BP-7454800 bEECELANICALS & PREMARY Fum
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)
one of the above to be provided
Hot Water Gas - Electric 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? ltllw
1000.REQUIRED OFF-MMEL+T PARKING for ZONING & Architectural Access
lINOT APPLICABLE
- Parkimg Plan submitted To Z Building Department Planning Board Date submitted
Number of spaces indoors outside total provided ®,
H-ndicap spaces required s yes _no. If yes, how many as a p-3rt of the total required number.
Is Route 6 (State Road) Entrance permit required? yes no Z. If yes has it been issued yes no
Submit copy of application and/or permit as soon as available.
100 IDENTMCA71ON (print or type except as noted)
Current owner - name
�®
address_��/%/�j /I %
phone # "If�- /J``"
I1 corporation. officer in charge
Arclzitect/Engmeer - for overaD design
Company name
Address
Phone number
Certified by State of Massachusettsas
Certification number
NOT , Signatures and seals on ail tans, affidavits and other documents SHALL BE originals and not
reproductions.
ArchhecMngmeer - project supervision and reportt
Company name �✓/" "
Address
Phone number
Certified by State of Massachusetts as
Certification number .
NOTE Signatures and seals on all Glans, affidavits and other documents SHALL BE originals andzi not
reproductions. -
General Contractor (if Homeowner, state homeowner here then complete section 1300)
Company name
Address
Phone number
Construction, Supervisors license number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and+, not
reproductions.
1200 FOR RESIDENTIAL REMODEL WORK ONLY
Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes ,_ No If no go to nxdxt section!
Are you claiming exemption from the requirement? Yes No _If yes, submit the required affidavit!
RerLodel contractor name (please print)
Address
Registration number (it 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 �" 2-Z' %�
1300 OWNER SIGN - OFF
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 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 maybe 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 new application may be required, including fees and current
other requirements (including Zoning),
Name Ci�P/Q
Signature
The above signature is my voluntary act and is signed under the pains and penalties of perjury.
Date
Who is authorized to pickup the ern. at the Building Department? (please arintl �//G/�,✓� �/�p/�
Address Phone's
1400 HOMEOWNER E 31MON ONE & TWO FAMILY ONLY
FOR HOME OWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT
109.1.1 Licensing of Construction S rs: 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
constrsaction, reconstruction, alteration, repair, removal or demolition involving the structural elements of buildings or
structures, unless he or she is licensed in accordar+ce wits the rules and regulations promulgated by the BBRS"entitled
RLIes and Regulations for Licensing Constri.edon Supervisors.
Exception: Any Home Owner performing work for which a Building Permit is required shall be exempt from
the previsions 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 sectiori only, a "Home Owner" is defined as follows: Person(s) 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 he 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 51
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1500 COST
Cost of Improvement
Items to be installed but not included in the above cost: Electrical S
Plumbing
HVAC
Other
TOTALD
Alteration of existing,: no increase in gross square feet. A separate Refuse Disposal Declarmtion required.
_Demolition - describe structure
Number of dwelling units Number of bedrooms A separate Refu=•e Disposal
Declaration requhv&
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 dwelling will be
considered as an Alteration, otherwise will be included in new construction. (see Code secti(an 3401.10 for
residential and Articl- 8 it.-- commercial)
Temporary structure - includes when allowed, trailers, tents and the like and only for limiterll periods of time.
Describe
500 CONSTRUCTION PLANS
None submitted. Why)
Submitted, usually three sets required. Four sets for food service uses. Number of sets submitted
600 SITE PLAN
Not required, why?
= Submitted When? = Previously, date C With this application
700 VTILITIhS
Water supply - required _ yes no, public ? yes no; on site weal?,",V yes no,
existing? *yes _ no
If required and nonexisting 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 supply, when
required, is available. See Code 780 CMR section 114.1.2)
Sewage disposal - required _ yes no, public sewer _ yesX no
private septic on -site yes _ no. Submit copy of permit as soon as availabl3e.
Woodstove - used (will require inspi�dna. "or to installation), new (provide manufacturers
instructions). I.ocation(s) (list)
t-Ili
irepiace(s) - (includes flue) List location(s) f
Game Court - describe (include overall dimensions)
Tent, Trailer (Mobile Home) or Other - describe 1 V14 %
300 COMMERCIAL PROPOSED PROJECT/USE - INCLUDING THREE FAMILY OA(AIORE AND EXEMPT USES
j THIS SECTION NOT APPLICABLE
(The following descriptions are based on the Massachusetts State Building Code Article 3, AS NOTED) (See the
Code)
li, = Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe
Bu
siness - 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 / 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)
I
Utility & Miscellaneous Structures - includes tents and agricultural structures (see Code Section 311.0)
r —view tenant for any of the above, indicate above (see Code Section 119.0 and Zoning By-law section 35)
— Tent or Trailer - temporary purpose?
