BP-642 BUILDIN PERMIT
Dartmouth Building Department Plat: 70
400 Slocum Road-P.O. Box 9399 Lot(s) : 13-39
Dartmouth, MA 02747 Lot Size: 2. 19A
Telephone 508-999-0720 Zoning Dist. :SRB
March 27, 1997 (typed) Permit No. : (
Issued Date: ?/Z.G-/ 97 Clerk: BAS
Project Location: Millers Drive
Number Street
Subdivision Name:
•
Nearest Cross Street:
Applicant/Agent: Robert Kfoury _
Address: 306 McGowan Street, Fall River, MA 02723
Contact Person Phone #: (508 ) _678-8292
Type of License: Owner: (x) Const. Superv. License #: (
Architect: ( ) Engineer: ( ) Other: (
Proposed Use: Residential
Residential,Commercial,Industrial,etc
Permit Issued To: To Demolish
Type of Improvement,Add,Alter,New Const.,Demo,Land/Move,etc.
Demolition of existing dwelling (house only)
indicate no of bedrooms and bathrooms and other rooms
Gross Area of Const. : Cost of Const. 52 , 000. 00
Cost-Other Const. : TOTAL FEE: $ 25 .00
Owner(s) of Record: Robert Kfoury
Address: 306 McGowan Street, Fall River, MA 02723
All work shall comply with 780 CMR 5th Ed. (MGL Chap. 142) and any
other applicable Mass. Laws or codes and plans on file.
I hereby certify that the proposed work is authorized by the owner of record and
I have been authorized by the owner to make this application as his agent and to
receive this permit, I further understand other agencies may have reason to STOP
WORK if items under their jurisdic o are met; not withstanding the issuance
of this Building\Zoning Permit.
Signature of Owner/A ent:
Address:
******************** **** * * ***tf*' **************************
Signature:
Approved/Issued BpW oel S. Reed, Title: Building Inspector
COMMENTS: PLEASE 100ST PERMIT CARD SO THAT IT IS VISIBLE FROM
THE STREET. SCHEDULE APPROPRIATE INSPECTIONS AS
REQUIRED. UPON COMPLETION OF WORK, FINAL INSPECTION
IS REQUIRED.
0 ORIGINAL 0 APPLICANT 0 ASSESSORS 0 CLERK% 0 COPY
76/1
Required approval Approvals received
please (X) approvals Please (X) approvals ar
required forthis project Initial an received
DATE INITIALS A /rty
Zoning
i7. Building Comm.
Board of Appeals
Water Card
I `
Sewer Card I�
J Board of Health
Selectmen iw`I
Conservation
V_
Fire Chief
Cross Connections
Licensed Contractor
controlled Conet. Affid.
maxea Other information required
Water Cut-off document 4'A
Electrical Cut-off document A, 4
Gas Cut-Off document N A V
Board of Health Permit ' .
Sewer Cut off document 4/4
REMARKS:
TOWN OF DARTMOUTH.
01 256
BUILDING RECEIPTS
NO TAX ISSUES
COLLECTOR'S OFFICE
Name: i - - f ic-9 , Property Date
/ ( (—eft t.t„-L-r- zcs.,-----6-4,-4.--, own . _ 4..-----ft-rvi c.-
er
Job Location: )1 4 ct .6 ' /J._ _
Tow DART ,t,
IAXCOLLEcToRs p f;:klb„2 oy-Collectors Office
Plot: 7° L ot: / -:} - .7 "7 -it. opy-Customer's Receipt
A„Fink Copy-File Copy
;.•'A R 2 a INgtieen Copy-Building Department
Phone
Retiaz .., 4,
,,,
Description General Ledger#'s Ref.# Amount
License&Permits-Building 01000-44105 41
License&Permits-Building Misc. 01000-44105
License&Permits-Electrical 01000-44106
License&Permits-Plumbing&Gas 01000-44107
Other Department Revenue : 01000-42420
This is not a Permit or License for Building,Plumbing or Gas Received By:
_ _
TOWN OF DARTMOUTH BUILDING DEPARTMENT
TELEPHONE 508-999-0720 FAX 508-999-0738
APPLICATION FOR ZONING AND BLDG PERMIT
Instructions
Thee applicantunanswered-The
shall cumplele this application to the best of their ability prior to snbmissioA.'leavinv no item
Department staff will he available during regular business hours to assist as necessary:N/Ashould be inserted for those sections
which do not apply. .properly completed application will help avoid unnecessary delays. Nat BEES km as tot tt a ie>de.
