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It Architect/Engineer - project super ion and reports
= Furnace (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify)
= 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
goo SPRINKLERS - FOR
STRUCTURES OVER
7500 SQUARE FEET and
certain multifamily residential
- Required, plans provided, . iplans not provided, why?
- Not required, not to be installed, Whv?
so
1000 REQUIRED OFF-STREET PARKING . for ZONING & Architectural Access
_ NOT APPLICABLE
- Parking Plan submitted To Building Department - Planning Board Date submitted
?dumber of spaces - indoors outside total provided
Ilandicap 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 ves 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)
r.
CLMnt owner - name
eV;�7 7 Ir/t,"
%001
ddress
phone #
...—,_
If corporation, officer in charge
Architect/Engineer - for overall design
Company name
Address
Company name
Address
Phone number
Certified by State of Massachusetts as
Certification number
NOTE Signatures and seals on all laps,
affidavits and other documents SMALL BE originals and not
g
reproductions.
omeowner here then com fete section 1300)
r(if Homeowner; tate h PGeneral Contracto ,� �,�
Company name
Address —
Phone number
Construction Supervisors license number
NOTE Signatures and seals on all plans, affidavits and other documents SMALL BE originals and mot
S'
reproductions.
120() FOR RESID
ENTIAL REMODEL WORK ONLY
- 6 ?Yes + No .— If no go to ne:;�t section!
Are you a Home Improvement Contractor subject to (780CMR )
Yes No If yes, submit the required a rfidavit!
Are you claiming exemption from the requirement?
Remodel contractor name (please print
Address
Registration number (if none state "none")
Phone number
CONTRACTORS DO NOT HAVE ACCESS TO THE
CONTRACTING WITH UNREGISTERED
PERSONS CONTR.A
OR COMPLAINTS call or write:GIIARA.NTEE FL1ND. QUESTIONSlion
Home Improvement Contractors Registry
one Ashburton Place - Room 1301
Boston. -MA. 02108
(617) 727-8598
Phone number .
Owners name (print)
Certified by State of Massachusetts as
Signature
v
Date
Certification number
.1300 OWNER SIGN -OFF .
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
duc ons.
re ro ti authorized lessee(provide documentation) and I ha'j�e reviej�ved
Pthe undersi ned am the owner of record or a�, .
I' g and belief that the information prop ided in this
. submitted, I state that to the best of my knowledge
the application herein submi _ .
• that the permit requested be issuede
application is true and correct and P to of issue if no work 1s begun or
will expire in six months, from the da •
Further I understand that the permit tended for six months if: no work is
. k has begun and that the permit may be ex
six months after the last inspection if `'4'or g e extended only throne times by
• •fin I understand that the permit may b
anticipated if I request such an extension in wri g
P
wt-itten request. I understand that once the permit expires a new application may be required, including fees and current
other requirements (including Zoning).
Name'
i g n a to re _ _.1 , �► _ .. - � � ,..s
- The✓ above .signature is my voluntary act and is signed under the pains and penalties of perjury.
N.
Date
P ;
• e Building Department'.' (please rind :-�-����- {•, r-
Who is authorized to pickup the p _*wit at the B il gp p
Phone
Address
1400 HOMEOWNER EXEMPTION - ONE & TWO FAMILY ONLY
FOR HOME OWNERS WHO INTEND TO PERFOR117 AND BE RESPONSIBLE FOR THEIR OWN PROJECT
109.1.1 Licensing of Construction SupervLsors: 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 BBRS entitled
Rules and Regulations for Licensing Construction Supervisors.
Exception: Any Home owner performing work for which a Building Per is required shall be exempt from
provisions rovisions 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 Owner" is defined as f, Ilows: 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 he, a one or two family dw, 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 you are applying under this section sign below: -
Signature
Your 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
2.1 5.? of section �)
16500 COST
Cost of Improvement
Items to be installed but not included in the above cost:
TOTAL
The following section for official use only.
INSPECTORS' REVIEW
Date plan reviewed
Electrical 5
Plumbing
HVA,C
Other'
COO
2 Alteration of existing, no increase in gross square feet. A separate Refuse Disposal De��laration required.
' ^ Demolition - describe structure
Number of dwelling units Number of bedrooms . A separate Rr.;'%se Disposal
1kr1 Pion Iequh-ed•
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
7-7 Re -roofing - (for'existing only, is included in new construction)
Number of square feet
Number of lavers when complete
A separate disposal declaration REQUIRED
Number of layers already exisi'flng
Replacement doors and windows - (for existing only) (only where doors and windows ea :xist and will not be
enlarged) EGRESS dimensions must be maintained. -Enlarged or new windows in an existfing dwelling will he
considered as an Alteration, otherwise will he included in new construction. (see Code see7tion 3401.10 for
residential and Article 8 for commercial),
Temporary scture - includes when allowed, trailers, tents and the like and only for limilted periods of time.
Describe
500 CONSTRUCTION PLANS
.._ None sulmitted. NVhv.
Submitted, usually three sets required. Four sets for food serviceluses. Number of seta; submitted
600 SITE PLAN
❑ Not required, why?
