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BP-83374 Permit No. BP-83374 BUILDING Pe ; - � GIS#: 15127.00 I C,0,11.. fnoniealt fMa aothu$,ett,S Map: d066 T .. fqi '4,, ` tot - 0002 '400 S1occ4Rhat d,Dartila - 47 c3,t'a Sub-Lot: - 0128 _I ho)'e (S08)f 10'd�$20,�liat�'; ,508)_tDalEg g "a :;Category: - •SIDING/DOOR ` zf 4.. , 4 - ** -`'4�'�0 , °-. ' Project# JS-2017-001317 PERMISSION ISI4 RERYGR 1V7DTO x z,., Est.Cost: $3500.00 - Contractor: "si ' r x nse ° a Phone# z Fee ($75.00 DANA J PI v- +'a COnst.Class: ` 'S : r3,`"�{`£' y '.• . Cfai 3 i --, -I- 111 Use Group::' R3 Engineer: l i a a .r.3 7 ? a + ; 14-17 hit+54 0' a 'j Lot Size(sq.ft.) 41409 1 1'n i ' aP1a.mne# in Zone: NIA Applicant a ter' -' 3'' F Ma a AquFlood Zone: ZONE X CARE FREE HOpYE5 IfIC -w ito (( -g.),9ft ?I 1 New Consk: N/A RH0oryN D: h• v '' '+ " ,.� Via,- g RHODADONALD 34 ^`j i "' • uti �' 3 t •Alk Const: N/A _ 'V x y $ .,�m ' .rr .4 Date Typed:. 1122 2016 DATE ISSUED: ' ,, - ' .' s'a -, n TO PERFORM THI ► LOWING WORK: % ` a - ,a �°" ' New white cedar siding o .outh side -f house and one reply - "-'i=•doorr�'E SIZE, SAME OPENING ft a, o ,: 7 °e, GBIRDDR l , ram Approved/Issued By: / PAUL M MURPHY,DIRECT I! I `INSPECTIO • SERVICES All work shall comply with 780 CMR 8TTi Ed.(MGL Chap.143)and any other .pp able :ws or Codes and plans on file. Schedule appropriate inspections as required. Upon completion of work,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 oft ' Zo ' Pe mit. ^ . Signature of Owner/Agee 7 — "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 83374 PHONE: 508.910-1820 FAX: 508.91p-1838 / (1,tbil za ___,,,,...„.(-----"- ' e 1,,,, //A1(A47 Name. Property Owner: Da f, Job Location: /J ��'11/ �? , .. e-2' '"' Map: `Y' Lot:' /1/' Description General Ledger#'s Ref. # Amon t Building & Building Misc. 01000-44105 i/I-4-1' J OO ir 75 `e`l Electrical 01000-44106 '"),, Plumbing &Gas 01000-44107 Trench Safety 01000-44129 G�oARTN,O;J Other Department Revenue 01000-42420 sa K� ti \ t 1'0 White-Collector's Office Yellow Copy-Customer's Receipt Pink Copy Budding Department Re ivedhR y THIS IS NOT A PERMITILICENSE FOR BUILDING, ELEC CAL, PLUMBING OR GAS ;, E RESIDENTIAL ❑ Phased Apprpval(R106.3.3) F25.00 APPLICATION FEE IS NON RE-FENIDARLE &NON=TRANSFERABLE ° "�1 -DATE RECEIVED DARTMOUTH BUILDING DEPARTMENT 21 400 Slocum Road - Dartmouth, MA 02747 ° Phone: 508-910-1820 Fax: 508-910-1838 �i 3 www.town.dartmouth.ma.us '% APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING THIS.SEPTtON,FOR OPFICIRL.USEONLY RECEIVED BY: BUILDING PERMIT NUMBER: ' DATE D. SIGNATURE: S S` AllDATE: Building Commissioner/I, +ector o -,uiidi us Zonmg Dlstrh L . - . Proposed Use: . - Zone: DX OB 17 A '0 V Aquifer Zone:. ' THEFOLLOWINGAGENCIESSHOULDBENOTIFIED: . DPW ❑Board bf❑Board of Q Consa f7 Planning t?Address C Engineering 0 Cross /appeals .Health - Corginission ' .Card .i o Connection - CJ Eke 0 Gas ❑Electric 0 Other ❑Watercard ❑Sewer Card Chi - ef Cut Off Cut Off Cut'Otf Cut Off .mot; -I bEPARTIIENTAL APPROVALS) Board of Health: Signature: , Date: Conservation Commission: Signature: Date: D.P.W.: Signature: Date: Fire Chief: Signature: Date: Other: Signature: . .. IAA) ) Date: Brief description of work being performed: Si jal V rJ\ _SECTION 1 SITS iNFnRMt4TrePt , 1.1 Property Address: 7j(50 f)A;01 aQ 1.2 Assessors Map. Lott Number Contact Person: �f) 2,]. t2 Map (,(�2 Lot