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Architect/Engineer - project supervision and reports
800 MECHANICALS & PRIMARY FUEL
Ltd Furnace (hot air) - Fuel gas (natural or props =ffiel ectricity, other (specify)
Company name i
❑ Boiler (heating)- Fuel as natural orpropane),fuel oil electricity,
( g)- g ( � 'ty, other (specify)
Address
❑ HVAC (combined unit) - Primary fuel, natural gas, propane, electricity, other (specify)
Phone number
El Air conditioning - (separate unit)
I
Certified by State of Massachusetts as
❑ None of the above to be provided
Certification number
Iot Water Gas Electric Fuel Oil Other
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and nrnt
reproductions.
900 SPRIIHKLERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
General Contractor (if Homeowner, state homeowner here then complete' section 1300)
❑ Required, ❑plans provided, ❑plans not provided, why?
Company name
❑ Not required, not to be installed, Why?
Address
Phone number Zk
1000 REQUIRED OFF-STFEL+T PARIONNG - for ZONING & Architectural Access
?QNOT APPLICABLE
Construction Supervisors license number L t f
❑ Parking Plan submitted To ❑ Building Department ❑ Planning Board Date submitted
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and noit
reproductions.
Number of spaces -indoors outside total provided
Handicap spaces - required ® yes _no. If yes, how many as a part of the total required number.
1200 FOR RESIDENTIAL REMODEL WORK ONLY
Is Route 6 (State Road) Entrance permit required? yes ❑ no E. If yes has it been issued yes ❑ no ❑.
Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes o No If no go to next'_ section!
Submit copy of application and/or permit as soon as available.
Are you claiming exemption from the requirement? Yes No _If yes, submit the required afflOavit!
1100 IDENTIFICATION (print or type except as noted)
Remodel contractor name please print)
Current owner - name
a
Address
address r
Registration number (if none state "none")
phone # o .
Phone number
If corporation, officer in charge
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS F'O THE
Architect/Engineer - for overall design
GUARANTEE FUND! QUESTIONS OR COMPLAINTS ,call or write:
Home Improvement Contractors Registration
Company name
One Ashburton Place -Room 1301
Boston, MA 02108
Address
(617) 727-8598
Phone number
Owners name (print)
Certified by State of Massachusetts as
Signature
Cerhficatto n number
,Date
h
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
1300 OWNER SIGN - OFF
reproductions.
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 m knowledge and belief that the information e
h n PP Y g provide d 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 hfegun 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
4
5
written request. I understand that once the permit expires a new application may be required, including fees and current
other requirements (including Zoning).
Name
Signature
e "ab ve signature is my voluntary act and is signed under the pains and penalties of perjury.
Date
Who is authorized to pickup the permit at the Building Department? (pease nntl
Address Phone
i
1400 HOMEOWNER EXEMPTION - ONE & TWO FAMILY ONLY
i
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 intemded 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
Your 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
2.15.2 of section 5)
1500 COST
Cost of Improvement s
Items to be installed but not included in the above cost: Electrical
Plumbing G
HVAC .�
Other
TOTAL
The following section for official use only.
INSPECTORS' REVIEW
Date plan reviewed AUG 0 7 1996
30 days to review period expires psi
11 OK to issue date
6 _
❑ Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required.
El Demolition - describe structure
Number of dwelling units Number of bedrooms A separate Refuse;'
Declaration required. P Dispos al
❑ 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)
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 windows exist` and will not be
enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwwelling will be
considered as an Alteration, otherwise will be included in new construction. (see Code sectiom 3401.10 for
residential and Article 8 for commercial) --
El Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods of time.
Describe
i
500 CONSTRUCTION PLANS
None submitted. Why?
1�+�'Submitted, usually three sets required. Four sets for food service\uses. Number of sets sublimitted
600 STTE PLAN
❑ Not required, why?
NL," witted When? ❑ Previously, date ❑ With this application
700 UTHILITIFFLS -
Water supply required eyes _ no, public*? _ yes ieno, on site well? eyes 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 water supply, when
required, is available. See Code 780 CMR section 114.1.2)
Sewage disposal - required v yes no, public sewer yes
private septic on -site yes
no. Submit copy of permit as soon as available.