Submitted When? Previously, date -. With this application
i
700 ITTTLI'TIES
Water saPPS - required yno, public ? — yes r no, on site well? yes, w no,
q -es —
existing? . yes _ no
If required and not existing have necessary permits been issued? — no _ yes, 1 date
(M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a w -rater supply, when
required, is available. See Code 780 CMR section 114.1.2)
Sewage disposal - re yet no, public sewer yes no
� diPia required
private septic - on -site yes : no. Submit copy of permit as soon as availal:;le.
If
30 days to review period expires
OK to issue date
4.
Woodstove - used (will require inspection prior to installation), new (provide manufacturers
instructions). Location(s) (list)
Fireplace(s) - (includes flue) List location(s)
Game Court - describe (include overall dimensions)
Tent, Trailer (Mobile Home) or 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 (seeCode Section
304.0)
= Factory /Industrial - (see Code Section 305.0)
_ High Hazard - (see Code Section 306.0)
— Institutional - hospitaI, 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 (see Code Section 31J.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
D :.sthe 1 po. . briefly,INCLUDEt t tt 1dwe11 ' units t, and 1 bedrooms or occupant loadas applicable,
s •:tom condition
400 TYPE OF CONSTRUC ON 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
OK to issue subject to requested submittals (see project review worksheet) date
DENIED see project review worksheet date
u HOLD reason date
HOLD Subject to Zoning Board of Appeals action
Comments
Inspectors signature Date
Applicant informed of above - Date time staff hone iperson)
(fax, P � ill P )
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)
OFEICEUNSPECrORS NOTES
TOTAL FEE
Gross area - new construction Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit
0
FOR CONUKERCIAL ONLY
Will this project be subject to CONSTRUCTION CONTROL(over 35 000 cu.ft.) (If y
P J J Yes _ No. es
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
7
,AL AND Appp
Date of Application subtnissioa
� C
Plat �� Lof
Owner ,/"�/ / �
Owner snail address
01 A'aquifer Zone
Owner phone #
OTII£R INVOLVED .-AGENCIES -The following agencies re wire separate jurisdictional permit
s or approval for your
proposed project. fo?qTAC,T FOR REOUERMS7M O �
0 TAX COLLECTOR = Approved ` HOLD 'B ` D
t•
103 onservatlon Comm _ Approved By
P _ Date
_ e
Q D. P.W. water — Approved B�•
Date
Q D.P.W. sewer Approved By
Date
D D.P.W. cross connection = Appmved
Date
D.P. NN'. engineering - Approved
Date
II B )ard of Health well _ Approv
j Date
,.,II�3bard of Health septic - A,pPr-o
�D Date
0 Board of Health food service _ Approved
Date
aRE DISTRICT (I - II _ III = Approved
Y/
Date
C2 Planning Dept _ Approved
Date
()thc:r _ Approved
Date
0 t h e r _ Approved
t-'(,mments �.
Date
::::: t s s
Project summary new constructions aIteration1demo sewage _disposal - public1pirvate
[Alter. -add interior walls) [add roomsf [add footprint] water supply - publicr rtvate well
1pooll [garngefshedl [game courts rfood service
Describe
s:s its s:s:s
To the various departttients:
This notice has been forwarded to �•ou for •our ' o o . • inf tZaatton and anti appropriate action. Should you have any
questions P ease advise. If any reason to withhold the re wasted e u ai ! •'
4 p rmit is fo found. p ease advise. Your assistance and
cooperation is appreciated. .
The Buildirry Department
D3 -e sent for review f
By
_ 4
0.
9
TELEPHONE 508499anO720
,rnm � �t� ilr ��. i" I � 1 � ( ! }. E:, I D Imp)1 6��
10\
r4A.X- 508v1o9199w0738
} 1 3.40 2� I L_101);l
It Rim
li !)I A I
insamcelow •• co this application to the best of their ability prior to submission�'lenvin no item �� '�"ram• The
The applicant shall complete pp �.
Department staff will he available during regular' business hours to assist as necessary. NIA should be inserted for those sections
which do not a Iro eriv completed application will help avoid'unn delays. Kam'
PPv..-� P . P .
([or office � only)
AP!
Ncadon fee $ 4� received by � � � Date
Total Permit Few $ Permit #
o�
100 L6 'I'IO+I OF PROJECT
CID
�RltITT ACCESSORS' PLAT LOT ZONING DISTRICT
t THEI ZONING OVEJt1AY DISTRICTS , if applicable
now
��
i
4MBER & STREET
N'
-FRB-5T CROSS STRE
WV; ET
,..�
C"n, cr.,
St oDINI' SION NAME & LOT #
fh
or BUSINESS NAME
PREVIOUS TENANT i OWNER
00 MIDE - PROPOSED PROJECT - one & two famiIv residence oniy
= THIS SEC 1ON NOT APPLICABLE
= Sinde family - number bedrooms number baths
-' bedrooms unit 1
_ Two famtlti• - number be . number baths unit 1
number bedrooms unit ? number baths unit
P
Accessory a artnient Total gross sq. ft.*
.
_ Accessory structure
_ Garage - detached - attached to dwelling, dimensions L �
• -detached •attached to dwelling, dimensions L w
Carport
_
= Shed - dimensions L W
= Gazebo - dimensions L w
of above around m-ground Size total squar-e feet
_ Swimming pool v
= Chimney - # of Rues