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3
RECEIPT FOR PERMIT
•,o�* TOWN OF DARTMOUTH 43V
PERMIZ,NO.
oP t T ' '
No r
a /n
Date
Received From $i/eittana re. /, It ro 0 i 1C6,..,.J
Lacation 3 d f Dt< t,LQ i
t
Amount Paid 5i v U C -I 79'
Received By . 111u29
RECEIPT FOR PERMIT _
TOWN OF DARTMOUTH /,7
�f777/� N PERMIT <,0..
c_x No - ' sC--
Date 7 77( - E 7 '
//��
Received From f%'�-4 l t-C X---( ✓rt-h -.E-
Owner m tri c ti e.
Location / ��` r`�iw
L. 4,.
Type !mac /j. ..._.- ' { j
rt
Amount Paid' G Z) 1,,,.y r/>> / c
� t � ;
Received By )'
D i v
TOWN OF DARTMOUTII BUILDING DEPARTMENT
I1 TELEPHONE 508-999-0720 FAX 508-999-0738
APPLICATION FOR ZONING AND BUILDING PERMIT
Instructions
The applicant shall complete this application to the best of their ability prior to submission,leaving no item unanswered.The
Department staff will be available during regular business hours to assist as necessary.N/A should be inserted for those sections
which do not apply.A properly completed application will help avoid unnecessary delays. Ifate tig fees nut refaniable.
(for office arse only) �/t
Application fee $9c.5 �e 7
�) received by AC Date '7�l.G
Total PermmFee / j Permit#
100 LOCATION OF PROJECT // / p �j
CURRENT ACCESSORS' PLAT IP tp LOTo( Oa& ZONING DISTRICT S/C - 6
OTHER ZONING OVERLAY DISTRICTS , if applicable
1/ UMBER & STREET 3 GOLD 1=iiVC. i-I (�f1),4, .-
NEAREST CROSS STREET
SLIBDI VISION NAME & LOT# rZ.S C OA)e BIRD i9 C
or BUSINESS NAME •
PREVIOUS TENANT 1 OWNER
200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
E THIS SECTION NOT APPLICABLE
Single family - number bedrooms number baths
= Two family - number bedrooms unit 1 number baths unit 1
number bedrooms unit 2 number baths unit 2 -
Accessory apartment Total gross sq. ft.
Accessory structure
�7 i
Garage - detached �ttached to dwellia> %dimensions L Oc. 7 w 2t y
Carport - detached - attached to dwelling, dimensions L W
Shed - dimensions L W
- Gazebo- dimensions L W
- Swimming pool above ground in-ground Size total square feet
I. Chimney -#of flues
1
Woodstove - used (will require inspection prior to installation), new (provide manufacturers
instructions). Location(s) (list)
E Fireplace(s) - (includes flue) List location(s)
Game Court -describe(include overall dimensions)
a
Tent, Trailer(Mobile Home) o Other,describe .1-)e r�1C
300 COMMERCIAL-PROPOSED PROJECT/USE-INCLUDING THREE FAMILY OR MORE AND EXEMPT USES
THIS SECTION NOT APPLICABLE
(The following descriptions are based on the Massachusetts State Building Code Article 3,AS NOTED) (See the
Code)
E Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe
_ Business - office, assembly with less than 50 occupants - indicate Medical or other professional (see Code
Section 303.0)
_ Educational-structure for training including child day care for those over 2 years 9 months(see Code Section
304.0)
- Factory/ Industrial - (see Code Section 305.0)
_ High Hazard - (see Code Section 306.0)
_ Institutional - hospital, nursing home, infant day care(see Code Section 307.0)
1 Mercantile - retail stores (see Code 308.0)
▪ Residential - three or more family, hotel (see Code Section 309.0)
- Storage - includes garages (see Code Section 309.0)
• Utility & Miscellaneous Structures - includes tents and agricultural structures (see Code Section 311.0)
• New tenant for any of the above, indicate above (see Code Section 119.0 and Zoning By-law section 35)
- Tent or Trailer - temporary purpose?