Q� - 7,Yi Phone Number: Li PP -2717 -/'20't 1.3 Historical District 0 Yes El No 1.4 Water Supply(MGL c40 s54): 1.5 Sewage Disposal System: Year Built ❑ Municipal 0 Municipal LT Altering more than 25%per side of building 0 Private Well 0 On Site Disposal System Has application been submitted to the Historic Commission? ❑Yes 0 No Date: Revised 5/13 ❑ CONSTRUCTION PLANS 0 SITE PLAN 0 ENERGY REPORT ■ RESIDENTIAL _ � ; SECTION2-PRbPEfcTY`•OyJINERSHIP/AU7ti0R1ZEDAGENT , 2.1 Owner Record: Mvi latioPA • 'S G13ifz] nit- 9tQ -27D -Groq Name print) Contact Address Phone Number 2.2 Authorized Agent: 2>ctAt2t Uscial .4 VLC Ur'r 4 , 11:4-woclp-k) P-t ithkVtm, £rill G7'IL°i s eec ct7-r3L,L Name (print) Contact Address Phone Number SECTJQN 3=CoN571UCTION SER�(II:ES, :` 3.1 Licensed Construction Supervisor/Specialty License:' a J, pick'-t p LLien Number: ©�(,_, Company Name/Contractor NameeWc+ - 121S dlejIV1A-5 IVY' . _ Ere, It ° CCOSb3 Address:! I-ij1(csrm AVCC 4Fk3-ff 1v,n, J-t(�j.Gv iq Expiration Date: ,j/22`) v Signature. Ham/ •-�.----Telephone::pa 12/-1 (I / G f t'r/t fl 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: e1dTR +} 1i O:41 R";0 .010:0 -44:11N It SUCf/l4:0E'AF"E OOL (MGL c15 42$) , Worker's Compensation Insurance Affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached: ❑Yes ❑ No - SECTI6NS..�3£S.GRIpS10N;OF�F�I�FG�,SED,WOR1k��rheoF€a�X'�Pttcapl8} __ - . ;'� '�. s" : . 4 :: ❑ Deck 0 Pool ❑ Repairs ❑ Alteration 0 Chimney/Fireplace 0 Woodstove/Pellet Stove ❑ New Construction* 0 Accessory Bldg. 0 Addition XRoofing/SidingReplacement window/door (Energy report required) (Shed/Garage) (Energy report required) No.of windows Doors ❑ DEMOLITION (specify): 't1 L 7j fnStrttrz_lfpiRh ay 114L»tsii, ill i'p4'/ L- 1C.5"' Ftiver Potsn_ Location of debris removal(per MGL C.40 Sec 54): 4Dumpster on site ❑ Dumpster On Street Facility Name: -i4,cb, `'XS (-e/ 04‘,,z) r Location: 18 *If now construction, please complete the following: Single Family: No. of Bedrooms No. of Baths Two Family: No of Bedrooms Unit 1 No. of Baths Unit 1 No of Bedrooms Unit 2 No. of Baths Unit 2 ❑Furnace(hot air)-fuel gas(natural or propane),fuel oil,electricity,other(specify): ❑Boiler(heating)-fuel gas(natural or propane),fuel oil,electricity,other(specify): ❑HVAC(combined unit)-primary fuel,natural gas,propane,electricity,other(specify): ❑Air conditioning-(separate unit) ❑None of the above to be provided 0 Hot Water: Gas Electric Fuel Oil Other SEG3jbN 6•EWFIIlIQTEj(t E N$TRUCTION.CflST, I Item Estimated Cost($)to be completed by permit applicant 1. Building :351,r,, — 2. Electrical 3. Plumbing 4. Mechanical (HVAC) 5. Total= (1 +2 +3+4) 35-00 , '— : _ SECTIOI(T =OWNER AUT1tORIZAT1ON Ufa e m b aojile#ed when ov,Inii's agent or Coniraeto7 appGps for bulldrng permit) (Please Print) I, ,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. 5 ks k� AA4Iro J Signature of Owner Date : SECTION7S OWNERJAUTHORIZEDAGENT.,DECLARATION r 1, tLk(' - b r 4 vo -iis)Vi , 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. d under pains a d penalties of perjury. )a�1�� G l I(9 ' 16 Signature of Owner/Authorized Agent Date OS.-- J // SEETION r,tOFFICE(iNSFtGTOte4feWES _�j) 9/ "� Less Application Feer 22- Remaining Balance: Total Permit Fee: $ /// Other$Amount$ ± Gross Area-New Construction total sq.ft. Gross Area-Alteration�otal sq.ft. qq �A� c! Permit Issued to: J ' //21)— /li �.t e (X/s`-1rit_ -.