BP-432Architect/Engineer - project supervision and reports
Furnace (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify)
2' Boiler (heating)- Fuel as (natural . ( g) g ( tural or propane), fuel o 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
VHot %te ' r Gas Electric Fuel Oil Other
900 SPRINKLERS - FOR STRt1CTURES OVER 7500 SQUARE FEET and certain multifamily residential
- Required, --plans provided, =plans not provided, whv?
- 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
'umber of spaces - indoors outside total provided_.
Handicap spaces - required _ yes _no. If yes, how many as a part of the total required nu
- q tuber. .
Is Route 6 (State Road) Entrance permit required? yes - no =. If yes has it been issued yes - no
Submit copy of application ar.°:`r)r permit as soon as available.
1100 IDENTIFICATION (print or o•pe except as noted)
Current owner - name
address S Poc. �
Ne W
phone # l! 9 — Q 6 7
If corporation, officer in charge p 19
2 o ry- g►
Architect/Engineer - for overall design
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.
W
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 amd not
reproductions.
General Contractor (if Homeowner, state homeowner here then complete section 1300)
Company name
Address & Y k
Phone number
9
tv -e
Construction Supervisors license number '�l
P I
1�.
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals an(d not
reproductions.
1200 FOR RESIDENTIAL REMODEL WORK ONLY
Are
you a Home Improvement Contractor subject to (780CMR - 6)
? Yes
No
If no go to mext section'.
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")
Phone number
PERSONS CONTRACTING VVITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE
GIIARANTEE 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
1300 OWNER SIGN - OFF
I, the undersigned, am the owner of record or authorized lessee (provide documentation) and I ha :ve reviewed
the application herein submitted. I state that to the liest of my knowledge and belief that the information pro=•rided in this
application is true and correct and that the permit requested he 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 and that the permit may be extended for six months i;f no work is
anticipated if I request such an extension in writing. I understand that the permit may be extended only th-1ree 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).
Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required.
Name
Signature Z Z�
The above signature is my voluntary act
Date /d `lr
/� (,p
If
is signed under the pains and penalties of perjury.
�Yho is authorized to pickup the permit at the Building Department' iplease printi v-
Address Phone
1400 110INiEOWNER EXEMP'ITON - ONE & TWO FAMILY ONLY
FOR HO1N1E OWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT
1.09.1.1 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 persons) 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 defirQd as follows: Person(s) who owns a parcel of land
on Which he., resides or 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
1.1; . 1 of section )
1500 COST �/
Cost of Improvement o v ivJA/, c�N 5 / ���•aP
y
Items to he installed but not included in the above cost: Electrical S
TOTAL
The following section for official use only.
INSPECTORS' REVIEW
Date plan reviewed
Plumbing
H`'AC
Other
0C Q. a d
Demolition - describe structure
Number of dwelling units Number of bedrooms A separate Refuse 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 -rooting - (for existing only, is included .in new construction)
Number of square feet
Number of lavers when complete
A separate disposal declaration REQUIRED
Number of layers already existing
= Replacement doors and windows - (for existing only) (only where doors and windows exist and willl not be
enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwelling, will be
considered as an Alteration, otherwise will he included in new construction. (see Code section 3401.110 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?
Vsubmitted. usually three sets required. Four sets for food serviceluses. Number of sets submitted _
600 SITE PLAN
❑ Not requir-ed, Why?
• ., — _ With this application
_ Submitted When? _ Previously, date pp
700 UTILITIES
public? yes no on site well? ✓ es no,
Water supply -required _yes _ no, p ._ y
existing? yes — no ;
If required and not existing have necessary permits been issued? no _ yeso date
(M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a water supplyj, 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
El Woodstove - used (will require inspection prior to installation), new (provide manufacturers
instructions). Location(s) (list)
OK to issue subject to requested submittals (see project review worksheet) date
7 DENIED see project review worksheet date
Fireplace(s) - (includes flue) List location(s)
u 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
THIS 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 over 2 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 - retaiI 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 dweDing units and bedrooms or occupant load as applicable,
also existing condition
400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED
y
/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
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
HOLD reason date
11 HOLD Subject to Zoning Board of Appeals action
Comments
Inspectors signature Date
Applicant informed of above - Date
time staff
J Over six months since approved for issue -DEEMED abandoned!
