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BP-30226FIRE STOPPING REQUE�lw�� T Pennetrutions thru rated malls and floors J hall b o TOIN OF sealed with a material capab!0 of rtsmi-Aing tics RECORD FIM l xt.ssagv of il�.mes and i Font gasses w en t, �bjeotocl � COPY This €� gr to the rvquirom.nnts of the Test Stem rc specific plat lwbfjit B for Mira Stops ASTI I-E-814. -up ruction Eft/ d PY ' w s SONO-TUSE SIZE PND DEPTH INSPECTION IS REQUIRED BE -FORE THE CONCRETE IS POURED. . BUILDING DEPARTMIENT NbM of Dartmouth El YOUR DRA141I G WST BF- I;ZPT AT THE BUILDING DURING THE PROGRESS OF THIS WORK, . I DEG DEPARTMENT FAR C40 �F SCALE. s �nr - ' �.,.t , 'Af�PROVED SY: � >" AAWN BY s- DATE: ORAWtNG NUMBEA � 01 FIRE STOPPING EQUIREMENI" Penetrations tier€.t reed walls cmd floors s ',iall b sealed with a mat"eri l cap le of preventii g the passage of flees and hot gasses when sulx)jeotad to the requirements of the Test Standard sqpwific for Fire Stops ASTAA-F-814. SONO-TuSE SIZEpj'4 i O ti rN ACTION IS R ®vIRED 01` 14 E C4dNGRETE !S POUR5a TOWN GFOARIMOUTH RECORD PLAN Copy Of This a FIB tiBe Kept Ca Site Burl vvltj0 VOUR °IUG MUST BE KEPT AT THE BUILDING DURING THE PROGRESS OF THIS WORK, VVILDING DEPARTME,,gT Tmm of Dert f \j I FIRE STOPPING REQLJIREMI-Nj Penetrations thrlu rated w,,;A's and floors shall be, sealed with a material capablo of preventing the palssage of flarnes and hot gasses when subjected to the requirements of the Test Standard gsWcific for Fire Stops ASTM-E-81 4. SONO-TUCE SIZE AND DEPTH WPECTION IS REQUIRED BEFORE VOUR DRAWING MUST BE 7 RI THE CONCRETE IS POURED. AT THE BUILDING DUNG E PROGRESS OF THIS WORK. BUILDING DEPARTMENT 1� j Tftm of Dmrtmo* MDING DEPARTMENT T-M-M Of NdMOVIh TOM" OF URTHOUTE RECORD PLAN A Celpy G1 This EreftUnd, FILE u0py Plan Murr'l Be Kept On site 3� 0 I % Site JA FIRE STOPPING F Penetrations thr, u. rated *vm sealed with a material cat, p,,.ssage of flames and hc.t to the requires i -*nts of th:: -E-811 4 for Fire SItopaA,,.STM - �,- r— _ O I m D rn rn� ` 'll o D m w �q m nrrl sg 00 o mo z oz I i 0 .o zD tom cl a . J p qY.# D.� -i - D f" Ul O 6� zro_ Z�F p:. rn CL v N ; O M o W A _ m rn �'aDtiw In o_g-� ,\ z coM,yo \ c� y° a Z� man— SLL�S or o� � 0 T v.}1 nvJ TOP rR ND, -- -- J, W r��'DITIat, 1 . tS M16QkD 10 ACC�DAOCC MT1 j I ELM 12,7' Z -, �� a f j t — Z fLa©t> Ri?s 571Vf fZ[r1i t Fu I STA-TE BUILVI'y FOR, ZOOZ A'�. T+1C (�'-6 w DC DXQ L04)i r S1 ALL LIEoT�1- QC- 0 , 2X b PT. SILL �X T-T�IFTLO ' NC g�kS3IkiD j` iJt 1� x1 �" ?ttg ,� `L i t EXIa"i 19 T,F. ti 0 1 t C 1 o toa s��n I � 3Cs �G11 `� `Z `7.,� T 5 k- , i �� } ! t NALL 'j ® ,,,+++���������jjj w'L- c -� �, >!; L C,�t.. GQ-ML S�i�l. - '� _o I t OD KA. nIJV ALL co 1�x T S q A LL. C TO i GQ 4> � a; �L1 1". SL.' 1�` 5A' . '�. M st K U�..a..+pjj t °c i Q %3o- . 1 Z 0 tiS?" .. x.,,. • ��. 5 TOP OF U&b - g �3?./ SJ w ? EUV, 3 0 0 *> VAJEL FILL Ji s - _-- - r .F L `/ J � � t� -R ��l � h�TOQ `� &L L CXP- Irv' h- A kV E Q I .ALL �}_ `.,18'Qj�R `•`T1,_'r -���';a���:'C�"C".���.��►J�, r i {¢ '905 L "f{ ii1 "e thl' 51-CTI N A -A sT�!javk\L EIOCJEZ, FCUK10 N' iVLN� - .10016q ."?LbDbwATF-Ex1T `Su! v]ALt tQJrbf0 , OF ktJr:LS TAP,T E 14 T�' � 1_ f 1 TOM4 Or- j / sDtFiff MsTJ7V1Dv,-,)5-t-)- -4-_. - s E< .