BP-193 FIELD INSPECTION
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Dartmouth Building Department Plat : 066
400 Slocum Road—P. O. Box 9399 Lot (s) : 73
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North Dartmouth, MA 02747 Lot Size : 23, 430
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Telephone 508-999-0720 Zone Dist. : SRA
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• Issued Date : 09/22/93 Permit No. : 193
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• Project Location : 1221 Reed Road
Number Street
Subdivision Name :
Nearest Cross Street :
Applicant/Agent : George Reiniche
Contact Person Phone #: ( ) 508-993-1748
Proposed Use : Residential
Residential, Commercial, Industrial. etc.
- ------"Fernrit--Tssuea Tot— - - - -AlteraTion - --
Type of leproveaent, Add. Filter, Nem Cons0., Demo. Land/Move, etc.
Kitchen & bath (457 sq. ft. )
indicate no. of bedrooms and bathrooms and other rooms
Owner (s) of Record : Patricia Lobo
Address : 1221 Reed Road, North Dartmouth, MA 02747
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BUILDING PERMIT
Dartmouth Building Department Plat : 66
400 Slocum Road-P. O. Box 9399 Lot (s) : 73
North Dartmouth, MA 02747 Lot Size: 23, 430
Telephone 508-999-0720 Zoning Dist. : SRA
September 22, 1993 (typed) Permit No. : 193
Issued Date: 09 / 22/ 93
Clerk: its
Project Location: 1221 Reed Road
Number stea•t
Subdivision Name:
Nearest Cross Street : Reed Road
Applicant/Agent : George Reiniche
Address: 54 Nauset Street. New Bedford, MA 02745
Contact Person Phone #: ( ) 508-993-1748
Type of License: Owner: ( ) Const. Superv. License #: (20682 )
Architect : ( ) Engineer: ( ) Other: (
Proposed Use: Residential
Reti Ia1. Caaa•neial. laduatrlal, etc.
Permit Issued To: Alteration
Typo of Iapronaeat. Add, Alter. Ne.. Coast.. Demo. Lend/Nom etc.
kitchen & bath
Indlpate no. of b•dreoas and bathrooms end other Coat
Gross Area of Const. : 457 sq. ft. Cost of Const. $25. 000. 00
Cost-Other Const. : 1104 sq. ft. TOTAL FEE: $ 30. 00
Owner (s) of Record: Patricia Lobo
Address: 1221 Reed Road, North Dartmouth, MA 02747 'I
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 authori ed agen
Signature of Owner/Agent : >
Address:
signature: ja. ,0.J1,
Approved/Issued By: William A. Braga, Loca Building Inspector
COMMENTS: �{ �{
13 ORIGINAL L1 APPLICANT 0 ASSESSORS 0 CLERK 0 COPY
7 - _
$ 1 1. en. 5h- 11,' PERMT
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Required approval Approvals received
please (Xl approvals Please IX) approvals and
required for this project Initial as received
DATE INITIALS
Board of Appeals _
Rater Card
/ �Sever Card _
_ Board of Health 1 L- ;
Bond
Selectmen
Conservation
Fire Chief
Cross Connections
Licensed Contractor
Controlled Const. Affid.
I'
Other information required
2'.'
m ;
Cr PERMIT NO.
