BP-320800 ML.CHANICALS & PRIMARY FUEL
Furnace (hot air) -Fuel gas (natural or propane), fuel oiI, 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
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_ Hot Water Gas Electric Fuel Oil Other
900 SPRINKLERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
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j = Required, -plans provided, --plans not provided, why?
_ Not required, not to be installed. Why?
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{ l000 REQUIRED OFF-STREET PARKING - for ZONING & Architectural Access
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NOT .-APPLICABLE
= Parking Plan submitted To Building Department = Planning Board Date submitted
Number of spaces -indoors o:-tside tota,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.
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1100 IDEIS F`1GATION ( print or type except as noted)
Curr-nt owner name 4 f
address _ r r
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phone #7 911 �� Iri 5 f f]D12.� LJ6
If corporation. officer in charge
Architect,(Engineer - for overall design
Company name
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Address
Phone number
Cerrified by State of Massachusetts as
Certification number
NOTE Signatures and seals on all Plans, affidavits and other documents SHALL BE originals and not
reproductions.
' l project supervision and report
Company name
Address
Phone number
Certified by Stite of Massachusetts as
Certification number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals amd not
reproductions.
General Contractor (if omeown , state homeowner here then complete section 1300)
Company name I
Address
Phone number
Construction Supervisors license number
NOTE S'►g natures and seals on all plans, affidavits and other documents SHALL BE originals amd not
reproductions.
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1200 FOR RESIDENTIAL REMODEL WORK ONLY
tractor sub'ect to (780CMR - 6) ? Yes s No — If no go toy next section!
Are you a Home Improvement Con J
Are you claiming exemption from the requirement? Yes _No ___If yes, submit the requirecd affidavit!
Remodel contractor name lease rind
Address
Registration number (if none state 'none")
Phone number
PERSONS CONTR.ACI'ING AITH UNREGISTERED CONrIRACTORS 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 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 wark is begun or
work is
six months after the last inspection if work has begun and that the understand thatt tthe permit may be extended only! three times by
anticipated if I request such an extension in for six monthis if no
writing.
e
written request. I understand that once the permit expires a new application may be required, including lees and current
other requirements (including Zoning). -
Name t
a
Signature A .w t,
The%ibove signature is voluntary act and is signed under the pains and penalties of perjury.
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Date
Who is authorized to pickup the permit at the Building Department? i lease printi l
Address Phone a
L- j)
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
j 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 promuigated by the BBRS entitled
1 Rules and Regulations for Licensing Construction Supervisors.
Exception: Anv 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
Hore Owner shall act as supervisor.
For the purposes of this section only, a "Home Owner" is defined as follows: Persoms) who owns a parcel of land
on ss?hich hershe 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 -wear period shall not be considered a Home Owner.
If you are applying under this section sign below:
Sig_ nature
four signature carries certain responsibilities, including but not necessarily limited to, general liability
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
of section 5)
15oo COST
Cost of Improvement g —
items to he installed but not included in the above cost: Electrical 5
Plumbing
HVAC
Other
TOTAL $
The following section for official use only.
INSPECTORS' REVIEW
Date plan reviewed
30 days to review period expires
S/ OK to issue date
Alteratit - ` ;fisting, no increase in gross square feet. A separate Refuse Disposal Decl ration required.
Demolition describe structure
Number of dwelling units Number of bedrooms A separate Reff4se Disposal
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)
er of layers already ezistimg
Number of square feet Numb
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 sectilon 3401.10 for
residential and Article 8 for commercial)
= 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, usually three sets required. Four sets for food serviceluses. Number of sets submitted
600 SITE PLAN
❑ Not required, why?
Submitted 'When? = Previously, date With this application
700 U'TILTTIES
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
(D2.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a watfer 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,,.
dy
wooustove - used (will require inspection prior to installation), new (provide man_ ufacturers
instructions). Location(s) (list)66
e_
Fireplace(s) - (includes flue) List location(s)
Game Court - describe (include overall dimensions)
Tent, Trailer (Mobile Home) or Other - describe
300 COMMERCIAL - PROPOSED PROJECT/[JSE - 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 & MisceIlaneous 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
Descn'be the proposal briefly, INCLUDE number of dwelling units and berlrooms 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
see Code section 127.0). Designer to submit Code Synopsis. No, If yes
Will this project require Peer review (over 400,000 cu.ft. es
APPLICANT TO PROVIDE ) YNo (see Code Appendix n
t OK to issue subject to requested submittals (see project review worksheet) date;!
