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O m , �} , s i t I I I ;y t N i �- r zi • a tx'oEZmot;MC , 11 , , i ►► ' I 1 I , , ,1 / rr r y I �' {{ -----.-�-2 .... 2 2 8 2-8__.. Z o �• O ,:. 2-0 `2- 8 2-8 Z o �-2' I I I • (1P Ft -t, , r t7-4 4 ; I ,I � ,• , ,, it A - -- Cl) a -�- --�- ��-- O -- u1 >- II-D II-� 3 D 3-D ,t A q-p'q -o 4-8 3 uur TN ' 40— 0' THIS WORK. 2Z -p (v O (ii -61 7-O (A -/- !o D . LDtp.( - f - O DEFfl7MNT of rt, mgj - R�r'^,r 1�l�I ' �I RIGU DARTMCUTH FIM,� , � �' FIRE aT4PP1 ��f�111��NT �, pens thr , ._ s and floors . An � �1t Survey ��t �e E �' � �• u rated ��`� .. � a� jr M ;$ ' �;d icy ECT"3 r _ s+ii 1t%"�th -� �; i mated c c rep n UMSD 5�� � P 9 #v AI- I �'( = !` ..-�-o r t ,� -LEC 0a submitted to the Building �' • tBe t On Site THE CONCH is tou b' a� flames l; Dc prior to callingfor _ ,..,��" t V ames and ho, gacoes when subjefteC -� „I . to ao rc uiremsnts of the Tn t d 7d € :. O � � _ � 4f�C/ . - �IL:Ov$:�� L�EF';�RTh�IEM` on Inspection or ' ` T °M Cf Dar"outh for Rm Stopo AS - -814. hlrtlicf uction» 4 r KFY AIL P F 104Yz w s,s t' Q P LL - - -T P. "(Nt P. (tr i- —t 1— -�-t- -- --�-�- w f s. �a u r�k �,vr , of �t v, +I I o-• I +1 -. wa j NO ic Ty _ IZ +T- r c l 4 cAr- �r�'s,� / �z v rJr (q11 Z 60nf= p ram) ►+ CQ/iZ �cnF PtTr-44 -VA"4_�1 -�_LhS141q ==o ,- *f0M Vo APS AwAy FesoM 19-M• 1'%r7 foR 8=0�� I .,:-51 VF, t,� L f3 \/AT) 0 t\J u4r" V4 DARTMO DISTRIC PC 2. I �t ----�I T ✓ 7 -- a Lt --t ---E- - i- i rl%nt � ti An A6 Bit Survey rust be submitted to the Building FILE 0 f' Dept. prior to calling for a. foams on Inspection,or WG MATM KF9T any ftTrther con ruction. AM 114E CUILDING DURING THE '! $ S OF THIS WORK- 1ILDI•NG DEPARTIV'ENT FIRE STOPPII!G LEQUIREMENT CONO-TUgE SIZE AND DEPTH P ons thru rated wes and floors shill b- i!�'�_ IC'TIOI IS REQUIRED BF_FV'Rt Senbd WM a material capabla of preventing ,1h THE CONCRETE Is POUREIX Pam- rm of fumes and hot Mwes, wlhm subJectel. 8WLDVM3 DEPAARTr ENT to the rOquire tants of the Test Stendtrd c:�c Tom of Daftovt� for Fire stope ASTM-E-81 X AfAVEK'�N WINPOW pND POOR�tlt-r SYMso" tj N IT X, D- �DU�i� Of�N(1J<a � I'(• 1763 ;Z 4' 0z"X tn' 0%2'` z � F�1��/a(�11��45tZ RI ►�X � at � . 2 2 2 z - 2 -.: c cl� GIB • Gt6 X15 tag" •1�2�•61&-c16 2=o5/a'tjC17.8t a . s y?," X S� Y.4 rr PI-EXI FRAM to'-0 3/gf' x 1 C3-(--14r.) 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WALL -ro f5�1= �i-AS N I N� r 11 v _3 v t _ t �Q L� (LF ,, •. 3 n 9 � I 2 - �X tD E-(t�Pi. - td v�, a .. •. 