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soo mrECHANICALS & PRIMARY FUEL
Arcbitec ngineer - Project supervision and reports
= Furnace (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify)
Company name
2 Boiler (heating)- Fuel gas (natural or propane), fuel oil, electricity, other (specify) Fu L 0 t (--
Address
= HVAC (combined unit) - Primary fuel, natural gas, propane, electricity, other (specify)
Phone number
_Air conditioning - (separate unit)
I
Certified by State of Massachusetts as
_ None of the above to be provided '
Certification number �•'
SHALL BE originals andl not
Hot Water Gas EIectric Fuel Oit Otheri��
NOTE Signatures and seals on all plans, affidavits and other documents
reproductions.
900 SPRINKLERS -FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
homeowner here then complete section 1300)
General Contractor (if Homeowner, state
_ Required, _plans provided, _plans not provided, why?
�s
}
Company name t tacri g
_ Not required, not to be ;installed, Why?
Address
1000 REQUIRED OFFS'I'REET PARKING - for ZONING & Architectural Access
Phone number
_ NOT ,APPLICABLE
Construction Supervisors license number
i
= Parking Plan submitted To = BuiIding Department Planning Board Date submitted
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals andl not
reproductions.
Number of spaces -indoors
P outside total provided
Ifandicap spaces - required _ yes no. If ves, how many as a part of the total required number.
1200 FOR RESIDENTIAL REMODEL WORK ONLY
Is Route 6 (State Road) Entrance permit required? yes _ no =. If yes has it been issued yes = no
Contractor subject to (780CMR - 6) ? Yes � No _ If no go to mext section.'
�
Are you a Home Improvement
Submit copy of application and/orpermit as soon as available.
from the requirement? Yes _No _If yes, submit the required taffidayit!
Are you claiming exemption
1100 IDEN'hiFIC kTION ( print or type except as noted)
Remodel contractor name lease Pint)
Cunt owner - name
Address
address ..
�r //) n
Registration number (if none srate "none")
phone � 1 l{� / A
Phone number
If corporation. officer in charge
UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE
PERSONS CONTRACTING WITH
ArchitectlEngineer - for overall design
GUARANTEE FUND! QUESTIONS OR COMPLAINTS call or write:
Home Improvement Contractors Registration
Company name �:Jij i\i t ;�; i �� 1 ✓�, C
- One Ashburton Place- Room 1301
Boston, :MA 02108
Address�J � n� 1 �R1 t;\; (" t- (- '' � 1 S �cl
(617) 727-8598
Phone number --
Owners name (print) _
Certified by State of Massachusetts as
Signature s
I, Certification number
Date
NOTE Signatures and seals on all Plans, affidavits and other documents SHALL BE originals and not
1300 OWNER SIGN - OFF
reproductions.
record or authorized lessee (provide documentation) and I haave reviewed
I, the undersigned• am the owner of
I that to the best of my knowledge and belief that the information provided in this
the application herein submitted. state
that the permit requested he issued.
application is true and correct and
will expire in six months, from the date of issue, if no work is begun or
Further I understand that the permit
has begun and that the permit may be extended for six months, iif no work is
six months after the last inspection if work
ft
I understand that the permit may be extended only three times by
anticipated if I request such an extension in writing-
written request. I understand that once the permit expires a new application may be required, including fees and current
other requirements (including Zoning).
Name �N� !0
Signature a _ �a(
The a ove signa isnv voluntary act and is signed under the pains and penalties of pe 'urv.
rJ
Datef%)�
F F
Who is authorized to ickup the permit at the Building�,Dep�aRrtment? (please pnntl
Address S ( ® 1 SD'`� L,l, .(F Phone V1 `
1400 HOMEOWNER EXEMPTION = ONE & TWO FAMILY ONLY
FOR HO.NIE OWNERS WHO INTEND TO PERFORDi AND BE RESPONSIBLE FOR THEIR OWN PROJECT
109.1.1 Licensing of Construction Supervisors: Except for those structures governed by Construction Control
i
in Section 127.0. effective Julv 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 accordance with the rules and regulations promulgated by the BBRS entitled
Rules 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 Ownt:r" is defi;-ed as follows: Peisoras) 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 dwellin , 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 cou are applying under this section sign below;
Signature
four 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
3.15.2 of section
150U COST
Cast of Improvement
Iterns to he installed but not included in the above cost: Electrical 5? n s
l
Plumbing
HvAc I "J ;' i
Other
TOTAL $ C j Wit;
The following section for official" use only.
INSPECTORS' REVIEW
IFTB11 1997
Date plan reviewed
30 days to review period expires
OK to issue date
Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaratilion required.
Demolition describe structure
Number of dwelling units Number of bedrooms A separate Refuse D'sposai
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-roofmg - (for existing only, is included in new construction)
Number of square feet Number of layers already existing
Number of lavers when complete
A separate disposal declaration REQUIRED
Replacement doors and windows (for existing only) (only where doors and windows exist an(ii will not be
enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dweilling will be
considered as an Alteration, otherwise will he included in new construction. (see Code section 34401.10 for
residential and Article 8 for commercial) `
Temporary structure - includes when allowed, trailers, tents and the like and only for limited per=iods of time.
Describe
500 CONSTRUCTION PLANS
None submitted. Why?
Submitted, usually three sets required. Four sets for food service\uses. Number of sets submiltted
600 SITE PLAN
2/Not required, why?
