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BP-2004-34456 C ^W'•F mil^ �,' 4. d y) C T i Z 1 # T Y 9 C . 1 zo. t, " x 5 ' x r.+t*a - "a,#'r i Y '" F.. v 3 .i R .eznn ,� x - ',�'. Permit No. BP 2004 34456 ,c ' 7"6+ 4, 40 mass "-.,-, r.� ig.tucr c;!� 1 n Y "M ,•' 'lilt , a .ad,Dartmouth, ' ° r 1 Iv'L l . Y € a ,.�.,' �+�p� • ` 08 11-1820 Faz sr c fill, PERMISS III A r" • jo (--• . t / ' a ma 's 0-i* •.1ti4 - 6 y 4 spilt . - ,�rt,� Y Contractor. • 0 ' :� d # , : '.RISES i-: `"(S 763-1950 1 I .e: w91/4 `: EDgineer s p _ 4ta 's a. ✓ s:�".a g �q '' e# Ir.S o, (r f Applicant: :„ �^y 11), '�4 r Z ! ., 11 KRISTINE SO`' .10 se` t;. �," se ' 508)672-6053 -�'ea • • eq,ree' SOUSA MANUEL °s*a 'J 6 6 aee+ �`` • eeeaaaewe®ese'ee DATE ISSUED. 6 d S U- 'T TO PERFORM THE FOLLOWING WORK: 24 foot round above ground swimming pool with a ladder enclosed by a four foot fence with a self closing/latching gate PER MASS STATE BUILDING CODE - BUILDING PERMIT ' Project Location: 82 MILLERS DR -1 Approved/IssuedBy: l -" LYNWOOD R.COMSTOCK,LOCAL BUILDING INSPECTOR All work shall comply with 780 CMR 6T Ed.(MGL Chap. 143) and any other applicable Mass.Lawlor Codes and plans on file. POST THIS CARD SO IT IS VISIBLE FROM THE STREET SCHEDULE APPROPRIATE INSPECTIONS AS REQUIRED. UPON COMPLETION OF WORK, FINAL INSPECTION IS REQUIRED. THIS PERMIT WILL EXPIRE PER 780 CMR 111.7(NOT MORE THAN 3 EXTENSIONS WILL BE GRANTED)OR ON ISSUANCE OE A REGULAR OCCUPANCY PERMIT. 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 TOP WORK if i II under their jurisdiction are not met; not withstanding the issuance oft, : iiding/Zoning P 'i . Signature of Owner/Agent: I I'd ` /�� Comments: / "Persons contracting with unregistered contractors do not have access to the guaranty fund(as set forth in MG'.c.142A)" REPLACEMENT FEE WILL BE REQUIRED FOR LOST SIGNATURE CA TOWN OF DARTMOUTH 34456 BUILDING RECEIPTS V COLLECTOR'S OFFICE �-' q ,. Name • '41 // � n j, a� `- r ert .j ..2 ,--• Date: 4? ffP. _ !,' 1 /��� y� , Owner: .�� nu, f � " � Job Location: }( . i _ 1 ` f^ i� , i. F'--- - TO hot IMIli i',,T ? _ r ,� / l i Whi e Copy-Collectors Office Plot 1 7) Lot: F, — ..? /�'; Yellow Copy-Customer's Receipt ` ✓ / ' �.d L P nk Copy.-File Copy Green Copy-Building Department Phone: Description General Ledger#'s Ref.# /' Amount License&Permits-Building 01000-44105 (4- ' 7 if - _ ( ': E T License&Permits-Building Misc. 01000-44105 I License&Permits-Electrical 01000-44106 License&Permits-.Plumbing&Gas 01000-44107 Other Department Revenue 01000-42420 ''i 1 A .-mot. This is not a Permit or License for Building.Plumbing or Gas Received By: `/ !, i RESIDENTIAL ❑ FOUNDATION ONLY , 2004 $25.00 APPLICATION FEE IS NON-REFUNDABLE & NON-TRANSFERABLE r ¢a.= \: DARTMOUTH BUILDING DEPARTMENT DART:' DA1'hRtED 400 Slocum Road, P.O. Box 79399 21114 Sid 1 o Ail 10: 1 4 �`� >. Dartmouth, MA 02747 `�� 508-910-1820 FAX 508-910-1838 APPLICATION TO CONSTRUCT, REPAIR,RE VATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING T ON/FOR `OFFICIAL USE ONLY RECE D BY: -BUILDING PERMIT- DATE SENT FOR REVIEW: —/ — D� DATE ISSUED: 2 ?