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BP-74954' m F o ;CD m � S - --- -� Ilk g ' v` �n to 4 rn tCD `c, S�� zCIO cla I CD e M Jt .. IE OCD Q - i— Q d en CD CD P ,_--- m z N d o=p s c� o 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 �i