� w �� f-- F L-, EC0t - j f c - it s =, » # Q K E\f L k)� .T1 - I" ' 1ST g�4 ----- -cam;mD, L' b- � 4. �5{��` A '�{-^ #j {p''�� yl�,{{p #. G Rt � -, �. RE S 11 ii d.-_. 7 � D I #. S 'ai f `4 j EC-M)g C—C, 4 0 FREDICK M. ON.<TMO. P A MASS,LAW r 24405 Dr. Frederick M. Law, P.E. JOB; it?10. 1 Structural Engineer 1 i 10 Swift Rd. So. Dartmouth, MA 02748 RSV f«.Z DlUCTnl l®T'PT A T . 2003 RF.CTT1F.1vTTT A T . " 2003 5 oY\lz�� �ilFtTiP\ 3 .��c a �- � � l ^� - 4 IN HOW - 2.1 Owner of Record: Name (print) Contact Address Phone Number 2.2 ATithorized Agent: �` ` Conta t Address Phone Number Name (print) {, g -E a ° IN 3.1 Licensed Construction Supervisor: NotApplicablez Licensed Construction Supervisor License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor: Not Applicable ❑ Are you a Home Improvement Contractor subject to (780 CMR-6)? ❑ yes ❑ no If no, go to the next section! Are you claiming exemption from the requirement? ❑ ,yes ❑ no If yes, submit the required affidavit! Company Name Registration Number (if none, state ❑ none❑) s Address SignatureTelephone Expiration Date 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 - Room 1301, Boston, MA 02108, (617) 727-8598 N1 Owners Name (print) Own�-1 Signature - by signing the above,.. e horde owner acknowledges dat there will be no eligibilty to the Guaranty Fund _ Date i 3.4 Homeowner Exemption - One & Two Family Only FOR HOMEOWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT 199.1.1 Licensing of Construction Supervisors: Except for those structures governed by Construction Control in Section 116.0, 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 buil&ngs 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. from the provisions of this section provides that if a Exception: Any Homeowner performing work for which a Building Permit is required shall be exemptp , p Homeowner engages a persons) for hire to do such work, that such Homeowner shall act as supervisor. For the purposes of 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 to be, a one or two family dwellin¢, attached or detached structures accessory to such use and/or farm structures. Aperson who constructs more than one home in a o-yeahperiod shall not be considered a Homeowner. If you are applying under thi e o si be cy . f Signature: Your signature carries cer ain responsibilities, including but not necessarily limited to, general liability E To LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that any licensed Construe.,'tron NOTIC i Supervisor, whether or not they have taken the permit are responsible for code compliance. (see Appendix of 780 CMR R5.2.15) EM_eft f a P 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 9 �_ m :e .. ❑ alteration ❑ repairs ❑ chimney/ ❑ wvoodstove ❑ new construction* X(ene gaddition (energy report required) rgy report required) fireplace ❑ deck ❑ pool ❑ accessory bldg. ❑ replacement window/door ❑ other o (demolition (shed/garage) no. of windows_ doors_ (specify below): (sp)ecify below): * If new construction, please complete the following: 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 Brief Description of Proposed, Work: US Sk Item Estimated Cost ($) to be completed by permit applicant_ ,-' 1 Rnilrina �. Flertrirnl, 8 Phimhina d Mrchnnirnl (14VAC') -� 5. Total = (1 + 2 + 3 + 4) * Estimated Total $ G%�z d : (Please print) 1 , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date - '.. r �� -1 m � m NN ` ., .