� � OK TO ISSUE- SIGNATURE: cCsee DATE Q�'1 B ' Commissioner/Ins�for of Buildings Zoning Distrir ••t 8Proposed Use: Zone: C ❑B ❑A 0 V Outside Flood Zone 0 Aquifer Zo / THE FOLLOWING AGENCIES SHOULD BE NOTIFIED: a Board of r}'`Baard of ❑-Con.Com.. ❑Demo 0 DPW 0 Elec. zq Energy Report , Appeals Health Affidavit Card Sent: Cut Off - ,Follow-upx, ' .` o Fire= ' ' ` 0 Gas 0 Planning Board* ❑Sewer Card 0 Water Card s. ,. Pr oning�L,,,d Other, u Chief _ Cut Off /Cut Off 1 Cut Off` „ ' ' , "„�'Reyiew*s,. . , ."5. N.. n'x :."... 4. �`,•�b m REQUIRES INSPECTOR'S REVIEW BEFORE THE ISSUANCE OFF PERMPL...* .*g .` "gg ",,,,rC"° `'t", DEPARTMENTAL APPROVAL - s . , * a & e 4s r< ,,'o _+. =o :a"..x . .� i. �. m= Zoning Review: Signature: Date: Energy Report: Signature: Date: Fire Chief: Signature: / / Date: • of Health: Signature: J1A( Date: Conservation Commission: Signature: Date: Other: Signature: ) I el, Date: Description of work being performed: //' 1i(O� V r SECTION 1-SITE I? ORMAfON y ;, : x !`" ti NUMBER OF PLANS SUBMITTED: SITE PLAN SUBMITTED: 1 yes 0�� n noyy � 1.2 Assessors Plat&Lot Number: 13' 3p 1.1 Property Address: b A l I\e,rS 1 ACI ti(i . n Plat Lot Nearest Cross Street: Cla f-A(1 i tJt (- NOOtCt �', 11 1.3 Historical District ❑ yes btto Subdivision Name: i 'eif,S Ev1RIM , :� Has application been submitted to the Historic Commission? Total Land Area Sq. Ft.: '-A 1� yes ❑ no Date: 1.4 Water Supply (MGL c 40§54): 1.5 Sewage Disposal System: Municipal uyrrivate Well 0 Municipal. On Site Disposal System C:\bldg.forms\Bldgapp:res.wpd Page 1 Rev.January 1,2003 RESIDENTIAL 2004 "a.e. sxh r ' s ;p li a r � ( y � i '� �.onmwnme+..1***.?tellMralsxn9.aaikateamaW.a.�r+ t ;• .. . a.mtmo�Vat"ti:$x4";+�;-ces Pd ce +b ., , . ea 4 2.1 Owner of Record: IS— NIIIAe. �O3sO Sa tvIllt•etrs abk02i4,093 Name(print) Contact Address Phone Number 2.2 Authorized Agent: Name(print) Contact Address Phone Number rig. w a eivi "a 'L 40 ::`Y ays rentttaaraw .a m^ ytl:ro+�+$" _.,o-�. n �" ,. ..v..;wc^.kssx - .,,... s '+kz�k.v��m :. r,.«rna&5k.6 vna 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 o Are you a Home Improvement Contractor subject to (780 CMR-6)? 0 yes o no If no,go to the next section! Are you claiming exemption from the requirement? ❑yes 0 no If yes, submit the required affidavit! Company Name Registration Number(if none, state 0 noneo) 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:z�Hoo Improvement Contrac ors Registration, One Ashburton Place-Room 1301,Boston,MA 02108, (617)727-8598 Ow rs Name{print) (ri(�7�nf SOL)C -- ign re /r. itAdI NUL St ^���J[�-- by ' ning e home owner acknowledges that tktere will be no eligibilty to the Guaranty Fund ate a 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 Construction Supervisors. 