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800 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)
Air conditioning - (separate unit)
= None of the above to be provided
_ Hot Water Gas EIectric 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
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 part 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) ,
Current owner -name v-1 May 1 N5 �_M �R +�! (►JS
address Kk)bt-LW%00 hfc/ r i / VTI
J honen
V
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 seats on all plans, 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 sea Is n ai —pf5ns, affidavits and other documents SHALL BE originals amd not
reproductions.
General Contractor omeowner, state homeowner here then complete section 1300)
Company name l Bt'i� .bJ�l�'UIIV`-� l�C✓/� 1
Address �I' J-M e � EY FOLD i � -s , SLVa 1 ru� l PF � M "T
��
Phone number-4a7 ��
/
Construction Supervisors license number & o
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals arnd not
reproductions.
- xx��x*xxxxxxxxx*Kxxxxxxxx*xxxxxxx**xxxxxxxxxxxsxsxxxxx�xxxssrxxxx;;##sxxxxsxx.:xxxx#xxxxxxxxxa-xxsxsxxxxxxx
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 requiredl affidavit!
Remodel contractor name lease rintl
Address
Registration number (if none state "none")
Phone number
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCIESS 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 lhave 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 S
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 writingbe extended only t#hree times by
. I understand that the permit may 5
written request. I understand that once the permit expires a new application may be required, including fees and current
other
-requirements (including Zoning).
t c a m e IV
Signature
The
The above signature is my voluntary act and is signed under the pains and pena f perjury.
Date
Who is authorized
Address 22 A
the permit at the Building Department:' (please ptintt ► 1 ��7�� &�,TIN
ryaD DR Phone
1400 HOMEOWNER EXEMPTION - ONE & TWO FAMILY ONLY
FOR HOME ONVNERS 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: -knv 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
Home Owner shall act as supervisor.
For the purposes of this section only, a "Home Owner" is defi;-ed as follows: Personis) who owns a parcel of land
on which he,
she 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:
Sig_ nature
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 anv
licensed Construction Supervisor, whether or not they have taken the permit are responsible for code compliance. (see
2.1 5.2 of section 5)
1500 COST p / i�J W'
Cost of Improvement $
Items to he installed but not included in the above cost: Electrical 5
Plumbing
HVAC
Other
f r9U
TOTAL 1� �oil>� ✓^
The following section for official use only.
INSPECTORS' REVIEW
Date plan reviewed
_ 30 days to review period expires
'J
= OK to issue date
Alteration of existing, no increase in gross square feet. A separate Refuse Disposail Declaration required.
Demolition - describe structure
Number of dwelling units Number of bedrooms A separa4e 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 unitt
_ Re -roofing - (for existing only, is included in new construction)
Number of layers already, :existing
Number of square feet
Number of lavers when complete
A separate disposal declaration REQUIRED
- Replacement doors and windows - (for existing only) (only where doors and windrows 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 Coriie section 3401.10 for
residential and Article 8 for commercial)
— Temporary structure - includes when allowed, trailers, tents and the like and only forr limited periods of time.
Describe
500 CONSTRUCTION PLANS
None submitted. Whv4
ubmitted, usually three sets required. Four sets for food service uses. Number of sets submitted
600 S= PLAN
❑ Not required, why? -
Submitted When? — Previously, date With this application
"*I
700 UTILITIES
Water supply - required _ _ves no, public ? _ yes _ no, on site well? / yes _ no,
existing:' yes _ no
If required and not existing have necessary permits been issued? _ no _ yes, dabe
(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 _ ved _ no, public sewer _ yes _ no
private septic - on -site W yes _ no. Submit copy of permit as soon as awailabie.
Woodstove - used (will require inspection prior to installation), new (provide manufacturers
—• OK to issue subject to requested submittals (see project review worksheet) date
instructions). Location(s) (list)
J DENIED see project review worksheet date
Fireplace(s) - (includes flue) List location(s)
HOLD reason Elate
u Game Court - describe (include overall dimensions)
❑ HOLD Subject to Zoning Board of Appeals action
Tent, Trailer (Mobile Home) or Other - describe
Comments
300 COMMERCIAL - PROPOSED PROJECIyUSE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES
Dat+ MAY 0 8 1997
Inspectors signature x
.