(for office me only) r'
Application fee Si received by 7) Date S 4 >7/ 4
Total Permit Fee $ Permit# 'f ' " `4,2t 3 ' l q
2
LOD LOCATION OF PROJECT • 3
r° n
CURRENT ACCESSORS' PLAT / L.' LOT,/,-/ — ZONING DISTRICT
OTHER ZONING OVERLAY DISTRICTS , if applicable
NUMBER & STREET 7/lL 4 `/le `C
NEAREST CROSS STREET
r_
SUBDIVISION NAME & LOT# � � �� ('c_L i ��Ci L k or BUSINESS BUSINESS NAME
-PREVIOUS-TENANT-; OWNER /- l �.c
200—REESIDENTIAL - PROPOSED PROJECT - one & two family residence only
/HIS SECTION NOT APPLICABLE
_ Single family - number bedrooms number baths
_ Two family - number bedrooms unit 1 number baths unit I
number bedrooms unit 2 number baths unit 2 -
•
_ Accessory apartment Total gross sq. ft.
_ Accessory structure
_ Garage - detached - attached to dwelling, dimensions L R'
_ Carport - detached - attached to dwelling, dimensions L a'
_ Shed - dimensions L W
_ Gazebo - dimensions L W
_ Swimming pool above ground in-ground Size total square feet
7 Chimney -#of flues �—
• -'•••-••^••- iMw requireinspection 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 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 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 number of dwelling units and bedrooms or occupant load as applicable,
also existing condition
400 TYPE 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 COMMERCIAL ONLY
Will this project be subject to CONSTRUCTION CONTROL(over 35,000 cult.) _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 No (see Code Appendix I)
APPLICANT TO PROVIDE
I
(Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required.
- _ olition - describe structure _
Number of dwelling units Number of bedroi‘s A separate Refuse 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-roormg - (for existing only, is included in new construction)
Number of square feet Number of layers already existing
Number of lavers when complete
A separate disposal declaration REQUIRED
_ Replacement doors and windows - (for existing only) (only where doors and windows exist and will not be
enlarged) EGRESS dimensions must he maintained. Enlarged or new windows in an existing dwelling will be
considered as an Alteration, otherwise will he included in new construction. (see Code section 3401.10 for
residential and Article 8 for commercial) •
▪ Temporary structure- includes when allowed, trailers, tents and the like and only for limited periods of time.
Describe
500 CONSTRUCTION PLANS
▪ None submitted. Whv?
• Submitted. usually three sets required. Four sets for food service uses. Number of sets submitted
600 SITE PLAN
0 Not required, why?
▪ Submitted When? — Previously, date _ With this application
700 UTILITIES
Water supply - required_ yes _ no, public ? _yes_no, on site well? _yes_ no,
existing? _yes _ no
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)
Sewage disposal - required_ yes _ no, public sewer_yes_ no
private septic - on-site _yes _ no. Submit copy of permit as soon as available.
J
800 MECUANICAL.S & PRIMARY FUEL
I 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
L. Hot Water Gas Electric Fuel Oil Other
900 SPRINKLERS - 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
I NOT APPLICABLE
_ Parking Plan submitted To = Building Department I Planning Board Date submitted
Number of spaces - indoors outside _ total provided
Handicap spaces - required_ yes_no. If yes, how many as a part of the total required number.
Is Route 6 (State Road) Entrance permit required? yes = no I. If yes has it been issued yes = no I.
Submit copy of application and/or permit as soon as availahle.
1100 IDENTIFICATION (print or type except as noted)
it /
On-rent owner- name /` <-' --r /�
address `361 4, 41" C- f
phone R jo /Jl 9 '7 ,k
If corporation, officer in charge
Architect/Engineer - for overall design
Company name
Address
Phone number
Certified by State of Massachusetts as
Certification number
NOTE Signatures and seals on ail laps, affidavits and other documents SHALL BE originals and not
reproductions.
