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MEDE]ioiOS LAIVIT-�;'
1�1W�01 MMMMMMMMME
TOWN OF
ti paint Qe' Kept On Site
I
NO�iU glZIx AND DEPTH
gEOUIRED BEFORE
COt4IFI.ETE IS POURED,
-NjU..'t)I G DNT
[��� ART yi�iE
Y E If �"�'^e ivy
YQ1 MUST T
ATl?� E'�UiLDINa C?uRING� '�H
i
r-,,O'.LDING DF-PAR='T-
C4 V"m
Penetrations t'��'u raicd citp�� and f�egr� �h�zti �.:
iw ble Oj preventing Vic.,
sealed With ; r� me
t t; a {asses v�iben subj e6
Pass g of taaTls3 a
Test stand and : 0HIc
to the requirements of t
fertrb its AT�m-=`
NO TES
1, ALL WORK SHALL BE IRi COMPLIANCE WITH
STATE AND LOCAL BULL -DING CODES,
2, ALL EXTERIOR WALL STUDS SHALL BE 2'7 6"
@16" O,C. UNLESS OTHERWISE NOTED,
3, ALL INTERIOR WALL STUDS SHALL BE X 4
16 O,C, UNLESS OTHERWISE NOTED,
4, ALL EXTERIOR WALLS �HALL HAVE 112AI C �`,�x
PLYWOOD SHEATHING AND R-13 INSULATIOf
w/ KRAFT VAPOR BARRIER,
5, ALL FLOOR FRAMING Si-d,ALL BE TRUSSES
TO TRUSS CODES,
6, ALL FINISH WORK AND MATERIALS SHALL PE
COORDINATED BY OWNER AND CONTRACTOR.J,
7, THE OWNER, BUILDER, AND CONTRACTORS SHALL
CHECK AND VERIFY ALL DIMENSIONS BERF RE
STARTING WORK.
8, ALL WINDOWS SHALL BE AS SELECTED BY
OWNER. CONTRACTOR T11 COORDINATE WITH
TE FOUNDATION AND FOOTfNGS
RAWIN6. I
FOR WALLS AND SLAB SHALL
q, COMrRESSIVE STRENGTH'; OF
28 DA'BS- I
7OUNDATION SHALL BE ADEQUATELY
'AND VRACED TO FORM TRUE
CORNERS, AND PLUMB WAL�' LS.
SHALL BE POURED CONTINOJOUSLY
-S, DO NOT USE CONCRETE THAT
'LASH AND UNWORKABLE,
GS SHALL BE POURED ON
'OIL,
iIA, X 160 LONG ANCHOR B[1LTS
F SHALL BE EMBEDDED 1/—[]//
JNDATIDN WALL, I
FILE COPY
Town (w W0511SWx
A WY C3 TW3 Endmin,-�
Pion 6
Kept On Site
Mum tG
ou
tr! i
$ONO.Tilt jE SIZE AND DEPM, RE' lg pECTION ISREQUIRED13E
njECONCRETE 1 P URE�
r,IJILDING DEPARTMENT.
T"n of Dar"Outb
YOUR DRAWING MUST W2 VA "T
AT THE BUILDING DURING TIIIE
PROGRESS OF THI$ WORK,
MILDING DEPARTMENT
Tmn Of r�artmom)
STOpr-,G REQ.UIFI.—EMENT
thru W�ed walls and floors shall t
a matet-Pl capable of preventing
ft ,ames a��d hot gasses when subjeCtIll;
me 1rents Of the Test stan&rd`e�cJ^,,44d
n AsTm-,E-;C14- I
# —L If If e L I v
SCALE: 114 1'
_3
.:z
SEC�I�jD FLQ�11� PLAN
SCALE: 3/8" = i'
]\[OT,ES
1, ALL WORK SHALL BE M COMPLIANCE WITH'
STATE AND LOCAL BUDDING CODES,
2. ALL EXTERIOR WALL STUDS SHALL BE 2" IX 6"
@16" O,C, UNLESS OTHrRWISE NOTED. j
3. ALL INTERIOR WALL STUDS SHALL BE 2n X 4"
@ 16 ❑.C, UNLESS OTHF-i-RWISE NOTED.
