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(S - B AWING PLANS) I
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DH SET IN
S70NEWALL
43/3-12
N/1-
COLUA S; GEORGE A. -
s- - FRS 2. 46
• �_
1. PROPERTY LINE, TOPOGRAPIC AND EXISTING CONDITIONS SURVEY
PERFORMED BY EARLE 0. PHIWPS, JR., PROFESSIONAL LAND SURVEYOR IN
MAY 2004.
2. ELEVATIONS ARE BASED ON BENCHMARK DATA SHOWN ON THE PLAN.
3. THE SUBJECT PARCEL IS SHOWN AS LOT 3 -- 3 ON THE TOWN OF
REBAR DARTMOUTH ASSESSORS MAP 43.
4. THE SUBJECT PARCEL IS PART OF THE "WILCOX FARM" SUBDIVISION,
SUBJECT TO SPECIAL CLUSTER ZONING REGULA11ONS REGARDING THE
PRESERVATION AND MAINTENANCE OF OPEN SPACE AND THE RURAL
CHARACTER OF THE NEIGHBORHOOD. ALL HOMES ARE TO BE OF
TRADITIONAL PRE-1930 RESIDENTIAL NEW ENGLAND STYLE. ALL BUILDINGS
ON THE LAND CONTAINED WITHIN THE SUBDIVISION ARE TO BE APPROVED
AS TO ARCHITECTURAL STYLE BY THE DARTMOUTH PLANNING BOARD PRIOR
TO THE ISSUANCE OF ANY BUILDING PERMIT. DETAILS MAY BE FOUND IN A
CERTIFICATE OF ACTION FOR A SPECIAL PERMIT ...RE: "WILCOX FARM"
CLUSTER ZONE '.:SUBDIVISION PLAN AS APPROVED BY THE DARTMOUTH
PLANNING BOARD DECEMBER 9, 1997.
5. THE SUBJECT PARCEL IS LOCATED WITHIN FLOOD ZONE C (AREAS OF
MINIMAL FLOODING) AS DETERMINED BY FEMA MAP COMMUNITY PANEL NO.
250051-0020C ATED JULY 3, 1985.
6. ALL DWELLINGS ARE SERVICED BY DARTMOUTH TOWN SEWER AND WATER.
o► 112 Len volm m 214
FRONT 25 FT.
SIDE 15 FT.
REAR 15 FT.
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SCALE
1. PROPERTY LINE, TOPOGRAPIC AND EXISTING CONDITIONS SURVEY
PERFORMED BY EARLE 0. PHIWPS, JR., PROFESSIONAL LAND SURVEYOR IN
(AWAY 2004.
Z. ELEVATIONS ARE BASED ON BENCHMARK DATA SHOWN ON THE PLAN.
a. THE SUBJECT PARCEL IS SHOWN AS LOT 3 - 3 ON THE TOWN OF
D)ARTMOUTH ASSESSORS MAP 43.
4. THE SUBJECT PARCEL IS PART OF THE "WILCOX FARM" SUBDIVISION,
S;UBJECT TO SPECIAL CLUSTER ZONING REGULATIONS REGARDING THE
I"RESERVATION AND MAINTENANCE OF OPEN SPACE AND THE RURAL
(::'iARACTER OF THE NEIGHBORHOOD. ALL HOMES ARE TO BE OF
..RADITIONAL PRE-1930 RESIDENTIAL NEW ENGLAND STYLE. ALL BUILDINGS
CIN THE LAND CONTAINED WITHIN THE SUBDIVISION ARE TO BE APPROVED
j,,S TO ARCH ITECT!_IRAL STYLE BY THE DARTMOUTH PLANNING BOARD PRIOR
'•J THE ISSUANCE JF ANY BUILDING PERMIT. DETAILS MAY BE FOUND IN A
C:LRTIFICATE OF ACTION FOR A SPECIAL PERMIT ...RE: "WILCOX FARM"
0-USTER ZONE SUBDIVISION PLAN AS APPROVED BY THE DARTMOUTH
F'—ANNING BOARD UECEMEER 9, 1997.
