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BP-86770 Permit No. BP-86770 BU _ S11''r="''' A IT GIS#: 3345.00 Coo ' , is -1 - :a` . - is Map: 0066 em y,. Lot: 0002 a W o.,1... y . t • % Sub-Lot: 0131 00 "i *-6$i•°..• ri 47 8$ _ Category: ROOF ' �• i7ty Project# JS-2018-000958 PERMISSIONI • ^' C taP Est Cost: $4000.00 e 0 -_ 2, • - Fee: $75.00 Consr@Goc - s t Const.Class: JESSEJF• 'u •'• it 3 .y^ Use Group: R ® iotts `` ° --- -Lot Size(sq.ft.) 41,000 Engineer s 7t H P o e#" Zoning: . _ __ SRB + _ p� 9 _ _ .. — Aquifer Zone: N/A - — - . - a g 'Hup¢ld _.. _ Flood.Zone: N/A APPficant ; EF 3 t • '- 508 .,�,#.,G+w'P31;` JESSE FARIA i . • .s^�., New Const: N/A OWNER: $ Alt.Const: N/A BOGIE CHRIS . ° •lip $° Date Typed: 10-13-2017 #' a e DATE ISSUED: " tk 4,J.0 o7� 1 TO PERFORM THE FOLLOWING WORK: ,- -.teas+ ++aa° 1 Strip/re-roof residence oject Location: 3 WREN LN Oil' All( Approved/Issued By: t /......drits —� FA 7 M.MURPRY,D I' CTOR OF INSPECTI s -"4WD' All work shall comply with 780 CMR 8Th Ed.(MGL Chap.143)and any..i er applicable Mass. or Co. and plans on file. Schedule appropriate inspections as required. Upon completion of work,final r: • ction is .. red. I hereby certify that the proposed work is authorized by the owner of record and I hay .. 1.r . • the owner to make this application as his agent and to receive this permit, I further understand other agencies m y have reason to STOP WORK if items under their jurisdiction are not met; not 'withstanding the issuance of this Buildin ing Perini - i t Signature of Owner/Agent: a i 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 ,.. v # 9 0 PHONE: 508.910-t 20 FAX: 508.910.1838 i .fr id Name ,ILO, _.f Property Owner: ril I J Date J ` it1 ` , i 7. Job Location: 2 (,t. Yeti ill Map: (1t_„/i Lot: i Description oytN OF . tl eral Ledger#'s Ref. # Amount Building &Building is�. p i',110-44105 ic. ^T M tt d�'ti # ,�_3 Electrical 0100,1-44106 t `� OCT 1S1017 Plumbing & Gas 01001-44107 A I Trench Safety %, 6 Jo t 10-44129 Other Department Revenue — 01000-42420 y White-Collectors Office Yellow Copy-Customer's Receipt Pink Copy-Building Department Received By _ j%/ y�f' THIS IS NOT A PERMITILICENSE FOR BUILDING ELECTRIC PLUMBING OR GAS ' 1 RESIDENTIAL ❑ Phased Approval(R106.3.3) S25.00 APPLICATION FEE IS NON RE-FIINDAMLE 4 NON-TRANSFERABLE "O v l DATE RECEIVED q DARTMOUTH BUILDING DEPARTMENT 0"6�-"t8 s:. it, 21 400 Slocum Road `z - i Dartmouth, MA 02747 A \t.3 1�� O:` Z // qJ- v: Phone: 508-910-1820 Fax 508-910-1838 //mil//yam// csa / www.town.dartmouth.ma.us APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING -THTS SECT(ON FOR OFFICIAL USE oNLY - "RECEIVED BY_ BUILDINGPERMIT NUMBER: 7/ . DATE ISSUED. 70/i''.47 SIGNATURE:. DATE: l0//?jj/7. - Building Commissioner/Inspector of Buildings Zoning District- Proposed Use. -Zone: tax O B ❑A 0 V- Aquifer-Zone: :THE FOLLOWING AGENCIES SHOULD BE NOTIFIED:- ' ' DPW a Board of 0-13oard of ❑Cons. - p Planning 0 Address U Engineering 0 Cross. ;Appeals .-A Health . Commnission,' --Cara' Connection 0 Fite 0 Gas 0 Electric 0 Other 0 Water Card , 0 Sewer Card a PO P Chief. Cut Off Cut Off Cut Off Cut Off DEPARTMENTAL APP.ROVAL(S) Board of Health: Signature: Date: Conservation Commission: Signature: Date: D.P.W.: Signature: Date: Fire Chief: Signature: Date: Other: Signature: Date: Brief description of work being performed: p tet{Q " . <rSECT10 ;1 �tTS1N�taRMATiOF1 - 1.1 Property Address: 3 //��k'Il e ry 1` U(i..