' 'F.-1L'`E ou `-.% TO i OF DARTMOUTH DATE ISSUED / %,
Ito :. .,-�!4! -ci!io�i. -;')f.l TOTAL COSTrEctr5_? ' tr APPLICATION FOR5 GU
��. C� y LESS APPLICATION FEE
°.. sy BUILDING PERMIT
884y. FINAL PERMIT FEE —5, `-6
LOCATION OF BUILDING
01 Number & Street / G 1/ �-o ' 01.1 Zoning District.5
02 Cross Streets(between) and
p /
03 Lot Plat Lp 04 Subdivision Lot
�/ 0 ERSFIIP COST
'Private (individual, corporation, l%Gj f>
non-profit institution, etc.) 36 Cost of Improvement
p 36.1 To be installed but nott
06 ❑ Public (Federal, State, or local government) included in the above cost
TYPE OF CONSTRUCTION 36.2 Electrical
07 0 New Construction 36.3 Plumbing
08 U Addition -Type of Room(s) 36.4 HVAC .
09 ,I4 Alteration >YTcgn- "t- C3nrN 36.5 Other - Specify �p
10 0 Foundation Only example: elevator / l/p //�
11 ❑ Demolition (#of units if residential) 37 TOTAL
12 ❑ Moving (relocation)
STRUCTURE
STATISTICS 38 Wood Frame
13 Number of Bedrooms '� 39 Masonry (wall bearing)
14 Number of Bathrooms (Total) p 40 ❑ Structural Steel
Full-Tub 41 ❑ Reinforced concrete ,
3/4 - Shower 42 ❑ Other- Specify
1/2 - Toilet Only
RESIDENTIAL-PROPOSEDI
``ID/ USE DIMENSIONS
15 }One-Family 43 Number of stories
16 Two or more families 44 Total square feet of floor area, all floors,
Number of units based on exterior dimensions 51,5-1 ift
18 ❑ hedge 45 Total land area, square feet /�
19 ❑ Carport r2�/g3V
` 20 ❑ Swimming Pool SEWAGE DISPOSAL
In-Ground_Above-Ground
21 ❑ Woodstove 46 Public or private company
22 ❑ Fireplace 47 rivate (septic tank, etc.)
23 ❑ Other- Specify
WATER SUPPLY
48 ❑ Public or private company
NON-RESIDENTIAL - PROPOSED USE 49 ❑ Private, (well, cistern)
24 ❑ Amusement, recreational 25 ❑ Church, other religious PRINCIPAL TYPE OF HEATING FUEL
26 ❑ Industrial 50 ❑ Gas
27 ❑ Parking Garage 51 a Oil 1
28 ❑ Service station, Repair garage 52 4 lectricity •
" 29 ❑ Hospital, institutional 53 • Coal
30 ❑ Office, bank, professional 54 ❑ Other - Specify
31 ❑ Public utility
32 ❑ School, library, other educational TYPE OF MECHANICAL
33 ❑ Stores, mercantile 55 Will there be central airconditionin ? ❑Yes ❑ No
34 ❑ Tanks, towers g
35 ❑ Other- Specify 56 Will there be an elevator? ❑Yes ❑ No
P ING PER ZONING BY-LAWS
57"Enclosed 58 0 Outside
59 Does this building contain asbestos? ❑ YES O If yes complete the following:
Name & Address of Asbestos Removal Firm:
x
IDENTIFICATION - To be completed by all applicants PLEASE PRINT
60 Owner (print) rt l Cryg / 7/µ �f 1/V .
IVIE Q z _ -•,•�/A ING . �R SS / TELEPHONE NO.
61 Signature Lr. E DATE
�t->u.a 1
/' �z JU /�' ' ilder's _
62 Contractor (prin) % Icense No. Ci
NAME MAILING AD R TELEPHONE .
63 Signature r1 DATE
64 Architect or Engineer (print)
NAME MAILING ADDRESS TELEPHONE NO.
65 Signature DATE
CERTIFICATION TO PERF W/ORK �� '
66 I/We hereby appoint � ielA • l 7�,A % �� � .
J ' NAME ' ADDRESS
as my/our agent purpose of applying for and obt fining a building permit for the work to be done described in this
application.
j Signature Y. (C/4.,LAt-r-iL/ r / DATE A//71/4C7D%
ADDITIONAL INFORMATION
67 Has A-1 or Determination been issued by Conservation Commission? ❑ YES ❑ NO
Submit copy of notification sent to DEQE and the State Dept. of Labor Industries and result of air sample analysis after
asbestos removal is complete.
68 Owner or Agent - I certify under peril of the penalties of perjury that the information herein is accurate to the best of
my knowledge.
Signature DATE
- //Owner or Agent
69i BOARD OF HEALTH REVIEW 41,11:• ' oro DATE 9--z-2-7'3
// Inspector or Authorized Person
COMMENTS:
70 DPW- WATER Service No. SEWER Service No.
To be completed upon issuance of permit- (if applicable)
71 I will post permit and address so as to be visible from street.
Signature DATE
Owner or Agent
72 I have received list of required inspections
Signature DATE
Owner or Agent
n
.C.
