Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
BP-61107
Permit No. BP-61107 BUILDING PERMIT GIS#: 3653.00 Commonwealth of Massachusetts Map: 0070 TOWN OF DARTMOUTH Lot: -0013. - -400 Slocum Road,Dartmouth,MA 02747 Sub-Lot: 0039 Phone: (508):910-1820 • Fax::(508)910-1838 Category: DECK:. Project# JS-2011-000643 Est.Cost $10000.00 PERMISSION IS HEREBY GRANTED TO: Fee - 5350.00 Coast.Class: - - Contractor - Licenser Phone#:Use Group: R3 CHARLES J GABORIAU CS-49472 (508)243-3784 Lot Size(sq.ft.)_. 95246 HI-108523 Zoning: SRB Engineer License; Phone# ' Aquifer Zone: N/A Flood Zone ZONE X Applicant Phone#i New Coast:- 512 sq.ft C J GABORIAU BUILDERS (508)243-3784 Alt.Coast N/A OWNER:Date Typed: 09-28-2012 GILLIS PAUL J I DATE ISSUED: G/ TO PERFORM THE FOLLOWING WORK: Construct a 16' x 32'three season room on existing deck; frame and exterior only OWNER WILL COMPLETE Project Location: 78 MILLERS DR Approved/Issued By: t l>.s. /,C 2. 1-y✓�s DAVID BRU ETTE,LOCAL BUILDING INSPECTOR All work shall comply with 780 CMR 7TH Ed.(MGL Chap.143)and any other applicable Mass.Laws or Codes and plans on file. SCHEDULE APPROPRIATE INSPECTIONS AS REQUIRED. UPON COMPLETION OF WORK,FINAL INSPECTION IS REQUIRED. THIS PERMIT WILL EXPIRE PER 780 CMR 5110.9(NOT MORE THAN 3 EXTENSIONS WILL BE GRANTED)OR ON ISSUANCE OF A REGULAR OCCUPANCY PERMIT. I hereby certify that the proposed work is authorized by the owner of record and I have been authorized by the owner to make this application as his agent and to receive this permit, I further understand other agencies may have reason to STOP WORK if items under their jurisdiction are not met; not withstanding the issuance of this Building/Zoning Permit. Signature of Owner/Agent: ( jLf ZS9• Comments: PERMIT NUMBER IS REQUIRED WHEN REQUESTING INSPECTIONS/RE-INSPECTION FEES.MUST BE PAID BEFORE RECEIVING ANOTHER INSPECTION/REPLACEMENT FEE WILL BE REQUIRED OF LOST CARD "Persons contracting with unregistered contractors do not have access to the guaranty fund (as set forth in MGL c.142A)" Inspector of Inspector of D.P.W.Inspector Building Inspector Inspector of Gas Fire Department Plumbing Wiring Water Service#: Footings: Underground: Oil: Underground: Service: Foundation: Rough: Smoke: Rough: Rough: Sewer Service#: Rough Frame: Insulation: Final: Final: Final: Cross Connection Final: Final: Treasury: Board of Health E-911 Additional Comments: Planning Board Prior to issuance-of Certificate of Occupancy/Completion,this card must be returned to the Building Department with all necessary inspections signed off. Department phone numbers are listed on the white"Required Inspections"document provided with the issuance of the building permit. POST CARD SO IT IS VISIBLE FROM THE STREET TOWN OF DARTMOUTH o,0. ,:c BUILDING RECEIPTS . Lqq PHONE: 508-910-1820 FAX: 508-910-'4 T.' n 11• : a _,. ,C_.83 �) �' f ., ht `, j j ile name: / ° f party Uate, (_✓Cj it/4 hr'?//ad e , : / ' C t<C9 _ (-7 ✓:" 2�/D Job Location: �/ ✓ f// White Copy-Collector's Office // , Yellow Copy-Customer's Receipt {._ &if .._% Pink Copy-File COPY Map: p- 1 Lot: /j '9 ® .) ///F ` ✓ / Green Copy-Building Department rota Phone: Description General Ledger#'s - Ref. # Amount License & Permits -Building 01000-44105 f '-l-- .� 4 Q CT 6 License & Permits -Building Misc. 01000-44105 License &Permits - Electrical 01000-44106 %', License & Permits - Plumbing & Gas 01000-44107 -,`f (' ' -ir' , f License &Permits - Trench Safety 01000-44129 Other Department Revenue 01000-42420 THIS IS NOT A PERMIT OR LICENSE FOR BUILDING, PLUMBING OR GAS (.f eceived By::,--` / ?L.-2,2L.,,:_t7 :4e4 e! "../ TOWN OF DARTMOUTH I BUILDING RECEIPTS; �+ ..a TFqI 1 8�0: .FP 508-970.1838 V 7 y� . y' Name: ./ '. rroperty ' f . ra uate ; s` o/ e ._..(! ;---1- t .. —"Owner: .. •r:..� - fc. F/_ Job Location: r'-" White Copy-Collectors Office /if s f / • ` e/-r r I,. �W F Yellow Copy-Customers Receipt .'�! f f -,eJ ; ti f - - Pink Copy,File Copy i /' ' 7, Green Copy-Building Department Map: i f S ji Lot �.r f ,/ -�., Phone: Description , General Ledger#'s TO 0Aef. # Amount Rmourn toWN CCLLECTTOR License & Permits - Building 01000-44105 License & Permits - Building Misc 01000-44105 cn ' '.. y < . License & Permits -Electrical 01000-44106 13 2;i License & Permits - Plumbing & Gas 01000-44107 KM 04 License & Permits - Trench Safety 01000-44129 Other Department Revenue 01000-42420 THIS IS NOT A PERMIT OR LICENSE FOR BUILDING, PLUMBING OR GAS Received By: V i RESI BENT ME ❑Approval in Part(Per 780 CMR.5111.13) rr r'-...!,,t,:n S25.00 APPLICATION FEE IS NON HE-FUNDABLE &NON-TfAF S 'E!hns - -n- e sgen, „. DATE RECEIVED ` a` r DARTMOUTH BUILDING DEPARTMENT n 13 II 9: 19 _.,P=w,r. 400 Slocum Road, P.O. Box 79399 li ` A ' Dartmouth, MA 02747 7O IF "L Phone: 508-910-1820 Fax: 508-910-1838 IfifiJ. www.town.da rtmouth.ma.us APPLICATION TO CO STRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING • Vas i z . _< --`n; iff.OTHIS'SECTION FOR OFFICIAG()SEONLYM> uaN4 r p1 ' `tf ? " 'y :TOSE ' RECEIVED BY ,, r c tau r x, x'" ,a, Ult: I °7v z a a se «. � �" � s °"�` '^-.�'P' �, ""_ rBUILDINGPERMITNUNI,BER ,iDATE SENT FOR REVIEW t.rn r � ... ,DATE ISSUED 5-' S '" ig -"'" s^ r&K TO ISSUE StGNATURa ' ', .g DATE a.! I tl b -*r 'q,. W:t2-',- i. 2 . S,"3s( fix+- ar z- k4 y,ilt Waa xk'*ems'- . kAY-l--4.