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BP-2003-28737 ?3 7s 1 k L 6 �xU F f Permit No. BP 2003 28737 7\4 ���F � 4 ' . " " ',� ,:2,it, k, Qaersrsoe c "a r}'� fasx,4 ' n N I1 or��l r�r s'J,,a + i iPif r_47...>,..3T I11 da sc _mot 'P 4' ,� rr h2 tCa orxs r ' P +1 .-s,"l wiz a o /� y,' - 4 s^a . OD�Slecutg Road,Dartmouth, 0 7 ... 'pro t` `x ="4 !xi '9 : ndite:4 ft 9 0-182 az: 08 IP. t ;Esi Ce`st' 4. n w ,$,7000 00 ' , is ` a B 1 °e I :- $42. I 0 ' ' > ' PERMISS,O °FIE B �' Const.Clasic '1". a4Sc ,+ '''' i dam+ f��p "� • �* UseGroup '�„r t4`°s•1,'0" <31 Contractor:, 1. {� I{ .�,s e "ra„`y #: tot Size(C. if)1 s411409 ?' I WAYNE S CINQUINI sty , 0 .9 (SD ) 65-9580 Zoom ' SRB7+• ¢ s Engineer , '' LicenseP e#: NewConsl.':V ai� s °a k-'` . !� `o ti tit:'Const Cl/V 1N( ' 7 7 's, Applicant: k w e t s�1 °, , ' hone#: Date Type:w 01 05-"E9 2003 s�z WAYNE S CINQUINI ' ` ^i '' ' 4 e4; 4508)265-9580 OWNER: "� l G• .- s MILLIGANROBERT - ." t`" .g"s, ` DATE ISSUED: •. TO PERFORM THE FOLLOWING WORK: 14'x 29'rear deck PER PLAN BUILDING PERMIT Project Locatio,� S I NGBIRD DR Approved/Issued By: _ / ©/ / '�,� ' LP//OUZA, OCAL BU DI INSPECTOR All work shall comply with 780 CMR 6TH Ed.(MGL Chap. 143)and any th, applicable Mass.Laws or Codes and plans on file. POST THIS CARD SO IT/S VISIBLE FROM THE STREET SCHEDULE APPROPRIATE INSPECTIONS AS REQUIRED. UPON COMPLETION OF WORK, FINAL INSPECTION IS REQUIRED. THIS PERMIT WILL EXPIRE PER 780 CMR 111.7(NOT MORE THAN 3 EXTENSIONS WILL BE GRANTED)OR ON ISSUANCE OF A REGULAR OCCUPANCY PERMIT. 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/ thi Building/ g Permit. Signature of Owner/Agent: ; Comments: REPLACEMENT FEE WILL BE REQUIRED FOR LOST SIGNATURE CARD O p' TOWN OF DARTMOUTH 29183 BUILDING RECEIPTS r. • COLLECTOR'S OFFICE • Jf Name i J;yL/� '�- � � �l�i Property 1'1. it Date j J -�;;,.��'--% 1 ! Owner: Job Location: A a G� { fir . / White Copy-Collectoi s Office Plot: �./1, / Lot: Yellow Copy-Customer's Receipt Pink Copy-File Copy Green Copy-Building Department Phone: Description General Ledger#'s , r Kit E Amount License&Permits-Building 01000-44105 /w�cC/ r` „el f�. G License&Permits-Building Misc. 01000-44105 3.11,3/4 4 w C License&Permits-Electrical 01000-44106 /1 % // License&Permits-Plumbing&Gas 01000-44107 Other Department Revenue 01000-42420 ri This is not a Permit or License for Building,Plumbing or Gas Received By: / TOWN OF DARTMOUTH 28737 BjMLetNG RECEIPTS r •COLLECTORS OFFICE // 4A - / /C �// 1 1 i a /' 7` - ,{�t C • Date: / I i /Chi—.) Name: / /� Jr j.' r4J �, id/ Property t 1� - L. / �. i .�l,�i�%�!�! �...C....• x Owner: l j Job Location: / / t� /. 1 I J 2 Z-1 i' ?- 't- G'L✓r 'c White Copy-Collector'sOffice / / " " "j - ; / r- - Yellow Copy-Customers Receipt f 4 ;JI Lot: '�.. /A ~/ - - Green -File Copy Plot - if d, z/. Green Copy-Building Department Phone: - - General Ledger#'s 0 Re`f t v *,ik Amount Description �. ,;cr, J Or.wr. License&Permits-Building -44105 ding � ry License&Permits-Building Misc. 01000-44105 W. , 2OU3 J -- (7 License&Permits-Electrical 01000-44106 ,%j _ afr /./b ie License&Permits-Plumbing&Gas 01000-44107 Other Department Revenue 01000-42420 / , r This is not a Permit or License for Building.Plumbing or Gas ' Received By:,/ - RESIDENTIAL 2003 ❑ FOUNDATION ONLY $25.00 APPLICATION FEE IS NON-REFUNDABLE dt NON-TRANSFERABLE " DARTMOUTH BUILDING DEPARTMENTh n = Da F #IVED % s ;fe,, 400 Slocum Road, P.O. Box 79399 �.,� Dartmouth, MA 02747 •�..c,,.