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BP-60701SECTION 8 INSPECTOR'S REVIEVVICOMMENTS 1. Date pla- reviewed: AUG 13 2010 2 DENIED ,see project review worksheet): Date: 3. HOLD ReasonDate: 4. HOLD suoject to Zoning Board of Appeals action: Date. - Comments: Inspector's Signature: Date: AG 13 2010�--- ECTIOJN 9 - APPLICANT NOTIFICATION Applicant in`_ med of abov Date: Time: 1 �l/� Clerk: r Comments: f SECTION 10 - OFFICE6INSPECTOR'S NOTES / Less Application Fee: $25.00 Remaining Balance: $^ Total Permit :=ee: $ 7 Other $ Amount $ TOTAL FEE: Gross Area - New Construction total sq. ft. Gross Area - Alteration total sq. ft. J� Permit Issued to: d G. .� y,a.. h, m,�>� ... _„ "; SECTION 'I1 - ADDITONA� COM"1iE1dTslSIfETCi-IES � to l )?_0o rU ❑ Approval in Part (Per 780 CMR.5111.13) ! •�,.-� N*2 a_On A Vc 7wim"w7 ,., 1iTfj -, - DARTMOUTH BUILDING DEPARTME 400 Slocum Road, P.O. Box 79399r� - cs.a�3a.sar�a�.raJ DATE RECEIVED -7r, AU6 _ ti 9:� Dartmouth, MA 02747 Phone: 508-910-1820 Fax: 508-910-1838 www.town. dartmouth. ma. us APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING THIS SECTION FOR OFFICIAL USE ONLY RECEIVED BY: BUILDING PERMIT NUMBER: GATE SENT FOR REVIEW: DATE ISSUED. d G. O.K. T O ISSUE -SIGNATURE: - � � DATE. o Zoning Gistrict Proposed Use: -- Zone: ❑-X ❑ e ❑ A ❑ V Aquifer Zone. TIE FOLLOWING AGENCIES SHOULD BE NOTIFIED: 11 Board of © Board of - 0 Cons. ❑ Demo ❑ DPW El Eleo. ❑ Energy report Appeals Health Commission Affidavit Card Sent: Cut Off Follow ❑ Fire ❑ Gas D Planning C1 Sevier Card ❑ Water Card 11 Zoning ❑ Other' Chief Cut Off Board Cut off Cut Off -REQUIRES INSPECTOR'S REVIEW BEFORE THE ISSUANCE OF A PER:v1iT. DEPARTMENTAL APPROVAL Zoning Review: Signature: ar�'�,�s %�� Date: aU6 2010 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: SECTION 4 - SITE INFORMATION �h n e 1.2 Assessors Map-& Lot Nu A PropertyAddress: ` � ��Stuber: ,•., Lot Area (sf.) Frontage Map Lot - Required Provided Front Yard 1.3 Historical District ❑ Yes ❑ No Side Yard Rear Yard Year Built ❑ Altering more than 25% per side of building 1.4 Water Supply (MGL c40 s54): 1.5 Sewage Disposal System: Has application been submitted to the Historic Comr fission? ❑ Municipal ❑ Private Well ❑ Municipal ❑ On Site Disposal System ❑ Yes ❑ No Date: Page 4 EICONSTRUCTION PLANS FISI T E PLAN �G Ni t Pa 1 C O P Y O F L C E N C E (S) RESIDENTIAL SECTION 2 PRGt'ERTY (3wNER.SH PlAUTHORZED;AGE 2.1 Owner Record: AA ACK �,tr3 ) M b - a • 31V Na .e (print) Contact Address Phone Number 2.2 Authorized Agent: KCIV-144 `-`. Name (print) ontactttAddress Phone Number 3.1 Licensed Construction Supervisor/Specialty License : License Number: Comaany Name/Contractor Name: Address: Expiration Date: Signature: Telephone: 3.2 Registered Home Improvement Contractor: Not Applicable ❑ Are you a Home Improvement Contractor subject to (780 CMRA 10.R6)? ❑ Yes ❑ No Are you claming exemption from the requirements? ❑ Yes ❑ No If Yes, Go to Section 3.3 Comoany Name/Contractor 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 I am a Homeowner performing all the work myself. Owners Name (print): Signature: OdIF y signing the above, the homeowner acknowledges that there will be no eligibility to the Guaranty Fund Date: 7 ; /`% 3.4 Homeowner 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 in 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 Constructioi Supervrsors. 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 whic 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 the one hone in a two-year period shall not be considered a Homeowner If you are applying under this section sign below: Signature: our nature carries certain responsibilities, includi but not nec6sgFily limited to, general liability I — Page 3 Page 2