BP-28390RESIDENTIAL 2003 RESIDENTIAL
. SECTION 8 - INSPEC 'OWS REVIEW/COMMENTS
1. Date plan reviewed:
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 of Appeals action: Date:
S. Comments:
9. Inspector's Signature: Date: L1
SECTION P - AP LI N NOTIFICATION
Applicant inform of flue Date: Time: Cle.
Comments: " `r
SECTION 10- OFFICE\INSPECTOR'S NOTES
Total Permit Fee: $
Less Application Fee: $ 25.00
Remaining Balance: $
/ Gross Area -New Construction total sq. ft.
TOTAL FEE: j 1i� ,
((��//VV Gross Area - Alteration total sq. ft.
Permit Issued To- Zylt'l xj�
SECTION 11 - ADDITIONAL CONINIENTS/SKETCHES
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❑ FOUNDA TION ONLY
$25.00 APPLICATION FEE IS NON-REFUNDABLE & NON -TRANSFERABLE
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i DARTMOUTH BUILDING DEPARTMENT
/
400 Slocum Road, P.O. Box 79399
DATE RECEIVED
Dartmouth, MA 02747
508-910-1820 FAX 508-910-1838
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
T S ECTION FOR OFFICIAL USE ONLY
RECEIVED BY:
BUILDING PERMIT
DATE SENT FOR REVIEN:
NUMBER:
DATE ISSUED:
OK TO ISSUE - SIGNATURE: DATE
Buil ng i omm' goner/Inspector of uildings
Zoning District5jCB Proposed Use: S Zone: O C ❑ B ❑ A ❑ V O side Flood Zone ❑ Aquifer Zone
THE FOLLOWING AGEN S SHOULD E NOTIFIED:
❑ Board of B rd of on. Com. ❑ Demo ❑ DPW ❑ Elec. ❑ Energy R4
Appeals alth Affidavit Card Sent: Cut Off Follow-up*
❑ Fire ❑ Gas ❑ Planning Board* ❑ Server Card ❑ Water Card ❑ Zoning ❑ Other
Chief Cut Off / Cut Off / Cut Off Review*
* REQUIRES INSPECTOR'S REVIEW BEFORE THE ISSUANCE OF A PERMIT.
DEPARTMENTAL APPROVAL
Zoning Review: 7le Signature: Date:
�f
Energy Report: �`' Signature: Date: (,, /'
M'
liief: �a, Signature: Date:
zoardof Health: Signature: tit Date:
nservation Commission: Signature: Date:
Other: Signature: D te:
Description being
of work performed:
SECTION 1 - SITE INFORMATION
NUMBER OF PLANS SUBMITTED:
SITE PLAN SUBMITTED: ❑ yes ❑ no
1.2 Assessors Platki Lot Number:
1.1 Property Address: ��j//� fL j%/�/Q/�
Plat�f2 Lot -
Nearest Cross Street:
1.3 Historical District ❑ yes Xno
Subdivision Name:
Total Land Area Sq. Ft.: �'! a
Has application been submitted to the Historic Comn
� ►
❑ yes ❑ no Date:
1.4 Water Supply (MGL c 40 S 54):
1.5 Sewage Disposal System:
❑ Municipal Private Well
❑ Municipal On Site Disposal
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C:'11du.lorms t31d_app.res.%%I)d
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Rev.Janu,
1 IAL
2003
SECTION 2 - PROPERTY ON�'; ''' SFItP / AGTIiORiZED AGENT
ner of Record:
dt C. I3Oiit26r. oz,-r-
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hint)
Contact Address Phone Number
torized Agent:
lint)
Contact Address O Z7yQ Phone Number
SECTION 3 - CONSTRUCTION SFRViCES
used Construction Supervisor:
Not Applicable ❑
l Construction Supervisor
License Number C�S�6d
7;kz;1,71 Z 7 ,F
Expiration Date
i Telephone %z
Ater Home Improvement Contractor:
a Home Improvement Contractor subject to (780 CMR-6)? ❑ yes no
If no, go to the next ,��cttion!
Maiming exemption from the requirement? ❑ yes ❑ no
If yes, submit the
required affidavit!