-s vz, r ro"' ..yam y r ,?. v A sir ,,iy m"°�--3-'g4 y>�.:. g , 'Zoning District '6 S ` > oposed Use t `€,x,,Zo e r q El A D V' Aquifer EoheR 4 , 'G`mrsrt .:'4 „a •5 m,nw c x '4ts±a.. x ,� -c<m' .+`r �'d.5i�'�s yx, � rk ''''' },it +t'du��ax�. �,.�a4 r"i6' g #i:'. T,HEF9LLOWNGRGEN CI •l11}D EN FIED it '`� _ `' � tT ' '',a:��S;;rr S S' �• r 2a i 'm r ''?"'st,h's"d Sri` „, �'` eti>"' t"+e'v o, ` +`a'`. ' : I aw t""�; } _ '� '-' ' : '''sh, - nr�oa�rd gf , '' k, Pa ti' 5` k dns't't 1 .,si�i43Demo 1 W �• rD E ec" ' tD Ener a wp. r AP 5 , Mtn:` p za —44,E:,.,r.,n €, o mission`s Affidavit a S ' x ' t , 9 P .s,Y v x z zr :r ;ci � `m.� 1lY-� �i�" a k Cut AH" �z oUa "t� ▪ -yy,'xf?*,'a v u '.�.4t ra--- S`�`e 47-to 'r-'.* s Silk W�er-lfx l--.'''$a . t` `fit w i,,1, ,5 w` ,"-,d€,5 ��,�...n hL7 Fjre t jt 7 ; ar 4LTPIartrnn� D SeweGCacd afe *arsl :�,2> p�onm "�"�-x. y9�`1h �; rtz"`Chief '� ' k' Cut��f�'��`' Board 4 S- Cut4{ i �'" 'i�' y y .,z t _ a t.i�.t S^.'Cil3tC a, E? 3 hhvv__ �+ _r . re � a" z "^*< '+•' .w t w „ .,�'z ;. tea' r n - � •. t*s z5 � �_� ..*REQUIRES4NSPEGTOR S FttVIEW BEFORETfEISSUANCEOI A PERMIT :� .., ,taik,;::_ is__ ., _it,~.- .,a; ".DEPARTMENTAL`APPRO`VAC n '` . , . ,::,n ., . .; Zoning Review: Signature: cy)Q�,,Q S / Date:SEP 2 4 2010 Energy Report: - Signature: Date: Fire Chief: Signature: (" Date: Board of Health: Signature: c. (�' tF c f..er.-A-, Date: Conservation Commission:. Signature: Lie.. Q)ft 2 A.. Date: Other: Signature: rite: Brief description of work being performed: M 6a4a. ` yt— - d ; r 1-- iir .,,K SECTION 1-%SITE INFORMATION4 ... z :- fr. ,., . . 5,..'.. , - .':y .a_".-'' 1.1 Property Address: 7f �Y//E/L 4),-j vQ 1.2 Assessors Map&Lot Number (n.y Lot Area (sf.) Frontage Map 7 Lot -3! Required - Provided Front Yard 1.3 Historical District ❑Yes t)(No Side Yard Rear Yard Year Built ❑Altering more than 25%per side of building 1.4 Water Supply(MGL c40 s54): 1.5 Sewage Disposal System: Has application been submitted to the Historic Commission? 0 Municipal fa Private Well 0 Municipal 51t On Site Disposal System ❑Yes 0 No Date: ® CONSTRUCTION PLANS 0 SITE PLAN ® ENERGY REPORT Page 1 1 7 RESIDENT/Ai i'j'tona i2 Tf,'.._ , 7 +SEG7'ION 2-PROPERTY OwtJERHIP, gotHORIZED''AGENT. i.._ t <: /1 Owner Record: / )6e Name(print) CbntactAddress Phone Number 2.2 Authorized Agent: 0.r GAt° -rng /2c6 dLD Mel /liVatted 54P.7 y3 3 71 Name(print) Contact Address Phone Number ;,`"x,..,:�1a, " a.le— _. < t St a.SEOTION.'3 .CONS-FRUCTLOMERVICES 7's .,s ,f- ' . ,." .: ` __,ii 3.1 Licensed Construction Supervisor/Specialty License: License Number: egg 7,; r9sf'2,Company Name/Contractor Name: 2t-�./ / arlddeiCS C Address:/20e (Xi) t 111/// 9// //e- C/. ,(// / l)ig/�1ll�fl"�G{T?y/ 'piration Date: 0 Signature: alga a�- _,,/Q1j ,Telephone:501-02-&32Ft' /_// - /off P 3.2 Registered Home Improvement Contractor: Not Applicable ❑ 0 Are you a Home Improvement Contractor subject to(780 CMR.110.R6)? Yes ❑ No F j Are you claming exemption from the requirements? ❑Yes R.No i _ If Yes, Go to Section 3.3 II L � Company Name/Contractor Name: ,e,i ri_ot Registration Number(if none, state"none"): 1 ! "�6..r/s,P, r Address: /20g %/ 4/f// 12 /2 ) /08593 E\ Signature: / /4:2z01 �® ,tee/ /a Telephone: ..��y'.b 7�T%lf`.S / Expiration Date: -/9-��^ N ` 3.3 For Residential RemodIoork Only C PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND: E. QUESTIONS OR COMPLAINTS call or write: (s) Home Improvement Contractors Registration, One Ashburton Place-Room 1301, Boston, MA 02108, 617-727-6598 ❑ I am a Homeowner performing all the work myself. Owners Name(print): Signature: By signing the above,the homeowner acknowledges that there will be no eligibility 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 5108.3.5 Licensing of Construction Supervisors: Except for those structures governed by Construction Control in Section 116.0,effective July 1,1982,no individua shall be engaged in directly supervising persons engaged in construction,reconstruction,alteration,repair,removal or demolition involving the structural elements of building- or structures,unless he or she is licensed in accordance with the rules and regulations promulgated by the BBRS entitled Rulesand Regulations for Licensing Constructioi - 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 Homeowne 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 whit 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 tha one home in a two-year period shall not be considered a Homeowner If you are applying under this section sign below: Signature: Your signature carries certain responsibilities,including but not necessarily limited to,general liability Page 2 'y,,,,, SECTION`4-WORKER'S COMPENSATIONINSURAtNCEAFFIDAVIT(MGLc11;52§,25) Worker's 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 Ma;SECTIONS&DESCRIPTiONOFPROPOSEQWOR(C{Check aii.applica$leW NiiftaViISertqc O Deck 0 Pool 0 Repairs RAlteration 0 Chimney/Fireplace IS.Woodstove/Pellet Stove ❑ New Construction` 0 Accessory Bldg. 0 Roofing/Siding ❑Other (Energy report required) (Shed/Garage) (Specify below) ❑Addition 0 Replacement window/door 0 Demolition (Energy report required) No. of windows Doors (Specify below) 'If new construction, please complete the following: Single Family: No. of Bedrooms No. of Baths Two Family: No of Bedrooms Unit 1 No. of Baths Unit 1 No of Bedrooms Unit 2 No. of Baths Unit 2 ❑Furnace(hot air)-fuel gas(natural or propane),fuel oil,electricity,other(specify): ❑Boiler(heating)-fuel gas(natural or propane),fuel oil,electricity,other(specify): ❑HVAC(combined unit)-primary fuel,natural gas,propane,electricity,other ❑Air conditioning-(separate unit) ❑None of the above to be provided ❑Hot Water: Gas Electric Fuel Oil Other Description of proposed work: 3etofn, i 2 ern, ,'„^ SECTION Fs`-ESTIMATED�CONSTRUCTION COST ., _ m ._ _ Item Estimated Cost($)to be completed by permit applicant 1. Building 2. Electrical 3. Plumbing 4. Mechanical(HVAC) 5 Total (1 +2+3+4) • SECTIONN,7A. OWNER AUTHORIZATION,,,x.