BP-741Arch eer - project supervision and report
800 MECHANICAAS & PREMARY FUEL .
, electricity, (specify)Furnace (hot air) •Fuel gas (natural or propane fuel oil electrlci other
ea ' - Fuel as(natural orpropane), fuel oil, electricity, other (specify)
Boiler (h ting) g
- 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
900 SP - FOR
STRUCTURES OVER
7500 SQUARE FEET
and certain multifamily residential
Required, -plans provided, :-I plans not provided, why?
Not required, not to be installed, Why?
1000 REQUIRED GFF PAREING - for ZONING & - Architectural Access
NOT APPLICABLE
Parking Plan submitted To _ Building Department L � Planning Board Date submitted
Number of spaces - indoors outside total provided
Handicap spaces - required — yes no. If.,.. -es, 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.
1100 ID NTIP'ICATION (print or type except as noted)
G�krrent owner -name ' � /7 li�� ..� ��'`��� � U1� y�G_ ► i � 1
` address 7
hone # � v � � � � r1 �l (?'� � �� � �1 �1 � •�. 6 � 0 ���
If corporation, officer in charge
• t !J 11 1 /
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 and not
reproductions.
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 and not
reproductions.
eneral Contractor (if Homeowner, state homeowner here then complete section 1300)
Company name � �11 E. � �-{'n�
Address
Phone number
Construction Supervisors license number
NOTE Signatures and seals on all plans, affidavits and other documents SMALL BE originals, Eand not
reproductions.
Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes No — If no go rto next section!
Are you claiming exemption from the requirement? Yes No _If yes, submit the requir'22-d affidavit!
Remodel contractor name (please print)
Address
Registration number (ir 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
5
.13 00 OWNER SIGN - OFF
Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaratiain required.
I, the undersigned, am the owner. of record or authorized lessee(provide docu 4- - • •mentation) and I have reviewed Demolition - describe structure
the application herein submitted. I state that to the best of my knowledge and belief that the information rmation provided in this
application is true .and correct and that the permit requested -be issued.
Number of dwelling units Number of bedrooms A separate Refuse D'j:e
Further I understand that the permit will expire in six months, from the date of issue ifP �gosal
no work is begun or DecIlecla.rataon requn�ed.
six months after the last inspection if work has begun and that the permit may be extended for s' •
Y ix months if no work is
anticipated if I request such an extension in writing. I understand that the may bextend
P Ye extended only three times by Moving - (Provide copy of D.P.W. mourn license Type of
Nvritten request. I understand that once the permit expires a new application may be required, including g ) yp structure
Y q ding fees and current
other refluirements (including Zoning), , .
from where (plat/lot or address)
'a me
f to where (plat/lot or address)
/'
Signati re
Number of dwelling units Number of bedrooms r dwelling unit
Pe g ..
The abov signatur ��my voluntary act and is signed under the .
ig pains and penalties of perjury0010-10,
f Date �9 Rom- Ong - (for existing only, is included in new construction
•i�/ a Number of square feet •
Who is author ed to pickup the permit at the Building De artment? lease rint) �'
q Number of layers already existing
. Address 4 �A_-J Phone ��o /Y 5
�-' Number of layers when complete
1400 HOMED _ A separate disposal declaration REQUIRED
HOMEOWNER ExER�'YPTION ONE � TWO F T� 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 • g _ ed by Construction Control
in Section 127.0, effective July 1, 1982, no individual shall be engaged in directly supervising y supervising persons engaged -
in
construction, reconstruction, alteration, repair, removal or demolition involvingthe structural • total elements of buildings or
structures, unless he or she is licensed in accorda~ a with the rules and re ula*:ons promulgated by the BBRS entitQd
R LIes and Regulations for Licensing Construction Supervisors.
Exception: Any Home Owner performing work for which a BuildingPermit is
required shall be exempt from
the provisions of this section; provides that if a Home Owner person(s) a es en a s
engages p () for hire to do such work ,that such
Rome 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 he/she resides or intends to reside, on which there is, or is intended to be e o a on •
,.. r two family dwellin ,attached
or detached structures accessory to such use and/or farm structures. A person who constructs cis more than one home in
t,",o-year period shall not be considered a. Home Owner.