�`� 01 -11W SI //e? J4J2e) Sty .,.tga -,SEtTa4rfs,..'bESGRIP3YipA IJ 4INka hilEgia. „ cilag,,c . aZ £ 'id - . Care Free Homes, Inc. 239 Huttleston Ave Fairhaven,Ma 02719 MA Builders Lie.#021330 Phone 508-997-1111 MA HICL# 100503 Fax 508-997-1297 Don and Karen Rhoda 75 Songbird Dr Dartmouth, Ma I propose to furnish materials and perform all labor necessary to replace cedar shingles on the south side of the house and replace the main door slab at 75 Songbird Dr. Dartmouth, Ma. Permits Building permit Siding Remove existing cedar shingles from south side of house Inspect house wrap Install white cedar shingles at existing exposure Door Remove existing front door slab Install new S210 slab to existing front door system Misc. Work(to be billed) Remove risers from south side rear deck stairs Install new p.v.c. risers Install existing screen room panels to screen room Install new mailbox(customer supplied) Debris Disposal All construction debris removal will be handled by CFH. We,the customer, shall pay any and all expenses incurred by Care Free Homes, Inc. in collecting money due under this contract and enforcing the terms of this contract, including but not limited to,reasonable attorney's fees, interest, and court costs. Z Z 1 Don Rhoda Date � Kare oda Date 913o1,6 Na han J. Pickup, Care Free owes, Inc. Date The Commonwealth of Massachusetts I Department of Industrial Accidents 1 Congress Street,Suite 100 ��� Boston, MA 02114-2017 www.mass.gov/dia • Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH IRE PERMITTING AUTHORITY. Applicant Information _ Please Print Legibly Name (Business/Organization/Individual): ( Are 4.2 . dtse.3 C ' Address: Q3°/ rG/v/l l QS�J//i 4lt,< . City/State/Zip: 4/CAv • • • e ^ Phone#: Sid" - a97- //// Are you an employer?Check the appropriate box: Type of project(required): I.1314(rn a employer with 2.67 employees(full and/or part-time).* - 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in $, ], Remodeling any capacity.[No workers'comp.insurance required.] 3. Iamahomeo e9. Demolition❑ ❑ homeowner doing all work Myself.[No workers'comp. t Y insurancerequirsd.] 4.0l am myPPertY.a homeowner and will be hiring contractors to conduct all work on pro 10 El Building addition Iwilt ensure that all contractors either have workers'.compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. . These sub-contractors have employees and have workers'comp.insurance.[ 13.0Roof repairs 6i0 We are a corporation and its officers have exercised their right of exemption per MGL c 14.❑Other 152,§1(4),and we have no employees.[No workers'camp.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. [contactors 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'camp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. /� 9 Insurance Company Name: • Policy#or Self-ins.Lic.#: G,tf✓ /C a N $/ I Expiration Date: / / / 7 Job Site Address: - City/State/Zip: / 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 a under the ains 2eraittis of perjury that the information provided above is true and correct. Signature: �/�— Date: Phone r: — 9`7 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#: A YIT CERTIFICATE OF LIABILITY INSURANCE DATE 9/7/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. - IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NCNTACT AME: Pat Boss Herlihy Insurance Group PONE 508-756-5159 51 