4, ALL EXTERIOR WALLS SHALL HAVE 112" GDX
PLYWOOD SHEATHING AND R-13 INSULATION
wf KRAFT VAPOR BARMIER,
5, ALL FLOOR FRAMING SHALL BE TRUSSES
TO TRUSS CODES.
6. ALL FINISH WORK AND MATERIALS SHALL BE
COORDINATED BY OWNER AND CONTRACTOR
7. THE OWNER, BUILDER, AND CONTRACTORS oHALL
CHECK AND VERIFY ALL DIMENSIONS BERFORE
STARTING WORK.
8, ALL WINDOWS SHALL E AS SELECTED BY,.
OWNER, CONTRACTOR TO COORDINATE WITF
OWNER.
9, INSTALL CONCRETE FEUNDATION AND F❑❑TINGS
AS SHOWN ON DRAWING.
10. ALL CONCRETE FOR WALLS AND SLAB SH LL
DEVELOP A MIN, COMDRESSIVE STRENGTH OF
2,500 P,S,L IN 28 DAYS- `
11. ALL CONCRETE FOUNDATION SHALL BE AD QUATELY
TIED TOGETHER AND BRACED TO FORM T .UE
LINES, SQUARE CORNF-RS, AND PLUMB WA�_LS,
12, ALL CONCRETE SHALL- BE POURED CONTINUOUSLY
WITH NO JOINTS. DO NOT USE C❑NCRETE�I THAT
BECOMES NON —PLASTIC AND UNWORKABLEI,
13, POURED FOOTINGS SHALL BE POURED ON
UNDISTURBED SOIL.
14, INSTALL 112" DIA, X 16" LONG ANCHOR B`.ILTS
@ 6'-0" O.C„ IT SHA'L L BE EMBEDDED 1'—b//
MINIMUM IN FOUNDATION WALL,
COPY
FIFIE STC?PtNG REQUIREN11ENT
All lar
Paneiratlons thrrated walls and floors Sh�
seated with e rt� tefi t o paNe of prmntin j t ,
Pam, of fig.1mv, and hot gasses when suh��Doti,:
ssa
to tho requiremc,")ts of the Test Standard ;rla
for Fire Sys ASTM-E-814.
�a
NO-TUBESIU AND IC1MPTH
I ECTION IS REOUIRED'RSFORE
THE CONCRETE IS Pot►RED.
BUILDING DEPARTM ENT
1; mr of Darts ot6
YO mm nA T m fq*T
AT THE BUILDING DU(JINQ TtIE
PRO'ni OF THIS WOk.
Ei
01=mDEPART r4T
au ift&
j
TOV91 OFT _
t k
Copy C1 T S F_11 d. yr o
plan a-st C mp!i On Site
0
a� a
i
4..
S�'COND FL,OQR PLAlb
i
,�VOTES
1. ALL WORK SHALL BE IN COMPLIANCE Wi ,H
STATE AND LOCAL BUILDING CODES,
2, ALL EXTERIOR WALL STUDS SHALL BE 2' X 6"
@16" O,C. UNLESS OTFdERWISE NOTED.
3. ALL INTERIOR WALL STUDS SHALL BE 2'' X 4"
@ 16 O.C, UNLESS OTHERWISE NOTED,
4. ALL EXTERIOR WALLS SHALL HAVE 112" CDX
PLYWOOD SHEATHING AND R-13 INSULATION
wl KRAFT VAPOR BARRIER,
5. ALL FLOOR FRAMING SHALL BE TRUSSES
TO TRUSSCODES,
6. ALL FINISH WORK AND MATERIALS SHALL' BE
COORDINATED BY OWNER AND CONTRACTOR,,
7, THE OWNER, BUILDER; AND CONTRACTORS;SHALL
CHECK AND VERIFY ALL DIMENSIONS BEFIFORE
STARTING WORK,
8. ALL WINDOWS SHALL BE AS SELECTED BY
OWNER, CONTRACTOR TO COORDINATE WITH
OWNER,
9. INSTALL CONCRETE rOUNDATION AND F❑bTINGS
AS SHOWN ON DRAWING,
10, ALL CONCRETE FOR WALLS -AND SLAB SHALL
DEVELOP A MIN. COMPRESSIVE STRENGTH ❑F
2,500 P.S.I. IN 28 DAYS.
