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BP-3359014VEZT' r u�� 2i9.38 I� 47C C t4 vzp-r o I►u�lr`� `�`"e IAc/rC Zt�,9e� l _ IN V,Zi— 2/ 7.3 s��8 5 Zi7, �oZt°� z144,c,q' z 14,¢T Z14,2g 213. 7o -' Rio � ' '� C� (.,) ( —• (i ' � C,a L` 1. z4.1 358 od - 4/ _ T��,�� 4 ��►tJ - \ /� , —c r.f� 0 LX�511ti11. G�f% Too /�I.J,G717?O h Un AT THE BUILDING f�Da! PROGRESS OF THIS URjNG fh� W©RK. ELMD I)CIxou¢h 3 MR. OF Dop RECORD pum CePy Of lis Enjdersed P; an Be r c eri� ®Sifie DateO _I r- rV vae7- )Qr /o9. u'ur� 2l9,15 217 til I!E `� (A�t1 C Zt8.9eo 35 217,,o�10zf°� c 214.23 z 14,¢T 214, zI3.G,o E Z/3 7o E "4 1s7' z4 r$ \� —c � to f�5 - 4—:7 _ ✓,E U1 /' 4� AT Yc?Uii DY lVVJi,t(3 a THE BUILpr�G tv]D� J PROGRESS URI -- fh� TH'S WORK. rowia Dr-PAp Z,M1:NZ 7-51 kllo r�ofo-� OF p,pp�g is p A H ' o x�ooi�o� "COD FLAB A 2VIV. r- 2�g. 34c - Lt7 = 4� CcPY O; Thi.- Endorsed Plan il,,Ivst B. n� a' KePt On Site date `"u, iR9 o'nstrne � o � PRESIDENTIAL 2004 RESIDENTIAL 204 q m.. F m �E a me eae AX1k� i u, .Fe ass,, m 2.1 Owner of Record: �onlcz,s 4&' e. l ,/ram - 1 �Z � k5lt�lf Name (print) Contact Address Phone Number 2.2 Authorized Agent: Contact Address Phone Number Name (print) �a SIiCf1i mrYt"�1 ��re °g a. 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor: Not Applicable ❑ Are yrou a Home Improvement Contractor subject to (780 CMR-6)? ❑ yes ❑ no If no, go to the next section! Are y`ou claiming exemption from the requirement? ❑ yes ❑ 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 W": Owners Name (print) Signature�� 1 that ere will be no eli ibilt to the Guaranty Fund by signing the above, home caner acknowledges t t there g y y Date 3.4 1 Tomeowner 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, 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: An Homeowner performing work for which a Building Permit is required shall be exempt from the provisions of this section; provides that if a P Y P g g 4 P P 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 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 sect, ,gn below: Signature: Your signature carries certain responsibilities, including but not necessarily limited to, general liability ED CONTRACTORS: The Building Code provides in the Rules and Regulations section that an licensed Const . NOTICE TO LICENSED CO O g p g y 1'tuction Supervisor, whether or not they have taken the permit are responsible for code compliance. (see Appendix of 780 CMR R5.2.151) `,,S1 TION 4' ° 1GO�II NS CONTPEN ATION INSURA`l CE' ;AFI+IDAVIT 11IGL C l } 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: ❑ yes ❑ no I• kP"Wop sk,01 , , c e 1 p 1C ? t') =i t.._.._. ue�sna_��a,mti�.d' 4N, ❑ new construction* ❑ addition ❑ alteration ❑ repairs ❑ chimney/ IM woodstove (energy report required) (energy report required) fireplace ui/ ❑ deck V pool ❑ accessory bldg. ❑ replacement window/door ❑ other g 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 ❑ 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 ❑ Hot