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BP-228 BUILDING PERMIT FIELD INSPECTION Dartmouth Building Department Plat: 66 400 Slocum Road P.O. Box 9399 " Lot(s) :2-71 Dartmouth, MA 02747 Lot Size: 1 . 5A Telephone (508 ) 999-0720 Zone Dist. :SRB Issued Date: 09/13 /96 Permit No: 228 Project Location: 4 Goldfinch Drive Number Sheet Subdivision Name: Nearest Cross Street: Applicant/Agent: Jose A. Roderiques Contact Person Phone #: (508 ) 998-1412 Proposed Use: Residential Residential,Commercial, Industrial,etc Permit Issued To: New Construction Type of Improvement,Add,Alter, New Coast Demo,Land/Move,etc 29 ' x 14 ' deck (FOOTINGS ARE TO BE INSPECTED BEFORE CONCRETE IS POURED) (400 sq. ft. ) Inthcatr no of bedrooms and bathrooms and other rooms Owner(s) of Record: Jose A. Roderiques Address: 4 Goldfinch Drive, North Dartmouth, MA 02747 DATE TIME TYPE OF INSPECTION REMARKS INITIAL VP 2 ' II /113 /9 -0 (-7.„ _Lc A) it< 2 1 41Crtod-7 CV. , --- BUILDING PERMIT Dartmouth Building Department Platt 66 400 Slocum Road—P. O. Box 9399 Lots) :2-71 Dartmouth, MA 02747 Lot Size : 1. 5A Telephone 508-999-0720 Zoning Dist. :SRB September 11, }996 (typ d) Permit No. : d o- Issued Date : Y //, h Clerk : BAS Project Location : 4 Goldfinch Drive Number Street Subdivision Name : Nearest Cross Street : Applicant/Agent : Jose A. Roderiques Address : 4 Goldfinch Lane, North Dartmouth, MA 02747 Contact Person Phone 4$: (508) 998-1412 Type of License : Owner: (x) Const. Superv. License 44 : ( ) Architect : ( ) Engineer: ( ) Other: ( Proposed Use: Residential Residential. Commercial, industrial. etc. Permit Issued To : New Construction -._ Type of la{T'omeaentc Add, hers -aim Censt.. 'Data, tantlMove, etc --. _ _. -- 29' x 14' deck (FOOTINGS ARE TO BE INSPECTED BEFORE CONCRETE IS POURED) indicate no. of bedroom and bathrooms and other rooms Gross Area of Const. : 400 sq. ft. Cost of Const. $1, 400. 00 Cost—Other Const. : TOTAL FEE: $ 40. 00 Owner(s) of Record : Jose A. Roderiques Address : 4 Goldfinch Lane, 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 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 Bui o n get. Signature of Owner/Agent : / J Address : **at****4*******4*****- ****c ***g* **** **********-***********it*** Signature : JVI( I19 Approved/Issued By :/del . Reedy, Title : Building Inspector — COMMENTS: PLEASE a'aST PERMIT CARD SO TH T IT IS VISIBLE FROM THE STREET Li ORIGINAL U APPLICANT U ASSESSORS U CLERK 61 COPY BUILDING §m..... ri .I oath Building Department ; Plat ? 174a ;3 oc+,t>4 Read—P. O. Don rf t_of _. _ f't4:ootht MA ise?i4? ; Cot Si2eit; ItS0 iept.one 50a 99'.3 -0720 Prit. icIer Septembe.y_.11, L996 ,lIcyppeA f ter`. ` u. :c . _ Issued U. tet, _.L. L/ Is: Zfr Ciertil -r njebt i,ord(; 1un reed?/dfigch_Dr iv it rest Nearest Cross Streets 3ppi k art /Anon$ t t?5e A R ele a_ii9 Rt-iIirii r ,3-09. 1 7Zdli #,,.rt t t r t t) Eflitn'mouth, tip 3 s_ Contort y.erson Phone fie 4:509) ,_ ,:”0-2.1414t Type of Licenses Owners fait Cont Su; er v. s . l. eb •r . i-:rc[-vsterti 3 Eng3:1ee"a z Others s Prepti ed Otos __ Residential_-: ,.__.._.. .. _.._ . _ ._.._ ..._..... incA4sntiu etea=c:nls isesett a3, utw. _-.. Permit Iststie✓i Tea New C F91^il`-.7 c son 'lac,.... ._ ......t .; se 4ep u;iarn€n AeY7x pLta*e Kr ra»a. 4taAe® k.+F:' o- ptr{{3iwD}•._d.inH„rase na. of 8eh-a aati anl bAtha:a+:ns amf A r.(4v OrG5q Area of Con st. i r f?1fh k 'ff t- Cost of d ontt, . kt'.l Fti 1 .Y _., Cost—ntn. r Con:;t a ,^, TOTAL Fitts s t .1,0. Vita Owner?sa of Record: a1 �, sa �s1 Fr titr fddre'csr 4 €Jt3kd ixi n Bait E_y_rpa.Q Kfa o4 i rt'C+4.Ath _ io oa747 _ At a work nssar; comply With &M Cr4R 5th r.W (rra83L Chap. ?