11. ALL CONCRETE FOUNDATION SHALL BE ADEQUATELY
TIED TOGETHER ANC BRACED TO FORM ))RUE
LINES, SQUARE C❑RjERS, AND PLUMB WALLS,
12. ALL CONCRETE SHALL BE POURED CONTINUOUSLY
WITH NO JOINTS. DO NOT USE CONCRETE THAT
BECOMES NON —PLASTIC AND UNWORKABLE,
13, POURED FOOTINGS SHALL BE POURED ❑
UNDISTURBED S❑IL.
14, INSTALL 112" DIA. X 16" LONG ANCHOR OLTS
@ 6"0" ❑.C.. IT SHALL BE EMBEDDED 1'-0"
MINIMUM IN FOUNDATION WALL. 11,,
l ME 'TOPPlf G PLEQUIREkiEf 111T
Penetrations Mru rued walls and floors 1sh,ll br
sealed with s material capable of prevei sting ti c
passage of f: yes and hot gasses when subjected
to the requirelents of the Test Standard spedflc
for Ftfe S STPA-E-814. `
TOWN Of DMTNUUTH
A Copy W TWS r1�f l`
pion laud 0 Dept C, a Site
CONO.TU%s. sVS AND DE ,'TH
INMECTION IS REQUIRED 6E F E
THE CONCRETE Is POUR" ED.
VU1,Lj)jNG DRARTME T
'd
YOUR DRAWM T Re, w T-
g'r'Ttir, BUILDING DU,RINQ Yig
S OF THIS Wof3K.
n I etratOm thru rated wo-lis and Beers shau b-0,
aced k0i a rnate-rial capable of braventrng t e
SwgO of f►'arnes and hot gasses When sub!Wed
the rtqui.rements cif the Test S ndard r
iASTM-E-614.
SIDE E�,� Y��i TIONSCALE: 114 1'�
0
F CQUi 3
Penstrathns thru r:;ted waUs and floors shaD b-
seated with a mt =Tia4 cpoae of preventing
pa ge of f times nd hint gasses when sZb preventing
to tho require ntOr Of the Test Stt-ndlyd
VOU T KFPT
A-r ' E BUILDING DU"q11 Q THE
•_,,M OF THIS K.
UJIMM DF-PA
krm of
eoNo-TUq-E Sim AJ 0 DEPTH
I ECTICii+l IS REOUJIAED SE FOIRE
T14!; CONMRSTE IS OURED.
�' i AF ITM5NT
T0,197-11 Of T
nEGURIV
ACopy C1 VisEn
roan mmt ce,'Keptl On
��i
FILE- COPY
r
J
.RESIDENTIAL
2004 RESIDENTIAL
�
.
2 004
2.1 'Owner of Record:'
Name (print) �,5,5 - 21 � ,02 3
YYe f Contact Address Phone Number
2.2 Authorized Agent:
Contact Address
Name (print) Phone Number
"M,w
RPAli..re
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 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:
Homy Improvement Contractors Registration, One Ashburton Place - Room 1301, Boston, MA 02108, (617) 727-8598
Owners Name (print)
Signature--�
_�jaY��-�-
by signing the b.,,, the home owner acknowledges that there will be no eligibilty to the Guaranty Fund
Date
3.4 Hoffh _
eowner 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 in construction,
persons engaged 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
Construction Supervisors: and Regulations for Licensing
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 Homeowner
such shall act as supervisor.
