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DATE OF AERIACOMPLETION
PHOTOGRAPHY 3 - 29 - 69 TAX MAP MAP NUMBER
DATE OF COMPLETION I-�-8� TOWN OF DARTMOUTH
DATE of REmroNs - ate_ _ -- BRISTOL COUNTY, MASSACHUSETTS /I 4 445
LEGEND io B �o PREPARED BY -T-T
PARCEL NtWERS .........
MATCH LINE .°i ss_ __--- JAMES W. SEWALL COMPANY, OLD TOWN, MAINE
-.. - «r•r nl
o
- --1 f1 1
24'-0'
I ..
'_
24-0'
--------"'----------
oorrl. ridge vent
r----------------
5/8• shtg, over
I russes with -H' dips as-
- 12
required per tru
s manuf., IN feet paper
-7
p"dch to be
and roof ahingl
to match house as dose
verified
as possible
I
I I
I
N
rooIF trusses at 2'-(' ox.,
see manuf. tlrewings
4• concrete sla+ Wn.) on tl iYA. -
.
II
poly v.b. and 8'mmhBd akinB I
I
2 Car Garage
�—CoM. soffit Tern
I
I
I
.
- wall freights to be
2 x at 18' o.o.
_ §
,I
9
N
I
a•
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§
verified with owner
t 11
wftirl/2'&rtg„
I
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building paper and
-
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I a
a
'., Sj
v
aiding to match
ro
-
w
exl88ng house
a
-
-
concrete slab to be pitched
min. one 2 x p.t
I
I m
..
!
to overhead doors
ilp.tls
�slll with sill sealer
I
( drop top of%rd to top of finis
e'
I
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--------I i------.
Slab elevation at pass door
`
I
-
5' concrete slab on 8 mll. poly v.b. and
location of door to I
I
x
-
-
8' crushed stone, W.W.M. In concrete
footings to be min. 4'-0'
I
I be vertned with I
I~
N
'
optional
below finish grade
9
in
I
owner before -drop mf of ma at overhead
I pouring � doors K 8' balowMtah grade I
I
�
'v
I
I I I
I 9'-0'x8'-0•overheaddoor ( I
8'-0'x8'-0'overhead doar
Garage Section
-------
-------
o
Scale :1/4• =1'-0'
1'-g• g'-8' 1'$ 5-0- 1'-8'
I
6.
8'-8' -.r
11'-0•
g'.g•
24'-0'
-
Fi FI rst PI
Right Side Elevation
Scale: 1/4' =1'-T
Rear Elevation
Scale: 1/4' =1'df
or an
Foundation Plan- Scale: 1/4•=1'-0'
M
PECORM
A Copy of Thu; Erg 0MA
Pig E Must Be Kept Or
Dw irg ons wct.'o ?;
Dale
Left Side Elevation
Scale: 1/4• = V-W
Massano Garage
372, Lucy Little Road
Dartmouth, MA
Front Elevation
Scale :1/4-= T-W
RESIDENTIAL NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Re ulations section that an lice tl C
SECTION 2-PROPERTY OW NERSHIPIAUTHORIZED�AGENT
-,• - , -= _
2 Owner Record:
r I (l � o x l- s5 16
3?, - /_ u cy 41'�P f F.3 6.53Z
Name rint
�p ' )
Contact Address Phone Number
.2 Authorized Agent: ,
Name (print)
Contact Address Phone Number
SECTION ,3 = CONSTRUCTION SERVICES,,
3.1 Licensed Construction Supervisor:
Not Applicable ❑
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 claming exemption from the requirements? ❑ Yes ❑ No
If Yes, submit the required affidavit)
Company Name:
Registration Number (if none, state "none"):
Address:
Signature: Telephone:
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
b
I am a Homeownerperformingall the work myself.'
��
i V� J�) -S
tt�'wners Name (print): L?' t S I} A C
/ignature: 1,
`By signing the above, the homeowner acknowledges that there will be no eligibility to the Guaranty Fund
/ate-
3.4 Homeowner Exemption - One & Two Family Only
FOR HOMEOWNERS WHOINTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT
109.1.1 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 buildings
or structures, usdless 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 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 hire to do such work, that such Homeowner shall act as supervisor.
For the of this section purposes o onl ; a "Homeowner" is defined as fol
lows: 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 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 two-year period shall not be considered a Homeowner.
If you are applying under this section sign below:
A%
Signature: , 'm 4 P S un -1,
Your signature carries certain responsibilities, including but not necessarily limited to, general liability
g Y rise onstructlon
Supervisor, whether or they have
taken the permit are responsible for code compliance. (see Appendix of 780 CMR R�5,2.15)
r SECTION 4 - WORKER'S COMPENSATION'INSURANCE`AFFIDAVIT
I
Worker's Compensation Insurance Affidavit must be completed and submitted with this application. Failure to provide thus
affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached: ❑ Yes ❑ Nro
SECTION 5 DESCRIPTION OF PROPOSED WORK (Check all applicable)
❑ Deck ❑ Pool ❑ Repairs ❑ Alteration ❑ Chimney/Fireplace ❑ Woodstove/rPellet Stove
I
❑ New Construction" PAccessory Bldg. ❑ Roofing/Siding ❑ Other
(Energy report required) (Shed/Garage) (Specify bellow)
❑ Addition ❑ Replacement window/door ❑ Demolition
(Energy report required) No. of windows Doors _ (Specify beltow)
*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
❑ Air conditioning - (separate unit)
❑ None of the above to be provided
❑ Hot Water: Gas Electric Fuel Oil Other
f �
I
Description of proposed work:
"SECTION:6 ESTIMATED CONSTRUCTION .
..._:.. . COST
Item Estimated Cost ($) to be completed by permit applicant
1. Building a
2. Electrical F--0 0
3. Plumbing df E
4. Mechanical (HVAC) ,eve r-
5 Total (1 + 2 + 3 + 4) DQ
-'' SECTION 7AOWNER AUTHORIZATION >k
».
" (lo be completed when'owner'a agent or eontractor:a lies for buildm ` permit)," J
M�4 PP _ 9 P �_
y a:
(Please Print)
I, to tKi C 1 `S6 as Owner of the subject property hereby authorizq.
alf, in all matters relative to work authorized by this building permit application.
� gkil A
Signatur of Owner Date
QWNER/AUTHORIZED<AGENT;DECLARATION _ .. , ... ..�
lq-t ��) ASS ��
,�� , as Owner/Authorized Agent hereby declare that the statements and it'iformation
on the foregoing application are true and accurate, to the best of my knowledge and belief.
Signed under the pains and penalties of perjury.
Signature of Owner/Authorized Agent Dat
i
- - -- - -- - -- I 1 1 - 1-1-
❑ SPECIAL PERMIT (Per 780 CMR 111.13)
$25.00 APPLICATION FEE IS NON BE -FUNDABLE & NON-TBANST.E�ABLE.
{ D} TE RECE1,VED ,
o�TH.. # F i ,
DARTMOUTH BUILDING DEPARTMENT
x:
400 Slocum Road, P.O. Box 79399
^Dartmouth, MA 02747-
-