£;?i < n3i atar3. ♦v-her appiichble i'fisst: Lawn ar- codes -_.nd pl ors on I hereby certify that the prepos ci work isott. r .? oy the 3wrlr-t .3f < as .i arid z have been authorized by the owner to ea <F tfr3 _ app./ Scat ittlf; v.. s's7'i '+StL :13'M s;t, receive this pt'rkit, le:shi r tinders-tend (Atterc2j F.3•'.3 .5 "day itive ;.safin, With IC .items under their.. jurisdiction a^ s rat mei ; -:-al w:ath.t ,.., n:Z rr: e;•., ,... •s: of this MIA Permit. Signature of '•.3wn rb/rPIent S . .._..:. _ • _. . .._......_ _._........... ... Y"IC7A'i"^n.s s ****aic4 K'» a,X- -3-&AGts✓ # kx^.}#-F1i.Y•ri^k#-tl feassi. krM"h-# xsa - 4 ;f-i .. ^ n-•: v.ae Signatures_ Y 4.. ' nirevi ..U• Z _ st`Coa Bys 4clei z" heFri. r -.- :r,2r3y.f COMMENTS. PL.:EnSE 73Oill PERMIT CARD SO THAT t E ,, ati ifs' THE SMELT i a Dal _. t 3-_ il. ,irst_ 5_f e-ti-,irg 11:fisti a., €-ek ,. ..,,W ., r-i ill it; Plat '%CO Lot �j Address 7 /� } ✓ c� Required approval Approvals received please (X) approvals Please (X) approvals and required for this project Initial as received DATE INITIAL ____� Zoning SEP 1 0 1996 Building comm.SEP 10 1996 Board of Appeals Water Card Sewer Card Board of Health G/c 7 - to -96 -0 Bond Selectmen (7- Conservation CAA/ 9 YY 6 Fire Chief Cross Connections Licensed Contractor Controlled Const. Affid. /�q ,��-✓ Other information required l/ 4 • Plat Lot Address Required approval Approvals received please (X) :approvals Please (X) approvals and required for this project Initial as received DATE INITIALS Zoning Building Comm. Board of Appeals Water Card Sewer Card Board of Health Bond Selectmen Conservation Fire Chief Cross Connections Licensed Contractor Controlled Const. Affid. Other information required RECEIPT FOR PERMIT ® TOWN OF DARTMOUTH C )` V 5 e PERMIT NO. 2 i= No Date ` 6 —9 4, , ' f _fit .�� - . Received From Location F 1 ype —. ,l‘ ".sa +%.-Gee — —z.* 1 - .._ a Amount Paid 5..- c� /�az Received By / , {/ --- -/- -1-4 3 4 RECEIPT FOR PERMIT uT -• TOWN OF DARTMOUTH St (� PERMIT NO. I iii 1 •' O ,�s//� yy_ S No �/ ®✓5✓ 1 vclZ�' Date 1P i, /-.3, / y'77 Y ceived Froth L Q-�/ - 1 YWner" ,.- -ssvt.G Location - 't: ,y ! Amount Paid ;"�'�a " ^ 52° (kk j Received By l\-' - • Y:-"--( 0- "t- TOWN OF DARTMOUTH BUILDING DEPARTMENT TELEPHONE 508-999-0720 FAX 508-999-0738 APPLICATION FOR ZONING AND BUILDING PERMIT 'SG SEP 6 BPI 10 EB front eat A t T mii u l it 1 U:I DING DEPT. mu,leaving no item unanswered.The The applicant shall complete this application to the best of their ability prior to sobisti.,o Department staff will he 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. We Mug tot S.refaielele• (for office me only) Application fee$ rreei ed byo� Date Total Permit Fee S Permit# !� rX �S !c� 3'?C, 100 LOCATION OF PROJECT CURRENT ACCESSORS' PLAT 1" /1 LOT 01 — 7/ ZONING DISTRICT 5' OTHER ZONING OVERLAY DISTRICTS ; if applicable NUMBER & STREET e NEAREST CROSS STREET A2 " SUBDIVISION NAME St LOT# or BUSINESS NAME /�; PREVIOUS TENANT ; OWNER `��, 200 RESIDENTIAL -PROPOSED PROJECT - o�family residence only = 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 Garage - detached - attached to dwelling, dimensions L w = 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 = Chimney -#of flues -11=C-'+'4-li) ■ • Woodstove - used (will require inspection prior to installation), new (provide manufacturers instructions). Location(s) (list) ❑ Fireplace(s) -(includes flue) List location(s) Game Court-describe(include overall dimensions) T- ent, Trailer(Mobile Home) or Other- describe 