BP-7433800 1' M : 1
F41.•1 ISM
Furnace (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify]
E_ 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)
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 PARKING - for ZONING & Architectural Access
_ NOT APPLICABLE
= Parking Plan submitted To =. Building Department Planning Board Date submitted
Number of spaces - indoors outside total provided
Handicap spaces - required yes _no. If yes, how many as a p?rt of the total required number.
IR
Is Route 6 (State Road) Entrance permit required? yes no If ves 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 owner - name vj Q�j
address
phone #
If corporation. officer in charge
• I lJII � � 1 � • �. •J�
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.
Company name
Address
Phone number
Certified by State of Massachusetts as
Certification number
NOTE Signatures and seals on ail plans, affidavits and other documents SHALL BE originals anal not
reproductions.
General Contractor (if Homeowner, state homeowner here then complete section 1300)
Company name (L • CIbQ64,
Address t t Q Cars 1' -o I 1 � t '
Phone number 3 Z
Construction Supervisors license number Q `t J Ll
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals andl not
reproductions.
11 'f1' it71 V rl 091814R Zito 1' •7104.q ���_
Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes _ No _ If no go to ntext section!
Are you claiming exemption from the requirement? Yes _No ,_If yes, submit the required aiffidavit!
Ren_ ,)del contractor name (please print)
Address
Registration number (if none state "none")
Phone number
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO 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 (prin
Signature
Date
1300 OWNER SIGN - OFF
Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration recquired.
I. the undersigned, am the owner. of record or authorized Iessee (provide documentation) and I have
the application herein submitted. I state that to the best of my knowledge and belief that the information reviewed
application is true .and correct and that the permit Provided in this
P requested -be issued.
Further I understand that the permit will expire in six months, from the date of issue, if no work'
six months after the last inspection if work has begun and'that the permit may be extended f si � begun is
anticipated. if I request such an extension in writing.I understand y or six months if no work is
derstand that the permit may be extended only three times by
written request. I understand that once the permit expires a new application may be required, including fees
other requirements (including Zoning). m$ and current
Name
Signature
The abbve siOnature it my voluntary act and is signed under the pains and penalties of perjury.
p rJury.
Date
«'ho is authorized to pickup the permit at the Building Department? Lil_
c�
Address �o r.�C., P
Phone CP-- 3 U -7•-7
FOR HO NIE OWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT
109.1.1 Licensing of Contraction S rs: Except for those structures governed b 'Construction in Section 127.0, effective July 1, 1982, no individual shall be engaged in directlysupervising n Control
alteration, repair, removal or demolition involvingthe s p persons engaged in
construction, reconstruction, structural elements of '
structures, unless he or she is licensed in accord2� ,; buildings or
ce with the rules and reguIa..�ns promulgated by the BBRS enti!'ed
RLIes and Regulations for Licensing Construction Supervisors.
Exception: Any Home Owner performing work for which a Building Permit is required shall be exempt
the provisions of this section; provides that if a home Owner engages a person(s) for hire to do such from
Home Owner. shall act as supervisor, work ,that such
For the purposes of this section only, a "Home Owner" is defined as follows: Person(s) who owns a a
on which he; she resides or intends to reside, on which there is, or is intended to be, a one or two fain'dwelling,
P rceI of land
or detached structures accessory to such use and/or farm structures. A person who c tjv dwellin ,attached
two-year period shall not be considered a Home Owner. P °IISc� more than one home in
If you are applying under this section sign belo
ignature
Your sigature Farries Ncertain responsibilities, including but not necessarily limited to
'general liability
NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations
licensed Construction Supervisor, whether or not they have taken the permit are responsible f n section that any
2.15.2 of section 55) P Po for code compliance. (see
1500 COST
Cost of Improvement
Items to be installed but not included in the above cost:
rtu ,
Electrical S
PIumbing
HVAC
Other
Demolition - describe structure
Number of dwelling units _ Number of bedrooms A separate Refuse Disposai1
Declaration required.
Moving - (Provide copy of D.P.W. moving licenseType of structure
from where (plat/lot or address) '
to where (plat/lot or address)
L
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 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 will: not be
enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwelling �viill be
considered as an Alteration, otherwise will be included in new construction. (see Code section 3401.1rn for
residential and Articl , 8 ft.: commercial)
Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods mf time.
Describe
500 CONSTRUCTION PLANS
None submitted. Why?
= Submitted, usually three sets required. Four sets for food service uses. Number of sets submitted o�
600 SITE PLAN
❑ Not rewired, why?
Submitted When? = Previously, date ith this application
Water s - required es no public ? es ? ,!
