BP-591800 hry-'G'EL4IdICA.I.S & PREWARY F[TEi.
= Furnace (hot air) - Fuel gas (natural or propane), fuel oiI, electricity, other (specify)
— Boiler(heating)-
Fuei as(natural
g
propane),
or ro ane),
fuel
oil, electricity, other
(speci€y)
VAC
combined unit) -
Primary
fuel, natural
gas,
propane, electricity,
other (specify)
= Air conditioning - (separate unit)
. one of the above to be provided
- Hot Water
Gas Electric
Fuel Oil
Other
90() SPRINKLERS - FOR
STRUCTURES OVER
7500 SQUARE FEET
and certain multifamily residential
- Required, - plans provided, -plans not provided, why?
Not required, not to be installed, why'
IOOU REQUIRED OFF-STREET PARKING -for ZONING & Architectural Access
NOT APPLICABLE
Parking Department Plan submitted To - Building Dartment — PIanning Board Date submitted
—
T aces -indoors outside total provided
N.
umber of spaces
IIP spaces - required y
andica s ired es no. If }•es, how many as a part of the total required number.
q —
Route 6 "State Road Entrance permit required? }•es — no -. If ties has it been issued yes - no
Is Ro ( ) Q q
Submit copy of application and/or permit as soon as available.
1100 IDF FICA'nON ( print or type except as noted)
If
nt owner - name
ddress
hone #;
If corporation. officer in charge
Archi ngineer - for overall design
Company name
.address
Phone number
Certified by State of Massachusetts as
Company name
Address
Phone number
Certified by State of Massachusetts as
Certification number
and other documents SHALL BE originals a�rid not
NCiE Signatures natures and seals on all lapsaffidavits,
reproductions.
state hom
eowner het a then complete section 1300)
General Contractor (if Homeowner
iv
Company name.
Address '
Phone number
Constructi
on Supervisors license number
BE on inaLs u�nd not
and seals on all fans. affidavits and other documents SHALL g
NO`I E Signatures
reproductions.
1200 FOR RESIDE REMODEL WORK ONLY
. � No If no go too next section!
r subject to (780CMR - 6) . Yes
u a Home improvement Contractor sub ,l
Are you P
es submit the required fida`'it�
• requirement? Yes No _____.I f yes, af
ou claiming exemption from the
Are v g
r
Remodel contractor name (please print)
Address
Registration number (if none state "none")
Phone number
UNREGISTERED CONTRACTORS DO NOT HAVE AC'CESS To THE
C,TING WITH UNREGIS .
PERSONS CONTRA N�'S call or write:
OR COMPLAi .G 1;ARANTEE FUND. QUESTIONSContractors Registration
. Home Improvement
On
e Ashburton Place - Room 1301
B
oston, :MA 02108
(61-7) 727-8598
Owners name (print)
Signature
Date
Certification number
. 1300 OWNER SIGN -OFF
NOTE Signatures and seals on alal=,l_s, affidavits and other documents SMALL BE originals and not
• documentation) anc�' I have reviewed
g
record or authorized lessee (provide ocum
re roductZons.
undersigned, am the owner 0 t the in€ormation� provided jIl this
P I, the g
hest of my knowledge and belief tha
• i submitted. I state that to the
the application herein be issued.
• d correct and that the permit requested
. � true an date of issue, if no t,�vrork is begun or
application is expire in six months, from the
at the permit will P or six momths if no work is
Further I understand that P at the permit may be extended f
• work has begun and that P on7ly three times by
t six months after the last inspection if , , that the perm,
shay be extended
• • �,ritin . I understand P
' ' ated if I re nest such an extension in g
antics q
written r quest. I understand that once the permit expires a new application may be required, including fees and current
other re uirements (including Zoning). r
Nracne
signature
The abode signature is my voluntary act and is signed under the pains and penalties of perjury.