• Other
Describe the proposal briefly,INCLUDE number of dwelling units and bedrooms or occupant load as applicable,
also existing condition
400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED
Y`New Construction and/or Addition - total gross square feet
/` �_.\(For commercial only total gross cubic feet) -indicate
L_jIt will be considered new construction if there an increase in square footage in addition to any
alteration(s).
If project is an addition to existing structure -Total gross square feet of existing
FOR COMMERCIAL ONLY
Will this project be subject to CONSTRUCTION CONTROL(over 35,000 cu.ft.) _Yes No. (If yes
see Code section 127.0). Designer to submit Code Synopsis.
Will this project require Peer review(over 400,000 cu.ft.) Yes _No (see Code Appendix I)
APPLICANT TO PROVIDE
I
- Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required.
E Demolition - describe structure
- Number of dwelling units Number of bedrooms A separate Refuse Disposal
Declaration required.
Moving- (Provide copy of D.P.W. moving license) Type of structure
from where(plat/lot or address)
to where (plat/lot or address)
Number of dwelling units Number of bedrooms per dwelling unit .
- Re-roofing - (for existing only, is included in new construction)
Number of square feet Number of layers already existing
Number of layers when complete
A separate disposal declaration REQUIRED
- Replacement doors and windows - (for existing only) (only where doors and windows exist and will not be
enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwelling will be
considered as an Alteration, otherwise will be included in new construction. (see Code section 3401.10 for
residential and Article 8 for comn.ercial)
- Temporary structure-includes when allowed, trailers,tents and the like and only for limited periods of time.
Describe
500 CONSTRUCTION PLANS
/2\/k/7 - None submitted. Why?
T Su//bmitted, usually three sets required. Four sets for food service\uses. Number of sets submitted I
600 SITE PLANi
2�� li of requited, why?
Submitted When? _ Previously, date ` With this application
700 UTILITIES }� �/
Water supply - required_yes_ no, public ? _yes /1 no, on site well?/7 yes_ no,
existing? _yes _no
If required and not existing have necessary permits been issued? _no_yes, date
(M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a water supply, when
required, is available. See Code 780 CMR section 114.1.2) Y
Sewage disposal - required_ yes_ no, public sewer_yes /i no
private septic - on-site /yes_no. Submit copy of permit as soon as available.
3
800 MECHANICALS & PRIMARY FUEL
• 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
900 SPRINKLERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
= Required, =plans provided, :plans not provided, why?
- Not required, not to be installed, Why?
1000 REQUIRED OFF-STREET PARKING- for ZONING & Architectural Access
- NOT APPLICABLE
• Parking Plan submitted To = Building Department _ Planning Board Date submitted
Number of spaces - indoors outside total provided
Handicap spaces - required_yes_no. If yes, how many as a part of the total required number.
Is Route 6 (State Road) Entrance permit required? yes _ no I. If yes has it been issued yes = no 7.
Submit copy of application and/or permit as soon as available.
1100 IDENTIFICATION (print or type except as noted)
Current owner- name �z_Exim JJ - _ i' -.
� S
LI7
n8
a/d/dyess _3 < OLi�r1: /NC_ H flP V R'o urn AAmQ�2`�
phone# J6% - y7.���j yc,2 8
If corporation, officer in char
ge
Architect/Engineer- for overall design
Company name
Address
Phone number
Certified by State of Massachusetts as
Certification number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
4
Architect/Engineer-project supervision and reports
Company name
Address
Phone number
Certified by State of Massachusetts as
Certification number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
General Contracto (if homeowner, state homeowner here then complete section 1300)
Company name
Address
Phone number
Construction Supervisors license number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
iiiif f i ii fi i iiifiiii ************ifiiffiiif*Sif*ffiffifiiiffffiif******iiifiiifi fiffifiifi***i
1200 FOR RESIDENTIAL REMODEL WORK ONLY
Are you a Home Improvement Contractor subject to(7S0CMR-6) ? Yes_No_If no go to next section!
Are you claiming exemption from the requirement? Yes No_If yes, submit the required affidavit!
