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NOTICE
S MOKE DETECTORS shall be installed in
accordance with 780 CMR, Section 3603.16. HEAT
Fl- �11
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FIRE STOPPiNG REQUIREMENT
Penetrations thru rated walls and floors shall be
sealed with a material capab!e of preventing the
passage of flames and hot gasses when -subjected
to the requirements of the Test Standard spocific
for Fire Sto;� AST.M.-E-814. Wom 15
PUT! OF 1) ART F101H H
YOUR DRAVVING MUST BE KEPT REW, n o p u, v
AT THE BUILDING DURING THE p, Copy. (if This EneAmlud
PROGRESS OF THIS WORK. pie t on Site 'n V111'st 68 riRp
BUILDING DEPARTMENT C-Irg Co
Town of 0artmouth 1pns"ruction
SON -TUBE SIZE AND DEPTH
INSPECTION IS REOUIRED BEFORE
THE CONCRETE IS POURED.
BUILDING DEPARTMENT
Town of Dartmouth
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Residential
1999
2.2 Authorized Agent:
Contact Address
Name (print)
Telephone
..>:.
3.1 Licensed Construction Supervisor:
Not Applicable ❑ `'
Licensed Construction Supervisor
License Number
Address
Expiration Date
Signature V 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 Q no
If yes, submit the required
affidavit!
Company Name
Registration Number (if none, state "none")
Address
Signature Telephone
Expiration Date
3.3 For Rdsidential 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
Owners Name (print)
Signature
by signing the above, the home owner acknowledges that there will be no eligibilty 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
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, 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.
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 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, 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 are7applyin der is section sign below:
Signature:
Your signature carries certain responsibilities, including but not necessarily limited to, general liability
c:\wpwin\foruns\bldgapp.res Page ? January 20. 1999
c:\wpwin\forms\bldgapp.res Page 3 January 20,1999
Residential
) 01999 Residential
[EvufeQil��l is
1. Date plan reviewed: `"'
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 reason: Date'
7. HOLD subject to Zoning Board of Appeals action:
8. Comments:
9. Inspector's Signature: Date:` /
Applicant informed of above bates Time: / ` l C
Comments -
Total
Total Permit Fee: L Less Application Fee: $ 25.00 Remaining Balance: $
TOTAL FEE: Gross Area -New Construction total sq. ft. !/
y;
Gross Area Alteration total sq. ft._
0� �- ,Ir-,,- r
17
Permit Issued To m '
ar-
)yiv
❑ FOUNDATION ONLY
NOUTK.1j i DATE RECEIVED
9 . DARTMOUTH BUILDING DEPARTMENT r
400 Slocum Road, P.O. Box 79399 1
Dartmouth, MA 02747 °"
.,
hfi4 .='Y 508-999-0720 FAX 508-999-0738
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELL?ING
Zoning Review: Signature: Date:
Energy Report: ��� Signature: G Date:
C
Fire Chief: -,�- ` Signature: Date:
Board of Health: Signature: Date:
Conservation Commission: Signature: J Date:
Other: Signature:9
Q f%
1999
NUMBER OF PLANS SUB ITTED: SITE PLAN SUBMITTED: ❑ yes ❑ no
1.1 Property Addres : �� r 1.2 Assessors Plat & /Ljot Number:
Nearest Cross Street:
Platy Lot
Subdivision Name: j'lfZZ e17,5 '° - 1.3 Historical District ❑ yes ❑ no
Has application been submitted to the Historic Commission?
Total Land Area Sq. Ft.: ❑ yes Ono Date:
1.4 Water Supply (MGL c 40 § 54): 1.5 Sewage Disposal System:
Municipal(kprivate Well ❑ Municipal ,4n Site Disposal System
Co to t Addres
-
Name (print)
phone number
c:\hvpwin\forrms\bld,-app.res Page 4 January 20, 1999
c:\wpwin\forms\bldgapp.res Page 1 Jiannary 2(1 1999