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BP-10292
BUILDING PERMIT 86 MILLERS DRIVE SPECIAL PERMIT PER 780 CMR 111.0 Dartmouth Building Department Plat: 70 400 Slocum Road-P.O. Box 79399 Lot (s) : 13-37 Dartmouth, MA 02747 Lot Size:46, 192 Telephone 508-999-0720 Zoning Dist. :SRB March Issued 2Date4, 99',.7 (S(D/ /v PermitNo. : /S Clerk:: BA Project Location: 86 Millers Drive Number Street Subdivision Name: Millers Farm -- Lot 37 _ Nearest Cross Street: Person Permit Issued To: Melissa Sousa _ Address: 38 Pitman Street, Fall River, MA 02721 _ Applicant/Agent: Same Contact Person Phone #: (508) 674-1034 Type of License: Owner: (x) Const. Superv. License #: ( Architect: ( ) Engineer: ( ) Other: ( Proposed Use: Residential Residential,Commercial,Industrial,etc. Permit Issued To: To Install 'type of Improvement,Add,Alter,New Coast.,Demo,Land/Move,etc. Foundation Only indicate no.of bedrooms and bathrooms and other rooms — Gross Area of Const. : Cost of Const. $8, 800 . 00 _ Cost-Other Const. : TOTAL FEE: $ 50 . 00 Owner (s) of Record: Melissa Sousa _ Address : 38 Pitman Street, Fall River, MA 02721 All work shall comply with 780 CMR 6th Ed. (MGL Chap. 143) 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 agent and to receive this permit, I further understand other agencies may have reason to STOP WORK if items under their jurisdic n are not m- ; not withstanding the issuance of this Building\Zoning Permit (p,, D r-' ll Signature of Owner/Agent: � tl 4I ICE J Address: ******************** ** ** * ************************************ Signature: Approved/Issued By: oel S. Reed, Title: Local Building Inspector COMMENTS: PLEASE P ST PERMIT CARD SO THAT IT IS VISIBLE FROM THE STREET. SCHEDULE APPROPRIATE INSPECTIONS AS REQUIRED. UPON COMPLETION OF WORK, FINAL INSPECTION IS REQUIRED. 0 ORIGINAL 0 APPLICANT 0 ASSESSORS 0 CLERK 0 COPY TOWN OF DARTMOUTH 1n2 2 a g, 1r� ns 3 . - BUILDING RECEIPTS j .1 4 ' 4 s ' COLLECTOR'S OFFICE Name: J / F /- � {' Property ) �� Date:. g! / l /�'f f t� ! �d Owner: "' .. CV/ Job Location: f 1/U 4,-7 �,� �• TOWN OF DARTMOUTH ty l COLLECTOR'S OFFICE White Copy-Collectors Office. Plot: �/ 6) / - Lot: 2- 2 _ Yellow Copy-Customer's Receipt. „1 - ,-I Pink Copy-File Copy I;iAy 2 b : 1999 Green Copy-Building Department Phone: `", ;- Description General Ledger#'s Ref.# / ' _ Amount \. License&Permits-Building 01000-44105 F t/ / .93 - G' v License&Permits-Building Misc. 01000-44105 License&Permits-Electrical 01000 44106 License&Permits-Plumbing&Gas 01000-44107 Other Department Revenue 01000-42420 This is not a Permit or License for Building.Plumbing or Gas Received By: 1/f ,!• 1 TOWN OF DARTMOUTH ` 10215 BUILDING RECEIPTS COLLECTOR'S OFFICE - Name: / Pro er o - Date r /li C f �-/✓:�v�;� altp Ownerry. A 1'e-� `'� ‘� j/ + I' t Job Location: - it / 1 .ao / ~- ,.� TOWN to Copy-Collectors Office Plot: J Lot TO�tN OF DARTMO ow Copy-Customer's Receipt ' � ' COLLECTGR'SQFFI ' copy-Pile Copy Green Copy-Building Department Phone: MAR 2 2 1999 / k# 715 Description General Ledger#'s !?