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 p poses 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' ,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 tha one home in a two-year period shall not be considered a Homeowner. I yo are app yi under lis section si'�(u\.1�lelow: /Signature: k ),�1. J -- Your signature carries certain responsibilities,including but not necessarily limited to,general liability C:\bldg.forms\Bldgapp.res.wpd Page 2 Rev.January 1,2003 RESIDENTIAL 2004 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) SECTION 4-WORKER'S..COMPENSATION INSURANCE AFFIDAVIT(MGL C 152§ 25) 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: 0 yes 0 no SECTION 5 -DESCRIPTION OF PROPOSED WORK(check all applicable) ❑ new construction* 0 addition ❑ alteration 0 repairs 0 chimney/ ❑ woodstove (energy report required) (energy report required) fireplace ❑ deck pool ❑ accessory bldg. 0 replacement window/door 0 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 I 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 Dese lion of Proposed Work: a'.:° `. * SECTON-6"asnivarkb"coNsiratittiON COSTS F Item Estimated Cost($)to be completed by pemut applicant 1 Rnildiner 2 Flertriral 3 Plnmhinv ❑ Merhaniral (HVAC'1 5.Total=(1 +2+3 +4) *Estimated Total $ d O0 —� . d 4 '41 . • I k o sTION 7itaLY WR AUTHORIZA s � � ' 4to be completed'rvit..eii owner's at'enlor contractor app4es4for building phi tt)"' •' (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 SECTION"7B-OWNER/ADTIIORIZED AGENT.SDECLARATION I, '�"fr155h D e 71 J c�� 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. � al iota Signature f Owner/Authorize Agent Date C:\bldg.forms\Bldgapp.res.wpd Page 3 Rev.January 1,2003 RESIDENTIAL 2004 0 FOUNDATION ONLY $25.00 APPLICATION FEE IS NON-REFUNDABLE & NON-TRANSFERABLE 3 ar "m 's w .. K .. '' r a a. = ..,�.. � �.:#� _` ,§zxCTIQN$--INSPECTOR'S REVIEW/COMMENTS -. . I. Date plan reviewed: (c/e4/63 Q- 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: N Dater/t¢�EV TION 9//JJAP CANT NOTIFICATION Applicant informed o !aM`vee // O' I Time: Clerkt Comments: +! v i ( SECTION 10- OFFICECTOR'S NOTES c Total Permit Fee: $ 4 5 Less Application Fee: $ 25.00 Re aining Balance: $ TOTAL FEE: Gross Area-New Construction total sq. ft. �//� �/ /� Gross Area-Alter tion total sq. ft. Permit Issued To: O / / /7 4 C/ 0 7J e,a t/ , ' SECTION 11 -ADDITIONM..COMMENTS/ T- S C:\bldg.forms\Bldgapp.res.wpd Page 4 Rev.January 1,2003 I 'ermit No. BP-2004-34456 Project Location: 82 MILLERS DR Commonwealth o.f Massachusetts TOWN OF_DARTMOUTH Isn# - 6s20o1 400 Slocum Road,Dartmouth.MA 02747 _,a:dgf 0013� a A fr" Phone: (508)910-1820 (508).910 1838 :l � , m j r :BUILDING PERMIT ,� t�• , t 6p Est Bost a "S2Q00"A - t FIELD INSPECTION y er. 25.0. yy , Contraetor: License: Phone#: a iys R r pl�z NARCISOENTERPRISES NC ( 08) 763-1950 0 i t27° -1 SRB" , Engineer: ., License: Phone#: �r • 1IeVCOicat. NIA Applicant: Phone#: - Qa r 1tl/ x R KRISTINE SOUSA (508)672-6053 1 ��F : raa „sole,„ � i .; OWNER: '' r '• ,pa, c M ae rir' °Oil"! SOUSA MANUEL & ,GIazin *. ,,;," " N sear,: DATE ISSUED: 1�1771Il y TO PERFORM THE FOLLOWING WORK: 24 foot round above ground swimming pool with a ladder enclosed by a four foot fence with a self closing/latching gate PER MASS STAFE BUILDING CODE DATE TIME __ TYPE OF INSPECTION&REMARKS INITIAL k A -fib /A. r o . erfill,4n_ JUN-23-2004—WED 10: 28 AM QUEBECOR WORLD FAX No, 508 880 5574 P, 001/001 u .c. v, , .J • �4 .. . y:u.9.f.y'F V'4.