I-r-
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 and not
reproductions.
General Contractor(if Homeowner, state homeowner here then complete section 1300)
Company name
Address
Phone number
Construction Supervisors license number —
NOTE Signatures and seals on all plans. affidavits and other documents SHALL BE originals and not
reproductions.
***a******************************************************.r****,`t tiff***** iiiiit**** t t o f
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!
Remodel 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 owner of 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 S
written request.I understand that once the permit expires a new application may be required,including fees and current
other requirements (including Zoning). (J
Name , .�.'>- •
Signature
,.,,//
ipe above sivature oluntary act and is signed under the pains and penalties of perjury.
Date -7 " ,s2
y
Who is authorized to pickup the permit at the Building Department? l please prin0 --z`<-. 1-'7"7 G'.,
Address Phone
1400 HOMEOWNER EXEMPTION - ONE &TWO FAMILY ONLY
FOR HOME OWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT
109.1.1 Licensing 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 accordance with the rules and regulations promulgated by the BBRS entitled
Rules and Regulations for Licensing Construction Supervisors.
Exception:Any Home Owner performing work for which a Building Permit is required shall be exempt from
the provisions of this section; provides that if a Home Owner engages a persons) for hire to do such work ,that such
Home Owner shall act as supervisor.
For the purposes of it is section only,a 'Home Owner' is defined as follows: Person(s)who owns a parcel of land
on which he/she resides or intends to reside.on which there is, or is intended to he,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
t t ttttattS*t t;;;;t;t;;;;; ;; ;;; ; ;; *flan* t ; ;;;;;;******;;;;t;;;
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 )
stititmttt;itit;;tt;;;t;;;;;;;;;;;t;i;i;i;;t;t;;;;;;;ttt;;;;;it;itt;;;;t;it;;;;;;;;;;;;;;;t;;;t;t;;;;t
1501) COST
Cost of Improvement
Items to he installed but not included in the above cost: Electrical S
Plumbing
HVAC
Other
TOTAL S 2 C on
The following section for official use only.
INSPECTORS' REVIEW
Date plan reviewed
30 days to review period expires
2 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
n HOLD Subject to Zoning Board of Appeals action
Comments / �,�
Inspectors signature IC Date MAR 2 5 1997
Applicant informed of above - Date time_ staff - (fax, phone, in person)
YYii#ii{ilii************fiiiii******Snits******iiiiitisliff******kf*****Yiiit*i}Z/ii;i;kki******#;if#kk!#
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)
ssssrsssssss******ssasssssssssssssrsssssssssssssssssssssssssss******ssssssssasssssssssssssssssssssssssss
OFFICE\INSPECFORS NOTES
a
TOTAL FEE 5 '-rb
Gross area - new construction _ Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit ,( _ C
.i� yam
7
1600"Ii)-t1 nAPPLICANT/REFERRALAND APPROVAL
Dam of Application submission .-_ --- ,/ C,
c,
Plat 7C Lori-3 Street
/211 - Aquifer Zone
OwnerZ�,;:.,
Owner mail`/teas 3 S )/ c.' 7 �
Owner phone#
OTHER INVOLVED AGENCIES -The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT THEM FOR REQUIRED SUBMISSIONS.
® TAX COLLECTOR = Approved ._ HOLD By Date
❑ Conservation Comm = Approved By Date
a D.P.W. water = Approved By Date
❑ D.P.W. sewer = Approved By Date
❑ D.P.W. cross connection = Approved Date
❑ D.P.W. engineering = Approved Date
❑ Board of Health well = Approved Date
0 Board of Health septic ' Approved Date _
❑ Board of Health food service _ Approved Date
s FIRE DISTRICT It - II - IIII = Approved Date
ct Planning Dept _ Approved .Date
Other _- Approved Date
Other _- Approved Date
t',.mments
Project summary oew construction/ alteration/demo sewage disposal - public:private
(Alter-add interior walls] [add rooms] [add footprint' water supply - public:private well
(pool) [garage:shed] [game court' [food service'
Describe_ < -LYE-t''-C2 d. j-e,
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 -.