% 508-910-1820 FAX 508-910-1838 1ffl3 1 ;; 3 All U 03 APPLICATION TO CONSTRUCT,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING THIS SECTION FOR OFFICIAL USE ONLY RECEIVED BY: BUILDING TL., DATE SENT FOR REVIEW: la---) NUMBENd%( > DATE ISSUED: OK TO ISSUE-SIGNATURE: DATE 5 01/ I .� //�I Bui/fmgg om sioner/Inspeecc ofBuildi s Zoning Distr'ct:S�7.Rroposed Use: eem Zone: [8"C ❑B CIA ElV Outside Flood Zone ❑ Aquifer Zone's THE FOLLONN N AGENCIES SHOULD BE NOTIFIED: ❑Board of Board of ❑Con.Com. 0 Demo 0 DPW 0 Elec. ❑Energy Report Appeals ealth Affidavit Card Sent - - -;.Cut Off Follow-up* ❑Fire ❑Gas ❑Planning Board* ❑Sewer Card ❑Water Card ❑Zoning ❑Other Chief Cut Off /Cut Off /Cut Off Review* *REQUIRES INSPECTOR'S REVIEW BEFORE THE ISSUANCE OF A PERMIT. DEPARTMENTAL APPROVAL "-"--"- Zoning Review: Signature: Date: Energy Report: Signature: Date: Fire Chief: Signature: Date: R -I . 7 Board of Health: Signature: (j J� ill----- Date: Conservation Commission: Signature: Date: Other: Signature: Jdia/C . Date: Description of work being performed: /qVJ 7 SECTION 1-SITE INFORMATION - - NUMBER OF PLANS SUBMITTED: SITE PLAN SUBMITTED: ❑yes 0 no `� ` (� 1.2 Assessors P e7Lot Number: 1.1 Property Address: -7 Cj t,3t r 13(. Plal( l// Lot I Nearest Cross Street: Subdivision Name: 1.3 Historical District ❑yes ❑no Has application been submitted to the Historic Commission? Total Land Area Sq. Ft.: ❑yes ❑ no Date: 1.4 Water Supply(MGL c 40§ 54): 1.5 Sewage Disposal System: ❑ Municipa11124vate Well ❑Municipal QD'On Site Disposal System C\blde.Comm\I3ldgapp.res.wpd Page 1 Rev.January 19,2001 • RESIDENTIAL 2003 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: \1 % 1; 5-zr 15- Sc.) bcra IJ.. sl-&4a-33--71 Name(print) Contact Address Phone Number 2.2 Authorized Agent: Cell/ SOS--" 4g yS€10 L ) [tine L°c t)t�t alb. ('61a1/41n \aci `vs---0),-Gd ) Name(print) Contact Address Phone Number SECTION 3-CONSTRUCTION SERVICES 3.l Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor i \ (t,,1��JfNs W ?`��lP l License Number c 5 0.7?1 7 c" Address „Do c1 rc (� e, L) po& t ,A1n,N. Expiration Date Signature (D 11 ` �'� Telephone' -636-colyz 3 /ae Loot/3.2 Registered Home Improve nt Contractor: Not Applicable 0 Are you a Home Improvement Contractor subject to (780 CMR-6)? 0 yes D no If no,go to the next section! Arc you claiming exemption from the requirement? 0 yes 0 no If yes, submit the required affidavit! 1. Company Name �a4 l .t.AC��ytir- �nf) cI`�dC'✓r! Registration Number(if none, state"none") Address .J.s0 TEA l GllF3t,16ff ha_ (1t�Yec Signature //, ) /f Telephone[�//J.c �.�'✓ P 5'�� 7J -6aCg Expiration Date 3.3 For ResidentiafRemode Work Only PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY 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 by signing the above,the home owner acknowledges that there will be no eligibilty to the Guaranty Fund Date 3.4 Homeowner Exemption-One&Two Family Only FOR HOMEOWNERS WHO INTEND TO PERFORM AND DE RESPONSIBLE FOR THEIR OWN PROJECT 109.1.1 Licensing of Construction Supervisors: Except for those structures governed by Construction Control in Section 116.0,effective July I. 1932,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 promuleated by the BBRS entitled Rules and Regulations for Licensing