Water: Gas Electric Fuel Oil Other Brief Description of Proposed Work: ETON 6S D CO -SIN COSTS15 m Item Estimated Cost ($) to be completed by permit applicantt 1 Rnildina ?. F1Pctrical '; Plnmhina 4 MP.chanicnl (HVAC') 5 Total (1 + 2 + 3 + 4) * Estimated Total SECTTOf OWNLI2RizATTtII x (to be ompieted when rwne ;agent or cont> or ppltes favbu drrig pernut} (please print) I, as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date �as� inNkS1 {9 �> O'Nl%R/il,L1TIU)rl% GEIVTD)Eft 1©1V EM 00 �.w 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. Signature of Owner/ uthorized Agent Daft C:\bldg.Forms\Bldgapp.res.wpd Page 2 Rev. January 1, 2003 C:\bldg.forms\Bldgapp.res.wpd Page 3 Rev. January 1, 2003 RESIDENTIAL ❑ FOUNDATION ONLY 525.00 APPLICATION FEE IS NON-REFUNDABLE & NON -TRANSFERABLE 2004 ,-d,8 "� �JE A6:tCi# �lS3Askt� "3°y. ,.?,..a- n%a'w .� .� :.w,. .,.a".°�`vsh,.,,.�.>:a 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): 5. DENIED (see project review worksheet): 6. HOLD reason: Date: Date: Date: 7. HOLD subject to Zoning Board of Appeals action: 8. Comments: Date: 9. Inspector's Signature: �- Date: Ll : �P �n e. � a,., _. _.N'_.. _ _ .__ ,� m,.�a` ... � ®... _.A,mx'�4.e�3m.. .-�.... we.sa„ r:" »k�,m Ii R Applicant informed of above Date: / /Vi Time: Clerk: Comments: !� %Ii t�i����� f 1���l/ 1_�7 ' h � d t y go w B d 20 S d�. t gg� �+5.;,>&.a'. ..m, OMEN�o�w'.d,.. t . .. 9a,. E . �e®S. °! ,za Total Permit Fee: $ ®0 Less Application Fee: $ 25.00 Remaining Balance: $ TOTAL FEE: � e5eq Gross Area - New Construction total sq. ft. Gross Area - Alteration total sq. ft. Pernut Issued To: & (FS P�/t_11 -� RESIDENTIAL 2004 ❑ FOUNDATION ONLY $25.00 APPLICATION FEE IS NON-REFUNDABLE & NON-. TRANSFERABLE l P.;'oK.�"�. DARTMOUTH BUILDING DEPARTMENT).p` DATE RECEr 7ED n\ 1. 400 Slocum Road, P.O. Box 79399 � � : 13 y � .r� � ���� _SyYr Dartmouth, MA 02747 64 508-910-1820 FAX 508-910-1838 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING H SE ir�I IAL ISR #1I. aL �P9 h: volmr rr ,. >b s`a:. e :9 a wltluii(TB[f.A ate... 9M �� ma's b r. �eie."e'iEd ��`� 9s �.. " •.` � �m :. a e ?,.,� ��HeM��I � i� � " ...a, e !. �e� "�� M � a,,. ��+ �..: ;, :� . � �. �i$�, � -k; '� z _ • -:..e .. a:.e may. .. � ., .--....:: ,.e��-� ...-, e.® � :v � _ i� a ram'. e-a. ,C .�� €: m e r �.- bM01 01 Zoning Review: Signature: Date: Energy Report: Signature: Date: Fire Chief: Signature: Date: Board of Health: Signature: Dater Conservation Commission: Signature: Date: Other: Signature: Date: Description of work being performed: NUMBER OF PLANS SUBMITTED: SITE PLAN SUBMITTED: ❑ yes ❑] 1no rj /1� 1.1 PropertyAddress: sa4 (�' � ](� 7"�i ��� / r 1.2 Assessors Plat of Number:. Plat Lot--� � & Nearest Cross Street: P s" y'S Subdivision Name: _5 1.3 Historical District ❑ yes ❑ no Hasa application been PP submitted to the Histr aric Commission? Total Land Area Sq. Ft.: ❑ yes ❑ no Date: 1.4 Water Supply (MGL c 40 § 54): 1.5 Sewage Disposal System: ❑ Municipal V Private Well ❑ Municipal Site; V/On Disposal System C:\bTdg.forms\Bldgapp.res.wpd Page 4 Rev. January 1, 2003 C:\bldg.forms\Bldgapp.res.wpd Page 1 ;/Rev.January� 003 INVERT SCHEDULE TOP OF FOUNDATION 225.96' BLDG. SEWER 222.81' IN TANK 222 56' OUT TANK 222.31' IN D-BOX 221.76' OUT D-BOX 221.56' IN CHAMBER 221.41' ;C� 30 . 