BP-78845 Permit No. aPassa5 BUILDING P �,r Li, �
Gts#: 15294.00 Comrno rea h b asssachl3setts
Map: 0070 p QUTH y ,
Lot: 0013 : 400Sind "jkoad 0aY mouth,°`MA'. 747 3
Sub-Lot: 0035 i Phone:..(50$).9'.(0'1820 _ SS08)41QI838
Category: RE-ROOF : ,%', 1 + , ,,
Project# JS•2016-000869 pERMISSIONIII EB-YGRq�'TDTO 0' `A
Est.Cost: '$8500.00 Contractor , ; F,x nse s Hone#
Fee: $75.00 PHILIP E DEIM1.4{CO 5' 1 ' u ?„ 'i V (59.9 674p ,343
Const.Class: , _ . a' I , at r- ,.` yy,,
Engtneer. 1 s ;tom .<s Pb ne# j
Use Group R3 I s Q ."
Lot Size(sq.ft) 3.37A Applicant � i�; : l tQ4itatQi�x � P�tgne#zy�
Zoning: SRB MCNULTY HOME I OVEME >--1., ,:. -wt'- (5001674-8343
Aquifer Zone: N/A OtvivEtt: -F j j i �. , ' 4 r z
Flood Zone: ZONE X BARBOSA ROGERAa4c4°x s S < t r .� v 1 P.14..)y
NewConst.: N/A ,.,,. ryl
Alt.Const: N/A �`i, ' i7 �r e a �,+'j
DATE ISSUED _t .4 -
Date Typed: 09-23-20154. ' ,.-„. '12 'g`
TO PERFORM THE FOLLOWING WORK: ,. ^ 1r . d
Strip/re-roof residence - .,,r
/`p_)roje//ct Lon: 94 MILLERS DR
Approved/Issued By: a�2�6?4z—ct /
DAVID BRUNETTE,LOCAL BUILDING INSPECTOR
All work shall comply with 780 CMR 8"Ed.(MGL 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.
I hereby certify that the proposed work is authorized by the o-ner of r:cord and I have been authorized by the owner to make this application as his agent
and to receive this permit, I further understand other ar ncie. may ha ason to STOP WORK if items under their jurisdiction are not met; not
withstanding the issuance of this Building/Zoning Perirdt. .
Signature of Owner/Agent: `�
"Persons contracting with unregistered contractors i not 'ave access to the guaranty fund(as set forth in MGL c.142A)"
Inspector of Inspector of D.P.W.Inspec 9 r Building Inspector Inspector of Gas Fire Department
Plumbing Wiring
WaterService#: 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
c<7.‘ 014 ' a., -1s- BUILDING DEPARTMENT RECEIPT 7 5 8 4 5
�/ y y , - / )
Name:/ ro.. Owner:
i Date.
Job Location: `�-1 44//`' Map: / Lot: / is
Description General Ledger#'s Ref. # Amount
Building &Buildin MAW",J9,9T 1000-44105 /(� �( 9S -'2)
s.
Electrical , yF� �1100-44106 v
Plumbing &Gas 241'1675 01100-44107
Trench Safety Sn S 1 000-44129
Other Department Rev-��tECTOR 01000-42420
White-Collector's Office Yellow Copy-Customer's Receipt Pink Copy-Building Department Received By '/1 / ----
THIS IS NOT A PERMITILICENSE FOR BUILDING, ELECTRICAL, PI IMBING OR GAS
RESIDENTIAL ❑ Phased Approval(R106.3.3)
$25-00 APPLICATION FEE IS NON RE-FUNDABLE & NON-TRANTSFFRABLE
�c`oaH y, I, . DATE RECEIVED
f/�Y _ t, DARTMOUTH BUILDING DEPARTMENT
q
`;1< 400 Slocum Road 2015 SEP 23 Pi4 12:
Dartmouth, MA 02747 52
' ° � ya; Phone: 508-910-1820 Fax: 508-910-1838
lfi M16
www.town.dartmouth.ma.us
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
THIS SECTION FOR OFFICIAL USE ONLY + yG/ty/f`-.