3
❑ OK to issue subject to requested submittals (see project review worksheet) date
[Y Woodstove - used (will require inspection prior to installation), new (provide manufacturers 41
❑ DENIED see project review worksheet date
,._
instructions). Location(s) (list)
1
❑ HOLD reason Fate'
❑ 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
AUG 0 7 1996
300 COhfiMRCIAL -PROPOSED PROJECT/USE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES
Inspectors signature Dante
THIS SECTION NOT APPLICABLE
❑ Applicant informed of above - Date time staff (fax, ph(one, in person)
• Massachusetts State Building Code Article 3 AS NOTED See the
(The following :descriptions are based on the M g , )
************************************m*************************#***********m**s**************************
. .::...Code)
❑ Over six months since approved for issue -DEEMED abandoned!
Advise applicant. Hold 90 days for return then dispose if not picked up.
i ❑ Assembly - restaurant, lounge, theater, school, etc, (see Code Section 302.0) Describe
Inspector Zate
❑ Business - office, assembly with less than 50 occupants - indicate Medical or other professional (see Code
❑ Advised applicant Date Time staff (by phone, fax or in perston)
Section 303.0)
❑ Educational - structure for training including child day care for those over 2 years 9 months (see Code Section
OFFICE\JNSPECTORS NOTES
304.0)
S ��
TOTAL FEE
❑ Factory / Industrial - (see Code Section 305.0)
Gross area -new construction 0 Total Sq. Ft.
Higa Hazard - (see Code Section 306.0)
alteration Total Sq. Ft.
' day care see Code Section 307.0 _ ant home infant hospital, nursing )
❑ Institutional p , g , Y (
Permit is issued to ---
El .Mercantile - retail stores (see Code 308.3)
❑° Residential - three or more family, hotel (see Code Section 309.0)
Comments/notes on permit
❑ 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
I,
Describe the proposal briefly, INCLUDE number of dwelling units and bedrooms or occupant load as applicable,
also existing condition
j
400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED
;New Construction and/or Addition - total gross square feet l "1
(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
_
t ❑ 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
7
x**xx**xxx***xm***xx***xx****x****xx**x*x*x*xxs***********x*x***xxx***xx**x*xx***xxxx*xx*xxxxx*xxx**xx*x
1600 TO THE APPLICANT/REFERRAL AND APPROVAL
7f / 11'1r7 6
Date of Application submission `�'�
Plat Lot Street
Aquifer Zone
Owner 2.a
Owner mail address
Owner phone #
OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT THEM FOR REQUIRED SMhffl%IONS.
® AX COLLECTOR ❑ Approved ❑ HOLD By
Date
nervation Comm ❑ Approved By
Date
❑ D.P.W. water ❑ Approved By
Date
❑ D.P.W. "sewer ❑ Approved By
Date
❑ D.P.W. cross connection ❑ Approved
Date
❑ D.P.W. engineering ❑ Approved
Date
El
OoardA of Health well ._.
Approved
Date
❑ oa'rd of Health septic ❑ Approved
Date
❑ Board of Health food service ❑ Approved
Date
IRE DISTRICT (i - T3 -III 1 Apprvvea _
D'Je
Planning Dept L'. Approved
Date
Ot er 1/❑ Approved
Date
Other 7 Approved
Date
Comments
Project summary new construction/ alteration/demo
sewage disposal - public/private
[Alter/add interior walls] [add rooms] [add footprint]
water supply - public/private well
[pool] [garage/shed] [game court] [food service]
Describe
xx**x***xxx*x*x*x****xxxxxxx*x**�****xxx*xe*xxxxx**xxxxxxxxxxx*****xx**mxxxxx*x**sa******xx*x*x*�****s****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
8
TOWN OF DARTMOUTH BUILDING DEPARTMENT.
TELEPHONE 508-999-0720 FAQ 508-999-0738
APPLICATION FOR ZONING AND BUILDING PERMIT
Ingtractioas
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 imserted for those sections
which do not apply. A properly completed application will help avoid unnecessary delays. N.1t FlkgCirae is u.f
(for office use only)
Application fee received byja3 Date
Total Permit Fee Pernsit #
100 LOCATION OF PROJECT
CURRENT ACCESSORS' PLAT,_ LOTCOZONING DISTRICT°�- dam'
�::7 i
OTHER ZONING OVERLAY DISTRICTS , if applicable
NUMBER & STREET —
NEAREST CROSS STREET
SUBDIVISION NAME & LOT # " Roo Le-
• �—
or BUSINESS NAME
PREVIOUS TENANT / OWNER
200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
El THIIS NOT APPLICABLE
SECTION
i L'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
>
u Garage - detached ttached to dwellin mensions L
W f�
Carport - detached - attached to dwelling, dimensions L
W
❑ Shed - dimensions L W
❑ Gazebo - dimensions L W
❑ Swimming pool above ground in -ground Size
xtotal square feet
❑ Chimney - # of flues