Pullman Street ��C1+aF )' Nc.N#1;50&751-5747 Worcester MA 01606 - E-MAIL DD RE4s certificates@herlihygroup.com INSURER(S)AFFORDING COVERAGE NAM# INSURER A:Liberty Mutual Insurance Company INSURED CAREFRE-01 INSURER B:Safety Indemnity Insurance Company Care Free Homes Inc INsuRERc:Guard Insurance Company 239 Huttleston Avenue Fairhaven MA 02719 INSURER D: INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:483769728 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE INSD,WVD POLICY NUMBER PoDDNYYF MWO POLICY EXP (MOUCY EFF (MM/DDr sxp) LIMITS A X COMMERCIAL GENERAL LIABILITY BK356134197 9/1/2016 61/1/2017 EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $300,000 X PD ded:250 MED EXP(My one person) $15,000 PERSONAL 8ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X yea LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILEUABILETY 6213850 7/1/2016 7/12017 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 ANY AUTO _ BODILY INJURY(Per person) $ AUTOS/NED X SCHEDULED BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-0WNED PROPERTY DAMAGE $AUTOS (Per accitlen0 — UMBRELLA JAB OCCUR EACH OCCURRENCE $ EXCESS LIRE CLAIMS-MADE AGGREGATE $ DED RETENTION$ C WORKERS COMPENSATION CAWC724817PER OTH- $ AND EMPLOYERS'UABIDTV YIN 9/1/2016 9/1/2017 X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N NIA E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) EL DISEASE-EA EMPLOYEE $1,000,000 If yes,desaibe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more apace Is required) CERTIFICATE HOLDER CANCELLATION Town of DARTMOUTH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDING DEPARTMENT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SLNG DEPART ACCORDANCE WITH THE POLICY PROVISIONS. 400M ROAD DARTMOUTH MA 02747 AUTHORIZED REPRESENTATIVE a.),1Nr.ale I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety V Board of Building Regulations and Standards License: CS-095228 Construction Supervisor a. . • DANA J PICKUP F- c 239 HUTTLESTON AVE 4; i FAIRHAVEN MA 02719 - - - • Expiration: - Commissioner 03/22/2018 C7Ar 6r irin f rrr,(t r/C4(%r.,,Rder,w/L fcc of Consumer Affairs&Business Regulation �. id TOME IMPROVEMENT CONTRACTOR Registration: 1.00503; Type: Expiration: 6/19/2018>; Supplement Card CARE FREE HOMES, INC. DANA PICKUP JR. 239 Huttleston ave - .\\(.-- z-�..(;,..�� Fairhaven, MA 02719 Undersecretary Permit No. BP-83374 Project Location: 75 SONGBIRD DR Comm n, sachusetts TO �® . ' a UTH 9 4051 ��L +.' ° tj ties r Mir zP -". fVWI 1 *aroP *� b a3? rs "a m , k -ems 4., a rt a _et r! tea,, '� .xi rt �,rg' 4 it .= r jig H.`y +3Y< 4->7 X a r s sac i a.su --li c{ r °S IDS iil r�' iya- Ft. . - „fr: Con[ra r;� ,� �°z , a e.� � ;one#: DANA k s }� S a 18)997-1111 L- i ,-a }I Architect �� � Phone#: '� is �ti a , a �� '' so®�'a �, yr F Applicant:_ e '- ��M1 ®° / Phone #: �� " ' s '4 ' CARE FREE ANC ��� .>='l (508)997-1111 OWNER: $��°� :s:sa:ro �...ta RHODA DONALD A& DATE ISSUED: TO PERFORM THE FOLLOWING WORK: New white cedar siding on south side of house and one replacement door; SAME SIZE, SAME OPENING DATE TIME TYPE OF INSPECTION&REMARKS INITIAL l/7. . 0N ,:i4 0,-1,...xle. co< ol e, an4n4zze., ctricz-b` '-, 4toirOL“ - nn -, 0 crzt-o, O• n, zz- , 0 „•-i L " - -1 b efl at0olatre :14l 1 it r- .- 0 '1 t.(0zmi2C-, 0 c - © 0 Prl •• .• 'RI t.-105.,. cz• .-3 C•>44 --L t..4. 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