BP-45342;SECTION 8 - INSPECTOR'S REVIEWICOMMENTS
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❑ SPECIAL PERMIT (Per 780 CMR 111.1 3)
$25.00 APPLICATION FEE IS NON BE-FITNI)ABLE &, NON-TBANSFEBABLE
1. Date plan reviewed:
2. DENIED (see project review worksheet):
Date:
3. HOLD
Reason: Date:
4. HOLD subject to Zoning Board of Appeals action: Date:
Comments:
Inspector's Signature:
Applicant informe f above:
Comments: /
Total Permit Fee: $ l0 O • d
C�T7IO //9 -`APPLICANT I
/ Oco Time:
`SECTI 0 OFFICE/INSP TC
Less Application Fee: $25.00
Other $ Amount $
CA
NOTES
Date: 2 d
Clerk:
Remaining Balance: $ ''<- 0() I
TOTAL FEE: ��f . 0 d Gross Area - New Construction total sq. ft.
Gross Area - Alteration total sq. ft.
Permit Issued to: _IW O V.-IV 9 //O /y7 ,e / d °Z/ 'S '6 rah ,&"!2 VI G L4e-
SECTIONI - ITE INFORMATION
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1.1 Property Address:
1.2 Assessors Map & Lot Number:
Nearest Cross Street:
Map_ G� Lot v'-577 -
Subdivision Name:
1.3 Historical District ❑ Yes ❑ Nro
Total Land Area Sq. Feet:
Ha s� a��iication been submitted to the Historic.(Commission?
L�!'Yes ❑ No Date:
1.4 ar Supply (MGL c40 s54):
❑/Municipal ❑ Private Well
1 ewage Disposal Syste :
❑ Municipal On Site Disposal System
❑ CONSTRUCTION PLANS SITE PLAN ❑ENERGY REPORT
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SECTION: 2 - PROPERTY OWNERSHIP/AUTHORIZED
AGENT
2.1 Owner Record.
Tro t �osW�2-ri�
-b Arr7,-"oO . sag- i y 4G
Name (print)
Contact Address Phone Number
2.2 Authorized Agent:
Name (print)
Contact Address Phone Number
SECTION/3 -'CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor: gG 1I;A2 c l
Not Applicable ❑
Licensed Construction Supervisor:
License Number:,9.6 ! 3 /�-�-
Address: 102 V,'1;n _D'live_ �crTslm®�f�G %
Expiration Date:
06 - 0% - O
Signature: Telephone:
3.2 Registered Home Improvement 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 claming exemption from the requirements? ❑ Yes ❑ No
If Yes, submit the required affidavit!
Company Name:
Registration Number (if none, state "none'):
Address:
Sigl,aiture: 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
❑ 1 am a Homeowner performing all the work myself.
Owners Name (print):
Signature:
By signing the above, the homeowner acknowledges that there will be no eligibility 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: Arty 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 thev have taken the oermit are responsible for code compliance. (see Appendix of 780 CMR R5.2.=15)
SECTION 4 -WORKER'S COMPENSATION INSURANCE AFFIDAVIT (MGL c 152 § 25)
Worker's 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)
❑ Deck ❑ Pool ❑ Repairs ❑ Alteration ❑ Chimney/Fireplace ❑ Woodstove/Pelltst Stove
❑ New Construction* ❑ Accessory Bldg. ❑ Roofing/Siding
(:!! Dh(Energy report required) (Shed/Garage) ow)
❑ Addition ❑ Replacement window/door ❑ Demolition
(Energy report required) No. of windows _ Doors _ (Specify below)
*If new construction, please complete the following:
Single Family: No. of Bedrooms No.*of Bath§ +
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
❑ Air conditioning - (separate unit)
❑ None of the above to be provided
❑ Hot Water: Gas Electric Fuel Oil Other
Description of proposed work:
'• > = •� SECTION 6 -'ESTIMATED CONSTRUCTION COST
Item
Estimated Cost ($) to be completed by permit applicant
1. Building
2. Electrical
3. Plumbing
4. Mechanical (HVAC)
5. Total=(1+2+3+4)
SECTION 7A - OWNER. AUTHORIZATION
(to be completed when owner's agent' or contractor applies for building permrt)
(Please Print)
I, Tt-( dcl�ks n�u% Owne f the subject property hereb uthoriz
to on my behalf, in all matters relative to work authorized by this building permit application.
S' nature of Owner' Date
SECTION 7B - OWNER/AUTHORIZED AGENT DECLARATION
I, `T J40MA,1, o`.xova;t'4 as ner/ thorized Ag�t ereby declare that the statements and infor-mation
on the foregoing application are true and accurate, to the best o my now a ge and belief.