`w ;tMatp o` i' pu^-,` , ` .x _{tcbe completed when owtier`3 ageri�.or,Contractor�pphes fo�i�fuiiding permit,}• (Please Print) I, -Pm `.J . C5 I(_[_I S 'r , as Owner of the subject property hereby authorize 7Lc22,/e 'g i>9C•1 to act on my behalf, in all matters relative to work authorized by this building permit application. 112_A gnature of Owne Date 4__ ./'r ,0.,.=m;` SECTION 7B „OWNER/AUTHORIZED;AGENT DECLARATION. M . " . .,i"+.-.., /< C .f c Wp *,�./�/�--(/� , 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 er the pains and penalties of erjury. /Signature of Owner/Author' d Ag nt Date Page 3 1 1. Date plan reviewed: SEP 2 ,4 20113 2. DENIED(see project review worksheet): Date: 3. HOLD Reason: /(Jrj _ Date: 4. HOLD subject to Zoning Board of Appeals action: Date: Comments: Inspectors Signature: . Date: SEP 4 2010 _ 5Z = TIO --,AppucANTN9TIFJCORDN: Ilh, ...�,=_ .. .. 7T� �,9 Applicant informed of boy • e: /v Time: ��(J Clerk: PM Comments: ' -• ;1;:c:_M—r;5: SECTIONs1Q OFFIC.EIINSPEC:tOR'$_NOTES z ri», _ .r I., .w1 . ,.. , Less Application Fee: $25.00 Remaining Balance: $,?a 5 Total Permit Fee: $ ;J d Other$Amount$ TOTAL FEE: Gross Area-New Construction total sq. ft. SIZ. Gross Area-Alteration total sq. ft. Permit Issued to: T.4.1,ccV r _ /6 / 1t'J�, ' 3 d-cc,.,n c /iC.�rra .,•�_ cJ"7. ,-.4246.eS Tv "' ';, —Crt trg..'`.'_+'h". .!,::=a. Er aiu'-'faM:'sECTION'f1,.,CDOITIO SL CO$JWEN TSJSKETCHES "?k?ma`.. ..k r. tt,,,. -r aV j�Se3z = s/ 2 $ . 2- /z� =i�z.,v Fes. �0v P1-1' I ) Page 4 Office ot`eansumer ffa rs mess e u anon HOME IMPROVEMENT CONTRACTOR Registration 108523 Type: Expiration: 8/19/2012 DBA C. . 'ABORIAU BUILDERS Charles Gaboriau - - 1206 Old Fall River Rd N.Dartmouth, MA 02747 Undersecretary sL- Massachusetts- Department of Public Safet> Board of Building Regulations and Standards ' F Construction Supervisor License License: CS 49472 Restricted to: 00 CHARLESJ GABORIAUry'� 1206 OLD FALL RIVER RD NO DARTMOUTH, MA 02747 yf` ....rr `rr _e � �� Expiration: 1/6/2012 Tom; 13941 ommwioncr FILE Copy IM SIBINT 0 Approval in Pad(Per 7(30 CMR.5111.13) UM S2.55.00 APPLIICATION FED IIS NON zOaII-FU TDABLE ticNON TOA SLEIlA IE -.,--s /;GrT+ DATE ,RECEIVED I ` �" DARTMOUTH BUILDING DEPARTMENT Lo '_' 400 Slocum Road, P.O. Box 79399 Sri j Id i 9 3 Dartmouth, MA 02747 ";, ,h,i.j Phone: 508-910-1820 Fax: 508-910-1838 www.town.dartmouth.ma.us APPLICATION TO CO STRUCT,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING " < ^' ;: '^t7HIS-SECTIOAfFOR OFF11CIALUSEONLY i3 c '.l"° 4 "'+-�„ s `�`�a u,��tr � s k �sY m M k`i= "' i n '.�n a + .�i, $ � ca '" .d m3 c�L- �i 'w"'s. < `C "ic y F s" iCA< rc5 . " s"' `'J,� 7 '• �rai°TE*1 : mow" .0 s i 1ZECEIVED BYE- t�-,f � G rp. . . Styr s 'M AM R i ti '� e OWE - r 4 a� ,BUILDSfen'oI UMBER a , 0'ATi "' ''- t.-''�x :Zee„cf ys-Rra �r 3�'F * `� 'k3 ° {` , t k, .. sw a 1 e el ES �REVI ' r f` c4 y ,'' ,D TEISSUED "1c , T1.4' .ris�,ra `r' k'' �§ 'fir" w e - �,'a 4� G s�s ,r7 s 'V �,:c ,If.,., , f m�i'+."' .Lt - 1�'L ` "`v= 3 -, a- •t' " 4 zz.. t x: 3- .. }n'='-_? . -M e�" ..=y tea' a- e, r'' :�`- w V i- ems., x : } = s �_Ki' ��� URE N` '' iX : �`�j' � �h �.. O= a;„T® S E SIG PsT a �"` m-t a� "'_� �y t' j A""E �rsg 5 c;of ^ i"�'�`R%ssh LW_ .1 0.,m4`9174 1Pasx4W1 .e`' *""t3n' ae, -csa,"-. _..y �Ha a..Y "'9l.vV..e.., t3�4 s-� : ,$sy ,, - . F a ,4;—-a: t 4 Sao. `a—w-4 T^ ;i ti s g .3 i 5 4. , -'a �- oQ!f1g; ,isttnCt xk �.f ..s n Pro osed-1Jse t "6 uu�3''.Z q u +v.<-a. 5 .e ^s"E'b ^., o_ ?'+e c. z". awe x� �F ?r?�s.ti�'"a = r'� J +,zht:e'�' 3-ar', oq t 7..7.n�s'fl Ulf One �si�i�� `„ '°Y, 'TII 3`7 ;*.' ,a,, c i t �i., ,,, :mom _„ c " x � rT' -: n,e .* ^, so- S- . �.a ICI€t-4tr WIN AGENCIE HO& DBl N. ' ° a "_z i "- "�",s i 'a. �� "kr4 �. x�x sr s` ` s FIED 4ac > 0� u1 �j a ' 1a%a`*:.�- ° `''' 1a T. - .$�}"0 5 b �Y i63 dJ' i^ V' 3` !� Sl' ' aN a 6 "1N ¢ .�1 .CZ-x .Y A ,..1.06 za4 s�eld age i= . ram , ysy t&. ¢ xrr.i -tas-�,fit 4,1 74. ❑BnardA r- " o U ottl s -:{'t = i a„ sail �` -e*s f z i A eals o rdof ?z ons; u4Cl De tVeQ4 +f�_ .+au-x - -gy p re a Ener o kli,�,., PP $ . Heatsth . t.3,Co�niissiorY .-S AfiAdavli "'r-' b y Car Sent `1a i a . ":.. 9-Ug' i� i r " m':: , + r ., -"'` „ a. CUt!':l a` �-.ttir-dip 1 5�m�- + 0}Firee� t �c7�r G ` �' ., ':.+;`a' Pla g r El wer jt""' W- gem '' - *r'` " 5,I E h x T .a - ricas, -, - p.,Plafinm {t ,L7Sew,, C,4-an qWa rCar . ` „'Loran '� " g5� n �.. '-w- c Other . & Cul Off V e"+1ag e i-t, - C� -y'44?, -`r , *.. ,- `z'"` -a . .33.�".% vi "S`4 d "fa . aS ✓w ai , `t 8 k �"= ",� S + a+k: �Fi - ;5 ",, n •, :- C * " a " t a 1a:*f rOSI3d5& p TORs BV1EGy E O E ' eta f m ` T E-1S,SLJA E � A�PERM6T �` " .�� -�* '- e ,3,:t` :' � .c ?"