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BP-78290
Permit No. BP-7829.0 T BUILDING PERMI _,e° G1s#; 3296.00 - tC9. oflwealth ofMVlassathusgtts Map: 0066 N6F11-ART. U5IJTR Lot: 0002 _. :. 400 SrocurRoad Dartmouth,.MA 02747 Sub-Lot 0082 - ,phone (508)910 1824,•, Fat (508)41Q 1838 Category: ROOF ti Project# JS4016-000446 PERMISSION ISIIERBBYGRANTED TO: Est.Cost $1000.00 - - Contractor: � erase 3 Phone# Fee: $75.00 - ' ,�-irnet ')trr` .: A Const,Class: - Engineer } b .,"r'I� .7' '-� Phone Use Group: R3 -. . - 1 1 Lot Size(sq.ft.) 45124 - x j� , Applicant a ' � ✓ 13.##A# rr Zomng: SRB ALEXANDRE FERNA.NDES d; < c�'* (508)995 3928 Aquifer Zone: N/A n . - ;t Flood Zone: ZONE X OWNER: 40 r ., New Const.: N/A FERNANDES ALE RE L y ci: ay 1 /L '4 Alt.Const: N/A DATE ISSUED % M1•ft � ,� � Date Typed: 08-12-2015 TO PERFORM THE FOLLOWING WORK: " Construct roof over existing patio to match existing P o'ect Location: 3 GOLDFINCH DR 1. Approved/Issued By:_,______` �� ' .� ..G�jT`✓ DAVID UNETTE,LOCAL BUILDING INSPECTOR All work shall comply with 780 CMR 8ra Ed.(MGL Chap.143)and any other applicable Mass.Laws or Codes and plans on file. Schedule appropriate inspections as required. Upon completion,final inspection is required. I hereby certify that the proposed work is authorized by the owner of record and I have been authorized by the owner to make this application as his agent and to receive this permit, I further understand other agencies may have reason to STOP WORK if items under their jurisdiction are not met; not withstanding the issuance of this Building/Zoning Permit, Signature of Owner/Agent: "Persons contracting with unregistered contractors do not have access to the guaranty fund(as set forth in MGL c.142A)" Inspector of Inspector of D.P.W.Inspector Building Inspector Inspector of Gas Fire Department Plumbing Wiring Water Service#: Footings: Underground: Oil: Underground: Service: Foundation: Rough: Smoke: Rough: Rough: Sewer Service#: Rough Frame: Insulation: Final: Final: Final: Cross Connection Final: Final: Board of Health E-911 Additional Comments: Planning Board Prior to issuance of Certificate of Occupancy/Completion,this card must be returned to the Building Department with all necessary inspections signed off. Department phone numbers are listed on the white"Required Inspections"document provided with the issuance of the building permit. POST CARD SO IT IS VISIBLE FROM THE STREET TOWN OF DARTMOUTH--BUILDING DEPARTMENT RECEIPT 7 290 irAtti 508-910.1820 FAX: 508-910-1838 isgt Name: <Ji i/et 1e'(£ A Owner: ---�cl f%1-- ` Date7N�+ //7 Job Location: , D l2U I LA-J i;'�" Map: V Lot: Description General Ledger#'s Ref. # Amount Building&Building, c�OwN 0Fo4 00-44105 t # 'j Electrical R i '44 01�'' -44106 Plumbing & Gas d ,0/0100 -44107 Trench Safety 9-4. 'S 010 -44129 Other Department Reven CO<<EC-0F 000-42420 White-Collector's Office Yellow Copy-Customer's Receipt Pink Copy-Building Department ReceivedYy r t ILC THIS IS NOT A PERMITILICENSE FOR BUILDING, ELECTRICAL, PLUMBING OR GAS ' RESIDENTIAL o Phased Approv20tRfde:3.3) 525.00 APPLICATION FEE IS NON RE-FUNDABLE 6c NON-TRANSEERABLE,-r ;- DATE RECEtVEb ` ` � "4 r DARTMOUTH BUILDING DEPARTMENT I. r:Via,-1. 