38.00 fL3 S Date AS BUILT SWING TIES YiJISR pRA4°ItNG NIv3T vL SEPTIC TANK D-BOX POINT"D" At THE BUILDING, DURING THL PROGRESS OF THIS WORK. A 33.8' PL.T£i:DliyO DEPARTMENT B 17.2' 40.1' 78.2' Town of Dartmouth C 52.7' 90.3' 33.00 I HERBY CERTIFY THIS SYSTEM HAS BEEN BUILT tN SUBSTANTIAL COMPLIANCE WITH THE APPROVED; PLAN, AND MEETS ALL STATES AND LOCAL REGUL/A 77oN I� DATE ?tamp ENG�� 3 �� 145.58 42.1 8 S ROY ENGINEERING AND ASSOCIATES. SCALE: 1"=40' 18 QUARRY STFALL RNER, MA TEL: 508-679-6684 DATE. 3-12-98 PROJECT., LOT#23 MILLERS DRIVE MILLERS FARM SUBD. DARTMOUTH MA s cuENT: ROBERT KFOURY AS BUILT SEWAGE DISPOSAL SYSTEM SHEET: i OF 1 r `RESIDENTIA$ 2004 RESIDENTIAL 2004 „r t}N�mfi*ER gERSH1i'�A I"l�i'110R1AGEN 2.1 Owner of Record: 5 3 Name (print) Contact Address Phone Number, 2.2 Authorized Agent: Contact Address Phone Number Name (print) w ®� a SEC 1L)N 3 r€}STtUCTI{}1SERVIC - m 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor License Number Address Expiration Date Signature Telephone' 3.2 Registered Home Improvement Contractor: Not Applicable ❑ Are you a Home Improvement Contractor subject to (780 CMR-6)? ❑ yes ❑ no If no, go to the next section! Are you claiming exemption from the requirement? ❑ yes ❑ no If yes, submit the required affidavit! Cor_Ipany Name Registration Number (if none, state o 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 Da,v I� DI me-C Owners Name (print) Signature by signing t abo e, 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, 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 Cor:struction Supervisors. Exception: An Homeowner performing work for which a Building Permit is required shall be exempt from the provisions of this -section provides that if a P y P g g 4 P P � 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 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 b Signature: Your signature carries certain responsibilities, including but not necessarily limited to, general liability 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 R5.2.1t`5) r : wW mM �f. x%tl ��� '_a x ' .°��'x �� 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: ❑ yes ❑ no, + �! UICRIPION ( 1'R(�P+C)S18DtiRK1e111)�a °�.x....._. ❑ new construction* ❑ addition ❑ alteration ❑ repairs ❑ chimney/ '❑ woodstove (energy report required) (energy report required) fireplace ❑ deck 'pool ❑ accessory bldg. ❑ replacement window/door ❑ other ❑ 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 ❑ 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 ❑ Hot Water: Gas Electric Fuel Oil Other Brief Description of Proposed Work: �61 a l round pnn i SECTIfib ESQ DI.-C� STRUCTI[fJN COS = xT 4 r?