Loading...
BP-17514RESIDENTIAL 2000 RESIDENTIAL 2000 ❑ F'OTINZ?ATIONOIVLY $25.00 APPLICATION FEE IS NON-REFUNDABLE & NON -TRANSFERABLE 1. Date plan reviewed: /U / U 2. 30 days to review period expires: 3. OK to issue date: 4. OK to issue subject to requested submittals(see project review worksheet): Date: 5. DENIED (see project review worksheet): Date:_ 6. HOLD reasor Date 7. HOLD subject to Zoning Board of Appeals action: Date: 8. Comments: 1 9. Inspector's Applicant informnn�d above D/ate: (J (l Time: Clerk: Comments: (/ �t n SECTION�11 OFF,10EIINSPECTOR!$I\OTES Total Permit Fee: $ f 42 9. W Less Application Fee: $ 25.00 Remaining Balance: TOTAL FEE: �` 00 Gross Area - New Construction total sq. ft. 1374 4v Gross Area - Alteration total sq: ft.// "�� /J t � X.(�L.rC.17 0, /" XM� lXe Permit Issued To. k +�� /�/ dg� �/�J-� 3o jr os a' s�8.OQ / I ob - % A a OQ A, id Y C0.1 `DATE RECEIVED DARTMOUTH BUILDING DEPARTM400 Slocum Road, P.O. Box 79399 Dartmouth, MA 02747 u`ft[,n b 508-999-0720 FAX 508-999-0738 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Zoning Review: Energy Report: Fire Chief: - Board of Health: Conservation Commission: Description of work being NUMBER OF PLANS SUBMITTED: Signature: Date: Signature: Date: L I Property Address:_ 116 NJZ& a "bi 9LNIN A@� Nearest Cross Street: 9ry17-{ Subdivision Name: Total Land Area Sq. Ft.: 1.4 Water Supply (MGL c 40 § 54): ❑ Municipal X Private Well SITE PLAN SUBMITTED: ❑ yes ❑ no 1.2 Assessors Plat B Lot Number: Plat Lot 1.3 Historical District ❑ yes Ano Has application been submitted to the Historic Commission? ❑ yes l;Kno Date: 1.5 Sewage Disposal System: ❑ Municipal ,fit On Site Disposal Syste C:%blde.forms\BIdeapp.res.wpd Paee 4 Rev. January 13, 2000 a� C:\blde.forms\B1deapp.res.wpd Pan I Rev, Janu, T4 RESIDENTIAL 2000 RESIDENTIAL 2000 SECTION �-PR4PERTrU4WER3FTtPfatl'f1on EbACE?VT 2.1 Owner of Record: /11 S guzp_&— iD A6. Name (print) Contact Address Phone Number 2.2 Authorized Agent: t�hyi,o ,9p 0AR-Z77 A 4 17 lJC �friJ ULr 99Y--s Name (print) Contact Address Phone Number i(\B C f 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor _ fFtltle 8P UAO License Number O / ,2 yS`L. Address [� Jte o Expiration Date l— /_ O 2' SignatureU F Telephone cT%z 3.2 Registered Home Improvement Contractor: Not Applicable ❑ Are you a Home Improvement Contractor subject to (780 CMR-6)? Ages ❑ no If no, go to the next section! Are you claiming exemption from the requirement? ❑ yes •R-no If yes, submit the required affidavit! Company Name 7Ql.V7— T Registration Number (if none, state "none") Address c Signatur— Telephone r Expiration Date S / %— tlly z 3.3 For Residential Remodel Work Only • PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND: QUESTIONS OR COMPLAINTS call or write: Home Improvement Contractors Registration, One Ashburton Place - Roam 1301, Boston, MA 02108. (617) 727-8598 Owne Name (print) Signature by signing the above, the home owner acknowledges that there will be no eliamilty to the Guaranty Fund Date 3.4 Homeowner Exemption - One & Two Family Only FOR HOMEOWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT 10 ..1 Licensing of Construction Superxisors: Except for those structures governed by Construction Control in Section 116.0, effective July 1, 1982, no individual shall bee aged in directly supervising persons engaged in construction, reconstruction, alteration, repair, removal