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BP-90452
Permit No. BP.90452 BUILDING PERMIT GIS#: 3343.00 Commonwealth of Massachusetts Map: 0066 TOWN OF DARTMOUTH Lot: 0002 - . 400 Slocum Road,Dartmouth,MA 02747 Sub-Lot: 0129 - - Phone:(508)910-1820..• Fax:.(508)910-1838 Category: DOOR - - Project# JS-2019-001205 PERMISSION IS HEREBY GRANTED TO: Phone It Est.Cost: $5000.00 Contractor _ License Fee: . $75.00 DANA J PICKUP CS-095228 (508)997-1111 Const.Class: - HI-100503 Use Group: - R3 Engineer _ _ License: - Phone#: Lot Size(sq.ft.) 43561.003 - Zoning: SRB Applicant Phone#: .. Aquifer Zone: ZONE 3 CARE FREE HOMES INC (508)997-1311 Flood Zone: I ZONE X - OWNER: New Const.: N/A MCCORMACK DONALD F.Si Alt.Const: N/A- Date Typed: 10-31-2018 DATE ISSUED: de • TO PERFORM THE FOLLOWING WORK: Replacement of one entry- door;SAME SIZE, SAME OPENING Project Location: 6 WREN LN Approved/Issued By: Caf • - _ DAVID BRUNETTE, OCAL BUILDING INSPECTOR An'ow c shall comply with 780 CD'IR 9Ta Ed.( IGL 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. t 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 agert cud to receive this permit. I further un and other agencies may have reason to STOP WORK if items under their jurisdiction are not met; not withstand'itg the issuance of this Buiidi g/Zoning P ' - O� 3igttaiure of Owner/Agent: e_ "Persons contracting with unregistered contractors do not have access to the guaranty fund(as set forth in MGL c.142A)" r Inspector of Inspector of D.P.W.Inspector Building Inspector Inspector of-Gas Fire Department i. Plumbing Wiring _ l Water Service it: Footings: Underground: i Oil: r_i idergrtmnd: Service: I Foundation: Rough: Smoke: Cough: Rough: Sewer Serviced: i Rough.Frame: Insulation: Final: Final: Final: Cross Connection Final: Final: Board of Health E-911 Additional Comments:_ Planning Board _—J 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 die building permit. POST CARD SO IT IS VISIBLE FROM THE STREET (14) TOWN OF DARTMOUTH - BUILDING DEPARTMENT RECEIPT 9 0 4 5 2 PHONE: 5084101a2r FAX: 508-910-1838 ) ' / Nah: il t (i 41. -- t 129 /1,1; ht_41--PropeyOwner ///( 7f /,y f,io D4 i" Job Location: , P 1 , i- '7. 4 p / , 0—.... Map: if /VC Lotv i 1,- / Description 4ilti(edger#'s ef. # Amount Building & Building Mis ..e i.,..9, 01000-4105 4 06 dc, /A; : / D Electrical , 01060-44",06 - , , Plumbing& Gas 01000; 4' 07 Trench Safety tide 0 V-44129 Other Department Revenue 01000-42420 No White-Collector's Office Yellow Copy-Customer's Receipt FRPRIVIENTSd By 1: 1-7 THIS IS NOT A PERMITILICENSE OR BUILDING, ELECTRICAL, PLUMBING OR GAS RESIDENTIAL o Phased Approval(R106.3.3) S:25.00 APPLICATION FEE IS NON Ill.-Ft7NDABI.E & NON-TItANSFCRAfLC �, r„ t . DATE RECEIVED F r DARTMOUTH BUILDING DEPARTMENT (9 `�, ,v At 400 Slocum Road, P.O. Box 79399 w \t,\ t A, Dartmouth, MA 02747 \ Phone: 508-910-1820 Fax: 508-910-1838 �— www.town.dartmouth.ma.us APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING JHIS SECTION FOR OFFICIAL USE ONLY RECEIVED BY: BUILDING PERMIT NUMBER 7 DATE ISSUED: SIGNATURE: (Z2e �,_ DATE: la -33 C 78 Building Commissioner/Inspector ofMies_ of BuildingsBu AZoning District: 5 Proposed Use: n� e: 0 X 0 B 0 A 0 V Aquifer Zone: THE FOLLOWING AGENCIES SHOULD BE NOTIFIED: O Board of 0 Board of ❑Cons. E Demo ❑DPW ❑Elec. O Energy Report Appeals Health Commission Affidavit Card Sent: Cut Off Follow-up^ ❑Fire 0 Gas 0 Planning U Sewer Card ❑Water Card ❑Zoning 0 Other Chief Cut OffBoard Cut.Off Cul Off ' 'REQUIRES INSPECTOR'S REVIEW BEFORE THE ISSUANCE OF A PERMIT, - DEPARTMENTAL APPROVAL b_ Board of Health: Signature: Date: Conservation Commission: Signature: Date: ). Other: Signature: Date: Signature: Date: Signature: Date: Brief description of work being performed: — SECTION 1 -SITE INFORMATION 1.1 Property Address: 1r ('e vi 1.4 , 1.2 Assessors Ma&B not Number: / n /��Lot Area (sf.) Frontage Map /V./„ Lot (/� Required Provided Front Yard 1.3 Historical District 0 Yes 0 No Side Yard Rear Yard Year Built ❑Altering more than 25%per side of building 1.4 Water Supply(MGL c40 s54): 1.5 Sewage Disposal System: Has application been submitted to the Historic Commission? 