BP-773NOTES B r ARE TAKEN F�RDtfl IJEFINITIVE StJBDI�.%ISIQt'�
PLAN '' DARTMOUTH LANDING ,r, --B' !L�; BEADS 9. CHIf���1NEYS ARE PART OF THE FOUNDATION,
fi,'1Nl -1 __) I DISTANCE FROM SE:,..PTIC TANK -10 FOUNDA l IQf� -=� 1.J10'
,. r``T'\"f,,�,Lj'-` DISTANCE FROM SEPTIC SYS l Eft TO FOUf�DATIOI� = L__SJ10'
NOTE B - i. ..�.-"_- `,.
l-IF FGLLOWING RES I RICT1-ON IS PLAC_I_D -- �:— .��
�, ! ,*� r -- !_�T ' i iO�ti N IS LOCATED /ITHIN AQUIFER PROTECTION �.,,11 __--
Qi�1 i. [.�T#I09, BUILD�;11G SE� i,BACK FRD! S QC� : �I�� T RICTO�E 3f fAfifU LOT COVERAGE QE 10�, �.��
PlC�l1'�'° LINE SHALL DE SIX � Y(6G')FEC 1 ,
--THERE ARE NQ SE PTIC
f�tr
S�'STEC S �RIITHIN 100' OF �
. HE PR OPQSED1E E.�L, -
ND.T!E C 1.
. Z.
T}.1E FOLLOWING RESTRICTION IS PLACED PEF'k_.— Cif LOT CQ��ERAGEI z .
[IN 1.OT'=109, NO LIVING TREE SIX(6")It\ HLS [a�: r'��XIC��U! ! LOT COVERAGE = 4,054 . S,F,
GREe)TER IN DIAft1ETER SHALL FE REf��Q�/ED '�.j11.
-{-�-�-!� -- H0USE = I,400 S,F, .
1 OR" '<4 ')F- ET OF THE STREE T R,O,W, L_1-N E=X(],LP�i PROPESED - BIT. DRIVE .= 1,982 3"fF,
i a E ,
DRIVEWAY AND UTILITY ACCESS' �. H1 C�� SH-IAE_L ``\)D � TQ T AL = 3,382 SIEK1 %f`
F ❑ R D r %t "
EXCE" END 5,Oo0 S,Ff IN AREA, PERC,Ek i' OF LOT COVERED
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PE RCQLA T I 0 N TEST TAKEN,.' 3/7/96 CORREI( �S- ENGINEERING INC,
SAIL EVALUATOR: ♦JIMi W A L S H
I 1PLC 1 QP CHRIS [,1IC1 ,AUD
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1 • All Y,►orl, must be in accordance: with the t,�.�ssachusetts Department of. f
Environmrntai Protection' Regulotions 310 C}P 1 1.00 & 1 �.00 (Title V)
end any local Board of Health M,odificatiomc
2. No modifications shall be made to this sy,?-:�'11_m without prior written
approval by the engineer and the local Boc-d of Health.
3. Engineer and the Boord of Hoalth rust inz: 4.'+cct• the completed system
I
prior to bockfillinQ. .
+ Elevations : ho\gym ~ on plan - are based on an subdivision datum.
5. }-,00vy equipment shall not be run over the° disposal sYatem.
6, M unsuitable sail is to be excavated from 'fie Leaching area
aw �:ho��fn on plan, and bacl�fillcd �'itl�i Glocr` caravel or coarse sand:
. , rpr;ciI in i CII.�R 1 .2 r��(2).
7. Washed crushed, stone -shall be free of ir-o,- fines and dust.
41 8. ��optiG tank., di:-tribution boy:, eta:. shah bo , r)UICctured by Rotondo &
Sores Inc. 6r cpproved equal, and installed +r,�r manufacturer's specifications.
