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SILL TOP OF STEEL BEAM I I DROP 28" N ---------1------1------------— I1.1 wloxlsBEAM _ _ _ _ --�__I_ BEAM POCKET BOILER I ° 6" WIDE 9" HIGH 36"X36"X12" DEEP COLUMN PADS 5" DEEP A 3 1/2" LOLLY COLUMNS BOTH ENDS �^cn I ° i�I ig IgII � • I I' LL 6" FORM 4'-9" BELOW T.O.F. TO INVERT I .jb II cv - Ia PERRYI ST. MARTIN to V I it VSO COURTLYN 13 I I I yin I `. 1 I I DBL2X6SILL(1)P.T.B(1)K.D. UP FOUNDATION I II v L�— — I—" — a9 — — — — — — — — — — I 4" PERIMETER DRAIN I -`t • S.D. � 10" - 3!4" STONE gruirmT- I o I �-------------------------- (ELECTRIC OIL TANKI I! 4" CONCRETE SLAB I NIV, II I---------- — — — — — — — — — — — — — — — — — — ---- — ° ° a ------_ ---------- 33'— — — — — — — — — — — — — — — — -3—' 24' �I 36' 624 JULY 24, 2001 I RESIDENTIAL 2001 RESIDENTIAL PR PE� _WNE rP A T RIZED AGENT `- 2.1 Owner of Record:g CSbBcm!Fb-Se.go Contact Address Phone Number Name (print) 2.2 Authorized Agent: ;�Mz;i�D "Q AD , Name (print) Contact Address Phone Number E' TI N - YCONSTRUCTION SERVICE -. 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor O License Number AddresslSp, Expiration Date Signatur Telephoncnrs 3em 3.2 Registered Home Improvement C65tor 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") 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 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 Ucensing 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 are applying under this section sign below: Signature: Your signature carries certain responsibilities, including but not necessarily limited to, general liability NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that any licensed Construction Supervisor, whether or not they have taken the permit are responsible for code compliance. (see Appendix of 780 CMR R5.2.11`5) `SECTION 4 WORKER'S COMPENSATION INSURANCE AFFIDAVIT (MGL C 152 § 25) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provtide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached: Xyes ❑ nm SECTION 5 - DESCRIPTION OF PROPOSED WORK {check all apphca6le) - new construction, t ❑ addition ❑ alteration ❑ repairs ❑ chimney/ [❑ woodstove (energy report required) (energy report required) fireplace ❑ deck ❑ pool ❑ accessory bldg. ❑ replacement window/door ❑ other 10 demolition (shed/garage) no. of windows doors (specify below): ((specify below): * If new construction, please complete the following: t Single Family: no. of bedrooms 15 no. of baths /O e_ 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: - =,SECTION - 6 ESTIMATED CONSTRUCTION COSTS r 1 ,. n " Item Estimated Cost ($) to be completed by permit applicant, 1. Buildiniz ` 2. Electrical 3. Plumbiniz 4. Mechanical HVAC 5. Total = (1 + 2 + 3 + 4) *Estimated Total SECTION 7A OWNER AUTHORIZATION 's (to be completed when owner's agent or`contractor applies for building permit)`~ (please print , O 6 , as Owner of the subject property hereby authorize,,S�t�i t a t'o in in all afters relati e to work authorized by this building permit application. =1&_ a6. �CiJ Signature of Owner Date s "3 TH RTZED n . AGENTDE L RATION aOwne /Authorized Agent hereby declare that the statements anal information + on the foregoing application a4 true and accurate, to the best of my knowledge and belief. nder the pains and pen It* of perjury. Signature of Owner/Authorized Age n Date C:\bldg.forms'\Bldgapp.res.wpd Page 2 Rev. January 19, 2001 C;\bldg.forms\Bldgapp.res.wpd Page 3 _ _ _ ___ _ Rev. January 19.2001__ RRISIDENTIAI 2001 SECTION 8 -INSPECTOR'S REVIEW/COMMENTS - _.. K . b.. .