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BP-4635800 M ECI AMCALS & PRIMARY FUEL = Furnace (hot air) Fuel gas (natural or propane), fuel oil, electricity, other (specify) 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 SPREVKLERS - 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-STREET 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 epaces - required _ yes ,_no. If yes, how mane as a part of the totsl 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 owner - name address' G / , / phone f# � 6 � 4 7 S o� ij If corporation, officer in charge Architect/Engineer - for overall design Company name Address Phone number Certified by State of 'Massachusetts as Certification number MOTE Signatures and seals on all nlans, affidavits and other documents SHALL BE originals and not reproductions. Architect/Engineer - project supervision and reports 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 00) Company name Address Phone number wr } Construction Supervisors license number e�,l / % 3® NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals anon 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! I Are you claiming exemption from the requirement? Yes �No _If yes, submit the required' ,-affidavit! Ren_-)del contractor name (please print) i Address Registration number (it 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 (print) I Signature Date 5 Alteration of existmg,,no increase in gross square feet. A separate Refuse Disposal Declaration rerquired , 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 knowledge Demolition -describe structure of my 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 expire in six p months, from the date of issue, if no work is Number of dwelling units Number of bedrooms A separate Refuse Dis m P� P� begun or six months after the last inspection if work has begun and that the permit may be extended for Declaration required. 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 anew application maybe required, including fees ' —Moving -(Provide copy of D.P.W. moving license) Type of structure and current other requirementK ding Zoning). from where (plat/lot or address)' ;dame ' to where (plat/lot or address`) Signature e a one sig store is my voluntary act and is s' ed under the airs and Penalties of perjury. rg p P P rj rY- �j Number of dwelling units Number of bedrooms per dwelling unit Date Q �z _ — Re_rvofing - (for. existing only, is included in new construction) `�'ho is authorized o pickup the permit at the Building Department? : I ` Num - f f Number osquare feet Number of layers already existing Address_. Phone �o y Number of layers when complete 1400 HOMEOWNER EXEMPTION - ONE & TWO FAMILY ONLY A separate disposal declaration REQUIRED FOR HOME OWNERS �VHO INTEND TO PERFORb1 .AND BE RESPONSIBLE FOR THEIR OWN PROJECT a Replacement doors and windows - (for existing only) (only where doors and windows exist and willl not be 109.1.1 Licensing of Contraction Supervisors: Exceptthose for ose structures governed by Construction enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing `dwelling swill be Control in Section 127.0, effective July 1, 1982, no individual shall be engaged in directly supervisin Persons g Pe ns construction, engaged in reconstruction, alteration, repair, removal or demolition involving the structural elements of buildings considered as an Alteration. otherwise will be included in new construction. (see Code section 3401.10 for or structures. unless he or she is licensed in accordance with the rules and regulations promulgated by the BBRS entitled Rues and Regulations for i•icensmg Co^structic-1 Supervisors. re:° idential and Article 8 for commercial) Exception: Any Home Owner performing work for which a Building Permit is required the of this section: • q shall be exempt from — Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods cnf time. provisions provides that if a Home Owner engages a person(s) for hire to do such work ,that such Home Owner shall act as supervisor. Describe For the purposes of this sectioi. „nIy, a "Home Owner" is defined as follows: Person(s) who owns 500 CONSTRUCTION PLANS a parcel of land on which he.rshe 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 -None submitted. Why'? structures. A erson who cons two-year period shall not be considered a Home Owner. P tructs more than one home in 1C Submitted, usuallv three sets required. Four sets for food serviceluses. Number of sets submitted • If you are apphIng under this section sign below: I 600 SITE PLAN Signature Your signature carries certain responsibilities. including but not necessarily limited to, x#r#Ss##s#smmsz#xsx2#sssssz#s#szsssssss#ssss#22##ssssssss#xm#s#ssxsms2#xs#s2ssssssss#sss:slsssblsll*###smsxs ❑ Not required, why? tv NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations _ Submitted When? _ Previously, date ❑ With this application j section that any licensed Construction Supervisor, whether or not they have taken theermit are res '_.15.2 P ponstble for of section code compliance. ;(see }��7� �+�� ��,,700 UTILIT L� ,..-. 1500 COST Cost of Improvement ' 5 l/ SUG Water supply - required ves _ no, public ? _ yes _ no, on site well? Zyes _ no, I Items to be installed but not included in the :above cost: Electrical 5 A!51 UV existing? _ yes -_ no '5� - z _ Plumbing 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 HV:AC�. (� Other �. required, is available. See Code 780 CMR section 114.1.2) Sew e disp osal posal - required no, yes _ public sewer yes _ no TOTAL _ private septic - on -site yes _ no. Submit copy of permit as soon as available. b - Woodstove ji _ stove - used (will require inspection prior to installation), new (provide manufacturers The following section for official use only. instructions). Location(s) (list) INSPECTORS' REVIEW .