BP-31720COMMERCIAL 2003
$25.00 APPLICATION FEE IS NnN-REFUNDABLE & NONTRANSFERABLE
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11 Licensed Construction Supervisor: Not Applicable ❑
Name of Construction Supervisor License Number
Address Expiration Date
S i nature
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Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit
will result in the denial of the issuance of the building permit (MGL 152 Section 25A) Signed Affidavit Attached: ❑ yes ❑ no
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® new construction ❑ addition ❑ alteration ❑ repairs ❑ accessory bldg. (shed/garage)
other (specify Sec. 6): ❑ demolition ❑ sin ❑ replacement window/door g p no. of windows doors
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e following
wln descriptions ar e base dOnt .fhe Massachusetts
S State
Building6th Edition Code Article e 3 as noted. See the Code
0 Assembly - restaurant lounge, theater, school, '
Y g , ool, etc. (see Code Section 302.0)
Describe:
d Business - office, assembly with less than 50 occupants - indicate Medical or other professional (see Code Section 303.00)
0 Education - structure for training including child day care for those over 2 years 9 months (see Code Section 304.0)
a Factory /, Industrial (see Code Section 305.0)
❑' High Hazard - (see Code Section306.0)
Institutional hospital, nursin
g g home, infant day care (see Code Section 307.0
* Mercantile - retail stores (see Code Section 308.0)
❑ Residential -three or more family, hotel (see Code Section 309.0)
❑: Storage` -`includes garage (see Code Section309.0)
❑ Uti ' & Miscellaneous Structures - includes tents and agricultural structures (see Code Section 31.1.0)
ew Tenant - for any of the above, please indicate (see Code Section 119.0 and Zoning By -Law Section 35)
d Tent or Trailer - temporary
ptirpose?
❑, Other:
Describe the proposal briefly, INCLUDE number of dwelling units and bedroo or occupant load as applicable, also existing
c dition if s e is e d, attac an ad itio 1 sheet):
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❑ New Construction and/or Addition (total gross cubic feet proposed) - indicate
If the project is an addition to existing structure - total gross square feet of existing:
❑ Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration is required.
Will this project be subject to CONSTRUCTION CONTROL, (over 35,000 cu. ft.) ❑ yes ❑ no
If yes, see Code Section 116.0. Designer to submit Code Synopsis in addition to original plans.
Will this project require Peer Review (over 400,000 cu. ft.) ❑ yes ❑ no (see 110.1 Code & Appendix 1)
APPLICANT TO PROVIDE PEER REVIEW AT THEIR EXPENSE. SEE 780 CMR.
❑ Demolition* - describe
❑ Moving* - (provide copy ,ofDPW moving license)
* Type of structure: from where (plat/lot or address):
to where (plattlot or address): number of dwelling units:
number of bedrooms per dwelling unit:
COMMERCIAL
2003
El Replacement
cement. doors and windows s (for existingonly) (only where doors an
y) ( y d windows exist and will not be enlarged) EG.c;Ess dimensions must
be maintained. Enlarged or new windows in an existing dwelling will be considered as an alteration, otherwise will be infeluded in new
construction. (see Code Section 3603.21 for residential and Article 10 for commercial).
❑ Temporary structure - includes, when allowed, trailers, tents and the like and only for limited periods of time.
Describe:
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❑ Furnace (hot air) - fuel gas (natural or propane), fuel oil, electricity, other (specify):
❑ Boiler (heating)- fuel as natural orpropane), fu S ( el 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
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❑ Required: plans rovided plans not pro
vided, why_,
❑ Not required, not to be installed, why?
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❑ Parking plan submitted to: Building Dept. 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.
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11.1 Architect/Engineer - for overall design
Company Name:
Address:
Phone #:
Certified by State of Massachusetts as:
Certification Number: _
Note: Signatures and seals on all plans, affidavits & other documents SHALL BE originals and not reproditictions.
11.2 Architect/Engineer - project supervision and reports
Company Name:
Address:
Phone #:
Certified by State of Massachusetts as:
Certification Number:
Note: Signatures and seals on all plans, affidavits, & other documents SHALL BE originals and not reprodurctions.
11.3 General Contractor
Company Name:
Address:
Phone #:
Construction Supervisors License Number
Note: Signatures and seals on all plans, affidavits, & other documents SHALL BE originals and not reproducetions.
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COMMERCIAL 2003
COMMERCIAL 2003
$25.00 APPLICATION FEE IS NON-REIFU14DA33LE & NON-TRANSFE ABLE
Item Estimated Cost ($) to nearest dollar. To be completed by permit applicant
1. Building
2. Electrical
3. Plumbing
4. Mechanical (HVAC)
Total 1+2+
S o 3+ 4
( )
✓/
Estimated Total Cost I
C Including Labor: $
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(please print)
I, as Owner of the subject property hereby authorize
to act on m behalf, in all matters relative work
y to wo authorized by this building permit application.
Signature of Owner Date
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as Owner/Authorized Agent >hereby declare that the statements and information
on the foregoing application are true and accurate, to the best of my knowledge and belief.
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Signed under the and penalties of perjury.
Signa re of Owner/Agent Date
SECTION 14 - INSPECTOR'S REVIEW/COMMENTS
1. Date plan reviewed: 5. DENIED (see project review worksheet):
2. 30 days to review period expires: Date:
3. OK to issue date: $. HOLD reason:
4. OK to issue subject to requested submittals (see project Date:
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review worksheet): Date: 7. HOLD subject to Zoning
i � g Board of Appeals action:
8. Comments:
9. Inspector's Signature: Date:
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Applicant informed of above Date�/3 ' Time: Clerk:
Comments:
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Total Permit Fee: Z E2 - _7 Less Application Fee: $ 25.00 Remaining Balance:
Gross Area - New Construction
Gross Area - Alteration
Permit Issued To:- 7_ " ,.
`OUT° .�9s DARTMOUTH BUILDING DEPARTMENT DATE R�'�EIVED
400 Slocum Road, P.O. Box 79399
Dartmouth, MA 02747 Y'R '
508-910-1820 FAX 508-910-1838 _
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A COMMERCIAL BUILDTNO'(�inc1"udes cdr more family dwellings)
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Zoning Review: Signature: DatMOV 2 0 2003
Energy Report: Signature: Date:
Fire Chief: Signature: Date:
Board of Health: Signature: Date:
Conservation Commission: Signature: Date:
Other: Signature- Date -------
Description of Work Being Performed. UJ 11 t4 5 m�46
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1.1 NUMBER OF PLANS SUBMITTED:
1.2 SITE PLAN SUBMITTED: ❑ yes ❑ no
1.3 Property Address: tJ�6f
1.4 Assessors Plat & Lot Number:
Nearest Cross Street:_
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s. Name � tei9 C ,.Le_ Phone# -
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Plat Lots. - +:
Total Land Area Sq. Ft,:
1.5 Water Supply (MGL c 40 § 54):
1.6 Sewage Disposal System:
❑ Municipal ❑ Private Well
❑ Municipal ❑ Om Site Disposal System
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2.1 Owner of Record:
Contact Address Telephone
Name (print)
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2.2 Authorigent:
�rme (print)
Contact Address S -06p- el1PC/- 1;>:._> o Telephone
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