��q#G o Amount License&Permits-Building 01000-44105 License&Permits-Building Misc. 01000-44105 d 0 2j/-3 e oral License&Permits-Electrical - 01000-44106 License&Permits-Plumbing&Gas 01000-44107 Other Department Revenue 01000-42420 fj This is not a Permit or License for Building,Plumbing or Gas Received By:,'/ "-.2-- '" L ' -mac-/--r- d J �/, Residential 2UNDATION ONLY 1999 MourFr ,yy` DATE RECEIVED DARTMOUTH BUILDING DEPARTMENT !o �� 400 Slocum Road, P.O. Box 79399 `.. _yam 45 Dartmouth, MA 02747 ` ^=:.:c-7 508-999-0720 FAX 508-999-0738 APPLICATION TO CONSTRUCT,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY D%ELLING ...•........._......... .. ...____..................._._..... k'oXt(IF....I#,SP.::..DX:'i€ :::.::;:<::::;: .::,:.::,: .,.,:: . :..:::.. . . :.. ...._:...:.._.:<,:. �•<!:2< >`>zu> L , %a2s'j! `;::.:;.::: s ftEgra:g !immi ?><:'>5' <<: ::4:,:::,,Ai :.` ;:!:! _!ai�` :_s: 4: :: , ui.: :<:::;.:::(::i i;.:....: RECEIVED ltiy :;... BW il'G PER`<IIT NU BER FQ ;i.0. :L'.k NErt'T ., i'3'iggi i<1:' "I` €:a is ':Iz;:^F aggit.? . R IIEYISW AA11ISSUEA. 7 D1C1 t?ISSUE StCNA FITRLt mm s BATE ....• .. B lMin f asianertlns r of Ratltd...s , ::Z l' `tt.-D..iii nc t ii`i>is :fli pos yitc,". :E E:I:':isiia 2' :". .c.'":'*Ei ':„'I'.'i ii::16 << ::Outgli'e Floo nie::: 0:. iliil Z: ;:!!, A::::' ning District Proposet�Tsa Zone.> >�C...©B 0•.A�II Y Oatstde Flood Zone:' 0 Aquifer Zane : :'ITIE:1<.r3 :G 3t1,44:SPi ig,::§.:.. ._:':::z:::r: :;_><:?:t''' ::z:>;::i:::::::i: : ::3::'> :;'y:: i::r3 >:>i. :::>:><::;r:;.,;: ....�s::::::�:>::::.r.:•.;: :::" . : :":ii _!a ,::i'` :; : , .�: ii:: ' r:, �:i:.¢�. Roan!of C Board of L3von Cori; C Tlernp U Dk Cl Eiee. C`ncrgy R port A eals:+:::3 :<`::: . ..: . :?::s;:::>;:::>:€::1::3::.:1; ..::,.::::;:::;::<:::: :_: ,.e:: '::-.:..res.;:Car<..::>;:<:::;. :;::p ipT ::::is ;:Foit :;::::::: :.::..,FP.•.,... :.::,,:.;:::.:.:..:IiBa[fh;;:.,<.,<.:::...:.:.:::.:...:.::.>:.>:.>::::::.:.::.:::. ..Aida..tt:.:.:.:.:.,:,::.::.:;<:.Aate:fldeires :: :. .. .;:>::>;::>::>::: :. .; . :_ :.:.::. _..........::.:....:..•.::::.. .....:::::: . .•,....:.:.:.. . .:.:•.......__.......:..:...::......::X:.::::::..:,.:..._::.:.:•...::............:._.s.Card.::::.:..:.:.�ut:DfC :::,.:.-...Fotlaw-u :•,:,:;:.;:<:::::.;.-. � > ": E22'�:< '�':': :� �!T' ' : .'i� . <'�'`= ?h : � '.`;!:;:€::: hire Chtet Cl Gas. 0 Plannit g Ll Sewer Card C water Card ©?anutg Ci Other i ntOVIII.ES;INSPEL R'S:R:EVWEW?RERORE T'IIE.ISStL&N0 OP:A PERMIT.:; Zoning Review: Signature: Date: _ Energy Report: Signature: Date: Fire Chief: Signature: Date: Board of Health: Signature: Date: Conservation Commission: Signature: Date: Other: Signature: Date: .:.........:.......... ......... ... 5:::': .:":is:«z1:<:': : s':: ^;::::':z">;sia`;z 5f T[U`il'Ii: 5 Tit IIkRRiSIATIIT: ri':'<> i'::: E'i'::!.: i:,:::::: i::,::;'is.;':ii:i`;::':!`::>i:i'i:'::!;! i!.':::)'<:`: i::r JNUMBER OF PLANS SUBMITTED: SITE PLAN SUBMITTED: ❑yes 0 no 1.1 Property Addrefain `te c� Dr . v 1.2 Assess s Plat&/'Lot Number: Nearest Cross Street. pO Id rai 11P-1i er (�I l/ Plat Pk Lot I3 37 vvvv /Subdivision Name: P&t`Ie(S Ttl.(V'y 1.3 Historical District 0 yes 0 no ,V/ II-Li t I Has application been submitted to the Historic Commission? Total Land Area Sq. Ft.: � ` I 0 yes 0 no Date: 1.4 Water Supply(MGL c 40§54): 1.5 Sewage Disposal System: 0 Municipal0 Private Well 0 Municipal 0 On Site Disposal System FR€3I;1�R: .:. :..::..:.:.:.. .::.:::::::. ::.::::::.:: :::..:.:..: _. �`MI1RSil F:I:hTfi'H+a: ..:::::..::....::-:..,.::..:..:..:. ;:.....::.::::._::;:..:.:.:... I2t.