_ Other
Describe the proposal briefly, INCLUDE -amber of dwelImg units and bedrooms or occupant load as applicable,
also existing condition
400 TITE OF CONSTRUCTION OR WORK TO BE PERFORMED
New Construction and/or Addition total gross square feet /ter
(For commercial only total gross cubic feet) -indicate
Q It will be considered new construction if there an increase in square footage in addition to anv
r 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)
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 worksbeet) date'
DENIED see project review worksheet date
HOLD reason (date
HOLD Subject to Zoning Board of Appeals action
Comments
-JUL 2 2 199
Inspectors signature Mate
Applicant informed of above -Date time staff (fax
+ Fllsone, 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.
:Date
Inspector
Advised applicant Date Time staff (by phone, fax or in person)
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OFFICE\JNSPECTORS NOTES a
TOTAL FEE
Gross area - new construction a-- Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Commentsinotes on permits
1600 TO THE APPLICANT/R, ,,%Np APPROVAL
Date of Application submission
Plat Lot Street }
Aquifer Zone
Owner
Owner mail address `
Owner phone #
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OTHER. INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT THEM FOR RE(HJI1tEp �B11SI=ON3.
If TAX COLLECTOR = Approved HOLD By Date
a Board of Appeals - Approved By Date
11 Conservation Commissioner Approved By Date
13 D.P.W. Water _ Approved By 13 D.P.W. Sewer = Approved By___ Date
13 D.P.W. Cross Connection Approved By bate
17 Treasurer (Bond) 11 Approved By Date
13 D.P.W. Engineering--, Approved By Date
7 Board of Health (well) :1 Approved By Date
13 Board of Health (septic) Approved By Date
® Board of Health (food seevi. i�) _ Approved By Date
13 Planning Board (parking) �— AppsvvedBy Dar,+
iz FIRE DISTRICT (I - II - III) — Approved By Date
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BUILDIlti G DEPART XMT APPROVAL:
C3 ZONING
E3 BUILDING INSPECTOR/BUILDING COMMISSIONER
c CONTROL CONSTRUCTION AFFIDAVIT
PROJECT" SUMMARY:
new constructioni alteration/demo sewage disposal - publiciprivate
[.41teriadd interior walls] [add rooms] [addfootprint] water supply - public/private well
[Fool] [garageished/deck] [game court] [food service]
Describe
To the varsous 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
cooperations appreciated.
The Building Department - Date sent for review By
S
TOVVN- OF 1.1. KP E
TELEPHONE 508-999-0720 F X-10 . 99-0738
APPLICATION FOR ZONING AND BUILDING PE RMIT
Instroetions .
The applicant shall complete this application to the best of their ability prior to submission, leav®g no item mtaassvIft a The
Department staff will be available daring regular business hours to assist as necessary. N/A should be inserted for t1hose sections
which do not apply. A properly completed application will help avoid unnecessary delays. Nsiee 1111ift ion im seat
(for otfim use only) �DNIl�A?T1 ONLY
Total Cost $ Received By Date Rec'd /
Less Application Fee $
Total Permit Fee $ Permit # Issued Date
100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET
CURRENT ACCESSORS' PLAT LOT / 17 ZONING DISTRICT"
OTHER ZONING OVERLAY DISTRICTS , if applicable
NUMBER & STREET 6rl,
NEAREST CROSS STREET —�
SUBDIVISION NAME & LOT # -- -
or BUSINESS NAME
PREVIOUS TENANT / OWNER
200 RESEDENTIAL - PROPOSED PROJECT - one & two family residence only
= THIS SECTION NOT APPLICABLE
= Single family - number bedrooms _ number baths v
Two family_ - number bedrooms unit 1 number baths unit 1
number bedrooms unit 2 number baths unit 2 =- 7
Accessory apartment Total gross sq. ft.
� s -
_ Axcessory structure:
Garage detached - attached to dwelling, dimensions L W
- Carport - detached attached to dwelling, dimensions L W
a
= Shed dimensions L W
I
= Deck - dimensions L W
Gazebo - dimensions L W
= Swimming pool above ground in -ground Size
_ himnev number of flues
7�' t