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BP-44612 Permit No. BP-44612 BUILDING -PERMIT GIS#t '` 0.754.00 s �, : .._ � > �m�.,u`ullPosyarl„>ett, .. -,t' 3a'p .:00 4?n � �T1E�T AIYPMOUTI . Lot:`.-. ` " '8117 u =Lox �-�` � -dO,Q$Foglilrt'Roali,Dartmoath,MA 02747 _ Q lND Phone(508p91D 1820-. -Fax:(5,08)910 838 . " -` tegory: P .ject ft i S 0 -00'3f PERMISSION ISI ER YGRANT'ED TO Et.',ost:f ,I 9.;I `e- i ' a xlc e•tl 1 Iti I Contractor: - gg: . -� 2aeh p; a 't Ph,,,„, W q v�.e�.1 ( Y. F "'€+aC"Po AN 't_ ' ep: -- i-. T,� ' m r e frii ,r., : i.aa h i _ Bv. t , b: Engineer -, ��� yrs�t. e > Pbone„,�#a adj a }n '' A licant r .. ' Phone# � FRB -...- t t, �, - RODNEY LAgERGE ,. > :.- - - (598)985.bp73 '3A .a. OwrvER ", qe y ate"'-ed r . 6°04:- 0 7 . ' T&D INC ', — a ., DATE ISSUED: a /y% 7 fyy TO PERFORM THE FOLLOWING WORK: E _ Temporary office trailer for one ,;.r ONLY B ess Name: KRI IES•WRECKING Proje I l ocat n: 1 I 0 D F L RIVER RD Approved/Issued By: ^'4e % y 9--'2 Jo L .REED,DIRECTOR INSPECTIONAL SERVI S All work shall comply with 780 C R 6"H d.(MGL Chap.143)and any other applicable Mass.Laws or odes and plans on file. / SCHEDULE APPROPRIATE I&SP IONS AS REQUIRED. UPON COMPLETION OF WORK,FINAL INSPECTION IS REQUIRED. THIS PERMIT WILL EXPIRE PER 780 CMR. .8(NOT MORE THAN 3 EXTENSIONS WILL BE GRANTED)OR ON ISSUANCE OF 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 undersm : ,ther agencies ma have ason to STOP WORK if items under their jurisdiction are not met; not withstanding the issuance of this B,' :it.g/Zo' g P rmil Signature of Owner/Agen : i� f Le _. A Comments )IE 11T i a 3 e, et . I l,e a-i ® 42.7 I: e t� H MO 5.. �' ®t„t, am s - a 2 .?;_ „met j,�e ® 'f 1.` "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: 4. Treasury: Board of Health E-911 Additional Comments: Planning Board 1 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 v TOWN OF DARTMOUTH ,_, BUILDING RECEIPTS • '" COLLECTORS OFFICE / v Name,, Property _Date: /' t / /, \ ---T "� ,,.�• Owner: 1'ti / Job Location: 4 1 ()OC C. L`-i'df - rictc, rk._I. -.,<-fr iri /g White Copy-Collector's Office Plot: --7 Lot: - Yellow Copy-Customer's Receipt / / —7 4, !cal / Pink Copy-File Copy et ! 1/�' I - Green Copy-Building Department Phone � Q. r Y .2.' i t tlf / Description General Ledger#'s Ref.# / Amount License&Permits-Building 01000-44105 --- License&Permits-Building Misc. 01000-44105 1 f License&Permits-Electrical 01000-44 ,o,.,v e oi+ ..., •,•., J, License&Permits-Plumbing&Gas 01000 441 „ ? Other Department Revenue 01000- 242 yl, y m This is not a Permit or License for Building Plumbing or t as '- eived By: f b� �ti � '� i TOWN OF DARTMOUTH g_ 12 AIBU;LDING RECEIPTS t' COLLECTOR'S OFFICE I Name: �`' .f1} s . r /7 Property I -ss ; i -1` _ Date: ( t, L s/: P h 7 ro? it ; �f.L/� - 'Jl r f-,�-[r'- .._.._- Owner. / se .�,f".'.�/ '-�..._. ! f t - JobLocahon. /sLr�rs` i'Al`J -• t -- u Ii ' �^ � ,�SABtite Copy-Collectors Office /Plot: Lot: �`i L- \7 , - Yellow Copy-Customer's Receipt -t i G./ Pink Copy``Pile Copy ‘'6 , Green Copy Building Department Phone: i}t 't Description General Ledger#'s , Ref.