VRemodel contractor name(please print)
Address
Registration number Of none state"none')
Phone number
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE
GUARANTEE FUND! QUESTIONS OR COMPLAINTS call or write:
Home Improvement Contractors Registration
One Ashburton Place - Room 1301
Boston, MA 02108
(617) 727-8598
Owners name (print)
Signature
Date
1300 OWNER SIGN-OFF
I, the undersigned,am the owner of record or authorized lessee(provide documentation) and I have reviewed
the application herein submitted. I state that to the best of my knowledge and belief that the information provided in this
application is true and correct and that the permit requested he issued.
Further I understand that the permit will expire in six months, from the date of issue, if no work is begun or
six months after the last inspection if work has begun and that the permit may be extended for six months if no work is
anticipated if I request such an extension in writing. I understand that the permit may be extended only three times by
5
written request.I understand that once the permit expires a new application may be required,including fees and current
other requ' ements (including Zoning).
✓ Name AL.C; &VD R c L. CR iv'ANi)i
Signature ye" 7,fr vrY,7 I. /'. 3/44U14gO/c 1
The above
above signature is my voluntary act and is signed under the pains�anndpenalties of perjury.
Date /X//1 i�j ORl2# / J "-3 /v2
Who is authorized to pickup the permit at the Building Department? 1plesse print
Address Phone
1400 HOMEOWNER EXEMPTION - ONE &TWO FAMILY ONLY
FOR HOME OWNERS 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 127.0, effective July 1, 1982, no individual shall be engaged in directly supervising persons engaged in
\1' 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.
Y% Exception:Any Home Owner performing work for which a Building Permit is required shall be exempt from
ir) the provisions of this section; provides that if a Home Owner engages a person(s) for hire to do such work ,that such
Home Owner shall act as supervisor.
For the purposes of this section only,a"Home Owner" is defined as folk, Person(s)who owns a parcel of land
on which he/she resides or intends to reside,on which them is,or is intended to he,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
two-year period shall not be considered a Home Owner.
If you are applying under this section sign below:
Signature .r.��0�.�,4 41 ,E c-z-7,v -1
Your signature carries certain responsibilities, including but not necessarily limited to, general liability
##x###xx ##txxs##x#xx#ttitxxxx#x******tttttsx xt #x#t t x xxs#x*Y t xttis#xttitt xx i###
NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that any
licensed Construction Supervisor, whether or not they have taken the permit are responsible for code compliance. (see
2.15.2 of section 5)
tt##x#xtsxtttssstsxs#xxxxxxsstx#xsissss#xitxsxssxtzsxsssstsxxsxsss#ssstssxxxit#sstxsssxxssxs#xst#sstssss
1500 COST
Cost of Improvement $
Items to be installed but not included in the above cost: Electrical $
Plumbing
HVAC
Other qJ
TOTAI,� $ 101(el t cam(/
The following section for official use only. ��-
INSPECTORS' REVIEW
Date plan reviewed APR 19 1�9999966j
30 days to review period expires ��� O /9- 9
l
OK toissu date
6
OK to issue subject to requested submittals (see project review worksheet) date
DENIED see project review worksheet date
HOLD reason date
HOLD Subject to Zoning Board of Appeals action
Comments 'n' f/fin, n
Inspectors signature !\ .2v�y\ Dat�k!.PR 1996
Applicant inform of above - Date time_staff (fax, phone, in person)
*********.******************************Y******* ****** k ** ******Y Y *** S *** *
Over six months since approved for issue - DEEMED abandoned!
Advise applicant. Hold 90 days for return then dispose if not picked up.
Inspector Date
Advised applicant Date Time_staff (by phone, fax or in person)
*S*****iik2YF*S*********S*******S**S*SS**********;;;;;S******;;i;;;;;YYYY******************SSSS******55*
OFFICEHNSPECTORS NOTES
TOTAL FEE /4V. Cb
Gross area - new construction 6 7G Total Sq. Ft.
alteration Total Sq. Ft. �I�
Permit is issued 4._I e--<f X on-�l -..e ye- -f- /O-X l 0 to-e--e- C
Comments/notes on permit
mot /— dA if G —..-
7
1600 TO THE APPLICANT/REFERRAL AND APPROVAtLy� 7�9 C�
Date off/Application
�submission
``//��//'' Q ,—/yam//�
Plat/!'S�" Lot, O+�'Street L )/C�C.. 7C-4
��" Aquifer ZoneOwner . Y :: =% ci7L��—
Owner mail address t�7-yt�
Owner phone$ 9 / 5� ^ S f,;Z I
S*Sii2#i##Si2i3ii#SSii#;iiY2Y
OTHER INVOLVED AGENCIES -The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT
FOR CURED SUBMISSIONS.