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) 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) 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 ants and bedrooms or occupant load as applicable, also existing condition 400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED _ New Construction and/or Addition - total gross square feet - i (For commercial only total gross cubic feet) -indicate It 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 n = Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required. 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 he maintained. Enlarged or new windows in an existing dwelling will be considered as an Alteration, otherwise will he included in new construction. (see Code section 3401.10 for residential and Article S for commercial) _ Temporary structure- includes when allowed, trailers, tents and the like and only for limited periods of time. Describe 500 CONSTRUCTION PLANS _ None submitted. Why? Submitted, usually three sets required. Four sets for food serviceiuses. Number of sets submitted 0 600 SITE PLAN CI Not required, why? : Submitted When? - Previously, date = With this application 700 UTILITIES Water supply- required_ yes_ no, public ? _yes _no, on site well? _Vie;_ 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) Sewage disposal - required_yes_ no. public sewer_yes_ no private septic - on-site ✓yes _ no. Submit copy of permit as soon as available. S00 MECHANICALS & PRIMARY FUEL = Furnace(hot air) - Fuel gas(natural or propane), fuel oil, electricity, other(specify) C 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 7. 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 =. If yes has it been issued yes = no =. Submit copy of application and/or permit as soon as available. 1100 IDENTIFICATION (print or type except as noted) Current owner- name 2 address "✓// y— /i . phone # 275 /tjc If corporation, officer in charge/ 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. Architect/Engineer-project supervision and repotis 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 Contractor(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. ss*ns t i iis.fiiiiiiiii ii t / s*****itftiti • ** 1200 FOR RESIDENTIAL REMODEL WORK ONLY Are you a Home Improvement Contractor subject to (780CMR -6) ? Yes_No_If no go to next section! Are you claiming exemption from the requirement? Yes _No_If yes, submit the required affidavit! Remodel contractor name (please print) Address Registration number(if 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 written request.I understand that once the permit expires a new application may be required,including fees and current other requirements (including Zoning), Name (� g oA ,f n Q_d �,Signature _ etri, 1424. The above signatu my voluntary act and is ned under the pains and penalties of perjury. Date y 6 - 96 Who is authorized to pickup the permit at the Building Department? 'please print] Address Phone 1400 HOMEOWNER F.XFMPTION - 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 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. Exception:Any Home Owner performing work for which a Building Permit is required shall be exempt from 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 follows: Perscnis)who owns a parcel of land on which he.