BP-740Date of Application submission��
Plat 1 Lotl�z—Street ➢C. Ce (�C� `
Aquifer Zone
l 4 - n
Owner
Owner mail address
Owner phone # - 7 / f
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OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT TfIEM FOR REQUIRED SUBM MON& -
COLLECTOR Approved HOLD By Dat
e
❑gonseryation Comm - Approved By Date
❑ D.P.W. water = Approved By Date
❑ D.P.W. sewer Approved By - Date
Q D.P.W. cross connection Approves Date
❑ D.P.W. engineering _ Approved bate
Huard of Health well -- Approved Date
•� oard of Health septic — Approved 414,14
V Date
❑ Board of Health food service = Approved Date
SIRE DISTRICT' iI - II -III) = Approved` / Date
❑ Planning Dept - Approved Date
Other 1 Approved
Date
Other
Approved Date
( •„mmunts
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Prn"ect summary new co
1 nstruc tto n; alteration demo sewage disposal - public/private
[Alter.�add interior walls] [add rooms] {add footprint) water supply - publicrprivate well
[pool] [garage shed] / [game court) [foodservice]
Describe t L'
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To the various departments:
This notice has been forwarded to you for vour information and any appropriate action. Should you have anv
questions please advise. If any reason to withhold the requested permit is found. please advise. Your assistance and
cooperation is appreciated.
The BuiIdin, Department
Date seat for review By
TOWN OF DARTMOUTH BUILDMG DEPi!1kRTAffiNT
TELEPHONE 508-999-0720 FAX 508-999-0738
APPLICATION FOR ZONING AND BUELDING PERMIT
Insumetions
The applicant shall complete this application to the best of their ability prior to submission: leaving no item tmansweredL The
Department staff will he available during regular business hours to assist as necessary. N/A should be inserted for those>secdous
which do not appiv. A prnperiv completed application will help avoid mnecessary delays. lee is ®t
(for office use only)
ApPiacatioa fee $ lsw received b//S Date
Total Permit Fee $ Permit #
100 LOCATION OF PROJECT
CURRENT ACCESSORS' PLAT 06- LOT—(!!�' Z- ZONING DISTRICT
OTHER ZONING OVERLAY DISTRICTS, if applicable
t;N r 1BER & STREET 5 O ��' r
/U
r
NEAREST CROSS STREET -� U ri ✓�' �� P T'-1)
tC
SUBDIVISION NAME & LOT # �Or- ✓' 6� n <
LO f
or BUSINESS NAME
PREVIOUS TENANT,' OWNER
200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
= THIS SECTION NOT .APPLICABLE
= Single famii} - number bedrooms number baths
_ Two famih_• - number bedrooms unit 1 number baths unit 1
number bedrooms unit 2 number baths unit 2
= Accessory apartment Total gross sq. ft. .
_ Accessory structure
= Garage - detached - attached to dwelling, dimensions L
W
Carport - detached - attached to dwelling, d' ensions L
W
Shed - dimensions L W J0
Gazebo - dimensions L W
= Swimming pool above ground in -ground Size
total square feet
_ Chimney - # of flues
j 800 MEMANICALS & PRIWARY FUEL
Arehitect/Engffieer.- project supervision and reports
- Furnace (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify)
Company name
L Boiler (heating)- Fuel gas (natural or propane), fuel oil, electricity, other (specify)
- Address
- HVAC (combined unit) - Primary fuel, natural gas, propane, electricity, other (specify)
Phone number
IAir conditionin - se crate unit)
g ( P
Certified by State of Massachusetts as
None of the above to be provided
Certification number
Hot Water Gas Electric Fuel Oil Other
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals; ,and not
reproductions.
goo SPRINKLERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
homeowner here then complete section 1300)
i
General Contractor (if Homeowner, state
- Required, -plans provided, -plans notprovided, why?
ff
be '.,, hy?
Company name
- Not required, not to installed,
t
R (t �ViJ �1 ��f i41( D r( 0 P C U r4 i
Address 1—
M c Z
1000 REQUIRED OFF-STREET PARKING - for ZONING'& Architectural Access
Phone number
II - NOT APPLICABLE
Construction Supervisors license number
Parking Plan submitted To - Building Department = Planning Board Date submitted
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE original; and not
reproductions.,
Number of spaces - indoors outside total provided
;�
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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 -. If yes has it been issued yes - no
Contractor subject to (780CMR - 6) ?Yes _ No If no goy to next section!
Are you a Home Improvement
j Submit copy of application and/or permit as soon as available.
Are you claiming exemption fromtherequirement? Yes No _If yes, submit the requiired affidavit!
1100 IDENTIFICATION (print or type except as noted)
Remodel contractor name lease rint
nt owner - namei
/� /"
� " %� � dZ `
Address
address LJ t t I� l� t � ( i^r U V �' f:?
j
Registration number (if none state "none")
phone #
Phone number
If corporation, officer in charge
WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE
Architect/Engineer - for overall design
PERSONS CONTRACTING
GUARANTEE FUND'.QUESTIONS OR COMPLAINTS call or write:
Home Improvement Contractors Registration
One Ashburton Place - Room 1301
Company name
Boston, MA 02108
Address
(617) 727-8598
Phone number
Owners name (print)
Certified by State of Massachusetts as
Signature
Certification number
Date
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) and4 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
be extended for six moths if no work is
after the last inspection if work has begun and that the permit mayn
six months
anticipated if I request such an extension in writing. I understand that the permit may be extended o8ily three times by
written request. I understand that once the permit expires a new application may be required, including fees and current
other r quirements (including Zoning).
e r�cl F l n 4 _7Sigmn at
The above signature is my voluntary act and is signed under the pains and penalties of perjury.
iDate
Who is authorized to pickup the permit at the Building Department? (pleaseorino /�,4`lem � c7 �7 A
Address �Ac, k- 6 r Q) C -r Phone a5 tP l �L
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.