RECEIVED BY: BUILDING PERMIT NUMBER: 0 1
DATE ISSUED:
SIGNATURE 01(:2 4 ,,,[ � DATE:
Q ,(� Building Commissioner/Inspector of Buildingslng -
Zoning District: S � Proposed Use: Zone: de{0 B O A ❑V -Aquifer Zone:
THE FOLLOWING AGENCIES SHOULD BE NOTIFIED: DPW
❑Board of 0 Board of 0 Cons. ❑ Planning , ❑Address 0 Engineering El Cross
Appeals Health Commission Card Connection
O Fire 0 Gas ❑Electric 0 Other ❑Water Card "- 0 Sewer Card
, Chief- ,, Cut Off , Cut Off Cut Off Cut Off
i-
DEPARTMENTAL APPROVAL S) -`
Board of Health: Signature: Date:
Conservation Commission: Signature: Date:
D.P.W.: Signature: Date:
Fire Chief: Signature: � ,-,�(/'/� Date:
Ite
Other: Signature: - V Date:
Brief description of work being performed:
SECTION 1 -SFTE INFORMATIONr
1.1 Property Address:s�9 t //,y; 1 1.-L- 'E A-. ,®/ v 1.2 Assessors Map&Lot Number:/3
Contact Person: 7// 7 117 �e1I}'14(1 cd Map / Lot - 3 J
Phone Number , >C� i r/� Rj O 7
1.3 Historical District ❑Yes 0 No
1.4 Water Supply(MGL c40 s54): 1.5 Sewage Disposal System: Year Built
❑ Municipal ❑ Municipal 0 Altering more than 25% per side of building
❑ Private Well ❑ On Site Disposal System Has application been submitted to the Historic Commission?
0 Yes 0 No Date:
Revised 5/13
❑ CONSTRUCTION PLANS 0 SITE PLAN 0 ENERGY REPORT
RESIDENTIAL
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner Record:
6-6POD R 3nR13O ¶11 iiii1eg b14 r 7bceg •
Name(print) Con act Address ' ) /j�',J/1/ Ace
Phone- Number
3 OF
2.2 Autlpci,;�d y gr�t y-� _ , i 14 p Cx 9 91 1i W/Gr'( //t V rJ /r c 7,9,4, 8D bill
Name (print) 1/Y_J-'U} `J C nttaa+ct dre i V'€J� 69 7 . Phone Number
r SECTION 3-CONSTRUCTION SERVICES,, ' v� +U
3.1 Licensed Construction Supervisorr��q//Sp'ecialty z.oz'
License:s lit License Number: � 17/0/
Company Name/Contractor Nam C JtJ )U 1-10711F ,tyl/f/' cm+
'7 �
Address: , ,Z i „cm! Ao-Vj,ram. j lt)C L . _ Expiration Date:
Signature: Telep r�AQ j 7 / 236 .—//
3.2 Homeow r emption -One&Two Family Only Section 110.R5.1.3.1 Exception: '� •
FOR HOMEOWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT / -7 wil`
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 Homeo r
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:
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 to rovide this
affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached: Yes ❑ No
SECTION 5-DESCRIPTION OF PROPOSED WORK(Check all applicable)
❑ Deck 0 Pool 0 Repairs 0 Alteration 0 Chimney/Fireplace 0 Woodstove/Pellet Stove
❑ New Construction* 0 Accessory Bldg. 0 Addition Roofing/Siding 0 Replacement window/door
(Energy report required) (Shed/Garage) (Energy report required) / \ No.of windows Doors
❑ DEMOLITION (specify): 014 ge,6A
//L �
Location of debris removal (per MGL C.40 Sec 54): [cumpster on site 0 Dumpster On Street
Facility Name: et J 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
❑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
SECTION 6-ESTIMATED CONSTRUCTION COST
Item Estimated Cost($)to be completed by permit applicant
1. Building
2. Electrical
3. Plumbing
4. Mechanical (HVAC)
5. Total=(1 +2 +3+4) IvoQo-
SECTION 7A-OWNER AUTHORIZATION
(to be completed when owner's agent or contractor applies for building permit)
(Pleas rmt) p7 /1�//
I, D7<j2 ,tl f2-,��2> , as Owner of the subject property hereby authorize PA I`r f 11Urn (6
to act on my in al matt 'vet ork authorized by this building permit application.
Signature o O Date
" -SECTION 7B -OWNER/AUTHORIZED AGENT DECLARATION
I, VJ \ ( Ct 11404—EP , as Owner/Authorized Agent hereby declare that the statements and information
on the foregoing ap lication are true and accurate, to the best of my knowledge and belief.
