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BP-37758
RESIDENTIAL 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): 5. DENIED (see project review worksheet): 6. HOLD reason: 7. HOLD subject to Zoning Board of Appeals action: R_ Comments: 19. Inspector's Signature: Applicant i. Comments: Date: . Date: Date: Date: Date: Date: 2005 Total Permit Fee: $ %©d• 00 Less Application Fee: $ 25.00 Remaining Balance: $ TOTAL FEE: Afl/eD. 00 Gross Area - New Construction total sq. ft. Gross Area - Alteration ,total �sq. ft. f!7�� X `�o , i`'� w> U L1� P� laY®Q'J � Permit Issued To- 10—ee/=�•warIf RESIDENT AL 2(D05 X FOUNDATION ON LY .. i $25.00 APPLICATION FEE IS NON-REFUNDABLE & NON -TRANSFERABLE C:\bldg.forms\Bldgapp-res.wpd - Page 4 Rev. June 26, 2003 C:\bldg.forms\Bldgapp.res.wpd Page 1 Rev. June 2(6, 2003 RESIDENTIAL 2005 RESIDENTIAL 2005 �.OPERTY 011ESHIPIALITHORIZEDA 2.1 Owner of Recor4; 1C 1� G�) AY 10 � a6(-0 bn NCy\-y(Li�t P srT-990 Name (print) Contact Address Phone Number 2.2 Authorized Agent: CHUCK 17� 15 C-A-1 3�y -ricT�(-C ru�) 601-(036-1-619 Name (print) Contact Address Phone Number N TTI 3.1 Licensed Construction Supervisor: tjG Not Applicable ❑ Licensed Construction Supervisor License Number 65 Address `3 (0 H -r—S G t::� Expiration Date / ( 3 (06Signature TelephoneIso 3.2 Registered Home Improvement Contractor: Not Applicable ❑ Are you a Home Improvement Contractor subject to (780 CMR-6)? bryes ❑ no If no, go to the next section! Are you claiming exemption from the requirement? ❑ yes Ex no If yes, submit the required affidavit! Company Name C , K ( S Lj\ y Registration Number (if none, state "none") 19` 0 /1 Address -C-1 L je:� &, C) Iry STpo IC Signature Telephone �15/ Expiration Date � � Epp " 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 Na,ne (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. 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 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. If you are applying under this section sign below: Signature: Your signature carries certain responsibilities, including but not necessarily limited to, general liability 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: yes ❑ no SECTION 5 - DESCRIPTION OF PROPOSED WORK, (cr eck all a llcable P �.,... .,..�,.. ❑ new construction* ❑ addition ❑ alteration ❑ repairs ❑ chimney/ ❑ woodstovfe (energy report required) (energy report required) fireplace ❑ deck ❑ pool ❑ accessory bldg. ❑ replacement window/door ❑ other ❑ demolitiotn (shed/garage) no. of windows_ doors_ (specify below): (specify below): * If new construction, please complete the following: Single Family: no. of bedrooms no. of baths Two Familv: no. of bedrooms unit I 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: l' IA/s Ails Item I Estimated Cost ($) to be completed by permit applicant 5. Total = (1 + 2 + 3 + 4) (please print) I, to act on my behalf, in all ma Signature of Owner * Estimated Total $ tVhe subject property hereby authorize to w tzed by this building permit application. Date I, l-K , as Owner/Authorized Agent hereby declare that the statements and informatiion on the foregoing application are true and accurate, to the best of my knowledge and belief. C:\bldg.forms\Bldgapp.tes.wpd Page 2 Rev. June 26, 2003 C:\bldg.forrns\Bld2app.res.wpd Page 3 Rev. June 226, 2003 PIPE fit. 0 o08 \ ` CONC. JXL4" SCH 40 PVC \_ L • 13.5' S n 0.027 T-' PERT' PIPE s 0.004 4"PVC Ls6.3' \. y,..jG L ,. �` �„ pEi�F • _ p1PE SP PLUMBING QE TAIL SCALE: I" is 10' LAYOUT PLAN SCALE: 1" - 30' I 3,007'+ snM REFER TO AS —BUILT LETTER DATED: NOVEMBER 15, 1990 V � sN OF DARTMOUTH REND PLATI A Copy Of This Endorsed Nan Must BA Kept On Site Dnrin� C nstructia ;ate �.� ........".._............ FILE COPY cx�/yj3& I8g? 5 SUBSURFACE SEWAGE DISPOSAL AS-B, MARCIA 8 EDWARD DUPE LOT 36 MKFRVXLE ROi DARTMOUThfn MASS* Land Survey Co., Inc. / Engineering Co., Inc..// Environmental As! 172 William Street New Bedford, Mass. 02740 Tel. #(508) 997-6494 FAX #(508) 997=_9656 Job Number: 08E903 Drown By: S.A.1A. D Scale: AS NOTED Checked By:: r Date: IW5-90 MAIN HOUSE ,� FOUNDATION PLAN