BP-14869-- I Rev. Januan, 13. 2000
RESIDENTIAL o FO UNDA T] . ON ONLY
$25.00 APPLICATION FEE IS NON-REFUNDABLE NON -TRANSFERABLE
_DATE RECEIVED
DARTMOUTH BUILDING DEPARTMENT D
400 Slocum Road, P.O. Box 79399 10
-0
Dartmouth, MA 02747 25 IT1 2if"
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:
of Health:
Commission:
Signature:
Date:
2000
Signature: Date:
Signature: Date:
Signature: EE eEDate:**,�
Signature: Date:
Other: Signature:
Description of work being performed:
NUMBER OF PLANS SUBMITTED:
'b roperty Address:
eearest Cross Street: A es
Ku/bdivision Name: a��bdlzlz
Total Land Area Sq. Ft.: / :0 o 2 26 Z -2-36=Afs-6`5
Date:
SITE PLAN SUBMITTED: 2-5-es" 0 no -
1.2 Assessors Plat & Lot Number:
Plat ") 9 Lot 04(-
1.3 Historical District Dyes no
Has application been submitted to the Historic Commission?
0 yes 0 no Date:
1.4 Water Supply (MGL c 40 § 54): 1.5 Sewage Disposal System:
C Municipal 0 - Zivate Well 0 Municipal 0-0--n Site Disposal System
Rev. January 13. 2000
C:\b1da.fbrrns\B1d
jai.` 31,ul' i 11AL
2000
RESIDENTIAL
2.1 Owner of Record:
Name (print) DAl/ �A�'//lr So•�Q��rt�c
2.2 Authorized Agent: Contact Address
Phone Number
Name (print)
Contact Address
3.1 Licensed Construction Supervisor:
Licensed Construction Supervisor
Address
Signature Telephone
3.2 Registered Home Improvement Contractor:
Are you a Home Improvement Contractor subject to (780 CMR-6)? ❑ yes ❑ no
requirement? If no, go to the next section!
Are you claiming exemption from the re
q ❑yes ❑ no
If yes, submit the
required affidavit!
Company Name
Not Applicable ❑
License Number
Expiration Date
Not Applicable ❑
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)
S C1 f(l\!a..:ttl[ibLtCnlnr .:..:. ,
Workers Compensation Insurance affidavit must be completed and submitted with this application Failure to provide this affidavit
will result to the dental of the issuance of the building permit. Signed Affidavit Attached: ❑ yes ❑ no
Phone Number new construction* ❑ addition
(energy report required) (energy report required)
❑ deck ❑ pool ❑ accessory bldg.
(shed/garage)
* If new construction, please complete the following:
El
egistration Number (if none, state "none")
Address
Signature Telephone
xpiration Date
.4.3 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 - Roont 1301, Boston, atA 02108, (617) 727-8598
Owners Name (print)
Signature
Date by signing the above, the home owner acknowledges that there will be no eligibilty to the Guaranty Fund
3.4 Homeowner Exemption - One & Two Family Only
IEOwNERS WHO
109.1.1 Licensing of ConstructionFOR Supervi ors: Except for hoseDstructuTO resogoverned by ConstructioAND BE n
FOR THEIR 01V?J PROJECT
shall be engaged in directly supervising persons engaged in construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of
non Control in Section 116.0, effective July 1, 1982, no individual
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 omens a parcel of land on which he/she resides or intends to reside o
there is, or is intended to be, a one 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. n which
If you are applying under this section sign below:
Signature:-;22Z'/.sl 7 _ _—
Your signature carries rPffa
- il-luuwng our not necessarily limited to, general liability
Single Family: no. of bedrooms
❑ alteration ❑ repairs ❑ chimney/
fireplace
❑ replacement window/door ❑ other
no. of windows_ doors (specify below):
no. of baths
❑ woodstove
❑ demolition
(specify below):
Two Family: no. of bedrooms unit 1
no. of baths unit I
no. of bedrooms unit 2no. 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: / '
a,.,o>/ /
Item
5. Total=(1 +2+3+4)
Estimated Cost ($) to be completed by permit applicant
* Estimated Total $
(please print)
I, , as Owner of the ject prerty hereby authorize
to act on my behalf, in all matters relative to work authorized by this bbuilding permit application.
Signature of Owner
Date
, as Owner/Authorized Agent hereby declare that the statements and information
ern the foregoing application are true and accurate, to the best of my knowledge and belief.
igned under the pains and penalties of perjury.
Signature of Owner/.
.ygeni
ae�-1
C:\bldg.forms\BIdeapp.resm-pd
Page 2
Rev. January 13, 2000
C:\bldg.forms\BIdLapp.res.mypd
Page 3
Plot #28
Lot #93
85.1 0'43"E
` 121'
V• o /
q1
s�
o�
s
Plot #28
Lot #92
BM "L
24 TREE
EL.=33.67
S85'36'55"E
L s gaff165.77'
'ryo5 p ruction Lane
6
SS'
� oy .�
\60• pfo�6 L = 11587440
L0T#1
100,286 S.F.
2.30 ACRES
(FR.=209.33')
136'
35' - \ '�F$33NG
� S,
Plat #23
Lot #20
Plat #23
Lot #20
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.
9 LAND SURVEYING �'
8 Grinnell Street South Dartmouth, MA. crVrL ENGINEERING
02748-2314 SUBDIVISIONS
Telephone (508) 996-6052 SITE PLANS
Fax (508) 979-5949 AS -BUILT PLANS
Joseph E. Correia III Pres. & Joseph E. Correia IV VP.
n Copy GE "'is indorsed
11,n Must fir, vopt On Site
DUrin Construction
00,
�o •34'09"E FILE
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4
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AS -BUILT
FOUNDATION PLAN
in
DARTMOUTH, MA.
prepared for
MIKE LOPES
Scale 1 "= 60' MARCH 19, 199:
FILE#96-0099 - PJD
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/ 31
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TOP OF FOUNDATION
ELEV. = 33.50
` 31.5
10_' Min.
4 H 4 V
OP of Basement : a
Floor El. 26.1 r 29.54
• /
10" U UID
31.2
PLAN SCALE.
-
I "=30'
30.3