BP-VOID800 11IECOANICALS & 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 toad' `oning - (separate unit)
one of the above to be provided
Hot Water Gas Electric Fuel Oil Otherrs��`'r�'r
goo SPRINKLERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
Requ' , _plans provided, plans not provided, why?
of required, not to be installed, Why?
1000 REQUIREI) OFF-STREET PARKING - for ZONING & Architectural Access
"OT PLICABLE
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 pirt of the total required number.
Is Route 6 (State Road) Entrance permit required? yes no If ves 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 Z E'er V
address f��
phone #�
If corporation. officer in charge
i
ArchitectlEngmeer for overall design
Company name�1
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.
i
ArchitectEnmeer PSIect 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 originals aind not
reproductions.
General Contractor (if Homeowner, state homeowner here then complete section 1300)
Company namer��
/ aE
Address
- Phone number
Construction Supervisors license number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals wind not
reproductions.
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1200 FOR RESIDENTIAL REMODEL WORK ONLY
Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes No _ If no go tro next section!
Are you claiming exemption from the requirement? Yes No If yes, submit the require ai affidavit!
Remodel 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 call or write:
Home Improvement Contractors Registration
One Ashburton Place -Room 1301
Boston, MA 02108
(617) 727-8598
Owners name (print)
Signature�,�._��
Date
i
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
� p 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 by
written request. I understand that once the permit expires anew application may be required, including fees and current
other requirements (including Zoning).
Name
Signature to
The abovesignatureis my voluntary act and is signed under the pains and penalties of perjury.
Date �rl/
j Who is authorized to pickup the permit at the Building Department? (please orintl
Address %l. Cs /s/ate r.Y�� n� Phone
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 July1, 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
R:.les and Regulations for Licensing Construction Supervisors.
Exception: Any Home Owner performing work for which a Building Permit is required shall be exempt from
kne 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 v,,ttich he she resides or intends to reside, on which there is, or is intended to be, a one or two family dweilin , attached
or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in
two -`ear 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
N( dCE 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 5)
1500 (COST
Cost of Improvement v
Items to be installed but not included in the above cost: Electrical 5
Plumbing
HVAC
Other
TOTAL``
i
_ Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declm7ation required.
Demolition - describe structure
Number of dwelling units Number of bedrooms - A separate Refn--" 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 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 exit 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 Artici- 8 A— commercial)
Temporary structure . includes when allowed, trailers, tents and the like and only for limited! periods of time.
Describe
500 CONSTRUCTION PLANS
_,/
None submitted. Why?
u�'S bmitted. usually three sets required. Four sets for food service uses. Number of sets suibmitted
600 SITE PLAN
of ttgnu+ed, whys
Submitted When? = Previously, date With this application
700 UTILITIES
Water supply- required _ yes no, public ? _ yes�no, on site well? yes no,
existing?/_1K 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 watevr supply, when
required, is available. See Code 780 CMR section 114.1.2)
Sewage disposal - required _ yes - "' no, public sewer _ yes Zno
private septic - on-siteves no. Submit copy of permit as soon as available.,
Woodstove - used (will require inspection prior to installation), new (provide manufacturers
instructions). Location(s) (list)
Firepiace(s) (includes flue) List location(s)
Game Court - describe (include overall dimensions)
tit, T iier (MRbile Home) or Other - describe
300 CO:rl�I, OPtSSED INCLUDING THREE FAMILY OR MORE AND EXEMPT USES
LelIIIS SECTI'ON 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 train
ing including child day care for those over _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)
Tent or Trailer - temporary purpose?
Other
D-escribe the proposal briefly, INCLUDE --umber of dwelling units and bedrooms or occupant load as appiicabie,
also existing condition
400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED
Ya9 /�S' , t�or
ew Construction and/ Addition tal gross square feet
(For commercial only total gross cubic feet) - indicate /� ' llQ/� y ('col/
It will be considered new construction if there an increase' footage in add' ' n to any y
alterationts).
