BP-11463Residential
1999
Residential XFO ONLY 1999
1. Date plan reviewed: f `� `f d ` s `
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 1p eals action:
8. Comments: �f,
9. Inspector's Signature: Date:
Applicant informed of above Date- Time: Clerk•
Comments:
Total Permit Fee: $_ Less Application Fee: $ 25.00 Remaining Balance: $
TOTAL FEE: Gross Area - New Construction total sq. ft.
Gross Area - Alteration total sq. ft.
Pen -nit Issued To:
<7..
DATE RECEIVED
DARTMOUTH BUILDING DEPARTMENT
400 Slocum Road, P.O. Box 79399
_ Dartmouth, MA 02747 ! es! 2i
'�0.,, 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:
Conservation Commission:
Other:
Signature:
Date:
Signature:
Date:
Signature:
Date:
Signature:
Date:
Signature:
Date:
Signature:
Date:
NUMBER OF PLANS SUBMITTED: 3
1.1 Property Address: C"uS`CLl M_ QW_4%0r
Nearest Cross Street: InA15'ibla 9.0�
Subdivision Name: ZO�A�°
Total Land Area Sq. Ft.: A0, Goc
1.4 Water Supply (MGL c 40 § 54): ��.,,
❑ Municipatkl`rivate Well
SITE PLAN SUBMITTED: ,yes ❑ no
1.2 Assessors Plat & Lot Number: SUO. -*. 1g
Plat Lot ! —AS
1.3 Historical District ❑ yes )&no
Has application been submitted to the Historic Commission?
❑ yes ❑ no Date:
1.5 Sewage Disposal System:
❑ Municipal )(On Site Disposal System
1.1 Uwner of Kecorci: (0Sa
Contact Address
Name (print)
phone number
c:\wpwin\forms\bldgapp.res Page 4 January 20, 1999 c:\wpwin\forms\bldgapp.res
Page 1
January 20, 1999
Residential
1999
Residential
2.2 Authorized Agent:
G!SRN OZ`')_gfl
Contact Address
Name (print)
Telephone
:> :.
«::.;>;:;.;;;:.:;;::::;>:;.:.:.:.:::.;.::....::.:.:::.::::.:::.......................... 41S5 .it#IC`P)
.. ;.
..:.
4N s1al�rc>ws
3.1 Licensed Construction Supervisor:
Not Applicable ❑
Z
Licensed Construction supervisor
S a
License Number
CS oSLgZ�,
Address kT
— O -sue
Expiration Date
/
Signature Telephone
3.2 RegistbreTHome Improvement Contra tor:
Not Applicable
Are you a Home Improvement Contractor subject to (780 CMR-6)? ❑ yes ❑ no
Ifno, go to the next section!
Are you claiming exemption from the requirement? ❑ yes ❑ no
Ifyes, 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 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.
E'tception: 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 dwelline, 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
1999
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: Xyes ❑ no
Xnew ❑ 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 "A no. of baths r—�' 1Z
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: V _ , r
Item
1. Building
2. Electrical
3. Plumbing
4. Mechanical (HVAC)
5.Total=0+2+3+4•
Estimated Cost ($) to be completed by permit applicant
* Estimated Total
Signed under the pains and penalties of perjury.
of Owner/Authorized Agent
$ 11l"t ,
Date
c:`•.wpwin\forms\bldQapp.res Pace'_ January 20. 1999
c:\wpwin\forms\bldgapp.res
Page 3 January 20, 1999
�) J
OVU71 OF DARTMOUTH
RECORD IP!
N 83'20900" E P Ccpy Of Vils Eta smed
lan Must Cc Kept an Site
105.00' �'��9en Canstructl�
21
►�ri
rn
O N
0 N
O
d-
zo
0
Z
BENCHMARK
T.O.F.
LOT 5
ELEV 131.01
T.0.F
ELEV 126.17
PROPOSED T.O.F.
ELEV 126.00 91
55'
SL
LC
4C
PLOT
LOT
27 89'
7-15 1
L=180.00'
N 83'20'00" E
I certify that the foundation
shown on this plan is in
compliances with the applicable
Zoning By -Laws in the
Town of Dartmouth
Correia's Engineering
8 Crinnell Street LAND SURVEYINc
South Dartmouth, MA. CIVIL ENGINEERING
02748-2314 SUBDIVISIONS
Telephone (508) 998-6052 SITE PLANS
Fos (508) 979-5949 AS BUILT PLANS
Inc.
X,
Joseph E. Correia III pres. & Joseph E. Correia IV Vp.
42'
N
O
N
AS -BUILT
FO UNDA TION PLAN
ROLLING HILLS
LOT 14
in
Dartmouth, MA.
Prepared for
Long Built Homes
Scale 1 "= 40' JUNE 21.4 1999
FILE # 96-0202 JEC III