D a to
authorized to pickup the permit at the Buildin De artment? r lease print) ..?`.., � /��
`�� o is a u P P P g P p
Address Phone _
14100 IIOIIEOWNER EXEMPTION - ONE & TWO FAMILY ONLY
FOR 110,N-iE ONNNERS 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 July 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 B13RS entitled
Rues and Regulations for Licensing Construction Supervisors.
Exception: A.ny Home Owner performing work for which a Building Permit is required shall be exempt from
the provisions of this section: provides that if a Horne Owner engages a person(s) for hire to do such work ,that such
Ho,. e Oixner shall act as supervisor.
For the purposes of this section oniv, a "Home Owner" is defi-A-ed ay follows: Person(s) who owns a parcel of land
on %if-hich he; she resides or intends to reside, on which there is, or is intended to be, a one or two Iamily dwelling 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:
tzanature
four signature tarries certain responsibilities, including but not necessarily limited to, general liability
N0710E TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that any
licer15ed Construction Supervisor. whether or not thev have taken the permit are responsible for code compliance. (see
2.1 ." of section
I50�1 COST
Cost of Improvement �
Items to be installed but not included in the above cost:
TOTAL
The IFoIlowing section for official use only.
Electrical 5
Plumbing
HVA.0
Other
• gross
square feet. A separate Refuse Disposal Deciarvaition required.
AAferation of existing, no increase in gro q p P
Z Demolition - describe structure .
Number of dwelling units Number of bedrooms A separate Refuse:, Disposal
Decl=tion r-equhr d.
.:Moving - (Provide copy of D.P-We 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 lavers when complete
A separate disposal declaration REQUIRED
:= Replacement ement doors and windows - (for existing only) (only where doors and windows exist :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 sections 3401.10 for
residential and Article S for commercial)
Temporary structure - includes when allowed, trailers, tents and the like and only for limited foeriods of time.
Describe
500 CONSTRUCTION PLANS
- N ne submitted. W`hv?
Submitted, usually three sets .required.
600 SPLAN
our se for food servtceluses. Nu er of sets sui;)mitte:d
1
❑ Not required, why?
Submitted When? PreviousIyl date With this application
700 i1'I'ILITIES
Water supply - required ves _ no, public ? — yes _ no, on site well? _ yes no,
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 -supply, when
required,
is available.
See Code
780 CMiR section 114.1.2)
INSPECTORS' REVIEW
Sewage disposal - required yes _ no, public sewer r yes _ no
Date plan reviewed
rivate tic - on -site veS no. Submit copy of permit as soon as available.
P se P ____
30 days to review period expires
OK to issue date
Woodstove - used (wi(willrequire inspection prior to installation), new (provide manufacturers
L
uested submittals (see project review worksheet) date
OR to issue subject to re q
DENWID see roject review worksheet date
P
instructions). Location(s) (list) MMONEEMEEMENS
Firepiace(s)' - (includes flue) List location(s)
71 Game Court - describe (include overall dimensions)
Tent, Trailer (Mobile Home) r other describe
300 COMMERCIAL - PROPOSED 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 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 -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 & MisceIIaneous 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
Descnbe the Proposal briefly, INCLUDE num r of dwe units and bedrooms or occupant load as appfic�ble
also existing condition I
400 T'ITE OF CONSTRUCTION OR WORK TO BE PERFORMED
= 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).
If project is an addition to existing structure - Total gross square feet of existing
FOR COMMERCIAL ONLY .
Will this project be subject to CONMUCTION 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
date
HOLD reason
HOLD Subject to Zoning Board of Appeals action
Comments
`J U 4, C-9 0
Inspectors signature .
Dal
— ate time staff --• (fax, phone, iin person)
Applicant informed of above - D .
*..*.•�.**********��7`.�.'*.�.'**.#.i+•..�.•******..�•**1`********��T���������•7`�T��T����T`9`�'4'���FF��t��R`T7`��!`���F���•%��`T��'1''T'T'�`�
Over six months since app • roved for issue - DEEMED abandoned!
.�
Advise applicant. Hold 90 days for return then dispose if not picked up.
