BP-6741800 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 Electric Fuel Oil Other
900 SPRMKLERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
Required, --plans provided, �pians not provided, why?
= Not required, not to be installed, Why?
1000 r%EQUIRED OFF-STREET PARES iG - for ZONING & Architectural Access
NOT APPLICABLE
= Parking Plan submitted To = Building Department Planning Board Date submitted
Number of spaces - indoors outside total provided
H,ndicap spaces - required _ yes _no. If yes, how many as a p-irt of the total required number.
Is Route 6 (State Road) Entrance permit required? yes no If ves has it been issued ves no �.
Submit copy of application and/or permit as soon as available.
1100 IDENTIFICATION (print or type except as noted)
Current owner - name 2L
address r1`Jou' CI
phone # �c3� '; 2>
If corporation, officer in charge
ArchitecVEngineer - for overall design
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.
Architectq n&eer - 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 or 'inals and not
reproductions.
General Contractor (if Homeowner, state homeowner here then complete section 1300)
Company name A �5PA S
a
Address SQ 7 TATf:- VZ n
Phone number
Construction Supervisors license number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
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1200 FOR RESIDENTIAL REMODEL WORK ONLY
Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes o No _ If mo go to next section!
Are you claiming exemption from the requirement? Yes ---No _If yes, submit the r equired affidavit:
Ren-,)del 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 can 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
= Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration r-�quired.
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.he 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
written request. I understand that once the permit expires a newlication may be required, including fees and current
other requirements (including Zoning), f,
V Name l�
r,
Signature 1/
The above signat46 is my 'oluntary act and is signed under the pains and penalties of perjury,
V Date
Who is authorized to pickup the permit at the Building Department.? (glease vrinnAPOWpb6LS Y&PAS
Address Phone 9�e- P 33 Z 0
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 accords-ce with the rules and regulations promulgated by the BBRS entitled
RLhis 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
Home Owner shall act as supervisor.
For the purposes of this section only, a "Home Owner" is defined as follows: Person(s) who owns a parcel of land
on which hershe 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:
Signature
Your signature carries certain responsibilities, including but not necessarily limited to, general liability
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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
2.15.2 of section 5)
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1500 COST
Cost of Improvement S
Items to be installed but not included in the above cost: Electrical S
Plumbing
HVAC
Other
TOTAL $ I < O o C)
_ , Demolition - describe structure
Number of dwelling units Number of bedrooms A separate Refuse Dbpo,sal
Declaration requftwL
= 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 when complete
A separate disposal declaration REQUIRED
Number of layers already existing
_ 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 dwelling; will be
considered as an Alteration, otherwise will be included in new construction. (see Code section 3401;;10 for
residential and Articl- 8 fi.. commercial)
Temporary structure - includes when allowed, trailers, tents and the like and only for limited period:, of time.
Describe
500 CONSTRUCITON PLANS
_ None submitted. Why?
_ Submitted, usually three sets required. Four sets for food serviceluses. Number of sets submitteoi
600 SITE PLAN
❑ Not required, why?
tnitted When? _ Previously, date C With this application
700 UIUXI'IES
Water supply - required _ yes _ no, public ? v 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 supple,, 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.
- Woodstove - used (will require inspection prior to installation), new (provide manufacturers
instructions). Location(s) (list)
Fireplace(s) - (includes flue) List location(s)
1 - Game Court - describe (include overall dimensions)
Tent, Trailer (Mobile Home) or Other - describe
300 COMMERCIAL - PROPOSED PROJECTIUSE - 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 Iess 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)
Vent or Trailer - temporary purpose?
- Other
Des cnbe the proposal briefly, INCLUDE - umber of dwelling units and bedrooms or occupant load as applicable,
also existing condition
400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED
t - New Construction and/or Addition - total gross square feet
y (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
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
Inspectors signature
v
- Applicant informed of above - Date time staff (fax, phone, !in person)
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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)
OFFICEWVSPECTORS NOTES
TOTAL FEE`
�J
Gross area -new construction Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit
- FOR COMI4IERCI4,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 Peer review (over 400.000 cu.ft.) Yes No (see Code Appendix 1)
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Date of Application submission
Plat 4Lot^� Street /% / ��^ i,� s�,� ��
Aquifer Zone
Owner
Owner mail address l
Owner phone # /� 117
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OTHER INVOLVED AGENCIES _The following agencies require separate jurisdictional
permits or approval for your
proposed project. CONTACT 7EE1N FOR REOiTIRED EMISSIONS.
in TAX COLLECTOR = Approved HOLD By
. Date
❑ Board of Appeals -- Approved By
• Date
❑ Conservation Commission LZ Approved By
Date
❑ D.P.W. Water Z Approved By ❑ D.P.W. Sewer — Approved By Date
❑ D.P.W. Cross Connection Approved By
Date
❑ Treasurer (Bond) ❑ Approved By
Date
❑ D.P.W. Engineering _ Approved By
Date
7 Board of Health (well) = Approved By
Date
103 and of Health (septic) Z Approved By
Date
❑ Board of Health (food service) Approved By
Date
❑ Planning Board (parking) - Approved By
Date
® FIRE DISTRICT (I - II - III) — Approved By
Date
BUILDING DEPARTMENT APPROVAL:
❑ ZONING
❑ BUILDING INSPECTORBUILDING COMMISSIONER
❑ CONTROL CONSTRUCTION AFFIDAVIT
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PROJECT SUMMARY:
new constructions alteration/demo
[Alter,,add interior walls] [add rooms] [add footprint]
[pool] [garage/shed/deck] [game court]
Describe
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To the various departments:
sewage disposal - public/private
[food service]
water supply - public/private well
This notice has been forwarded to you for your information and any se advise. Your
appropriate action. Should you have anv
'questions please advise. If any reason to withhold the requested permit is found, please assistance and
cooperation is appreciated.
The Building Department - Date sent for review
By
TOWN OF DARTMOUTH •BUILLI N 0 P R lvT
TELEPHONE 508-999-0720 FAX508=999-Q738
APPLICATION FOR ZONING AND BUILDM G PERMIT
Insirnetiom -
The applicant shall complete this application to the best of their ability prior to submission, leavimmg no item unamwered. The
Department staff will be available during regular business hours to assist as necessary. N/A should be inverted for those sections
which do not apply. A properly completed application will help avoid unnecessary delays. Heft FRing few is aid:eFasaiaiia
(for offim use only) i Q ]FOUNDATION ONLY
Total Cost $ Received By—/—�e�Date xec'a
Less Appbcation Fee $ r,2 -
Total Permit Fee s Permit # Lvmed Date
100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEMT v
61
CURRENT ACCESSORS' PLAT LOT - ZONING DISTRICT .s1,01
OTHER ZONING OVERLAY DISTRICTS, if applicable
NUMBER & STREET I-,KJOLL %-400 �
NEAREST CROSS STREET
SUBDIVISION NAME & LOT #
or BUSINESS NAME ,o
PRE-VIOUS"TENANT / OWNER
200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
- THIS SECTION NOT APPLICABLE r "
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. EL % J
Accessory structure:
Garage - detached - attached to dwelling, dimensions L W
d = Carport - detached - attached to dwelling, dimensions L W
U
s
� —Shed -dimensions L R' a
^ Deck - dimensions L W
- Gazebo - dimensions L W
- Swimming pool above ground in-groun Size
_ Chimney - number of flues 67q