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_= Afternoon of exisnnQ, :no increase in gross square feet. A separate Refuse Disposal eclaration. r6aquu-ed, - -
I• the undersigned, am the owner of record or authorized lessee (provide documentation) and I have reviewed _ - Demolitjon -.describe structure
the application herein submitted. I state that to the best of my knowledge and belief that the information provided in this
application is time .and correct and that the permit requested be issued. Number of dwelling units Number of bedrooms A separate Refuse DispcFml
Further I understand that the permit will expire in six months, from the date of issue, if no work is begun or Declaration required. '
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 tunes by - Moving - (Provide copy of D.P.W. moving license) Type of structure i
written request. - understand that once the permit expires a new application may be required, including fees and current
other requirements (including Zoning). ^ from where d (plat/lotor a dress)
4arne to where (plat/lot or address)
S an ture •
Number of dwelling units Number of bedrooms per dwelling unit •
The • bove !yina a is my voluntary act and is signed under the pains and penalties of perjury.
_ P r�ury.
•'Date
CZ,a C3.2it
Tp 4 iz•,
�N`ho is authorized to pickup the permit at the Building Department? r lease crincl
Address 658 RQQ 14-bA-WE_: k\1F_ Nt B . Phone %a al 9 cl 9 —'76 (o 7
1400 HOMEOWNER EXEMP'IiON 'ONE & TWO FAMMy ONLY
FOR HOME OWNERS «'HO• INTENT) TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT
109.1.1 Licensing of Constmction Supervisors:
pernsors Except for those structures governed by Construction Control
in Section 127.0• effective July 1, 1982. no individual shall be engaged in directly supervisor Persons en
g Pe gaged in
construction, recongstruction, 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 prnmulgated by the BBRS entitled
R:.les and F.eguIadons for Licensing Construction Superti•isors.
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
Horne Owner shall act as supervisor.
For the purposes of this section ualy, 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 intended 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 he considered a Home Owner.
If you are applying under this section sign below:
— Re -roofing - (for existing only, is included in new construction)
Number of square feet
Number of layers 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 w►ill not be
enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwelling; will be
considered as an Alteration• otherwise will be included in new construction. (see Code section 3401.:10 for
residential and Article 8 for commercial)
= Temporary structure - includes when allowed, trailers, tents and the like and only for limited period;_, of time.
Describe
500 CONSTRUCTION PLANS
= None submitted. Why?
Submitted, usually three sets required. Four sets for food service\uses. Number of sets submittedl
600 SITE PLAN
Signature
0 Not required, why?
four signature carries certain responsibilities• including but not necessarily limited to, general Uabilih
Submitted «Then? =Previously, date With this application
NOTICE TO LICENSED CONTRACTORS: 7
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
700 U 11TIES
1500 COST Water supply - required ves no, public ? yes _ no, on site well? _ yes no,
Cost of Improvement
rexisting? ves no
Items to be installed but not included in the above cost: Electrical 5 ` If Trequ redTana not ezisfiti "have necessary permits beenuisswid? , _ no yes, date
g
Plumbing cla !"�"" (IM.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a water suppily, when
HVAC required, is available. See Code 780 CMR section 114.1.2)
Other Sewage disposal - required _X_ yes _ no, public sewer yes , no
TOTAL S ` �O �j'-� "'"_..'
i private septic - on -site yes no. Submit copy of permit as soon as available.
_T
The following section for official use only.
= Woodstove - used (will require inspection prior to installation), new (provide manufacturers
instructions). Location(s) (list) INSPECTORS' REVIEW
Fireplace(s) Date plan reviewed
- (includes flue) List location(s)
- `Game Court -describe (include overall dimensions)
30 days to review period expires
Tent, Trailer (Mobile Home) or Other - describe
300 CONUK RC'IAL - PROPOSED PROJECr/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, Iounge, 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 - 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
Descrffie the proposal briefly,, INCLUDE - nnAxw of dw and bedroornsor Occup2at 1o2d as applicable,
also existing condition
400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED ,
)(New Construction and/or Addition - total gross square feet a, 2,go
(For commercial only total gross cubic feet) - indicate
It will be considered new construction if there an increase in square footage in addition to anv
alteration(s).
If project is an addition to existing structure - Total gross square feet of existing
= FOR COMW[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
c,.