3- �• I_l 1-AM- Ht�. .- 4_ _ 3 xr � g f s o I —0 3U g3 tUF 11 HI I •' • 1 .� �• r _ r a e ow N 1 o s w n - s f�( t; f w �.6. . _£ cb_ Lo _1 Get <r11J� I , t r t z o uQi FLA — 8 _ zaW<z Q o z a m 'Q -¢� z 0 P oF Nv LLJ r /4Y oUIN - 2 q4 l 7{ FIRt- AOU"w (3 i L F a Kf=1`1 MDR. FTTI, . � 1 •' t v _ Z �- � _ coFc70v U I 1 G•. WAIL tEIVt= �t WA�-hCT 2 0 < LU to atSA GoN �l�n Tn �z o � a 6 fJ l-1,i7 t r tC,E R .10 ^ tl t I _ W _ 8 41� i � Z Z Z Cr O U Q t I z 1 : , L u ItloUS Gil It.(� f L�. -L+ L M d- �tN t3sMl � t. Jr 1 _ Au As Wit% t'At - Built'�Ir"' mu St i�3i a f s 2 Go w � E� X a � � u�( milt tding rt 11 t I L I ) I ( ��� ST�PP {,� T he III I -1 _114_ 3 - 2 1.0 � 8 I -and � callingfor I , T�-�th,t �.on i #11'1 �� inspection -�— revers or 1 J _ _ 10 .r�wN�v w .�. _ a�.� a rnate.►s� P `� l ��� P� t octe•... fufth y i�3eS t���i1 Siit�� �' c4' 382St�UCtt?�. 4 � Vo r OPT oP iN RD+t�t6t✓ � � � l.J T W/ -z tZ rt GAB'S. i 1� ti _ u Lts 14 I o i (gfi2 f3a�F '�i'j-GN P� O� fl�mo5 a an 9 v. G�,owf�l Movr.viN6 to tho mgfirements of ►e Test S;Antic' s tZ t N5 tD� SST-�•14. SON( TUQE SIZE` AND DEPTH t?Ctc _ is 13 REQUIRED BP':EFORE THE ONCRETE IS POURED. .. b _DING DEPARTMENT � v 5Df'f�D LIImW usi �ILINI At3uJe r5G ANn - Svc `' XEe,,-Trs-T I8 WORK. z®)/� }•� �-4f AFMIZW • 0 14'I L/us,d 4-• - + U? 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V 1 - 5o6g WI, G .I� s > M - GGd aM 7 � fia � y - IBC LTG � L� T{� ply • J. it 14 q & P = At- - ■■%iii■i■■ Boom as mom GdLU . , • C N6 j L LL I I , i ( 1Ti V 1 1�l ._ t/�Tl D(�(c t t� G ��7" �ooM , � �� - l 4 -• � �--o ,, _ � � l� l�"f�-!l� YOUR DRAWV4Q WmTKWT THE , JT !H BUIDIN DURRK If� _ 1 .. 1 i io„,rrswo l i R. -3 mr DARTMOUTH[- DISTRICT NO -RI, `Pc s SIZE A14o DEPTH �h,�-TUB -R REc�uP�ED � FQAE � E�t1DI'1 I5 Inv p� p/� - P!lR�R� THERfTE IS i j L DEPARTMENT _ ®$ri411� i N0i 1 I k._., h f h__ EW TIA OF ftrAft TOr Tyr,, Of Dn brMM AnAs Built Survey r , 1. submitted to tls �x , ',_- .!) e Dept. rior to `cafi;En _or P�teown a foundation inspection or • t FIRS 41�t� vt MEN w.11CSfloors sha !l IrePenetrations thru roted so :� preventing �''. �, : � ®# reua g material, R l d w1th a mat® c. as when sty as passage of flame and hot D ! • e Tod • to tho r:�Lla for l ASTM-E-614- i • X � J 11_ Q V ,2 1 _ i • GUL R , I ; I i �- � �lPLAC.t✓ ' • MIW 6PDL)r GL\RF ,i • 0 Z X 4 G'' N (f6t' T gmm Mrt-AK L.- LAJ Ff F)e•Gt�- ef-EVA c� _ J � N �jGAL-� t — ✓'!