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BP-91950 Permit No. BP-91950 BUILDING PERMIT GIS#: 3745.00 Commonwealtlj of Massachusetts Map: 0071 :_ TOWN.OF DARTMOUTH Lot: 0065 '400 Slocum Rod Dartmouth;MA 02747" Sub-Lot: 0000. Phone:.(508)910-1820 o Fax;-(508)910 1838 Category: WINDOWS - ,, , : g • Project# JS-2019-002347 PERMISSION IS JIEPLEBYGIjANflO TO: --'"- Est.Cost: -S12000.00 Contractor: ' i - . License: # Fee: S75.00 DENNIS E COSTA CS 025410 ,z (508)7584010, Const.Class: ; t` $I 154793 ' - Use Group: R3 Engineer: " Lteense f '�':1P�tone# Lot Size(sq.ft.) 30500 .14 Zoning: SRB Applicant: ` P/tone# Aquifer Zone: ZONE 3 - - DENNIS E COSTA _ - 508 758-6010 Flood Zone: ZONE A - ( )( - New Const.: N/A OWNER: BOWDEN JOIN H& Alt.Coast: N/A Date Typed: 04-08-2019 DATE ISSUED: f s - -%' Jk. J1 _ TO PERFORM THE FOLLOWING WORK: Replace two bay windows and one door; SAME SIZE, SAME OPENING , n P °ect Location: 569 OLD FALL RIVER RD r .. IA • Approved/Issued By: '1 _.tv. -/l -a4.bZ 4 �. ;IUD C DAVID BRUNETTE,LOCAL BUILDING INSPECTOR " `�' M All work shall comply with 780 CMR 9"n 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 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 jurisdiction are not met; not withstanding the issuance of this Building/Zoning Permit. -. p/ Signature of Owner/Agent: f( ,ie 1•2 -‘>h "Persons contracting with unregistered contractors do not have access to the guaranty fund(as set forth in MGL c.142A)" Inspector of Inspector of D.P.W.Inspector Building Inspector Inspector of Gas Fire Department Plumbing Wiring Water Service#: 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 TOWN OF DARTMOUTH - BUILDING DEPARTMENT RECEIPT 9 19 30 PHONE: ,55(8=910.1820 FAX 508 910-1838 it _ Name: ,? t Ult-"7' 1 tilk:1f7 ' Propeytyopner: k ' vi'4i "� Date' '%41`,7_ t' 7 .7 . 2 C Job Location: 11 r' f L 11' 141 ' Ad (/ i t LIMP: ! Lot: Description General Ledger#'s ?.ce�ce�f # Amount Building & Building Misc. 01000-44105 ��;r ) ot ,)/ f I..-2/ Cc. 'YE"—fir) Electrical 01000-44106 _ . U. Plumbing & Gas 01000-44107 ~ '��o„ Trench Safety 01000-44129 MCP Other Depai tiuent Revenue 01000-42420 BE�ERt%Jt �J L .� - White-Collector's Office Yellow Copy-Customer's Receipt Pink Copy-Building Department Received By _ L;3-f THIS IS NOT A PERMITILICENSE FOR BUILDING, ELECTRICAL, PLUMBING OR GAS RESIDENTIAL ❑ Phased Approval(R106.3.3) $25.00 APPLICATION FEE IS NON IFE-FLIl41DA1�LE it NON•TIt4NSFEPABLE noy.. DATE RECEIVED 1 �,>::- DARTMOUTH4 BUILDING DEPARTMENT O N; . Io = 400 Slocum Road 3 a Dartmouth, MA 02747 \\°�,,.,�5�% Phone: 508-910-1820 Fax: 508-910-1838 \' www.town.dartmouth.ma.us APPLICATION TO CONSTRUCT EPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING HE A 67'!ON FOR OFFICfAL 1JSE o(7Lx _ �//� RECEIVED BY 1 BUILDINGPERMtf N R GATEISSUE€Y' ` SIGNATEIR `/ G� G v Building Commissionerllnspector of Buitdfrigs Zan>Ft Qfstrrsf t roposed Use Zone, WC p B A o V Aq die r7one THE E'OLLOW[fV AGENtrIES`SNOlULD BE NOT7F(ED D f Cf€3oarc7 of EL Hoard of • ❑Cons, , ' 17 Planning - Address - d"Eggineenng- .-Li Cross Appeals .; keafth Co[i fi}'Nssron _ . . Gard " _ - _ - Conncctiori- p Erre q,Gas ❑Electrrc U Other ❑Water Card .. C Sewer Gard a PC F ` , Chief; `Cuttlff Cutoff _ Cutoff �CuEOfF =Y a k- ;w � �'' 5.3sxx- v x S'+s id ti s « n Board of Health: Signature. r Date. tre ' f > Conservation Commission: Signature: Date. % - D.P.W.: Signature: Date: If Fire Chief: Signature: Date: Other: Signature: Q � �, Date; Brief description of work being performed: 4-1/4 /T� "tom 5E�Toi4 44rfi lF 01T,I©0`:474 14 1.1 operty Address: O L_ � 1.2 Assessors Map&Lot Number ontact Person: Den/IUO C. t, Map / Lot _ hone Number SOP— 97" - 2$S�Z 1.3 Historical District ❑Yes 0 No 1.4 Water Supply(MGL c40 s54): 1.5 Sewage 0 Municipal ❑Al tering more than 25%per side of building ❑ Private Well 0 On Site Disposal System Has application been submitted to the Historic Commission? -r ❑Yes Li No Date: Revised 5/13 CONSTRUCTION PLANS I�I RITF 19I AM f to ..,-„, ®cnnn,- RESIDENTIAL SEET.J ;Kt 3 ARtirojjt''OYMNERtMP/AUTI1d�zeorr +En_:::r� . ..