THIS SECTION NOT APPLICABLE
i
Applicant informed of above -Date time staff - (fax, phcnne, in person)
(The following descriptions are based on the Massachusetts State Building Code Article 3, AS NOTED) (See the
Code)
*s:***mm:msm*:s*sin*sinsss**zsssssm*smm�:ss***mmms**s:smxms:ss*ssmmm*sss*#*smsss***ss*azsssxss s*m*ss�:sszmss
Over six months since approved for issue - DEEMED abandoned!
- Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe
Advise applicant. Hold 90 days for return then dispose if not picked up.
Inspector Mate
= Business - office, assembly with less than 50 occupants - indicate Medical or other professional (see Code
_
j Section 303.0)
i
_ Advised applicant Date Time staff (by phone, fax or in persoin)
_ Educational - structure for training including child day care for those over years 9 months (see Code Section
304.0)
OFFICEUNSPECTORS NOTES
Q
FEES
= Factory / Industrial - (see Code Section 305.0)
TOTAL
_ High H,aard - (see Code Section 305.0)
Gross area - new construction Total Sq. Ft.
Institutional - hospital, nursing home, infant day care (see Code Section 307.0)
alteration Total Sq. Ft.
= Mercantile - retail stores (see Code 308.0)
Permit is issued to
= Residential - three or more family, hotel (see Code Section 309.0)
t
= Storage - includes garages (see Code Section 309.0)
r i
Comments/notes on permit j (� �( ✓�
_ 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?
I
_ 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 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 I)
APPLICANT TO PROVIDE
i
1600 TO THE APPLICANT.APPROVAL--- '-`"`
AND - _--
Date of ppfication submission
Plat L Street Aquifer Zone
Owner
Owner mail address
Owner phone #
tzizzzii#Zi##ii#iiifiifi!###f##i#flifiiiiiiii#ifi#itffli!!#!!ff#fififfzifffiiff#ffff!!!R!!#;f##f###ff##ii
OTIIER INVOLVED .-AGENCIES - The following agencies require separate jurisdictional permits or approval for your
Proposed project. CONTACT THEM FOR REQUIRED SURNff IONS. '
ff TAX COLLECTOR — Approved — HOB By Date
�-
�_/"-t�.�'onser.•ation Comm =Approved gv Date
17 D.P.W. water --Approved By Date
❑ D.P.W. sewer _ Approved Bc Date
a D.P.W. cross connection = Approved Date
0 D-PAN'. engineering — Approved Date
-lard of Health well 7—Approved Date
Q
Board of Health septic = Approved , C
� F' Date .� tJ •�J'
C3 'Board of Health food service - Approved Date
S FIRE DISTRICT J - II . III) — Approved Date
t1 Planning Dept _ Approved Date
Mhrr — Approved Date
O;Facer — Approved Date
C"Mments
.............:s#ii##iiii##fizli#;if;;;#f;i#zf#;#lfzz;lzzzzzzZzi##z##iiitiiiiifi;;#l;;i#;#f#!ff#!l;fiifif#
Prnject summary new construction/ alteration/demo sewage disposal - puhiiciprivate
(.-kIter.•add interior walls] [add rooms) [add footprint] water supply - pubiiciprivate well
(pooh [garngershed] [game courtl [food service]
D.scrtbe
zzzzzzzzzzssz.zzzzsssszszssss:ss###:szs#ssze;szs;sass:ssszsz:s::szss:ss:zs::szszzszsszssz;ssszszsszssssszzzz
To the N arious 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
OUTH BUIT..DING DE
TOWN OF DARTMPARTItii1ENT
TELEPHONE 508-999-0720 FAX 508-5"99-0 J
APPLICATION FOR ZONING AND BUII.DING PERMIT
i
The applicant shall complete this application to the best of their ability prior to submissiori.'leaviag no item tmansw.ered. The
Department staff will he available during regular business hours to assist as necessary:"NIA should be inserted for dhose sections
which do not apply. A properly completed application will help avoid unnecessary delays. NWC FOO9 Fee is eet s'=
011
(for obi« use only)
Application fee received b Ihte
Total Permit Fee $ Permit #
100 LOCATION OF PROJECT
CURRENT ACCESSORS' PLAT LOT ' // ZONING DISTRICT
OTHER ZONING OVERLAY DISTRICTS , if applicable (�
NUMBER 3 STREET
NEAREST CROSS STREET �� �tf L(, / t� 1 V LC �
SUBDIVISION NAME & LOT #
d
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
= Carport - detached - attached to dwelling, dimensions L W
Shed r dimensions L 1rAW l9F7--
Gazebo - dimensions L W
- Swimming pool above ground in -ground
- Chimney - # of flues
Size total squat• feet
7q
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