0 Municipal D Private Well Q Municipal ❑On Site Disposal System 0 Yes 0 No Date: ' Revised 10l11 C! CONSTRUCTION PLANS © SITE PLAN ❑ ENERGY REPORT RESIT ENTMAL SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner Record: `` -- /�/( I � hez to '' \ ,G.,n ILEriv ` al h 6 khe,h. Et— Name(prim) Contact Address Phone Number 2.2 Authorized Agent: Care tree Homes, In t 239 Huttleston Ave 4g 1-1 If( Name(print) Fairhaven, Ma 0271 Contact Address Phone Number r SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor/Specialty License: bt�1A— acd p License Number: 9 in-7 Company Name/Contractor Name: Address: / Expiration Date: 3i22/L6 Signature: S ephone: . lf,7—(a / 3.2 Homeowner Exemption-One&T o Family Section 110.R5.1.3.1 Exception: FOR HOMEOWNERS WHO INTEND TO PERFORM AND SE RESPONSIBLE FOR THEIR OWN PROJECT Exception: Any Homeowner performing work for which a Building Permit Is required shalt be exempt from the provisions of this section;provides that If a Homeowner engages a persons)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 hefshe resides or intends to reside,on which there is,or is intended to be,a one or two faf:itj dwelling,attached or detached structures accessory to such use and/or farm structures. A_..-eon giro mistrusts mare than one name in a two-year period shall not be crnc`ered a Homeowner. If you are applying under this section sign below: Signature: SECTION 4-WORKER'S COMPENSATION INSURANCE AFFIDAVIT(MGL c 152§25) Worker's Compensation Insurance Affidavit must be completed and submitted with this application. Failure topr6vide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached: i 'es 0 No SECTION 5-DESCRIPTION OF PROPOSED WORK(Check all applicable) ❑ Deck 0 Pool C)Repairs 0 Alteration 0 Chimney/Fireplace 0 Woodstove/Pellet Stove O New Construction* 0 Accessory Bldg. O Roofing/Siding 0 Other (Energy report required) (Shed/Garage) (Specify below) ❑Addition I4Rehe�placernent window/door 0 Demolition (Energy report required) No. of windows_ Doors r (Specify below) '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 ❑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): io l 0 Air conditioning-(separate unit) 1 0 None of the above to be provided i0 Hot Water: Gas Electric Fuel Oil Other SECTION 6-ESTIMATED CONSTRUCTION COST Item Estimated Cost($)to be completed by pc aril applicant ;'1. Building 2. Electrical 3. Plumbing 4. Mechanical(HVAC) � � • 5, Total= (1 +2+ 3+4) • SECTION 7A-OWNER AUTHORIZATION (to be completed when owners agent or contractor applies for building permit) (Please Print) I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authoriz d by this building permit application. I (' Signature of Owner Date SECTION 7B-OWNER/AUTHOR/ZED AGENT DECLARATION bahr y P � as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and Curate,to the best of my knowledge and belief. Signed under e ains and penalti /0 2Y/t Signatur 0 Werer/ e Agent Dale /. a f�' SECTION 8-OFFICE/INSPECTOR'S NOTES Total Permit Fee: $ /J Less Application Fee: 25 fID1 Remaining BalaS IOther$Amount$ ' Gross Area-New Construction total sq.ft. Gross Area-Alteration total .,q. ft. /— Permit Issued to' �SAUL_ a,,/ IJ� / / ' 0 ad22/7_41,;;;, . SECTION 9-ADDITIONAL COMMENTS/SKETCHES j .47 , ( ( j, 3/ze it SEP-19-2018 04:01P FROM: TO:5089101838 P.1/1 ASWI CERTIFICATE OF LIABILITY INSURANCE °A „ 18"Y' 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(Ies)must have ADDITIONAL INSURED provisions or 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 CON mITEM Heather poRaway Herlihy Insurance Group AX 51 Pullman Street Pal"ie F�m:508-756.5159 iwAe.Noe 5013-751-574Y Worcester MA 01606 ADDRESS: oarolRates hedihygroup.com etSUREa(3JAFFOROMO COVERAGE ..