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BP-781i . � I c,— w II O 1 CIO s �z La i &,i mLL 0 <? Oto LLJ LLJ CD 0 LU fn CIA i.ijj 1 _ '• Q Y U U C r �\13d -a d — -aQ (� w—y X N Ec v�1� LU M.0CL _ p b� VO *aaaass�ss*aa**as*aaa*aas*aaa#*aa##aa*a**#aasssaa#*s**aaaaa**aaa*aaaaaaaaaa*a*aa*a*s*aaaaa*a*a**a*aaaa**. i 1600 TO THE APPLICANT/REFERRAL AND APPROVAL Date of Application submission Plat Lot Street Aquifer Zone Owner Owner mail address Owner phone # *smxasaa*****saaa*aasm****aa*a*a****saaaaa*****a**aaaaaaa*****aa**aa**mm*****a*aas*****ss*ssa*a*aa*m*a*** OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACT' THEM FOR REOLIAEp SUBMISSIONS. 12 TAX COLLECTOR ❑ Approved ❑HOLD By Date a Board of Appeals ❑ Approved PP APP ed BY Date 0 Conservation Commission ❑ Approved By Date 0 D.P.W. Water ❑ Approved By 0 D.P.W. Sewer J Approved By Date ® D.P.W. Cross Connection ❑ Approved By I Date 17 Treasurer (Bond) o Approved By Date O D.P.W. Engineering ❑ Approved By Date 7 Bo-rd of Health (well) ❑ Approved By Date 13 j Board of Health (septic) ` ❑ Approved By Date ❑ Board of Health (food service) ❑ Approved By Date O Planning Board (parking) ❑ Approved By _Date ® FIRE DISTRICT (I - II III) `; Approved By Date sssssassasassssssssssssasssssssssassssaassassssssssssssasssssssssssaasssssssssssssasssasssasssss BUILDING DEPARTMENT APPROVAL: I ZONING ❑ BUILDING INSPECTORBUILDING COMMISSIONER [a CONTROL CONSTRUCTION AFFIDAVIT aaa*aaass:aaa*ara****a*a**a**a**a**aa*aa****aa*aa*saa***aaa**aas*aa*aas*aaaa*#*aa*aaaaa*ariaaa*a*aa*asa** PROJECT' "SUMMARY - new construction/ alteration/demo sewage disposal - public/private t [Alter/add interior walls] [add rooms] [add footprint] water supply- public/private well [pool] [garage/shed/deck] [game court] [food service] Describe *aaaaa*aaa*a****aa*aaaa*aa*aassa**aaaaa*a*ess*a*a*a*aaaas*saaams**aaaaa*aaa*aaaa*a*aaa**a*asa**aa*aaaasaa** 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 By g TOWl�i OF DARTIV (JU H BUILDING "EPA ��'l ENT, TELEPHONE 508-999-0720 FAX:08 999-0?3 APPLICATION FOR ZONING AND BUILDING PERMIT � Instrnctioav The applicant shall complete this application to the best of their ability prior to submission, leaving no item unanswered. The Department staff will be available during regular business hours to assist as necessary. N/A should he inserted for those sections; which do not apply. A properly completed application will help avoid unnecessary delays. hbtc Mag fees not refindablip- (for owke use only) ❑ FOUNDATION ONLY Total t DA $ Received By Date Reed Less Applim iion Fee $ Total Permit Fee S Permit #E bsaed Date 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET CURRENT ACCESSORS' PLAT LOT ZONING DISTRICT OTHER ZONING OVERLAY DISTRICTS, if applicable NUMBER & STREET NEAREST CROSS STREET SUBDIVISION NAME & LOT # or BUSINESS NAME PREVIOUS TENANT / OWNER 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. E Accessory structure: ❑ Garage - detached - attached to dwelling, dimensions L W ❑ Carport - detached - attached to dwelling, dimensions L W ❑ Shed - dimensions L W ❑ Deck - dimensions L W ❑ Gazebo - dimensions L W LE Swimming pool above ground in -ground Size E Chimney - number of flues 1 800 MECHANICALS & 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) i ❑ None of the above to be provided �I !E Hot Water Gas Electric Fuel Oil Other 900 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? I 1000 REQUIRED OFF-STREET PARIONG - for ZONING & Architectural Access I NOT APPLICABLE ' . = Parking Plan submitted To Building Department E 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 —7, no If yes has it been issued yes El no = . Submit copy of application and/or permit as soon as available. 