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BP-91056 Permit No. BP-91056 BUILDING MLoatp:: - 00006062 - v'400 5 d9 GIS#: 3296.00 Coorlwea oV ' ssathO tts 47-4' � TH e , SIca sadtpartm Eby <2747aoo Sub-Lot: 0082 a Category: .ALTERATION �?'�' ,� e..,t >., Project# , JS-2019-001635 PERMISSIONL$I�EREB��Cr� D TO: �� Est.-Cost: $6500.00' Contractor. _ Rw rs; ; ' nse:" hone ° Fee: f - ,e 1- r �), 0 575.00 � 3 � �� e�#d Const.Class: Engineer. ^ >f� s j ,� P ecP Use Group: R3 j of i Lot Size(sq.ft.) 45124 Applft nt: a g z z Y 3 P o airs t m .. Zoning: mg ALEXANDER F„t ES `,� ✓ Aquifer Zone: N/A o t# h a- -s+ , ^ (77q 81/4„, 0, Flood Zone: ZONE X FERNANDES AI. RAND• L- 4%? , -� Alt Const: N/A DATE ISS(IED �� � � +fc Date Typed: 12-21-2018t, a > o t 'Sppa``,,;+�.,, TO PERFORM THE FOLLOWING WORK: ° oov,so.vouAva Enclose existing covered patio in rear oject Loci don: 3 GOLDFINCH DR Approved/Issued By: / DAVIDBRUNETTE,LOCAL BUILDING INSPECTOR All work shallcomply with 780 CMR 9'a 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. tt 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: fartain pit( t- ( � "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 910 5 6 PHONE: 508.910-1820 FAA: 508.9104838 OF N Name: /.' Property Owner . it - n`�N NA, ate./ AR � r Job Location: ; 1 J. t ','-r; Map: (- Lot ) ).."‘)- r DEC 20r1111 Description General Ledger#'s gf # Amount °frBuilding& Building Misc. 01000-44105 yeVCLE6j�o l Electrical 01000-44106 Plumbing& Gas 01000-44107 NO Trench Safety 01000-44129 T � nrn'T Other Department Revenue 01000-42420 B'E I T E R I V I L!V I S White-Collector's Office Yellow Copy-Customer's Receipt Pink Copy-Building Department Received By- iI( ,47 THIS IS NOT A PERMITILICENSE FOR BUILDING, ELECTRICAL, PLUMBING OR GAS RESIDENTIAL ❑Phased Approval(R106.3.3) $25.00 APPLICATION FEE IS NON RE-FUNDABLE &NON-TRANSFERABLE - 6ii �. a ' _. trt "' DARTMOUTH BUILDING DEPARTMENT D TE RECEIVED' ioa _! 400 Slocum Road z , Dartmouth, MA 02747 3O� j` Phone: 508-910-1820 Fax: 508-910-1838 ' www.town.dartmouth.ma.us APPLICA TION TO CONSTRUCT,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING tF SF L t ° i:< ttTdp I 6 $EDNEY riy s s z .c - 'ar : n ,{ s- };lt.e, a � , Q) :dE 3Y } 7 [jG ( MTNJCirBEfle 3g;:j r ` DATEI$s&E[� ,SIGTLgTLiR d Building Cot ttisiionerRnsP •rofBufrtlfigs : , --- yr h " _ 1'OEry(t , St T " _ ES OSe -r� S 4x p . ce s - ] 1 Pf a d Se_- 1 r ., YS w .L�Qrfe, B Q ,! Afll)r eFzOn t „..L.s` • ' z;ir tystf 1 -, , € cLt A E . o�t ro B� ' z } D3W s�aEa�f $egd of O Cons EI Pla ^ `"APPe1fs �� Hdalfkr: - � RRmg _- f�.gdd -- �' ,-Oo Srnssron Ca Engineeung C1Cross �- Prre Gas " , - r ` Conrcegtiori r�-Ohef; 17 Eiegac t70ther - I . is catflff cutoff 'I Where-and ❑etkoit,ard ! -,Q. ,vr -r }, C4t'OfF CU€Off - " i;;I: t Kr yn i.uJ x p i t v^a i a..?r._,„S d'�9S?i`�tica -s's " iaftitil $A 'max Mir fix; _ - 4PPRO f��gr ,,T Board of Health: Signature: Date: Conservation Commission: Signature: Date: D'P'W" Signature: Date: Fire Chief: Signature: Date: Other: Signature: Brief description of work bein Date: g performed. / - 1.1 Property Address: � ���5`'��`'s "� �'�°`��' -. -:` ���}A h 1 ' /� 1.2 Assessors Ma '&Lot Number: Contact Person: Map ` 'C _ Lot fa- Phone Number: 1.3 Historical District ❑Yes - 0 No 1.4 Water Supply(MGL c40 s54): 1.5 Sewage Disposal System: Year Built ❑ Municipal 0 Municipal El Private Well 0 Altering more than 25%per side of building 0 On Site Disposal System Has application been submitted to the Historic Commission? ■' ' %, �- ❑Yes ❑No Date: 0 CONSTRUCTION PLANS ® GJTP P1 AM i 1 raven.., rr.n...gr/13 RESIDENTIAL 2.1 Owner Record: 1:611il 117e s �ara .- G2 a 617-7/ q- �C7z- Name(print) Contact Address Phone Number 2.2 Authorized Agent: Name(print) tContact Address Phone Number 91 ISI IKa. _ F .z i3 . = ' ice m i 3.1 Licensed Construction Supervisor/Specialty License: 1 License Number: Company Name/Contractor Name: l`1 _re: _j /6e-use 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 he 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 mom than one home in a two-year period shall not be considered a Homeowner. If you are applying/] under this section sign below: V Signature: id&XC7(f/ L• . - netCa a tP -vim �> x z �,� � - ,m - � ;tom �Ff© � �". nr`Tratd3iCrc"t tr'�a�i6"� Jg�6 ��R �' ." �.