�EI?a��>rrEN'f:::::: ::..:.::::>;'asr:-:?:.:-:::::::':' :::.'::::.:::;:c=::; ... ........ 2.1 Owner of Record:11 11 e11 SSa G yC'1 N.Sa., ontactac Address �,,� L It Name(print) 3 D �)Url�i� �� 1 Q�1 ^taer MR(,SI b 144o4 phone number c:\wpwin\forms\bldgapp.res Page I January 20, 1999 _ • Residential 1999 i2.2 Authorized Agent: j\.\el,ssck Sovkso1/4.) Contact Address Etivat\ S -TikRt,)-Er /4-k 01-1.13 e5tA)(011-Itc64 Name(print) Telephone $E.CTfel*3il»ECOrtSIERATCTIONiURVICE$,idmi*::::,i:i*E ;K:i:::::K:i:x*i*;:i,i:i,i,i,i,x::::i:i:x:m,m,]:i,E:::]8::::::::::x,]*K*i::: :i,]*E 3.1 Licensed Construction Supervisor: Not Applicable 0 Licensed Construction Supervisor License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor: Not Applicable 0 Are you a Home Improvement Contractor subject to(780 CMR-6)? 0 yes 0 no If no,go to the next section! Are you claiming exemption from the requirement? 0 yes 0 no If yes,submit the required affidavit! Company Name Registration Number(if none.state"none") Address Signature Telephone Expiration Date 3.3 For Residential Remodel 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 BE RESPONSIBLE FOR THEIR OWN PROJECT 109.1.1 Licensing of Construction Supervisors: Except for those structures governed by Construction Control in Section 116.0, I effective July 1, 1982,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 promulgated by the BBRS entitled Rules and Regulations for Licensing Construction Supervisors. \ Exception: Any Homeowner performing work for which a Building Permit is required shall be exempt from the provisions of this sectioM provides that if a Homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor. Fcly the purposes of this section only,a"Homeowner"is defmed 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 applyiiander this section sign be ow: Signature: //, //// 1 / our signature ies certain responsibilities, including but not necessarily limited to,general liability c:\wpwin\formsthldgapp.res Page 2 January 20, 1999 Residential 1999 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) EM::'f::E: EgiMna:M:n§t-eIIj6/II;4WWCijiiak%tti.iOENs•Ik:iaOSISNtjnkISttE::AsfnpAv)ttovf000a:szi;fiOgywgmi-dgi;;;;;sisifO .:..-...•.....:::,::::,:.:,:,,,,::.:.>.....•: :...:.:C.:,>:...:.:.;...:.:...:,:.:.:.......:.):“.:.:C...X..“V.W:Y)...::::: :.:6 .::.:',..,:./.,::::,,,::::::...:.:::::::::::.:.::::::::.):::::::::::.:.::::::,.,::::::::::::.:::::.:::::<.:,:::i::(,::::,::;::::::,::i:,:::ti:::::•::*i;:;:::: :X:i:::::::::::::*::,:::,:::,7::::,::::,,,::::::,:,:::::::::::,:, 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: Eyes 0 no in'gMMEgnimiINEN§Caitigit;gti,adifieffeltbkhi §tAWokk(ehgt1t41140011iO4,510)MiNgniflEgEgaft nimmiu::::i:-:i]::::::*:::::::::*:::i::::i*i*:x::.::u:::::*:.:::::E:i :*::::::::::::::::]::::.,,,.:.:.i.i..i.:::::.:.:.:„.:...;:.:.:.:,.:,,::::::i::7:.,::,..:7:,:c.:..;:.:„..::: :,,,,i::.:.i,:.:::;:;E:::E.:_:.i::::::;::ii::i:::];:;:::;..-7:;:::,,,,),:., ::;:.:7:;:.:;:.:::;:;:;:-..:,:.:.:::::::::::::.:.:.:,-.7:::,:,:::::.:.:.:.:.::::]:-::: ::::::::;:-.:::::•:::::::::;::.