°"' ,. DEP_AIRTMENTAI. APP:ROVA g F mac" ' 7, Zoning Review: Signature: FILE Energy Report: Signature: Date: Fire Chief: Signature: - Date: Board of Health: `-;? k U"`�I- ,A Signature: 1V 1oc c i- l Date: 9t3 Conservation Commission: Signature: Date: Other: - Signature: D e: Brief description of work being performed; t--f- i t,L .e IT> 3 sac(0 n ('c • wainefaxtruor,Liat . . SECitON1=�SkYEJNFQRMAT103�,-�,�.-�,�i.t? �z°'"°' tom` ,,-"f`;'.,.�_„�.-�`.'�" c .a.��.�'_. 1.1 Property Address: 7/ , i de-,z )sy ye 1.2 Assessors Map&Lot Number: , Lot Area (sf.) Frontage Map �� Lot _ Required Provided Front Yard I 1.3 Historical District ❑Yes IX.No Side Yard Rear Yard Year Built ❑Altering more than 25% per side of building 1.4 Water Supply(MGL c40 s54):1 1.5 Sewage Disposal System: Has application been submitted to the Historic Commission? El Municipal t Private Well ❑ Municipal q,On Site Disposal System ❑Yes ❑ No Date: El CONSTRUCTION PLANS ID SITE PLAN 0 ENERGY REPORT Page 1 ENTIM RESIB ❑Approval in Pad(Per 780 CMR.5111,13) 7. 525SO APPLICATION FEE IS NON JSE'-EITNf[ .E & NOPT-'�'.Air,. Sf $f'1.3CLE r. wU=t,: `DATE RECEIVED '' r/ --T,- DARTMOUTH BUILDING DEPARTMENT 19 'ok 't 400 Slocum Road, P.O. Box 79399 r 1 3 2"' y Dartmouth, MA 02747 • :: • • s„_:/ Phone: 508-910-1820 Fax: 508-910-1838 www.town.dartmouth.ma.us APPLICATION TO CO STRUCT, REPAIR RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING stvait 'N 'y+` `i-` .;'PLIC ' u x F '� ,rsTHi SEC1r10N FOR OF RCIA[ •1J& ONLY `` "- '� " �.q,.meQ)-W '- #Y-' i.- 4- "`v >v ;4.-s " ..a- m3^ie�cktiAtte%....'. c te ' �tt 'e d-.`° ry n x,.'* .tatIWI . RECEIVED B K r ^ -. P - '` r I ;--- ."S� W u �, �BUILDINGt_,_,,,NUMBER , vota y it � `x e2° 1 C zs .H, vt > ,;- z ,^Lss iiit ` .E. r ,° .DATE"SENTFORREVIEW Y,,,, .. . 1F `- -4 -4-,.. ' - ' - ',..- ,' ^. � ei. y ° s, x s ..'SW.>TM`d, a" 3 `4''a„ gt r c > m D(e ISSU' ,1,, -.''`ik d'" 3 ?a:.T«t".m---. z�3 a,"�.- � 'ek+ -+" rt`-3'' ra " ,^ '-.�..Y.+ 4"''+ay„"4 ii''w� e.y' '1 4�'y�?kfe� t� 'a?i' h r ' ti4:1 '3,' - �ea y°�r?- zy h'N- ,-4-` , °P xr «s :' au " c ��z `; ti sou dfio��, `x. Lin e� _. i s aaz '^e G-..;e 4 1 sy �.. u r t; rr v- O: �O`iSS �.� ,SIGN4TJ �� J x �� �xk tiZtrr ti x i e raw ir� ' � i` sa""'ht`;?', t Er" :.'-„r"`xi° . t" r,„c, .� ,a'yt xrr. y?' ey - -e�"a'�` '',a r..� *" Va `' a?+ T-'Pb Frd ,, *s 'z=`3.:5. t_ of r a K -itq .�.:. b a".- a r,. e U c 1a 1„'t.s. t,T.c.`a,,. . •"�-'+ 7 P,-r " fn bn , ,-t , g'- Zgrnng District x- a --xPro osed Use ':, ' t""- �- �' .. t.. � 3p r -� Zone ❑��B Q'A O U '-�4n'erY`one'" � g� � - ,.*. r s -r to e ° � , -,fir bye' ._,� `�-�`u`s�'`" , rt '1 l 1 ES s e- GENG.IE lafogIciO rifts Tex; Fa's `- - -?,., a--, "x ,t e t4 x � '$;�' k,l � r a w,r wpm ig . l ry 4m.d' ix"�t` rs, ,T a ,�"4.s c:r .3 -:v C"'i#=w 2+ , ;�$ 17,6 rrlyox '�, oard�f � atx4-�1 � c ,� x;t' ��° -'�k 'k 4„ ���.rs -. e= ,. ,� 'A ''-l`, ` t :u ;.":= bligla^ 4C, :;;;,r.!.e lne=a,'3 y �t q : r D Eco - '�D"Ener Repo i.. r .i'.i `{ eas w� `= • aHealth s,ecti Rlissio u, e flAdaytt" .�`" tt d-Seu�t, .'Z ,s ,"ka"''�,CSrO �a fie, 's k 9`-uy; � 1'I' x 3 ', tat?�"�*_,n ,� ; e-.,A w tR' ^> - .?'e"k-�'r tgat * gi SHE ^c t .i .t „Follow-r,>1 taltfi.: t: D ire „� -^r- Gas c4 - a0Pl2nning 3Sewer-Card �, mow, r :;, sa x on 'c`� ; e -xt--, 5 Chtefa:,, ,�' CutOff' � Board,rr` t %"""'•." 4,r.,- ,-� D a r ard: �r D.Zo9ing ©OtherAs s! L - 'REQUfR S I tSsEGTOR S REV Ei BEFOR TFFE S ANGE O1�IS PERMR „., ` E � .,a'R .Tle-K 4,e-.kz zr _k ktea +. 1.4s.: ,,`s DEPARTMENTAL'APPRQVA`.-* "r �'' kar. -'" x us"°izz:, .ue..;,' ,,:�,,3 � Zoning Review: Signature: 1` Date: ��° Energy Report: Signature: Date: Fire Chief: Signature: - - Date: Board of Health: Signature: � 0Ci Date: Conservation Commission: Signature: Date: r 3 7j v Other: Signature: , � D e: _ Brief description of work being performed: [ 6t Q_ - ` - ; ..`x„` 4}b > ,'.; ;: ; 'SECTI.ON."E-SETE�.INFORMAT(OttS `:._.,� - .>1 '�„.max, ;; -r ,� 1.1 Property Address: 2. i://e2 /j 1✓p 1.2 Assessors Map/&Lot Number: • Lot Area (sf.) Frontage Map Midi Lot / -0 Map Required Provided - Front Yard - 1.3 Historical District ❑Yes - f7(No Side Yard Rear Yard Year Built 0 Altering more than 25%per side of building 1.4 Water Supply(MGL c40 s54): 1.5 Sewage Disposal System: Has application been submitted to the Historic Commission? 0 Municipal 'g Private Well 0 Municipal atOn Site Disposal System 0 Yes 0 No Date: ® CONSTRUCTION PLANS El SITE PLAN El ENERGY REPORT Page 1 000 0 0 0 0 0 0 O V 0 0 eo o� eee o y e e o 0 o ON voo e Q' y hV C 0 C. V V V h � OV V'� en 4 re a N ti~ O N ^ - `I' R , .--i OR O O �"w o"i C ^ 5.5 en V 1� C V �� L i n, 74 to ooe O + cil U000 Fes .. 0 PP r ,. *7 GOWO'J es � � N0 O e .�+ m in Q 4 v v0ivv R C 5.000 O 5 -..._ ..,.0 c y C :< NWt� HO NNN C C/1 V F „o -2 rye.. a ,, 000 0,o:' cy W gmamcara '". k;. vooav w .: '`Gf70.F0. t. .-. b tl , R U.y 4' '�-� v ry e., v Xxj C f .per•+ a� a , d I ,,;tza . o o v r''�', v000 .JY, 'gym roZ 0 9 . a Ct y ,�.43) .. m 7 7 m v m .. :, Gs n -: ve0e otl , 9 > . P. v tcl 4 r-0 h d CO a ,� 01 .� o i.. Q0. "' c000 y ? 0. a. n 7 y 1-.0 Vvv go,O. - 000 tl Qa k 0 .-7 G A a-et oee001 ro a eeo F 000 0 40 . a) 0 d 4 a P. 0 v to ° NNtIN'I U VU 00o F,v nvi r. N y .`°. .id. `.�.. A .`= a - '0 o ,r,:g vv.-.t�.N. j N O S+' d a Q. a U ..... 3 ? F V ., w y 3� ar Q s E O F el .. O FZF .�oee c . :U f�'I �FF .Z 00 '.4 za Zp UoOo .. V E- c ¢oo •n i , t a. y hu,m .^��f4 Grpw K in to .erg GG K' �`�NNN e, .:W :�NQ C��f�i�� 00 V n00 >. O ON .oigg U.eeeeee W UNN QUt, c vvDn v t�iio gn oo t y00 Q ee q i ,� 5 g c c \ 9 a Z N Qa al a .N a) Lei ,`0 000 ��yj Ul00O ti c O F q aaooaaa C - � a N cc 'ti 4 mn cont-.nN Cl . 