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Building Permit Application
TOWN OF TISBURY
BUILDING INSPECTION & ZONING ENFORCEMENT
POST OFFICE BOX 1239
VINEYARD HAVEN, MA 02568


Kenneth A. Barwick - Rhonda DeBettencourt, Phone (508) 696-4280, Fax (508) 696-7341
 FEE:  ____________

OTHER PERMITS/APPROVALS REQUIRED:

BOARD OF APPEALS:  _______________     PLANNING BOARD:  _______________

BOARD OF HEALTH:   _______________     CONSERVATION:  _______________

FIRE DEPARTMENT:   _______________     HISTORIC DISTRICT:  _______________

MARTHA’S VINEYARD COMMISSION:  ______ SITE PLAN REVIEW COMMITTEE: _____

************************************************************************************
PROPERTY OWNER:_______________________________________________________________

MAILING ADDRESS:__________________________________________________________

TELEPHONE:_______________________________

PREVIOUS OWNER IF PURCHASED WITHIN 1 YEAR_____________________________

APPLICANT NAME:________________________________________________________________

MAILING ADDRESS:_______________________________________________________

TELEPHONE:________________________________

PROPERTY LOCATION:

STREET:  ______________________________________________________________

ASSESSOR’S PARCEL:  _____-_____-_____     ZONING DISTRICT:  _______________

DATE OF DEED TO OWNER:  _______________  BOOK:  __________  PAGE:  __________

DESCRIPTION OF CONSTRUCTION ACTIVITY:
__________________________________________________________________________
__________________________________________________________________________




DIMENSIONS:  _______________(LIVING AREA)     SQUARE FEET:  _______________

NUMBER OF EXISTING BEDROOMS: __________    BATHROOMS: __________

NUMBER OF PROPOSED BEDROOMS: __________    BATHROOMS: __________

DISTANCE FROM WETLANDS, BOG, MARSH, BEACH, OR BODY OF WATER:        __________

BUILDER:     _________________________________________________________________

MAILING ADDRESS:  ___________________________________________________

TELEPHONE:  ___________________________________

CONSTRUCTION SUPERVISOR:  ______________________________________________

MAILING ADDRESS:  ___________________________________________________

TELEPHONE:  ___________________LICENSE NUMBER________________

ESTIMATED COST OF STRUCTURE:________________________________

(MATERIAL & LABOR)  PLANS REQUIRED (3 SETS EACH):

A.  PLAN OF LAND REQUIRED FOR NEW CONSTRUCTION OR ANY CONSTRUCTION OUTSIDE EXISTING PERIMETER OF STRUCTURE*

B:  DETAILED BUILDING PLANS INCLUDING DIMENSION LUMBER, INSULATION VALUES, MATERIALS TO BE USED, ELEVATIONS, SECTIONS, ETC.**

C.  APPENDIX J (ENERGY AUDIT)

*All such plans and computations shall bear the Massachusetts Seal of Registration and signature of the qualified Registered Professional Land Surveyor.

**All building plans must comply with 780 CMR Building Code.

This application will not be processed unless it is deemed complete including attachments as required.
-------------------------------------------------------------------------------------------------------
Signed under the pains and penalties of perjury.

Signature:  OWNER___________________________________________________________________

APPLICANT________________________________________________________________

*************************************************************************************
OFFICE USE ONLY
APPROVED:__________    DISAPPROVED: ___________
COMPLIES WITH ZONING BYLAW SECTION: _________________________
PERMIT NUMBER: ___________________ 
DATE OF ISSUE: ___________________________


_________________________________________________
SIGNATURE OF BUILDING INSPECTOR




APPLICATION FOR:  ATTACHED___  DETACHED___  TEMPORARY STRUCTURE___

NEW - DWELLING___  GARAGE___  SHED___  OTHER_______________

ADDITION TO - DWELLING___   GARAGE___  SHED___  OTHER_______________

BUILDING TYPE (SELECT ONE):

BUNGALOW___   CAMP___   CAPE/SALTBOX___   COLONIAL___   COMMERCIAL___(see Page 4) MODERN/CONTEMPORARY___  
TWO-FAMILY___ RANCH___  RAISED RANCH___  
SPLIT-LEVEL___  OTHER_______________

STRUCTURAL DATA (MUST BE COMPLETED FOR ALL BUILDINGS):