„µ.rq r. , #36 \ $50 00 THE COMMONWEALTH qr MASSACHtJ E`FI S Town of Dartmouth-Award of Health Type of Pool Above Ground Pool Location: Plat 70;':Lot 1S-38, #82 Miller Drive Owner. Kristine Sousa, Contractor Narcisco,P.O:.13ox'680,Freetown,MA .. Date 11.1....gn 18,2004 MU TRU LEDASDESCRIBED11 4T APPLICATION N F012 THE'SWuvSNll1VGPOOL • atoqr • /7 w id_ 7 e of Applicant t: • I THE COMMONWrEALTH OF MASSACHUSETTS Town of Dartmouth-Board of Health kType of Pool Above Ground Pool Location:-- • - Plat 70, Lot 13-38, #82 Miller Drive -'- Owner: '. - Kristine Sousa Contractor Narcisco, P.O. Box 680,Freetown, MA Date Tune 18,2004 1 THIS POOL MUST BE S!RUC I ED AS DESCRIBED IN THE APPLI & ON FOR THE SWIMMINGPOOL / :/ /, r , Q,} tl( NYT 1 �► ) i 9iy r i atureofApplicant '% ,T,. ._ fj1\ r' t` i L �i �� �.k3 .ar`t a ..i zr 4at— ��a' h E' i� '�'. ` "'�`S`S'3s'� -c -,at'-� � �3. —'s°"� i. • _ - xvF'.�= `—� - 4 2 ".' 4- s,1 t"r 1 ".-;"f.' iRS St e*-: 3a �. ' " . rX�- { e1' + 43 Y ) SSvPet' ' '< p-Yx t- Er A�v a< h . Tz rn K r ,4 za ,, ,' i. s , -2,,i�- S. (u.N c . Please attach a plan indicating locations of house, septic system, reserve area, pool, and accessory a structures. Plans must also show lot dimensions and approximate distances between o�ol and house ,-'s septic system, property line, and•accessory,structures. If there..is no plan on file, please use the space ,_, above. - SETBACK REQUIREMENTS(MINIMUM): POOL TO SEPTIC TANK:: - 10' POOL TO FOUNDATION: � t o'_, POOL TO LEACHING AREA - 20' POOL TO BUILDING SHED, GARAGE, ETC:-' ` 10'` APPLICANTS SIGNATURE. `AO— �t 1,( _ DATE: V l'011 DATE SUBMITTED:`° it .__APPLICATION APPROVED: - - APPLICATION DISAPPROVED: INSP.: - - C:\MSOFFICE\WINWORD\ORIG\POOLAPP.DOCJ,g. -- - c,"` �"` The Commonwealth of Massachusetts {Ind.."-.--fat i_ . ▪ -t-- Mirail Uin ▪ - ___� ;:' 600 Washington Street `"a_' '' Boston,Mass. 02111 \�i,_ Workers' Corn ensation Insurance Affidavit-General Businesses ry //// ,/j// // „ rods,,,,, ,,/,/,iiai�a//idol,/ s - iaZeZz.. ,.,ff I.7,i;1//A 7 41i ,: name: — address: — city state: S: phone .'-' — work site location (full address): — ❑ I am a sole proprietor and have no one Business Type: 0 Retail❑ Restaurant/BarfEating Establishment e:cr14-lig in any capacity. ❑ Office 0 Sales(including Real Estate, Autos etc.) ❑ I am an employer with employees (full &part time). ❑ Other 6,72,',G'/'%O/%///%/%////%//%,/,/%//%,.///%%%%%%%%/%%%%//%%%%//%%//%//%///%/%%/%%///%/////////%///%//%////%//i////////////,%%%%/6%/%%%%/%/%/%%/%%///%/O%/%/%///////% %//.