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BP-14824RESIDENTIAL 2000 RESIDENTIAL cFOUNDATIO?`. '2000 $25.00 APPLICATION FEE IS NON-REFUNDABLE & NON TRANSFERABLE 1. Date plan reviewed: 2. 30 days to review period expires: 3. OK to issue dater 4. OK to issue subject to requested submittals(see project review worksheet): Date: 5. DENIED (see project review worksheet): Date: 6. HOLD reason: p rr-Date: 7. HOLD subject to Zoning Board of A peals act/ion: Date:. -3 t- 8. Comments: ,I' e-e_� Total Permit Fee: S Less Application Fee: '$ 25.00 Remaining Balance: $ L TOTAL FEE: /�� Gross Area - New Construction total sq. ft. Gross Area - Alteration total sq. ft. Permit Issued To- r n ✓ _ , .► 1DATE RECEIVED °� T" DARTMOUTH BUILDING DEPARTMENT 400 Slocum Road, P.O. Box 79399 Dartmouth, MA 02747 ; ; € -7 508-999-0720 FAX 508-999-0738 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Zoning Review: Signature: G' Energy Report: Signature: Date: Fire Chief: Signature. Date: Board of Health: Signature: Date: _ Conservation Corn mtsston: Signature: Dater Other: Signature: _Date: Description of work being performed: . � SIT NUMBER OF PLANS SUBMITTED: SITE PLAN SUBMITTED: es 0 no 1.2 Assessors Plat & Lot Number: 1.1 Property Address: �3r"�LL,%V f �! � _ Plat � Lot -S - Nearest Cross Street: 1.3 Historical District ❑ yes ,-to Subdivision Name: Has application been submitted to the Historic Commission? G Total Land Area Sq. Ft.: 5 ❑ yes ❑ no Date: 1.4 Water Supply (MGL c 40 § 54): 1.5 Sewage Disposal System: ❑ Municipal APrivate Well ❑ Municipal pDn Site Disposal System c:\«pwin\forms`,bldeapp.res Paae 4 Rev. January 20. 2000 c:\wpwin\fbrrns\b1dgapp.res Paee I Rev. January 20, 2000 RESIDENTIAL 2000 .:..::> ...:...: >:::>::::.: <:>::.:.:..::.> tusnip. AT 2.1 Owner of Record: j'i S 7 LeY.,'r-(clot e- 1<a+r I �c Cm rr�v lc v� Name (print) Contact Address Phone Number 2.2 Authorized Agent: I Y S 7 L.e y-,6v ,ra rr t�- gO9--7653 Name (print) Contact Address Phone Number XX tiT>cT1 iv .]s kv.1c ...................... 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor License Number Ve j gI2 1J Z ' -Z_ Address - J�k-k--, oA ' Expiration Date Signature elephone,9�15�� �— —. 02 , 3.2 Registered Home Improvement Contractor: Not Applicable ❑ Are you a Home Improvement Contractor subject to (780 CMR-6)? Z yes ❑ no If no, go to the next section! Are you claiming exemption from the requirement? ❑ yes 2no If yes, submit the required affidavit! Company Name ®1� Registration Number (if none, state "none") Address �! Signature elephone ;.��'�rj' Expiration Date 6 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 Hom'Cowner Exemption - One & Two Family Only FOR HOMEOWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR Ow" V 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 directl}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: Sienature: Your signature carries certain responsibilities, including but not necessarily limited to, general liability RESIDENTIAL 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 R5.2.15) 2000 Workers 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 ❑ new construction* Xaddition ❑ alteration ❑ repairs ❑ chimney/ ❑ woodstove (energy re port required) (energy report req uired)wired) 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 I 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: ,1 r --J 71 Item Estimated Cost ($) to be completed by permit applicant 1. Buildiniz 2. Electrical�- 3. Plumbin 15. Total = 0 + 2 + 3 + 4) 1 *Estimated Total $ ,ease prinEEt) '�ona act on my �fha),f, in Owner , as Owner of the subject property hereby authorize„ 1)4 � relative to work authorized by this building permit application. Al \� 3/ 8 %®(-) Da e k �✓ '_!