Grout rholi �}11
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en ter:. or leaves c concrel.e. structure.
i'
Q. Outlet di tribulion lines `zholl be, level for c rninimum of �:he firv-t two fect
of th6r length as spcctficd in 310 Cl,/R l !" 13"(3). 1.
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11. Gi:�trib.a1-ior1 lire=-s {-o bP, capped at cutict�.
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800 MECHANICALS & PRIMARY FUEL
Furnace (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify)
a
Archite eer - project supervision and reports
Company name
Boiler (heating)- Fuel gas (natural or propane), fuel oil, electricity, other (specify)
HVAC (combined unit) - Primary fuel, natural gas, propane, electricity, other (specify)
Air conditioning - (separate unit)
C None of the above to be provided
Hot Water Gas Electric Fuel Oil Other
900 sP - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
J Required, plans provided, J plans not provided, why?
Not required, not to be installed, Why?
1000 REQUIRED OFF PARKING - for ZONING & .Architectural Access
7 NOT APPLICABLE
Parking Plan submitted To Building Department i i Planning Board Date submitted
Number of spaces
- indoors
outside
total provided .
Handicap spaces -
required
_yes no. If yes,
how many as a part of the total required number, .
Is Route 6 (State Road) Entrance permit required? yes no If yes has it been issued yes � no
Submit copy of application and/or permit as soon as available.
1100 IDENTIFICATION (print or type except as noted)
Current ow
address
phone #
If corporation, officer in charge
Architect/Engineer - for overall design
Company name
Address
Phone number
Certified by State of Massachusetts as
Certification number
VVC��f
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
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 notL
reproductions.
General Contractor (if Homeowner, state homeowner here then complete section 1300)
Company name
P Y
f
Address
�0
Phone number y r� - C_.) 1
Construction Supervisors license number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and noit
reproductions.
1200 FOR RESIDENTL4L REMODEL WORK ONLY
Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes No If no go to next':�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 WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS 70 THE
GUARANTEE 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
4
5
1.1 uu-V wN ER SIGN -OFF
Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration irequired.
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 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
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 b
written request. I understand that once the permit expires a new application may be required, including fees and current
other requirements (including Zoning).
Name V e AA,-k AA 4c�l s; ( /'h A �
Signature
The above signa
rK� � ��Date9�
is my voluntary act and is
Who is authorized to pickup the
Address' 6 - 1--i1V P,.oc 7 lc
ed under the pains and penalties of perjury,
ermit at the Building Department? (please printl
vo
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 127.09 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 regula*:ons promulgated by the BBRS entitled
Ru''s 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 sectiou 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 intended to be, a one or two family � dwellin , 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 an
licensed Construction Supervisor, whether or not the • have taken the permit are responsible y
� � y p ponsible for code compliance. (see
_.15._ of section 5)
1500 COST
Cost of Improvement
Items to be installed but not included in the above cost:
Electrical $
Plumbing
HVAC
Other
Demolition describe structure
Number of dwelling units Number of bedrooms A separate Refuse Dispc,,,&Il
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 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 periods of time.
Describe
500 CONSTRUCTION PLANS
None submitted. Why"),
�4bmitted, usually three sets required. Four sets for food service uses. Number of sets submittefd
600 SITE PLAN
❑ Not required, why?
7-,Submitted When? Previously, date
With this application
Water supply - required yes no, public ?' _ yes _ no, on site well? yes 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 supplly, 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.
0
Woodstove - used (will require inspection prior to installation), new (provide manufacturers
instructions). Location(s) (list)
The following section for official use only.
INSPECTORS' REVIEW
C Fireplace(s) - (includes flue) List location(s)
Game Court describe (include overall dimensions)
u Tent. Trailer (Mobile Hnmel nr nt�er _ rleccrihe
300 COMMERCIAL - PROPOSED PROJECT/USE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES
LE 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 - retail stores (see Code 308.0)
77 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 r umber of dweW g units and bedrooms or occupant load as appilc-able,
also e3dsting condition
400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED
u 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 IERCIAL 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
Date plan reviewed
30 days to review period expires -
OK to issue date
OK to issue subject to requested submittals (see project review worksheet) date
DENIED see project review worksheet date
J HOLD reason date
HOLD Subject to Zoning Board of Appeals action
Comments
Inspectors signature yi�1997'
Applicant informed of above - Date time _ staff (fax, phone, sin person)
Over six months since approved for issue - DEEMED abandoned!
