BP-3598800 XC:IA,4c,`'< v, & PI EgAR'< 7L
Furna« shot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify)
Boiler :heating)- Fuel gas (natural or propane), fuel oil, elec : other (specify)
'C �ibined unit) - Pt-imary fuel, natural gas, propane, electricity, other (specify)
_ .Air conditioning - (separate unit)
None of the above to be provided
Hot `rater Gas Electric Fuel Oil Other
goo SPRINIe3.ER5 - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
R equiied, --plans provided, _plans not provided, whv?
Not required, not to be installed. IVhy?
1000 RZEM)" D OFT-STR= PAREING - for ZONING & .Architectural .Access
LOT .�,PPLICG%BLE
= F ,rant; Plan submitted To = Building Department Planning Board Date submitted
dumber of spaces - indoors outside total provided
l sndicap -oa ses - required _ ves no. If ves, how many as a part of the tota! required number.
is Route 6 tState Road) Entrance permit required? ves _ no =. If ves has it been issued yes _ no =.
-; hmit cops of application and or permit as soon_ as available.
1100 Ti— +''74ri1FICiiO'7 (print or type except as noted) ,ry
C °wrrsnt owner • name -s e G`Y&,
address 6z /� !i- 4/K
n
.)hone
f corporation, officer in charze
�r 2itcrs�,'n;iaep�- - for overall desi n
Company name _
address
Phone number
er'fied by State of 'Massachusetts as
em ication number
N TE Signatures and seals on all plans. affidavits and other documents SILALL BE originals and not
reproductions.
ArchitecU r., ieer - project supervision and rrports
Company name
_Address
Phone number
Certified by State of 'Massachusetts as
Cer ficat: : number
NOTE `signatures and seals on ail fans, affidavits and other documents SMALL BE originals and mot
productions.
General C.ont actor (if Homeowner, state homeowner here then complete section 1300)
Compan:
Address
Phone number
Construction Supervisors license numbers % �l
NOTE Signatures and seals on all mans, affidavits and other documents SHALL BE originals and niot
reproductions.
11 FOR RESIDENTIAL WORK f '
Are you a Home Improvement Contractor subject to (780CNMR - 6) ? Yes ® No ® If no go to uex t section'.
Are you claiming exemption from the requirement? Yes No _If yes, submit the required affndavit!
Reti-)del contractor name (please print)
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, ilLA 02108
(617) 727-8598
Owners name (print) _
Signature
Date
:ao increase :n _,ress square feet. A separate Refuse Disposal Declara Lion required.
1. the undersi ;red. am the owner of record or authorized lessee !provide documentation) and I have reviewed
the appiication herein submitted. I state that to the best of my knowledge and belief that the information provided in this
appiication 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 he extended for six months if no work is
an ipatd if I request such an extension in writina. I understand that the permit may be extended only three times by
,vrr*en request. 1 understand that once the permit expires a new application may be required, including fees and current
other re(luirements (including Zoning).
tore 1'
The 'above/s afore is my volun r_s ae. d s lined under the pains and penalties of per"
is
Date
` o J . Utnori''ed to oickup the rE rmit at. the Building Department? rfle2,e cri.nt)l.y�Efi� �`7/r� oc,
Phone! �-- -
_40`';: liO�iF,O;v?t`ER E E� t c ON - ONE 1 7 0 Fr' TfflL 07II _Y
i GA i'IOME AN -NE RS 'XII0 1YFEND TO PERFORM :�_D BE ?FSPONSIBLE FOR THEIR ONN-N, PROJECT
1{9.1.1 L —rsy of Co estr^c ur, SapervLsor�_: Except for those Structures zoverned by Construction Con -of
_. for ffecnVe „ui_, 1, 1982, no individual shail be erga>ed in di ectly supervising persons engaged in
_ons- uct on, ; econsrrucnon, alteration, repair, removal or demolition involyin2 the structural elements of buildings or
li=;res.:.,,iess he or she is licensed in accordance with the rules and reguiarons promul-gate- by the BY3RS entitled
,. ci IIaiioi s r Licensing Co-structicn Supervisors.
ryc:pton:.%m Home Owner performing work for .;hich a Building Permit is required shall be exempt From
the Dt ,onS ,.t 'his section: provides that if a home Owner engages a penonlsi for )lire to do Stich work .that SUCn
lio;r_ O�;ncr _hail :,cr as supen•isor.
1-ur the rurposes of this sect o,..�Lsp, a "Home Owner' is defined as fohows: Fersonis) who owns a parcel of land
1ich he she asides or intends to reside, on which there is, or is intended to be. a one nr t n family dwellin', attached
C,^:�:.; �trt: is r�r e5 accessory to Stun use and;nor farm structures. -i Person �;-no constructs more than one home in
tar ::eri, ail he considered a Rome Otvner.
_'Fe pi�ins; under this section sign below:
-Nour s! na.ire carries certain responsibiiines, inciudine but not necessariiv iimited to, general liabilivy
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TE TO L1C LASED CO"°t'leZACTVM S: The Buddinti Cude provides in the Ruies and Regulations section that any
list" { onS n':;CnOn dupe-'-`: LSOr, whether or not they have taken the permit are responsibie for code compllance. (see
if
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l 5 .0 .- ObT
fast ;f I.npro%ement
i',2ms :, _ Installed hat not included in the above cost: Elecrmcai
Plumbing
HVAC
Other
TOTAL 5
F1�1c1V;1TfZ_
_ 13emodtfon -describe structure
Number of dwelling units Number of bedrooms A separate Refuse,: Disposal
Deciaration required.