Signed under the pains and penalties of Deriury.
ign ure of Owner/Author' d Agent c--N_,Q gte
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TOWN OF DARTMOUTH
DEPARTMENT OF PUBLIC WORKS y
No:
APPLICATION FOR PERMIT TO MOVE HOUSE
Fee: $250.00
! FApplicant (Mover): � r e: L�,°. �*.�� u r � c� � caves. r ` •
Address: j b
Telephone No. _401
Bonding Company:
Amount of Bond:
Insurance Company: �
44111
Amount of Insurance:
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Home Owner's Name:—
.n�,a ti Telephone No. ►
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Address:
F
Date of Moving House: , / 15 ¢,
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Height of House/Loaded on Trailer
_ Width 21 1 Length 2—
Trailer Registration No. '
Valid Inspection Sticker? CtYes ONo
Present Location of House:
Destination of House:
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Route from present location to destination: r o v
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Are any of the streets along the route designated "Scenic Roads" as designated in the Town of Dartmouth General
Bylaws? t9fes ONo If yes, please list. V
Number of days required to move house: i
Location where house may temporarily be placed off the road; ��� •
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Owner's Permission? a
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Owner's Permission?
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Owner's Permission?
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Owner's Permission?
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Check those agencies or utility companies who have been notified of the move and have approved the moving date:
Electric Company ❑ Gas Company
31'elephone Company O Cable T.V.
focal Fire Chief Cable Police Department eArborist
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All of the above information is correct and accurate to the best of my knowledge.
k
Date:
Signa of Applicant (Mover)
proved:
— — I
` it ing Commis loner
Date:
Chief of Police —
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i
Date:
Superintendent, Department of Public Works —
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TOWN OF DARTMOUTH
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DEPARTMENT OF PUBLIC WORKS
RULES AND REGULATIONS FOR HOUSE MOVING PERMITS
RESPONSIBLITIES OF MOVER:
1. All precautions shall be taken to prevent damage to private property, utilities, and road surfaces. The permit
holder shall be liable for any damage ''or injury to persons or property or to any road or bridge due to our
resulting from the operation of the vehicle.
2. The movers shall be responsible for making all arrangements with utility companies and the Town of
Dartmouth's Building Department, Police Department, and the Department of Public Works at least two (2)
weeks before the moving of the building and shall coordinate the moving of the building.
3. If a State Permit is necessary, the Town will require a copy before it will issue a moving permit.
4. The mover shall hire a professional tree trimmer/arborist if tree cutting or trimming is required.
INSURANCE REQUIREMENTS:
1. A surety bond in the amount of $10,000 and a Certificate of Insurance in the amount of $100,000/$300,000 to
cover bodily injury and property damage shall be provided for the duration of the permit.
2. Any damage caused by the mover in excess of the bond requirements and general liability insurance shall be the
full responsibility of the moving contractor.
VEHICLE REQUIREMENTS FOR TRANSPORTING THE LOAD:
1. The operator of the truck must possess a Class I Drivers License.
2. Signs with letters at least 4" inches in height indicating "WIDE LOAD" shall be displayed on the vehicle.
3. The vehicle shall not be operated at a speed in excess of (10) ten miles per hour on any bridge.
4. No load shall be moved before 9:00 a.m. when schools are in session.
5. The permit shall remain with the moving load at all times.
SUPERVISION OF MOVE BY MOVING CONTRACTOR:
1. The moving contractor's foreman must be on the job at all times during the moving of the building.
2. A vehicle must follow behind the moving load with flashing lights.
3. A minimum of five moving company employees must be present while the move is in progress; foreman
(directing driver), driver, man tailing the building in vehicle with flashing lights, two men removing and
replacing mailboxes, signs, and removing broken or cut branches from the street, etc.
4. At the completion of the move, the moving contractor shall clear the debris in the traveled way caused by the
move and repair any damages.
IN PREPARATION OF MOVING BUILIDNG:
1. House must be of foundation and ready to be moved by 9:00 a.m. on the moving date. Failure to be ready by
10:00 a.m. will mean possible revocation of the moving permit.
2. All chimneys must be removed above the peak -of the house.
3. Rescheduling of move will require notifying the Town of Dartmouth's Building Department, Police
Department, Department of Public Works, and utility companies.
PERMIT RESTRICTIONS:
1. Any permit issued for a certain date will be for the date only except for cancellation due to weather conditions
or rescheduling by utility companies.
2. The reissuing of a permit will require a new application and a new fee.
3. Permits will only allow the moving of a building on a Tuesday, Wednesday, and Thursday. A building shall
not be moved on a holiday or the day before a holiday.
4. Permits may be revoked or modified at any time by the Board of Public Works or their designee without any
town liability.
The Town of Dartmouth reserves the right to restrict the moving of any large building or object on its highways or land
and further to withhold issuance of any Moving Permit unless and until such requirements as are stated herein have
been fulfilled to the full satisfaction of the Board of Public Works.
The Board may not approve a Permit if it is deemed that the proposed route, or tonnage, or size may constitute a
serious detriment to the public or private property, or interests, or is not in the public interest.
This permit is issued pursuant to Massachusetts General Laws, Chapter 90, Section 19, for the period commencing
_/_/ and shall expire on _/_/ unless sooner if revoked by the Department of Public Works.
Date of Approval: __/_/
BOARD OF PUBLIC WORKS
Chairperson