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I j j: xu,-cw elESt)C{6 05o cE, €:. on:FiTc PLAR D,1 E. i;w - : a DATE. „U8.16.t5' - =E:ia:G"DRAWN BY:: NJV - LO`YR£c �...._-.-'•J- � t �Tf'PE�X'-eY?YN!L'eAR✓ "�i 41r'i � � � EOT'GY 4f ExiS : _ . gg j DE f JOB NUMBER: 75-221 i6A ib'KTAi ST+?5- 21C'.!1.G.^rk - I. V =°DRAWING NAME- .. EY ChiER: _:ffGSTENAY ✓'G'G'rc FR2V{E}EJ F_.�*;11N5 RC A' S ' - E%;_ru5,w: TGR.=taA•'r =' = E:cSYi+usrc'.Rr::�: .• cod -E u7Ert-AL '::= EXiSTf6EM0 AN - .. � I::. i � I : - bG3 n..Y .:.. _ .. -• ..: : , a\� n';tai:�:eDaai - - .. _ _,. _ ' . s tnsrin�-acr�E r� bveD - :.L`;.<FOE� w::>a',zD e PL S< li I . �' Euvr A\D REYdTF x vs ,:-- €3. E.\.-TYiGF.. eE REGCAr� FLOOR $CEILING PLAN, i - (l l jr G?ac�ic AAJ hEAl w " As '� l 4 .._. _ E g_a; REr FGa ti<ta At.,:ci••t--e. ' 1 �9>A,:TUL-tpv✓ SECTIONS, DETAILS $'` <rT msmut� rissrToaccrawK c :a 2YrcB NOTES - � ,�. RETFOR,E W.ty yitiB.GFPfE: ._ B_Aq Gk{FEA C2,Y�Atii i �_f /F' . Pow e,e o+A,*ALL Sa_o '. E L� xuurSmnDGa EDRAWING.NUMBER •_.,,._ SO' AAD P�t`eN. 'EYE!`,ZR Av Sa.,Lt_i 21' ' f.En Y£RirLAx L':FT f EXurL1 FLQa41& 5A O SE S G E ccu'r-A:-FVArE:iy $OPf�,:a e=nTT-+3e*t Ghn'Ek #1. '!: aX Av^JA.�n' 4:3i5. €4 �-] E iNS Yc'AL PA<'T:+'Gh QE^X+.YG 416; 39' a q'ev.Ye`✓iCD GrE¢,y M1..N _A,,_AL Paet LlfiN -c YrYDO F:.iED AVS' *xT<9VF'C 1 ..Kl 4.EA2N,!: Icy' Fn LOLxArit i 1TA Ar-L= MG 6f.D ■ ■ F,.3 GE LIU. 4aElt9 AT�CL. f{TM 1Ff5 AGTGEfl.'6 A>iDD bb z �f� tiL�GOR +R1Y'G,Vr.3..'Y..L'r Eati^ �bX^=GGR DETA=.F:, YOU3 is GG'+43:,F .. /3P Ed_aRC1ED F{ CCR F-LAN 31 AT E)'15T: NI6 JCIS �_ C 1 __ o a ,nrh =E>xc�EPe COMMENTS: �„ '..L.L.E:.yd•.1.0 -. A .,G _BI:•=.-F,, �%�?. xA-E:Ir<': -P.p+ GYM EX15TING WALL PROPOI W/l/2" SHEETROGK ON BOTH 51 GYM 5GRLE IF PRINTED ON 11" X 17" 3/16"=1' TOWN OF DARTMOUTH BUILDING DEPARTME p p F�� 010 TED tf) v rr= Q V H N W Z Z: _ 4) CD ci Q tL � r sz < d' O NOTED 1 2/11 /2017 Al-1 SECTION 3 - CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor: 14A(Zi - LE Not Applicable O License Number: CS"Ad y dress: q0 A mr i i� � < � Expiration Date: nature: Telephone: S N 4 - WORKER`S COMPENSATION INSURANCE AFFIDAVIT (MGL c 152 § 25) Wor'�,er's Compensation Insurance Affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial f the issuance of the building permit (MGL 152 Section 25A). Signed Affidavit Attached: IYes❑ No SECTION 5 - DESCRIPTION OF PROPOSED WORK (Check all applicable o New Construction ❑ Addition ❑ Repairs 11 Accessory Building (Sheri/Garage/Other) ® Other (Specify Sec. 6) ❑ Demolition o Sign o Replacement window/door No. of Windows Doors o Fire Protection SECTION 6 - PROPOSED PROJECT USE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES The following descriptions are based on the Massachusetts State Building 8th Edition, Cade Article 3, as noted. See the Code. 0 Assembly - restaurant, lounge, theater, school, etc. (see Code Section 303.0) Describe: ❑ Business - office, assembly with less then 50 occupants - indicate Medical or other professional (see Code Section 304.00) k Education - struction for training including child day care for those