6,0rAX COLLECTOR = Approved = HOLD By /
0 /`-' 9 DStp
• �.onservation Comm = Approved By ,j`/ %j 95 Date
❑ D.P.N. water = Approved By Date
❑ D.P.N. sewer = Approved By Date
❑ D.P.N. cross connection _ Approved Date
❑ D.P.N. engineering = Approved Date
0oard of Health well _ Approved ` to�eg"yam , Date //7.9C
f
❑ Board of Health septic = Approved �� Date
❑ Board of Health food service = Approved yr Date
r P ��
FIRE DISTRICT (I - II - [II) Approved- Date
❑ Planning Dept = Approved Date
Other = Approved Date
Other L,�// = Approved /f' /I /�� .�.. Date
C„mments / (� ( l-F� (�L(, eti_. ] z)
ixx:; ; ;x; 2 tii3iii33itY i2Sii Yi2iSiiSiYS3iSii Y;;ii;iS;; Y S YiSii i#33iYi3 3itii33ii
Project summary new construction/ alteration/demo sewage disposal - public/private
[Alteradd interior walls] [add rooms] [add footprint] water supply - public/private well
spool] hed] [game court] [food service]
Describe i�.0 CV. G�� �
;k2k;xYYiY2i;i2ii3222iiii;23i23i3ii3if;;t Yk;;i2i;;;iii;iiii;i i 3 2 i Sii iY;;ii i2iiiik2i;;;Y
To the various departments:
This notice has been forwarded to you for your information and any appropriate action. Should you have any
questions please advise. If any reason to withhold the requested permit is found, please advise. Your assistance and
cooperation is appreciated.
The Building Department
Date sent for review 477 h i By4147
Date
�offr/Application submission _ vty
j` `7 L//
Plat'fi''!' Lot �treet L. /yir �- Aquifer Zone_
Owner �? /�e :� / ( a
Owner mail address
Owner phone ft 99c. - 2 J oZ
OTHER INVOLVED AGENCIES -The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT THEM FOR REQUIRED SUBMISSIONS.
03 AX COLLECTOR = Approved = HOLD By Date
• '.onservation Comm = Approved By ��j /7Zf ? Ct JD
❑ D.P.W. water = Approved By Date
❑ D.P.W. sewer _ Approved By Date
❑ D.P.W. cross connection _ Approved Date
❑ D.P.W. engineering = Approved Date '/
❑ :oard of Health well = Approved NA, &S. Date 5`'/?- l
i
❑ Board of Health septic = Approved ./ �� fRr
_ Date
❑ Board of Health food service = Approved Date
FIRE DISTRICT(I - II- III) = Approved Date
❑ Planning Dept = Approved Date
Other = Approved Date
Other = Approved Date
('umments
Project summary new construction/ alterationidemo sewage disposal - public/private
]Alter,add interior walls] [add rooms] [add footprint] water supply - public/private well
'pool] s] hed] [game
court] [food service]
Describe �.0 CV ei��J
w
To the various departments:
This notice has been forwarded to you for your information and any appropriate action. Should you have any
questions please advise. If any reason to withhold the requested permit is found, please advise. Your assistance and
cooperation is appreciated.
The Building Department
Date sent for review 47/ 7 1 - By
•
4747
Date of Application submission ,je` ?/V L ^�y�/�
Plat' LotiZtreet �� .Ve �S-i�� - Aquifer Zone_
Owner a 1, � Yee; �,•-
Owner mail address 0-—V
Owner phone# 99o- - S J p2
OTHER INVOLVED AGENCIES -The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT'THEM FOR REQUIRED SUBMISSIONS.