� AMC INSURER:Liberty Mutual Insurance Company INSURED CAREFRE411 1.. Care Free Homes Inc ' Sawa s':Guard Insurance Company 239 HuttleSton Avenue INsu .4 C:Article Mutual Insurance Company Fairhaven MA 02719 INSURER O: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:12421415S 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: NOTVNTHSTANDING 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, SEEXCLUSIONS AND CONDmONS OF.SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN.REDUCED BY PAID CLAIMS. - - INN/ TYPE OF RISUMNCE Avim POLICY NURSER OahaaligYY%1wise A X CDMMERCIILL GENERAL LIABILITY 'Y. BK356134197. 4 S/10201e 91112019 EACHoccumENCE 51.000.s00 CWMS-MADE OCCUR DAMAGETO RENTED PREMISES(Es 000arencel 3300.000 X PDded:2W MEDEXP(Any one person) 313:000... PERSONAL S ADS INJURY $1.003 am GENL AGGREGATE LIAR APPLIES PER GENERAL M-GPFGATE SZ000.000 POLICY JECT LOt I PROWCTS-COMP/OPAGG 12,000,000' OTHER: $ C AUTOMOBILEtJASIUTY. Y 1020074433 maw S 7/11J019 pummW SINGLE UNIT S 1J1�,900 ANY AUTO ecceleni lEE�S BODILY INJURY(Per person) 3 OWNED X SCHEDULED BODILY WURY leer modern) 3 AUTOS ONLY _ AUTOS • - - HIRED NON-OWNED X- X AUTOS ONLY AUTOS ONLY - (P a )MMAGE S. 3 UMBRELALIAB OCCUR • EACH OCCURRENCE $ EXCESS UAB CLAIMS-MACE AGGREGATE $ DED.I RETENTIONS 3 B WORKERSCOMPENSAIION CAWC997175 Ni7t01e 911RO19 PER OYH- ANDEMPLOYERatNeIUfY YIN X STATUTE ER AND ANYPROPRIETORIPARTNERIFXECUTIVE EL EACH ACCIDENT 31, 00,000 OFFICERMEMBEREXCUJDEoi ❑ NIA II&lndebn In NONI - _ -EL DISEASE-EA EMPLOYEE$1.000,000 DESCRIPTION OF OPERATIONS below. E.L.DISEASE•POLICY LIMIT $1,003000 OESCRIPRON OF OPERATORS I LOCATIONS/VEHICLES(ACORD 101.Add3Mr51 Romano SdMduh,may beaaid lid N mom spice I required) Subject to paltry terms,forms end conditions.Certificate holder is included as an Additional Insured with rasped to General Liability per form CG8810 Ed 04r13 as required in a written contract Additional insured status is afforded on the Automob a Liability policy when required by a written contact. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OP THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE NU BE DELIVERED IN Town of DARTMOUTH ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT 400 SLOCUM ROAD AUTHORIZED REPRESENTATIVE DARTMOUTH MA 02747 NJ.94423_ I b 0198B-2015 ACORD CORPORATION. All rights reserved. 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Board of Building Regulations and Standards j Construdtton ttlpervisor , CS-095228 i4 E pires: 03/22/2020 DANA J PICKNP ^-f / 239 HUTTLEST9N AVE e,A" C ; • ; 4 FAIRHAVEN MA'02719• - >+ Commissioner Ctir e iCon?ntonzueafrit o�'041rwadaaeas Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE.,Suopiement Card Registration Expiration 100503- - 06/18/2020 • CARE FREE HOMES,INC.