0 7< in Ca Q �. Q V {{y 00P000,0 0 • 1 g N0' 0 P! e [Q' y,A..�ON�M� :,.G Q [[[�yyy CGY 0 V !IQ-4. f! 6. o.N.00ee .. lial00 ;p�4 ael ©'. '�~ a W � x m a. =v za a " a v .-. w ti I0 o y e„ ti �. -M e4nnven ,2 O ='�Q 0o 1.1 ri V u ,,i: 4 ..0000o CU'F 5 `,, J w a'71.14 u a a\ Qatea Maa e C.0 '� rig en .'i .N0 v m enMel o h IC; u in V n i 00000 : z ri} N -. ..4 .0 e - 0 h' i g fJ e a o< n : .'j .e h - C. : d �' V x o o : y g"a'c g;MM171 EF w .. w4iEF z ..:. taa Nye n 'Il a & 0 F 7 N 00 U tg 1QA�_: Q F w ,'4 "q: n o 0 0 4 e t-4 tit R 7 azn-g St, (.) •>E-iwzz>—r. g p '-oo g .w.l.w.l A F Z �� O M ��ra/� `--� 3 wYi �COpio- h a 44 �, � Z rn+W^ EO r..•ye ti y� .� :�e ra '.O eo a oo L C CID Wa co �:�0 OOR' t:Z ' ery v'a o0 .1.. o Gaza �:= aF 'L''xa 'z vv4,v jU 20 o y az£ D 'azOQaa 0. r IUSn ZQ U>k»k, ___ 400 ':Wat I.. mm - - 1 Xm --1H9=ry9xx5 ❑❑5 0 AXtom0 G) E W :' C b W CO GI 009 1-0A�C�+ta w 0 0 0 0 0 nm rn 0 0 x x 0 o 'w 0 ,2 } �,'.�.'wiV"A ,'mo wNCA S m 5 F. w. = ..7 R: .o.. y - - 3n Q-n `0+ °. o : a 0- rn ,. 0. 'O w z ,9 o k lc d W W�a c 0 0 5 0 0 g 0 0 s y - o : a ma =Ce C17CW zIb H Cx+'1 "p: q G %, lta3 o N ._. = o= c = ^' 0 b e A 0'9 ,0,' W W %iy OKC/' T � kt yN 3 N N � C}` Wa �, m off 'mrt `^ (i '�ryyb 0 (0 A B. 3 + Fact 3 ..1; •G 7 o 5, 00 .0N o o ee .- 0e0 N .- i.+ o 00 '0 p » O '�1 T O q = O E n r y N 0.) GI W a 0.) A N ton W (a H A + tot) () 0)1 O 9 .w OO 9S' Rs ?.?aa '7y I... °' b -ya a) n •n O_ nz d 0 < t+ 9 :on O'1 A "T no 3 rya W R O H 9 6 S O i A'' O fl O a a. V O m o a s o 4 A •. W �� ❑ 4 :z Ciy tati 4. ts A Z. a,a 3 a c A . = w' y .,5ct fa I,; po 3 C < C wrr� y c en Xy !!• �ONC N tott4 :-ass OAS 00 OOCOOOA4 [maV WNO' N.., Cl Ca coot.. . y y__0 0 0 < 0 0 x c d rn a d.nG 9{ ts c,�aii • yS. b .. .. . .a-05 ant .. m ^a , 5a lee ttla 0 oo JA A .. ..av o `° b 0na9 'O0y —% o3 moo � ag � Os= � k owa m�I # A 'o�.+:. aN"-om oo0< ti 0 $ n< u ` o 0 0. 0°= o0. 7,J 0 8>n m'p < � 2'i a ma aaoa a � aveia b 00 «O OO O'3 ' 0 0 E C g `D-y o az rn G]e ~ * l�7 ,.am. n =g et, a ° 0 0 a w ty_. 01 :. �. N .. ..4 y ..oa-6 � 3 3 333 4ti ti a' J O—�G,N ... O-SOS --PLO IJv o �.. n �p -, —V rta abn JU.r 'a. 4 A Co DV -aLit j O 'er te. 4 �y V V OJ OJ0 OOa IA OOOn ..i �O 4' b tJ OIA 14r "`J .N. J N O0NO.+uN A .k O b ' ' S Oi u...W aai�. �-I W a O�Oo 4 to 4 ti. La R O O O A` Tti a,A+ N co M L coo LA OOAa avaa 1p b gt W W N J a.Oa J J- J J W O'l W A N OJ C O W < N 0 CO 00 3 3 On w A n atac • o m T coil 0 A _ iv A m n 0 W T ! N T a. V J C) O A A ri•O N Pd O O m 0 A O a O. W e w a^ A A C •• R • G .-. e O r W 1 The Commonwealth of Massachusetts ' Department of Industrial Accidents VA — r Office of Investigations G{ _ , , 600 Washington Street "—c, Boston, MA 02111 F, www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians n /Plnt mbersy pplicant Information Name (Business/Organization/Individual): e rt gieli5ove. — Address: / 2--0 al/ H47/ ,Ef ,/Px._ City/State/Zip: P.Pnrertyc g4 Je- o 7V7 Phone #: S 0E679--X1S/ Are you an employer? Check the appropriate box: Type of project(required): 4. ❑ I am a general contractor and I 6. ❑New construction 1.❑ I am a employer with have hired the sub-contractors employees (full and/or part-time).* 7. Remodeling These sub-contractors have 8. ❑ Demolition ship and have no employees employees and have workers' working for me in any capacity. 9. ❑ Building addition comp. insurance.t [No workers' comp. insurance10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ p 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.❑ Other employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compens i ance for my employees. Below is the policy and job site information. Copy ______ Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: /� City/State/Zip:/State/Zi ( ' I ' ` 7Job Site Address: 7� l�i lle� jr/G� p' Od Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that_a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: l 41', �� U �, Date: Phone#: ✓5at 2VI`37., Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials • Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information (if necessary)and under"Job Site Address"the applicant should write"all locations in town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the or applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax# 617-727-7749 www.mass.gov/dia S e hermit No. BP"-61107 Project Location: 78 MILLERS DR Commonwealth of Massachusetts TOWN OF DARTMOUTH M p#: 0073.00 400 Slocum Road,Dartmouth,MA 02747. Lot 0013, Phone: (508)910-1820 • Fax: (508)910-1838 Sublot: 0039 BUILDING PERMIT Category: DECK 1-000643 FIELD INSPECTION Est.Cost: $35o 0 Cons .Class: Use Group: R3 Contractor: License.• Phone#: Lot Size(sq.ft.) 95246 CHARLES J GABORIAU CS-49472 (508) 243-3784 Zoning: $RB HI-108523 Engineer: License: Phone#: Aquifer Zone: N/A Flood Zone: ZONE X Applicant Phone#: NewConst.: 512 sq.ft. C J GABORIAU BUILDERS (508)243-3784 Alt.Const.: N/A OWNER: GILLIS PAUL J II& �) m 664 DATE ISSUED: U C uffil bLi. 11 1 9 TO PERFORM THE FOLLOWING WORK: Construct a 16'x 32' three season room on existing deck; frame and exterior only - OWNER WILL COMPLETE 419-)c2C-YZ) DATE TIME TYPE OF INSPECTION&REMARKS INITIAL /7 o 9m. t F"li1,a1-,#qt OK 21As. L A 4 494/ .1 96-..' an,eA___ s it k e ,.AI ` � �S ` � / ' , ) p MijOr r +;(0'7C67) lam— Z� yorTOWN OF DARTM To. - L + 'I` MENT RECEIPT 6 31113 Name: /� ([4tY1 •T/ x""th Property Owner: �� Date:;/42' Job Location: / (/ it/4-t75 I)f Map: f "-- /!