0 AX COLLECTOR = Approved = HOLD BByy'7�/ Date
• onservation Comm = Approved By /' ` Date
❑ D.P.W. water = Approved By Date
❑ D.P.W. sewer = Approved By Date
❑ D.P.W. cross connection _ Approved Date
❑ D.P.W. engineering = Approved �l� Date '/
(oard of Health well = Approved -r .S. '0L7 • Date $Z77- C
❑ Board of Health septic = Approved 7 Date
❑ Board of Health food service = Approved Date
FIRE DISTRICT(I - II - III) - Approved Date
❑ Planning Dept = Approved Date
Other Approved
Date
Other = Approved Date
Comments
Project summary new construction/ alterationidemo sewage disposal - public/private
[alter,add interior walls] [add rooms] [add footprint] water supply - publiciprivate well
]pool] arage" hed] [game court] [food service]
Describe �29. CV e!�6L—z��i
#RYt YY;t*I;Yi*Y;Y•; YY •* Y ..*5*5*** ► Y;Yii;aan;i
To the various departments:
This notice has been forwarded to you for your information and any appropriate action. Should you have any
questions please advise. If any reason to withhold the requested permit is found, please advise. Your assistance and
cooperation is appreciated.
The Building Department Date sent for review 1/7 /-7 4 By'J�zc%J
8
THE COLLECTOR 'S OFFICE
DATE: . ac2, /CCZ'
TO: BUILDING
LDING DEPARTMENT
FROM: COLLECTOR'S OFFICE
RE: PAYMENT OF PAST DUE flYP'r
PLEASE BE ADVISED THAT ON Mu'- DAY _2 . as /G c4, mz TABS FOR
PROPERTY LOCATED ON✓ 4111Sitzdi 1 PARCEL # (, , -G7 c 2
HAVE BEEN PAID. THE PERMIT WBIC$ SAS HEW REQUE.VEr, MZLY BE
ISSUED- IF YOU HAVE ANY " t9
QUESTIONS CONOD'iIgG
-v PLEASE CaL.L-
o m
N 0
C
C' / J
o
Q_
0 o
o c.0
-o
a
c••--_elrnnn rrr r nrrrr
t000tonth
= W AP CAx /REGERRAL AND APPROV L 6 / - D ',� 7//
Date of Application submission
PlaaLoS2Sfreet ��id l ` Aquifer Zone
�Q LGt
� "
�r - `'�'1 a.
� b
O• or mail address Q > 7
e▪ ) C car phone f / 9� '- J ?c. z/
j�s:�ssas
STHER I )LVED AGENCIES -The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT THEM FOR REOUIRED SUBMISSIONS.
TAX COLLECTOR = Approved = HOLD By Date
�j Date
onservation Comm = Approved By /' `/ &a"_a t /fF9S Date
❑ D.P. V. water = Approved By Date
❑ D.P.W. sewer = Approved By Date
❑ D.P.W. cross connection = Approved Date
❑ D.P.W. engineering = Approved Date
3oard of Health well = Approved Alt j t �L7 Date $L/]• C
'
❑ Board of Health septic _ Approved fX� Date
❑ Board of Health food service = Approved Date
FIRE DISTRICT (I - II - III) - Approved Date
❑ Planning Dept = Approved Date
Other = Approved Date
Other _ Approved Date
(*liniments
Project summay new construction/ alteration/demo sewage disposal - publiciprivate
(Alter/add interior walls] [add rooms] [add footprint] water supply - public/private well
[pool] arage, hed] [game court( [food service]
Describe 12/1
To the various departments:
This notice has been forwarded to you for your information and any appropriate action. Should you have any
questions please advise. If any reason to withhold the requested permit is found, please advise. Your assistance and
cooperation is appreciated.
The Building Department G/�/ 4747
Date sent for review / � YB
8
BUILDING PERMIT
FILLD'-IMSPCCTION
Dartmouth Building Department nn {{{����( Plat:66
400 Slocum Road P. O. Box 939g0j",t{ 1\�D Lot(s) :2-82
North Dartmouth, MA 02747 �j �111111(1147 ,J t� Lot Size: 45, 1'24
Telephone (508)999-0720 Zone Dist. :SRB
Issued Date:04 /23 /96 Permit No: 634
Project Location: 3 Goldfinch Drive
Maaber street
Subdivision Name:
Nearest Cross Street :
Applicant/Agent: Alexandre L. Fernandes q 6-)$G (}(o j Dr
Contact Person Phone 4 : (508) 995-3928 ya.5242,7.,
Proposed Use: Residential
Raeidentiel. taeeerelel. Industrial. eto.