Construction Supervisors. Exception: AnyHomeowner P o ner performing chk for which a B Homeowner Perwner is requiredact s 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: Your signature carries certain responsibilities,including but not necessarily limited to,general liability C:\bldg.fonns\Bldgapp.res.wpd Page 2 Rev.January 19,2001 RESIDENTIAL 2003 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 Appendix of 780 CMR R5.2.15) SECTION 4-WORKER'S COMPENSATION INSURANCE AFFIDAVIT(MGL C.152 §25) Workers 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: 0 yes 0 no • SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) 0 new construction* 0 addition 0 alteration 0 repairs 0 chimney/ 0 woodstove (energy report required) (energy report required) fireplace e deck ❑pool 0 accessory bldg. 0 replacement window/door 0 other 0 demolition (shed/garage) no. of windows doors (specify below): (specify below): ❑ If new construction, please complete the following: Single Family: no. of bedrooms no. of baths Two Family: no. of bedrooms unit I 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 ❑ Hot Water: Gas Electric Fuel Oil Other Brief Description of Proposed Work: \ Lay t-t erk z 1C1 X) 5 `yewvote, k•cett rA UeC s• a,xIX ennsti rVOA It:an Cptlt'er , 2 Q,uh\r lw Iaa XIS, 13eztt 9tr *iA5 Ae< goat cbetrkt btwr. a` HI tL\s l*w33 � �•c� h5tobe S"r, r'cat ot. SECTION-6 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost($) to be completed by permit applicant I. Building 2. Electrical 3. Plumbing 4. Mechanical (HVAC) 5. Total=(1 +2 +3 +4) *Estimated Total $ 70Or) °1) SECTION 7A-OWNER AUTHORIZATION (to be completed when owner's agent or contractor applies for building permit) (please print) y� '' `` I, \Eck \u t(�\(570 , as Owner of the subject property hereby authorize W 2t-Ir p �.ncie,:W to act on my behalf, in al)matters relative to w k authorized by this building permit application.�� �O 3 Signature of Owner J� SFr .� 1 Date F,CTION 713-OWNER/AUTHORIZED AGENT DECLARATION • I, L, j p ,as Owner/Authorized Agent hereby declare that the statements and information on the fo egoing ap lication are true and accurate, to the best of my knowledge and belief. Signed tymder the pai s and pen ties of perjury. f / tc/ .�/O/Us Signature of Owner/ thorized A nt Date C:Abldg.1brmsV6ldgapp.res.wpd Page 3 Rev.January 19,2001 RESIDENTIAL 2003 SECTION$-INSPE TORnn'S-�REVIEW/COMMENTS 1. Date plan reviewed: 5 W/ 2. 30 days to review period expires: 3. OK to issue date: 4. OK to issue subject to requested submittals(see project review worksheet): Date: 5. DENIED(see project review worksheet): Date: 6. HOLD reason: Date: 7. HOLD subject to Zoning Board of Appeals action: Date: 8. Comments: 9. Inspector's Signature: Date: 3 SECTION -A L CANT NOTIFICATION Applicant informed f above 1 Date- / 7 s Time. (1 /9 Clerk:41 Comments: ✓7//��}/0 rej / SECTION 10-OFFICE\INSPECTOR'S NOTES Total Permit Fee: $ `-y`�y�'�0�.J Less Application Fee: $ 25.00 Remaining Balance: $/7,Qo, TOTAL FEE: t �G ` W Gross Area-New Construction total sq. ft. T Gross Area-Alteration tota sq. ft. �� Permit Issued To /xd9 &Ait '// P SECTION 11-ADDITIONAL COMMENTS/SKETCHES 37_0 k . /d — y0 , aO C:\bldg.l'orms\131dgapp.res.wpd Page 4 Rev.January 19.2001 Permit No. BP-2003-28737 Project Location: 75 SONGBIRD DR Commonwealth of JKassachusetts TOWN OF DARTMOUTH ;GIp#' = '' oo :: - 400 Slocum Road,Dartmouth,MA 02747 Lot: O Q2 Phone:(508)910-1820 Fax:(508)910-1838 Sublot 0128 BUILDING PERMIT Pros# . Js ooauo97 ; .