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ZSUU ZYMUL A►NlU-A j„S & P Y 1411M
= Furnnce (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specif
Y)
EMI
Company name
= Boiler (heating)- Fuel gas (natural or propane), fuel oil, electricity, other (specify)
- HVAC (combined unit) - Primary fuel, natural gas, propane, electricity, other (s ecif
P Y)
- Air conditioning - (separate unit)
— None of the above to be provided
= 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?
1000 REQUIRED OFF-STREET PARKING - for ZONING & ArchitecturaI Access
_ NOT APPLICABLE
= Parking PIan submitted To = BuiIding Department = Planning Board Date submitted
Number of .spaces - indoors _ outside
total provided .
Ilandicap spaces -required _ ves no. It yes, how many as a art of the total required P q number.
Is Route 6 (State Road) Entrance permit required? ties = no =. If ves has it been issued n es = _
Y o _.
Submit copy of application and/or permit as soon as available.
1100 ID NTIFICATION ( print or type except as noted)
(.u.imnt owner - name W1e_&1,41L(
ddress %
phone # V17,
L- �+ e I /o x,
Address
Phone number
Certified by State of Massachusetts as
s
Certification number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
General Contractor (if Homeowne state homeowner he"en complete section 1300)
Company name
Address
Phone number
Construction Supervisors license number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
1200 FOR RESIDENTIAL REMODEL WORK ONLY
Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes _ No _ If no go to next sectioin!
Are you claiming exemption from the requirement? Yes No _IF yes, submit the required affidavit!
Remodel contractor name (please print)
Address
Registration number (if none state "none")
If c:orpoi-a Lion, officer in charge
Phone number
Architect/Engineer - for overall design PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO TEE
GUARANTEE FUND'. QUESTIONS OR COMPLAINTS call or write:
Home Improvement Contractors Registration
Company name One .4shburton Place - Room 1301
Address Boston, :MA 02108
(617) 727-8598
Phone nuaaher
Owners name (print)
Certified by State of Massachusetts as
Signature '
Certification number
Date
NOTE Signatures and seats 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 hest of my knowledge and belief that the information provided in thiis
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 wr
six months after the last inspection if work has begun and that the permit maybe extended for six months if no work-.iis
anticipated if I request such an extension in writing. I understand that the permit may be extended only three times b)v
written request. I understand that once the permit expires a new application may be required, including fees and current
other re uirements (including Zoning).
ame I L. Cr �4' y�,` l L K /) ; S Q Gam'
Signature
The above signature is my voluntary act and is signed under the pains and penalties of perjury.
ate 4!5; .9
Who is authorized to pickup the permit at the Building Department? iplease print)
Address 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 fol? -ws: Person(s) who owns a parcel of land
on Nvhich he; she resides m -intends to reside. on which there is, or is intended to he, 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.' of section
1500 COST
Cost of Improvement
Items to he installed but not included in the above cost:
The following section for official use only.
INSPECTORS' RE IEW
Date plan reviewed
TOTAL
JUN 2 0 1996
5
Electrical 5
Plumbing
HVAC
Other
Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Dem-clarntion required.
- Demolition - describe structure
Number of dwelling units Number of bedrooms A separate R� fuse 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)
Number of square feet
Number of lavers when complete
0
A separate disposal declaration REQUIRED
Number of layers already exir1ting
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 existfing dwelling will be
considered as an Alteration, otherwise will be included in new construction. (see Code section 3401.10 for
esIT, and Article 8 for commercial)
- Temporary structure - includes when allowed, trailers, tents and the like and only for limiited periods of time.
Describe
500 CONSTRUCTION PLANS
None submitted. Why?
- Submitted, usuallv three sets required. Four sets for food service\uses. Number of sets submitted
600 SITE PLAN
0 Not required, why?
- Submitted When? .- Previously, date - With this application
700 UTILITIES
Water supply - required e ves no, public ? _ yes ._ no, on site well? _ yf:x — no,
existing yes _ no
If required and not existing have necessary permits been issued? _ no _ yes,* date
(M.C.L. Chapter 40, section 54 provides that no building permit may be issued unless a wtater 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,
30 days to review period expires
- OK to issue date
OK to issue subject to requested submittals (see project review worksheet) date
.. � �
Woodstove - used (will require inspection prior to installation), new (provide manufacturers
DENIED see project review worksheet date
instructions). Location(s) (list)
J
date
HOLD reason
!� Fireplace(s) - (includes flue) List location(s)
HOLD Subject to Zoning Board of Appeals action
LE Game Court - describe (includ overa �d�ensions)
C(_....._- Comments
Tent, Trailer (Mobile Home) Other describe/���' L' `'``�
. JUN 2., 0 1996
INCLUDING THREE FAMILY OR MORE AND EXEMPT USES � Date
300 CONE%ffiRCIAL - PROPOSED PROJECTIUSE - IN Inspectors signature .
PP
THIS SECTION NOT APPLICABLE
Applicant informed of above - Date time _ staff (fax, phone, in rperson)
(The following descriptions lions are based on the Massachusetts State Building Code Article 3, AS NOTED) (See the
Code) Over six months since approved for issue - DEEMED abandoned'.