RECEIPT FOR PERMIT
TOWN OF DARTMOUTH t,
PERMIT NO.
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Date / / /
Received From / / eo `/
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Owner
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Location ,1
Type
Amount Paid
Received By
RECEIPT FOR PERMIT
our TOWN OF DARTMOUTH '
f.: ,.� PERMIT NO
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Amount Paid t `' ( .l ( I-Le ___-
Received By i C• C --rC
COITMONWEALTH OF MASSACHUSETTS
DErAIC'Mfl T OF INDUSIRIALACCIDENTS
600 WASHINGTON STREET
James.: Carnme+. BOSTON, MASSACHI75tt lb OZIII
,srm-nss;oner
WORKERS' COMPENSATION INSURAN AFFIDAVIT
4/`1 1A) /�
(licensee/permitter)
with a principal place of business/residence at:
(Cary/Srate/Zip)
do hereby certify, under the pains and penalties of perjury, that
[] 1 am an employer providing the following workers' compensation coverage for my employees working an t:
job.
1z& It./4\ 2cr 3/I -20fl7 OZ3
Insurance Company
Policy Number
[ ] I am a sole proprietor and have no one working for me.
[ ] I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors lined b
who have the following workers' compensation insurancepoliaet
Name of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy, Number
I am a homeowner performing all the work myself
NOTE Please be aware that while homeowners who employpinions to do msintenan¢,contraction or repair work or
dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are not general
considered to be employers under the Workers' Compensation Act(GI- C. 152.sect 1(5)),application by a homeowner for lice_
or permit may evidence the legal sums of an employer under the Workers' Compensation,rct.
I undeannd that a copy of this statement will be forwarded m the r�Department Office ofIsuuraa¢for mve.^.
verification and that failure to scour coverage as required under Section 25A of MGL 152 as lad to the imposition of criminal pm:
consisting of a fine of up to S1500.00 andlor imprisonment of up to one year and civil
fine of S100.00 a day against me. penalties in the form of a Stop Workdzoe r
Signed-this day of 19
er.:.iret licensor/Permitzor
TOWN OF DARTMOUTH BUILDING DEPARTMENT
TO:
4 Board of Health X Fire Chief Dist. 1, 2, / 3
0 Conservation Comm. ❑ DPW Engineering �J
❑ Selectmen-Licensing 0 DPW Water/Sewer
0 Selectmen-Special Permit 0 Planning Board
0 Town Clerk X Tax Collector
0 Police Department Cl Other
The following is forwarded to your office for your information
only - no response is required.
The Building Department is in receipt of an applicatio for
Plat (J'4 Lot 73? , Address in/ //mill o €?
by / 7M, &n`
/ "S to p
ovnor/opplio•nt demo. aoa�atrvct. alter, occupy. eta.
a(n) A ) tc. i9 tc1U V oZ GL��T« S .
The plan was received by this office on 9 7t
t.
This office will review said plans and subject to availability
of potable water, where required, the provisions of Zoning By-law
per MGL Chapter 40A and MSBC 780 CMR 5th Edition will have
available to issue or will deny a permit for the above-mentioned
work within 30 days of date of receipt.
The applicant has been advised that your office as indicated
above may require them to apply for licenses or permits subject to
your jurisdiction and that they should contact your office, as
indicated, for specific information.
It is not necessary to respond to this notice unless the e is
a specific issue at hand or you wish to forward material or
information required for permitting. When required, an Occupancy
Permit will not be issued until all Town Agencies have had the
opportunity to "sign off" that the work under their jurisdiction is
complete to their satisfaction.
To The Applicant:
Be advised that this notice will be sent to the Agencies
checked above as they may have separate jurisdiction for your
project. Any questions about the Agencies Regulations & Policy
should be addressed to the individual Agency.
this29Y signature only acknowledges your receipt of a copy of
2
ce and p� contact phone number.
Mill /0 C 9c?/7 0`C/49
APPLIDAr (tan tutu/ PRONE • DATE
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