� VZ l7 IWAL 2X,4 1 N : 2 f�. • i W ti� Z y AILt- I . �7l'�Qt�✓' z U bR w/ �o t i �tt-I� l�_Ott _ z �a - -- ► 4 _ 1 .10 �->< - ,� _ � �, � •� M �4;T� S r f� it -A r3 l � t/� 1 �-o �o Af- - -314 e O # lE't PDy _ N ov r s t urav tc ZFaT P r_X 6 TFl ttJ6 o ,_ 1 A tl m 2 r� gt..c� w 5 .. _ Gq rz : � � F x 4 � K � �g�t 1 ) twt. . 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I I z IS+r r N o P��1e Uor( fit'U t� �1; I / F1' /2 x Z� -�' l8 M - s s rs shall 1ta , as c1ht(SFIa;D S I _ 1( 3/z4TI' tFt5v1- C IN) SUMP - Z at - , t X-7� 8 tN t✓M € w X4 s clad vjIM a materl c 9 of pr, l tuj of LaP sIMW, I t N • q o CONG, MIN. 4� o, o,�gE �+-IG�S ec.� _ • j - _ n r ►-VsTss s of flames and i r �-� — ( I hot w n sub tea, • o .� 5tf�ivN n>��wa l�L �tvcso - �>�_ - GDt�tG,Mt 5 wr N — v wl 6 n ,� . �. � -- � _ N �' � LAb ®• � Z to the r ��,� its of tl ?� Q oVEtK 4 ,vac, X4 the T� Spa and t+' 'Q LION - 4'I GaNG, 45 Ml �, V-1 VAMM I GoNc'. $A5E dti.``+ 1 oe t '� ` - i Fire S � A T ,-E-Q14, j \ ASFVAI.T _ DvER 4' &FAVtrt- I i e r-oW e o I Kr°i� At-L 2 4 P5COAFS 0 # r yvq ° $ASS (-A r3 , ' Qo . a a • r� 2 12 �•Kt tlyd lb ftCo�'� •� ��_ =p 4"cam V ( � r r '. t a �� E� ASS a z t ° 2 u :o o _ to � o �C tQ _ 4 ID c tG • d NL i 0 D e. a( jtwt - _ .. �� 2D, WALL a • . °t P a r�R g0mrAc� : -- _ Jo(sT- E �4r tG s - C N ?' S • ' Aa ' d3 0 J - Bi t SrvesJ~ 1 he _ t`Of� v� Jo[s•� ed a the B����� ,� 4 tT�N w/ Z . 7 i AEA 't�l> w/7®ept. cT tO c T1L. p(M C Dot N Z 3 h t�i' • d - � Prf?e tt�rt�t .lour i t N G t-IAN6OZ6 GN a . 3LU�N fog c)]1 f i1 - .• o • . o Q ?'l L �) � • - -•: - Z X to L. E pe+4t�can o. . gp. Il L z Ks o o fort ' V�l� L L: e u�ton. �T i�K -TYn64� v�a�� + _ G (of T Q - g„pa _ __ io ��M� MT C tit t wAt.r< I + r i wj �= [/z" � Itix 7 (-5, 3/4' - I �a f M AtL x! �4 M -� -� T �,s�MeNT) > AT W� ��i - ,r - L° 3Co'1 O,G, _ '�'� r��Lt?IF� Dt,IF�tRt � 1YF' FN V, LK otfT —T—— MLM ;I - c�� T}i8� 1�r� x rz �rto. r . � T�� IV : L +r r. -- 4 • : I I r,•t-� : g �L uxV GOLu - *— wa�� M N tN �- ---�-gLU �Uf3!-t✓ ...%I�'��- UNa�t� Q�LL �vL�RR`� T�� r "(r � t=�ua�t�`s b csJ Uj LAJ N KE a � N Too, � _ , %� < Ede � . opt On Si 6 2 10 5 14 Tip vl__ WCOV P, T JiUI.L� - 7 - �rt _ r T f�AILIwn, v r 17d-_ ZxfO 5 6 . o, r ,L c tCn D• G . • Wr► =1 o► D 17�gL Jo �- 1. (STs Lt rAatzI -(_ Qura • �� II � ioX 15 _ z� to o.G . __ to 10 LLI IItat-tsT Z i r, i _ °=-N�r�zs � •. t� I I��._�.tt�r�t�t-�,�r-t��tT`,��-c�ul�� _°� _. s � � wA1 o iNlo X 4 S - w [o ( a c�,)MCRETI: t. URIRtaut t X3o �. r - r `v E.o - AT�itLlly Zx (o s e -t 4 5 