THE SUBJECT PARCEL IS LOCATED WITHIN FLOOD ZONE C (AREAS OF
MIINIMAL FLOODING) AS DETERMINED BY FEMA MAP COMMUNITY PANEL NO.
2'SO051-0020C DATED JULY 3, 1985.
E. ALL DWELLINGS ARE SERVICED BY DARTMOUTH TOWN SEWER AND WATER.
MINING REQUIREMENTS
REQUIRED
F •RON ( 25 FT.
SIDE 15 FT.
R'LAR 15 FT.
h'J BUILDING ZONE 40 FT.
ENGINEERING
CO., INC.
CONSULTING ENGINEERS
19 COUNTY ROAD
P.O. BOX 1178
MATTAPOISETT, MA 02739
TEL: (508) 758-2749
FAX: (508) 758-2849
THE CROCKER BUILDING
4 COURT STREET SUITE 102
TAUNTON, MA 02780
TEL: (508) 824-9279
FAX: (508) 824-9276
Revisions
ADD COVERED PATIO
3/27/08
RNF
,.
DPI
Date
Appvd.
Date
04/27/04
1 "=20'
LxaM By
RMS
Designed By
KDW
Cheded By
RMF
,,,sued For
ROBE{
i FIED m.
CIVIL
No.39788
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1 OF 1
Sit No.
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DOS SANTUS RU/ &
MOCO SANTUS RUSE M.
W/NSTON (50' LA YOUTH LANE --__
INV.=97.1.3 � �-� PA�Yr't
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GENER t,i NOTES
1. F"ROPERTY LINE, TOPOGRAPIC AND EXISTING CONDITIONS SURVEY
PER!"ORMED BY EARLS 0. PHIWPS, JR., PROFESSIONAL LAND SURVEYOR IN
MA` 2004.
2. E:_EVATIONS ARE BASED ON BENCHMARK DATA SHOWN ON THE PLAN.
3. --iE SUBJECT PARCEL IS SHOWN AS LOT 3 3 ON THE TOWN OF
DAR -MOUTH ASSESSORS MAP 43.
4. T'-IE SUBJECT PARCEL IS PART OF THE "WILCOX FARM" SUBDIVISION,
SUB..IECT TO SPECIAL CLUSTER ZONING REGULATIONS REGARDING THE
PRE'S;ERVATION AND MAINTENANCE OF OPEN SPACE AND THE RURAL
CHA,�.ACTER OF THE NEIGHBORHOOD. ALL HOMES ARE TO BE OF
TRA,:IITIONAL PRE-1930 RESIDENTIAL NEW ENGLAND STYLE. ALL BUILDINGS
ON -HE LAND CONTAINED WITHIN THE SUBDIVISION ARE TO BE APPROVED
AS "3 ARCHITEC (!RAL STYLE BY THE DARTMOUTH PLANNING BOARD PRIOR
TO '-HE ISSUANCE OF ANY BUILDING PERMIT. DETAILS MAY BE FOUND IN A
CER'_IFICATE OF ACT10N FOR A SPECIAL PERMIT ...RE: "WILCOX FARM -
CLUSTER ZONE :'SUBDIVISION PLAN AS APPROVED BY THE DARTMOUTH
PLAM114ING BOARD DECEMBER 9, 1997.
5. T'-IE SUBJECT PARCEL IS LOCATED WITHIN FLOOD ZONE C (AREAS OF
MINIkAL FLOODING) AS DETERMINED BY FEMA MAP COMMUNITY PANEL NO.
250051-0020C A TED JULY 3, 1985.
6. A,__ DWELLINGS ARE SERVICED BY DARTMOUTH TOWN SEWER AND WATER.
REOUiRi't,,tFNa
FROM T
SIDE
REAR
NO BI.JILDING ZONE
REQUIRED
25 FT.
15 FT.
15 FT.
40 FT.
FILE COPY
ENGINEERING
GO., INC.
