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BP-14274NOTE: FOR PROPERTY LINE INFORMATION SEE "APPROVAL NOT REQUIRED PLAN DRAWN FOR GEORGE LEONTIRE & MARK G. SHUB" DATED MAY 14, 1999; AND RECORDED IN PLAN BK. 142, PG. 77. \ANR ESTATE 363,000 SOT S.F.± NSF INDURAMA RNANCE USA CORPORATION AREA OF DETAIL -`�' ANR ESTATE LOT 1 363,00O SIA _ 4 ANR ESTATE LOT 2 'r _Rp � OVERALL SITE - LOCUS 1„=200' ; ANR ESTATE Q�S CORNER +,�� LOT 3 alp Iv ',., _ TE BENCHMARK: ,_� AIL IN 18" OAK TREE -� �� L ? I r _EVATION = 106.39 (ASSUMED DATUM) `i -1 .F�i. ,4 J :s -,. P - V t ` - V j r FOUNDATION 'As BUILT', PLAN `� 1N DARTMOUTH, MASSACHUSETTS PLAT 28, LOTS 4&5 - ANR ESTATE LOT 1 EvTNk—, PREPARED FOR MARK G. SHUB NOF�,gs�q SCALE: 1" =30' DATE: MARCH .13, 2000 MARKA BOUCHER y PREPARED BY 412,M Boucher 8c Heureux, Inc: z9 2 CIVIL ENGINEERS A : LAND 4 SURVEYORS MARK A. BOUCHER, P.L.. DATE 648 AMERICAN LEGION .HIGHWAY, SUITE ONE MA. REG. No. 41246 WESTPORT, MASSACHUSETTS `02790 tel. (508) 636-5905 -- fax. (508) 636-2477 COPYRIGHT© 2000 BOUCHER & HEUREUX, INC. FILE 1012 ' 01 RESIDENTIAL 2000 )61-RESIDENTIAL ❑ FOUNDATION ONLY ?,P- N 2-1 $25.00 APPLICATION FEE IS NJO.V-NEFUNDABLE & NON TRANSFERABLE 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: I Date: 7. HOLD subject to Zoning Board of Ap eals action: Date: 8. Comments: 9. Impector's Signature: Applicant informed of above Comments: Time: Clerk: Total Permit Fee: $ p Less Application Fee: S 25.00 Remaining Balance: S TOTAL FEE: / �% Gross Area - New Construction total sq. ft. (Q O� Gross A lea - Alteration total sq. ft. Permit Issued Tom Date: �-6. ECG S. e— 43 �� S- 3 116- c:`acpNin4onns`.bldeapp.res I Page 4 Rey. Januan 20. 2000 r7I SATE RECEIVED DARTMOUTH BUILDING DEPARTMENT-_ 1.. g , 400 Slocum Road, P.O. Box 79399 �, , �., Dartmouth, MA 02747`' Fri' 59 508-999-0720 FAX 508-999-0738 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING c Zoning Review: Signature: Energy Report: Signature: Fire Chief: Signature: Board of Health: Signature: Conservation Commission: Signature: Other: Signature: Description of work being performed: `cam` Date: Date: Date: Date: Date: Date: NUMBER OF PLANS SUBMITTED: SITE PLAN UBMITTED: ❑ yes ❑ no .2 ssessors Plat & Lot Number: 1.1 Property Address: l��Sg lfii�r _ a Plat 'Z-e Lot 'k J- 4N7ubdivision arest Cross Street:,cc,e*� , Name: 4s e \ 1.3 Historical District ❑ yes ❑ no i Total Land Area Sq. Ft.: '��6ob pb Has application been submitted to the Historic Commission? ❑ yes ❑ no Date: 1.4 Water Supply (MGL c 40 § 54): Sewage Disposal System: ,/ ❑ Municipal Private Well ❑ Municipal El�fn Site Disposal System c:\wpN in\forms\bldgapp.res Page I Rev. Januan, 20. 2000 RESIDENTIAL .:: gre" 16 Z=PT2Di'lE1tT Y (SWl`1F1tStI1P1�[r9'HORIZEV: GEN 2.1 Owner of Record: Name (print) Contact Address Phone Number 2.2 Authorized Agent: Name (print) Contact Address Phone Number .. Ecrr© » Cai`TR1.cTrati sElttieEs .. 3.1 Licensed Constructioh _ Supervisor: �w tiA� II J P � Ili ✓U � Not APP licable ❑ Licensed Construction Supervisor License Number S c; Address ' ' t i l Expiration Date \ Z Signature Telephone 3.2 Registered ome Imr rovement Contractor: Not Applicable ❑ Are you a Home Improvement Contractor subject to (780 CMR-6)? ❑ yes ❑ no If no, go to the next section! Are you claiming exempt on 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 II Work Only PERSONS CONTRACTIN WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND: ,QUESTIONS OR COMPLAINTS call or write: Home Improve ent Contractors Registration, One .Ashburton Place - Room 1301, Boston, .414 02108, (617) 727-8598 `Owners Name (print) Signature signing the above. the home owner acknowledges that there will be no eligibilty to the Guaranty Fund Date r• 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 Constri ction Supervisors: Except for those structures governed by Construction Control in Section 116.0. effective July 1, 1982, no individual shall be eneased in directly sup rvising persons engaged in construction. reconstruction. alteration, repair, removal or demolition involving the structural elements of buildings or structures. unless h 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 3erforming 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 secti n 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 oi ie 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 per od shall not be considered a Homeowner. Ifyou are apph ing under this se tion sign below: Sienature: Your signature carries certain responsibilities, including but not necessarily limited to, general liability RESIDENTIAL 2000 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) SECTUI 4 »WC3ttK1E�It'Oi�tFF3NSATffil' >liCl r l kll?A1€� €1tIGL 15� § 2 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 S1CTICl1\15 bR8C1'Ei41 UP PR4'US�VgRf€ (ehek All app€i<eale) ❑ new construction* ❑ addition A/alteration ❑ repairs ❑ chimney/ ❑ woodstove (energy report required) (energy report required) / , fireplace ❑ deck ❑ pool ❑ accessory bldg. ❑ replacement window/door ❑ other ❑ demolition (shed/garage) no. of windows doors (specif}, 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 ❑ 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: M. 5ECTI(]`s fi ES IA <A'li ED CONSTRi `G TIE�`� flSTS Item Estimated Cost (S) to be completed by permit applicant 1. Building 2. Electrical 3. Plumbing 4. Mechanical HVAC 5. Total = (1 2 + 3 + 4) Estimated att(e}d Total � �j [� }7 � ${/� SECT10 /n Q�f jl k A 1S1Q�iR 1.�F4f T ...:.. . ;puha nwntr's agetrtncanrpples or buiidg h .: :..: (please print) 1, as Owner c e subject property hereby authorize to act on alf� in I „ s rela ' e to work --authorized by this building permit application. Signature of , wner _ Date bkt, it t C1b�f �fRORMl WEN T o��-�-� �..�; ��_-•, ,��, as Owner/Authorized Agent hereby declare that the statements and information heforegoing 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 pent Da e c:.wpwin forms bldgapp.res I Paee 2 Rev. January 20. 2000 c:\wpwin\forms\bldeapp.res Page 3 Rev. January 20. 2000