�:. FIELD INSPECTION Fee c°St ` t :$4200 0 Use=Group R4=r Contractor.* License: Phone#: Lot Size(sq:ff.) 41409 !,, WCAYNE S CINQUINI CS-072795 (508)265-9580 Zoning SRB" Engineer: License: Phone#: New .' 422'sq.ft:_ ,--- Alt.'Const , ,r N/A t , , Applicant: Phone#: Ceiling WAYNE S CINQUINI (508) 265-9580 Walls a , h. OWNER: MILLIGAN ROBERT p door � ❑ Glazing �:: 011 DATE ISSUED: UU ) CO TO IP D TO PERFORM THE FOLLOWING WORK: uu 14'x 29'rear deck PER PLAN DATE TIME TYPE OF INSPECTION&REMARKS INITIAL e/66 /03 3 IS c G ( �Y d' V �L� ---•‘----,t,441/14L4-11, -C:e.,..4A.CL.---,iC i soma:tor stelatiG Ns / ' Licenet PraistRucTioN suPeRvisoa 1 Neeperriz& -072195 . I j • *---.2-..- -iagg' ' •a4 Birtirdatera/204.:6- GrPfreze 03126/2004 CIO Tr.erk: 20860 Restlictoe I j WAYNE 3 CINQUINI -7 230 MAIN ST WESTPORT, MA 02790 t, Administrator - --z; — --- -- se,r Board of Building Regulations and Staiiarat ; ,4 rag ' Pit 41 Rome IMPROVEMENT CONTRACTOR Mt- , scri Registration: 137739 k expiration: 1/2/2005 WAYNE S.CINQUINI I- Type: Individual r , 230 MAI WAYNEN RD CINQUINI . WESTPORT,MA 02790 I Atitninist t: (406 I The Commonwealth of Massaschusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Applicant information: Please PRINT Legibly name: Ca2‘t '€ C(.VScJttl location: -7-5 ' n5 rik Prt city hh-strt-n W m Phone# G C—C2-4l ❑ / I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity ❑ I am an employer providing workers' compensation for my employees working on this job. company name: t 02%re C iY\It"C COYtSt;fuckie Vt address: ++ a meiN l 1 O\ ek 1�p od> 3 city U)0'1410VC �fl Oa-150 phone# tS C9C, LAVZ insurance co. Pc6 ulke'co OtlJt..AM phone# cbt-990— 7367 ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation policies: company name: address: city phone# insurance co. phone# company name: address: city phone# insurance co. phone# Attach additional sheet if necessary Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 andlor one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. l do hereby certify under the p ins' re penalties of perjury that the information provided above is true and correct. I ��{ Signature: (mot/ �p Date 5-/6/O3 Print Name: G r0 /tp S (7 hf,n'hi Phone# 5Dt 3.`t 2Y..2 official use only do not write in this area to be completed by city or town official city or town: pennit/license# ❑ Building Department o Licensing Board o check if immediate response is required ❑ Selectmen's Office ❑ Health Department contact person: _ - phone#: ❑ Other intormatfon awl lnstructionb • \lassachuserts General Laws-chapter 152 section 25 requires all employers to provide workers' compensation for the: employees. As quoted from the Flaw an employee is defined as every person in the service of another tmder any contract of hire. express or implied. oral or written. An cam/over s defined as an individual. partnership. association, corporation or other legal entity, or any two or mon the :bregcing engaged in ajoint enterprise. and includirg the legal representatives of a deceased employer, or the receiver or trustee of an individual . partnership, association or other legal entity, employing employees. However tht owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dww eilina house of another who employs