% I am an employer+^ providing weorkers' compensation}r�� for (myCem�pl�ooyees workjng on this job. comnany name: NCI Cl ` ct /Jc0 `^yil rp` 1 s s inc, address: Pt 0. Boy O `1 0 /�Q �1 ^� g U — city: Lca,Sr Free town 1' A Oe9-71 7 (� nhone#: SO S- 7 63 - 19SO insurance co.Ann er't Ce. ✓1 If0Wie [ 1SSUk1 Ct"(l `0nolicv# e ? 6/0, ❑ I am a sole proprietor and have hired the independent contactors listed below who have the following workers' compensation polices: com➢any name: address: - city: phone#: insurance co. oolicv# • comnanv name: address: — phone#: insurance co. policy# r.-y"; rehs 'g4;2/,/ / /i ' 7, 7 0 , ti .// . . 7/., Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 31,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 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. 1 do hereby certi er the pains and allies ofpe^u" that the information provided above is true and correct c- Siggnature - , Date Print name Ca e(OS 0 Q f 1 S 0Phone# 30 g' 7 6 S 19 5 0 gofficial me only do not write In this area to be completed by city or town official bcity or town: permit/license# ❑Bonding Department r. ❑Licensing Board H ❑check if immediate response is required ❑Selectmen's Office 1 liealth Department .� contact person: phone#; Other totvaed seat DN) j 3 • ' yj ) Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston. Massachusetts.02108 Home Improvement Contractor Registration Registration: 117031 Type: Private Corporation Expiration: 8/17/2004 NARCISO ENTERPRISES, INC CARLOS NARCISO P.O. BOX 680 EAST FREETOWN, MA 02717 Update Address and return card. Mark reason for change. --- _._ Address Renewal Employment Lost Card nt v.7. nee. * o �Sv �� rM 1lF�fi^"f ♦ ti •I`l .l l o-�✓ V. � z1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit - name: V1cc Sousa.., - C 1 n&}SIn location: Oct 01111 of 5 1 ,)}�}c i 't. /� city: 11tIK�t�Vlt�vf� �rf phone# 5'O 'Y ( 'J .I.0 ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity. '• ' • • y� x •z o� x" ' tsa" ' k¢ VIEWS m °Z° . swS « w So 33r Y�x RswxsY e An a M• ea ❑ I am an employer providing workers' compensation for my employees working on this job. P 5 i 5 cctnpah Hattie „atldreaS g'; •r'. .,.:; x .: .'.,:: :!: i .., ? u.a: y ( Y l • sty phnnr 4 ini`f3r,�nCP Cc(3° �: hY pnl3£y# r • t`�.... ,s.,:t c'�,mf,�Yr�'e ^ „9".,.�^r ;.�¢;..w.b ¢a s n+.µ5`.fib„ °?xae ...,^9. �`:+n,A��'9. .. ¢;el.W,Po•,.. .,.L.e ° $'� c;: " am a sole proprietor, general contactor, or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation policies: ydtsm�raely sfamd �}�pp �� i•F�{/3a:it'?+f.^ �a s x xJt ¢ • address. �F k .. f ( x L Gtty' 4 ffeetxu>;. x �t phot�te# -" � g . iltetiaixe ti9 '� I 'r t >hpolit '# L -: �°y8s`$''��$n4 C �¢is' 3a&�x' x � ws+a 9 "P Rd Y '$ °¢�S gg55''6% 8 k:a`�' fix "i r N^ '4 x,+n .f x r ¢ a 5ar ` NJ etli � s a ft b6 ` �. �`¢)�L�C'("s a>a e S.utxFiFFa Qy"�'mi'fi l"Z�� .x WaS .gh �saroY .`i aa°,F'}"'3 `�'$ L�Y, S +Y a%� iy 4 5 G R SH uA 'address a e i5o 5 M ance-W x policy# ^x wx • ¢x,.w;x+n u:¢.x3w x I 2s� `knerr: � g �1wY mart, _ xnmw „;..:aeititk gS, Kqi:ffi ie :, ,5:: *i l r . . t .n.