IIPP� q — y _. P _ y _ 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 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 s no. Submit copy of permit as soon as available.
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A Copy of This End'orsed
Pisa n MustBe� On Site
8_ _ C VA-ba_z, During Construction
D at ct _�.j.UL 3 0 1998
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DDILDING C)Ep
-A� 113
i
Woodstove used (will require irnspecJon prior to installation), new (provide manufacturers
instructions). Location(s) (list)
The following section for official use only.
INSPECTORS' REVIEW
Fireplace(s) - (includes flue) List location(s)
Game Court - describe (include overall dimensions)
Tent, Trailer (Mobile Home) or Other - describe
300 CON4KFRCI4L - 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
04.0) .
- 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)
f ercantile - 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 3
Tent or Trailer - temporary purpose?
- Other
Descrffie the proposad briefly, INCLUDE -umber of dweWmg ifis and bedrooms or0=pant1o2d as appUcable,
also 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
y alteration(s).
If project is an addition to existing structure - Total gross square feet of existing
- FOR COMN[ERCIAL ONLY
INU 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 1)
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
HOLD reason date
- HOLD Subject to Zoning Board of Appeals action
Comments
JUL O 19BB
Inspectors signature Daty
- Applicant informed of above - Date
time _ staff (fax, phone, in rnerson)
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)
OFFICE\INSPECTORS NOTES
TOTAL FEE YO 0,,6
Gross area - new construction 7 Total Sq. Ft.
alteration Total Sq. FL
Permit is issued to
Comments/notes on permit
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1600 TO THE APPLICANT ***
AND APPROVAL
Date of Application submission
Plat ` Lot 113 Street '�
C�. 6J
Owner
Owner mail addresspm
)C
AgUifer Zone
Owner phone #OTHER -
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.INVOLVED AGENCIES _
The following agencies require separate jurisdictional permits or a
proposed project. CONTACT rovaI for
PP your
'I�►i FOR RF,��� �l4+QIS.SIONS.
d TAX COLLECTOR 7 Approved .— HOLD By
Date
Q Board of Appeals Approved By
Date
o Conservation Commission 1-7 Approved By
Date
Q D.P.W. Water 7 Approved By 0 D.P.W. Sewer = Approved B
y _ Date
G D.P.W. Cross Connection Approved By
Date
G Treasurer (Bond) 0 Approved By
Date
a D.P.W. Engineering Approved By
Date
Board' of Health (well) Approved By
Date
C oard of Health (septic) ` Approved By
Date
G Board of Health (food service) = Approved By
Date .
G Planning Board (parking) Approved By
Date
* FIRE DISTRICT (I - II -III) = Approved By
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BUI1. DING DEPARTM9KNT APPROVAL:
Q ZONING
a BUILDING INSPECTORBUILDING COMMISSIONER
o CO`7ROL CONSTRUCTION AFFIDAVIT
PROJECTS Y:
ne�l construction/ alteration/demo sewage disposal - publictprivate
[.4.lter,add interior walls] [add rooms] [add footprint] water supply public/private ' PP _ - P /private well
[pool] [garage; shed/deck] [game court] [food service]
Describe
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To the various departments:
This notice has been forwarded to you for your information and any appropriate action. Should
questions pie.ase advise. If any reason to withhold the requested permit is found, lease you have any
cooperation is appreciated. P P advise. Your assistance and
The Building :Department - Date sent for review _7---3 LLOC--
By
r
TO WN OF
TELEPHONE
APPLICATION FOR ZONING
Jim). b"",
AND BU_ I—ILDINGP"ERMIT
Ia�rndio� .• .
The applicant shall complete this application to the best of their ability prior to submission, leaving no item unanswered. Ile
Department staff will be available during regular business hours to assistas necessary. N/A should be inserted for those �-ctions
which do not apply. A properly completed application will help avoid unnecessary delays. Neft FES=g Amin x=1�
(for office use a*) 0 FDU lAnOW ONLY
Total Cost $ Received By Date Reed � 3 O —;. =
Less A.pp&=tion Fee S-�
Total Permit Fee �_ Permit # l;d Dote
q-
100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE
CURRENT ACCESSORS' PLAT / �'� LOT d ZONING DISTRICT - --=
OTHER ZONING OVERLAY DISTRICTS , if applicable
i
�.,►
NUMBER &STREET To
NEAREST CROSS STREET
SUBDIVISION NAME & LOT #
or BUSINESS NAME .�.
PREVIOUS TENANT / OWNER - :, ,,- 12
200 RESID -PROPOSED PROJECT - one & twAamily 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: d.
Garage - detached - attached to dwelling, dimensions 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