�. Owner/Authorized Agent hereby declare that the statements anru information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pal and lties of perjury. cDtt' Signature of Owner/Authorized Agent C:\bldg.forms\Bldgapp.res.wpd Page 2 Rev. January 1; 2003 C:\bldg.forms\Bldgapp.res.wpd Page 3 Rev. January 1, 2003 RESIDENTIAL 2002 -RESIDENTIAL 2003 ❑ FOUNDATION ONLY ❑ FOUNDATION ONLY $25.00 APPLICATION FEE IS NOW -REFUNDABLE & NON -TRANSFERABLE $25.00 APPLICATION FEE IS NON-REFUNDABLE NO-TRANSFERAR'LE WIN s :w m u 1. Date plan reviewed: Z11103 2. 30 days to review period expires: 3. OK to issue date: 4. OK to issue subject to requested submittals (see project review worksheet): Dater 5. DENIED (see project review worksheet): Date: 6. MOLD reason: Date. . 7. HOLD subject to Zoning PP Board of Appeals action: Date: 8. Comments: 9. Inspector's Signature: - Date.• te'_=tom:.. ,._+.' A lr n ca t mfo e of abo� D t . pp Time: � Clerk. Cornments: Zell& i mo ' j^�'���" A,- a" v ,m L /f� Total Permit Fee: $ Less Application Fee: $ 25.00 PP Remainin Balance: � J??�� g $ � t-/ TOTAL FEE: 5VI t�� Gross Area - New Construction total s . ft. ! q Gross Area = Alteration . totals ft. q Pertnit Issued To: j % ..,,. ,. .,v,.... DARTMOUTH BUILDING DEPARTMENTT4 O N1 j.z 400 Slocum Road, P.O. Box 79399 SyYZ Dartmouth, MA 02747 1664 ' •.. 508-910-1820 FAX 508-910-1838 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING ina kN PE,KJ ,.��'"'. , Y ME- .�._ �,, Who�` °, .: "".. ,; a.w...« tl"'', :.. a.:OF �;!d'...."'„ram -' u.�., a' ;IIV, I�.§.:,3 SLL'd h5-rt" rz1,+,, r..., " :?x i' F a ,,, .s: �' fit" �'.a .. i;; '- „ .. " m - x , . 5 'tl: u �x .��, :� _� �xs a wx - i� •4, 5+�J eKa� ,wrN §�A§ Ors - = 3 ��•,r ?Yen '�,I ', °e,•raM � "=�" mr� a" '� *'��r. v 5, '�_ § .:C� r�?'L"e, "'Wc .: — ; - =:e �w n ,P w, :,. ,: „§ r,n::s:s ;ti,Y.I m r. .r r•.r, - I °d� 'h�,§" � -.:: ti;; _§� � a,w�.v' e��&, - _ 4 - 'a;,,w� �i5'�,' _ � 5 ,;� , s �j r , 4 v N.0 a , u ' ar: ' a " @, a+aa�-,rl:.,. �Y, { _ _: .��i Wit,.: x i ", " ::, - :a ,u.. ';5,9` •§:v 'fir _ - j �sr 2.. "�i4 _ 'x �" Ate* v � s 5 n: § a a ixa �I (° pi �„�:'( L ®' v-onnno.�� "'a v a, 5:' . ,•. ,:�i3a"�Y _ _ u " F DE AT PR = _mql yam �, •. Zoning Review: c%/ Signature:- ✓ Date.°1� t Energy Report: Signature: Date:' Fire Chief: Signature: Date: t f — o _ Board of Health: Signature: Date: Conservation Commission: Signature: Date: Other: Signature: Date: t Description of work being performed: 1 cT S - 'w NUMBER OF PLANS SUBMITTED: SITE PLAN SUBMITTED:, yes ❑ no ` �Y 1.2 Assessors Plat & Lot Number: 1.1 Property Address: Plat fV0 Lot ���t� Nearest Cross Street: r(� Ll F vt 4, 4U 1.3 Historical District ❑ yes P/no Subdivision Name: Total Land Area Sq. Ft.: Has application been submitted to the Histories Commission? ❑ yes ❑ no Date: 1.5 Sewage Disposal System: 1.4 Water Supply (MGL c 40 § 54)` Municipal ❑ Private Well // ElMunicipal VOn Site Difsposal System C:\bldgJorms\B1dgapp.res.wpd Page 4 Rev. January 1, 2003 C:\b1dg.forms\B1dgapp.res.wpd Page 1 tRev. January 1, 2003