`.• ZNIED see project review worksheet date
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HOLD reason date
HOLD Subject to Zoning Board of Appeals action -
Comments f
Inspectors signature ` Date
Applicant informed of above Date time staff (fax; phone, 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.
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Inspector 'Date
Advised applicant Date Time staff (by phone far or in pf--:-so n)
OFFICEUNSPECTORS NOTES
TOTAL FEE
Gross area new construction Total Sq. rt.
alteration Total Sq. Ft.
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Permit is issued to
Comments/notes on permit
_ II
1
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160o TO TiiE APPLICANMEFERRAL P P�
AND APPROVAL
Date of Application submission
"-
TOW - f" DARO U H B ILL G` DE .'13R
P1a t �treet
TELEPHONE 508-999-0720 �A; 50�-999-073�
�.
Aquifer Zone
Owner
Owner ail add
m address
`
CATION R ZONING
APPLICATI(JN
` _ + lam' �"L� i�lrli 1
8
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Owner phone #
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OTHER INVOLVED AGENCIES The following agencies require separate jurisdictional permits or
t�w�c L,� $ii
The applicant shall complete this application to the best of their ability prior to snbmission.•Iesving no �lsw Ted. The
Jse
approval for your
proposed project. CONTACT ZMs FOR REOUMM S�QBARLS.SIONS.
Department staff "ill he available d„r;uo regular business hours to assist as necessary. Pi/A should be linserted fort sections
application will help avoid unnecessary delays. M06= ', lie s tot
which do not apply.. properly completed
TAX COLLECTOR = Approved _ HOLD By
Date
❑ Conservation Comm = Approved By
Date
(for office use
fee $ % received by Date
�
APP ikatioa
_
❑ _
D.P.W. water Approved By
Date
Total Permit Fee Permiii #
LLL 2
q D.P.W. sewer _ Approved By
—�
Date
—
❑ D.P.W. cross connection = Approved
Date
100 LOCATION OF PROJECT
0 D.P.W. engineering —LOT
g g _Approved
CURRENT ACCESSORS' PLAT LOTGNING DISTRICT'
Date
❑ Board of Health well _ Approved
Date
OTHER ZONING OVERLAY DISTRICT'S ,, if applicable
❑ Board of Heath septic - Approved
PF
Date
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. NUMBER 3 STREET =t��� !1_�i��til �.
�
❑ Board of Health food service _ Approved
Date
NEAREST CROSS STREET
$ FIRE DISTRICT J - II -III) = Approved r
Dam
SUBDIVISION NAME & LOT #
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❑ Planning Dept ='Approved
Date
or BUSINESS NAME
Other _ Approved
Date
PRECIOUS TENANT; OWNER
Other — Approved
Date
200 RESIDENTIAL -PROPOSED PROJECT -one &two family residence only
C ,mmenu
= THIS SECTION NOT .-APPLICABLE
- Sinele family - number bedrooms number baths
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Prn[ect summary z:e^-• c:;nstrt: 'ivr.; after-aronrdemc
sewage disposal - ruhIic,pt•ivat_
Two family -number bedrooms unit 1 number baths unit 1 -
number bedrooms unit : number baths unit„
[After -add interior walls] [add rooms) [add footprint]
water supply - publicrprivate well
— Accessory apartment Total gross sq. ft..
[pool). [garage;shed) [game court ) [food service)
- Accessory structure
Describe
- Garage - detached - attached to dwelling, dimensions L W
-Carport - detached - attached to dwelling, dimensions L 'W
...........
To the carious departments:
- Shed - dimensions L W
This notice has been forwarded to cou 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
- Gazebo - dimensions L W
cooperation is appreciated.
ooi above round in round Size `total square feet
Swimming p g 'g
The Building Department
_Chimney . # of flues
Date sent for review
„�
By