If project is an addition to existing structure - Total gross square feet of existing
- FOR COMIM[ERCIAL ONLY
`Vill this project be subject to CONSTRUCTION CONTROL (over 35,000 cu.ft.) _yes
N(Ies
o f y
see Code section 127,0). Designer to submit Code Synopsis.
Will this project require Peer review (over 400.0W cu.ft.) Yes No ,(see Code ;Appendix I)
APPLICANT TO PROVIDE
The following section for official use only.
INSPECTORS' REVIEW
i
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 dafte
HOLD Subject to Zoning Board of Appeals action
Comments
Inspectors signature Date,,,, -
Applicant informed of above - Date time staff (fax, phoate,' 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 Datxe
Advised applicant Date Time staff (by phone, fax or in personl)
OFFICEVNSPECTORS NOTES
TOTAL FEE -
Gross area - new construction Total Sq. Ft.
n _
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1600 TO THE APPUCANTAREFIUURAL AND APPROVAL
Date of � Apphcatlon submission �
Plat Lo tree (, ;r,;�ts�`'—
°�' -AAlf Zone
Owner'
Owner mail address
Owner phone #
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OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional
Permitsproposed project. CONTACT THEM FOR or approval for your
-N��D SUEMIS.SIONS.
IN TAX COLLECTOR = Approved ` HOLD By
Date
❑ Board of Appeals _ Approved By
Date
❑ Conservation Commission ` Approved By
Date
❑ D.P.W. Water Approved By Q D.P.W. Sewer — Approved By Date
3 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
❑ Board of Health (septic) Approved By
Date
❑ Board of Health (food service) Approved By
Date
❑ Planning Board (parking) - Approved By
Date
® FIRE DISTRICT (I II - IIn _ Approved By
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„UILDING DEPARTMENT APPROVAL:
❑ ZONING
❑ BUILDING INSPECTOR/BUILDING COMIIIISSIONER
❑ CONTROL CONSTRUCTION AFFIDAVIT
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PROJECT SUMMARY:
new construction/ alteration/demo sewage disposal public/private
[Alter,,add interior walls] [add rooms] [add footprint] water suppiv publiciprivate well
[pool] [garage; shed/deck] [game court] [food service]
Describe
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To the various depaments:
4 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 I
y_—
TOWN OF DARTMOU -BUI. tT
TELEPHONE 508-999-0720 FAX 50-999-0738:
APPLICATION FOR ZONING AND BUEUDING ; RMIT
IastrneSom
The applicant shall complete this application to the best of their ability prior to submission, leaving no item ==wwered. Ile
Department staff will be available during regular business homy to assist as necessary. NIA should be inserted'7or those sections
which do not apply. A properly completed application will help avoid naaeeessary delays. Nn6w IMbS Ervin mae
(for office use oniy) 0 FGV7,�MIION ONLY
Total Cost $ Received By Date
Less Application Fee $
Total Permit Fee S Permit # limmed Date_
100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET
CURRENT ACCESSORS' PLAT LOT `--i ZONING DISTRICT
OTHER ZONING OVERLAY DISTRICTS , if applicable
NUMBER & STREET Slc��
NEAREST CROSS STREET
SUBDIVISION NAME & LOT #
or BUSINESS NAME
PREVIOUS TENANT / OWNER
00 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
:1, HIS SECTION NOT APPLICABLE 1J
= Single family - number bedrooms number baths
= Two family - number bedrooms unit 1 number. baths unit 1'"'
number bedrooms unit Z number baths unit 2
Accessory apartment Total gross sq. ft. c
— Accessory structure:
= Garage - detached - attached to dwelling, dimensions L W
' - Carport.- detached - attached to dwelling, dimensions L R'
Shed - dimensions L W
Deck - dimensions L R'
Gazebo - dimensions L W `
_ Swimming pool above ground in -ground Size
'Z:e\ Chimnev - number of flues