# Amount_ N. License&Permits-Building 01000-44105 \- - ' N License&Permits BuildingMist' 01000-44105 -1/j/ '�" '•_ '����,( JJ// License&Permits-Electrical 01000-44106 '-- - _.--- License&Permits-Plumbing&Gas 01000-44107 Other Department Revenue 01000-42420 1 This is not a Permit or License for Building,Plumbing or Gas Received By: i. COMMERCIAL $25.00 APPLICATION FEE IS NO15-REFUNDABLE&NON-TRANSFERABLE P` ' r F ' J? TE RECEIVED '67 DARTMOUTH BUILDING DEPARTMENT ',` _a'.�. • 400 Slocum Road,P.O.Box 79399 a, '.7 Dartmouth,MA 02747 5 r',j 57 508-910-1820 FAX 508-910-1838 - ` APPLICATION TO CONSTRUCT,REP R,RENOVATE OR DEMOLISH A COMMERCIAL BUILDING(includes 3 or more family dwellings) THI&SECTION OR DFBICL#I.TSSS ONIIr IRECEIXWED$F t IiIIILDINfi�PERIFII'I` Al; .EA DATE SENT:I?OR REVIEI'tr 3 HATE ISSlIEII ono ISSUE sxolr.TlllRE - d IIA'IT JUN 1 2 28% u ding Cornmuswner/.Gtapetturnf trgs Zonrng37rsttiii �;& kr•.. titlse' " Znue. I It CIA CIV Aquifer Zone "" : THEF'OLI OW'It' G GENCIES•'S.I. .. LB BENOTIFIEDr;.: ..: ` C#Boatdof' Itardal Clllenui C3Drw C1Ete o&ergyEeporl Appealx aa1Lh C ir! : titd#s7.I Card.Sent CutOffi,_: ;I+'41tvw+#p": 5 :: !iii y� Cl Eire Cl E;as ': C11?Iauning Cl Server C1 WaYerOard CFNaterlllvislurt g Z,rrnrng Ct Outer Chief Cut Off'. B iiiid" Card I Cut.Cit Crtgu Cdnnecden .Earlea k ' RtQUIRE^a INSPEOYORtS REVIEWBBFORETBE XSSUAN4`E O1 A PERMff TIE li t Yt`lit)ratt nk.g. W Zoning Review: Signature: Date: • Energy Report: Signature: Date: Fire Chief: Signature: Date: Board of Health: Signature: L / iet Date: L/(OZA7 Conservation Commission: Signature: /t//1 Date: Other: Signature: Date: Description of Work Being Performed: :�LX ,>---L-A. 1.1 BER OF PLANS SUBMITTED: 1.2 SITE PLAN SUBMITTED: ❑yes ❑ no 1.3 Property Address: 1.oe-t. OR AOR s.t `d ({t.pwQ 1.4 Assessors Plat&Lot Number: Near rocs Street: /l fici • L vs.Name: ..Zub k krygne# 554-76Sv973 Plat 9/ Lot_it- . Total Land Area Sq. Ft.: •$g -t- A Phan 1.5 Water Supply(MGL c 40§54): 1.6 Sewage Disposal System: • ❑Municipal FiPrivate Well ❑ Municipal lid On Site Disposal System SE ORI TnR04kiiitklYN $HI'/4T3'iliOlRl 'EI;- i fW € 2.1 er of Record: N / % !1 LNG. L 1OC OAJtSfP,w.2r /'4�f. 565 7g7•v573 Name(print) Contact Address Telephone 2.2 A thorized Agent: Rs p NE ti LASEI E J(RI S7/E-r Lv l?�G if/Alt- __________--S /9-mv tc. Name(print) Contact Address Telephone e.\hldo forma\hldoann nom Page 1 rev.March 12.2004 \ t COMMERCIAL . r... sRcrrarr3-eiSig€it al -skiiiide 3.1 Licensed Construction Supervisor: Not Applicable❑ Name of Construction Supervisor License Number Address Expiration Date Signature Telephone SECT[Okt?f wogK a Gb1t4YENS/iZl[i1 INKS:t2ANt'F illFElliaM .iiatGLc iS-rS$2 .. 