If you are appIyi.ng under this section sign below:
S i.crna
our signatu a cafrfes%,,=reOffain responsibilities, includingbut not necessarilylimi
led to, general liability
NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and •
P Regulations section that any
licensed Construction Supervisor, whether or not they have taken the permit are responsible • � p ponsible for code compliance. (see
2.15.2 of section )
1 500 COST
Cost of Improvement
Items to be installed but not included in the above cost: Electrical
Plumbing
HVAC
Other
TOTAL
r �.
Replacement doors and windows - (for existing only) (only where doors and windows exist anti1 will ll not be
enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwellling wil
l be
considered as an Alteration, otherwise will be included in new construction. Code
(see section 34(01.10 for
' residential and Article 8 foa commercial)
x
Temporary structure - includes when allowed trailers tents a t •• • �.. , , and he Like and only for limited per��ods of time.
Describe
500 CONSTRUCTION PLANS
None submitted. Why?
�. Submitted, usually three sets required. Four sets for food serviceluses. Number of sets submii fled
600 SITE PLAN
❑ Not requn-ed, why?
Submitted When? Previously, date With this a lication
PP
700
Water supply - required — yes — no, public ? es no on site ? '
P .—.. Y —. � well. yes — rr(o,
existing? — yes _ no
If required and not existing have necessary permits been issued? no es d — y ate
(M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a water suP)P YI, when
required, is available. See Code 780 CMR section 114.1.2)
Sewage disposal - required yes _ono, public sewer yes _ no
private septic - on -site — yes _ no. Submit copy of permit as soon as available.
R
wooustove used (will require inspection prior to installation), new (provide manufacturers
instructions). Location(s) (list) ,
1
C Fireplace(s) - (includes flue) List l ' ocation(s)
Game Court -.describe (include ove •tall dimensions .
Tent, Trailer (Mobile Horne) or Q
ther - describe
uu "u cam, - PROPOSEDPROJECT/USE - INCLUDING THREE FAMILY OR MORE
AND EXEMPT USES
THIS SECTION NOT APPLICABLE
(The following descriptions are based
. P on the Massachusetts State Building C •
Cade) g ode Article 3, AS NOTED) (See the
. -
Assembly- restaurant, urant, lounge, theater, school, etc, Co
(see de Section 302.0) Describe
--� Business -office, assemblywith less • ss than 50 occupants - Indicate Medical •
Section 303.0) or other professional(see Code
Educational -structure for trainin •
g including child day care for those over
304.0) 2 years 9 months (see Code '
Section
L..Factory / Industrial - Code Se(see coon 305.0)
_-. High Hazard - (see Code Section 306,0)
Institutional -hospital, nursing home, Infant day care (see Code Section 307.0
_. Mercantile - retail stores Cod
(see e 308.0)
Residential -three or more famil S � , hotel (see Code Section 309.0
Storage - includes (see C •
garages ode Section 309.0
=-� Utility &Miscellaneous Structures - includes tents and agricultural structu
res (see Code Section 311.0
�..: New tenant for any of the above indic
ate above (see Code Section 119.0 and Zoning ng By-law section 35)
Tent or Trailer - temporary purpose?
u se?
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 mit#aIs (See project review wor
ksheet) date
DENM see project review worksheet date •
HOLD reason
date
J HOLD Subject to ZoningBoard of A •
ppeaLs action
Comments
Inspectors signatureVX t Fl7
Da
Applicant informed of above - Date •
trine =staff fax `.
( ,phone, un person)
******************************************************
Over six months since approved for issue -
PP DEEMED abandoned!
Advise applicant. Hold 90 days for return •
y then dispose if not picked u
P p
Inspector
Date
- —: Advised applicant Date Time
staff _ (by phone, fax or in e . p rson)
******************************************************
OFFICEiINSPECTORS N017 S
TOTAL FEE
Gross area - new construction
Total Sq, Ft.
alteration Total S
q. Ft.