� f as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application a; ue and accurate, to the best of my knowledge and belief Signed under t" pains and pe alties of perjury. Signature f Owner/Authorized Agent Date c:�NNpwin'.famis',bldgapp.res Page 2 Rev. January 20. 2000 c:\wpw in\forms\bldgapp. res Page 3 Rev. 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CX.�'1 • C;e •m'�act Jet Y ALL 1tF1L11Y LOCAf1C?N5 'I Ta G TION rpkrm a�i, M& '7" BONA R TI�GH i�1G Sf�l~ � Gib APP'�ATI~ f' ,+et�1G115 At�:7 f2�� CY 01� .: 5�IV1' Si�1V�.� t,�' i'C1 �t5 GAY tN�IGk�f" C� tT� # Oi2 OF IGO .:C)AN I'1KiN5 AUSi1N ni50T,r I1 5 TO M5IGN eN6iNeW, 5A� MAYM a MW ON 7� 4 51EW 59Ve ANALYSIS AL50 5HA4 L 34.25 // 3-.2 #81=C�STiZfM.AGiNINN Y r � ON A FRACIUM OF 5�� PA59% � 4 W � ;,,/ NG P 'Nl, 5, GC NT AGTC?12 `'HALL NOTIFY TIC i S�tGN MaWER OF ANY AW ALL /, M Y5 5 M115r(d-MON5Jftl'AT TM-r THe MASM& M 't5 eACH C ,/. (,. Z �t♦, ! fit. GPinr�, MA, C�21 , nIS pANc s ot, I:N s11 G InoNs THC SHOWN NJ POl.aA5 5 fNtI #& 0 G,WM ON Vey PLAN RW Tie GOWN1ATIO�N Or- WOW, FOLLCOANG 5MCINCATION5, � , C�?iC �` ` , ��'' pR : SYSTEM carvN15 L > H-C� T51� LtCA"t? 5�'J SIZE THAT p G55CNIV. �� AY Nei' A ,� �.� r"/ ; pD X . ALf. OT'r SYSTe hA Gt�l�'ON�N1"5 SHALL rE H-ICE I?GdICTS. # . . _ 33.25 r��l. tt►aF 1 Co�1�` k O IDS 14f3x // . aO 7; ALL TANKS ?"O K WAT91Z 116f TWOLOi M>An ACTU M 5 5PEGIr GATiON5, # _ !O ox /,/ y tYpICAL 8 MILS C M►,) / G ' N. Cat) 8. Cl�01r CF GA5r" IN PL-A k 0001715 fO K D Of r'11 5 ENTER OR 200 ox X UGLA 0L'f 9 w E i . Q �� , LIALt Ate.• G f� 5°t"G?'lnS � C71$e12 TC71�12C�'I A WAT�12r1' R , _ c�1" M. I~`�VA 8�. AT A ♦ 4.5 � ; / �� , � C� � ,� F"1 _ G 2 , % ,WSJ 29J� � �{ . `, �, 9. U5� � �5 r'VG t'i E IN M : 5�p(rZ 4C? C74�'` I�iSF'G�A(.. 5Y5� AS `C��C7 / ; Nm 3I3 ry , : _ 2�t 1M1� (Min.) CLAY >3 540 .. ,. e Ifl: SLC ALL SOLlCI AT 17.MIN, LAB' ALL I�I�DIZAr� PrpT IN LEAt�NG M � a � � 1' # '� �► C71✓ > AT , , � . 3 .0 � wlth i If�MA131 ~..,.. F - Ar ,� ,. !'OW L ITY : cHAM12� a.5a ., I�V�r Ingo GOPifAGTfJt� t�tlr5 T I!. t� c f LeVA fi0 r�'X t P .. 'r 1 I~ w n �To I� �Ir o� nI >~r, �ow r out Awn clzsl SHALL ALL Ir. Gs 2.5 adrent .. cr >~ P- . C?�' IAA STCiN1r> 12. A r"C�'' C� ILL PegNM r'L� i:X't� TO �1. T1�5 5i'S1"�M 5 C. �C� t�lsp SAL I�' ! NCi!" 51'�li � O U'Ni11`. VVATi~ � r, :_... . So�T>~Nef Gq orb MIGH ,NA°t5� U55, L 41 mil' 122-49u —r— �aht�'lmJEa� �,FtFr►CryL�� lr`rrE-7r-:larz %,,,'a Caws � 5��2 bR�s .IN�dra> 1*��sav�- vikPafL F,i�lLtLl�� f5%-meiof, 15 L-S vetl-r 00 -L - -rq eir'AL. %4`STtN(c:r - G FS i ref - 0 ��p1�VINC MUs AT THE BUILDING DARING THE THIS WGRK. PROGRESS OF......•»�..® nEPAR Tav*?► of Da;rtmoxl* L TOWN OF DARTMOUTH RECORD PLAN A Copy Of This Endorsed Plan Must Be Kept Ott Site During Construcdon Date 60tQ-TIM19E AND DEPTH eoumv MR WJ"1?4 DMRTMENT. Town of Dartmouth itxis- hy,w, cAeiN FILE COPY - ;�� ? fn Se sE-LD i G J!IH P "a2 30 p w2 71�G) 9 Zx< ?r51LA, w/ l �' ,fit / lGt # - c3v+,-C'S G,`-� �t ©ems C 1' ok (itit,&, 2� 1 72 r � c 2.7 f 4f4 i �J& L.,r, Z-571 t7l lq .; _ N w " g J AU IDA PLAHNISCALE: ,°APPROVED BY <rUDATE, '.." ✓��/'.� �.�a .Y a 0. A err 4,161 0/ - Zoo r2- sKYU-r 2- x =a W-1 L 8T . A.elo,i IJAP&A10A r PPLAIN. MAC-�aA 0 s'8 e $ #2 6 1 7 ,n KY A s R—ez` I