CONSULTING ENGINEERS
a COUNTY ROAD
0. BOX 1178
Mti4TTAPOISETT, MA 02739
il: (508) 758-2749
-JX (508) 758-2849
? E CROCKER BUILDING
a ,;OURT STREET SUITE 102
AUNTON, MA 02780
t L: (508) 824-9279
r AX: (508) 824-9276
j:avi310r18
[1 ADD COVERED PATIO 3/27/06 RMF
No. Description Date AppW
D80
04/27/04
S,-A*
1 "=20'
a� By Designed By Chedced By
Rms KDW RMF
Isl" gad For
ROBERT M.
o FIELD
CIVIL
No. 39788
/1 70�
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1265 1 OF 1
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! SECTiO`3 3 INSPECTOR'S REV EWIC01"A TENTS
1. Date olan reviewed: _ MAY 2 8 2010
2. DENIED (see project review worksheet):
Date:
3. HOLD
Reason: Date:
4. HOLD subject to Zoning Board of Appeals action: Date:
Comme-ts:
Inspectc-'s Signature:
Applica-. informed of
I Comme-ts:
Time:
Date:
aCt� i ltJ . tY�IJ['1-#1 t:l ziett; UK'S TIU 1 t
Less Application Fee: $25.00 Remaining Balance: $�'
Total Permit Fee: $ � S
Other $ Amount $
TOTAL = EE:
I Permit Issued to
Gross Area -New Construction total sq. ft. `�yT:;)
Gross Area - Alteration total sq. ft.
rage 4
RESIDENTIAL ❑ Approval in Part (Per 780 CMR.5111.13)
S25_nn APP1,11 ATM`► FFF IQ %T"M RF_FiT3W1 :a&"Y W .e. 19L,n\T_Ir"AL 9 a,
rf/
:si
DATE RECEIVED
�
a r
DARTMOUTH BUILDING DEPARTMENT
't
400 Slocum Road, P.O. Box 79399
}z
.t3 Al
Dartmouth, MA 02747
�r�
T.
J y�
Phone: 508-910-1820 Fax: 508-910-1838
www.town.dartmouth.ma.us
1,[ + �. r
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
THIS SECTION FOR OFFICIAL USE ONLY
RECEIVED BY:
t
BUILDING PERMIT NUMBER:'
r
DATE SENT FOR REVIEW
DATE- ISSUED:
O.K TO ISSUE - SIGNATURE: .�- -m
DATE. jr sy,
Zoning District
` •= Proposed Use: Zone ❑ X ❑ B ❑ A ❑ V Aquifer Zone
THE FOLLOWING AGENCIES SHOULD BE NOTIFIED
L. Board of
❑ Boa d of ❑ Cons. ❑ Demo ❑ Dp\N
111 Elec. ❑ Err ,gy Report
Appeals
Health Commission Af idavit Card Se;.;:
Cut Off F(:,u )w-;gyp*
❑ Fire
❑ Gas 11`aPlanning El Sewer Card u %Nats card 0 Zoning El
Chief
Cut Off "VJPN o d2L110 Cut Cis Cut Oft
*REQUIRES 11`48 E _ 'S REVIEW BEFORE THE ISSUANCE OF A PERM! T
DEPARTMENTAL APP VAL
Zoning Review:
Signature:
Date:
Energy Report:
Signature:
Date:
Fire Chief:
Signature:
Date:
Board of Health:
Signature:
Date:
Conservation Commission: Signature:
Date:
Other:
Signature:
Date:
Brief description of work being performed: (/� �(,'y:x
SECTION 1 - SITE INFORMATION
1.1 Property Address:% )) )C iy Lk 1.2 Assessors Map & Lot Number:
Lot Area (sf.) / 1�te� Frontage- Map f Lots
Required Provided
Front Yard 1.3 Historical District ❑ Yes ❑ No
Side Yard
Rear Yard Year Built
❑ Altering more than 25% per side of buildiing
eMuater Supply (MGL c40 s54): 1.5 Sewage Disposal System: Has application been submitted to the Historic Commission?nicipal ❑ Private Well "Municipal ❑ On Site Disposal System ❑ Yes ❑ No Date:
,CONSTRUCTION PLANS SITE PLAN ❑ ENERGY RE DORT
Page 1
RESIAENTIAL
SECTION 2 - PPOPERTY OWINERSHIP/ THORIZED'AGENT.
