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1300 OVVNTR SIGN - OFF
1, 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 b
written request. I understand that once the permit expires a new application may be requiredfees and current
uired includ' y
pp
other requirementsents (i(including Zoning).
Name N A-lu E— A C i-t -o
Signature
The above signature is my voluntary act and is signed under the pains and penalties of perjury.
D2te j 4
Who is authorized to PVkup the permit at the Building Department? (please print)
Address _4�4mF Phone
1400 HOMEOWNER EIMAPTION - ONE & TWO FAMILY ONLY
FOR HODfE 'OWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT
109.1-1 Licensing of Construction Su
pervisors: 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 e
construction, reconstruction, alteration, repair, removal or demolition involvingthe structural ngaged in
structures, unless he or she is licensed in accordar�� elements of buildings or
ce wit1 the rules and regulations promulgated by the BBRS entitled
RLtes and Regulations for Licensing Constmetion Supervisors.
mpt from
Exception: Any Home Owner performing work for which a Building Permit is required shall be exe 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 heishe 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 c r
Your signature carries certain responsibilities, including but not necessarily limited to, general liability
##i#i######i###i###s#iii#####i##
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 a-)
1500 COST
Cost of Improvement
Items to be installed but not included in the above cost: Electrical $
Plumbing
HVAC
Other
TOTAL
Alteration of existing,_ no increase in gross square feet. A separate Refuse Disposal Declaration ,uired
=Detnolition - describe structure
Number of dwelling units Number of bedrooms A separate Refuse DisposQ
Declaration required.
I
Moving - (Provide copy of D.P.W. moving license) Type of structure
from where (plat/lot or address)
to where (plat/lot or address)
i
Number of dwelling units Number of bedrooms per dwelling unif
= 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 dwelling will be
considered as an Alteration, otherwise will be included in new construction. (see Code section 3401.10 for . i
residential and Articl- 8 fa. commercial) _
Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods 6f time.
Describe
$00 CONSTRUCTION PLANS
% None submitted. Why?
ZSubmitted, usually three sets required. Four sets for food service uses. Number of sets submitted
600 SITE PLAN
❑ Not required, why?
Submitted When? = Previously, date ❑ With this application
700 UTELITIES
I
Water supply - required _ yes _ no, public ? yes _ no, on site well? Zes no,
existing? _yes _ no
If required and not existing have necessary permits been issued? no yes, date k
(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
p septic on site _yes _ no. Submit copy of permit as soon as available.
I
Woodstove - used (will require inspection 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 CoApdERCIAL - 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
r
= Business - office, assembly with less than 50 occupants , indicate Medical or other professional (see Code
Section 303.0) /
1
Educational structure for training including child day care for those over 2 years 9 months (see Code Section
I
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)
l
= Mercantile - retail stores (see Code 308.0)
= Residential - three or mor family, hotel (see Code Section 309.0)
Storage - includes ga es (see Code Section 309.0)
= Utility & Miscellan ous Structures - includes tents and agricultural structures (see Code Section 311.0)
= New tenant for ny of the above, indicate above (see Code Section 119.0 and Zoning By-law section 35)
o
- Tent or T er - temporary purpose?
_ Other
ji
Des the proposal briefly, INCLUDE -amber of dwelling units and bedrooms or occupant load as appIi mble,
aTSo 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 COND4ERCIAL 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)
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!Oot Date
Applicant informed of above - Date time staff (fax, phone, inn person)
#s###zz##zssslsss#sss##z!z#ssss##s#sz#ssslssz##zlzs#lzszss#is#ss#ssssssss#zsss#ssss!##sz#z!slss!##szzsssz!
Over six months since approved for issue - DEEMED abandoned?
Advise applicant. Hold 90 days for return then dispose if not picked up.
Date
Inspector
Advised applicant Date Time staff (by phone, fax or in person)
OFFICE\INSPECTORS NOTES Q
TOTAL FEE U r
Gross area - new construction Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit
-
1600 TO THE APPLIcANTAREFERRAL AND APPROVAL
Date of Application submission
-------------- 7 ----------
Plat a Lot ` Street
Aquifer Zone
Owner � �
Owner mail address
Owner phone #�fi '
O iIEER INVOLVED AGENCIES _ The following agencies require separate jurisdictional
Proposed project. CONTACP THEM FOg� �� or approval for your
ED SUBMLSSIONS-
TAX COLLECTOR — Approved _ HOLD By
Date
❑ Board of Appeals . = Approved By
Date
Conservation Commission r Approved By
Date
❑ D.P.W. Water _ Approved By 13 D.P.W. Sewer _ Approved By.
Date
❑ D.P.W. Cross Connection E: Approved By
Date
71
❑ Treasurer (Bond) Q Approved By
Date
❑ D.P.W. Engineering .=i Approved By
:Date
Board of Health (well) Approved By
Date
C3 oard of Health (septic) >_ Approved By
Date
❑ Board of Health (food service) = Approved By
Date
❑ Planning Board (parking) 7 Approved By
Date
- II - II
n ..
s:a::asRE DISTRICT (I Approved By Datessss:aaass:asssssssssslsssss:a:asssssssiala:::a::a:::::assssssssssssasssaa:asss
BUILDING DEPARTMENT APPROVAL:
❑ ZONING
❑ BUILDING INSPECTORBUILDING COMMISSIONER
❑ CONTROL CONSTRUCTION ,AFFIDAVIT
PROJECT SUMMARY:
new constructions alterationidemo
sewage disposal - public/private
[Alteriadd interior walls] [add rooms] [add footprint] water su lv -
PP public/private well
[pool] fgaragejshe / Eck] [game court] [food service]
':Describe
To the various departments:
This notice has been forwarded to you for your information and an 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
TOWN- OF DARTMOUTH B.UKDWGKPA �El\TT
TELEPHONE 508-999-0720 FA9-0738
APPLICATION FOR ZONING AND BUILDING PERMIT
I -
The applicant shall complete this application to the best of their ability prior to submission, leaving no item unansw-ered. The
Department staff will be available during regular business hours to assist as necessary. N/A should be inserted for thiose sections
which do not apply. A properly completed application will help avoid unnecessary delays. roaft forma in in it
(for office use ody) �f� ❑=110�ONLY
tal Cost s Received ByAS
Date ReedLess Application Fee S
Total Permit Fee f Permit # - Issued Date
100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET
ell
CURRENT ACCESSORS' PLAT LOT ZONING DISTRICT 5 ` "ID
OTHER ZONING OVERLAY DISTRICTS,
if applicable
NUMBER & STREET J a cllij,'
NEAREST CROSS STREET
SUBDIVISION NAME & LOT
or BUSINESS NAME
PREVIOUS TENANT / OWNER
200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
- THIS SECTION NOT APPLICABLE
i
Single family number bedrooms number baths
I
Two family - number bedrooms unit I number baths unit 1
number bedrooms unit 2 number baths unit 2
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 - dimensions L f� W /0r
i
Deck - dimensions L W
Gazebo - dimensions 'L W
iF
Swimming pool above ground in -ground' Size
_ Chimney - number of flues
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