BP-839= Furnace (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify)
= Bolter (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)
_ Atone of the above to be provided
— Hot Water
Gas Electric
Fuel Oil
Other
900 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?
1000 REQUIRED OFF ET PARKING - for ZONING & Architectural Access
— NOT A.PPLI C,AB LE
_ Parking Plan submitted To = BuiIding Department = PIanning Board Date submitted
Number of spaces - indoors outside total provided
Handicap spaces - required yes _no. If yes, how many as a part of the total required number.
Is Route 6 (State Road) Entrance permit required? Ves _ no =. If ties has it been issued ves - no
Submit copy of application and/or permit as soon as available.
1100 IDENTIFICATION (print or type except as noted)
Current owner - name .� bcsoC�
..°
address
phone
C)t1 v �Ll_(a �J
If corporation, officer in charge
Architect/Engineer overall design
Company name
Address
Phone number
Certified by State of Massachusetts as
Certification number
,NOTE Signatures and seals on aII 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 S BE originab -and not
Ng
rwwwA�••Ar1AN!'
General Contractor (if Homeowner, state homeowner here then complete section lsuu)
C, U
*�?CN6\s
Company name lv,-- W 0�dLv voo�-
Address
Phone number
Constr
uction Supervisors license number
ans. affidavits and other documents S 13 origina s3
NOTE Signatures and seats on all nl and not
reproductions.
120() FOR RESIDENTIAL REMODEL WORE; ONLY
- 6 ?Yes No If no gQ) to nett section!
Contractor subject to (780CMR)
Are you a Home Improvement
' � es No If es, submit the tequila ed affidati•it!
• exemption from the requirement. Y _ Y
Are You claiming
Remodel contractor name
Address
lease Print)
Registration number (if none state "none")
Phone number
CONTRACTORS DO NOT HAVE A�^CES S TO THE
. ING `'WITH UNREGISTERED
PERSONS CONTRACT'
GUARANTEE FUND! QUESTIONS OR CON1PIjAINTS call or write:
Home Improvement Contractors Registration
One .Awshburton Place - Room 1301
Boston, :MA 02108
(617) 727-8598
Owners name (print)
Signature
Date
1300 OWNER SIGN - OFF .
documentaon) an�j I have reviewed
I, the undersigned, am the owner of record or authorized lessee (provide
knowledge and belief that the infot-�aatiorrl provided in this
g
the application herein submitted. I state that to the best of my
• the ermit requested he issuedo application is true and correct and that permit 'sue if no T�,�ork is begun or
will expire in six months, from the date of is
Further I understand that the permitmoths i f no work is
d that the permit tray be extended for six
six months after the last inspection if work has begunano ; three times by
• d to d that the ermit may be extended rr Iv
s
• a extension in wt-iting• i un era n
anticipated if I request such n
est. I understand that once the permit expires a new application may be required, including fees and current
written req. u P .
requirements (including 7oniag) '
other req •
Namei\
g
_ ►.,
r
Signature
e above signature is nv erY
ta act and is signed under the pains and penalties of per jury.
300110�
D a to
1400 H
OMEOWNER EXE oN - ONE & 'IWO FAMILY. ONLY
FOR H®]NiE OWNERS WHO HO INTEND TO PERFOR I AND BE RESPONSIBLE FOR THEIR OWN PROJECr
�
of Constriction Superiors: Except for those structures governed by Construction Control
I
� i
•n Section i...7 .0• effective JuIv 1, 1982, no individual shall be engaged in directly supervising persons engaged n
reconstruction. alteration, repair, removal or demolition involving the structural elements of buildings or
construction. r P
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.
EsceP tlon:.env Home Owner performing work for which a Building Permit is required shall be exempt from
_
the provisions . • s of this section: provides that if a Home Owner engages a person(s) for hke to do such work ,that such
Home owner shall act as supervisor.
purposes For ur
the oses of this section oniv. a "dome Owner" is defi:-ed ab follows: Person(s) who owns a parcel of ?and
• e resides or ;_tends to reside. on which there is, or is intended to he, a one or two fa►nily dweiIin�, attached
on which he., sh
structures accessory to such use and/or farm structures. A person who constructs more than one home in
or detached �
two-ti•ear er. iod shall not be considered a Home Owner.
91
P
If you are npP I`'ing under this section sign below:
Signature
Your' signature tarries certain responsibilities, including but not necessarily limited to, general liability
� g
N 4'I'I CE TO LI
e'ENSED CO CI'ORS: The BuiIding Code provides in the Rules and Regulations section that any
licensed Cons P
• truction Supervisor. whether or not they have taken the permit are responsible for code compliance. (see
2.1; . 1 of section 5
1 iqoti COST
Cost of Improvement
Itern.s to he installed but not included in the above cost:
TOTAL
The followinz section for official use only.