Advise applicant. Hold 90 days for return then dispose if not picked up.
Inspector Date
J Advised applicant Date
OFFICEII.NSPECTORS NOTES
C2
TOTAL FEE
r
Gross area - new construction
alteration
Permit is issued to
Time _ staff _ (by phone, fax or in person)
Total Sq. Ft.
Total Sq. Ft.
Comments/notes on permit
2
1600 TO I APPLICANTAND APPROVAL
Date of Application submission
Plat Lot _ Street Aquifer Zone_
Owner
Owner mail address
Owner phone #
OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT' 71MM FOR REOUHUM SU IbUMONS.
is TAX COLLECTOR tEl - Approved HOLD By Date
❑ Board of Appeals El Approved By
❑ Conservation Commission 0 Approved By
❑ D.P.W. Water 0 Approved By ❑ D.P.W. Sewer El Approved By
❑ D.P.W. Cross Connection u Approved By
❑ Treasurer (Bond) o Approved By
❑ D.P.W. Engineering ❑ Approved By
Board of Health (well) p Approved By
❑ Board of Health (septic) 0 Approved By
❑ Board of Health (food service) r Approved By
Date r'
Date
Owe� l
Date -
Date
Date {-
❑ Planning Board (parking) --J Approved By Date
® FIRE DISTRICT (I - II - III) ' Approved By
D��V
s:ss:ss:;ssssssss:sssssssssssssssssss::sss:ss::sssss::s:sss:ssssssssssss::::::sssss ::sssss:ss:::::sssss
BUILDING DEPARTAflM APPROVAL:
❑ ZONING
❑ BUILDING INSPECTORBUILDING COMMISSIONER
❑ CONTROL CONSTRUCTION AFFIDAVIT
PROJECTS Y:
new construction/ alteration/demo sewage disposal - public/private
[Alter/add interior walls] [add rooms] [add footprint] water supply - public/private well
[pool] [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 action. Should you have an
questions lease advise. y
9 p 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
IkT IN Aw JA
APPLICATIGN FOR*
� � r
Ias'trnct:oa� -
The applicant shall complete this application to the best of their ability prior to submission, leaving no item tmanswerF-!d. The
Department staff will be available during regular business hours to assist as necessary. N/A should be inserted for those sections
which do not apply. A properly completed application will help avoid unnecessary. delays. Nefts. FMM fee is
(for office use only) �UN1)AT'tDN ONLY
Total osh OV Received By Date Reed 4- (
Cce2
Less Application Fee $ s
Total Permit Fee $ 0 -`0 Permit # Lssaed Date
100 LOCATION OF PROJECT .• TOTAL LAND AREA SQUARE FEET W S ��
j/ Gi
CURRENT ACCESSORS' PLAT LOT t u • 10 ZONING DISTRICT
OTHER ZONING OVERLAY DISTRICTS , if applicable
NUMBER & STREET
NEAREST CROSS STREET
SUBDIVISION NAME & LOT #
or BUSINESS NAME
PR / OWNER
t
11��
ram-
tw A eCA Cut=
200 RESIDENTIAL - PROPOSED PROJECT
- one
&
two family
residence only
THIS SECTION NOT APPLICABLE
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:
L Garage - detached - attached to dwelling, dimensions L W
u Carport - detached - attached to dwelling, dimensions L W
11 Shed - dimensions L W
G Deck - dimensions L W
C Gazebo - dimensions L W
L Swimming pool above ground in -ground Size
Chimney - number of flues
4
C�
S
1