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(MGL 152 Section 25A)Signed Affidavit Attached: ❑yes ❑no S1gOTION K ngSca€PTr©lsl€iitikti6ttiss,Ir ORICfelttek al€ittppircable?,: ❑ new construction ❑addition 0 0 repairs ❑accessory bldg. (shed/garage) ❑other(specify Sec. 6): 0 demolition 0 sign 0 replacement window/door no. of windows doors SEL"FI•tii*.6 PltbPCCigitinti etter.t3S`E.atsie:t.tittq:ylkRt,E.:k`AiVIffi atat toRr Als1Mtxr,m#a'YI s The following descriptions are based on the Massachusetts State Building 6th Edition,Code Article 3,as noted See the Code ❑ Assembly-restaurant, lounge,theater, school,etc. (see Code Section 302.0) Describe: o Business -office, assembly with less than 50 occupants-indicate Medical or other professional (see Code Section 303.00) o Education-structure for training including child day care for those over 2 years 9 months (see Code Section 304.0) o Factory/Industrial (see Code Section 305.0) ❑ High Hazard-(see Code Section 306.0) ❑ Institutional-hospital,nursing home, infant day care(see Code Section 307.0) o Mercantile-retail stores(see Code Section 308.0) ❑ Residential-three or more family,hotel (see Code Section 309.0) o Storage-includes garage(see Code Section 309.0) '0 Utility&Miscellaneous Structures -includes tents and agricultural structures(see Code Section 311.0) ❑New Tenant-for any of the above,please indicate(see Code Section 119.0 and Zoning By-Law Section 35) ❑Tt or Trailer-temporary purpose? r their:�„ rOp 7ji et iQo� es ribe t proposa briefly, INCLUDE number of dwelling units ynd bedrooms or occupant load as applicable,also existing c dition(if extra space is needed,attach an additional sheet): /2 S. 24 , iv L Thy.0 1) la/6 tc) S l+ 7fn?EO1COiv zrr �QN' WOfx'I fRI� R•M New Construction and/or Addition(total gross cubic feet proposed)-indicate If the project is an addition to existing structure-total gross square feet of existing: ❑Alteration of existing,no increase in gross square feet. A separate Refuse Disposal Declaration is required. Will this project be subject.to CONSTRUCTION CONTROL(over 35,000 cu.ft.) 0 yes 0 no If yes,see Code Section 116.0. Designer to submit Code Synopsis in addition to original plans. Will this project require Peer Review(over 400,000 cu. ft.) 0 yes 0 no(see 110.1 Code&Appendix I) APPLICANT TO PROVIDE PEER REVIEW AT THEIR EXPENSE. SEE 780 CMR. ❑Demolition*-describe structure: Moving* -(provide copy of DPW moving license) * Type of structure: from where(plat/lot or address): to where(plat/lot or address): number of dwelling units:_ number of bedrooms per dwelling unit: \ c:\bldg. fors\bldgapp.com Page 2 rev.March 12,2004 COMMERCIAL ❑ Replacement doors and windows-(for existing only)(only where doors and windows exist and will not be enlarged)EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwelling will be considered as an alteration,otherwise will be included in new construction. (see Code Section 3603.21 for residential and Article 10 for commercial). ❑ Temporary structure-includes,when allowed,trailers,tents and the like and only for limited periods of time. Describe: SEf`flON 8MtC3;Eta(I;C L&PI 1kIAYt.'