1100, IDENTIFICATION (print or type except as noted) Current owner -name "' � e address jj phone # i 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 seas on all plans, affidavits and other documents SHALL BE originals and not reproductions. Architect/I:ng veer - 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 n't ; r.. 3 "Address D I 10 hone numbert� 16. t Construction Supervisors license number NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not reproductions. *xz*x*x****z*xxxxxxxxxx*x*x*x-xxzzz**xz*****x**xsxz*szs�*z**zx*x**x*zxz*zxz**x*z*xz***x*zsat*zs**sxx*z*** 1200 FOR RESIDENTIAL REMODEL WORK ONLY Are you a Home Improvement Contractor subject to (780CMR - 6) ?Yes _ No If nog o to next section! Are you claiming exemption from the requirement? Yes �No _If yes, submit the requiired affidavit! Ren_odel 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 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 work is begun or six months after the last inspection if work has begun andthat 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)J r r ameLL63__ �' C VSignatu� The above signatu�i, � y voluntary act and is signed under the pains and penalties of perjury, Date ` Who is authorized to pickup the permit at the Building Department? lease rint ¢ ai Address Phone - " %%-1'if)% 1400 HOMEOWNER EXEMPTION - ONE & TWO FAMH.Y ONLY FOR HOME OWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT 109.1.1 Licensing of Construction SupervisorsExcept for those structures governed by Construction Control in Section 127.0, effective July 1, 1982, no individual shall he 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 PBRS _;ntitled 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 dweliin , 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 Your signature carries certain responsibilities, including but not necessarily limited to, general liability zzzx*zzs*s*zzszsz*ss*szszzsszsszss*ss*zszsz*ss*szsszs*s*szsz*ss*szszs*zssszszz*ss**szssz*****zzzzzsszzsz 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) *xzs*zs*s*z*z*s*mzs*z*sz*s*zsz**szss*zs*ss*sszsz*s*ss*s*szsz*szz**zzszszsz*szssss*ss*ss*****zzzzs***sss* 1500 COST Cost of Improvement 1' Items to he installed but not included in the above cost: Electrical $ Plumbing HVAC Other TOTAL ! '� 6 Alteration of existing, no increase in gross square feet. A separate Refuse Disposall Declaration required. Demolition - describe structure Number of dwelling units Number of bedroomA se tr Declaration teq ui�, s P Reface Disposal 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`: -roo Re Number - (for existing only, is included in new construction) Number of square feet Number of layers already existing Number of layers when complete A separate disposal declaration REQUIRED Replacement doors and windows - (for existing only) (only where doors and window;=s 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)rsection 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 service\uses. Number of sets submitted 600 SITE PLAN ❑ Not required, why? Submitted When? Previously, date ❑ With this application 700 UTILITIES Water supply - required _ yes _ no, public ? _ yes _ no, on site well? _.ayes _ no, existing? _ yes _ no If required and not existing have necessary permits been issued? no _ yes, date (M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a iwater 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 availaable. Woodstove used (will require inspection prior to installation), new (provide manufacturers instructions). Location(s) (list) El Fireplace(s) (includes flue) List location(s) Game Court -describe (include overall dimensions) u Tent,Trailer (Mobile Home) or 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 I 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 j Section 303.0) _ including child day care for those over 2 ears 9 months see Code Section Educational structure for training g y Y 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) family, hotel see Code Section 309.0 three or more f Residential - thr ( ) Y Storage - includes garages (see Code Section 309.0) Utility & Miscellaneous Structures includes tents and agricultural structures (see Code Section 311.0) C New tenant for any of the