INSPECTORS' REVIEW
Electrical 5
Plumbing
HVAC
Other
.+ F w�
f
9
Date plan reviewed -
40
—
Alteration of existi• •ngno increase in gross square feet. A separate Ketuse juislios� Lr=�a�►��.
,
f.
DemoUfion - describe structure .
. A se to Refuse Disai.
units Number of bedrooms Pam
Number of dwelling .
UAI.bi &0. 1 rt I ITO I W %_T�
—'
Mom -(Provide coPY of D.P.W• moving license)
from where (plat/lot or address)
Type of structure
to where (plat/lot or address)
Number of dwelling units Number of bedrooms per dwelling unit �_-
= Re-rroofmg - (for existing only, is included in new construction)
Number of square feet
Number of lavers when complete
Asparate e disposal declaration REQUIRED
p
Number of layers already existing
._ Replacement
doors and Windows - (for existing only) (only where doors and windows exist and tvrili not be
• • ' ed. Enlarged or new windows in an existing dwelling will be
enlarged) EGRESS dimensions must he maintained. rg .
g �
e included in new construction. (see Code section 3401.' .10 for
considered as an .Alteration, otherwise will b _
cesidential and Article 8 for commercial)
— ed trailers tents and the like and only for limited periQ�1?s of time.
_ Tem ra structure -Includes when allow
l� �
500 CONSTRUCTION PLANS
= None submitted. NVhv'
ervice�uses. Number of sets suhmitt�:�d
— c..t.....:4+r%A evc*In1it► *16f pN sets required. Four sets for food s
600 SITE PLAN
❑ Not requh-ed, why?
js•, •' date = With this application
ubmitted When? ..._ Previously,
700 U11LI'TIES •' '.
4
Water supply - required yes , public ' � yes � no, on site well. yes _. nM,
____• no
existing? — yes no
permits been issued? no •_ Yes � date
If required and not existing hate necessary P _— 1
. be issued unless a water sug�Ppiy, when
section 54 provides that no building permit may (M.G.L. Chapter 40, se P
See Code 780 CMR section 114.1.2)
required, is available.
Sewage disposal - required yes no, public sewer yes � no
• Submit co of permit as soon as available.
. _ _Site yes ____ no. S u to copy p -
private septic on -site
i
30 clays to review period expires
OK to issue date
pnor io IIISuum on), new pro
instructions). Location(s) (list):
Fireplace(s) - (includes flue) List location(s)
Game Court - describe (include overall dimensions)
e manufacturers
Tent, Trailer (Mobile Horne) or Other - describe
300 Co RCiAL - PROPOSED PROJECT/USE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES
OK to issue subject to requestea bUL)MiLuzii ksCV FL�� J--i . .--
Y Y
-"
D see project �•ect review worksheet date
date
HOLD reas o n
HOLD Subject b� e cg
t to Zoning Board of Appeals action
.�
Comments
Ins ectors si nature
{
Date
THIS SECTION NOT APPLICABLE — hone, imperson)
• above - Date time staff (fax, p
_. Applicant informed of abo .
i
descriptions are based on t State Building Code Article 3 AS NOTED(S-ee the
(The following p he Massachusetts S $ g )
Cade)
Over six months since approved for issue - DEEMED abandoned!
. - �
Advise applicanty
Hold 90 days for return then dispose if not picked up.
Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe
Inspector Date
— Business - office, assemblywith less than 50 occupants - indicate Medical or other professional(see Code _._.(byhone fax or in person)
P P
Advised applicant Date Time staff p
c 'on 303.0)PP
Se Section
— 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)
tI.
= 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)
OFFiCEXINSPECTORS NOTES
TOTAL FEE zv
Gross area - new construction
alteration
Permit is issued to
- _ _ Storage - includes garages (see Code Section 309.0) Comments/notes on permit,
�= = Utility & Miscellaneous Structures - includes tents and agricultural structures (see Code Section 311.0)
New tenant for an`• of the above, indicate above (see Code Section 119.0 and Zoning By-law section 35)
C Tent or Trailer - temporary purpose
- Other
' J ' 1 1 /1 Ia' ''� �!!1 • 1 1 �. 1 f �• / If �.b 1 •✓. 1 1 • /-✓.
•
400 TYPE OF CONSTRUCTION OR WORK TO ICE PERFO
J v New Construction and/or Addition - total gross square feet �bt)i r
1,01 1
(For commercial one total gross cubic feet) - indicate
It will be considered new construction if there an increase in square footage in addition to anv
alteration(s).