-she resides or intends to reside, on which there 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 Your signature carries certain responsibilities, including but not necessarily limited to, general liability 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 51 1500 COST Cost of Improvement S Items to he installed but not included in the above cost: Electrical S Plumbing HVAC Other TOTAL S / �G G The following section for official use only. INSPECTORS' REVIEW Date plan reviewed SFP 1 0 1996 30 days to review period expires /O— 24 OK to issue date 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 Inspectors signature Date cry 1 () 1996 Applicant in ed of above- Date time_staff (fax, phone, in person) *****kk k;;;;;;k Y;Yk ;Y;;Y5;kkk;;;;;YYYk ;;;;;kkkkk;YYY f ;;;;kk kk ; ;Y;;;Y;YY;kk;; ; ;kk Yk 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) ;;kkk;;*Y*;k;;*Y;Y;Yt*;;;;;;;;;k;;kk;; i k Y;k ;Y; ; Y; Y ;; ;; ;;;;Y;Y ; *Y*Y;k;;k OFFICE\INSPECTORS NOTES O TOTAL FEE /O �Gross area - new construction 4/0 o Total Sq. Ft. alteration Total Sq. Ft. Permit is issued to Comments/notes on permit h Q� 1600 TO THE APPLICANT/REFERRAL AND APPROVAL . . ._" Date of Application submission Yr. .6 -f6 1 Plat Lott 1/Street ,.Eo, L �J<j -yu � Aquifer Zone_ Owner L Z id. , � „ li QiLf Owner mail address - n, __ i e Owner phone# ,Fj V jot OTHER INVOLVED AGENCIES -The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACT THEM FOR REQUIRED SUBMISSIONS- ® , AX COLLECTOR Z Approved Z HOLD By Date a onsen•ation Comm = Approved By Date ❑ D.P.W. water = Approved By Date ❑ D.P.W. sewer Z. Approved By Date a D.P.W. cross connection = Approved Date a D.P.W. engineering : Approved Date • t and of Health well = Approved Date • toard of Health septic - Approved Date _ a Board of Health food sem' L. Approved Date s FIRE DISTRICT(I - III) Z Approved Date a Planning Dept — Approved Date . Other —- Approved Date Other —- Approved Date F'..mments Project summary new construction: alteratlon:demo sewage disposal - public/private fAlter.add interior walls] [add roomsj [add footprint] water supply - public::private well ]pool] [garage:shed] [game court] [food rvicel Describe ..---- , a y>(/* D•---- -4lt - To the various departments: nanny. 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 :ouperation is appreciated. The Building Department /'� Date sent for review ' 9 r ---/ 6 ' , / By -- -- -I Q iI s \.ST ; lital I 1 k f H �Q Ca I. Z M ik .v `6 N) 1 jt . k N ' nz 11. O S F. r C7CO i tt t 3 O F- ! A — - k tH I.• C) W h 5 i IS r ti ! FQ j i ;, Ii i j • i '� � �'Vic 0 0 10 lit CS � ® , Di co CI tie i I 1 THE COLLECTOR 'S. OFFICE RECEIVED '96 SEP 6 API 2 12 DAR-NOUTH BUILDING DEPT. Dan: 6, /99 TO: BUI LD111TG DEPARTJ1E2TT FROM: tenrrx+CTOlq,S OF'3 = RE: PAYMIST OF PAST DDZr IrArr5 PLEASE BE ADP.TSED ,TEAT or Tags DAy 999 , zarrs roR PROPERTY LOCATED ON � � h ‘17 PARCEL # 7/ HAVE An'S PA.TD. TEE PEI?MST WEICS SAS BEEN REMIZSTED EAT RE ISSUED. 1F YOU SAVE ANY QUEST=ONS CONCERS721G =XS P____E BALL. cc:DEBORAH L. PTVA 1600TOTHEAPPLICANT .AND APPROVAL • 16 -p2_7/ Date of Application submission p,— 6 ,"/l7Q Plat Loth 1/Street r� � �{ Aquifer Zone_ M o �wn9 Piste P Al • /atet ��q J� a OwntAail address — _ /�� i & CD`E7 9 / �- wne5 phone f{ �� U 'OTHER INVOLVED AGENCIES -The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACT THEM FOR REQUIRED SUBMISSIONS. r C- AX COLLECTOR = Approved _ HOLD By Date . a Conservation Comm =Approved By Date a D.P.W. water = Approved Be Date a D.P.W. sewer = Approved By Date • a D.P.W. cross connection _Approved Date a D.P.W. engineering = Approved Date a Si and of Health well =Approved Date a oard of Health septic = Approved Date a Board of Health food se = Approved Date alFIRE DISTRICT (I - /I- III) f Approved Date i a Planning Dept = Approved Date Other = Approved Date Other = Approved Date t'-rnmentt