Other
Permit is issued to
--------------
M;2 ",,a
New Construction and/or Addition -total gross square feet
(For commercial anlY total gross ss cubic feet) -inidcate
It will be considered new construction .
tion if there an increase in square •
alteration(s), q footage in addition to any
If project Is an addition to existing g structure - Total gross square •
_ g q feet of existing
�. FOR COM31ERCL4L ONLY
Will this project be subject to Co
� NSTRU®N CONTROL(oversee Code section 127.0 . 35,000 cu.ft.) yeS
Designer to submit Code Synopsis,
No, (If yes
Will this project require P y psis.
q Pew review (over 400, 0 o cu. ft.
APPLI TO P ) Yes No(see CoR®vIDE Code Appendix I
Comments/notes on permit
2
1600 TO THE APPLICAWIRFTERRAL AND APPROVAL
Date of
Application submission f ,
Plat _Lot Street,,` ,/''=*vow*,
Aquifer Zone
r
Owner
Owner mail address
lij, - /n ((4�� /
Owner phone #
OTHER **********************
INVOLVED AGENCIES - The following agencies. require se 'u
eseparate q p jurisdictional permits or approval for our
proposed project. CONTACT FOR�MISSIIONSS
y
® TAX COLLECTOR 0 -Approved 7 HOLD By
Date
❑ Board of Appeals 17 Approved- By
Date
❑ onservation Commission C Approved B
• Date
❑ D.P.W. Water El roved B
Approved r ❑ D.P.W. Sewer roved B
Approved Date
❑ D.P.W. Cross Connection G Approved By
Date
o Treasurer (Bond) o Approved By Date
❑ D.P.W. Engineering 71 Approved By Date
Board of Hea.lth(well)❑ Approve
d By
Date
❑ oard of Health (septic) E! Approved By Date
❑ Board of Health (food service) ` Approved B
pp r Date
❑ Planning Board (parking) .=! Approved B
Date
® FIRE DISTRICT (I - II - III) Approved g
pp y Date
BUILDING DEPARTMEW APPROVAL:
❑ ZONING
❑ BUILDING INSPECTOR/BUILDING CONIMISSIONE R
❑ CONTROL CONSTRUCTION AFFIDAVIT
**************************************************************************** ****************************
PROJECT s Y:
new construction/ alteration/demo
sewage disposal - public/private
[Alter/add interior walls] [add rooms] foo rint[add footprint] water su I - public/
_ PP y p he/private well
[pool, [garage/shed(d5eck [game court .
] [food service] Describe
*****************************
To the various departments:
This notice has been forwarded to you for our infor
mation rmation and any appropriate action. Should you have an
questions please advise. If any reason to withhold the re y v
quested permit is found, please advise. Your assistanc cooperation is appreciated, se. a and
The Building Department - Date sent for review °
By
$1, V x [A. 1W-CLi5k�!, US) I��
ON M II ,V4001 t �',r",
- WH�. �� 0rMs- ill- 5
Insum
The applicant shall complete this application to the best of their ability prior to submission, leaving no item unaansweered. The
Department staff will be available during regular business hours to assist as necessary. N/A should be inserted for tihose sections
which do not apply. A properly completed application will help avoid ' ��
unnecessary. delays.F� fem b _
(for office use only)
Total Cost �
Liss Application Fee $
Total Permit Fee $
Rived By
Perffiit #
11 FOU .K.ITON ONLY
I2te Reed
100LOCATION OF PROJECr TOTAL LAND AREA SQUARE FEET
CURRENT ACCESSORS' PLAT LOT ZONING DISTRICT �
OTHER ZONING OVERLAY DISTRICTS, if applicable
NUMBER & STREETS
NEAREST CROSS STREET I -
11 SUBDIVISION NAME & LOT # �A - -
-�?
or BUSINESS NAME 'e
PREVIOUS TENANT OWNER
S A Vvt
200 RESED - PROPOSED PROJECT - one & two family residence only
THIS SECTION NOT APPLICABLE
Single family - number bedrooms number baths
Two family - number bedrooms unit 1 number baths unit 1
number bedrooms unit 2 number baths unit 2
.r. Accessory apartment Total gross sq, ft.
Accessory structure:
ri
r Garage - detached - attached to dwelii.ng, dimensions L W
Carport - detached -attached to dwelling, dimensions L W
i
t �
Shed - dimensions L W
�. ec13
k -dimensions L`' W 25
L, Gazebo - dimensions L W
Swimming pool above ground in -ground Size
i Chimney. - number of flues
1