e. , o USAM Gdv Z ,, tU o A � Prat t t F•G•_1't3L'O _- +r p,G , - .tlo- I � � U Gl3otut�-1�lat1L t _ o - ti:. „ 00 EMT,.0 Cory _ L DARTMUU •ZTF CT NO .. { • T o � o. o y " 30 rr 0 D 0 /1 0 wC N d � s y2 ac yt L.ANOI N /2 �psrHG,�_up Aoof, �0 X 2q c A r 2-2 3' �a���pr� 1'i a IV�,� cls � d: 23, a a6oOT-n-, A a /R �i c j' Torits. ;orf nPORTMOURvi }} }� t ♦ 7 RECORD a $. .., +..&. to. Dept, pr� A COPY s T hl N � . 0 Kept On silk, r a found 3t1© �'Cit>a11 or .. , �t►r � LUu3 0.,4..l*.I*, .7 �4 ,I„�wr itl E SONG-TU E WE AND tz rta t 13 REQUIRED BEF( $ iPOURED.CONCRETE tTHE � ,R _ IS � !`// EP Ats I Q RiMENT nAir, o THE � BUILDING DU�ti. TH L .�� OF T&t@S V4f4RK. r-FIRE STOPPING - EST - .)I Zo % D 1 , VENT Penetrations thru rated wa,"as and floors shall he ef $ g t ; seated with a materiel capi�ie ofi preventin hf passage of fiamaG and riot gasses when subjected �vis�� 8,UCYdvr A?ooh R?L4rL) to the rcquirements of the Test Standnrd c for Fir St t ^ ASTI�,�-E- 1 EY. 30 X' 17 i 60 i _ t �• 15-1341 ■lYl�. La:;�.�F�^J�ltiL/�'' fit• t(:2»E+m�ra asp ate! iilt�mOt��-9 Dfir� �'E•Lii•17S>♦ t�il♦��� �FrY3'�#. , r as v •� (ifs .. ii����'.L.>iti i vow-21"mr k.. .�r tSTf_F.^Iilt�li�II':• rasa / • IN PREPARINO THE PLAN EN111LED DEFINITIVE SUMVI9PLAN0N PDARWOM PIANNOW 110ARD !. DA OF PINE RIDGE COMMONS AND DATED APRIL 14. 1997. (REV. TMOVGH 9/113/97) ��gp�Sfq APPROVED UNDER AlA1 l CONV7RM LAM (Fly I HEREBY CERTIFY THAT'l1iE MOVE NAKED PLAN AND ACCOMPANIING APPROVED (Wq:: NOV 1 i r ,. DATA IS TRUE AND CORRECT TD THE ACCURACY. REQUIREDBY v THE CURRENT SUBDIVISION REGULATIONS FOR THE TOWN Of ENDORSED (WF7 1 DARTMOUTH. MASSACHUSETTS. AND AS REQUIRED BY THE }1 ' L RULES OF THE BRISTOL COUNTY (S.D.) REGISTRY OF DEEDS. /7 +6 t SEE NOTE BELOW/LEFT us- a.r."�.cCI_ +.• d-y v \ JOHN W. DELANO. PLS GATE • i. 1 • (FNq s , 5' I HEREBY CERTIFY THAT THE NOTICE OF -,APPROVAL Sp ¢/ N/F OF THIS PLAN BY THE DARMOUTH PLAfAIINC BOARDWAS RECEIVED AND :I �• ! oy \ (° , ` ` ON PAUL G. CLANO AT THIS OFFICE. AND NOO APE EAL WAS TRECENED nu'1R T3 Siii:ET 8 Gr tfilRt�CAti E9 M.- ouRlNc THE TWENTY (zo) DAYS NEXT Ait1ER SUCH 4pt•0 RECEIPT AND RECORDING OF SAID NOTIf,:Z 'A. rND BUJ M ' _ ' ` � \` • D'H\ 241FiA - a TOWN CLERK, DARTMOUTH. MA DIATE � •` I;W- II 1tN/F MID is (STATE LOT 200' 1 ty \\ / \ �T \ �. No BUILDING LINE JOSEPH E. A(ELANSON • 1 \ I Ca V� I < DRAINAGE ' of c` •' 4A+��� 1 • 1 1 \ \\ \ ���� \ __ 9 0- EASEWENT N/Ft ANTONE & ( t�� 1 \\ —� SUBJECT TO PERFORMANCE -AND RESTTA'ICTIVE a t \ \ I r ANTS DATESIY_1,Lf&ilRUNNINC SWI1H THE '•1• NORBINA491, ,� CO VENANTS c \ /� t .