-..::::.:-::::::::.: 0 new 0 addition 0 alteration 0 repairs 0 chimney/fireplace 0 woodstove construction* 0 deck 0 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 1 no. of baths unit 1 no. of bedrooms unit 2 no. of baths unit 2 Brief Description of Proposed Work: 70)(_ ,O1 , ,ffligifflagg Imoia-R•o•:,fli•.i'i•,,i'i-]E•i•J'0.,•--,MIEli•ittctl.'''.-. •tti..N-4.'I.6HF.i$-....rrA....t4...A--T-EAIHlt'b.Nk•t-k-e.O'...ittitit-tb.•.$tg•-•.'-I-i:•f:IM;i<i;iilii•ii•ii•iiigigni'iin:•]:•:•i•:••,•-;:•:',--;:ii-:•:•:••:•:',••,-:.•,-:•i•,--;-:•Ei:•Ei•:••:',•-:',i:•ii,%:',:iini-::- : :::,:::::::::::::,--;:::;:-:-:-:;:ii*;:iiii,ii,]-H-i:::,:::::*i---i*:::::::::::::.,,,,,,-.,:, Item Estimated Cost($)to be completed by permit applicant 1.Building 2. Electrical 3. Plumbing 4. Mechanical(HVAC) - 5. Total=(1 +2+3+4) * Estimated Total $ StOttil*Zi.gtiMtlitatitiCiitiZATICRIEERMEMinMEMog:immaiigni:EimE EA W MMEN,:iMErAU',,MiNe(tolkvattibletettmiliejttotieogeritweiiitiie4etiie: tiailortiritittitonigtseivitymnumEammimg.: ,, ,, ,,,,,,,,,,w,wm,, ,,,,,,, pleasg,print) // I, I\At\TAS(Ld So kkc ,as Owner of the subject property hereby authorize to acnjnimy 37ehalf„.in all ers relative to ork authorized by this building permit application. . /77/1/111.-gAiii-l-nA-- 3/1/C19 . Signature of Owner Date • iigniEVIEiRMIEIMMENNMESECTION:,.17.13iitOWNER.I.Atat-ORIZEII:ii!iGENT,D- -ClrAftATION]i-:]imi: i:ii:::ii::::gi,:iwi:::::E:mi]E:]:iiii:igii*-,x.::: ::i:R: II the foregoing application are true and accurate,ast Owner/Authorized o the bestofmy n imowAlgeedngtehaenrdebbyeldieefclare that the statements and information Sigtur0 under the pas and penalties of perjury. Rke.\,xts 0, ozA.s&L.> Si a Si e wner/Au o- ...)tie).^-4A---2-/ ed Agent Date e:\wpwin\formaldgapp.res Page 3 January 20, 1999 Residential 1999 SEC +DNB-IN'SP:ECTQR'sREVrtwfca\1). NTs 1. Date plan reviewed: 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: 8. Comments: L6tM9� er�Cz 9 Inspector's Signature: Date __ ll SECTION APPUCA T NOTIFICATION < / Applicant informed of above Date: `>jo J7L� Tune:Y-0c) ,'t( Clerk: Comments: G' s :i.mw i28mx:4#FPICI;IINSPIS K: :: ;3�1© �S Total Permit Fee: $ SOrvC Less Application Fee: $ 25.00 Remaining Balance: $ TOTAL FEE: Gross Area-New Construction total sq. ft. Gross Area-Alteration total sq. ft. Permit Issued To. �f1 �2-e� A 0�-�ct . SECTION II ADDI`TiONNGie'MME,NTSf,SKETCIIES • • • • • c:\wpwin\forms\bldgapp.res Page 4 January 20, 1999 REQUEST FOR ASSIGNIENTTOF HOUSE NUMBER Owner(s) of Property /l e, /iss A C��t l�c �� Present Address 3 ? f T/t/&'L' (sr-- y //,ver X/% Telephone Number \611 P 4' 7z /— //1 3L/ House Location: Plat `7 6 Lot /3- 3 -7 � U d' Subdivision 0 ///fir F ,C/4 Lot 3 7 ' 1fl) \q Corner Lot ?/ /Yes No �(0 A. gars 1 Street � S �,ci(f e__ Sin,le Family v Multi Family Condominium # of Units_ Site P?dn Submitted ? Yes No L- Date Submitted /ign N/ urA-1e o� _ e o r _it4...• 44-tce # House Number Assigned 86 MILLER DR. Date Assigned 3-23-99 Date Assessors Notified 3-23-99 Date Building Dept. Notified 3-23-99 Date Owner Notified St►9e , Department of Public Works f°! Dartmouth Building Department ate 64. 