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BP-2515240T 4 ' Cv W 0 z �m R= 1573. WINSTON 35' LAME t DA= 05'-23'-56" L= 148.25 ' S 82 -54 -25" E . h - _ F 64.07' -------------- s .� _ �Z BUILDING I W SETBACK LIN � y -'r- =vl = CC 0.mum Lo 79 \ 1 jj'J _m '� wecw EXISTING BARN SITE BENCHMARK: � L SET IN 24'TREE =84.17 (NGVO) �0 LOT 3 78,024 S. F. W (1.791 Ac.) o SCALE: 1 " = 40' 40 0 20 40 SO �%� FEE1 MARK A. BOUCHER, P.L.S. MA. REG. NO. 41246 HLE COPY PARCEL "B" (OPEN SPACE) TOWN Of - mmouTH RECORD -PLAN A Copy . This End2rverl Plan must Be Kept On Site, QW'i a cti©n 0 of o-c90 DATE TOP OF FOUNDATION = 78.9 (PROPOSED T.UF78.2)120.3' FOUNDATION S 82-37'-44" E 88.91' AS -BUILT PLAN EXISTING PLAT 43, LOT 3-3 House, � WINSTON LANE DARTMOUTH, MASSACHUSE17S l �• �' _. '� _� �`' -r O O SCALE 1 "=40' DATE MAY 1, 2000 Ln MONG i7 PREPARED FOR HOUSE N- - NO BUILDING ZONE �J � �, BENJAMIN BRAYTON �-- ---� rn 152 'PREPARED BYSHED -N 76 -59`20"W BOUCHER 8� HEUREUX, INC. NO BUILDING ZONE146.28'PLAT 43, LOT 2 CIVIL/ENVIRONMENTAL ENGINEERS, SCIENTISTS LAND SURVEYORS AND PLANNERS N 86--19'-32" W 648 AMERICAN LEGION HIGHWAY WESTPORT, MASSACHUSETTS 0" "90 TEL- 508-636-5905 FAX: 508-636-2477 FILE. 1108- .: )1 SECTION 8 - INSPECTOR'S REVIEW/COMINIENTS 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 �,vorksheet): Date: 6. HOLD reason: Date: 7. HOLD subject to Zoning Board of Appeals action: Date: S. Comments: 9. Inspector's Signature: Date: SECTIO 9 - APP C T NOTIFICATION Applicant informed f ove Da _ 'd Time Clerk: Conmlents: -p SECTION 10- OFFICEVNSPECTOR'S NOTES -T- Total Permit Fee- S Less Application Fee: S 25.00 Remaining Balance: S TOTAL FEE: 6b �� Gross Area - New Construction total sq. ft. d(II r Gross Area - Alteration total sq. ft. Permit Issued To' ,4 SECTION 11 - ADDITIONAL COMMENTS/SKETCHES IN N 1 U PUUIYDA11U1Y UIYLT $25.00 APPLICATION FEE IS NON-REFUNDABLE & NON -TRANSFERABLE DATE RECEIVED DARTMOUTH BUILDING DEPARTMENT r•. r . 400 Slocum Road, P.O. Box 79399 Dartmouth, MA 02747 508-910-1820 FAX 508-910-1838 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FfAMILY DWELLING THIS SECTION FOR OFFICIAL USE ONLY RECEIVED BY: BUILDING PERMIT DATE SENT FOR REVIEW: NUMBER: DATE ISSUED OK TO ISSUE - SIGNATURE: DATE�� 'Building Comissioner/ldsp5oor eFB4,ldings Zoning District: -5eoposed Use: Zone: C ❑ B A ❑ V Outside Flood Zone ❑ Aquifer Zone THE FOLLOWING AGENCIES SHOULD BE NOTIFIED: ❑ Board of ❑ Board of ❑Con. Com. ❑ Demo ❑ DPW ❑ Elee. ❑ Energy Report Appeals Health Affidavit Card Sent: Cut Off Follow-up* ❑ Fire ❑ Gas ❑ Planning Board* ❑ Sewer Card ❑ Water Card ❑ Zoning ❑ Other Chief Cut Off / Cut Off / Cut Off Review* * REQUIRES INSPECTOR'S REVIEW BEFORE THE ISSUANCE OF A PERMIT. DEPARTMENTAL APPROVAL Zoning Review: Signature: Date: Energy Report: Signature: Date: Fire Chief: Signature: Date: Board of Health: Signature: Date: Conservation Commission: Signature: Date: Other: Signature: Date: Description of work bein- performed: SECTION 1 - SITE INFORMATION NUMBER OF PLANS SUBMITTED: SITE PLAN SUBMITTED: ❑ yes ❑ no / 1.2 Assessors Plat & Lot Number: 1. I Property Address: Plat Lot - Nearest Cross Street: Subdivision Name: 1.3 Historical District ❑ yes ❑ no Has application been submitted to the Historic Commission? Total Land Area Sq. Ft.: ❑ yes ❑ no Date: 1.4 Water Supply (MGL c 40 § 54): 1.5 Sewage Disposal System: ❑ Municipal❑ Private Well _ ❑ Municipal ❑ On Site Disposal System C:`bldg.lormsBldgapp.res %%pd Pace d RCV. January 19, 2 00 1 (: hId .=.k);'11, BILIg;Ipp.res.�cpd Page I Rev. January 19, 2001 RESIDENTIAL 2002 RESIDENTIAL 2002 SECTION 2 - PROPERTY OWNERSHIP AUTHORIZED AGENT 2.1 Owner of Record: � VC� A1,,,A Lq W %Gtv,e— 1W 7-11 L(D Name (prim ) Contact Address Phone Number 2.2 Authorized Agent: Name (print i Contact Address Phone Number SECTION 3 - CONSTRUCTION SERVICES 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 Naine (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 familv 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 r this se t on sig�lo�� Signature: Yo r 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 Constiruction Supervisor, whether or not they have taken the permit are responsible for code compliance. (see Appendix of 780 CMR R5.2.15; SECTION 4 - WORKER'S COMPENSATION INSURANCE AFFIDAVIT (MGL C 152 § 25) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provi(de 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) ❑ new construction* ❑ addition ❑ alteration ❑ repairs ❑ chimney/ C woodstove (energy report required) (energy report required) fireplace ❑ deck ❑ pool accessory bldg. ❑ replacement window/door ❑ other C demolition shed/garage) no. of windows doors (specify below): (smecify below): * If new construction, please complete the following: Single Family: no. of bedrooms no. of baths Two Familv: no. of bedrooms unit 1 no. of baths unit I 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 fVork: x ltn SECTION - 6 ES MATED CONSTRUCTION COSTS Item Estimated Cost ($) to be completed by permit applicant 1. Bttildina&—co 2. Electrical 3. Plumbinc — 4. Mechanical HVAC '- 5. Total = (I + 2 + 3 + 4) * Estimated Total $ SECTION 7A - OWNER AUTHORIZATION (to be completed when owner's agent or contractor applies for building permit) (please print) I, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7B - OWNER/AUTHORIZED AGENT DECLARATION I, G Coy&( Acdov cti , as Owner/Authorized Agent hereby declare that the statements an(d information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under t pains and penalties of perjury. Signature of Own r/Authorized Agent Oate C: bldu.iinms Eldgapp.res.�Npd Page 2 Rev. Januarc 19.2001 C- hld,.for ms. llld�,:urn recwnd P90P 3 R,a 1a ,nry 19 ?001