__.. _ .:. ;. - 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: Date: 8. Comments: i 9. Inspector's Signature: i ti Date: .M I�ICANTNOTIFICATIONS TON9 _ Applicant informed of�aD-'°V e _ Date• Time: 6� %�Ll Clerk: Commen/t ts: U t ( ^ NOTES - - . -: E TION 0- E PECTOR S N _ S C 1 OFFIC 11N5 - Total Permit Fee: $ 15 Less Application Fee: $ 25.00 Remaining Bala e: TOTAL FEE: Gross Area -New Construction total sq. ft. Gross Area - Iteration total sq. ft. Permit Issued To -' _ SECTION 11-ADDITIONAL COMMENTS/SKETCHES = RESIDENTIAL 2001 0UNDATIO N ONLY $25.00 APPLICATION FE IS NON-REFUNDABLE NON -TRANSFERABLE DATE k'.ECEIVED �M°"TH' DARTMOUTH BUILDING DEPARTMENT 400 Slocum Road, P.O. Box 79399 2 Dartmouth, MA 02747 =' 508-999-0720 FAX 508-999-0738' ^ ' -�• „ APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMTTLY DWELLING THIS SECTION FOR; OFFICIAL US)%ONLY , RECEIVED BY �> f 1 3 BUILDING PERML T DATE SENT FOR REVIEW. r NiJ MBER: ��.� ..--s.� :DATE.ISSUED OK TO ISSUE SIGNATURE• f ` �V4z ding ommissioner/Inspector fl�ild ngs- 7 ' r, , .Bu , ,F » _ .. "!..^:: <:.., i*uvy" ; _'rx.•i+N`�c :y�?n+ "t .. -. C r 2 r'v t`. K' :.; k^:..�F r',yq„3L""'+5+ k::',' P��...... {. Xty .'S rn`3+k�%59rW^ .. ,:. +.'_ ... _ + . —•,.,� ¢. -. Z. r.......-6.....,.. r. . yy .. ., :... ,-•. - A ,-_.:. ... ... ..... _:_ r. .. ..k „sue""-;...:. cf.....: :-s: :' .. }, ., Zonm District. _: r, o osed Use..... _-, B ❑ A. ❑ V Autslde.,Flood Zone ❑' uifer:Zone ,�a....., g is P 4 ..,_ .Zone.-...❑ .-A THE F LLOWING AGENCIES SHOULD BE pq ix oard of❑ Board of ❑Con Com ❑Demote ❑DPW❑ Elec ❑Energy Report Appeals Health - Affidavit sCard Sent;Cut Oft Follow u _ �.,. n _ .. �,.�.'HYZN.d}xY h,,• S P}ii.,4 3 .y+a...-.'ate 'Yv'{'�..f',�.. .1 �5 _.L .. 77 Fv4-..,t-x--'-.:-�-�..if`3.<`."'r _ n ❑ Fire r❑Gas❑ Planning Board* ❑Sewer Card ❑ Water Card ❑ Zomr�ig ;y❑Other Chief CutSOff/Cut/Cut Off ReviewK e� , P ,. 'fi•3:� � L"� 1:'. ...., n Y' , _', I.! :AY 7 t .,. *::REQUIRES INSPECTOR'S REVIEW BEFORE'THEISSUANCE OFA PERMIT.'- ,wu<sDEPARTMENTALAPPROVAI Zoning Review: Signature: Daite: Energy Report: Signature: Daite: Fire Chief: Signature: Daite: Board of Health: Signature: Daite: Conservation Commission: Signature: Daite: Other: Signature: Daite: Description of work being performed: ..SECTION 1-SITE INFORMATION ^' ' NUMBER OF PLANS SUBMITTED: (3 ) SITE PLAN SUBMITTED: yes Elno 1.2 Assessors Platt & Lot Number: 1.1 Property Address:*'c Plat I ' Lot -- Nearest Cross Street: qt�, 1.3 Historical District ❑ yes /�M�/ne) '' / Subdivision Name: ''`` \ `' A, w �V �lV� �/'��� Has application been submitted to thie Historic Commission? Total Land Area Sq. Ft.: ��J� ��'�, ❑yes no Date: 1.4 Water Supply (MGL c 40 § 54): 1.5 Sewage Disposal System: ❑ Municipal Private Well ❑ Municipal On Site Disposal System C:\bIdg.forms\Bldgapp.res.wpd Page 4 Rev. January 19, 2001 C:\bldg. f6rms\B1dgapp.res.wpd Page 1 Rev. January 19, 2001