• ./. `... /Owner� Recoatord: 71 ��/&/� /f i` ' '" /�(�/�OL Name-(print) Contact Address Phone Number 2.2 Authorized Agent: Name(print) Contact Address Phone Number -±' 3 ., r-tr�O��� ;�. ..®a-_.,F�UYl�17::�iYI�LV �, 4 ;x. . S� l..V.y,� ... 9:+'.-v�nl C'�. :�.c�ii ra _1. .,;Y �•,.iNf,c+N-1.. .�3"�r � f -r Yr�..M...,=4 .t ...... 3.1 Licensed Construction Supervisor/Specialty License: / 1 Licenseic Number: ( 5 —aassi/O Company Name/Contractor Name: 0�q n /S (,OS/cc i Z1't A JL+eosc. It 1 SC/7?33 Address: ,j RI vier' "// 47 Lt /S€/ /7. Expiration Date: /1C S t��/o2.-�/ Signature: L'v �. � Telephone:5O?-- 751-- O/b r'IC; T/y/19 3.2 Homeowner Exemption-One&Two Family Only Section 110.R5.1.3.1 Exception: FOR HOMEOWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT Exception: My 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 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 he,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: 9 anature: 1 'S.EE'EI 1701110 .F 'ATiaki§0040 010/ fWI.a52.fart ii .: .RiW Worker's 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 .. =., l , ...t s.. 'l ca GTrot S jESCR T 21R atikERWof t g a�€i 'r'q]I� ,_ , ru a ` y �u � fQ� �� 3. �fi+�.$__. ' Pty.., .} .a„�e',:rr+�c?_�" :e..-..'�.5` ❑ Deck 0 Pool 0 Repairs 0 Alteration 0 Chimney/Fireplace 0 Woodstove/Pellet Stove ❑ New Construction* 0 Accessory Bldg. 0 Addition 0 Roofing/Siding Replacement.w5indow/door (Energy report required) (Shed/Garage) (Energy report required) No.of windows n! Doors / 0 DEMOLITION (specify): Location of debris removal (per MGL C.40 Sec 54): 0 Dumpster on site ❑ Dumpster On Street Facility Name: Location: *If new construction, please complete the following: Single Family: No. of Bedrooms No. of Baths Two Family: No of Bedrooms Unit 1 No. of Baths Unit 1 No of Bedrooms Unit 2 No.of Baths Unit 2 ❑Furnace(hot air)-fuel gas(natural or propane),fuel oil,electricity,other(specify): ❑Boiler(heating)-fuel gas(natural or propane),fuel oil,electricity,other(specify): ❑HVAC(combined unit)•primary fuel,natural gas,propane,electricity,other(specify): ❑Air conditioning-(separate unit) - ❑None of the above I42A-1 itAd ❑Hot water: A - , — - - Electric Fuel Oil Other Item Estimated Cost($)to be completed by permit applicant 1. Building 2. Electrical ' 3. Plumbing • 4. Mechanical (HVAC) 5 Total= (1 +2+3+4) ©r�� , � 1/ �=fo 6 c *iet * er r o l ;ag@n or e4 f -di t, or t>kt pe€it4i.a., . , (Please Print) 1, ,,�r ,as Owner of the subject property hereby authorize to ad rijj/beh If, i all m ters relative tq.wdrk authorized by this building permit application. f )17 ' 1 . V INJ�"' L{ f l i ci Signa re.oPOwner Date if it SECrtoNr76 •a iste>3(A>:Inot1a oONIDEetawenON 1 , as Owner/Authorized Agent hereby declare that the statements and information the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of p�rjurry. DMA Vie— 3/29//2 Signature of Owner/Authorized Agent Date � en3N8„0if ethiISP t RS Ltiat- i , s ,.' _ .._ , Less Application Fee:$2540 Remaining Balance: $19 Total Permit Fee: $�� Other$Amount$ 7J Gross Area-New Construction total sq.ft. Gross Area-Alteration otal sq.ft. Permit Issued to: i J Car- -e- d/7 • _L5\4/-te. 3i , ; ga0((7/4) (ploy Beverly Sylvia From: John Bowden <mtc750nd@aol.com> Sent: Monday,April 1, 2019 9:17 AM To: Beverly Sylvia Subject building permit I John H Bowden of 571 Old Fall River Road, am appling for a building permit to replace one bow window, souhside, one bow window east side and one entrance door on northside of my home. Dennis Costa will be doing the work and has my permission to apply for the permit. Need more infor please call 508-889-6615.1 am presently in Florida and returming in a week, Thankyou. John H Bowden 571 Old Fall River Rd. John Bowden mtc75ond@ao1.com REBUILDING MTC#75o 1 The Commonwealth of Massachusetts (t' Department of Industrial Accidents 1 Congress Street, Suite 100 _ Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNHTTING AUTHORITY. `//,/ Applicant Information Please Print Legibly t re (Business/Organization/Individua]): O e{7 n IS �p.S-/a- if Ad ress: 3 Z ��LL► A or ity/State/Zip:P1 4pol3ehtMar t273J Phone #: SO I 75-er 6 0/0 Are you an employer?Check the appropriate box: Type of project(required): I.0 I am a employer with employees(full and/or part-time).