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lDFP-r. rwavlme/Acm-T.S. AS BUI L LOT 4) C00m
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SCALE: APPROVED BY: DRAWN fay
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AS SKONV
DATE: i� Iasi REVISED
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800 MECHANICALS & PRIMARY FUEL
Architect/Engineer - project supervision and reports
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)
r A}r conditioning - (separate unit)
None of the above to be provided
Hot Water Gas Electric Fuel Oil Other
900 SPRTNKLERS - 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
-O'T 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 part of the total required number.
Is Route 6 (State Road) Entrance permit required? yes = no -. If yes has it been issued yes = no —7.
Submit copy of application and/or permit as soon as available
1100 IDENTIFICATION (print or type except as noted)
Current owner name— i ���� � � i,,�ACN L V� c GiZA+1i
address 16
phone ## E>Z% - '�S-a 4t -
If corporation, officer in charge 1�►`
Architect/Engineer - for overall design
Company name
Address
Phone number
Certified by State of Massachusetts
Certification number
%.r
NOTE Signatures and seals on all Plans, affidavits and other documents SHALL BE originals and not
reproductions.
Company name
Address
Phone number
N
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 � �\-)Q � %-
Address 5Q�
Phone number��`'�
Construction Supervisors license number
1-AF = tAv,
LZ Qep-3 s k
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not.
reproductions.
***xs**xsxsxxxxs****xsx*****x**ss*xssssxssxxsxxsx*x�xx*xxtss:sssss*:*sxssssssssssxxsss*sssssxss**�^nsxsx*s
1200 FOR RESIDENTIAL REMODEL WORK ONLY
.Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes _ No _ If no go to next seection!
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 reTviewed
the application herein submitted. I state that to the best of my knowledge and belief that the information provided,An 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 beggun or
six months after the last inspection if work has begun and that the permit may be extended for six months if no -*ork is
anticipated if I request such an extension in writing. I understand that the permit may be extended only three thmes by
4
Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaratiihn required.
-ntten request. I understand that once the permit expires a new application may be required, including fees and current
other requirements (including Zoning). Name S. l A G &M
Signature P S0 tL'
The above signs re- is my voluntary act and is signed under the pains and penalties of perjury.
Date ��2���►
Who is authorized to picku the permit at the Building De artment? i2iease Pnntl K'r1'kk G?,
Address j� 1Cy�d1��..nt f�� Phone —�'�+
1400 HOMEOWNER EXEMPTION - ONE & TWO FAMH.Y 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 person(s) for hire to do such work ,that such
Horne Owner shall act as supervisor.
For the purposes of this section only, a "Home Owner" is defined as folly. Person(s) who owns a parcel of land
or which he/she resides or inten•Is to reside, on which there is, or:?.s intended to be, a one or two family d-.4,ellinil, attached
or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in
two -near 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 5)
***z**z****zzzzz�#zzzzzz##zzzzzzzzz##z###zzzz*#zzz*zzzzzz#s�zzzzzz#zzzz###################zzzzz##zm#####
1500 COST
Cost of Improvement $ 1 • 17
Items to be installed but not included in the above cost: Electrical 3�
Plumbing i
HVAC
Other r'J
TOTAL i �B
The following section for official use only.
INSPECTORS' REVIEW
Date plan reviewed APR 3 0 1996
30 days to review period expires
��J� Q
- OK to issue date
Demolition - describe structure
Number of dwelling units
Declaration required.
Number of bedrooms A separate Refuse lriasposai
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
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 be maintained. Enlarged or new windows in an existing dwe?lling will be
considered as an Alteration, otherwise will be included in new construction. (see Code section 34101.10 for
resident;al and Article 8 for commercial.)
= Temporary structure - includes when allowed, trailers, tents and the like and only for limited pe0ods of time.
Describe
500 CONSTRUCTION PLANS
None submitted. Why?
Submitted, usually three sets required. Four sets for food service uses. Number of sets submittted
600 SITE PLAN
❑ Not required, why?
= Submitted When? Previously, date E; With this application
V111111ll YiilY Y
Water supply - required _ yes _ no, public ? _ yes _ no, on site well? _ yes n(b,
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 supr)ly, 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.