/ Lot: �>,- /__ Description General Ledger#'s Ref. # ;Amount ' Building & Building Misc. 01000-44105 ��� ,/��4w ) Electrical 01000-44106 { �; Plumbing & Gas 01000-44107 1) ===-- Trench Safety 01000-44129 I, i-� ' Other Department Revenue 01000-42420 61!i r 77 )1.j — White-Collector's Office Yellow.Copy-Customer's Receipt Pink Copy-Building Department Received By (f GJ�-- THIS IS NOT A PERMITILICENSE FOR BUILDING, ELECTRICAL, PLUMBING OR GAS •/Permit No BP 61107 BUILDING PER IT ,, GIS# x : 0`653b0 ` 0 ,fl Commonwealth of Massachusetts Ma!): E < r007b x''rxz r`� ',' : } I � ' T �I''N O'>!"DARTb10tUT[I Lot e,. '' `"*.001i,:.E:'°a 'If P ae a �400 Slocum Road,Dartmouth;MA+02t/47 1 S'u6 Lpt' ' d 400391't 'r m, Ph(pe (50S)910-1820 • Fax.(508)910.1838 ''Catagory """ .wD_ CzK tx_ A"I'+ + + - PT4'�#� ��.��)���241� YY""0643^4dr�"��v��' y ,, +E 'c 0t1 . 1- '. 1100110.o_0 .4,1 " ,I PERMISSION IS HEREBYGRANTED,TO �-, ,, ' , . E tx �fC1 2fn qVE' 'A 7T a § 41 + - .,p'd Phx (�#' 350410 n�. Tung tGons'TCla°s '3a`r'iter E i „ it Contractor �� a e '-' Groups°; " u`,,Y3"y°'ill a?"�tv. CHARLES J GABORIMIS,,:,:, ,,> 9"4 ;. c.1�.1508)243" .784 y .'Si+ i'iW y}, a��r 'b ?" mead �P� i ')' sz ,, F/UM�'� sq rM�n'x' iH��i4vEn.2Y�{�F:°'S' - Y'' 3 ez t •Zoning k:- _ t `-�',. n' Engineer: :: r '„ ""k. �i` aLic e iat+, Phone OP' - Aquifer�rZoniet� a hN k r �, Fl e ,a ,p '' 5,,,, ,$. r I � `FJooLone . ,'ZONE '` s , w w .tsl a`r )"? g' th; P ,t ',v .51 "' fl., �.Ii K Applicant: _ Y : e*- : bane T NewJCbnsL ' °w q C J GABORIAI7,BUILD S gg. ' , ' E50S)248k3784 i+Ai iad'st aa�+.- sN �+i,id girir w , ;, ho- ` h sof ,P � Ar �, .3.�v OWN&R: + y :y .� a Y+ ��'2 '� '""5 f vs ' F° ;nDateTyPe3 ' E i092S`-20"12+ '4# GILLISPAULJI`" ,,..3 ,, rs. 1 DATE ISSUED: A / ' s e TO PERFORM THE FOLLOWING WORK: <T,,m. mow, �..y Construct a 16'x 32' t ee s ason room on existing deck, frame aidlexterior on`I" - OWNER WILL � 9 , • COMPLFFE 3 / i /D G �v O/C r _>0 / Jat P oject Loca io�MILLERS DR Approved/Issued Bv:• f f. -.'.+a .'.( a A/_r DAVID BRUNETTE,LOCAL BUILDING INSPECTOR All work shall comply with 780 CMR 7T"Ed.(MGL Chap.143)and:any other applicable Mass.laws or Codes and plans on tile. ___ OTFiEU SCHEDULE-APPROPRIATE-INSPECTIt3NSAWRE UPON CoMPLICIiON OF-WORR,14N.4L LNSTECTIONISI:EQLURED. THIS PERRILT-;WILL EXPIRE EXPIRE.PER 780 CMR 5110.9(NOT MORE TITAN 3 EXTENSIONS WILL BE GRANTED)OR ON ISSUANCE OF A REGULAR OCCUPANCY PERMIT. I hereby certify that the proposed work is authorized by the owner of record and I have been authorized by the owner to make this application as his agent and to receive this permit, I further understand other agencies may have reason to STOP WORK if items under their jurisdiction are not met; not withstanding the issuance of this Building/Zoning Permit Signature of Owner/Agent: `11-7-1/ Comments: PERMIT.NUMBER'IS REQUIRED.WHENREQ•JESTING INSPECTJONS/RE-INSPECTION.FEES MUST BE PAID BEFORE RECEIVING ANOTHER INSPECTION/REPLACEMENT F EE'WI LL BE`REQUIRED-OF LOST CARD "Persons contractin_ with unre:istered contractors do not have access to the guaranty fund(as set forth in MGL c.142A)' Inspector of Inspector of - D.P.W.Inspector`. Building Inspector Inspector of Gas Fire Department Plumbing Wiring Water Service#: Footings: Underground: Oil: Underground: Service: Foundation: ���.' Q n Rough: Smoke: Rough: Roug Sewer Service#: Rough Framelf2-,^1� �y1.!J� 7 ' Insulation: Final: Final: FiaLi� �1-• • \./ ��1�`�/.'' Cross Connection Final: Final: f/1-/L Treasury; Board of Health - E-911 b -- Additional Comments:_ ////I Planning Board • �/ 94j v ..- ^a,/ iti Prior to issuance of Certificate of Occupancy/Completion,this card must be returned to the Building Department with all necessary inspections signed off. Department phone numbers are listed on the white"Required Inspections"document provided with the issuance of the building permit. - ,1 POST CARD SO IT IS VISIBLE FROM THE STREET--- Page 1 of 1 A! ARC HGARD F ! REPLACE PRODUCTS 94y( VW , a CHALET 1600 Wood Burning I. t F. Stove ��} ;co-, r. . : ' .ji4 ( Users ' Inst al l at is Operation and Maintenance Man PRIOR TO FIRST FIRE: Remove all labels from glass. Clean fingerprints from p) surfaces with a glass cleanser and soft cloth to prevent permanent staining. CHILDRENANDADULTS SHOULDBE ALERTEDTO TFE HAZARDS OF HIGHSUR TEWERATURES, ESPECIALLY THE STOVE GLASS, ANDS HOULDSTAY AWAY TO AV( ORCLOTHING IGNITION. THIS UNIT CONTAINS SMALL PARTS DURING ASSEMBLY TW BE KEPT AWAY FROM CHILDRE N DUE T O CHOKING HAZARD WHICH COULD RESULT Ih INJURY O R DE AT H. Installer: Please complete the details on the back c O-TL and leave this manual with the homeowner. ]-1J-JJ Homeowner: Save These Instructions for future ri NATIONAL FIREPLACE http://webmail.town.dartmouth.ma.us/owa/WebReadyViewBody.aspx?t=att&id=RgAAA... 5/10/2011 s r CHIMNEY CONNECTORS AND VENT CONNECTORS 211-27 Table 9.5.1.2 Reduction of Connector Clearance with Specified Forms of Protection 11finnnum Clearance Clearance Reduction Applied to and Maximum Allowable Covering All Combustible Surfaces within Reduction in Clearance(%) As Wall Protector As Ceiling Protector the Distance Specified as Required Clearance with No Protection (See 9.5.1 and As Wall As Ceiling Table 9.5.1.1.) Protector Protector in. mm in. mm 31/2-in. (90-mm) thick masonry wall without 33 — 12 305 — — ventilated air space 1/2-in. (13-mm)thick noncombustible 50 33 . 