Inspector Date
Advised applicant D
• ate Time _ staff ! (by phone, fax or m person)
*******************************************************************************************:--4-*********
OFFICEVNSPECTORS NOTES
TOTAL. FEE '05 6*7
Gross area -new construction ;9-?4�7 Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit
1500 TO "ITS AF Ty,ICANTAM 41,PROVAL
t P
l
Date of Appii=don submission
Pict
O N-vrner
Ovvner
Uuvner phone #
OTIiER INVOLVED AGENCIES -The foIlowin agencies •
g a g es require separate �ut-tsdichonai permits or ap royal for r your
Proposed project. CONTACT JUEM FOR RMUMM,%LMpMSS10?qS,
0 TAX COLLECTOR Approved = HOLD -
B Date
Q Co n s e rti• a ti o n Comm Approved g V
• Date
Q D . P . W. wa ter — Approved B �•
Date
Q D.P. �i'. serer — Approved By
Date
Q D.P.W. cross connection _ Appmved
Date
'. engineering _ App roved
..
- - --- Date
yard of Health well _ Approved Pp Date
and of Health septic = Approved
Date
� Board of Health food service _ Approved
Date
9 FIRE DISTRICT J - II -III) = Approved Pp ed Date
Q Planning Dept _ Approved
Date
Other— Apprxoved
Date
Approved
Date
('"Mments 11
::::::::::::zss:::sass::gasssa��sssssssss�,��ssaae�ars:ss�s:s:sssssss:::s:sssas�asaar,.�t��ra�
�r��rs*���rssas*s
Prnjecr summary oeK• construction/ slterati
onidemo sewage disposal - publicfP rivate
[-A1ter.-.zM'd interior waILs j {add rooms[add� footprints water su Iv - ublic
PP _ P rpnvate well
[pooll [garnae!shedl [game, cout-t[food•
� � sers•tcel
Describe
Sam :zaz::s:s:::sasaassaaasa:s��s,�,�,�sssssascxr:aasasa�ss�srs�srsr�ss�s:ssss�sss:sssssssassaaasa��r�a����
To the various demartments:
This nonce has been forwarded to ti•ou for
• •. dour tnfornianon and and appropriate action. Should 'Y u. have anti•
questions please udv ise. If anv reason to Withhold
the requested per it is found. please advise. Your assistance and
cooper--urion is appreciated.
The BuiIdinz Depat-trrtent
Date sent for review ¢ 9 %
By
A
TELEPHONE 508=999 0-74U
FA Ls
z r
zX
IMSUMCdom • . application to the best of their ability prior to sub tais "on
.'Ienv�g no items �ns�ver d. The
The applicant shall complete this pp
De available during remuiar business hours to assist as necessary*.NIA should be inserted for thosm sections
Department staff 'tit he avails _
which do not a PP . . IvA properly completed application will help avoid'unn delays. , - - -
Q ro .
n
(roc• office use only)j
fee"_ r�Its' u
Application � received b � g
Total Permit Fee $ Pelmma #
100 LOCA77ON OF PROJECT
t
C URRENT ACCESSORS PLAT LOT ONING DISTRICT
OTHER ZONING O
VFJUAY DISTRICTS , if applicable
NUMBER & STREET
CLEAREST CROSS STREET'
SUBDIVISION NAhiE & LOT #
or BUSINESS NAME
PREVIOUS TENANT ; OWNER
DO RESIDE - PROPOSED PROJE ' - one & two famiiv residence oniv
THIS SECTION NOT APPLICABLE
= Sinde family - number bedrooms number baths t
bedrooms unit 1 number maths unit 1
_ Two famti�• -number be .
number bedrooms unit ? number baths unit ? � I . r
_ Accessor`• aP artrnent Total gross sq. ft:
.
_ Accessory structure
- g
Gars e - detached - attached to dwelling, dunensions L w
_
• _ detached - attached to dwell�n , dunensions L ' ' W
_ Carport detach g
— Shed - dimensions L
= Gazebo - dimensions L W
- . ground is round Size total square f�•et
swimming pool above �,ro �
_
= Chimnev - # of flues