Permit Issued To : New Construction
Type of loprawaant. Add. Alter. Mae Dent.. One. Land/More. ate.
Gard .._.ar d deck
indlaate no. of bedrooms and bathrooms and other rooms
Owner(s) of Record: Alexandre L. Fernandes
Address: 3 Goldfinch Drive, North Dartmouth, MA 02747
DATE ' TIME TYPE OF IM...:PECTION REMARKS I INITIAL r
AUG 3 0 1996 //am /jj A pY G ,
AN 0 6 1997 as p -g,s, e.
/ - -7 - 27 // -,c �a--�L-z_2 , 7D
I/ -47-92 // ?e, .4a+. 47.0-6-nt 1 se-"7,v,‹ Gs,—._ --rrca,
_ r
q p 1Ltt d, . 1 I 1 r tee. /
/�
3 .-/' - 7 7 d ,i s, G ' a..aa�a yr it-
947
c omnfir
J13_2 /rCSOt et, of id<
TOWN OF DARTMOUTH
4,, u115O
BUILDING RECEIPTS
NO TAX ISSUES COLLECTOR'S OFFICE
Name- - ' f; .�,d..i�✓
}. + },-,_ h. 'ice'.`,—'� _'- c_ Date: C
` ,, Property Owner: ; f�7 r..- >'CL��r'v ..:9, / i--/�
Job Location: - -
White Copy-Collector's Office
Plot: - Lot: h �. Yellow Copy-Customer's Receipt
<` — e Pink Copy-File Copy
Phone:
Green Copy-Building Department
Description General Ledger#'s Ref.# Amount
License&Permits-Building 01000-44105 % s
License&Permits-Building Misc. 01000-44105
License&Permits-Electrical 01000-44106 TOWN 4F T R 'S FFI
TAX COLLECOR OFFICE
License&Permits-Plumbing&Gas 01000-44107 0 9 ' 1
Other Department Revenue• 01000-42420 ?V p2/� 9
SAS 3 .
This is not a Permit or License-for Building.Plumbing or Gas Received By: ' - t
I -
F
BUILDING PERM I T
Dartmouth Building Department Plat :66
400 Slocum Road-P. O. Box 9399 Lot (s) :2-82
North Dartmouth, MA 02747 Lot Size:45, 124
Telephone 508-999-0720 Zoning Dist. :SRB
April 22, 1996 (typed) Permit No. : 6311
Issued Date: y/ / @4' Clerk: BAS
Project Location: 3 Goldfinch Drive
Number Street
Subdivision Name:
Nearest Cross Street :
Applicant/Agent : Alexandre L. Fernandes
Address: 3 Goldfinch Drive. North Dartmouth, MR 02747
Contact Person Phone #: (508) 995-3928
Type of License: Owner: (x) Const. Superv. License #: ( )
Architect : ( ) Engineer: ( ) Other: ( )
Proposed Use: Residential
Residential, Commercial, Industrial. etc.
Permit Issued To: New Construction
Type of Ieprovecent, Add. Alter, Now Const., Demo. Land/Move, etc.
Garage and deck
indicate no. of bedroose and •
Gross Area of Const. : 676 sq. ft. Cost of Const. $3, 200. 00
Cost-Other Const. : TOTAL FEE: $ 140. 00
Owner(s) of Record: Alexandre L. Fernandes
Address : 3 Goldfinch Drive. North Dartmouth, MA 02747
All work shall comply with 780 CMR 5th Ed. (MGL Chap. 142) and any
other applicable Mass. Laws or codes and plans on file.
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 authorized agent.
Signature of Owner/Agent : /144524.7,7 / .y..r ,ceecd
Address:
*********************** ** *** ** **** *************************
Signature : .s i
Approved/Issued By : 0- el S. Reed, Title: Building Inspector
CO ENTS: PLEASE POST PERMIT CARD SO THAT IT IS VISIBLE FROM
Lill
THE STREET
❑ ORIGINAL ❑ APPLICANT ❑ ASSESSORS 0 CLERK ❑ COPY
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