- 1.2 Assessors Map&Lot Number: Contact Person: e- gc S bor), 2 Map( l Lot _ (3 / Phone Number: 1.3 Historical District ❑Yes 0 No 1.4 Water Supply(MGL c40 s54): 1.5 Sewage Disposal System: Year Built ❑ Municipal 0 Municipal 0 Altering more than 25%per side of building ❑ Private Well 0 On Site Disposal System Has application been submitted to the Historic Commission? OF 0 Yes 0 No Date: RS/15 Revised 5/13 ❑ CONSTRUCTION PLANS ❑ SITE PLAN 0 ENERGY REPORT RESIDENTIAL SECTION:7,-PROPERTY„OWNERSHIPIA rUT.HORIZEP AGENT:, .. •,_ 2.1 Owner R s TL b () -1 ( � I ,P/L( S Name(print) Contact Address Phone Number 2.2 Authorized Agent: - �s sQ �'r4/1t a ) � �' �- �'� 41/ 5 5053a6t Name(print) Contact Address Phone Number SECTION$" CO)IST1iUGTIO(-�ss11Sf RVICES ! '- 3.1 Licensed Construction Supervisor/Specialty License: ' S S-e 44 4 License Number: 0 7 qj Q9, Company Name/Contractor Name: t) pp nc 6- ItZ(Y 1 ICevs. t 1 S S9-C Address: (� i C( t L. [( F�ti4d S't Expiration Date: Signature: Telephone: 3.2 Homeown 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 andlor 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: -SECTION it WO0E.E &(`,QOMREFNSATION INSURANCE AFF1&AV1,T(MGLc 1$t tz$) , . . .. 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 SECTION 5:DESCRIPTl6N QF PRCiPt3SED.WOJ((Chegk'aII`,�ppli_cable} . , -. . 4,.," r•: _ ❑ Deck ❑ Pool 0 Repairs 0 Alteration 0 Chimney/Fireplace. 0 Woodstove/Pellet Stove ❑ New Construction* ❑Accessory Bldg. 0 Addition 0 Roofing/Siding 0 Replacement window/door (Energy report required) (Shed/Garage) (Energy report required) No.of windows Doors ❑ DEMOLITION (specify): Location of debris removal (per MGL C.40 Sec 54): 0 Dumpster on site 0 Dumpster On Street Facility Name: Location: 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 ❑Fumace(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 abet-� d- t`J d 0 Hot Water: Ga9x - , - - Electric Fuel Oil Other SECTION-S, ESTIINATE[3 CO�d_ST tJCTIOft COST; ■ Item Estimated Cost($)to be completed by permit applicant _ 1. Building 2. Electrical 3. Plumbing 5. Mechanical 5. Totall= +3 +(1 +2 +4) SECTION TA OWNER i9 ORIZATI Ito be c nplete¢When oWfle s agent ter bo ractOt applies fo1^budding perrrltO n (Please Print) }, �,ess- �(fi�t I, �{ir U 0 `1 e_ ,as Owner of the subject property hereby authorize ,T to act on my behalf, in all matters relative to work authorized by this building permit application. bow- (6- id--r7 Signature of Owner Date SECTION 7B-OWNER/AUTHORIZED AGENT DECLARATION ft; 0 6 ,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. Signed under the pains and penalties of perjury. 42 ,-//� Signature ner/Autho Agent Date /4 ' SECTION 8 0FFICE/1NSPECTOWS NOTES- .. Less Application Fee: $25.00 Remaining Balance: $ Total Permit Fee: $ Other$Amount$ • Gross Area-New Construction total sq.ft. Gross Area-Alteration total sq.ft. Permit Issued to: .,. ...:- Permit No. BP- 86770 Project Location: 3 WREN LN Commonwea A °Meyssachusetts wiiii TO g °� �. MOUTH �� [[ 5� 9lgi` ;y� "tF P y � ns W AY-i�P' -t, 6�ii�i t '�- ? �2� .� @P 40f IF 'M'4:1'fl� . s' ' it, k`-A ,Oj � ][ 1. r r a - �9�'Pi--, Fax '. Meta S'ir F3.� lii l�f- ':., t�v' pp 5 y M rs �Si.y� * !Mon, y�I:r.-- 1 x ' ref ,m .7g :f8 d+me h Y k +.x Ti' ,I I��1 .. �Pr; g�s j 0 13'e 3� ? Z�1 ilk ii (tone#: x � Contraatifit I: JESSE [[ is .�f� ( �i& 326-0230 v1� 1` `A 6:4k ^ , { q & F � I 15'���f � F A Engi•neer._ m a 'r , i z y t;r a t s C z _ �� a a a Phone#: �� ` a'v us fl i.L �� t iPk .A .3'.�.r Applicant: ;3 � ® - 9�n° Phone#: Y'���. #�' a'si -.� � -.. '�. JESSE FARIA i b ARIA't °I a I I RO NET (508)326-0230 ttirOWNER: . � s+-' , .' '. BOGIE C1 ISTOPFIE' DATE ISSUED: /D� /�7 TO PERFORM THE FOLLOWING WOR% Strip/re-roof residence DATE TIME - TYPE OF INSPECTION&REMARKS INITIAL c`44 � 6 /9` Massachusetts Department of Public Safety \,.1_J Board of Building Regulations and Standards License: CS-0711092 �' Construction Su pervisor i h u . , , e �r1 a JESSE J FARIA ' , 219 CLIFFORD ST u NEW BEDFORD MA 02745 •• g° j ✓ Expiration: Commissioner 12/29/2018 • c7jOffice of Co..timer Affa & I•-siness -ahnn ? HOME lI ROVEMENT CO RACTOR _ €€sg+'st Crt '159529 Type: `• Expirat n l212018 • I-A JESSE"ARIP..IMP-OVEME1tW �. • 4! xx: JESSE 1EARIA • ct^ef-.,t1FFrORDST _ _ 14FWZiefiEORD,.MA 02745 Und .ne. eary r The Commonwealth of Massachusetts two.