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BP-881m c 000,// / It, Architect/Engineer - project supervision and reports 800 MECHANICAJLaS & PRIMARY FUEL. Company name Furnace (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify) Address 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) ❑ 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, D plans not provided, why? Not required, not to be installed, Why? 1000 REQUIRED OFF-STREET PARKING - for ZONING & - Architectural Access NOT APPLICABLE Parking Plan submitted To Building Department ❑ Planning Board Date submitted Number of spaces - indoors outside total provided Handicap spaces - required — yesno. 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. 1100 IDENTIFICATION (print or type except as noted) VCuxTent owner -name (� address phone # I. t?UtJA)IA)( P4 SOS� 919, If corporation, officer in charge U�43E,1'111 iffelIq Company name Address Phone number Certified by State of Massachusetts as Certification number NOTE Signatures and seals on all plans, affidavits and other documents S BE originals and not reproductions. Phone number Certified by State of Massachusetts as Certification number Nth Signatures and seals on all plans, affidavits and other documents SHALL BE on finals and not reproductions. General Contractor (if Homeowner, state homeowner here then complete section 1300) Company name � �- i'Q. T' i�Vi Q C'� � f)0d LS '4 VAddress �J� � •�3 �i-�Q� � �i J � i� � d , Sid. � ,�-� j . -- Phone number 4/Construction Supervisors license number i NOTE Signatures and seals on all 1_plans, affidavits and other documents SHALL BE or4ginals and not reproductions. 1200 FOR RESIDENTIAL REMODEL WORK ONLY L//AAre you a Home Improvement Contractor subject to (780CMR - 6) ? Yes � No _ If rno go to next section! Are you claiming exemption from the requirement? Yes No )(.If yes, submit the :required affidavit! Ren_odel contractor name (please print) hprav� � U100" l�''�' �%d la.. � �" �� ��tJ Address SO Registration number (if none state "none") Phone number Elm 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 4 5 13 00 © SIGN . OFF -- .� Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaratioj u L-ectuired, I, the undersigned, am the owner. of record or authorized lessee(provide documentatio ' ' •. n) and I have reviewed -- Demolition -describe structure the application herein submitted. I state that fo 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 I1j-s;p Further I underix stand that the permit will expire in smonths, from the date of issue if no work is begun or Decn requn-ed- six months after the last inspection if work has begun and that the permit may be extended for six Y months if no work is anticipated if I request such an extension in writing. I understand that the permit may be extended — ' P Y d only three times by � Moving - (Provide copy of D.P.W. moving license) Type of structure written request. I understand that once the permit expires a new application may be including Ye required, ing fees and current other requirements (including Zoning). _ from where (plat/lot or address) Name to where (plat/lot or address) Signature . Number of dwellingunits Number of bed • rooms per dwelling unit ., The above signature is my vol. Lary act and is signed under the ena pains and P penalties of perjury. Date (9 ...... Re`roofmg - (for existing only, is included in new construction) Number of square feet Number of layers already existing Who is authorized to pickup the permit at the Building Department? lease Tint) Y Y g Address Phone Number of layers when complete . - - A separate disposal declaration REQUIRED 1400 go1�Eo EXEMPTION - ONE & Two F Y 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 b • P g y Construction Control in, Section 127.0, effective July 1, 1982, no individual shall be engaged in directly supervising persons engaged in construction, reconstruction, alteration, repair, removal or demolition involvingthe structural • raI elements of buildings or stx­uctures, unless he or she is licensed in accordance with the rules and regulations promulgated by the BBRS entit led R.Lles and Regulations for Licensing Cons►~uctiva- Supervisors. Exception: Any Home Owner performing work for which a BuildingPermit is required q fired shah be exempt from the provisions of this section; provides that if a Home Owner engages a person(s) for hi re 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 a one or two • - o family dwelling, attached or detached structures accessory to such use and/or farm structures., A person who constructs is more than one home in t- o-year period shall not be considered a Home Owner. If you are applying under this section sign below: Signature Your signature carries certain responsibilities, includingbut not necessarilylimited to, general liability N01iCE . TO LICENSED CONTRACTORS: The Building Code provides in the Rules and R • P Regulations section that any licensed Construction Supervisor, whether or not they have taken the permit are responsible • p p�onsible for code compliance. (see 2.1-5.2 of section 5) 15 00 COST Cost of Improvement Items to be installed but not included in the above cost: TOTAL Electrical $ Plumbing HVAC Other Replacement doors and W* dows - (for existing only) (only where doors and windows exist anvil will not be enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dweillin will be f g considered as an Alteration, otherwise will be included in new construction. (see Code section 34101.10 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 CONSTRUMON PLANS None submitted. Why. Submitted, usually three sets required. Four sets for food service\uses. Number of sets submiitted 600 S I 1E PLAN '9�0 ❑ Not regnured, why? Submitted when? Previously, date With this application Water supply - required yes — no, public 7 yes no, existing? -)L yes no on site well? yes nlo, t// 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 sui-o l vvi,o� _. P Y required, is available. See Code 780 CMR section 114.1.2 ) Sewage disposal - required — yes no, public sewer s yes no private septic - on -site yes no. Submit copy of permit as soon as available. on Woodstove - used (will require inspection prior to installation), new (provide manufact�lrers instructions). Location(s) (list) The following section for official use only. INSPECTORS' REVIEW G Fireplace(s) - (includes flue) List location(s) Game Court describe (include overall dimensions) u Tent, Trailer (Mobile N[�mpi nr (�t�pr _ riPcr%rii,n 3M CO CAL - PROPOSM PROJECT/USE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES THIS SECTION 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 less than 50 occupants - indicate Medical or o ' P other professional (see Code Section 303.0) .