.r' UE . :: ❑ 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 . SEIn1DlSr SPRINfefERS ANDt6RTMETR-079031b'N . ❑ Required: plans provided plans not provided,why? ❑ Not required,not to be installed,why? SECTICili •j.llEDU RRDIMP4S' REE rARE1 t ffor/Aintagand. ;rchriecti.ttA A.ceess) ❑ Parking plan submitted to: Building Dept. Planning Board date submitted Number of spaces- indoors outside total provided Handicap spaces-required yes no if yes,how many as a part of the total required number Is Route 6 (State Road)entrance permit required? yes no if yes,has it been issued? yes no Submit copy of application and/or permit as soon as available. -:. .. ..... .qr4!"!`loN 11.t7?1F;P - Y#1kI AfiliN 11.1 Architect/Engineer-for overall design / Company Name: Address: Phone#: Certified by State of Massachusetts as: Certification Number: Note:Signatures and seals on all plans, affidavits, &other documents SHALL BE originals and not reproductions. 11.2 Architect/Engineer-project supervision and reports Comp y Name: Addres : / Phone#. // Certified by State of Massachusetts as: Certification Number: �// Note:Signatures and seals on alYpians, affidavits, &other documents SHALL BE originals and not reproductions. 11.3 General Contractor Company Name: Address: Phone#: .."--- Construction Supervisors cense Number Note:Signatures and eats on all plans, affidavits, &other documents SHALL BE originals and not reproductions. c:\bldg.forms\bldgapp.com Page 3 rev.March 12.2004 COMMERCIAL slScrntbrl i�.�.ixrllxr�rntinc. rsrn�uc:r�trrrcasrns _ Item Estimated Cost($)to nearest dollar. To be completed by permit applicant 1. Building 2. Electrical 3. Plumbing 4. Mechanical (HVAC) 5. Total (1 +2+3 +4) Estimated Total Cost Including Labor: $ L aka ': .. d8 s 4 t 'P., 5{, '. t l i is i •k -��, 'd I S..B f 1 Y f , t t l B I I I I _ {• sic (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. .44 Signature of Owner Date `U. /1- ... I, , as Owner/ thorized Agent reby declare that the statements and information o e foregoing application are true and accurate, to the be ge and belief. S': ed un.-r 1 e pains al d pe les .-pe my. =• 6 rr /Q ignature of Own :ent ar Date .. .. ... SflIflN 14 IN'SPRI,'tbk°5 32: `x'1uwf.COMMRN'ffi:..s . . 1. Date plan reviewed: 5. DENIED (see project review worksheet): 2. 30 days to review period expires: Date: 3. OK to issue date: 6. HOLD reason: 4. OK to issue subject to requested submittals(see project Date: review worksheet): Date: 7. HOLD subject to Zoning Board of Appeals action: 8. Comments: 9 Inspector's Signature Date: jUN 1 2 21)116 t't(4Zr... . Applicant informed ofboyge *te . ssc°ItrrN 1fi FIPI t21GIIT ii3t l#;S Total Permit Fee: f��% , Less Application Fee: $25.00 Remaining Balance: Gross Area-New Construction Gross Area-Alteration Permit Issued To: ./Av—t__ fr;1 / 2 4/ r S„ p'/ u JcWia0 C — A,2 do /) *43 c:lbidg. formslbldgapp.com Page 4 rev.March 12,2004 Permit No. BP-44612 Project Location: 600C OLD FALL RIVER RD Commonwealth of(Massachusetts TOWN OF DARTMOUTH eis# ` '1754°° 400 Slocum Road,Dartmouth,MA.02747 Tot: AO 1 Phone: (508)910-1820 Fax: (508)910-1838 Sublot 0000 BUILDIN G PERMIT r f oao Y } BUSINESS NAME:KRISTIES WRECKING :Est.Cosee— ! 