Advise applicant. Hold 90 days for return then dispose if not picked up.
= Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe
Inspector Date
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 person)
Section 303.0)
************************************************************************************************tom*******
= Educational - structure for training including child day care for those over 2 years 9 months (see Code Section OFFICEVNSPECTOILS NOTES
304.0)
.-,
TOTAL FEE
Factory /Industrial - (see Code Section 305.0)
Gross area -new construction � � � Total Sq. Ft.
- High Hazard - (see Code Section 306.0)
alteration Total Sq. Ft.
- Institutional - hospital, nursing home, infant day care (see Code Section 307.0)
Permit is issued to
?Mercantile - retaiI stores (see Code 308.0)
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
Desen'be the proposal briefly, INCLUDE number of dwelling units and bedrooms or occupant load as applicable,
also existing condition
400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED Z6 Is
_ 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 COM ERCIAL 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
r
Date of Application submission � / -26� k�
Plat L Lot��'gtreet
Owner
ifer Zone
r
Owner snail address �•�j�%� �'�..�
Owner phone #
x:=i=:�:*:=*::ssssssssssssssasss*##sssssssssss�sssssssssssss#sass*sasssatsssssssssssssssssssssssssssss*==i
OTIIER INVOLN'ED :AGENCIES - The following agencies require separate jurisdictional permits or approval
Proposed Project. CONTACT -� FOR PP aI for your
. ` I��LS.SiONS.
® COLLECTOR - � r %1,/,
--� — Approved _ HOLD By
Q servation Comm pproved By_
Q D.P.W. water = Approved By
wire
Date
Date
Q D. P. ZN sewer — Approved B v
• Date
CI D.P.W. cross connection ` ApproTed Date
0 D.P.W. engineering = Approved
Date
0 Board of Health well = Approved Date
:2 Bard of Health septic = Approved
Date 0 • e
" Board of Health food set-ti•ice —A pp�oed Date
RE DISTRICT' (I • II - III = Approved - Date
Planning Dept Approved Date
Other _ Approved •
Date
O t h e r — Approved
Date
(',•mments
P,rnjeet summary new construction/ alterationidemo sewage disposal - ubIici 'v - P pri ate
[Alter -add interior walls] [add rooms/ [add footprint)
(pool] [garnge.shedj [game court] [food service]
D escr:ne /
water supply - publiciprivate well
sea sass::::s:sass:s=:=s==s======:sssssa*** sssss:#ass*sass*sass:=
To the vari-ous departments:
Th is notice has been forwarded to you for your information and any -a ropriate action. Should y
yucstions please advise. If any reason to withhold the requested PP - you have any
cooperation is appreciated.
q permit is found, please advise. Your assistance and
The BuiIdin Department
Dare sent for review
By
PARfn_ffNTBUELDIN.�
TOWZ
DART MOUTH
TELEPIONE 1.
��� 1 150t5j%-999m0738
APPLICA ON FOR ZONING AND BUILDINGPERMIT
Dona
The applicant shall complete this application to the best of their ability prior to stabmissioa.•ieaviag so ittna "�':�'�wered• TI1e
Department staff will be available durin10 regular business hours to assist as necessary. N/A should be inserted [ or those sections
which do not apply. A properiv completed application will help avoid'tmneces&u y delays. Nit= F
(for office use only) i
Oreceived
• b DateS�tton feeAPP�p
Total Permit Fes $
100 LOCATION OF PROJECT
Permit #
T T� LO2 '/ ZONING DISTRICT'
CURRENT ACCESSORS PLAT
OTHER ZONING OVEJUAY DISTRICTS ,.if applicable
NUMBER &. STREET e, u 63e,
CIE.-kREST CROSS STREET
SUBDIVISION NAINIE & LOT # -
or BUSINESS NAME
PREVIOUS TENANT ; OWNER
200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
= THIS SECTION NOT APPLICABLE
= SingIe family - number bedrooms number baths
_ Two family . number
bedrooms
unit
1
number Laths
unit 1
• number
bedrooms
unit::
number baths
unit
= Accessory apartment
gross sq. ft.
= Accessory structure
= Garage . detached - attached to dwelling, dimensions L W
= Carport - detached - attached to dwelling, dimensions L W
= Shed - dimensions L W
= Gazebo - dimensions L W
= Swimming pool above ground in -ground
= Chimney - # of flues
Size total sgfuare feet