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 person(s) for hire to do such work ,that such
Home Owner shall act as supervisor.
i
For the purposes of this section only, a "Home Owner" is defined as follo•s,: Person(s) who owns a parcel of land
on which he/she resides or intends to reside, on which there is, or is inVmded-to be, a one or two family dwelline, attach d
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
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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)
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1500 COST
Cost of Improvement $
Items to be installed but not included in the above cost: Electrical
Plumbing
HVAC
Other
TOTAL - 1100,75
The following section for official use only.
INSPECTORS' REVIEW
Date plan reviewed SAY 2 ® 1996
30 days to review period expires 20
OK to issue date
Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required.
Demo i - n - describe structure
Number of dwelling units Number of bedrooms A separate ReNise 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 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 existirng dwelling will be
considered as an Alteration, otherwise will be included in new construction. (see Code section 3401.10 for
residential and Article 8 fo, commercial)
Temporary structure - includes when allowed, trailers, tents and the like and only for limifted periods of time.
Describe
500 CONSTRUMON PLANS
None submitted. Why?
Submitted, usually three sets required. Four sets for food service\uses. Number of set y submitted
600 SITE PLAN
\
El Not required, why?
/ Submitted When? Previously, date ❑ With this application
700 UTILITIES
Water supply - required _ yes _ no, public ? _ yes _ no, on site well? _ ye!s 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 _ yes a no, public sewer _ yes _ no
private septic - on -site _ yes no. Submit copy of permit as soon as availaNle.
-� '- ---"r Y •.•• ••w.s.,a..,,.,,, ucn 1VLVVH/C mdnucaciurers
instructions). Location(s) (list)
Fireplace(s) - (includes flue) List location(s)
Game Court - describe (include overall dimensions)
Tent, Trailer (Mobile Home) or Other describe
300 COMMERCIAL - PROPOSED PROJECT/USE INCLUDING THREE FAMILY OR MORE AND EXEMPT USES
'PHIS 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 overt 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 & 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
Describe the proposal briefly, INCLUDE number of dwelling units and bedrooms or occupant load as applicable,
g ako 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
«ill this project be subject to CONSTRUCTION CONTROL (over 35,000 cu.ft.) Yes No. If es
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 1)
APPLICANT TO PROVIDE
Uii toissne suojecc w i c-quca.Cu�...,......,.�
DENIM -see project review worksheet date
HOLD reason data
HOLD Subject to Zoning Board of Appeals action
Comments
I
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.
Inspector Date•
Advised applicant Date Time staff (by phone, fax or in person),.
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OFFICEUNSPECTORS NOTES
ra
TOTAL FEE
Gross area - new construction _ 2 Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit
I
i
it
i
11
1600 TO THE APPLIMW/REFERRAL AND APPROVAL
Date of Application submission��
vplat/,4-Lo� A Street i (_ Aquifer Zone
d
.Owner
5 Owner mail address l ,
Owner phone # 1.
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OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACr THEM FOR REQUIRED SUBMISSIONS.
COLLECTOR Approved __ HOLD By 2 "f t� Date
❑ onservation Comm —_ Approved By �i" Date
��
❑ D.P.W. water —Approved By D e
❑ D.P.W. sewer — Approved By Date
❑ D.P.V. cross connection — Approved Date
❑ D.P.W. engineering= roved
Approved Date
>ard of Health well _ Approved Date
oard of Health septic — Approved
❑ Board of Health food service Approved Date
C_01,hRE DISTRICT (I - II - III) = Approved r/-�
Date
❑ Planning Dept Approved Date
Other — Approved Date
Other Approved�j ) Date
(',;mments
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Project summary new construction/ alteration/demo sewage disposal public/private
[Alter,•add interior walls] [add rooms] ; [add footprint] water supply - publiciprivate well
[pool] [garagershed] / 1[game court] [food service]
Describe Describe 1 CO
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To the various departments:
This notice has been forwarded to you for your information and any appropriate action. Sbould you have anv
questions please advise. If any reason to withhold the requested permit is found, please advise. Your assistance and
cooperation is appreciated.
The Building Department
J 1 1®
Date sent for review By
TOWN OF DARTMOUTH BUILDING DE.PAIATMENT
TELEPHONE 508-999-0720 FAX $08.999-0738
APPLICATION FOR ZONING AND BUILDING PERMIT
InsuTw lions
The applicant shall complete this application to the best of their ability prior to submission; leaving no itttF.a unanswered. The
Department staff will he available during regular business hours to assist as necessary. N/A should he inseam ted for those sections
which do not apply. A properly completed application will help avoid unnecessary delays. NN6= FEzmg fm'.'s •it ndmiamr-
(for oftice use only)
Application fee $ 06 w received bh��_ Date
Total Permit Fee $ y `�+ Permit # W®
100 LOCATION OF PROJECT
CURRENT ACCESSORS' PLAT LOT —& 2- ZONING DISTRICT
OTHER ZONING OVERLAY DISTRICTS , if applicable
IBER &STREET ,a /�v„>i7 coLll
e 1'
NEAREST CROSS STREET
J{
SUBDIVISION NAIVE & 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 i number baths unit 1
numberbedrooms unit 2 number baths unit 2 -
Accessory apartment Total gross sq.
Accessory structure -
- Garage detached - attached to dwelling, dimensions L
Carport - detached - attached to dwelling, /dJ'itnensions L
V
7s Shed - dimensions L
'-` Gazebo - dimensions L fit'
Swimming pool above ground in -ground Size toital square feet
_ Chimney - # of flues