or demolition involving the s[me[mal elements of buildings or truc[ures, unless he or she is licensed in accordance with the rules and regulations promulgated by the BBRS entitled Rules and Regulations for Licensing Construction pervisms. Exception: Homeowner performing work for which a Building Permit is required shall be exempt from the provisions of this section; provides that if a Homeowner engages a person(s for hip: to do such work, that such Homeowner shall act as supervisor. For the purposes f this section only, a "Homeowner" 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 be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a twoat period shall not be considered a Homeowner. If you are apph ing under IN 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 Appendix of 780 CMR R5.2.15) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached: -*Yes ❑ no ❑ new construction* addition ❑ alteration ❑ repairs ❑ chimney/ ❑ woodstove (energy report required) (energy report required) fireplace ❑ deck Cl pool ❑ accessory bldg. ❑ replacement window/door ❑ other demolition (shed/garage) no. of windows doors (specify below): (specify below): * If new construction, please complete the following: J. Single Family: no. of bedrooms no. of baths Two Family: no. of bedrooms unit 1 no. of baths unit 1 no. of bedrooms unit 2 no. of baths unit 2 ❑ 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 1 L Brief Description of Proposed Work: I:p Item I Estimated Cost ($) to be completed by permit applicant e127 15. Total = (I + 2 + 3 + 4) I * Estimated Total $ 1 ?,S COu. -� (please print) I, R1 kt:s&& ar- L r s as Owner of the subject property hereby authorize i, tN � r4,,,u vim. to act on my behalf, in all matters relative to w�jauthorized by this building permit application. 4'a "C�� X T�L \ 9h��D� Signature of Owner Date�� 1, "A..' I cam. , ru o ? 1. , as Owner/Authorized Aget,t hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Agent 9-13-er6 `,rms\Bldgapp.res.wpd Pagc 2 - Rev. January 13. 2000 C.',blda.forms\Bldgapp.rex wpd Paec 3 Rev, January 13, 200n r j - (LLL444g3bb i ���� f 5 -e�,1 A-c'T I1 h a r^ rz. v t�1 !"tea F��V � t2/<'rIe5lN PL- �4 Penetrations t j rated wells and floors shall be sealed v✓ik.h I tat�-rial capable of preventing the passage of fl 3rr sand hot gasses when subjected to the reaulr�4lants of the Test Standard spccific for Fire Stop F,STIM-E-814. SONG-TILY 7 SIZE AND DEPTH PR CoN'Q3iticEt*d SPEOLRREDa=FORC Nrn i. —1117c Rept (;te Sip, THc'Cor:'METEISPOURED. Dvri�7 �rO "`!- cfi67 BUILDING DEPARTMENT Tam cf DIrtmlluth YOUCt DRA WING WUST B=_ KEPT AT THE BUILDING DURING THE r� PROGRESS OF THIS WORK kLMIMING, rjEPj1,rj-r?,j=MT p. pp R [ f -n .Z4 �►�� phi �- 2-f3flo" Ij II I� �cj Wp L. I. AP, l I 7 1 72'; :�'L-� 101--,-2, ' r'e?✓I, 1DA'1IC7i C - A-r klh. LL. Q.>E- F7- 1A I1��11 II �I �I L f I TP,Ir,Lr� z�-.1© , i - GN.c.Nc�F.. �lrff% Ta.n��1041• FIRE STOPPI-NG RE'.YJ1R&Aa-,T Penetrations thru rated wa?is and floors shalt be sealed with a material capable of preventing the parsszge of flames and hot gasses when subjected to tho requirements of the Test Standard specific for Fire Stops ASTM-E-814. Ct t E i'u" rCPt Ca Site YOU.-i DP^." iNO VXT EE KEPT AT rviz OUILDING DURING THE ri.3...r m Or THI j WORK, CU:I.DING MPARTMEr•IT Tarn of Dertmouth 1 i� I &OND-TV`7 SIZE MID DEPTH l D .