°, daGk ��., xaxn x, Item Estimated Cost ($) to be completed by permit applicant 1 RttilrlinQ �. F ertrirnl I Plttmhinu 4 Marhnnirnl (HVAC) 5. Total = (1 + 2 + 3 + 4) * Estimated Total w � ., T t ° TTON OWNER UTHORIZ ION _NU V t or for b � be diluted owns en f actor � lies €iidtzt per �a � E x, �1�,P®. ,_�� M.,®rem agp ��®, �� ��'.���� �w (please print) I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date §EC OWLItfAVTHiRIi,RD AD1 lT D1tCL1RA1 ION g :re1OB Qflre �., e �a 1, r as Owner/Authorized Agent hereby declare that the statements sand 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. tgnature of Owner/Authorized Agent Efate C:\bldg.forms\Bldgapp.res.wpd Page 2 Rev. January 1, 2003 C:\bldg.forms\Bldgapp.res.wpd Page 3 Rev. January 1, 2003 RESIDENTIAL ❑ FOUNDATION ONLY A25-00 APPLICATION FEE iS NON-REFUNDABLE & NON -TRANSFERABLE 2004 RESIDENTIAL - 2004 ❑ FOUNDATION ONLY $25.00 APPLICATION FEE IS NON-REFUNDABLE & NON -TRANSFERABLE Cil' INPECTt?R, ' OMML+NTS -_ a$G$ a {¢o°ap , OP , •;- ,,`�-'tea_ t a; 5 .�' ,s' �" Rjllzq =:;�: .,..-. 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: Date: 8. Comments: 9. Inspector's Signature: T AI�La" a-, r W I Applicant inform d of above Date: � fd-�° �Time: Clerk: CommVents: se • H 84 e101L_ E � �� ,e ��:MOO$�- ��<u_.,__ ,m$�g..,gy Total Permit Fee: $ Less Application Fee: $ 25.00 Remaining Balance: $ TOTAL FEE: Gross Area - New Construction total sq. ft. Gross Area -Alteration total sq. ft. Penr It Issued To z ` <'V re,r,- l� l c> �` ' ECIY lDDITIONAfl141$KETCHES, 7 �� °"T"'M r " ate. 9s, DARTMOUTH BUILDING DEPARTMENT DATE RECEIV€ D 400 Slocum Road, P.O. Box 79399 f, Dartmouth MA 02747- 508-910-1820 FAX 508-910-1838 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING, 4 one- IS SE(' Ol iCIAVUSE ON Yf M,.�� R1Git B' $ 7 {t DATE SEN IOR� { `, t � > i re�AM,'REV 4 'k cE�° (. '"�4 rta� 1 "� P t• $ R m ° g �3 ®��e BuAtd y qEl �� ,� i.:. F$�5 .....4^:...... F "�*'� �' ��r�e �` m ,.i+"R wa �J w �. NININK5W). IR $.� a r � e " FEZ � IF Com ❑ DPV4x �� �til� $oard+�f _ crt%Gbn. ���� , o- 2 ati°�� ���,r N' "al s a Iilt $ � � Gard Sent Cut Ciif Fo1lrr 4 � $nP ...e-, .�.,�,._- ,�P e_ ,tea._ gi a 00 ENE m_ HiG Zoning Review: Signature: Date: Signature: Date: 7ir1ergyReport: e Chief: Signature: Date: Board of Health: Signature: Date: Conservation Commission: Signature: Date: Other: Signature: Date: Description of work being performed:414P AEG �!� 1§ �l . .:.n m NUMBER OF PLANS SUBMITTED: SITE PLAN SUBMITTED: ❑ yes ❑ no) ~j �� b�'l J� 1.2 Assessors Plat &Lot Number: 1.1 Property Address: 3 YYl [ P r_5 Plat- Lot - Nearest Cross Street: � hn Ve. Subdivision Name: wI, I krs &'Y o 1.3 Historical District ❑ yes ❑ no �t�� Has application been submitted to the Historiie Commission? Total Land Area Sq. Ft.: 5 ❑ yes ❑ no Date: 1.5 Sewage Disposal System: 1.4 Water Supply (MGL c 40 § 54): ❑ Municipal Private Well ❑ Municipal ar6n Site Disposal System C:\bldg.forms\Bldgapp.res.wpd Page 4 Rev. January 1, 2003 C:\bldg.fonns\Bldgapp.res.wpd Page 1 -Rev. J5ry i, 2003