• '! I LAND. TO BE DULY RECORDED 1MTH 1}FtiS PUN BY i ORE ' � 4 THEOD � -�' . O �^ � �+r�\ \ \ \ 1 \. i.'�\ �C � � � � .. Gd OR FOR THE OWNER OF RECORD.ce DOH .+� m g I \ \ ,�{i� � i TJ•� U P b. � el r W i 17 � Ii J T B U % '3• N �� `4 •f�• Ll . _: 9 i e ( I '7i T dj„ y4� I� DOMIN 0 J. Ac TOVN OF / O ,`y_�" ` ♦. A EZAURA J DARTMOUTH • • �. qy U 1 "'�uj % �� 4 ,a I Q G,(� /\ SYLVIA CONSERVATION • `� O� a jt / �Ls / Q' 1� v Yl�j l COMMISSION 4+` P /' • G �i.I,� I �r ��c. .CP �� vv'"rr ^1 g ; J Wetland Line r- • K c e 1 ,111 6 y N/F Buffer Zone Line HFND OF 9TTNE5 . `a $ , / •. ,J1 ` ' / 1 P JOHNN R. BRITO Replication Area i ll Yi � ROBIN M. CARON t t•���{•� 49 / Ja'S— /�F I Q (Z o jLa / • ��� ' 1 �I 1� 1 Rft N/F DEFINITIVE SUBDIVISION PLAN OF �+ ti ti� NOTE: 1 • / DIANE F. EAST do WETLANDS SHOWN HEREON WERE // y CEORGE L CORREA F1 ARY.WAI TER HFMITSON MAY / /.. / / .PINE RIDGE COMMONS (N'.FTT 1296 JULY 1996 _ r T+1' IN TOPOGRAPHY SHOWN HEREON IS FROM DARTMOUTH. MASS. + i A PLAN BY HANACK ASSOCIATES: P. C. C� / / / i �pGr j " w C(END (BRISTOL COUNTY).t j ENTITLED SUBDIVISION PLAN OF PINE 9•Q�7� D.H. / / / OE J /SC' ' T` RIDCE COMMONS•. DATED MAY 2. 1990. - Z ). 1 / 1 e° o �` �p N� OVERALL SCALE Y-100'. y DH W. ( / / �" �` ; e / (�� O) KAREN L. SINCLAIR TOPOGRAPHIC OpYAGRALL F�,QO ,. ; ,( .N/r 10 ± (\ CHARPENIIER SN 1OPOGRAPHI M PLANcu••lD• S / • ► , 3: \ , �, \ PREPARED FOR k OWNED BY 1 HEREBY CERTIFY THAT 1 HAVE READ THE CURRENT SUBDIVISION REGULATIONS FC4F C� \ PINE RIDGE COMMONS, LLC THE TOWN OF DARTMOU IH. MASS., AND THE PLAN ENTITLED DEFINITIVE SUBDIVISION- �.1 \ r�/ \ \ LEGEND PLAN OF PINE RIDGE COMMONS DATED APRIL 14. 1997 (REV. TIM 9/15/97) INQUDIN �J \ \ \ 1 JUDSON ST. AT SOUTH ST. A TRUST DOCUMENT ACCOMPANYING DATA ARE TRUE AND CORRECT TO THE ACCURACY REQUIRED BY SAID • WHICH SETS OUT THE RAYNHAAT, MA 02767 SUBDIVISION REGULATIONS AND AS REOUIRED.BY THE RULES OF THE BRISTOL COUNTY ---Io•--[31STINc CONTOUR (S.D.) REGISTRY OF DEEDS. IN ADDITION. ALL DRAINAGE SYSTEMS HAVE BEEN •► ��/ \ \ N/F PROCEDURE AND 500-823-011123 . —Iw — Wlw=D CONTOUR DESIGNED SO THAT ABUTTING PROPERTIES AND WAYS WILL NOT BE ADVERSELY v \ MANUEL J. ESCOBAR RESPONSIBILITIES OF EC—eROSwNCONrR* AFFECTED. THE PRESENCE OR URE t)F ANY DETENTION OR FILTRATION SYSTEMS AS ! THE HOMEOMNERS PROPERTY ASSTAIN THOtjE TO ® to CONOKIE #piNO FOUND DESIGNED Will NOT THREA \ \ ���jyyt°� • MAINTAIN THE ROAD PROFESS30NAL CIVIL AND ENVIRENTONMENTAL NIG , •❑ Cs CTINCII HOLE #DI1N0 TO 6E SCT \ oN Dal NQLZr!