-O I"^PECTION IS REQUIRED @EFOR`c W.'CRETE IS POURED, r r {, I DEPARTMENT E F [ S. Town of Dartmou!h 1 y I i 6 1 ! I I i ! 1 0 d.ST7RPRENANT f II 1 280 ELM STREET SO. DARTMOUTH, MA 02148 TEL. 508 997 5853 ARCHITECTURAL DESIGN murns 0 LD R�M-L {� D�-D t4 2z ILI,-< -a }- 2X �r o � LD x q ,Y .. �f�ti 3YY GIrA N'• ? �p � �LoSE�i'3 00 0 m J .tO' k4Iwr- h J qHY�yf t O O f _ i �... !�TNGpFVAt... Atz� 5� r r----- I d- I L..4 f t V '� • 52 I/p N .4,X : ' SO`JD.Tik"" SZE A°:7 VEPTH WrI77CTION IS REOLVEED BEFC!IE THE CONCRETE IS POURED. BUILD' O DEPARPIENT Tam of Dartmouth YOLri DFAYING ►NST BE KEPT AT TH7 PUILI)MG DURING THE Pr.�W=S OF THIS %1?OP;. Tvm of D?,�Inoffi:i /4 8 !!TPI fa Ca" Q' 04 Th1; E r d c Pi^ri Vurl Co I:EI: Ga Site FIRE STOPPING REQUIREMENT PenetraVons thru rated walls and floors shall be soaled with a mterial capable of preventing the pac -age of fames and hot gassas whon subjected to tho requirements of the Test Standard specific for Fire Stops ASPA-E-894. idle# $P,®li DETECT6 S - CEILING MOTHTED 0!11Y. L,•j� i ����H� 1 a I 1 d.SURPRE.NANT t 280 ELM STREET SO. DARTMOUTH, MA 02748 TEL, 508 997 5853 ARCHITECTURAL DESIGN I � TH EL.r, PI TIvt�l I fllRE SnPFIr G P.�q REp.E,EmtT -lall bn the atfi'1jec ed to tfle real ra7 ents of tho 'rest Sta:,durd specific `for Fire Stops ASTAl-E-914. - ii" '€ "` ',-ATE` II Er- 4E I N-J." lw.t4..V Pin Mill Cc I'ept On "Mr, YOU;'l w- y-n msT Eli KEPT AT TH'E mILDING DURING THE OP THIS WORK. EMLDING DyPAFrMEr4T Tavn Of Dartma;:!h SO.NO-TUI^ SIZE AND DEPTH IN'3PECTIO'1 IS REQUI1170 EEFORE THE CONCRETE IS POURED. LUIL DING DEPARTA",=_NT Tom of Dartmouth A I w _t~f l t7 N51 terra, i7�:��to Vt°(k�!i d.SURPRE NAliT r 280 ELM STREET SO. DARTMOUTH, MA 02748 TEL. 508 997 5853 j ARCHITECTURAL DESIGN 2x(o ova-!'i f f•.I�t.�`�'.��' �Z.,,t�c�-•C� �!F %..f''i-� PLYw ocat� 5t�13�R. C> e w /��;^�"'.'^'�'iFlcf'I•*J `. I��--�'f'.'-»-`�`'✓I�i �"i. i! ��Ga�I"�r l"* b�c _I y So".'O-TUff- SIZE AS.D DER,, 4t►^.•"Ir 2 �.i E KFFT IFC" ?ECr0N IS RFOUIR`:D B€fC A".: is E ''' DIY3 DURgT'P'G THE THE CONCRETE IS POURED. OF THIS AnRK. SUILDIN , DEPARTMENT ruF DING D_'-PARTMFNT Tm-n o`. Darl-neu:h \ � Ta•m of Dartmouth IJIM r1,rn f t E' hll- d Ze•) Sii4• D�rir G^ �'rre`�or: 17 lal'c�x p�`'Yl p e' t 'CMlts�n. •:I�1 IN��Il�f1�'� • FlI�E SfGf't`si%?� RF.�fJR MENT Pen.trations thru rated waft and roofs £h," b? Scaled viith a material capah'e of prev,? Iting 't`nia pa.sage of flames and hot gasses when subjected to the requvements of the Test Surd--fd specific for Fir-- Stops ASTMJI-E-814• i I 1 I t P s� ' f I� i a � li i �1 M 15� -i It -TM,} F70 I PN r i� R 1 I(F{ I f { { C� II I ,i l� D I v d.SURPRENANT Jt 280 ELM STREET SO. DARTMOUTH, MA 02748 TEL. 508 997 5853 i ARCHITECTURAL DESIGN 1 t2etA�L.-�'- t 1 . FIRE STOPPING REOUIRVIIEN T Penctrations thru rated walls and floors sh-all be sealed with a material capnb.c of preventing the passage of flames and hot gasses when sub p-'�cd to the requirements of the Test Standard specific for Fire Stops ASTM-E-814. g01;0-TU"_"� SIZE AND DEPTH Y')ljT D eytltlG X10ST BE KEPT ti. cECnON I REQUIRED UEFOrIE t:7 THE BUILDING DURING THE. FjE CONCRETE IS POURED. F .Y OF THSS WORK. \ WILDISls DEPARVAENT rU'LD:"1 DEPARTP-A W Town of Dartmouth Ton of L'ar;:� or t'• !.( F I L; t CQ;+, t'"t rn vxpl on Sit a E 2 r I 4 ! d.SiJRPRENAI'd'f' t s t� I ` 280 ELM STREET SO. DARTMOUTH, MA 02748 TEL. 508 997 5853 ARCFIITECTURAL DESIGN