1. c)-- 74` 27 By
•
•
•
•
•
Te —amm<aneaea aicyifaaaacAc ella
Restricted To: 00 j 4
tI = DEPARTMENT OF PUBLIC SAFETY
'dam ; CONSTRUCTION SUPERVISOR LICENSE 00 -'None
Number: Expires: . Birthdate: 1A - Masonry only
CS 055748 07/20/1998 07/20/1958 18 - 1 & 2 Faaily Homes
Res4tricted To: 00 Failure to possess a current edition of the
Massachusetts State Buiilding Code
� ROBERT EFOURY -is cause for revocation of this license.
�
306 MCGOWAN ST
FALL RIVER, MA 02723
•
FILE Cloy
MAR 2 5 1997
BUILDING PERMIT n
FIELD INSPECTION um ��11 ED
Dartmouth Building Department Plat: 70
400 Slocum Road P.O. Box 9399 Lot(s) : 13-39
Dartmouth, MA 02747 Lot Size: 2 . 19A
Telephone (508 ) 999-0720 Zone Dist. : SRB
Issued Date: 03/28 /97 Permit No: 642
Project Location: Millers Drive
Number Street
Subdivision Name:
Nearest Cross Street:
Applicant/Agent: Robert Kfoury
Contact Person Phone #: (508) 678-8292
Proposed Use: Residential
Residential, Commercial, Industrial,etc.
Permit Issued To: To Demolish
Type of Improvement,Add,Alter,New Coml.,Demo,Land/Move,etc.
Demolition of existing dwelling (house only)
Indicate no. of bedrooms and bathrooms and other rooms
Owner(s) of Record: Robert Kfoury
Address: 306 McGowan Street, Fall River, MA 02723
DATE TIME TYPE OF INSPECTION REMARKS INITIAL
BUILDING PERMIT
Dartmouth Building Department Plat: 70
400 Slocum Road-P.O. Box 9399 Lot(s) : 13-39
Dartmouth, MA 02747 Lot Size: 2 . 19A
Telephone 508-999-0720 Zoning Dist. : SRB
March 27, 1997 (typed) Permit No. : G y-,y
Issued Date: 7/4�/ `(2 7 Clerk: SAS
Project Location: Millers Drive
Number Street
Subdivision Name: _
Nearest Cross Street:
Applicant/Agent: Robert Kfoury _
Address: 306 McGowan Street, Fall River, MA 02723
Contact Person Phone #: (508 ) 678-8292
Type of License: Owner: (x) Const. Superv. License #: (
Architect: ( ) Engineer: ( ) Other: (
Proposed Use: Residential
Residential, Commercial,Induatnar etc.-_ - _-__—
Permit Issued To: To Demolish
Type of Improvement,Add,Alter,New Const.,Demo,Land/Move,etc.
Demolition of existinct dwellincr (house only)
indicate no of bedrooms and bathrooms and other rooms —
Gross Area of Const. : Cost of Const. $2 , 000. 00
Cost-Other Const. : TOTAL FEE: $ 25 .00
Owner(s) of Record: Robert Kfoury _
Address: 306 McGowan Street, Fall River, MA 02723
All work shall comply with 780 CMR 5th Ed. (MGL Chap. 142 ) and any
other applicable Mass. Laws or codes and plans on file.
I hereby certify that the proposed work is authorized by the owner of record and
I have been authorized by the owner to make this application as his agent and to
receive this permit, I further understand other agencies may have reason to STOP
WORK if items under their jurisdictio aye not et; not withstanding the issuance
of this Building\Zoning Permit. /
Signature of Owner/Agent: J/
Address: /
********************. **** / * ** ****/C **************************
Signature:
Approved/Issued B . Joel S. Reed, Title: Building Inspector
COMMENTS: PLEASE 'OST PERMIT CARD SO THAT IT IS VISIBLE FROM
THE STREET. SCHEDULE APPROPRIATE INSPECTIONS AS
REQUIRED. UPON COMPLETION OF WORK, FINAL INSPECTION
IS REQUIRED.