`- DANA PICKUP JR. 239 HUTTLESTON FAIRHAVEN,MA 02719 Undersecretary Care Free Homes,Inc. Page 2of2 *The Company hereby proposes to furnish labor and material to complete the above work for the amount herein. Fulfillment of this order is contingent,however, upon strikes,fires, ability to obtain materials or other conditions beyond the control of the company. All work is to be completed in a substantial and workman-like manner for the sum of Five thousand six hundred dollars and no cents ($5,600.00) Payment is to be made as follows: On completion Any alterations of deviations from the above specifications that require additional cost of material or labor will be executed upon written order for same,and will become an extra charge over the sum mentioned above for this contract. All agreements must be made in writing. I am providing the above proposal along with the terns of payment for your consideration. Please give me a call if you have any questions: Office 508-997-1111. Nathan J. Pickup, Care Free Homes, Inc. Date ACCEPTANCE You are hereby authorized to furnish all materials and labor required to complete the work described above,for which I agree to pay five thousand six hundred dollars and no cents($5,600.00),according to the terms described above. We,the customer, may cancel this transaction at any time prior to midnight of the third business day after the date of this contract. 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. Don McCormack Date 9 - 0_ jk Je cCormack Date The Commonwealth of Massachusetts F— M Department of Industrial Accidents € aiy 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.govidia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITI'NG AUTHORITY. A IicantInformation Name(Business Please Print Le ibl Organization/Individual): f G. Address: 3 2S. ® n • City/State/Zip: a„1- e Phone#: Stfa' 977- i 1 Are you an employer?Check the appropriate box: 1.'�t am a employer with _employees(fill and/or Type of project(required): pan-time).• 2.0 I am a sole proprietor or partnership and have no employees working for me in 8 ❑New de1in nChOn any capacity.[No workers'comp.insurance required.] . [v�'1Femoelig 9. ❑Demolition 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that an contractors either have workers'compensation10❑Building addition insurance or are sole 11. ❑Electrical re pairs or additions proprietors with no employees. ICIanached sheet I am a general contractor and I have hired the sub-contractors listed on the12.❑Roofring repairs or additions These subcontractors have employees and have workers'comp.insurance.: 13.❑ oof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§I(4),and we haveao a14.[]Other mPloyees..[No workers'comp.Inman= required.] `Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they am doing all work and then hire outside contractors must submit a new affidavit indicating such. tontactors 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 .k 'comp.policy number. I am an employer that is providing workers'co information mpensahon insurance for tiry employees. Below is the policy and job site Insurance Company Name: u r Policy#or Self-ins.Lic.#: AO . I V 21'7 S Expiration Date: Job Site Address: to U S 1 A _ City/State/Zip: Attach a copy of the workers'coin sation 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 S1,500.00 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 Jy under the p ' nd penalties o P (perjury that the information provided above tru and correct Si a la Date: 1/Phone#: q _ Official use only. Do not write in this area,to be completed by city or town official City or Ton: Issuing Authority(circle one): Permit/License# 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• Permit No. BP-90452 Project Location: 6 WREN LN Commonweas� -lam. sachusetts a®emoass-- TO : ,�„ ' t' r ' ' '. 4 UTH , . ,. . g io,,,. . (100.1 Contra., it. 9 r s r. ,e: l� ., /�y row o one DANA �. : ' � ..� : 08) 997-1111 asn Architect q i. ,x Phone# �1 ^y ®' _ Applicant v 0m,Net. �r r.. ' - e Phone#: CARE FREE a X -, !INC I L • .0* (508) 997-1111 ago . a00 �OWNER: 300 a® MCCORMACK DON• . DATE ISSUED: 'l / /`� TO PERFORM THE FOLLOWING WORK: Replacement of one entry door; SAME SIZE, SAME OPENING DATE TIME -- TYPE OF INSPECTION&REMARKS 1 INITIAL"