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BP-6273800 MECHANICALS & 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) i Air conditioning - (separate unit) 77 None of the above to be provided Hot Water Gas - Electric Fuel Oil Other 900 SPRINICLERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential Required, --plans provided, plans not provided, why? Not required, not to be installed, Why? I� 1000 REQUMED OFF-STREET PARING - 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 pert 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) nt owner - name U d dress� tC phone #r� If corporation, officer in charge Architect/Engineer for overall design ComP any name Address j 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. i Archihx tlEngmeer - 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 anril not reproductions. General Contractor (if Homeowner, state homeowner here then complete section 1300) Company name A dress/ Phone number Construction Supervisors license number J N017E Signatures and seals on all plans, affidavits and other documents SHALL BE originals an(d not reproductions. ssssssssssssstssssssssssssssssssssssssss:ssssxsssssssssssssssssssssssssssssssssssssss:sssssssYs:ss::s:sss 1200 FOR RESIDENTIAL 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! 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 (print) Signature Date 1300 OWNER SIGN - OFF I. the undersigned, am the ownerof 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 by written request. I understand that once the permit expires a new application may be required, including fees and current other requirements (including Zoning). ame; ature y The a ove signature is m oluntarp act and is signed under the pains and penalties of perju ry. 7ate Who is authorized to pickup the permit at the Building Department? (please print) Address Phone�,� 1400 HOMEOWNER EXEMPTION - ONE & TWO FAMILY ONLY FOR HOME .OWNERS WHO INTEND TO PE R AND BE RESPONSIBLE FOR THEIR OWN PROJECT 109.1.1 Licensimg of Construction Supervisors: Except 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 construction, reconstruction, alteration,, repair, removal or demolition involving the structural elements of buildings or structures, unless he or she is licensed in accords-ce with•: the rules andregula.. : ons promulgated by the BBRS emti!' Rules and Regulations for Licensing ConstrLctio led g n Supervisors..- Exception: Any Home Owner performi ng uig work for which a Building Permit is required shall be exempt from the provisions "of this section; ' provides that P �f 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 section only, a "Home Owner" is defined as follows: Person(s) who owns a parcel of land on which helshe resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, 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 any licensed Construction Supervisor, whether or not they have taken the permit are responsible for code compliance.' (see 2.15.2 of section a-) atsss####ss#ss#ssss#ssss#sssss#sssssssssssss##sssss#sxsssssssssssssx#sss#sssss:sssssss#s#sssss#sss#ss###s 1500 COST Cost of Improvement Items to be installed but not included in the above cost: Electrical 5 Plumbing HVAC Other TOTAL Alteration of existing, no increase in gross square feet. A separate Refuse Disposal jr�eciaration required. _ Demofta'on - describe structure Number of dwelling units Number of bedrooms A separate Egefuse Disposal 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 j A separate disposal declaration REQUIRED i _ 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 ex siting dwelling will be considered as an Alteration, otherwise will be included in new construction. (see Code 4ection 3401.10 for residential and Articl- 8 f(._ commercial) Temporary structure includes when allowed, trailers, tents and the like and only for linnited periods of time. Describe 500 CONSTRUCTION PLANS i = None submitted. Why? - Submitted, usually three sets required. Four sets for food service uses. Number of sets submitted 600 SITE PLAN ❑ Not required, why? i = Submitted When? = Previously, date ❑ With this application 700 VTILIZMS Water supply - required yes no, public ? _ yes no, on site well' _ yes no, existing? yes — no _ I 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) i Sewage disposal - required _ yes _ no, public sewer _ yes no 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 instructions). Location(s) (list) Fireplace(s) - (includes flue) List