over 2 year 9 months (see Code Section 305.0) ❑ Factory/Industrial (see Code Section 306.0) ❑ High; `Hazard (see Code Section 307,0) ❑ Instrutional - hospital, nursing home, infant day care (see Code Section 308.0) ❑ Mercantile -retail stores (see Code Section 309.0) ❑ Residential -three or more family, hotel (see Code Section 310.0) ❑ Storage - including garage (see Code 311.0) ❑ Utility & Miscellaneous Structures - includes tents and agricultural structures (see Code Section 312.0) ❑ New Tenant - for any of the above, please indicate (see Code Section 105.1) ❑ Trailer - temporary Purpose? ❑ Othe-: Describe the proposal, INCLUDE number of dwelling units and bedrooms or occupant load as applicable, also existing conditi®n (if extra space is needed, attach an additional sheet): SECTION 7`- TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED o New construction and/or Additional (total gross cubic feet proposed) - indicate If the project is an addition to existing structure - total gross square feet of existing: Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration is required. Will this project be subject to CONSTRUCTION CONTROL (over 35,000 cu. ft. ) ® Yes ❑ No If Yes, see Code Section 107.6.2 Designer to submit Code Synopsis in additional to original plans and if existing building Chapter 34. ❑ Demolition* describe structure: ❑ Trench Permit Required? ❑ Yes ❑ No See Trench Requirements G.L.C. 82A and 520 CMR 7.00 et seq. o Moving" - (provide copy of DPW moving license) *Type of structure; from where (map/lot or address); to where (mapgot or address): number of dwelling units: number of bedrooms per dwelling unit; ❑ Replacement doors and windows = (for existing only) (only where doors and windows exist and will not be enlarged) EGRESS dimensions must be maintained. • Temporary structure and uses - includes, when allowed, new tenants, trailers, tents and the like and only for limited periods of time. Describe: / SECTION 8 - MECH;AN1GAL &; PRIMARY FUEL C�1 Furnace hot air -fuel as natural orpropane), fuel oil, electricity, other (specify): ( ) g ( Y� (P fy): ❑ 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) Roof Top Unit (RTU) New ❑ Replacement ❑ ❑ None of the above to be provided Mechanical Ventilation 11 ❑ Hot Water: Gas Electric Fuel Oil Other SECTION 9 - SPRINKLERS AND/OR FIRE PROTECTION 3 COPIES OF PLANS AND NARRATIVE REQUIRED ❑ Required: plans provided plans not provided, why? ❑ Not required, not to be installed, why? Narrative Submitted? lr7'es Q No SECTION 10 -IDENTIFICATION 11.1 ArchitectlEngineer - for overalldesign Company Name: Address: Phone #; Certified by State of Massachusetts as: Certification Number. Note- Signatures and seals on all plans, affidavits & other documents SHALL BE originals and not reproductions. 11.2 ArchitectlEngineer - project supervision and reports Company Name: Address: Phone #: Certified by State of Massachusetts as: Certification Number. Note., Signatures and seals on all plans. affidavits & other documents SHALL BE originals and not reproductions. 