5%i 400 Slocum Road P.O. Box 79399 508-999-0720 Dartmouth, MA 02747 FAX 508-999-0738 STATEMENT OF REQUEST FOR SPECIAL PERMIT PER 780 CMR 111.0 PERMITS I, hereby request a Special Permit pursuant to 780 CMR Section 111.13 for the below described project. I understand that I assume all responsibility for proper compliance of Zoning and 780 CPV1R The State Building Code. This is pursuant to 111.13 Approval in part and will, if required, make any necessary corrections for failure to comply with the applicable code and regulations including but not limited to removal in its entirety of any work performed. !WI Dr\' e� Lo-E, 3"7 Location of Project: — Description of Project: F-011, 0 On On kl _ 4ii Signature of Owner or Authorized Agent Date Excerpt from 780 CMR The Massachusetts State Building Code 6th Edition: I l 1.13 Approval in pan: The building official may issue a permit for the construction of foundations or any other part of a building or snveture before the construction documents for the whole building or structure have been submitted,provided that adequate information and detailed statements have been filed complying with all the pertinent requirements of 780 Ova Work shall be limited to that work approved by the partial approval and further work shall proceed only when the building permit is amended in accordance with 780 OAR 110.13. The holder of such permit for the foundation or other parts of a building or structure shall proceed at the holders own risk with the building operation and without assurance that a permit for the entire building or structure will be granted. c:\wpdocs\forms\speci al.wpd_ r". T-- The Commonwealth of Massachusetts r+E_ ( Department of Industrial Accidents Office 600 Washington Street Boston,Mass. 02111 Workers' .,. Compensation Insurance Affdavit riia i? O�i._tlOn.-.«;.e * � > •I2aS'�'.Ri �" " Firii + .� Y�3`-=Ci aRtc z.�M i sy t,X Y-a srY . `r^a Jame: N\e \1 SS CA S kil S(kJ location: 1\ktI\fccI +_ 'fiVel MtIlccc 0.{' P(11 Lt* Sal "ci b(1ctc ww.`ch I nvn n, c phone# 5o f� i� b1,I--\b 4 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: address: city: phone#: insurance co. policy# 0 I am a sole proprietor,general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name: address: city: - phone#: insurance co. policy# _ company name: address: city: phone#: insurance co, policy'# ,1tifi'adittA sae¢essar s 'rt4 Failure to secure coverage as required under Section 25A of 111GL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or 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. /I//do hereby certif r the pains and penal 'es of perjury that the information provided abo a is true and correct. �Si nature j � �� p� �/�9/I "Print name Mel�sso, 5oi,\ScU '- hrne (5os) Cc-11/4{— b3\{ official use only do not write in this area to he completed by city or town official city or town: permit/license# 0Building Department ['Licensing Board f check if immediate response is required Selectmen's Office ❑Health Department r' contact person: phone it; nOther sN (revised 3,95 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall,not because of such employment be deemed to be an employer. MGL chapter 152 section 25 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 have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all 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 be 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 required to obtain a workers' compensation policy, please call the Department at the number listed below. •• iV4 ^:2�ra,. = { ruo r rat. . .. � .. .r ., s b sw N� .t . . ,., .ram s- . .. ..a .