Not Applicable ❑
Name ` —Dp t � t^o / S
Registration Number (if none, state "none")
Telephone
Expiration DaT:3:2 46
-side al Remodel Work Only
CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND:
VS OR COMPLAINTS call or write:
Home Improvement Contractors Registration, One Ashburton Place - Room 1301, Boston, MA 02108, (617) 727-8598
Rine (print)
j
—, a VwU, LrM n mme owner acknowledges that there will be no eligibilty to the Guaranty Fund
)caner Exemption - One & Two Family Only
FOR HOMEOWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT
censing of Construction Supervisors: Except for those structures governed by Construction Control in Section 116.0, effective July 1, 19S2, no individual
,,ed in directly supervising persons engaged in construction, reconstruction, alteration. repair, removal or demolition involving the structural elements of
tructures, unless he or she is licensed in accordance with the rules and regulations promulgated by the BBRS entitled Rules and Regulations for Licensing
Supervisors.
n: Any Homeowner'performing work for which a Building Permit is required shall be exempt from the provisions of this section; provides that if a
;ngages a person(s) for hire to do such work, that such Homeowner shall act as supervisor.
urposes 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
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
home in a two-year period shall not be considered a Homeowner.
lying under this section sign below:
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)
SECTION 4 - WORKER'S COMPENSATION INSURANCE AFFIDAVIT (MGL c 152 § 25)
2003
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
SECTION 5 - DESCRIPTION OF PROPOSED WORK (check all applicable)
❑ new construction* addition ❑ alteration ❑ repairs ❑ chimney/ ❑ woodstove
(ener,i� report required) (etrer�� report required) fireplace
deck ❑ pool ❑ accessory bldg.
(shed/garage)
* If new construction, please complete the following:
Single Family: no. of bedrooms
❑ replacement window/door
no. of windows_ doors_
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.
Britf Description of Proposed Work: r
/S w X /b
❑ other ❑ demolition
(specify below): (specify below):
SECTION - 6 ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (S) to be completed by permit applicant
I. Buildinu-St�iQOtJ
2. Electrical
5. Total = (1 + 2 + 3 + 4) I * Estimated Total S Q, G' I
SECTION 7A - OWNER AUTHORIZATION
(to be completed when owner's agent or contractor applies for building permit)
(please print)
as Owner of the subject property hereby authorize
to act of y behalf in atters relati r authorized by this building permit application.
--C Zy/O 7
Signa re of Owner Date � I
11 e - - - , as Owner/Authorized Agent hereby declare that the statements and information
on t foregoing application are true and accurate, to the best of my knowledge and belief.
Signed tinder the pains and penalties ofperj
Signature ofjKvner/Authorized Agent
Idgapp.res.wpd Page 2 Rev. January 19. 2001
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BENCHMARK
T.O.F.
LOT 5
ELEV 131.01
Li/ Jl �. .
19 ? Su!' ! 22 Vil
()�r'TOWN
a 3
t RECORD PU
A UPY Of Tibis En s
Plan i� v7l 15p Krc fA 0,,, cu
Burl n-vtr Won
B
N 83020'00" E
105.00'
044
T.O. F /
ELEV 126.17
PROPOSED T.O.F.
ELEV 126.00 91,
55'
sL
LC
4C
PLOT
LOT
27
7-15
L=180.00'
N 83020'00"
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 Grinnell Street LAND SURVEYING
South Dartmouth, MA. CIVIL ENGINEERING
02748-28 f4 SUBDIVISIONS
Telephone (508) 996-6052 - SITE PLANS
Far (508) 979-5949 AS —BUILT PLANS
Joseph E. Correia III Prey. &
Inc.
Joseph E. Correia IV VP.
E
FILE Cl�PY
Wkll OF DARTMOUTH
RECORD PLAN
P, Cepy Of This Endorsed
Ida Must Be Kept On Site
Urging Constructio
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ROBERT
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AS —BUILT
FO UNDA TION PLAN
ROLLING HILLS
LOT 14
in
Dartmouth, MA.
Prepared for
Long Built Homes
Scale > " = 40' JUNE 21, 1999
FILE # 96-0202 JEC III
t9i9 4ui 22 `.
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FILE COPY
a
i W1111 OF DARTMOUTH
RECORD PLAN
N 83020'00" E F? copy Of This Endorsed
sojan Must Be Kept On Site
CoUP_Aa- - 61"'`o
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BENCHMARK
T.O.F.
LOT 5
ELEV 131.01
105.00' Dur3
��2500 D,.)to
0 44
T.O.F
ELEV 126.17
PROPOSED T.O.F.
ELEV 126.00 91,
N
ci
N
N
55'
4204
SUBDIVISION , �
LOT 14 N
40,000 S. F. 89
PLOT 27
LOT 7-15
L=180.00'
N 83020'00" 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 Inc.
8 Grinnell Street IA" SURMINC
South Dartmouth, MA. CML aNCINBBRINC
02748-83f4 SUMMSIONS
ToUphom (508) 996-6052 SITE PLANS
Fas (508) 979-5949 es BUrzr PLANs
Joseph E. Correia III Free. & Joseph E. Correia IV Vr.
ng constructio
AS -BUILT
FO UNDA TION PLAN
ROLLING HILLS
LOT >4
in
Dartmouth, MA.
prepared for
Long Built Homes
Scale 1 " = 40' JUNE 21, 1999
FILE # 96-0202 JEC III
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