A.  FOUNDATION TYPE                                                      B.  FOUNDATION

CELLAR___                                                                           BLOCK___

CRAWL SPACE___                                                               POURED CONCRETE___

OTHER__________                                                               OTHER__________

C. EXTERIOR WALLS (SELECT ONE, UNLESS THERE ARE EQUAL PROPORTIONS OF TWO)

COMPOSITION/WALL BOARD___                                    WOOD ON SHEATHING___

ASBESTOS SHINGLES___                                                   STUCCO___

BOARD & BATTEN___                                                         STONE ON MASONRY___

BRICK ON VENEER___                                                       BRICK ON MASONRY___

STONE ON MASONRY___                                                  CLAPBOARD___

VINYL SIDING___                                                                ALUMINUM SIDING___

CEDAR OR REDWOOD SIDING___                                   WOOD SHINGLES___

GLASS/THERMOPANE___                                                  PREFAB WOOD PANEL___

PRE-FINISHED METAL___                                                  CONCRETE/CINDER___

LOGS___                                                                           OTHER_________________

D.  ROOF TYPE (SELECT ONE.  IF MORE THAN ONE, CHOOSE THE PREDOMINANT)

FLAT___  SHED___  GABLE/HIP___  SALTBOX___  MANSARD___  GAMBREL___

E. ROOF COVER (SELECT ONE.  IF MORE THAN ONE, CHOOSE THE GREATEST AREA)

ASPHALT___   WOOD SHINGLE___   CLAY OR TILE___   SLATE___

METAL OR TIN___   ROLLED COMPOSITION___   BUILT UP TAR/GRAVEL___

OTHER____________________

F.  INTERIOR WALLS

MASONRY___   PANELING___   PLASTER___   WOOD PANEL CUSTOM___

DRYWALL___   OTHER__________________

G.  INTERIOR FLOORS (DO NOT COUNT KITCHEN)

PLYWOOD___   PINE OR SOFTWOODS___   TILE___   HARDWOOD___

CARPETING___   PARQUET___   LINOLEUM___   VINYL___   OTHER_________________


H.  HEATING FUEL                                                               I.  HEATING TYPE

WOOD/COAL/KEROSENE___                                NONE___

OIL___                                                                        CONVECTION___

GAS___                                                                      FORCED AIR - DUCTED___

ELECTRIC___                                                            FORCED AIR - NON-DUCTED___

SOLAR___                                                                 HOT WATER___

STEAM___                                                                 RADIANT ELECTRIC___

J.  AIR CONDITIONING

NONE___                               CENTRAL___                                    HEAT PUMP___

K.  OTHER DATA

NUMBER OF STORIES:___              NUMBER OF FIREPLACES/WOOD STOVES:___

OTHER SIGNIFICANT FEATURES IF ANY:__________________________________

**********************************************************************

ADDITIONAL DATA (FOR COMMERCIAL BUILDINGS ONLY):

A.  HEATING/AIR CONDITIONING

PACKAGED___                                 SPLIT___                    NONE___

B.  STRUCTURAL FRAME

NONE___   WOOD FRAME___   MASONRY___   STEEL___                 

FIREPROOF STEEL___   REINFORCED CONCRETE___ OTHER__________________

C.  CEILING & WALL (CHOOSE ONE FROM EITHER SUSPENDED OR NOT SUSPENDED)

SUSPENDED                                                  NOT SUSPENDED

CEILING ONLY FINISHED___                    CEILING ONLY FINISHED___

CEILING WITH MINIMUM WALL___        CEILING WITH MINIMUM WALL___

CEILING & WALL FINISHED___                CEILING & WALL FINISHED___

D.  OTHER DATA

NUMBER OF ROOMS PER FLOOR___   WALL HEIGHT___

PERCENT OF COMMON WALL___   TOTAL NUMBER OF RESTROOMS___

IF RESIDENTIAL UNITS:

NUMBER OF UNITS___   BEDROOMS PER UNIT___   BATHS PER UNIT___


=======================================================================

WORKMAN'S COMPENSATION INSURANCE APPLICATION


COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF INDUSTRIAL ACCIDENTS
600 WASHINGTON STREET
BOSTON, MASSACHUSETTS 02111

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Town of Tisbury  51 Spring St., P.O. Box 1239, Vineyard Haven, MA 02568  Phone (508) 696-4200
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