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