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BP-8090Arc eet - project supervision and reports 800 MECHANICALS & PRMARY FUEL Company name = Furnace (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify) Address Boiler (heating)- Fuel gas (natural or propane), fuel oil, electricity, other (specify) Phone number HVAC (combined unit) - Primary fuel, natural gas, Propane, electricity, other (specify) Certified by State of Massachusetts as I Air conditioning - (separate unit) Certification number None of the above to be provided NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and', not Hot Water Gas Electric Fuel Oil Other reproductions. - 900 SPI2INI1•ERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential homeowner here then complete section 1300) General Contractor (if Homeowner state Required, --plans provided, plans not provided, why? �t Company name Not required, not to be installed, Why? "* % %.��✓�--/ �%� Address 1000 REQUIM OFF-STREET PARIING - for ZONING & Architectural Access Phone number NOT APPLICABLE Construction Supervisors license number _ parking Plan submitted To =Building Department ` Planning Board Date submitted MOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals an�ii not ' reproductions. Number of spaces - indoors outside total provided H-ndicap spaces - required _ yes _no. If yes, how many as a pirt of the total required number. sssssxsssmsxxxxxxsxsxxxxxxsxxsxssxsssxssxsxsxsssxxxsxssxsxssxsxxsxxxxsxsxxxxxxsssssssssxssssx:xssssxsssxs 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 go to mext section! Are you a Home Improvement Submit copy of application and/or permit as soon as available. Are you claiming exemption the requirement? Yes _No �If yes, submit the required,°affidavit! 1100 IDENTIFICATION (print or type except as noted) Ren_,)del contractor name lease Tint Current owner - name�/�• Address address Registration number (if none state "none") phone # Phone number If corporation, officer in charge WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACC)SS 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) I 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 reproductions. j r 'J I 1300 OWNER SIGN- OFF Alteration of existing, no increase in gross square feat. A -separate Refuse Disposal Declara Lion required. I, the undersigned, am the, owner of record or authorized lessee (provide documentation) and I have reviewed =Demolition -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 true and correct and that the permit requested be issued. Number of dwelling units Number of bedrooms Further I understand that the permit will expire in six months, from the date of issue, if no work is begun or Declaration required. A separate Refuse; !Disposal 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 by Moving (Provide copy of D.P.W. moving license) Type of structure written request. L understand that -once the permit expires a new application may be required, including fees and current other requirements (including Zoning). from where (plat/lot or address) Name A to where (plat/lot or address) = rSignature Number of dwelling units Number of bedrooms per dwelling unit f e ap ove signature is my voluntary act and is signed under the pains and penalties of perjury. � pe P rJ ry. _ Date Re -rooting - (for existing only, is included in new construction) iZ Number of square feet Number of layers already existing Who is authorized to pickup the permit at the Building Department? (please or;ntl Address Phone Y P Number of layers when complete 1400 HOMEOWNER EXEMPTION = ONE & TWO FAMILY ONLY A separate disposal declaration REQUIRED =Replacement doors and windows - (for existing only) (only where doors and windows exist and will not be FOR HOME OWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT 109.1.1 Licensing of Construction Supervisors: Except enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwrelling will be pt 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 considered as an Alteration, otherwise will he included in new construction. (see Code section. 3401.10 for construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of buildings or structures, unless he or she is licensed in accorda-8 t! promulgated y t� ce with she rules and re ula..ons romu ated b the BBRS enh, ed residential and Artiel- S fo_ commercial) RLle� and Regulations for Licensing Constn.ction Supervisors. _ Exception: Any Home Owner performing erform' work for which a Building —_ Temporary structure - includes when allowed, trailers, tents and the like and only for limited pceriods of time. ng 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 Describe Home Owner shall act as supervisor. 500 CONSTRUCTION PLANS For the purposes of this section only, a "Home Owner" is defined as follows: Person(s) who owns a parcel of land on which hershe resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached j�, \� None submitted. Why? 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.' Submitted. usually three sets required. Four sets for food service uses. Number of sets subimitted If ypu are app) g under this section sign below: 600 STTE PLAN ifarare fff �G' r ❑ of requu-ed, why? Your signature carries certain responsibilities, including but not necessarily limited to _ ,general liability ?