1 400 Slocum Road, P.O. Box 79399 2C15 JUL 31 , s 2 25_ Dartmouth, MA 02747 fiR v Phone: 508-910-1820 Fax: 508-910-1838 www.town.dartmouth.ma.us APPLICATION TO CONSTRUCT,REPAIR, RENOVATE OR DEMOLISH A ONE ° OR TWO sA MILY D ueL:ING Ms,,' �' " "� l >�ooti `9 G EoNY it a m i " c `ws +. Y ° £ r s' A43 a � - ama,, wAnckerC Eyi d 2 -:' Y 3 .J \_.n ki „ 5". `S _,�y SYr }Y "t ., NATURE _g fi ;,2, x� :44 1ingDistnct ° Sw. ; ss s e. n' ,s0,y c �, �LO eil r e e :� _ . a AV caw, < x s. .:"emskr ° ;_ ^ . ca a� f xi a e oanioft > ,a s.e m �t^ .p .�` �- etg ' ,tk"st"',: Me ' s s a ® a y ® 1 ftilittt ®:bthex 51 u 's '� W:^'a'w3�. .s'm<'� TMENr ,PPR0 ' ,. Y -. .x'"L',�',i,rx 3;.M Board of Health: Signature: Date: Conservation Commission: Signature: Date: Other. Signature: Date: Signature: Date: r Signature: !�� Date: Brief description of work being performed. '/i��i (nt �,u3 1d7o 12' )( f ' . / �CC ,- ' EOM—k�`$-T FfiRalilKEW f kk 5 3r 1.1 Property Address::/ j Got-brit t't N / , Tmoo rrf '7 1.2 Assessors Map/&Lot Number. Lot Area(sf.) rs Ic2 q Frontage 0F3. 4 t Map 66 Lot '� - �� Required Provided Front Yard gO — 1.3 Historical District ❑Yes B'No Side Yard Year Built - /995 Rear Yard 0 Altering more than 25%per side of building 1.4 Water Supply(MGL c40 s54): 1.5 Sewage Disposa System: Has application been submitted to the Historic Commission? CI Municipal ovate Well ❑ Municipal n Site Disposal System CI Yes RIM Date: Revised 10/11 ❑ CONSTRUCTION PLANS ❑ SITE PLAN El ENERGY REPORT • • • RESIDENTIAL 2. Owner Record: ry (SCe 935. 3a� 20-Ntet rs rll5&S 36.wDF ' Ac'OZ%'7 Name(print) Contact Address Phone Number 2.2 Authorized Agent: Name(print) Contact Address Phone Number 6-; ® G a .EO�b flfl��tt�tci't`,o7�:sitvl ,#0 "� �. �. � .` 3.1 Licensed Construction Supervisor/Specialty License: License Number: Company Name/Contractor Name: Address: Expiration Date: Signature: Telephone: 3.2 Homeowner Exemption-One&Two Family Only Section 110.R5.1.3.1 Exception: FOR HOMEOWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT 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 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: A an-rc 11e � �ls e�✓h �S E. E 041110.i? 0100100EN.S' IS`ROME A 7'i{Af(t ,0 2,445 a .alata 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 ttat i3ONE„ g0Otii t.CP OP0$00.*0$940heckalt 4ISM SM " _ ❑ Deck 0 Pool 0 Repairs 0 Alteration 0 Chimney/Fireplace 0 Woodstove/Pellet Stove ❑ New Construction* 0 Accessory Bldg. 0 Roofing/Siding her (Energy report required) (Shed/Garage) (Specify below) • Pj*r 0 j&L LY 15T pn; o %v 03470 r ❑Addition ❑ Replacement window/door B/ 0 Demolition (Energy report required) No.of windows_ Doors YXZ(e. Ns& C. UC5 (Specify below) *If new construction, please complete the following: Single Family: No. of Bedrooms No.of Baths Two Family: No of Bedrooms Unit 1 No. of Baths Unit 1 No of Bedrooms Unit 2 No.of Baths Unit 2 ❑Furnace(hot air)-fuel gas(natural or propane),fuel oil,electricity,other(specify): ❑Boiler(heating)-fuel gas(natural or propane),fuel oil,electricity,other(specify): O HVAC(combined unit)-primary fuel,natural gas,propane,electricity,other(specify): ❑Air itioning-(separate unit) one of the above to be provided 0 Hot Water. Gas Electric Fuel Oil Other • natSatkBEC;TIO »,E5l7[taUf eN53'i OCT,ON GoS7. Matt_ :ice • Item Estimated Cost($)to be completed by permit applicant 1. Building37 ..C= 2. Electrical C) '" 3. Plumbing r) 4. Mechanical (HVAC) 0 5. Total=(1 +2+3+4) Rt L1 cnN - c140 ftoaeCWAateten v ego Rea }gip O100 . P116,100:411 00430 _ ,. xr- (Please Print) 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 I. fitt'(A tv br-E f.12-1\aitN 4Dc,S , 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 pains and penalties of perjury. Or-ea /S/%%3` ignature of Owner/Authorized Agent . Date :h t M` � 14#4.r L i, -" <.