11.3 General Contractor Company Name: L tr�V��Ci����D��' Address: �'03 �qf>1� JCA2 J LECI(a1d J4W t-JEST-Poi2 l MA 6,72o Phone #: JC6IF_ �J ?5�— b1 i I /°� Construction Supervisors License Number: _ t-.3� Note Signatures and seals on all plans. affidavits & other documents SHALL BE originals and not reproductions. Page 2 Page 3 SECTION 11 - ESTIMATED CONSTRUCTION COST Item Estimated Cost ($) to be completed by permit applicant 1. Building 13. 2. Electrical Plumbing 4. Mechanical (HVAC) 5. Off -Street Parking S. Total = {1 + 2 + 3 + 4 + 5) Estimated Total Cost Including Labor: $ SECTION 12A - OWNER AUTHORIZATI©N (to be completed when owner's agent car contractor applies for building permit) (Please Print) I, "D0 v as Owner of the subject property hereby authorize /`7 #-t �� LL R-Y , Wit? to act on my atf, in [ matters rel 've to work authorized by this building permit application: Signature of Owne Date SECTION 12B - OWNERIAUTHORIZED AGENT DECLARATION as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed and he, ains p natties rjury. /7 Sign. ure o Ow ` Au 'or t Date SECTION 13 - OFFICEIINSPECTOR'S NOTES a . Total Permit Fee: $ ti�/ Less Application Fee: $25.00 Other Amount $ Remaining Balance: $ Gross Area - New Construction total sq. ft. Grass Area - Alteration total sq. ft. Permit Issued to: Page 4 Page 1 Revised 10/11 I COMMERCIAL S25.00 c P LICATION FEE IS NON 8E_F�:30A %E &'-wV- ANSFiE� ABkE �t^oUTH �iti DATE REC E1VE_ DARTMOUTH BUILDING DEPARTMENT 400 Slocum Road, P.0. Box 79399 � s: 7. _ '� o xi c ao y� Dartmouth, MA 02747 Phone: 508-910-1820 Fax: 508-910-1838 - ° i � t www.town.dartmouth.ma.us ' APPLICATION TO CONSTRUCT: REPAIR, RENOVATE OR DEMOLISH A COMMERCIALBUILDING (irteludingsormomorelamaydweiiings) THIS SECTION FOR OFFICIAL USE ONLY RECEIVED BY: BUILDING PERMIT NUMBC'R: �. fi DATE ISSUED: SIGNATURE: DATE: Building Commi si er/Ins ctor of Buildings Zoning District. Proposed Use: Zone: O X 1313 ❑ A D V Aquifer Zone: THE FOLLOWING AGENCIES SHOULD BE NOTIFIED: O Board of 0 Board of ❑ Cons. ❑ Demo ❑ DPW ❑ Elec. 10 Energy Report ppeals Health Commission Affidavit Card Sent: Cut Off Fallow -up" ❑ ire 0 Gas 0 Planning ❑ Sewer Card ❑ Water Card ❑ Zoning 10 Other ief Cut Off Board Cut Off Cut Off -REQUIRES INSPECTOR'S REVIEW BEFORE THE ISSUANCE OF A PERMIT. DEPARTMENTAL APPROVAL Board of Health: Signature: Date: Conservation Commission: Signature: Date: Other: Signature: Date: Signature: Date: x Signature: Date: Brief description of work being performed. �i Q 0, J -� 1 ti P 7`i W A. 1- ! ft SECTION 1 - SITE INFORMATION �i �r�-�v� 1.1 Property Address: �} 1.2 Assessors ' ap, of Number: Nearest Cross Street: F/�UNCr- C 2M&P__ RD Map Lot - Weer 1.3 eer Supply (MGL c40 s54): 0 Private Well pp L Business Name: ®A, S- I J1 �C % t �1' MAST -I C 5 Business Phone #: 5op 916 _ay5q 1.4 Seyrrage Disposal System: Total Land.Area Sq, Feet: f Municipal ❑ On Site Disposail System SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner Record: A veilk/i , D.%2 Name (print) 1 Contact Address FPhone Number 2.2Authorized Agent'. Contact Address�j-�.���.�. �� 'hone Number ---./-.J-.'� Name {punt}