6
woo stove - useu (will require inspection prior to costa lion), new (provide manufacturers
r
instructions). Location(s) (list)
Fireplace(s) _ (includes flue) List location(s)
Game Court - describe (include overall dimensions)
Tent, Trailer (Mobile Home) or Other - describe
CONEV ERCIAL - 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 i 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)
_ "Pent or Trailer - temporary purpose?
Other
Describe the proposal briefly, INCLUDE number of dwelling units and bedrooms or occupant load as applicable,
also eusting condition
!'YPE OF CONSTRUCTION OR WORD 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 cu.ft.) 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 l)
APPLICANT TO PROVIDE
UK issue su jecr io reques[ea suo►anuiu�sec pru3e� r review �voritsneuz� aerie
DENIED see project review worksheet date
HOLD reason date
HOLD Subject to Zoning Board of Appeals action
Comments
to to
1996
Date APB`, 3 0
Inspec rs s�gna re
Applicant inform-=nfnhave Date time staff (fax, phone, in person)
ssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssYssss
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)
sssss:sssssssssssssscosssssssssssssssssssssssssssssssssssssssssssss�ssssssssssssssssssssssssssssssxsr.:ssss
OFFICE\INSPECTORS NOTES
b
TOTAL FEE4 r9-S t 42
Gross area new construction "� Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit ��
i.uu� .%jvx-x.%---'W-rRLrLrJtU KeL AND APPROV.
Date of Application submission 4' % J(
yy�
Plat LotJ� Street XPF
Owner �'-L !/ 4
Owner mail address
)zf/-4—/--a-4quifer Zone
Owner phone#
xx##x#######x#ss##sxsssss#ssssss#s#ssssssss#s###s#ssssss##s###ssx#x#ssssss#ssssssssssssssss*x#sx#ss#s####
OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictions permits or approval for your
proposed project. CONTACT THEM FOR REQUMED
Q� MISSIONS.
® AX COLLECTOR - Approved - HOLD B4&--2&-
❑ onservation Comm /ApprovedoB
❑ D.P.W. water =Approved By Date
❑ D.P.W. sewer _ Approved BY Date
❑ D.P.W. cross connection - Approved Date
❑ D.P.V. engineering - Approved Date
❑ Board of Health well - Approved Date
®
oard of Health septic - Approved 7��,,
❑ Board of Health food service - Approved �/ Date
OIRE DISTRICT (I II - III) - Approved/ Date
❑ Planning Dept - Approved Date
Other _ Approved
Other - Approved
(',,mments
Date
Date
Project summary new constructioni alteration/demo sewage disposal - publiciprivate
[Alter,,add interior walls] [add rooms] [add footprint] water supply - puhliciprivate well
[pool] [garage/shed] [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
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 Z7ZI"Id B
Y
TOWN OF DARTMOUTH BUILDING DEPAR1 VIENT
TELEPHONE 508-999-0720 FAX 508'-999-0738
APPLICATION FOR ZONING AND BUIILDING PERMIT
hn&ue6om
The applicant shall complete this application to the best of their ability prior to submission, leaving no item maainswered. The
Department staff will be available during regular business hours to assist as necessary. N/A should be inserted fear those sections
which do not apply. A properly completed application will help avoid unnecessary delays. Noic 1Foiwg tees seed refi dd ir-
(for ofrice use only) Application fee $ �L' received by Date'`' I)
Total Permit Fee $ Permit #
100 LOCATION OF PROJECT V 119 U I
CURRENT ACCESSORS' PLAT_ -IJ LOT S - -I ZONING DISTRICT
OTHER ZONING OVERLAY DISTRICTS , if applicable V� 1
NUMBER & STREET
NEAREST CROSS STREET ' "ZA8
SIJBDIVISION NAME & LOT # Q V "d t4�-f ( \Ilc\eg Ltd
or BUSINESS NAME)
PREVIOUS TENANT i OWNER �,��1�'�% ��C•�
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 2
- Accessory apartment Total gross sq. It.
- Accessory structure
- Garage - detached - attached to dwelling, dimensions L W
- Carport - detached - attached to dwelling, dimensions L W
- Shed - dimensions L W
- Gazebo - dimensions L W
Swimming pool above ground in -ground Size �'� �� total squafre feet
�Y-
- Chimney # of flues �u\^
0