~ AN.SPEGTIG.I IQ +<`SR st ] e .. rR` Less Application Fee:$ .00 ' Remaining Balance: $ Total Permit Fee:$ 5 r' r- • Other$Amount$ • Gross Area-New Construction total sq.ft. Gross Area-Alteration total sq. ft.nt Permit Issued to: /v77$L7',,,Ucre f,�>/��tt- _A-WS'!�G?oC� �ee..777D .7 j 7-r G,ttL ,.yea/ Qr-r_A- „A w K - w $ECTfp`1?TflpPl t $A`.SiOMMEt!17 J,SRr f `" `r; 6:4* Location of Debris Removal per Ma C.40 Sec.54 Sec ATT4-c46b Permit No. BP-78290 Project Location: 3 GOLDFINCH DR CommonweAlvth ° of ssachusetts TOWN OF__,DARTMOUTH ¢o0 400 SlocumRoad.Dartmouth, IA 02747 yipt p002 ; . Phone (,5 8 910.1820 • .!a c: 508)910 1838 , ,'b ot: 082 :,r > UI I TG PERMIT , ; ,a x µ FIELDN ;C TI© Tree , 7 Oi) 0 cntc ty t Contraco : { n� xZ License: n.Phone#: op9 M sz p1, T( ti r5 . - z ti l . : c hone#: Engineer': >, one � ; e5 ; Applicant •, Phone #: `oodZono ! ALEXANDl FERNANOES t (508) 995-3928 i ,w ou a +T/K A OWNER: P 4 , ;r'�. `g, , $0t ', ' . .� 3`u 8*:' ' FERNANDES ALE • ND ,,,- (�(� DATE ISSUED: 1) co V,�UWTLE7M TO PERFORM THE FOLLOWING WORK: Construct roof over existing patio to match existing DATE TIME TYPE OF INSPECTION&REMARKS INITIAL //-Z-i 21w /a0 7� 77 raja Ok Ref COMI D (67own s‘foQQ`J`G \bqA4t-Me►S-C��3. kGt,\tikyt"- 7S 01- A r \fro y N ,c0(4:004-. .. - tx _ ,\.: Q., ,.....\ tc . -4e*:-\OA, S` Lo-(ik �, _ Ao` it SI cP, ` O. y alir.%. re �P eu ..uo *levy ji,Th cr c7.01.01 0Ov�1� • • 'a The Commonwealth of Massachusetts Department of Industrial Accidents ' Fa �l - f ikt Office of Investigations II � 7 600 Washington Street ��' Boston, MA 02111 \ , . S ,i- www.mass.gov/dig Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information y� Please Print Legibly Name (Business/Organization/Individual) /9/.6—tU a£ F6i i nru/-'Y-S Address: 3 City/State/Zip: Nt4/2 r/yloy76f 41/7 £7Y7Phone#: C 8 ) q 7s L51 Are you an employer? Check thetappropriate box: Tyjie of oject(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 4 6. ',Whew construction employees(full and/or part-time).* have hired the sub-contractors 2.0 'I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in anycapacity. employees and have workers' b P ty 9. ❑ Building addition [No workers' comp. insurance comp.insurance.t r rred.] 5. El We are a corporation and its 10.❑ Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] `Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: _3 6o/dh tck l/✓ City/State/Zip:I r j1 2 it(' Attach a copy of the workers' compensation policy declaration page(showing the poli number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby��cartify under the pains and penalties of perjury that the information provided above is true and correct Signatur freik ttt' :4 .-e4.4-1�l//Ytoz�Le Date: t7/ /, Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4.Elpctrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: \<---.-5u n•-m ,. il 8 v 1I, I• e I I I I il FI I sa L— — -• II f II C--->ii> ' ii ---; - - - IrE ®� I , I = , • 1 K m I I jj m I; D ._ ;Ii b I I IC _ I: DJ II l D I i _I • I! j I� i. 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