�)_F)y �+� AID DRAINAGE G1/7EEAS FOUND 4FAdUT1E5. ETC. le( BEDFORO ST. (ROUTES TB k 28)) tFWD Non a1 raalalY (� U �+•� _ \ SHALL 13E RECORDED BRIDGEWATER. MA 02324-3132 Njj�9% �,.. .� ' • ii q1 GRAPHIC SCALE VATH ......._ OR FO`ITMEIAN BY nc•E: ao4-arT-sau FAX. - FENCE >t>s-.•a5T - STONE WALL CHWE CHRI$ . PE DATE �1 �••.�' 1•h(�� T r + - i OWNERS of RECORD. .SCALE' NOR. 1•a100' DATE ATM11L 14;, igBj PF1r'I rtsT LOCATION A NDWWI REV. "OUCH CCAZSA T997 ,i 91 TLANOS D N. ON LARD( #OL40131 ( a OVER) 0Q SSA SOIL EVALUATION NOl! REFER TO SHEETS 2. 4, 5. 0..7 AND E FOR ADDITIONAL INFORMATION. (FWD) A ■.b . aA a SHEET 3 OF 8 c � , RESIDENTIAL 2004 — - — - - --- - — -- -- -- - -- -- — -- _ _ --- - - - — ----- RESIDENTIAL 2004 SF T(71 2.. Pit Pi R"' X RS 1P At}Tit712i21 f)tkC�T 2.1 Owner of Record: t1IS S r� fcW140 -�O� �5 l/ 5��-`�9�4-,?Lga, Name (print) Contact Address Phone Number 2.2 Authorized Agent: Name (print) Contact Address Phone Number ,. .. ... >::::.. -LSERVIC AS­ 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor License Number Address Expiration Date 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 claiming exemption 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 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 Name (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 Licens�ng of Construction Supervisors: Except for those structures governed by Construction Control in Section 116.0, effective July 1, 1982, no individual shall be engaged indirectly 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 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 aparcel 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 applyirtb under this section sign below: Signature: Your signature ies certain responsibilities, including but not necessarily limited to, general liability Construct) that an licensed NOTICE TO LICENSED CONTRACTORS. The Building Code provides In the Rules and Regulations section yoJn Su ervisor, whether or not they have taken thepen-nit are responsible for code compliance. (see Appendixof 780 CMR R5.2. 