` 1. Department of Industrial Accidents v 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 THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): J P a r �Address: 9\ ' tc`CP/ Yu 5 t City/State/Zip: 1. s Phone #: 5 7 ? 1&"0 Are you an a toyer?Check the appropriate Type of project(required): i. am a employer with t employee (full or part-time).* 7. ❑New construction 2.0 l am a sole proprietor or partnership and have no employees working for me in $. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.0 I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. ❑Demolition 10 ❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 I.❑Electrical repairs or additions proprietors with no employees. 12. Plumbin pairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. oof repairs These sub-contractors have employees and have workers'comp.insurance.t p 6.❑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'comp.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. tontractors 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'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: N rat /� Policy#or Self-ins.Lic.#: Expiration Date: /92'./ Job Site Address:3 t`-ire.,..„ Jz, --- 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 cert rider the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: 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#: brrcr� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDCIYYYY) 05/31/2017 THIS CF,RTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFTCAME-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). NN PRODUCER 02742-001 FpiiRI1OTTNEACT Branch 2742-1 Mertes Insurance Agency mat (413)592-3466 (NC.No.: 799 Front Street ROAOREss:Chicopee,MA 01020 Il1SUR66(SI AFFORDING COVERAGE NAIL# INSURER A: A.I.M.Mutual Insurance Company 33Z58 INSURED INSIIRER B: Jesse Faria Farra's Home Improvement INSURER C: 219 Clifford Street New Bedford, MA 02745 INSURER : D ' INSURERE: INSIIRFR F• COVERAGES CERTIFICATE NUMBER: 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, ggEXCLUSIONS AND CONDITIONS OF SLICH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS IN_R TYPE OF INSURANCE ANSPR WVBO POLICY NUMBER (MMIUDY ) 1(4MIDOV EXP) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMLSES(Ea occurrence) CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL SADV INJURY $ GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ $OLICY IJLI ECT Thr_OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Fa accident) 1 ANY AUTO BODILY INJURY(Per person) $ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS • (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ yypRKCEEpO pry.I RNE�TENNITIION $ �y;g `' T $ ANU EMPLOYERSLIAMIS% X TOR' IAtJITs OER A PR P R/EXECUTIVE����y/ I E.L EACH ACCIDENT $ 100,000.00 A (Mandatory' NHR/PXCIUDED� N/A AWC-400-7021073-2017A 4/26/2017 4/26/2018 (Mandadtory-bIna NH)����y EL DISEASE-EA EMPLOYEE $ 100,000.00 gnS011PfsTONAF6PERAT10NS below - E.L DISEASE-POLICY LIMIT $ 500,000,00 DESCRIPTION OF OPERATIONS/IODATION¢/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space is required) Workers compensation coverage applies to MA employees only. Operations/Location:Delmy Lopez Gonzalez,267 Dartmouth St;New Bedford MA The workers compensation policy does not provide coverage for Jesse Faria CERTIFICATE HOLDER CANCELLATION Embrace Home Loans 25 Enterprise Ctr SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Middletown,RI 02842 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1- x� ar445tlWGO a2' W'�C 07 C 1;O n en co a ° a o o oy':„ tnmrn Q ° ' `� 'A �'"p7tl tfi � 077 4:t�z 7 -+ O c 10 �to w�o "' C Ri+ d F1 O e o. z t" AN1w O.,' o .' aO.<f]f�= Mn H � r` obi. r0 '/ 5;y C rtr,`.c - C r n 4, Om' ac" 5` K'nncnnvrrcnr* 0O 'Y 37 " i- d t7 C. 5 nb co-.- 2 uoi:voiy Z zZy000 n' w ''[�S� G8 No a < �mS`. 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