9 229 12 305 insulation board over 1-in. (25.4-mm) glass fiber or mineral wool bans without ventilated air space 0.024-in. (0.61-mm),24-gauge sheet metal 66 50 6 152 9 229 over I-in. (25.4-mm) glass fiber or mineral wool bans reinforced with wire,or equivalent,on rear face with ventilated air space 31/2-in. (90-mm) thick masonry wall with 66 — . 6 152 — — ventilated air space 0.024-in. (0.61-mm),24-gauge sheet metal 66 50 6 152 9 229 with ventilated air space 1/2-in. (13-mm) thick noncombustible 66 50 6 152 9 229 insulation board with ventilated air space 0.024-in. (0.61-mm),24-gauge sheet metal 66 50 )6 152 9 229 with ventilated air space over / 0.024-in.(0.61-mm),24-gauge sheet metal with ventilated air space 1-in. (25.4-mm)glass fiber or mineral wool 66 50 6 152 9 229 batts sandwiched between two sheets 0.024-in. (0.61-mm),24-gauge sheet metal , with ventilated air space ten Ala); l,Q� Notes: ,--- le '' ?0-4-4A ' 1.All clearances and thicknesses are minimum;larger clearances and thicknesses maybe permitted. 2.To calculate the minimum allowable clearance,the following formula can be used:Cps.=C,,,,(1-R/100),where Cy,.is the minimum allowable clearance,C,,,,is the required clearance with no protection,and R is the maximum allowable reduction in clearance. 9.7.3 Connectors for listed gas appliances with draft hoods, constructed of combustible material to a masonry chimney,pro- other listed Category I gas appliances (Table 5.2.3.1,Column vided the connector system selected or fabricated is installed in I), and oil appliances listed for Type L vents (Table 5.2.3.1, accordance with the conditions and clearances specified in Fig- Column III)shall be permitted to pass through walls or parti- ure 9.7.5. tions constructed of combustible material provided one of the following conditions is met: 9.7.5.1 Any unexposed metal that is used as part of a wall pass-through system and is exposed to flue gases shall be con- (1) They are made of listed Type B or Type Lvent material for strutted of stainless steel or other equivalent material that resists gas appliances or of listed Type L vent material for oil corrosion,softening,or cracking from flue gases at tempeidenres appliances and are installed with not less than listed clear- up to 1800°F(982°C). ances to combustible material. (2) They are made of single-wall metal pipe and guarded by a 9.7.6 A connector for a medium- or high-heat appliance ventilated metal thimble not less than 4 in. (102 mm) (Table 5.2.2,Columns IV and V) shall not pass through walls larger in diameter than the vent connector. or partitions constructed of combustible material. 9.7.4 Connectors for residential-type appliances(Table 5.2.2, 9.7.7 Connectors shall maintain a pitch or rise of at least Column I) shall be permitted to pass through walls or parti- Y in./ft(6.4 mm/305 mm)of horizontal length of pipe from dons constructed of combustible material if one of the follow- the appliance to the chimney. ing is true of the connector: 9.7.8 Connectors shall be installed without sharp turns or (1) It is fisted for wall pass-through. other construction features that would create excessive resis- (2) It is routed through a device listed for wall pass-through and tance to the flow of flue gases. is installed in accordance with the conditions of the listing. 9,7.9*A device,other than a damper,that obstructs the free 9.7.5 Connectors for residential-type appliances (Table 5.2.2, flow of flue gas shall not be installed in a connector,chimney, Column I) with inside diameters less than or equal to 10 in. or vent unless listed for such use. (For requirements regarding (254 mm)shall be permitted to pass through walls or partitions dampers,see Section 9.9.) 2003 Edition Q CHASE ENCLOSURE If the chimney runs up the outside of thb house, for best performance, it should be enclosed in a chase. It is best to locate the chase away from any overhead obstructions. For best results, the chase should be con- structed in such a way that it is part of building envelope. It should be well insulated between the footings and the floor of the home to prevent heat loss. Insulate the chase in order to keep the chimney (flue gases) warmer. This will work to increase draft, reduce condensa- tion and creosote formation. Include an access door by the chimney"Tee Cap" for chimney maintenance. wip, MASONRY CHIMNEY ri e t t Ensure that a masonry chimney meets the minimum standards of the National Fire Protection Association (NFPA) Standard 211 .- n.ve.,,era+>r�canmasta�na+t in the U.S.A. In Canada ensure that the masonry chimney �i � , arnsWa)tndltpgtns nadinpleas. meets the minimum requirements of National or Provincial Build- i{ I i,,� ing and Fire Codes. It must have at least a 5/8" (16mm) fire 1� Irri Sitightersitedrkiable clay liner or a listed chimney liner system. Make sure there are r t = "" ' """'� �"'*m0" no cracks, loose mortar or other signs of deterioration and ) t I { I blockage. It is best to have the chimney inspected by a profes- r t t i sional, and be sure to have the chimney cleaned before the t I [ stove is installed and operated. I I t J. iAs� For optimal performance, masonry chimneys used to vent this t i + appliance should be lined with a 6" (152mm) stainless steel or t^04$. S lit cast in place liner. Installations into a clay flue without a t I�:"'t3` :� stainless steel or cast in place liner may reduce draw which af- t r t r ; � . i ,t fects performance, cause the glass to darken and produce ex- Cg At.ast.