0 ORIGINAL 0 APPLICANT 0 ASSESSORS 0 CLERK 0 COPY
Dartmouth Building Department
400 Slocum Road
P. O. Box 9399
North Dartmouth, MA 02747
588-999-8728
Mr 588-999-8738
in accordance with the provisions of MGL C 40, S 54, a condition of
Building Permit Number is that the debris resulting from
this work shall be disposed of in a properly licensed solid waste
disposal facility as defined by MGL c 111, S 150A.
LOCA I ON, OF PROJECT M/ & 1,L..bz
LOCATION OF FACILITY
SIGNATUR 0 - PERMIT APPLICANT
DATE
dr
Dartmouth Building Department
400 Slocum Road
N. U. Sox 439'3
North Dartmouth, MP ea747
SO&999-d72B
FAX 5aa-999-®73B
AFFIDAVIT
As a result of the provisions of MGL c 40, 554, I acknowledge that
as a condition of Building Permit Number all debris resulting
from the construction activity governed by this Building Permit
shall be disposed of in a properly licensed solid waste disposal
facility, as defined by MGL c 111, S 150A.
I certify that I will notify the Building Official by
(Two monvhs maximum) of the
location of the solid waste disposal facility where the debris
resulting from the said construction activity shall be disposed of,
and I shall submit the appropriate farm far attachment to the
Building Permit. /�
LOCATION OF PROJECT: «c � ,21/7 •
MTV 2 V, AveUATL SIUNATUHERMIT APPLICANT
PRINT UU TYPE THL FULLUWINU INFORMATION:
Name of Applicant
irm Name, i/t any/
TOWN OF DARTMOUTH
,
�, ('(� BUILDING RECEIPTS l nJ,e
.
No TAX I SSU La COLLECTOR'S OFFICE
Name:: i% Property Date: t .; --
,.i ,"i r 3 /.,s�_e.t._9 Owner .4--ef y� C... - -� - �% - „% i
Job Location: � �, r,, t
1
l �( ._Ld '' , TOWN OF DARTMOUTH White Copy-Collector's Office
Plot: Lot: TA --) 7 CTOR'$OFF1C€ellow Copy-Customer's Receipt
`. _ �_.:J ' —' - Pink Copy-File Copy
Green Copy-Building Department
Phone: RI tip, 4 lye/i /57
Ring-02
Description General Ledger#'s Ref.# Amount
License&Permits-Building 01000-44105
License&Permits-Building Misc. 01000-44105 , / if....-yr-'_e, _ -
License&Permits-Electrical 01000-44106
License&Permits-Plumbing&Gas 01000-44107
Other Department Revenue 01000-42420
\ j
This is not a Permit or License for Building.Plumbing or Gas Received By: Lt_ `''` -? T -- t.* --1
1600 TO TEM APPLICANT/REFERRAL AND APPROVAL •
Date of Application submission a— — y
3 9 'L� 14. Aquifer —
Plat 70 TA�3 � Street My'
�4.4 �
Zone
Owner
Owner mail ddrtss �3fizS 4l. �l�Lt t2 �C C-- : �e tot I of O ofe,712
Owner phone// 676-
OTHER INVOLVED AGENCIES -The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT THEM FOR REQUIRED SUBMISSIONS.
a TAX COLLECTOR = Approved = HOLD By Date
a Conservation Comm Z Approved By Date
❑ D.P.W. water = Approved By Date
a D.P.W. sewer = Approved By Date
❑ D.P.W. cross connection Z Approved Date
❑ D.P.W. engineering = Approved Date
❑ Board of Health well Approved � 417,4
/ Date 2-.f7 9/ -
❑ Board of Health septic _ Approved „recr /74 u.n 4E hicCED /-JDate
❑ Board of Health food service = Approved Date
S FIRE DISTRICT(I - II- IIII = Approved Date
❑ Planning Dept = Approved .Date
Other _ Approved Date
Other _ Approved Date
r..mments
Prnject summary Dew construction/ alteration/demo sewage disposal - public/private
[Alter:add interior walls] [add rooms] [add footprint] water supply - public/private well
[pool] [garage:shed] [game court] [food service]
Describe / -�i,:�~ C_�- -^E— •
-G-e.'—d.
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 V. '" ` -- 2 2 By f