Signed •.er re pain. an. •. -s of perjury.
at - of 9wl e'� horize. nt Date
x / SECTION B-OFFICE/INSPECTOR'S NOTES -
\ Less Application Fee: 25 00 Remaining Balance:
Total Permit Fee: $ 3 (
Other$Amount$
Gross Area-New Construction total sq.ft.
Gross Area-Alteration total s
ft. �
Permit Issued to: /fi- /.9 )/7„ SECTION 9,DESCRIPTION,OF WORK BEING PERFORMED
Hepy
Permit No. BP-78845 Project Location: 94 MILLERS DR
Commonwealth o !�Iassachusetts
TOWN F D TMOUTH �$ An � 6
4006IocumRoad,D�mouth,1 A 02,747 ,t, r 001 ,
'P▪ hone:(5 i 910`1820• FF"aac (508)910 7,S38y y 0 r
� � Y� Y +� � � `4 '�� k'Iti�.Y� r u.ID"QY�� ��$p J:��r '�:
rBUTT;D : - -.. .Pia , t
is'tlE /„ �. 0\ �90N a i4^ .k$8 t§rvi: -
Y ^a a, �, 4 a r a w 6k
tl
Contractori• eelise .Phone#: ���
PHILIP E OEMARCO k t " 001913 5 (508) 674-8343 Ii ze *�Fk)
Engineer 1 % e� All
,hone#.. ' �' �.xi s § i
n l if tel R Y 1 a� - 1 I
Applicant Phone#: 'Flood`Zone, l� s
PP
MCNULTY I3,OM• E IMPROYEME▪IN, C (508) 674-8343 & .N/A r
OWNER: '" ; "^ .. ` ,.:.co 14145e. ,N/A* ' ,
II BARBOSA ROGER-A '
DATE ISSUED: J
f tD
n�
TO PERFORM THE FOLLOWING W';te .
Strip/re-roof residence
DATE TIME TYPE OF INSPECTION&REMARKS INITIAL
� /� i'Q; ®ice
u\'`')
• The Commonwealth of Massachusetts
Department of-Industrial Accidents
I_re f:� • • Office of Investigations
7s� "s 600 Washington Street fi
4 MIST Boston,11/L4 02111 2.: ., _a
.."1-r"
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plurnbers
Applicant Information Please Print Legibly
Name e Bus Hess Organ zation Individual): Me Nu /iom �2provemirrr c.
• Address: ` ■ • ! Ili a City/State./Zip: i. g ' a' u r • Phone #: 5tfp 4 — I
i x
Are you an employer? Check the'appropriate box: Type of project (required): •
I 1 Sir am a employer with_3____ 4. ❑ I am a genera] contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. New construction
2.I I I am a sole proprietor or partner listed on the attached sheet. 1 7. I I Remodeling
ship and have no employees These sub-contractors have 8. H Demolition
working for me in any capacity. workers'comp. insurance. 9. I Building addition
[No-workers' comp. insurance 5. n We are a corporation and its •
required.] officers have exercised their 10.17 Electrical repairs or°add eons
3.Li I am a homeowner doing all work right of exemption per MGL l L I I Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4), and we have no 12.1A1 Roof repairs
insurance required.] t employees. [No workers' a
•
comp. insurance required.] 13 g..! Other
*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
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information_
Insurance Company Name: A r 13 e r I0.
Policy#or Self-ins.Lie. #: 9109 9 / Q 4 L5' l Expiration Date: I�(j�",��p�"/el
Job Site Address: 9 9 g, i/-c r Vim/{City/State/Zip: MQ j
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure,to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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 S250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certij5)under d penalties'of perjury that the information provided above is true and correct
Signature: \dt w r aDate: .=�Phone#: Q
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#:
Massachusetts -Department of Public Safety
Board of Building.Regulations and Standards
Construction Supervisor _
License: CS 001913
PHILIP E
924 HIGHLAND AV> F
FALL RIVER MA z
Expiration
Commissioner Oi/30/2016
`,� En ro,wnonterecria of A azezd ueln.-
Office of C gweec Affairs&Business Regulation
`s $OME IM ROVEMENT CONTRACTOR
a yam.
la �E4'egistra on 104565 Type:
bfhPiratro 7/74/2016- Private Corporatic
MCNULTY HOME IMPR EMENT INC.
Philip DeMarco
924 Highland Ave.
Fall River,MA 02720 - `a
Undersecretary
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