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BP-16826RESIDENTIAL 1. Date plan reviewed: 6 — 01 t ` C/A J 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: 2L 7. HOLD subject to Zoning Board of Appeals actio : 8. Comments: RESIDENTIAL FOONDATION ONLY zPc.X. V V Its- SJUA%oft A_A%JiN a && AM, 1V tP1V.J JL&_U1Y17A15LL &11i�it\1d- l Y$�i �lE E I��Si.€ '&JTi�; DATE RECEIVED_ ,N. DARTMOUTH BUILDING DEPARTMENT 400 Slocum Road, P.O. Box 79399 7 "`? R f 3 � Dartmouth, MA 02747 508-999-0720 FAX 508-999-0738 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING 2000 Zoning Review: Signature: Late: Energy Report: Signature: Date: Fire Chief: Signature:. Date: Board of Health: Signature: '� r P ;. GIB Date: l I / �oo onst. ation Commission: Signature: Date: Other. Signature: Date: Description of work being performed: NUMBER OF PLANS SUBMITTED: SITE PLAN SUBMI Ea ❑ yes ❑ no U' sors Plat & Lot Number: '1.1 Property Adt9ress:_& (0u I bme.e (Zd "��� Plat e�y Lot___-� > arest Cross Street: _ subdivision Name: ) ' �' 1.3 Historical District ❑ yes ❑ no Total, Land Area Sq. Ft.: I � . Has application been submitted to the Historic Commission? ❑ yes ❑ no Date: 1.4 Water Supply (MGL c 40 § 54): 1.5 ,wage Disposal System: Municipal ❑ Private Well ❑ Municipal 4n Site Disposal System C'.b1d2.forms'131dgaPr res.x%"rd Pare 4 R..,! i___ i i innn C:\bldg. forms\Bldeann.res.,,N od Page I R­ ­- 11 ')nnn t RESIDENTIAL 2000 ':. 5t CTCU1� Z httUPEAT Y Qi�'"�1 RSfi11 I.vi1Tli(R12 CU GE?�iT 2.1 Owner of Record: Mic,hete-i+ �v�tyn-Fre!aa }ham, Me..ba�t�, 1-�jSl-fly-�7D� Contact Address Phone Number Name (print) 2.2 Authorized Agent: Ot rbe CnM pcu,\.) _ � -r ,t1+-S �-- �gja i <<ji IVk�.o�atsLl )-6o3r 57q-yr13y //G,)b Name (print) Contact Address Phone Number ..... .. .. ... :: ;:;::;::.;» :;::: _-SEC! I©�1�:»>CQ �S # Ri.0 I IE3N:SERVICES..................... 3:; 3.1 Licensed Construction Supervisor: n Id Z Not Applicable ❑ Licensed Construction Supervisor kOn j d l ro- License Number % Address c�t)(54-04 144hw4ak-4 m o— Expiration Date Signature - Telephone08 3.2 Registered Home Improvement Contractor: Not Applicable ❑ Are you a Home Improvement Contractor subject to (780 CMR-6)? I 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, ;LIA 02108, (617) 727-8598 Owners Name (print) Signature by signing the above, the home owner srknowledoes 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 dwellins, 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 C:\bldg.forms\Bldgapp.res.wpd Pate 2 Rev. January 13. 2000 C:\bldg.forms\Bldgapp.res.wpd Page 3 Rev. January 13, 2000 SCALE: 1 =3 r r LOT2 r. 't (//J�J�[' i ..r , t r -s- 16 PROPOSED COMMON e LOT s � , DRIVEWAY TYPICAL Ao As Shown ForAp royal P JD Rev. Date Desaiption j By