`�wh i • Failure to secure coverage as required under Section 25A of MGL 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.verifiication. I do hereby ce ' that under the pains and penalties of pezjury that the information provided above is true and correct. Signature: r f l Q '�A Aqi — Date Print Name: d<P'`I -EI AT-)-) (}(J,S()k- Phone # 4 col Z tp():-C official use only do not write in this area to be completed by city or town official cityor town: ❑Building Department permit/license # ❑Licensing Board CIcheck if immediate response is required ❑Selectmen's Office OHealth Department ❑Other contact person: phone # • 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 com- monwealth for any applicant who has not produced acceptable evidence of compliance with the insur ance 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 insur- ance requirements of this chapter have been presented to the contracting authority. .a s ,,,, 'd y,:»4.C>Zut a ?'y�"a esr to fs s,�3Eet"4m'E:x'- sfl a tia t x l a4 k� °a�iD a ix 9 Fi S,3eynawi°uw n>x�it > p S d¢>�,. is s a sttis^a a a s x: s�5' t y t.3 n£x s mate S B . '��.t Q�Du�x✓e`��a�°> .»k'S�Rg>' &�z&,. a st�t oi.e .&>R td\e�dig .w s 5 fy Ct � a» t n'T g ag o «e.�: .D�.S:P s.,.......... A.S...:n>r.i a..�,s...SY, ��.m:a, ax "ds v�A»Efr.°eSe:'�'£kas>�Hw";u �"9»w•..m.+.ow�.».w.asC�:m"�- +�M�¢.m�a,.......,��e,.,,xw,ud�G.o-,.,�. �a,w�odi�ag.m. 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. `�> 7.ssWeeMs„s>y+3 z: :.w rpy st M, t xte."ce. »,i ,» ,fit .8'"�s> is Ss xi °(». :> '�'. h xa. 'we. . "a�V 4 i E'"E'' `agM sa. fit»•-'" n ., .aien�. xx 'a : $' 58e„�a P a$"'a'4Xat e a•�'z' w> ""°�s »v;K:D"'F;a"r. �e�.aob'Y:9.a k� 'A4.�°3o'rra.¢«ws>4�Sz��:,-:ars.`,yi ,...,..:u..^�A�.msa,ds✓.�'w. d`��.�.f�'��',. o .» «xtc�t�' -i� aiE.acm a�u ._,�,.. 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,your cooperation,and should you have any questions, please do not hesitate to call. M-.: � a » �.ta,FF s4r � � nti a g Vargie, rant"s's F 3.a s�s ap 'i t n p» a sw L,:..-T o.s a.m xf,&.....v> ✓v�. S`3.........a se ai. ..,x.. ai:a:S.. .,e4,.ne g,..;;;f.. e.Xse tw. zik,....x:r E„�:'?`6w The Department's address, telephone, and fax number The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409, or 375 25A�\ Lot 38 42,734 S.F.± TOP OF FOUNDATION h19h= 216.7 low: 210.7 �• 1- r i1 L: c 9200us M W FR OR/I e L: 140.96' V< 6 O C STOCKDRAFTING FORM NO.101-61 � � 31�T DAM POOH • „ r4 RECORD PLAN A Copy Of This Endorsed C 73 Plan Most Be Kept On Site Dunn. Construction Date ? S .� - i 3- 38 &- - 9 /� h x �4i• /y; Lot 37 ul .W O 7` D(, TOWN OF DARTMOUTH RECORD PLAN a��µzH0FmAs ti A Copy Of This Endorsed ° KENRc' . Plan Must Be Kept On Site f o H Dudg Co strut ' ,Art'• +s / ©ate i sTot.'� FOUNDATION AS-BUILT PLAN SCALE In _ 30' APPROVED BY DRAWN BY DATE 5-26-99' R� $SREVISED LOT 38, MILLERS FARM, DIARTMOUTH, MA. KENNETH R. FERREIRA ENGINEERING, INC. DRAWING NUMBER 46 FOSTER STREET, NEW BEDFORD, MA. 02740 I SE 6514.38A —