2. Owne- Record:
a e (pr ontact Addres I
2.2 Authc -zed Agent:
Name (prl--) Contact Address
Phone Number
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor/Specialty License : License Number:
Company \ame/Contractor Name:
C Address:
Expiration Date:
0 Signature: Telephone:
P 3.2 Registe-ed Home Improvement Contractor: Not Applicable ❑
Y
O Are you a Home Improvement Contractor subject to (780 CMR.110.Ri ❑ Yes ❑ No
F Are you cla7ing exemption from the requirements? ❑ Yes ❑ No
L If Yes, Go to Section 3.3
1 Company Name/Contractor Name: Registration Number (if none, state "none"):
C Address:
E Signature: Telephone:
Expiration Date:
N 3.3 For Res dential Remodel Work Only
C PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND:
E QUESTIONS OR COMPLAINTS call or write:
(S) home Improvement Contractors Registration, One Ashburton Place - Room 1301, Boston, MA 02108, 617-727-8598
1 ❑ I am a Homeowner performing all the work myself.
Owners Nar-e (print):
Signature:
y�gning the above, the homeowner acknowledges that there will be no eligibility to the Guaranty Fund
Date: - l 4- 1 -7/0 10
3.4 Homeow-ier Exemption - One & Two Family Only
FOR HOMEOWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT
5108.3.5 Licensing of Construction Supervisors: Except for those structures governed by Construction Control in Section 116.0, effective July 1, 1982, no individua
shall be engaged n directly supervising persons engaged in construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of building
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. V
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 Homeowne
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 whit
there is, or is inte^ded 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 tha
one home in a two-year period shall not be considered a Homeowner
If you are applying un thiJsection sign below:
Signature:
ur signature carries certain responsibilities, including but not necessarily limited to, general iia
SECTION 4
TION 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
❑ Deck ❑ Pool
❑ New Construction"
(Energy report required)
❑ Addition
(Energy report required)
`DESCRIPTION OF
❑ Rep 'rs ❑Alteration
Accessory Bldg.
(Shed/Garage)
❑ Replacement window/door
No. of windows Doors
"If new construction, please complete the following:
Single Family: No. of Bedrooms
No. of Baths
all a
❑ Chimney/Fireplace
❑ Roofing/Siding
Two Family: No of Bedrooms Unit 1 No. of Baths Unit 1
No of Bedrooms Unit 2 No. of Baths Unit 2
0 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
ascription of proposed work: 6-T- / WC' 1� i2— rj=, .
Item
1. Building
2. Electrical
3. Plumbing
4. Mechanical (HVAC)
5. Total =(1+2+3+4)
SECTION 6 - ESTIMATED CONSTRUCTION COST
Estimated Cost ($) to be completed
CEO, 00
SECTION 7 -OWNER AUTHORIZATION
be completed when owner's agent or contractor applies for b-ildinr
(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.
5lgnature of Owner
Date
SECTION 713 - OWNER/AUTHORIZED AGENT' DECLARATION
le
❑ Woodstove/PE!liet Stove
❑ Other
(Specify below)
❑ Demolition
(Specify below)
rmit applicant
as Owner/Authorized Agent hereby declare that the statements and informatics
o he foregoing application are true and accurate, to the best of my knowledge and belief.
Signed under thepains and es of Deriurv_
of Owner/Authorized Agent
Date
Page 2 `
Page 3