Advise applicant. Hold 90 days for return then dispose if not picked up.
(fax, phone, inl person)
Inspector Date
u Advised applicant Date Time staff (by phone, fax or in person)
OFFICEVNSPECTORS NOTES
TOTAL FEE L I # fl o
Gross area - Pew ci:1nstruction
alteration
Permit is issued to
Comments/notes on permit
Total Sq. Ft.
Total Sq. Ft.
- 1
. .-_�� .._�..��+..♦amass=
Date of Application submission
Plat r/► / Lot XStreet
Owner
Owner mail address
_ Aquifer Zone
Owner phone #�7i�l 6
OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional ern'
J permits or approval for your
proposed project. CONTACT'I-IMM FOR RF UIRLD smmi ,SONS.
® TAX COLLECTOR - Approved . = HOLD By Date
Q Conservation Comm = Approved By Date
t? D.P.W. water = Approved By
Date
17 D. P. W, sewer —Approved By
Date
D D.P.W. cross connection = Approved
Date
0 D.P.W. engineering — Approved
Date
Q Beard of Health well = Approved
Date
Q Board of Health septic = Approved
Date
Q Board of Health food service — Approved Dat
e
9 FIRE DISTRICT' (I - II -III) = Approved
Date
o Planning Dept = Approved Date
Other _ Approved Date
Other _ Approved
Date
C, Pmments
Project summary_ new constructioni alterationidemo sewage disposal - publicipriv
ate
[Alter add interior walls] [add rooms] [add footprint] water supply - publiciprivate well elI
(pool) [garage; shed] [game court) [food service]
Describe
________________::::
To the various departments:
This notice has been forwarded to you for your information and any appropriate action. Should you have a v
questions lease advise. - n
y p If any reason to withhold the requested permit a found, please advise. Your assistance and
Cooperation is appreciated.
The Building Department
Date sent for review
TOWN OF DARTMOUTH BU. MDH4--G:-- I)EPARTMEN-T,!
TELEPHONE 508-999-0720 FAX 508ew999m073
APPLICATION FORtc-ZONING AND BLM:DE744G PERMIT
'Oft 14
Iast�ct�aoas � �OT
The applicant shall complete this application to the best of th`e"�t�ial ilt�l f pHor to submission,'lctnving no item unanswered. The
Department staff will he available duii`in . re�isIlars business hours to assist as necessary. N/A shtould be inserted for those sections
which do not apply. A properly completed application will help avoid*unnecessary delays. is l
(for office use only)
Application fee' received by Date 76
Total Permit Fee $ Permit #
100 LOCATION OF PROJECT F C1 tl /Y 2� /,� % I V . 0 & Z.,--
CURRENT ACCESSORS' PLAT Co LOT �� �boZ ZONING DIS'MCT 5)?— 130
OTHER ZONING OVERLAY DISTRICTS , if applicable
tJ.N1BER & STREET
NE. -REST CROSS STREET
SUBDIVISION NAME & LO'
or BUSINESS NAME
PREVIOUS TENANT ; OWNER
?00 RESIDENTIAL - PROPOSED PROJECT - one & two family
residence only
A.0 A/
(0 �
= THIS SECTION NOT APPLICABLE ® v nj a
I
r
= Single family - number bedrooms number baths
= Two famiIv - number bedrooms unit 1 number Laths unit 1
number bedrooms unit 2 number baths unit ? -
= Accessory apartment Total gross sq. ft.
a�H,
_ :accessory structure �(p � !a -e e S ,
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 Size total square feet
= Chimney - # of flues
8
By