�t City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to 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 questions, please do not hesitate to give us a call. 4r-,Sq," 04:r-ra; , w 7,�r J, r F 7,4 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#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 BUILDING PERMIT 86 MILLERS DRIVE SPECIAL PERMIT PER 780 CMR 111.0 FIELkileRSPECTION Dartmouth Building Derr.tt ;S Plat: 70 400 Slocum Road P j 1• . Lot (s) : 13-37 Dartmouth, MA 027 � Lot Size:46, 192 Telephone (508) 99 • 120 Zone Dist. :SRB ��ii / Issued Date:, /x6 / / Permit No: /A.1 Project Location: 86 Millers Drive Number Street Subdivision Name: Millers Farm -- Lot 37 Nearest Cross Street: Applicant/Agent: Melissa Sousa Contact Person Phone #: (508) 674-1034 Proposed Use: Residential Residential,Commercial,Industrial,etc. Permit Issued To: To Install Type of Improvement,Add,Alter,New Const.,Demo,Land/Move,etc. Foundation only Indicate no.of bedrooms and bathrooms and other rooms Owner(s) of Record: Melissa Sousa Address: 38 Pitman Street, Fall River, MA 02721 DATE TIME TYPE ROFINSSP REMARKS INITIAL BLD. CODE 6! ;��: �n�p N E (yes no) 6-/-9`� 3;S¢ /C' / u�r f � (2, 12.46.6 a'S v -99 z"�f-,44� o� / 2 , 5 , BUILDING PERMIT 86 MILLERS DRIVE SPECIAL PERMIT PER 780 CMR 111.0 Dartmouth Building Department Plat: 70 400 Slocum Road-P.O. Box 79399 Lot (s) : 13-37 Dartmouth, MA 02747 Lot Size:46, 192 Telephone 508-999-0720 Zoning Dist. :SRB March 24, 1999 (t e�ac Permit No. : �Oc� %,� Issued Date: �<, SO/ / / Clerk: BAS Project Location: 86 Millers Drive Number Street Subdivision Name: Millers Farm -- Lot 37 _ Nearest Cross Street: Person Permit Issued To: Melissa Sousa _ Address: 38 Pitman Street, Fall River, MA 02721 _ Applicant/Agent: Same _ Contact Person Phone #: (508) 674-1034 Type of License: Owner: (x) Const. Superv. License #: ( Architect: ( ) Engineer: ( ) Other: ( Proposed Use: Residential Residential,Commercial,Industrial,etc. Permit Issued To: - To Install Type of Improvement,Add,Alter,New Const.,Demo,Land/Move,etc. Foundation Only indicate no.of bedrooms and bathrooms and other rooms — Gross Area of Const. : Cost of Const. $8, 800 . 00 _ Cost-Other Const. : TOTAL FEE: $ 50 . 00 Owner (s) of Record: Melissa Sousa _ Address : 38 Pitman Street, Fall River, MA 02721 All work shall comply with 780 CMR 6th Ed. (MGL Chap. 143) 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 agent and to receive this permit, I further understand other agencies may have reason to STOP WORK if items under their jurisdic r n ace not rat ; not withstanding the issuance of this Building\Zoning Permit p � Signature of Owner/Agent: *4 Address : A ******************** ** ** * * ********************************* Signature: tral Approved/Issued By: oel S. Reed, Title: Local Building Inspector COMMENTS: PLEASE P ST PERMIT CARD SO THAT IT IS VISIBLE FROM THE STREET. SCHEDULE APPROPRIATE INSPECTIONS AS REQUIRED. UPON COMPLETION OF WORK, FINAL INSPECTION IS REQUIRED. 0 ORIGINAL 0 APPLICANT 0 ASSESSORS 0 CLERK 0 COPY