Moving - ,Provide copy of D.P.W. moving license) Type of structure
from where iplaulot or address)
t where )platilot or address)
tiumber of dwelling units Plumber of bedrooms per dwelling unit
Re--oormg - i for existing only, is included in new construction)
Nun.ber of square feet
Number of layers when complete
separate disposal declaration REQUIRED
Plumber of layers already existing
'_tepiacernent doors and windows - )for existing only) {only where doors and windows exist :and will not be
eniargedl EGRE-QS dimensions must be maintained. Enlarged or new windows in an existing d'welung will be
considered as an :iteration. otherwise will be included in new construction. see Code sectiom. 3 01.10 for
:i
_esidential and .`_rrcle 8 for cnmmercial)
Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods of time.
Describe - -
.500 CONS `I RUMIiGNI PI-iNS
-_ 'vone submitted. 'Why?
_ Submitted, usLativ three sets required. `Four sets for food service\uses. 'lumber of sets su:'amitted
,)ou SITE
Not required., why?
Submitted y:'hen? - Previously, date - With this application
(dater supply - required e ves _ no. public ^. yes _ no, on site well? yes _ no,
existing' _ yes _ no
If required and not existing have necessary permits been issued? no a yes, date
(Y.G.L. Chapter 40, section S4 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 _ ves _ no, public sewer _ yes _ no
private sertic - on -site _ ves _ no. Submit copy of permit as soon as available.
_ ..,... �..�.. icyuuc Lnspcc.:ua pnor to uistauanon), new (provide manufacturers
instructions). Location(s) (list)
El Fireplace(s) - (includes flue) List location(s)
Game Court - describe (include overall dimensions)
Z Tent, Trailer (Mobile Home) or Other - describe
300 COM 1F—RCIAL - PROPOSIM PROJF.CT/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)
Tercantile - 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 ._gricultural 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
Der cr, be the proposal briefly, INCLUDE n umber of dwelling units and bedrooms or occupant load as applicable,
also emoting condition
400 TYPR 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
alteration(s).
If project is an addition to existing structure - Total gross square feet of existing
FOR C0hEWMCL4,L 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 Pee- renew (over 400,000 cu.ft.) Yes No (see Code Appendix I)
APPLICANT TO PROVEDE
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
AUG 2
Inspectors signatIrmed
Date ®
Applicant of above - Date time staff (fax, phone, in pc;rson)
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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)
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OFFICEUNSPECTORS NOTES
TOTAL FEE
Gross area - new construction Total Sq. Ft.
alteration Total Sq. FL
Permit is issued to
Comments/notes on permit
__-___-____.,
1600 TO THE APPLICANT/R, AND APPROVAL
Date of Application submission
Plat Lot Street
Aquifer Zone
Owner
Owner mail address
Owner phone #
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OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT THEM FOR MM
SUBMISSIONS.
® TAX COLLECTOR = Approved -- HOLD By
Date
❑ Board of Appeals Approved By
Date
❑ Conservation Commission G Approved By
Date
❑ D.P.W. Water _ Approved By o D.P.W. Sewer _ Approved By
Date
❑ D.P.W. Cross Connection _ Approved By
Date
❑ Treasurer (Bond) ❑ Approved By
Date
❑ D.P.W. Engineering —7 Approved By
Date
7 Bo. rd 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
9 FIRE DISTRICT (I - II - III) Approved By
Date
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BUILDING DEPAR17AIM APPROVAL:
�i[iXIIkTe3
❑ BUILDING INSPECTORBUILDING COMMISSIONER
❑ CONTROL CONSTRUCTION AFFIDAVIT
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PROJECT SUMIAARY:
new constructioni alteration/demo
[Alter/add interior walls] [add rooms] [add footprint]
sewage disposal - public/private
[pool] [garage shed/deck] [game court] [food service]
water supply - public/private well
Describe
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.
The ,'Building Department -Date sent for review By
APPLICATION FOR ZONING AND BUELDING.PEWI
Insbroe5ous
The applicant shall complete this application to the best of their ability prior to submission, leaving no item ®ans
wered. The
Department staff will be available during regular business homy to assist as necessary. NIA should be inserted fens those sections
which do not apply. A properly completed application will help avoid unnecessary. delays. Neft Firog swim m` '
(for of ioe use only) 4�1UPtMITON ONLY
Total Cost Received By Date Reed
Less Applimoon Fees Issued D:tc
Total Permit Fee S (f7t� Permit #Zallr�7
100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET
CURRENT ACCESSORS' PLAT LOT/24Y60NING DISTRICT
OTHER ZONING OVERLAY DISTRICTS , if applicable
NUMBER & STREET
NEAREST CROSS STREET
SUBDIVISION NAME & LOT #
or BUSINESS NAME
PREVIOUS TENANT / OWNER
re
200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
THIS SECTION NOT APPLICABLE
Single family - number bedrooms number baths
i
= 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
LE 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
0