* 7. ❑New construction 2 1 am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.(No workers'comp.insurance required.] 9. ❑Demolition 3.0[am a homeowner doing all work myself[No workers'comp.insurance required.]' 10 ❑ Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.D Plumbing repairs or additions 5 tam a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ li.❑Roof repairs, These sub-contractors have employees and have workers'comp.insurances 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[ Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] C+— 4 y v # ' *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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: lC Policy#or Self-ins. Lic.#: Expiration Date: ,,'„ ,,, y//q Address 369 0// hli f(Aiverf State/Zip: 004mi Pia, Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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 $250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certiih under/�er the pains andme penalties ofperjury that the informa ' h provided abo/'je isp true /gnd9correct. re: A --e4tivvrc_.J ( �(�J�L�— Date: 3j 29 J / one#: 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 j 6.Other Contact Person: Phone#: et �•_.: CATe V'oorumonevea ofC� exu'�auael/: . Office of ConsumerAffai43.Business Regufintof, -�. HOME IMPRAVEM QN ,TIa TOR Th', b�:• "TYPE t�uel III� .° ; Registration Expiration -m42,, 04/08/20 9 D NN'IS E COST --; - , 7 tl DENNIS E COSTAt;'�ti 32 RIVER RD. i ARATTAPOISETT,MA t/2739 5 .. Undersecr .. s' Commonwealth of Massachusetts ` • Division of Professional License re t artf of BuildingReg ins and Stan Const� ¢vir I'., `` i. CS-025410 ,.?'- - R ires:,06/23/2020 I • - DENNIS E COSTAE . ' a ' { 32 RIVER RD'�: y MATTAPOISEt&4)A' %P 46/SAS'1364 } ' / Commissioner -'S . iSp o0 o I:: o 0 0 0 0 0 U o 0 e 0 {,' 00 0 0 0 0 .; v 0 0 en Q' vO�D O �O N £^j ` N N ,ST� m y .N+ N t7 it j N tic Z , 5 0". y ty = T ^ O j O nnA'fcc l Q t•.*9'O V O M Cr ,�°o 's� a t V? o ri o � a H y aF, y > 0 C $ vsc� vo i dd J = y v Q00 `oV *' E� - 7 W sts .... h C i h V .] y Q O O o L— ..ri ri Q k. ra 0 0 4W. W C •o } ry,C CO '1 >,0 0, Q S 1... 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' & C o C1 n a o • o a.' m .aI 3 '`^' Yp"' at O n e U, .UV a•. y ,:. eo ce ^p• O ' °a �y' �' S P e Q e � F, C co sg '�� b y `r A , r Fi @N a ' < R : m A .:q m '- C a -,p o o'er nnggooaoennm-zo . omaz a •.� n- o 0 o rna m o o x n .< .< a * n a 0. y i=" o o �o y._,� .. -ice o o A �°a on Q lP sy. <0.�li ate. f0 � nnaa O< oao o m o^ _' c• n<° & -ia P�Trim m o 00o w n`-° y�� o. m � o a z n s nt n 3 0 � � " aw � .1 r'„O € n 3 .��-. 'c a o= g .4- n - yo b b 14 N w Q W -14 h. 3 a ali _ 2 , o0 qt i 4 E ~ O (CO' " a aoa .. z a c r 3 0 0 O M . 0 o a s 'e y Q m C 5 rt ;o A1-4 O W O N O b • 0 d.i W Permit No. BP-91950 Project Location: 569 OLD FALL RIVER RD Commonwe 0_,ea s . Sachusetts sesss.e...®.a.'`is TO %tie° �1i r I Ag ”' 1 4 UTH ses i :��m i ii {R% . 10 : it arir 17‘ i 0 lk to i • 0• Jrj, . • Contra', e: .: %one#• DENNI' 'C ® A V 1 ci, a; `I8)758-6010 Architect: : a°. ;Phone#: Applicant '®� a°, Phone#: DENNIS E CO`+ •:904, a 64 0 °.°e�' (508)758-6010 Ad OWNER: nee.seesees®ees , ®e� BOWDEN JOHN H& r DATE ISSUED: I1( ' /i TO PERFORM THE FOLLOWING WORK: Replace two bay windows and one door; SAME SIZE, SAME OPENING — I - DATE ' TIME I TYPE OF INSPECTION Br REMARKS -INITIAL