above, indicate above (see Code Section 119.0 and Zoning By-law section 35) E Tent or Trailer - temporary purpose? LE Other iDescribe the proposal briefly, INCLUDE- umber of dwelling units and bedrooms or occupant toad 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 u 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 I 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 subject to requested submittals (see project review worksheet) date 77 DENIED see project review worksheet date HOLD reason datte HOLD Subject to Zoning Board of Appeals action Comments Inspectors signature DaW, MAY 9 �9 7 -1 Applicant informed of above - Date time staff (fax, phome, in person) z******zzzz*s*zzs***z*zss*zzzzs***sz*s*zz*zsz*****zss*zzsssssszzzs*s*zs**sz*szsz*sz***zs**z**�zzz*ssz**sss 7 Over six months since approved for issue = DEEMED abandoned! Advise applicant. Hold 90 days for return then dispose if not picked up. Inspector Daue Advised applicant Date Time staff (by phone, fax or in persoa)) ssszs**zss**zz*z*szs***zzszzss*s*szssszz*zz***s*zsszzssszzzzzzzs*zzzss*szzzzzzszzz*s*ms*z�ses**zzs*s***zs OFFICE\INSPECI'ORS NOTES i� TOTAL FEE Gross area - new construction Total Sq. Ft. alteration Total Sq. Ft. Permit is issued to Comments/notes on permit y® 6 n ++•+ ##i####*#########Y###x#####*YY#####Y#YYYY#YY##Y###Y##xY###Y 1600 TO THE APPLICANT/REFERRAL AND APPROVAL Date of J. Aquifer Zone Owner mail address Owner phone # OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACT TUM FOR R_F.[H BWO SUBII�IS.SIONS. ® TAX COLLECTOR ❑ Approved ❑ HOLD By Date 13 Board of Appeals ❑ Approved By Date conservation Commission E Approved By Date ❑ D.P.W. Water ❑ Approved By ❑ D.P.W. Sewer ❑ Approved By Date ❑ D.P.W. Cross Connection ❑ Approved By Date ❑ Treasurer (Bond) ❑ Approved By Date ❑ D.P.W. Engineering - Approved By Date and of eaith (we Approved By Date ❑ oard th (septic) E Approved By Date ❑ Board f Health (food service) ❑ Approved By Date ❑ Planning Board (parking) ❑ Approved By Date ® FIRE DISTRICT (I - II - III)❑ Approved By Date ss:ss:sssss:sssssssssssssssssssssssssssss:sss:sssssssssass:sssssssssss:ssssssssssssss:ssss:s:ssssss:ssss BUILID NG DEPARTM 4T APPROVAL: ❑ ZONING ❑ BUILDING INSPECTORBUILDING COMMISSIONER ❑ CONTROL CONSTRUCTION AFFIDAVIT PROJECTSUMMARY- new construction/ alteration/demo sewnoe dknnnl _ n hl;../.,, .. [Alter/add interior walls] [add rooms] [add footprint] water supply - public/private well [pool] [garage/shed/deck] [game court] [food service] Describe ###xxx#s#*x#*#sx#*sxx##*###*#*x*###x*x#x#xax#x*#####x##*#YYx#*##*####x**#*#****#**#x#x#x#x##*x#s#*xx#x##x#* 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 By g TOWN OF DARTNIOUTHBUILDING DEPARTMENT TELEPHONE 508-999-0720 FAX 'S08-999-4738 APPLICATION FOR ZONING AND BUILDING PERMIT The applicant shall complete this application to the best of their ability prior to submission, leaving no item unanswered. Tina Department staff will be available during regular business hours to assist as necessary. N/A should he inserted for those section which do not apply. A properly completed application will help avoid unnecessary delays. No&= FMvg fees umd (for office use only) TION Q i,y Total Cost Received By Date Ree'd I Less Application Fee $ �e Total Permit Fee $ Permit # Issued Date 111 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET�� =. J �+ CURRENT ACCESSORS' PLAT LOT jni ' ONING DISTRICT - OTHER ZONING OVERLAY DISTRICTS , if applicable NUMBER & STREET NEAREST CROSS STl SUBDIVISION NAME & LOT # or BUSINESS NAME PREVIOUS TENANT / OWNER 200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only - THIS SECTION NOT APPLICABLE G 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: LE Garage - detached - attached to dwelling, dimensions L W El Carport - detached - attached to dwelling, dimensions L W El Shed dimensions L W El Deck - dimensions L W Gazebo - dimensions L W i —'✓ /�� Swimming pool above gro dd in -ground Size 7 b El Chimney - number of flues r 1 �'