=. Educational - structure for training including child day care for those over 2 ears 9 months • y nths (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 (seeSection 311.0) New tenant for any of the above, indicate above (see Code Section 119.0 and Zonin • g By-law section 35) Tent or Trailer - temporary purpose? Other Descrffie the proposal briefly, INCLUDE,-"-- umber of dwefling units and bedrooms or Occupant load as applhmble, also eids condition New Construction and/or Addison - total gross square feet (For commercial only total gross cubic feet) - indicate It will be considered new construction if there an increase in footage in addition to any square foo • • alteration(s). q If project is an addition to existing structure - Total gross square feet of existing ting FOR COAUKERCIAL ONLY Will this project be subject to CONSTRI]CrION CONTROL (over 35,000 cu.ft. � ) _____Yes _____ No. (If yes see Code section 127.0). Designer to submit Code Synopsis. Will this project require Peet- review (over 400,000 cu. ft.) Yes No (see Code Appendix 1) APPLICANTTO PRO vIDE 2 Date plan reviewed 30 days to review period expires -1 OK to issue date OK to issue subject to requested submittals(see •3 q project review worksheet) date I) ENsee project review worksheet date BOLD reason date J BOLD Subject to Zoning Board of Appeals action Comments Inspectors s a signature - 10 0 0, Date Applicant in/ormed of above - Date time staff(fax,{' phone, "in person) person) Over six months since approved for issue - DEEMED abandoned! Advise applicant. Hold 90 days for return then dispose if not . picked u P P Inspector Date Advised applicant Date Time staff e(byhone fax or in erson' phone, person) OFFICEVNSPEcrORS NOTES TOTAL FEE �? Gross area - new constru•rtinn �L`Tot al Sq. Ft. alteration Total Sq, Ft. Permit is issued to Comments/notes on permit 1600 TO 'I APPLICANT/REFERRALAPPLJCANT/REFERRAL AND APPROVAI. ......... .... JIM E. ,..R- -I-.. M. I H ou Date of Application submis"0sion .. 00"ol PP sion .. ........... E."508w999'0720.--- �. 4/__ r TE���O . . ..... .. .... Plat Lot Street -, t:� t.�,�-K�' y,.. A infer Zone q ne . . Owner fie,""'U` DING'PluRMIT ZONING APJ1 LICAT...T...ON FORX T1 AND i 1 v Owner mail address Owner hone # n ph one • complete this application to the best of their ability prior to submission, leaving no item un nnswered. The . The applicant shall mp pp . OTEOER INVOLVED AGENCIES - The followingagencies require separate jurisdictional permits or approval for our Department staff will be available during regular business hours to assist as necessary. liIIA should be inserted,. for those sections g P PP Y P project. CONTACT FOR SITB DNS, which do not apply. A properly completed application will help avoid unnecessary delays. F Fm is rr proposed P J ® TAX COLLECTOR Approved HOLD By Date (for owe use 0 TJMA►TION ONLY r' i r�.�q d / o Board of Appeals roved- B Date Total Cost Received By I PP Approved- Y 1. 1 f Less lhaton Fee $ t f�l DPP ❑ Conservation Commission Q Approved B Date Total Permit Fee Pere # Mte P y ❑ D.P.W. Water . Approved By ❑ D.P.W. Sewer Approved By Date 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET ❑ D.P.W. Cross Connection iu Approved By Date ❑ Treasurer (Bond) o Approved By Date CURRENT ACCESSORS ' PLAT LOT ZONING DISTRICT ❑ D.P.W. Engineering 0 Approved By Date OTHER ZONING oVERIAY DISTRICTS , if applicable Board of Health(well)� rc,led B _ PP Y Date t . NUMBER � STREET ❑ Board of Health (septic) E! Approved By Date N EET ST CROSS STR ❑ Board of Health (food service) F Approved By Date SUBDIVISION NAME & LOT # o Planning Board (parking) ? Approved By Date or BUSINESS NAME 13 FIRE DISTRICT (I - II - III) 7 Approved By Date TENANT OWNER PREVIOUS/ BUILDING DEPARTMENT APPROVAL: 200 P:ESID - PROPOSED PROJECT -one &two family residence only ❑ ZONINGr7 NOT APPLICABLE .� THIS SECTION N ❑ BUILDING INSPECTOR/BUILDING COMMISSIONER i g Sin le family -number bedrooms number baths ❑ CONTROL CONSTRUCTION AFFIDAVIT Two family -number bedrooms unit 1 number baths unit 1 number bedrooms unit 2 number. baths unit 2 , PROJECT SUMMARY: Accessory apartment Total gross sq. ft. w construction/ alteration/demo rY P new constru / radon/demo sewage disposal - public/private � Accessory structure: interior walls[add rooms[add foo rint water su 1 - ublic/ rivate well[Alter/add � j footprint] supply P P � � Garage -detached -attached to dwelling, dimensions L g [pool] [garage/shed/deck] [game court] [food service] � _ detached - attached to dwellin , dimensions L W' � Carport detach g Describe Shed -dimensions L W To the various departments: C Deck -dimensions L W This notice has been forwarded to you for your information and any appropriate action. Should you have any 7 Gazebo - dimensions L W r: questions please advise. If any reason to withhold the requested permit is found, please advise. Your assistance and cooperation is appreciated. Swimming pool above ground in -ground Size The Building Department - Date sent for review BY L_� Chimney _ n � umber of flues 8 1