(�,C //this application Submitted When? Previously, date ReWithE' 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 2.15.2 of section 5) code compliance. (see 700 1500 COST Water srpply - required yes _ no, public ? yes no, on site well': "= yes no, Cost of Improvement 5 .existing? _yes _ no � Items to be installed but not included in the above cost: Electrical 5 If required and not existing have necessary permits been issued? _ no _yes, date � Plumbing (M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a water supply, when I HVAC required, is available. See Code 780 CMR"section 114.1.2) I Other Sewage disposal posai -required _yes _ no, public sewer yes _ no TOTAL S private septic - on -site ✓ yes _ no. Submit copy of permit as soon as available. --- Woodstove - used (will require inspection prior to installation), new (provide manufacturers -T instructions). Location(s) (list) = Fireplace(s) - (includes flue) List location(s) = Game Court - describe (include overall dimensions) Tent,Trailer (Mobile Home) or Other - describe i 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 OTED) (See the Code) = Asseambly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) escribe i Business - office, assembly 'with less than'50 occupants indica edical or other professional (see Code Section 303.0) Educational -structure for training including child day c e 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 ho , infant day care (see Code Section 307.0) Mercantile - retail stores (see C de 308.0) a Residential - three or mor amily,, hotel (see Code Section 309.0) T Storage - includes ga es (see Code Section 309.0) i - Utility & Miscella eous Structures - includes tents and agricultural structures (see Code Section 311.0) New tenant f any of the above, indicate above (see Code Section 119.0 and Zoning By-law section 35) = Teat or iler - temporary purpose? _ t O he cube the proposal briefly, INCLUDE - umber of dwelling units and bedrooms or occupant load as applicable, also existing condition 400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED ter! ew Constru n and/or Addition - total gross square feet 19 2— {For commercial only total gross cubic feet) - indicate It will he 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 �I 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 APPLICANT TO PROVIDE No (see Code Appendix I) The followin section fo r or official use only, INSPECTORS' REVIEW Date plan reviewed 30 days to review period expires i OK to issue date OK to issue subject to requested submittals (see project review worksheet) date . I DENIM see project review worksbeet date HOLD reason HOLD Subject to Zoning Board of Appeals action I; Comments tdate Inspectors signature Date Applicant informed of above- Date a staff (fax, phhone, in person) xsxxxxxxx*xxxssxszsszsszzzxsxsszszzzzzzssxssssszssss*ssssssssssssssssssszsssssssssssssxzxzzrzzszzxzszzszzss Over six months since approved for issue - DEEMED abandoned! Advise applicant. Hold 90 days for return then dispose if not picked up. Inspector Mate Advised applicant Date Time staff (by phone, fax or in person) xsssxsszzxxxzzxxzxsssxzszssssssszzxzzssssxxssszsszzszzzsssssszsssszzzsxzzzzszssszszsxsszarassszzzsszzzxxx OFFICEUNSPECTORS NOTES TOTAL FEE .Ip L Gross area - new construction CA Total Sq. Ft. alteration Total Sq. Ft. Permit is issued to Comments/notes on permit ---������ sifsi###iii#####x###ii##xxsi##s#x###x#sisii##sxxs#xss#si##sxssssx##sszisiii##!#s# 1600 TO TnE APPLI {CANT/REFERRAL AND APPROVAL Date of Application submission Plat 14 Lot I Street f` 1 A uifer Zon e ne Owner a Owner mail address -/ Owner phone # OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your proposed project. ` -CONTACT TEEM FOR REOU M SUBMLS.SIONS. ® TAX COLLECTOR Z Approved HOLD By Date CT Board of Appeals ,= Approved By Date ❑ Conservation Commission 177 Approved By Date ❑ D.P.W. Water roved B -� Approved y ❑ D.P.W. Sewer =Approved By Date ❑ D.P.W. Cross Connection . Approved By Date ❑ Treasurer (Bond) ❑ Approved By Date ❑ D.P.W. Engineering Approved By Date 013ord n' of Health (well) Approved By Date of Health (septic) ` Approved By d Date ❑ Board of Health (food service) '_ Approved By Date ❑ Planning' Board (parking) Approved By Date ® FIRE DISTRICT (I II -'III) = Approved By Date BUILDING DEPARTMENT APPROVAL: ❑ ZONING ' ❑ SUILDING INSPECTOR/BUILDING COMMISSIONER 13 CONTROL CONSTRUCTION AFFIDAVIT PROJECT SUMMARY: new aconstructioni alteration/demo sewage disposal public private [Alter add interior walls] [add rooms] [add footprint] water supply -public/private well [pool] [garag fished deck] [game court ] [food service] Describe i#-##ixiii#st#iii##iii##iii##i###i#i#iii#iii##iii#x##i#iiii#ixiii###i##ii#ii#iiitii##ii#i###xii##ii##i#ixx#x To the various departments: i This motice has been forwarded to you for your information and any appropriate action. Should you have any questions please advise. 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 APPLICATION • ZONING AND BUELDING PERMIT Instructions The applicant shall complete this application to the best of their ability prior to submission, leaving no item unanswered. Tii,e 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. Nam FMPS fieiv=I 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET LOT ZONING DISTRICT CURRENT ACCESSORS' PLAT OTHER ZONING OVERLAY DISTRICTS , if applicable NUMBER &STREET NEAREST CROSS STREET SUBDIVISION NAME & LOT # j _.LW _P1'a`.\o`C� Q U - or BUSINESS NAME PREVIOUS TENANT / OWNER 200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only e THIS SECTION NOT APPLICABLE Single family - number bedrooms number baths Two family - number bedrooms unit I number baths unit 1 number bedrooms unit Z _number baths unit Z Accessory apartment Total gross sq. ft. Accessory structure: =' Garage - detached - attached to dwelling, dimensions L W Carport— detached - attached to dwelling, dimensions L W - �hed - dimensions L W Deck - dimensions L" W Gazebo - dimensions L W Swimming pool above ground in -ground Size .= Chimney -number of flues