R Submitted When? _ Previously, date _ With this application
700 UTILTIIES
Water supply required ves no, public ? yes no, on site well? eyes _ wo,
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 supjply, 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.
riooastove - used (will require inspection prior to installation), new (provide manufacturers
instructions). Location(s) (list)
P4 Fire laces �
P O - (includes flue) List location(s)
Game Court - describe (include overall dimensions)
1 Tent, Trailer (Mobile Home) or Other - describe
300 C0NUAERCIAL - PROPOSED PROJECT/USE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES
-1 THIS SECTION NOT APPLICABLE
(The following descriptions are based on the Massachusetts State Building Code Article3, AS NOTED) (See the
Code)
= Assemblv - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe
i
!
= Business - 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 - retaiI 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 anv of the above, indicate above (see Code Section 119.0 and Zoning By-law section 35)
_ "Pent or Trailer - ora tem purpose? temporary p rpose
= Other
Describe the ro '
P l�l briefly, INCLUDE number of dwelling units and bedrooms or occupant load as applicable,
also easting condition
400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMEED
1 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).
e If project is an addition to existing structure - Total gross square feet of existing
FOR`"COMAiERCIAL 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)
APPLICANT TO PROVIDE
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 Date
f
Applicant informed of above - Date time staff (fax, phone, iin person)
ss****s***s**s*s***s**s********s*ssss*ss*s***s***ss****ssssssssssssssss*sss*ssssssssssssssss**s*-ssss*s***:
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)
OFFICEUNSPECTORS NOTES
TOTAL FEE
Gross area - new construction Total Sq. Ft. 8 , r
alteration Total Sq. Ft.
Permit is issued to
r
�
Comments/notes on permit.��,��' f e� t J
1600 TO TTIE APP11CANrMWMMAL AND APPROVAL
,Q " • � � r�
t` ]b•1! ENT
Date of Application submission
rat
- :
TOWN O DARTNiOUTS
A v ���c��nn n•[Zg
.. ... FAX
AX 77N1I.7
TELEPHONE 508-999-0720
Plat Lot Sheet
Aquifer Zone
Owner
A n T CAT�O� IOi`Ie1 OR ZONING AND BUILDING IRMIT
AOwner PL1
mail address
-
Owner phone # _
,z,� .t Ft1 i if
::=z.:=::::Z::::::s:::=:::::::sssz:::::sssz::ss:: ::ss:::::..a::::.ss::■:::::._:
OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your
OII.•Iel<v� i$e
Ilutrac 4cation to the best of their ability prior to submuti ao item tmfor sections
The apptis #i"t,Ih it Hof fete this-alpp.. Ted
' ' �'lreular business hours to assist as necessary:-N1A should be imerl
be Bursa-
Proposed project. CONTACT THEM FOR RF.OUIRED SDBM MONS.
Department staff µill availa�ie
which do not appiv. A properiv completed application will help avoid unnecessary delays.
® TAX COLLECTOR = Approved = HOLD By
Date
t7 Conservation Comm _
- Approved By
Date r
(for office use only) - received b D=te L=_--
Application fee S 7 -__
a D.P.W. water _ Approved By
Date
Total Permit Fee S Permiit#
Q D.P.W. sewer = Approved By
Date
Q D.P.W. cross connection —App
Date
100 LOCATION OF PROJECT
� ;
13. P_ .1 . engineering — Approved
Date
r ORS' PLAT LOT ®� ZONING DISTRICT
CURRENT ACCESS
OTHER ZONING OVERLAY DISTRICTS , if applicable
❑ Soard of Health well _ Approved
Date
`
_
a Board of Health septic - Approved
Date
NVMBER 3 STREET
3oard of Health food service = Approved
Date
CIE-A.REST CROSS STREET L.i` t A 00
i ru
$ FIRE DISTRICT (I - II - III1 = Approved
Date
SUBDIVISION NAME & LOT #
v Planninz Dent _ Approved
Date
or BUSINESS NAME
�1/114 f� 1 I /!f f' A /�i
tlthcr - Approved
Date
PREVIOUS TENA1�'T i Oti�'NER
L:r _Approved
Date
200 RESIDEN'ITAL - PROPOSED PROJECT - one & two family residence only
= THIS SECTION NOT APPLICI.BLE
C' mr-ents
.
I Single family - number bedrooms number baths
:......==zzzzzs:::sszss=:::z::zsssass::ssessszszssszass:zss:ssssassssszss:axes:ssassesssassssssszsss:s:
— Two family - number bedrooms unit 1 �_ number )sails unit l _
Project summary new construction/ alterationidemo
sewage disposal - puhliciprivate
number bedrooms unit: ___ number baths unit Z
[Alter. -,add interior walls] [add rooms] [add footprint)
water supply - publiclprivate well
=Accessory apartment Total, gross sq. ft.
1pooi[ [garage.,shed] [game couril [food service]
= Accessory structure
Describe
•
_ Garage - detached - attached to dwelling, dimensions L W
zzsssss
— Carport -detached - attached to dwelling, dimensions L W
■====zszazszzxzss:zsszss zssssssaass:a:zszass:::sssz::ssszssazsssssasssszssasssssszszzszss
4 the N arious departments:
ssssss
—
_Shed - dimensions L W
This notice has been forwarded to you for tiour information and any appropriate action. Should you have any
— W.
Gazebo - dimensions L
iestions please ,advise. If any reason to withhold the requested permit is
found. please advise. Your assistance and
_
total sgsr gre feet
operation is appreciated.
Swimming pool above ground in -ground Size
e BuiIding Department
fit il'CTeS
Date seat for review
By
_ - __