If project is an addition to existing structure - Total gross square feet of existing
= FOR COMNERCLAL ONLY
Will this project be subject to CONS MUCI'ION 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)
.APPLJCAW TO PROVIDE
Total Sq. Ft -
Total Sq. Ft.
CM'rr5WFM
8A[. AND APPROVAL .
Now
Dare ofAppiicadon submission TO W
N �JL DARTMOUT.0 "UM�1l1\�1;T'. �11�1.C1'#�1L1L�1�1S1S�y� 8
Plat _Lot _ s�� TELEPHONE 508=999mO720 ��: 508W999�Oi3�
Aquifer Zone
Owner
Owner mail address
_ APPLICA11�1V 1L�1L0 //��1VB1r10.SL''alLV11J� 11]7UI{ti,�/1LLV�ll8li�Ad.lvuab
Owner phone #
OTHER INVOLN'ED AGENCIES
The following agencies require se crate jUrisdictiOM21permits or a rova
Proposed ro'e�t, PP i for your
project. CoygTACT FORTJUMQNS.
9 TA COLLECTOR Approved ` HO -
LD. B� Date
r
Q C'Ons en•a don COMM Approved PP 8 v
• Date
a D . P. W. water — Approved B v
Date
a D. P. W,. sewer _ Approved BV
Date
CI D.P.W. cross connection :: Appmved
Date
13 D.P.V. engineering , Approved
Date
Q ()ard of Health well = Approved
Date
Board of Health septic ; Approved PP ed
Date
12 Board of Health food service
Approved
Date
9 FIRE D ISTRI C'I' ( I - II - III = Approved Date
Pla n n i n z Dept = Approved
Date
Other _ Approved
Date
c��h�•r _ Approved
Date
c •l imments
:si
::::a:::s:s:ssss:ss:sssss���s.��s��ssass:affi���aaassasss�s+rssssssssssssss:ss:ssssaa
sssrs�t�eszts��a�aaa��et��a�aa s
Pro Je�•t surrtmar�• new construction/ slter-a .
ton/demo, sewage disposal - cl ubli• .
P prlti ate
r.Altar.oadd interior walls] [add rooms[add.
� footprtntl water supply- ; •
public private Nvell
1pooll [g2rnze.#shedj [game court
[food serti icel
.Describe
rss:s::sa:ss:s::ssasarsaxrstasrssszaffi�zsar�raxsas�s�a��ra��sar�sst��rst��asssass�sasss:ssssssssas
��ss�s�tr�ta�raa�as�as�ers
Flo the various depat-ttaeats:
This notice has been forwarded to Vou for - .
your uzforzaanon and any appropriate action. Should you have a ti•
n
uestions please sd�►•ue. If any reason to withhold •
the requested per is fouad. Tease advise. Your .
000erstion is appreciated. P assistance anct
he S uildine Depart ent
Date sent for review
The applicant lication to the best of their zbilit prior to s 'oa.-alenv� no i{tzmm ��swere,& ''The
shall complete this apP Y P ancient stiff w• he available during
DeP � lar business hours to assist as necemmry:-HIA should be exerted for those sections
_ regul
�
which do Qot a v. c�� feted a i ation wiiI help avoid*1wn ddnys. � � f� �z � -
ppl_ •� properly p PP
([or office use only)
APPikation fee S � � received by 6 Dnte � 171f
l
TOUIPermit Fee $ Pit #
�J
lOt) LOCATION OF PROJECT �kq
CURREI'T ACCESSORS' PLAT
LOT
OTHER ZONING OVERIAY DISTRICT'S ,. if applicable
III' M B ER & STREET
ZONING DISTRICT
NE. -REST CROSS STREET
•
StIB D I N•ISION NAME & LOT #
or BUSINESS NAME
PREVIOUS TENANT f ONN74ER
200 RESIDE - PROPOSED PROJECT' - one & two family residence oniv
THIS SEC71ON NOT APPLIC&0LE
= Single family - cumber bedrooms number baths
Two a • _ bedrooms unit 1 number laths unit I
f tniiti number-
.
number bedrooms unit ' number baths unit ? -
= Accessory a P artiaent Total gross sq. ft:
— Accessor v structure
- Garage e - detached - attached to dwelling, dimensions L
-'
Carport cached - attached to dwellia dim
_ port _ de , ensions L $
= Shed - dimensions L W
= Gazebo • dimensions L W
(imnLwground
�,.feet
Swi in ool above ground Size tQi square
Swimming p
= Chimney - # of Hues
By