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BP-58280 C m C3 , o e v NSKp to > k N• N a zr a o zr �' 4 — • S LTI r_ ^I J CD Gn N 900 MECHAMCALS &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 900 SPRI O LERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential Required, --plans provided, "—plans 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 = Planning Board Date submitted Number of spaces - indoors outside total provided Handicap -paces required ves _no. If yes, how :many as a art of the total ! required number. , Is Route 6 (State Road) Entrance permit required? yes _ no =.' If yes has it been issued ves _ no 7­ Submit copy of application and/or permit as soon as available. 1100 IDEN711FICATION (print or type except as noted) Current owner - name j address G hone #673 C> 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 olans, affidavits and other documents SHALL BE originals and not reproductions. Architect/Engineer - project supervision and reports Company name Address i 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' inot reproductions. General Contractor if Homeowner, sta homeownerhere then complete section 1300) Company name -- X—\f� Address Phone number Construction Supervisors license number NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and mot reproductions. xas***aexsxx*xxsxx**xx*ssxxxxxxxxsxx***x*x**;«xx*x*xsssssssssssssssssssssssxxxxx*sx*xxssxxxxxss;*x*x*sxxx 1200 FOR RESIDENTIAL REMODEL WORK ONLY Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes _ No _ If no go to next section! - Are you claiming exemption from the requirement? Yes No If yes, submit the required aEfidavit! Ren_-)del contractor name (please print) Address Registration number (it none state "none') Phone number i 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 i J- I H\{LiQWLL .11 i:..11JLWi/ uv •u. v.... �. .D-__ l - I, the undersigned, am the owner of record or authorized lessee _ Demolition - describe structure � (provide documentation) aad I have reviewed the application herein submitted. I state that to the best of my knowledge and belief that the information provided in this welling units Number of bedrooms A separate Refas:. Disposal application is true -and correct and that the permit requested be issued. Declaration Number of dwelling Further I understand that the permit will expire in six months, from the date of issue, if no work is begun orrequh six months after the last inspection if work has begun and that the permit may be extended for six months if no work is Moving - (Provide copy of D.P.W. moving license) Type of structure an. cipated 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 from where (plat/lot or address) other requirements (including Zoning). - /me � t� �'r-, C>" i kQ Q to where (plat lot or address) 4ature ?Y+'1. Number of bedrooms per dwelling unit Number of dwelling units The above signature is myluntary act and is signed under the pains and penalties of perjury. Re -roofing - (for existing only, is included in new construction) /Date C I,.( a i C �C,i> Q LCW � / Number of square feet Number of layers already existing;, R'ho is authorized to pickup the permit at the Building Department? ipiease nnntt Address sP S ELf__ C" tom Phone (o"2 3 -0 r Number of layers when complete A separate disposal declaration REQUIRED 1400 HOMEOWNER EXEMPTION - ONE & TWO FAMILY ONLY = Replacement doors and windows - (for existing only) (only where doors and windows exis;,. and will not be FOR HOME O«NERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing cdwelling will be 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 is considered as an Alteration. otherwise will be included in new construction. (see Code sectioin 3401.10 for 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 residential anti Article 8 for commercial) Rues and Regulations for Licensing Cor-ttructien Supervisors. Temporary structure -includes when allowed, trailers, tents and the like and only for limited, periods of time. I 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 persons) for hire to do such work ,that such ` Describe Home Owner shall act as supervisor. � ''�� 500 CONSTRUCTION PLANS For the purposes of this sectioc: , aiy, a "Home Owner" is defined as follows: Person(s) who owns a parcel of land " on hich he: she resides or intends to reside, on which there is, or is intended to be. a one or two family dwell in2, attached = None submitted. Whv? 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. =Submitted, usually three sets required. Four sets for food service uses. Number of sets scubmitted If you are applying under this ection sign below: 600 SITE PLAN I r SignatureAl El required, why? Your signature carries ce in responsibilities, including but not necessarily limited to, general Lability J'With this application zssrzzzzzszzzssssxsssssssssssssssss:sssssssxssssssssssssssssssssxsssssssssssssssssssssssssssssssssssssss 4 Submitted When. -Previously; date PP I, 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 700 ITTILTI'IFI;S II 2.15'.2 of section F sssxszzs:sssrszzzssssssssssssssssssszsssssssssssss;sssssssssssssasszssssmszssss*ss#*s*x*sx**xsisssssssss . Water supply - required _ yes no, public ? Yes _ no, on site well? yes F_ no, j 1500 COST Cost of Improvement g existing? yes _ no I Items to be installed but not included in the above cost: EIectrical 5 If required and not existing have necessary permits been issued? _ no _ yes, date Plumbing (M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a watter supply, when HVAC required, is available. See Code 780 CMR section 114.1.3) Other Sewage disposal required yes _ no, public sewer _ yes _ no TOTAL S ' D " private septic - on -site yes _ no. Submit copy of permit as soon as availabite, b- - The following section for official use only: Woodstove - used (will require inspection prior to installation), new (provide manufacturers INSPECTORS' REVIEW instructions). Location(s) (list) ` Date plan reviewed ._ Fireplace(s)_ (incl udes esflue)List 10ca ti0II (S ) 30 days to review penod expires Game Court - describe (include overall dimensions) OK to issue date Tent, Trailer (Mobile Home) Other -describe OK to issue subject to requested submittals (see project review worksheets) date 300 COMMERCIAL - PROPOSED PROJECTIUSE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES = DENIED see project review worksheet date THIS SECTION NOT APPLICABLE date HOLD reason (The following descriptions are based on the Massachusetts State Building Code Article 3, AS NOTED) (See the is action Code) - HOLD Subject to Zoning Board of Appea = Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe Comments s� y Date AR 3 0 99 Inspectors signature Business - office, assembly with less than 50 occupants - indicate Medical, or other professional (see Code person) Section 303.0) — Applicant informed of a ve - Date time staff (fax, phone, in . � � zsz*z**xzszss**sszzzz*s**szzs*szssssssszazszzssssssssssssssssszssss:`zssz*s**szzszzz*s*s*z*zs* = Educational structure for training including child day care for those over _ years 9 months (see Code Section *****:**x***** 304.0) Over six months since approved for issue - DEEMED abandoned! r return then dispose if not picked upe. Advise applicant. Hold 90 days fo Factory J Industrial - (see Code Section 305.0) Y ' Date High 71azard - (see Code Section 306.0) Inspector _ Advised applicant Date Time staff (bv phone, faix or in person) n Institutional - hospital, nursing home, infant dacare (see Code Section 307.0) — - Mercantile - retail stores (see Code 308.0) / zzz*zss*z*zzzzssssszzzzssszssz**sxssszs*zz**zzzsssszssss*szsssssszzzs*z**zzszzsszzszz*szzzz**sszzzs**zz** OFFICE\INSPECTORS NOTES Residential three or more family, hotel (see Code Section 309.0) C9 TOTAL FEE Storage -includes garages (see Code Section 309.0) Total Sq. Ft. Gross area -new construction _ Utility & Miscellaneous Structures - includes tents and agricultural structures (see Code Section 311.0) . Total Sq. Ft. alteration New tenant for any of the above, indicate above (see Code Section 119.0 and Zoning By-law section 35) Permit is issued to Tent or Trailer temporary purpose? Other Comments/notes on permit 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 andlor Addition total gross square. feet (For commercial only total gross cubic feet) - indicate It will he 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 he 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 cuA.) Yes No (see Code Appendix 1) APPT.TVA%"'rn PV0VM1? - x##ff#f##f#ii#!Yi#i##i#i#i#l#!f#!#i!#!i#i##ff##s#iY#Y##iflY#fi#l!##fifffff##sflff#f#!!;llsliY!###!llil## 1600 TO THE APPLICAPTP/REFERRAL AND APPROVAL I Date of Application submission 5; aS Plat Lot Street Zs Aquifer Zone Owner Owner mail address Owner phone # 4 7-3 Ci :ss*sssxf#x#x#i#ff#f#######fsY###fiiiitiffifiifi#ff#iYfff##fffi #ifssiif#f#i#iifl#ilYi#ills#il#!#iixf#ifff OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACT THEM FOR ItEOU MED 'UBNMMONS- IN TAX COLLECTOR Approved .— HOLD By Date ❑ Board of Appeals Approved By Date ❑ onservation Commission C. Approved By�� 7. ❑ D.P.W:" Water — Approved By ❑ D.P.W. Sewer. = Approved By Date ❑ D.P.W. Cross Connection a Approved By Date ❑ Treasurer (Bond) ❑ Approved By Date ❑ D.P.W. Engineering a Approved By Date 7 Board of Health (well) :.- Approved By Date (::134oard of Health (septic) Approved By Date o Board of Health (food service) Approved By Date ❑ Planning Board (parking) Approved By Date s FIRE DISTRICT' (I - III) _ Approved By ! /� C' Date 3A0.AF— sss::iss:::::!lsif:fs:ss###!Y!! !sl i!!ltYs!!!!isiss#!#YYSYii!lssis!lYYY::Ylsls!!!!i!!!liiii:i!lssY:sss BUILDING DEPARTMENT APPROVAL: ❑ ZONING ❑ BUILDING" INSPECTOR/BUILDING COMMISSIONER ❑ CONTROL CONSTRUCTION AFFIDAVIT i xsxtsisx#s#f#iii#f#f##zYz#i#lz#z#f#sssx#zss#ss:xfiz##zzizzz###zs##ssY#zs##s#ixi#ifz##l###ii##zixszs#zssf PROJECT SUMMARY: new constructions alteration/demo sewage disposal - public/private [Alter/add interior walls] [add rooms] [add footprint] water supply - public/private well [pool] [garage/shed/deck] [game court] [food service] Describe �i u i!t#YxYff�Kf*:ffffxf#:ffii#:#fYiYsi#ff:#fYfiRi:fi## #fff######i!#fiffl##iisfiiif#lit#l#:. i#!##li#lii��#i####! To the various departments: This notice has been forwarded to you for your information and any appropriate action. Should you v y 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 �Gi r '9 By APPLICATION FOR ZONING AND BUILDING PERMIT Ins4 oetiom 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 be inserted ffor those sections which do not apply. A properly completed application will help avoid unnecessary delays. fees mad (for office nae Doty) ❑ F00NMITON ONLY Total Cast Received By Date Rec'd. Less Application Fee S Total Permit Fee Permit # Issued Date 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET CURRENT ACCESSORS' PLAT LOT ZONING DISTRICT OTHER ZONING OVERLAY DISTRICTS , if applicable ,Z,�' NUMBER & STREET r` NEAREST CROSS STREET (t`a-'2 SUBDIVISION NAME & LOT # or BUSINESS NAME PREVIOUS TENANT / OWNER 200 RESIDENTIAL - PROPOSED PROJECT - one & two family'residence only THIS SECTION NOT APPLICABLE . r� Single family - number bedrooms number baths > �� = Two family -number bedrooms unit 1 number baths unit 1 t- number bedrooms unit 2 number baths unit 2 4 — Accessory apartment Total gross sq. ft. `dry u rvu s Accessory structure: Garage - detached - attached to dwelling, cimensions L W' Carport - detached - attached to dwelling, dimensions L Wi R Shed - dimensions L R' = Deck - dimensions L W Gazebo dimensions L W a Swimming pool above ground in -ground Size Chimney - number of flues