• cessive creosote. t I 2 i t I t / ;' When connecting the stove through a combustible wall to a ma- ) CI 4 Hearth sonry chimney, special methods are needed. The following r t I . ,a.C- Extension "Systems" are based on the NFPA 211 Standard for the U.S.A. I I 9 and it should be referenced for more detail. For Canadian re- asidaUeatneaon t mar, quirements, check the CAN/CSA B365 and your local building threughersileribet codes. System A: 12" (304.8 mm) Clearance to Combustible Wall it n1d stiss2in r51p7 Member Using a minimum thickness 3.5" (89 mm) brick and a 5/8" (15.9 mm) minimum wall thickness clay liner, construct a �! is hS.dzhum tlearnnca _ Smmi wall pass-through. The clay liner must conform to ASTM C315 nt PM* x "` (Standard Specification for Clay Fire Linings) or its equivalent. f g i Keep a minimum of 12" (304.8 mm) of brick masonry between IIu i lir Z\ a the clay liner and wall combustibles. The clay liner shall run — m "Or f, from the brick masonry outer surface to the inner surface of the 1am, as,�M,� "'�„� ,"e a`"'` - °` chimney flue liner but not past the inner surface. Firmly grout or in comtniskties NFPA 211 cement the clay liner in place to the chimney flue liner. , . i I • , if• , IP I ''al ' I I . II CI r i 1 I / I i --'-- /. I ! I 7 i —-.._,____„.... -- .„___ ki I it \If \ I . III i '14 Cej \ 1 eg „......% c'll I \ I I I n <1 q I I \ I CIC 1\ I I I I I ,q? il ;74 scr‘ 1 J 1 1 I I 1 I z;II tfi —rm \ . I 3 rr, rt. . I 1.,Ili ft) \ \ . . . . & S \ \ N / ƒ . . 5 � rito \ \ 'Cl.. - . . { 4. ° f a § 2 �~9 @ ¥ \ $ 3 . _ 7 t1Y 2 � - - J __ / \ --�-- �—!� w# / p Z S. \ i\ /\ \ \ »w vti / e , / / . . / L . . . .�. / �..... / I 1 1 H | / it- . . j 4 ,.- -r-r-----1---9- , - --,,, -,- i t , , t 1): , (.4; .,,,j 1 ! I ...,1 Id I i 'r... r ,..,................,............._.1 I v____„_________-,4 -,- —I „i 1; i I I 1 ..3 d ; I -I ---------t-/--- 2 c.-.Q.. T --...r. i i ________ „.. : , - -Yrr 6 i I 1 ----- ••-• • r ------------- ---ah- _ 1- X SJ L N-m<o tih -- -- — Syl S.1 -,- ri C -.I i 1\ -1 I 1 is;k: vri tt; za: ":\'''' ,i.,,, :-.1 „-• r = i \ ----1 • --,/-/- .v".; -7.c-:- ti•-t± -.... w ' \N- 1 . 1 -Zi- - `------ q) it. CZ r..X) ra. 1 I ' i - .›.-.' n C\cf if-- I , 1 N :,,,, IN-c- 1 I 1 4 . _______ ot_............._._ •*, ...._.,, I I, , , 1 1 , , \ , \ I 1 i I I _4_...wirliy 1,._ ---`1, : , 1 \-----4------ , I i ,-,1 A ‘-', N 1 li II I I (51-1 I 1 1 i 1 1 i ti N I 1 1 k -----„, 2, / —_—_,.........---4.1 0 c of a l' V S. h V -t ✓ '-i- e` 'A' -� CI P4 ry 1 J -- 1 7" I \� 1.r.1 fv,ial✓ i i ., rl , \ "-° i k 4 �, I I j p ,w> i ya ,j -I...‘,.. \ it i- ; ‘...i 14„ V ^•-'S T - k0 , ra sa a !) X ' w x tf • II ' I ll, a -e• i I r---- i0 I s. <------ co, - - 1 \ \ t)s a1 T \ \ * i' i z 1 `- 1 . `/1 --__ . _ \ ..... .-.1 t' ! 1 s�: ::y. 1 o 'icer ► // I ...__________I. /( II j Ui 4 is � \ t i {ri \ 1 ' ly \ j. ii Oa c3- c3 \--- ., ' Cl. 4 • 4 .4 • 9.i { v� r_ v6 4, -.-1 I '.12 '.i Cu / i j j y I ! / L . _� .. I r f / I f t f _ .. . _ ,. -____......___........_..—,....—.--..—...,..",—,........--____-_—_-- ,• ....b.y......... -4— -: -.. ii .1. 1 : I • ) (.1 t),._,,_ 4 i !I• lit i 4 -51, _.........,_4_ 1 I i.1 I ; :-.1.:. r =,-, It 1. , ! i . . 1 ' • i j 1 ' ! 72 :1 i--... I 1 —____ _____71 _:.,'i l''' I j 1 i I 32:1 1 I'i A..It —-- 0 ,... .•-•\ 44 ., s / fe, .L._—__ C i • - \ -.1 Vaj Z '.... 144 74./--- --1-.-.? ---‘ § ..-•-• -..- w • . ,,,) •c: ..-4),_. \.5 i--', &..:1 1 1 1 I \--.. 11 • ••• i;\ ..----, N Di i i N i ,1 1 t. Li I . L "iiia No, I I 4 i ik ! I I I 1 I \\ , .I I If 4 l>ii I 1 1 i I 1 I ! 1 1 4 1 /4. -11 1 1 1 IN1.,,--? I 1 I . i i 1 I it, N. 1 .1 i , , __ , 1. -,---4,--‘, -4 i . 1 2 1 ti —62 ? 'I N • -I-- Kt -3 'J Z — :IC: ll. -1 l,Jr .P �3 S J K ,� Cll T F^ n1 s '� xy t l + j0 f 4 L n .- r' , iU C t'1} \ ad.!?;,<?/c. \ II1J ff_ 1 ' '1 W "92,ino, 1 T :2 n ;,'7 X'1'.t,.. I \ /" I i �, \ I a ' ph i r� -- -_ 'CS itrI • 'L_ V ' ; V., ` ':) i , fr : — -,., ti ' - r. i. c\ 1 I 1 ka ! rk 11 i <---- f ©.� j 1 (321 •,_ 4 \ -'' ' \ .\ i 1\ ii\ - tl!, \ . \ 1 \ �F ' l t. '4 .Y; 04 cs ____.___.___.__� i + +(,.. i I 4 ` IP Fw , _ i i \ lc et i \ nOs; p%.) !KJ \ 1 - o /rf I � I_ _ / lr c 4 • 1 / } OQ. Y+rtyy Cf. Q. Z` 'I � -...-_��......,. . t / _I 1 an — "" _�. is i 0 I il ! , / ji / n / Z1 '''. \I W ' / t '<.-; -,t,. 3 ;A. f- s. t ` ._......_____.____...__...,a L..i rr el 5' 3 c v 1 !�v cA it ,a Za 1 b V' 1 C- 'CA • ,/‘ ----'1 — ----1 ,.-"-.1 . nal i T -1-1-1 ... e 1 . 6- - . 1 ' 1 1 L t ..; ,... ,-----, • .,-- r... i, 4 --Anr— - ...4, '(I ), -, --rk, Tu I -7,') N) `---- .-71 5i, 7.!-t.• ‘..--1 \ 1 I- -ft- al •••-• r.-4 - \,.. "F rA -it)'-- -N\ \t,„ . .. 70 \ 9'4'. ‘, I' y (-. _ ---z4,--)C ---____ .•••..7 i ec4 -t:i a 71 1 _ _____444...x________...,/ -• .. i I i:),t' L . ii • . _...., I .--... i 1 • i ----.4.___ , I ,.., •.:-., i, 1 i nil. I 1 i i • i i i i 1 i. .. . -73 \, \\ , I-1 -v' ell ' oIV 0. �v,_; t . t :t 4 . r 1 I '\I .. c`� t. i1 H { ?s i r t I el \ m I 1 I S u j GG'.et \\l . is.. 1 \11:5.__.._. CO ti �s I as iia • ' Ti -• hs C r' r � int- �r 0 151 .-j ` w EC' K- b 1.3 (;; x re, • i 1\-A!'-c--C' wt b 4 ts. tk\ �_.., tt qo - _--, 't 4\