location(s) Game Court - describe (include overall dimensions) Tent, Trailer (Mobile Home) or Other - describe 300 COl<31EItCIAL - PROPOSED PR JECI'/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 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) = 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 - amber of dwelling units and bedrooms or occupant load as apphcabk;, also existing condition 400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED New Construction and/or Addition o total gross square feet (For commercial only total gross cubic feet) - indicate y It will be considered new construction if there an increase in square foot age tage 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.) y� .see Code section 127.0). Designer to submit Code Synopsis. No. (If yes Will this project require Peer review (over 400,000 cu.ft.) Yes No (see Code Appendix 1) APPLICANT TO PROVIDE The following section for official use only. INSPECTORS' REVIEW 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 Inspectors signature Date ��,7 7/i h? Applicant informed of above - Date a staff (fax, phone, i1n person) szzzzszzx:zzzszsaszzzzzszzazszzzzzzzzssssssssssszssssssssssasssssssssssssssssssssssss*assaszsms*raaszszssss 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) zzaszzzzzzzzzaazszszzzzzzzzazzzzzzzzzsazzszzzzzzaszzazszsas*zassssszaazazzaszzzasszzzzazzzazza:z;zzaszzazs OFFICEUNSPECTORS NOTES TOTAL FEE i Gross area new construction Total Sq. Ft. alteration Total Sq. Ft. Permit is issued to Comments/notes on permit 1600 TO THE APPLICANTIREFERRAL AND APPROVAL ! Date of Application submission Plat Lot Street Aquifer Zone Owner Owner mail address I, Owner phone # #####Y######Y##Y##YYY##Y*##liYfY#####Y#iYiY#itYiY#iYYYi#iii#iiYYi#iYiY#Yi#iYYliili#YYY####ii##!!!#i##Yi#Y OTHER INVOLVED AGENCIES The following agencies require separate jurisdictional proposed project. CONTACT —THEM FOR RF,OCTi>Qrmtts or approval for your - — ..ED SUEMLS.SIONS. U TAX COLLECTOR Approved HOLD By Date I ❑' Board of Appeals Approved By Date ❑ Conservation Commission Approved By Date ❑ D.P.W. Water Approved By ❑ D.P.V. Sewer _ Approved By Date C D.P.W. Cross Connection 77 Approved By Date ❑ Treasurer (Bond) ❑ Approved By Date ❑ B.P.W. Engineering :�_— Approved By Date 7 Board of Health (well) = Approved By Date ❑ Board of Health (septic) Approved By Date ❑ Board of Health (food service) Approved By Date ❑ Planning Board (parking) _ Approved By Date ® FIRE DISTRICT (I - II - IIn - Approved By ssss#ssssssssssssssssssssssssss#ssssssssssssssssssssssssssssssssssssasssssssssssssssssssssDate sssasssssssss BUH.DING DEPARTMENT APPROVAL: ❑ ZONING ❑ BUILDING INSPECTORIBUILDING COMMISSIONER ❑ CONTROL CONSTRUCTION AFFIDAVIT PROJECT, SUNIMARY: new construction/ alteration/demo sewage disposal - public/private [Alter;add interior walls] [add rooms] [add footprint] water supply - public/private well [poor] [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 any found, please advise. Your assistance and questions please advise. If any reason to withhold the requested permit is cooperation is appreciated. The Building Department - Date sent for review By TOWN OF D OUTH BUILDING DEPARTMENT:' TELEPHONE 508-999-0720 FAIL>`508=999- 738 APPLICATION FOR ZONING AND BUILDING PERIT The applicant shall complete this application to the best of their ability prior to submission, leaving no item ®answered. Tle Department staff will be available during regular business hours to assist as necessary. N/A should be inserted for those seki:dons which do not apply. A properly completed application will help avoid unnecessary delays. NoW F31mg fee as at (for office use only) FOUN RATION �NiLY Total Cost $ Received By Dale Rec'd Less Application Fee S% Total Permit Fee Permit # 7,2 hmed 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET>j CURRENT ACCESSORS' PLAT LOT ZONING DISTRICT THER ZONING OVERLAY DISTRICTS if applicable A NUMBER & STREET i 1 NEAREST CROSS STREET r SUBDIVISION NAME & LOT # 'I 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 Two family_ - number bedrooms unit 1 number baths unit 1 number bedrooms unit 2 number baths unit Z Accessory apartment Total gross sq. ft. Accessory structure: '' Garage - detached - attached to dwelling, dimensions L W "t Carport - detached - attached to dwelling, dimensions L W A V Shed - dimensions L' W Al Deck - dimensions LW I Gazebo -dimensions ' L W - Swimming pool above ground in -ground Size Chimney.- number of flues ,.