persons to do maintenance . construction or repair work on such dwelling hot or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employe: \IGL chapter :52 section =5 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter 1 been presented to the contracting authority. Applicants • Please `.ill in the workers' compensation affidavit completely, by checking the box that applies to your situation and sucpiying company names, address and phone numbers as ail affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should he returned to the city or town that the application for the permit or license is being requested, not the Department of industrial Accidents. Should you have any questions regarding the "law"or if you are require( to obtain a workers' compensation policy, please call the Department at the'riumber listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom c the affidavit for you to till out in the event the Office of Investigations has to contact you regarding the applicant. Ple. • be sure to fill in the perm itil icense number-which will be used as a reference number. The affidavits may be returned the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questio: please do not hesitate to give us a call. _ _ - • .._. .mn • " ..."_ a .�.". .: .. '.. � The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Ma. 02111 fax R: (617) 727-7749 -" phone 4: (617) 727-4900 ext. 406, 409 or 375 RESIDENTIALIAL •LUUJ 0 FOUNDATION ONLY - $25.00 APPLICATION FEE IS NON-REFUNDABLE&NON-TRANSFERABLE ,. i\Iii' IVED '"T" 'y DARTMOUTH BUILDING DEPARTMEN M i 400 Slocum Road, P.O. Box 79399 y�J =` 't@3 11nY —8 A1°1 11: 03 3 - Dartmouth, MA 02747 `� ` '~ 508-910-1820 FAX 508-910-1838 APPLICATION TO CONSTRUCT,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING THIS SECTION FOR OFFICIAL USE ONLY RECEIVED BY: BUILDING / DATE SENT FOR REVIEW: �7�a 3 UMBEAG%DATE ISSUED: OK TO ISSUE-SIGNATURE: DATE Building Commissioner/Inspector of Buildings Zoning District:_ Proposed Use: Zone: ❑C ❑B ❑A ❑V Outside Flood Zone 0 Aquifer Zone THE FOLLOS N AGENCIES SHOULD BE NOTIFIED: - ❑Board of Board of OCon.Com. 0 Demo ❑DPW ❑Elec. ❑Energy Report Appeals ealth Affidavit Card Sent: CutOff- `_Follow-up* ❑Fire 0 Gas 0 Planning Board* 0 Sewer Card 0 Water Card El Zoning 0 Other Chief Cut Off /Cut Off /Cut Off Review* *REQUIRES INSPECTOR'S REVIEW BEFORE THE ISSUANCE OF A PERMIT. DEPARTMENTAL APPROVAL - "— '--"-- Zoning Review: Signature: Date: Energy Report: Signature: Date: Fire Chief: Signature: Date: Board of Health: Signature/ c C� tjaQQ Date: A A$ I j Conservation Commission: Signature: Date: Other: Signature: Date: Description of work being performed: yl �m erar .S SECTION 1-SITE INFORMATION - - - NUMBER OF PLANS SUBMITTED: SITE PLAN SUBMITTED: 0 yes 0 no / t� 1.2 Assessors P t Lot Number j 1\ _ 1.1 Property Address: 7 S bra 1J(-. PIa( Lot �n/Nearest Cross Street: Subdivision Name: 1.3 Historical District ❑.yes 0 no Total Land Area Sq. Ft.: Has application been submitted to the Historic Commission? ❑yes 0 no Date: 1.4 Water Supply(MGL c 40§ 54): , 1.5 Sewage Disposal.System: / 0 MunicipallH'Private Well 0 Municipal limn Site Disposal System C.bld__.f'urms,BkJgapp.res.wpd Page 1 Rev.January 19,2001 a..., 3 ch �i°" S wV N o O+ W i I OB 4.t �' o 14p •rik j\r = � cc, N M CIJ ;% )4 o/ cn y Z 7 26. 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