For the purposes of this section only, a "Homeowner" is defined as follows: Persons 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 signbelow:
lop e
Signature:
C/
t7Your 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 R5.2115)
I� N rt� ;
Z.a.Rm
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to prOJvide this affidavit
will result in the denial of the issuance of the building permit. Signed Affidavit Attached: ❑yes ❑ no
e
❑ new construction* ❑ addition El alteration ❑ repairs ❑ chimney/ ❑ woodstove
(energy report required) (energy report required) fireplace
❑ deck ❑ pool ( accessory bldg. ❑ replacement window/door ❑ other ❑ demolition
(shed/garage) no. of windows_ doors_ (specify below): (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 (specify):
❑ Air conditioning - (separate unit)
❑ None of the above to be provided
❑ Hot Water: Gas Electric Fuel Oil Other
Brief Description of Proposed Work: c
��re a
reUWM
Item Estimated Cost ($) to be completed by permit applicatnt
1 Rnilrlinu
� R1Prtrical
4 MPrhnnical (14VAC')
5 Total (1 + 2 + 3 + 4) * Estimated To I r
r
�¢..
..71° 25,
;;-e n, x-. H e , .°:... .s. � e e P :. �.�• a �,...re". P'"'ii re % a %.. P Pi .m: � a ue rei.-... M '�-:re '� "�°°: �..
t
m
"Cm Nft imfi_�9,
(please print)
1, , as Owner of the subject property hereby authorize
to act on my behalf, in all matters relative to work authorized by thisbuilding permit application.
Signature of Owner
Date
re;fi
,rer�.�re ®, .t fi &RE�, a
as Owner/Authorized Agent hereby declare that the statements anrd information
on the foregoing application are true and accurate, to the best of my knowledge and belief.
Signed under the and penalties of perjury.
/pains
nature of Owner/Authorized Agent
Dare
C:\bldg:frorms\Bldgapp.res.wpd Page 2
Rev. January 1, 2003 C:\bldg.forms\Bldgapp.res.wpd
Page 3
IAL 2004
RESIDENT
❑ FOUNDATION ONLY
N. EFU DA LENON-TRANSFERABLE
$25 00 APPLICATION
TION725 FEEIS g.
D t Ian reviewed:
1. aep
2. 30 days to review period expires:
3. OK to issue date:
Date:
4. OK to issue subject to requested submittals (see project review worksheet):
Date:
5. DENIED (see project re iew orksheet):
6. HOLD reason:
Date:
7. HOLD subject to oning Board of Appeals action:
8. Come ts:
_
RESIDENTIAL ❑ FOUNDATION ONLY
FEEIS NON- FU DA L'E ds
1 $25.00 APPLICATION
Date:— I W)01109 �€
9. Inspector'sSignature: e
-- -� � - � � � � � = •� a` , - �� -� . � -mom_. �,. ��. ; �� �."w�. P � -�
s
i
�- Da Time: Clerk:
Applicant info e _ "
Comments:
.m
0 pm
a `
m Remainin Balance: $ � �
Total Permtt Fee: $ `� Less Apphcatton Fee: $ 25 00 g
5 1, 5n 4
�i TOTAL FEE: ��� . � � Gross Area -New Construction total sq. €t: � ��
Gr ss ea - Alteration total sq. ft.
Zoning Review:
Permit sued d . Energy Report: /<
Fire Chief: '
Board of Health:
i
Conservation Commission
Other:
Ij
Description of work bein,
l
%0
�- �---� NWIN _ m
NUMBER OF PLANS SUBMI
a s
77 1.1 Property Address:_
Nearest Cross Street: —
Subdivision Name:
Total Land Area Sq. Ft.:
%Q
m 1.4 Water Supply (MGL
a
C:\b1dg.formQ-\B1dgaPP.res.wpd
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Page 4 Rev. January 1, 2003 g
Page 1
2004
LE
�
Rev. January 1, 2003