15 ) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide thins affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached: ❑ yes El no l�ew construction* ❑ addition ❑ alteration ❑ repairs 2-chimney/ ❑ woodEstove (energy report required) (energy report required) fireplace Ceck e<ool CfaGessorY bldg. ❑ replacement window/door ❑ other ❑ demolli i n (shed/garage) no. of windows doors (specify below): (specify lbelow): * 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): [''IIVAC (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: Item Estimated Cost ($) to be completed by permit applicant 1. Building 2. Electrical 30, goo.�'� 3. Plum in O 00; ° 4. Mechanical HVAC 000. 5. Total = (1 + 2 + 3 + 4) Estimated Total ,$ ,,2 yC� CCU ® ®, (please print) I, as Owner to act on my behalf, in all matters relative to work authori; Signature of Owner ;rty hereby authorize permit application. Date I, Zewf 92�/(/s1�-b , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pain and penalties of perjury. -2 Signature of Owner/Authori C:\bldg.forms\Bldgapp.res.wpd Page 2 Rev. June 26, 2003 C:\bldg.fomis\Bldgapp.res.wpd Agent Page 3 Date Rev. Jurne 26, 2003 RESIDENTIAL 2004 RESIDENTIAL _ 2004 ❑ FO�INDATIOP.' OINLY , :,::::::.::.:...:::.:.::::::..:.:.:.:..:......:;:.:::.::.; RECTI. Y ..: �. ::..:..::.:;>;:.;:.;»:.::::.;:.;::.;NSLE.C"IfJR:S:REVIEICO4.AE. £S......... _......... $25 00 APPLICATION FEE IS NON REFUNllABLE &NON TRANSFERABLE 1. Date plan reviewed: ? f 2. 30 nays to review period expires: 3. OK to issue date: 4. OX to issue subject to requested submittals(see project review worksheet): Date: 5. DENIED (see project review .,.DA F RFig, I ) 4 DARTMOUTH BUILDING DEPARTMENT r' 400 Slocum Road, P.O. Box 79399 Dartmouth, MA 02747 y 508-910-1820 FAX 508-910-1838 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO IFAMILY DWELLING Zoning Review: Signature: YIA 4,---- l-a Date: Energy Report: Signature4;--->� Date: Fire Chief: , Signature: f / Date: :5 — r - Board of Health: Signature: Date: %%Lr Conservation Commission: Signature: Date: Other: Signature: Date` _ Description of work being performed:i / kni & 11 NUMBER OF PLANS SUBMITTED: SITE PLAN SUBMITTED: M-51es ❑ no 1.2 Assessors Plat &Lot Number: � 1.1 Property Address: woo 0 - /U � Plat 4/2 Lot %® / Nearest Cross Street: A'6 Subdivision Name: pOfie C'08& QY_r 1.3 Historical District ❑ yes 8"'ho TotalLand Area Sq. Ft.: Has application been submitted to the Historic (Commission? ®29``l 394 �. 07 AGG) ❑ yes ❑ no Date: 1.4 Water Supply (MGL c 40 § 54): 1.5 Sewage Disposal System: ❑ MunicipalC/Private Well ❑ Municipal eon Site Dispfosal System C:\b1dg.forrns\B1dgapp.res.wpd Page 1 FRev. June 26, 2003 C:\bldg.forms'\Bldgapp.res. wpd Page 4 Rev. June 26, 2003