0
OK to issue date
OK to issue subject to requested submittals (see project review wcorksheet) date
DENIED see project review worksheet date
HOLD reason dart:
HOLD Subject to Zoning Board of Appeals action
Comments
Inspectors signature Date
Applicant informed of above - Date time _ staff (fax, phon(::, in person)
TT�T�T ���4�TT��•FTTT��T��T��T�����TTTT��T��T�FTTTT�T����TT+�+�T ��T��T��TT�T �T ���T+�TTT��1T���T��:VT������+T�+
Over six months since approved for issue - DEEMED abandoned!
Advise applicant. Hold 90 days for return then dispose if not picked up.
r
Inspector Data!
Advised applicant Date Time _ staff (by phone, fax or in person))
OFFICEXINSPECTORS NOTES
TOTAL FEE
Gross area - new construction
Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit
1600 TO THE APPLICANT
AND APPROVAL
Date of Application submission
Plat _Lot _ Street
Aquifer Zone
Owner
Owner mail address
Owner phone #
CrITMR
INVOLVED AGENCIES -
The following agencies require separate jurisdictional permits or approval
proposed project. CONTACT TMW FOR PP al for your
. sUg�Qsstale�s.
® TAX COLLECTOR Approved'-- HOLD By
. Date
---------------
❑ Board of Appeals � Approved By
Date
❑ Conservation Commission C Approved By
• Date
❑ D.P.V. Water Approved By p D.P.W. Sewer = Approved B
P BY---... Date
❑ D.P.W. Cross Connection E; Approved By
Date
❑ Treasurer (Bond) ❑ Approved By
Date
❑ D.P.W. Engineering Approved By
- Date
Board of Health (well) 7 Approved By
Date
❑ Board of Health (septic) Approved By
Date
❑ Board of Health (food service) = Approved By
Date
n Planning Board (parking) 1 Approved By
Date
0 FIRE DISTRICT (I - II -III) .� Approved By
ss::::ss:::::::::ssss::ssss:::sssssss:sss:::::ssss::::::::ssssssss:s::::::::sssssssssssss Date
BUILDING DEPARTMEW APPROVAL:
o ZONING
o BUILDING INSPECTORBUILDING COMMISSIONER
® CONTROL CONSTRUCTION AFFIDAVIT
PROJECT SUMMARY: ************
new construction/ alteration/demo
[Alter; add interior walls] [add roomsl [add footprint]
sewage disposal - public/private
water supply - public/private well
[pooll (garage/shed/deck] [game court] [food service]
Describe
To the various departments: **********
This notice has been forwarded to you for your information and any appropriate a '
questions please advise. If any reason to withhold the requested permit is found ctl°n. Should you have any
cooperation is appreciated. P ,please advise. Your assistance and
The Building Department - Date sent for review
By
TO WN OF DARTMOUTH BTJILDYNG IDEPAIBTM�P1T
TELEPHONE 508=999mO720 FAX 109 9911 nO
738
APPLICA ON FOR ZONING AND BU- ILDMG PERMIT
•
The applicant shall complete this application to the best of their ability prior to submission, leaving no item man swerw i"t. The
Department staff will be available during regular business hours to assist as necessary. NIA should be inserted for those -sections
which do not apply. A properly completed application will help avoid unnecessary delays. Neft Finn% % is sss
(for offim use only)
Total Cost Received By
Less Application Fee $
Total Permit Fee �_ Permit #
0 FOUNDATTC' N ONLY
Date Rec'd
-7 07_', §r
100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET
CURRENT ACCESSORS' PLAT LOT 2_ � Q Q ZONING DISTRICT
O 7'HER ZONING OVtLAY DISTRICTS , if applicable
NUMBER & STREET
NEAREST CROSS STREET
SUBDIVISION NAME & LOT #
or BUSINESS NAME
PREVIOUS TENANT / OWNER ASI-1�--T
200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
- THIS SECTION NOT APPLICABLE
XSingle family - number bedrooms number baths
= Two family - number bedrooms unit 1 number baths unit 1
number bedrooms unit ? number baths unit 2
Accessory apartment Total gross sq. ft.
= Accessory structure:
Garage - detached - attached to dwelling, Cimensions L W
Carport - detached - attached to dwelling, dimensions L W
Shed - dimensions L W
Deck - dimensions L W
= Gazebo - dimensions L W
_ Swimming pool above ground in -ground Size
Chimney - number of flues