ssssxx*sssxs*sssssxx***ssx*s***xx*s►**x*sxx*x**x*x*s*s*ss*sx**ssxssssx*s:�**sssx* 1200 FOR RESIDENTIAL REMODEL WORK ONLY Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes _ No _ If no go to nextrsection! Are you claiming exemption from the requirement? Yes No ,_If yes, submit the required affic?,avit! Ren_odel contractor name (please print) Address Registration number (if none state "none") Phone number PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS T'O 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 (pr;:nt) Signature Date 4 1300 OWNER SIGN - OFF Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Decilaration 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 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 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 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). lame o_ S'e�0/f �J/6 ignature � � h—e7 ab a signature is my voluntary act and is signed under the pains and penalties of perjury. tate Who is authorized to pickup the permit at the Building Department? teaseprint) -'U A,1 JC Address _4�:ZZ. C % Phone 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, 1982, 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 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 he/she 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 J Yq,t sign_A e carries certain responsibilities, including but not necessarily limited to, general liability *s**assess*as*ssssss*ss*ss*asssass*ass**ss*as**ssssssss*ssssss*sassy*sssssas*sssaasss*sasssss*ass*ssssss 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) *ss******s*ssssaasss*ass**asasssssaass*ass**ss*as**sssssss*as*ass***s**ss******sssss*seas***sssss*asss** 1500 COST Cost of Improvement Items to be installed but not included in the above cost: Electrical $ Plumbing HVAC Other TOTAL' 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 (platllot or address) to where (plat/lot or address) A separate Reffose Disposal 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 exisding 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 existimg dwelling will be considered as an Alteration, otherwise will be included in new construction. (see Code sec'.tion 3401.10 for residential and Article 8 for commercial ❑ Temporary structure - includes when allowed, trailers, tents and the like and only for limitted periods of time. Describe 500 CONSTRUCTION PLANS None submitted. Why? dl5ubmitted, usually three sets required. Four sets for food service uses. Number of sets submitted 600 SITE PLAN ❑ Not required, why? f Submitted When? Previously, date " With this application 700 U TILTTIFES Water supply - required �t/ yes _ no, public ? = yes �/ no, on site well? Z'_yes; _ no, existing? Z-YI i no If required and not existing have necessary permits been issued? _ no - yes, date 4/_ ! — (M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a waiter 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 Zes _ no. Submit copy of permit as soon as availabhe. " Woodstove - used (will require inspection prior to installation), new (provide manufacturers instructions). Location(s) (list) VFireplace(s) (includes flue) List location(s)%��% L; Game Court describe (include overall dimensions) u Tent, Trailer (Mobile Home) or Other - describe 300 COM MIERCIAL - PROPOSED PROJECT/USE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES E 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 to Describe the proposal briefly, INCLUDE- umber of dwelling units and bedrooms or occupant load as applicable, also existing condition 400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED 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 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 1) APPLICANT TO PROVIDE The following section for official use only. INSPECTORS' REVIEW Date plan reviewed 30 days to review period expires -:1 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 -:1 Applicant informed of above - Date time staff :Date 1� AY 15 1997 (fax,, ;phone, in person) *zz*zzz*zzszzsssszs*s*sszzs*ssszzzz**ssss*zz*zssszz*szz*szsszss*s*zszz******ssz**zzzzs**s�zsssssszssszssssz 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) sssssssssssssssssssss*ssssssssssssssss*ssssssssssssssssssssssssssssssssssszssssssszssszrszzzzzsszsss*ssss OFFICEVNSPECTORS NOTES TOTAL FEE ✓%,57/� Op � S Gross area - new construction % �� Total Sq. Ft. alteration Permit is issued to Total Sq. Ft. Comments/notes on permit /i, G�fc%� 7 4- �L ...sssss###*ix#ii#Y###i#####ix#YYx#i#iY##Yi##iY##YiYi#!!YY##i##YY#i#YlYYY 1600 TO THE APPLICANT/REFERRAL AND APPROVAL Date of Application submission 19,7 + P1attY Lot/ro Street / L�&��-�Aquifer Zone Owner 0 � j � ,�% 1. ' .�,� Owner mail address Owner phone # v x*###ix*#*##xx##xxxxxxx*##**x#Yx#'tYxs*xx*x*sY#Y#Y#Yx#ixssYssi*sY#x#xx###sssssssississi#i#iYi#*i#i#s#xsi## OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACT THEM FOR RF()iliQM RIBNftMONS. ® TAX COLLECTOR ❑Approved ❑ HOLD By Date ❑ Board of Appeals ❑ e Approved By Dat W Conservation Commission ❑ Approved By na*p ❑ D.P.W. Water ❑ Approved By ❑ D.P.W. Sewer ❑ Approved By - Date ❑ D.P.W. Cross Connection ❑ Approved By ❑ Treasurer (Bond) ❑ Approved By ❑ D.P.W. Engineering ❑ Approved By_ 7Board of Health (well) ❑ Approved By _ Q" Board of Health (septic) ❑ Approved By ❑ Board of Health (food service) ❑ Approved By ❑ Planning Board (parking) :1 Approved By Date Date Date D. +e Date Date Date ® FIRE DISTRICT (I - II -III) ❑ Approved By Date BUILDING DEPARTMENT APPROVAL: ❑ ZONING ❑ BUILDING INSPECI'ORBUILDING COMMISSIONER ❑ CONTROL CONSTRUCTION AFFIDAVIT xx#xx##ss#s#*x#sxx#*sssssssss#xss*ss#ss#s*Yxx#sxix#ix##xx#**#xs#*sss#sss#xxsx**#s*#*s#s#i#x#xxsissx#xxxs PROJECT SUMMARY: new construction/ alteration/demo [Alter/add interior walls] [add rooms] [add footprint] sewage disposal - public/private [pool] [garage/shed/deck] [game cou [food service] Describe To the various departments: water supply - public/private well 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 Inshmctiom The applicant shall complete this application to the best of their ability prior to submission, leaving no item unanmwered. The Department staff will be available during regular business hours to assist as necessary. N/A should be inserted for those sections which do not apply. A properly completed application will help avoid unnecessary delays. 1ST F36g fees not mefimAaYr- (for office use only) ❑ FOUNMATION ONLY Total Cost $ Received By Date Rec'd Less Application Fee $ Total Permit Fee $ Permit # Lssned Date 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET CURRENT ACCESSORS' PLAT PJ6 LO�"�`t` ZONING DISTRICT HER ZONING OVERLAY DISTRICTS , if applicable UMBER .,c STREET �T fI I d'Ld /i !� ! x, � L NEAREST CROSS STREET O L © .gLL ,�'/ vF.� X /0 - SUBDIVISION NAME & LOT # C E,O �' �R a ey ; [� or BUSINESS NAME PREVIOUS TENANT / OWNER 200 RES OxITAL - PROPOSED PROJECT' - one & two family residence only T IS SECTION NOT APPLICABLE Single family - number bedrooms _� number baths 13 Two family - number bedrooms unit 1 number baths unit 1 number bedrooms unit 2 number baths unit 2 Accessory apartment Total gross sq. ft-3J Accessory structure: ` Garage - detached - ttached dwelling, dimensions L W Carport - detached - attached to dwelling, dimensions L W Shed - dimensions L W IV eck - dimensions L Gazebo - dimensions L W Swimming pool above ground in -ground Size R Chtmney - number of flues C a