Project summary new construction/ alteration/demo sewage disposal - public/private fAlteradd interior walls) [add rooms) [add footprint) - water supply - publiciprivate well (Pool) (garage:shed) (game court! Describe 1 • Co the various departments: This notice has been forwarded to you for your information and any appropriate action. Should you have any ruestions please advise. If any reason to withhold the requested permit is found. please advise. Your assistance and ooperation is appreciated. he Funding Department Date sent for review ' 9 _ c 96 �_ By /// 1600 TO TDB APPLIC NT/REMRAL AND APPROVAL • / Date of Application submission Y'- 6 '-'Y. Plato Lotc) -7/Street rL , �/��,, --;,� J et. Aquifer Zone__ Owner9.--a-titt., Ct., /'C..,�ff QiL.-t-�4-.fL,,, Owner mail address Owner phone# ' 1 ' `' 99/- 207 9/ OTHER INVOLVED .AGENCIES -The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACT THEM FOR REQUIRED SUBMISSIONS. ® AX COLLECTOR = Approved = HOLD B_v Date O onsen•ation Comm = Approved By Date a D.P.W. water = Approved By Date a D.P.W. sewer = Approved By Date • o D.P.W. cross connection =Approved Date a D.P.W. engineering = Approved Date t1c and of Health well = Approved �/' �. _ Date / V) C oard of Health septic - Approved Date — a Board of Health food sere' = Approved Date X FIRE DISTRICT li - - IIII = Approved Date C Planning Dept _ Approved Date Other =- Approved Date Other -, -.- Approval Date ('.,mments Project summary new construction/ alteration:demo sewage disposal - public/private [Alteradd interior wails] [add roomsj [add footprint] • water supply - public:private well jpoolj [garage:shed! [game court] [food nice] Describe To the various departments: This notice has beets 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 ` J ^ --"5 v / ) By ./ 1600 TO'IIEE APPLICANT/REFERRAL AND APPROVAL . . Date of Applicatio�n submission 7 6 ^fe Plat/ Lotclh (Street r� Aquifer Zone__ Owner 9-tx_d_e_. C 1i, 1/ -cr--- e-4-- -- -c -a-4 Owner mail address .gL_4 -i fit_ Owner phone it_ 5C-� y� 9/f loqioe OTHER INVOLVED .AGENCIES -The following agencies require separate jurisdictional permits or approval for your proposed project. CONTACT 7IIEM FOR REQUIRED SUBMISSIONS. ® , AX COLLECTOR = Approved = HOLD By Datede iiiil onservadon Comm = Approved By 4:-. � e4' �..64 , Tay 1--6 Uate�,�-c-C.cE) Cy a D.P.W. water = Approved By Date a D.P.W. sewer = Approved By Date a D.P.1V. cross connection _ Approved Date a D.P.W. engineering = Approved Date • and of Health well = Approved Date • toard of Health septic _ Approved Date _ ❑ Board of Health food sere = Approved Date 2 FIRE DISTRICT (I - - III) I Approved Date ❑ Planning Dept _ Approved Date Other _ Approved - . Date Other = Approved Date ('••mmens Project summary new construction/ alteration:demo sewage disposal - public:private [.Alter•add interior wails] [add rooms] [add footprint! water supply - public:private well !pool! [garage:shed! [game court! [food ryicej Describe a 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. It any reason to withhold the requested permit is found. please advise. Your assistance and cooperation is appreciated. The Building Department Date sent for review / CJ �-'/ G By Qc :% En os � aJNy `irine ,`are ` n . 1 CDM y �� s c € r LI o�� k rri C k ,, � � � (nt Va O= •= >I ,`v� S oy m 134 n, MD = /P q � � oq � v � �° Ut= CA =CO CD -r 38y o coCa - mRtgm O X\ NI In SNc y , 3e oC C �� , �r S ono .:i t . ''- :A ' V t. d ik • G..oG!� 7-ci-it/c%/ ZA/VC. k7= zoo. oa ' 4-= /SO. 00 ' 4 0 th %3, m 5 %- r 3s o�0 0� ,` y• r .z- 4) o ----- ---------111111.1117 :. ` 1