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BP-12900/_ /� �I /` /1 ,�� / l _ / n FOUNDATIONONLY 1999 Residential /wit /// /�y 1999 Residential 1. Date plan reviewed: 7 'Y 7 2. 30 days to review period expires: 3. OK to issue date: 4. OK to issue subject to requested submittals(see project review worksheet): 5. DENIED (see project review worksheet): 6. HOLD reason: Date: Date: Date' 7. HOLD subject to Zoning Board of Appeals action: 8. Comments: 9. Inspector's Signature: Date:-7� Applicant c:\wpwin\forms\bldaapp.res Page 4 January 20, 1999 DARTMOUTH BUILDING DEPARTMENTDATE RECEIVED 400 Slocum Road, P.O. Box 79399 1, Dartmouth, MA 02747 i z k - --i 508-999-0720 FAX 508-999-0738 ` ' APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Zoning Review: Energy Report: Fire Chief: Board of Health: d Conservation Commission: Signature: Date: Signature: Date: Signature: Date: Signature: L72L—,-• Date: NUMBER OF PLANS SUBMITTED: I SITE PLAN SUBMITTED: ❑ yes ❑ no Nearest Cross Street:/ C, Subdivision Name:-0 Total Land Area Sq. FL: — 1.4 Water Supply IMGL c 40 § ❑ MunicipaILR.Private Well Plat_2_ Lot�- Historical District ❑ yes Ano Has application been submitted to the Historic Commission? ❑ yes ❑ no Date:_ ❑ Municipal 11 On Site Disposal System Name (print) phonenumber c:%wpwin\forms\bldgapp. res Page 1 January 20, 1999 Residential 1999 Residential 1999 2.2 Authorized Agent: Contact Address � at-))o Name (print) Telephone S> GTix?N 3 »©NSTRttCT14It 512IC1 S 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction supe or Le License Number �I Address Expiration Date -p Signature - Telephone 3.2 Registered Home Improvement Contractor: Not Applicable ❑ Are you a Home Improvement Contractor subject to (780 CMR-6)? Ayes ❑ no If no, go to the next section! Are you claiming exemption from the requirement? ❑ yes Z no If yes, submit the required affidavit! Company Name ^ ''_� J( Registration Number (if none, state "none") 7— 3 ', // Address -7 �^ � /,I'— sigmature 1 Telephone a G. Expiration Date .-, `I 3.3 For esidential 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 Owme�.i Name (print) Sicnature 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 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 R5.2.15) 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: Ryes ❑ no ❑ new �n addition ❑ alteration ❑ repairs ❑ chimney/fireplace ❑ woodstove construction* ❑ 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 Brief Description of Proposed Work: Item I Estimated Cost ($) to be completed by permit applicant �. Ioral =(1+)+3+4) * Estimated Total (please as Owner of the subject property hereby authorize I,� U7 ✓2 to act on my behalf, in all matters relative to work authorized by this building perm t application. 1/ � ,er. Z 5' L-- t/ (.a, 2 � Signature of Owner Date 1, a6U e-e .✓f lu /?x; , 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 under the pains.and penalties of perjury. Signature of Owner/Authorized Agent i Date -J c:\vpwin\forms\bldgapp.res Page 2 January 20, 1999 c: \wpwin\forms\b Idgapp.res Page 3 January 20, 1999 -- I r. t�4-I. 50ov p6I c N lO `'u'Olvj Plti'r� Y 0 nao F- Y I i �nN G•f`�R-me`µ � 1 � - rr+ i _-A -r I I Jn �VI/Y�'✓ .,,11 ,;.» S PATIAL DIE SIGN C O N S U L T A N T. S 2 .8 0 ELM STREET .SO. DARTMOUTH MA 0 2 7 4 8 A i ;5x- " .w�7, 1 t ,Q �LL G;,,rt'(•� !� �*Oi'D! ��J:.�'TiOi--'t j� IG%;,%-. 5"04a r6l G N IO'G.IM PAG�C%li �- if lam_ ,,- �Z7) j -.. %i " " - ✓�T✓11 olo � ✓! �ipG � �.i I�i�L.L ___._ ---- . --- _._ _._----_.____.� LE COPS' TC4 -1-' OF DARWO€17 H RECORD F J A Cfo?y Of This Flan fi"cel, Ca Y,ert an site Durir ^ Cor-' �r`� 915 YOUR DRAWING MUST BE KEPT AT THE OUILOING DURWG THE PROGRESS OF THIS Y.'ORK. SUtLOING 0-7VITMENT Town of Dartmouth L7 S P A T I A L D E S I G N C O N S U LT A N T S 2 8 0 ELM STREET S O. DARTMOUTH MA 0 2 7 - 4 6 d