= Fireplace(:) - (includes flue) List location(:) Date plan reviewed j Game Court - describe (include overall dimensions) 30 days to review period expires Tent, `Trailer (Mobile Home) or Other - describe OK to issue date I, 300 CON'II1�fEItCIAL -PROPOSED PROJECT/USE -INCLUDING THREE FAMILY OR MORE AND EXEMPT USES OK to issue subject to requested submittals (see project review worksheet) date , TZiIS SECTION NOT APPLICABLE _ DENIED see project review worksheet date I (The following descriptions are based on the Massachusetts State Building Code Article 3, AS NOTED) (See the Code) , - HOLD reason date HOLD Subject to Zoning Board of Appeals action - Assembly, - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe j Comments 1 9 - Business - office, assembly with less than 50 occupants - indicate Medical or other professional (see Code Inspectors signature Date Section 303.0) _ Applicant informed of above - Date time staff (fax, phone,, tin person) _ Educational - structure for training including child day care for those over 2 years 9 months (see Code Section 304.0) zsssszxzszzzssssssssssssssszzszsssssssssssssssssssssssssssssssssssssssssssssssssssssssssss:ssss��sssszzzzzs . - - Over six months since approved for issue - DEEMED abandoned! = Factory /`Industrial - (see Code Section 305.0) Advise applicant. Hold 90 days for- return then dispose if not picked up. High Hazard - (see Code Section 306.0) Inspector Date = Institutional - hospital, nursing home, infant day care (see Code Section 307.0) _ _ Advised applicant Date Time staff (by phone, fax or in person) ~ Mercantile - retail stores (see Code 308.0) zsssssssszsssssssssssssssssssssssssszsszsssszsssssssssssssstssssssssssssssssssssssassssssssss�szsmsssssxs Residential - three or more familv, hotel (see Code Section 309.0) OFFICEVNSPECTORS NOTES Storage -includes garages (see Code Section 309.0) TOTAL FEE Gross / Total Sq. Ft. _ Utility &Miscellaneous Structures - includes tents and agricultural structures (see Code Section 311.0)� area -new construction _ New tenant for any of the above, indicate above (see Code Section 119.0 and Zoning By-law section 35) alteration Total Sq. Ft. a _ Tent or Trailer - temporary purpose? Permit is issued to Other -- r Describe the proposal briefly, INCLUDE - amber of dwelling onus and bedrooms or occupant bad as applicable, Comments/notes on permit a.}so emoting condition 400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED _ New Construction and/or Addition - total gross square feet 1-7 C (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 L 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 n APPLICANT TO PROVIDE xzss::zsssssssssssssss#:ssssss:sssssssss::ssssss::s*sss*::::ssssss::ssssss;::::::ssssss:ssssss:sitssacxsss�s '.... .��� 1600 TO THE APPLICANT AND APPROVAL Date of Application submission Plat � 6 Lot Street �� ( IMP" Jd n?- Aquifer Zone Owner .is' �1� fY15 Owner mail address e APPLICATION FOR ZONING AND BUILDING =PERMIT Owner phone # :sss*z*xx*xz*z*z*********z*X******#********xs**#z*ssssxsssszssssssssxs*sssss*sss*sxsa:ssssssssssssssssssss `_ OTHER INVOLVED AGENCIES The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACT THEM FOR RF XjEgEp SIUBMISSIONS. TAX COLLECTOR ` Approved HOLD By Date ❑ rM4 F DATION ONLY ❑ for oil use Board of Appeals ,- Approved By Date Total Cost Received Bp � Date Reed - =� -2 servation Commission C Less Application Fee $ &01 Approved By Date Total Pernut Fee s Permit # Issued Date ❑ D.P.W. Water _ Annmved Rv n n n w e,,...,.- _ •-----� s- - -- ❑ D.P.W. Cross Connection u Approved By Date ❑ Treasurer (Bond) ❑ Approved By Date ❑ D.P.W. Engineering Approved By, Date oard of Health (well) Approved By Date Board of Health (septic) C Approved By Date 13 Boa Health Board of H 1 h ( food servic e) ) _Approved By Date ❑ Planning Board (parking) _ Approved By Date DISTRICT.(I - II - III) Approved By Date .::::: :::::::::::a:asassssaaaasssaaa:ass::asses:::aa:::assasssssasssssssasssssas BUILDING DEPARTMENT APPROVAL: ❑ ZONING ❑ BUILDING INSPECTORBUILDING COMMISSIONER ❑ CONTROL CONSTRUCTION AFFIDAVIT s*z*zzszz*xsszzsssssssszsxsssss*sss**ss*s*xtxs*xxsszsssszzzzxssz*z*xxxx*zx*xsxsssx*s*szszss**xz*xsxs*xxz , PROJECT SLR: new constructio alteration/demo sewage disposal - public/private terladd interior walls] [add rooms] [add footprint] water supply - public/private well [pool] , [garage/shed/deck] [game court] [food service] Describe /1 *�ssxxxxstcxxxs****sss*sssxzsssszsss*sss*s s*z**ssssssssssxz** x**z**xxz**x**szssszs**ss*sss*sss*sss*x*sz To the various departments: This notice 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. _Z� The Building Department -Date sent for review 7 By 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET' CURRENT ACCESSORS, PLAT LOT AO- A) ZONING DISTRICT OTHER ZONING OVERLAY DISTRICTS if applicable NUMBER & STREET NEAREST CROSS STREET21 / SUBDIVISION NAME & LOT # or BUSINESS NAME PREVIOUS TENANT / OWNER 200 RESIDENTIAL - PROPOSED PROJECT - one & two family'residence only = THIS SECTION NOT APPLICABLE = Single family - number bedrooms_ number baths .L.. 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: Garage - detached - attached to dwelling, cimensions L W' Carport - detached - attached to dwelling, dimensions L W, Shed - dimensions L W Deck - dimensions LId W /.2- Gazebo - dimensions , L W Swimming pool above ground in -ground Size - Chimney - number of flues