�-��` 42 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 0 No c .v';', ..,- la :ISIT tignal SCR rti1 lati t fi€�Lt r(€+ e -aTfaaa ntneac a 0 Deck 0 Pool 0 Repairs 0 Alteration 0 Chimney/Fireplace 0 Woodstove/Pellet Stove Cl.New Construction* 0 Accessory Bldg. ❑Addition 0 Roofing/Siding ❑ Replacement window/door (Energy report required) (Shed/Garage) (Energy report required) No.of windows Doors 0 DEMOLITION (specify): Location of debris removal (per MGL C.40 Sec 54): 0 Dumpster on site ❑ Dumpster On Street Facility Name: Location: *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 ❑Fumace(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 abovs It#+dd ❑Hot Water: Ga - , -- - - Electric Fuel Oil Other s.,sP"'v. '..,.n.. lr ti.r-,?. Fz ,. , as sl -6taSI la ne+"at 6 is? Y. ..=,i?k>;{ :intORW4 - i Item Estimated Cost($)to be completed by permit applicant 1. Building 2. Electrical 3. Plumbing 4 Mechanical (HVAC) 5 Total= (1 +2+3+4)iiint (Q � � "� nY Y=*'r} �.-�, P+. �� �. te .- 1 b �f. r.} r�ii 4k2 -. __-st?4 � (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 '_ � " ,; SEGTI©h�`7B U4iiNEt�17(�.TFlfl[�jbJ�GFN1i.DECt,r�i,�A'CIQy ... :; ,� ,' I , 7 lF3Lo,1/J �6:27't? wner/Authorized Agent hereby declare that the statements and information n the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. /�Ign //il�K L ed gent ignature of Owner/Authorized Agent Date L r.`. SCTIbt �„GSIxFZ56tiFFTEv 'T a N .�j,�,'. ��_� Less Application Fee:$25.00 Remaining Balance: $ Total Permit Fee:$ Other$Amount$ Gross Area-New Construction total sq.ft. Gross Area-Alteration total sq.ft. � v L Permit Issued to: foq /c' / - a-d%D 7@ /.✓u wa""l weas ' d t jiskitJ deck__ 1/3 nee kr lit Air The Commonwealth of Massachusetts 1 {' 6 Department of Industrial Accidents 1 Congress Street, Suite 100 if Boston, MA 02114-2017 www.mass.gov/dia Yorkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Oo Please Print Legibly arse (Business/Organization/Individual): r-ng Address: City/State/Zip: Phone ft: Are you an employer?Check the appropriate box: Type of project(required): LE]l am a employer with employees(full and/or part-time)_* 7. El New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling pacity.[No workers'comp. insurance required.] 9. ❑Demolition I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 10 ❑ Building addition 4.❑I am a homeowner and wilt be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole l l.n Electrical repairs or additions proprietors with no employees. 12.C Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp. insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.fOther 152,§t(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. +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. lithe sub-contractors have employees,they must provide their workers'comp.policy number. l 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 60/(64l,-4, City/Stolz/Zip: (9a.,-/- M79 vziVY Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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$250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: ' C 4- -eCe Date: /2/2, ce Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: �C vi'S nf^+1^-f0 MCP m -i --1 -7HH ➢ SSo > > > .'o 'Xmm O �+ p 3 v: ..,y p]'n.-3 S L)Cny soz(.) m 0 0 0 0 o n 0 m .- m ^ i 0 0 ..„ x o o ^m o •-e X37Jpmgy Sing Nd a. 8. as a a. a H8 8n M8 2 rn p 0 �I 78' a `� o ,< o x w W w a c o o 0 0 o w p p v y m eo Cuwto-oz C1S ?f _ inm � . a 0 '� X W [0 o N .- <= <= _ =� J.^ �J o O m rmi. .mi m m z R .3 CJ € y 3 N N E. 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OOOVIb r- , VxOW Ngir r M OOWO�� t P u o =oc d C m ,: — �• P O o000 N fD m< ` '' C C C 'D :. (0 F a 'a N O W Sol co Cu !1� EA'v.'•=+'O fr gal l a - V` ;Es O }+` .... i l y - O V O 4 aaei,,^' aY a m - Ca CO m x �� W W N A.-gG 5 C O N NO 2 fi �1 J N u W CO ': N W J<1' 3 W _ b O O � O x0 a J T t l T V +T� a O O o j O O O O O O O O O ?1i O 0 n 0 0 0 0 0 0 O 000 Permit l+►o. 056 Project Location: 3 GOLDFINCH DR Co nwe s:0:h,...11S etts �TQ gt ': .t�. . 1 .r ! UTH � t40 SIu i! - ., . -.. • A -413, �� 4r r ow ' ''+' 1. 1 ,I III ill' '(/�'1T a s �z i t s f ) (i t. q 4xU3�rZ g3 dr r a Contra _ h �r.e: �one#: r' � a .- Architee �t w; 'hone#: :a v a11 s Applicant. fl Phone#: � _ �E ALEXAND ' , 'AN q�ea" (774) 488-8860 ` , ��iy rv�h °�s s qg pan ui4 zee,, OWNER: 33$ S y� Xm 9��,y € u e [i ilg� v3 h +fl FERNANDES ALA -T ����� _ DATE ISSUED: TO PERFORM THE FOLLOWING WORK: Enclose existing covered patio in rear D TE TIME TYPE OF INSPECTION EMARKS INITIAL __ / � CILI�metc2 ®fit