510000 0a., FIELD INSPECTION Est crass :1500° ,,,, Tse;Group U Lot Size(sq.ft•) 88.OSA Contractor: License: Phone#: 'Zoning SRB ew Coasts f r ;.Ta Engineer. ', License: Phone#: .,. ' Alt.Const_�",, ; N/A_ '' Applicant: Phone#: RODNEY LABERGE ., (508) 985-0973 OWNER: T &DINC "` i q t� �rrJiii++ DATE ISSUED: 6 I TO PERFORM THE FOLLOWING WORK: Temporary officetrailer for one-year ONLY DATE TIME TYPE OF INSPECTION&REMARKS INITIAL NOV 3 0 2(07 ae, .--r ,1;�`=/ Town of Dartmouth >�� •N^: Board of Health io -Tr . 1 • y? 400 Slocum Road P.O. Box 79399 Dartmouth, MA 02747 O SYY. Ff4.ate, 66: JAN 1 7 2007 Wendy W.Henderson,R.S. Director Thomas W.Hardman,Chair Telephone: 508-910-1804 Linda Motha Fax Telephone: 508-910-1893 Gail Davidson,M.D. Esse papel 6 urn documento legal.E possivel de afectar os seus direitos. Voc€havia de ter a traducao deste documento. Esto es un documento legal que puede afectar sus direchos. Debe traducirlo. January 17, 2007 Rodney LaBerge Kristie's Wrecking, Inc. 600C Old Fall River Road Dartmouth, MA 02747 RE: Kristie's Wrecking Inc./Plat 71, Lot 71, 600C Old Fall River Road/Temporary Trailer with No Restroom Dear Mr. LaBerge: LJ At the Board of Health meeting held on January 17, 2007, the Board again dis7pssed your request for a temporary trailer with no restroom facilities. Originally your plan's were reviewed at the Board of Health meeting of January 3, 2007. At that time, the Board was awaiting a response from Joel Reed, Director of Inspectional Services to determine if he would permit a temporary trailer. Wendy Henderson, Director of Public Health informed the Board that Joel Reed would allow use of the temporary trailer for a one year period. However, since there are employees working in this trailer, it was the unanimous decision of the Board to require that a Port 0 Potty be installed on site for personal use. The Board is aware that the employees usually go home for restroom facilities but if a need arises, the Port 0 Potty would be there for their convenience. Once the Port 0 Potty is on site, please contact this office to verify and then the office staff will sign the application for the temporary trailer. (One year per Zoning Regulations) If you need further clarification relative to this matter, please feel free to contact this office. �ruly r �� DARTMOUTH BOARD OF HEALTH DBH:psd Cc:file Save:G:\HEALTH\PATTI\TitleSvar.&deeds\600CGldFallRiverRd 1172007.temptrailer.doc ` .-yam ` TOWN,Q1'ilimmoitini REQUEST FOR ASSIG'N'M ENT OF HOUSE NUMBER e 0 as, IL Owner(s) of Property ( ) O Present Address O/./ /,C �) id 1 V Telephone Number ,5, _ r ' �j lee A House Locatio • r n v I 'iii IA< \. Plat '�� Lotael 17 Subdivision Lo Lot U Corner Lot? Yes 0 No ❑ Street Single Family ❑ Multi Family ❑ Condominium ❑ # of Units Site Plan Submitted? Yes ElNo ElDate Submitted / � /' Signature of Owne il.(2 (, , „,, y ` House Number Assigned (C me avd 7 : i 7 /a-er, ,/ {e Assigned / / Department of Public Works Engineering Division COMMERCIAL . $25.00 APPLICATION FEE IS NON-REFUNDABLE&NON-TRANSFERABLE °`T'" DARTMOUTH BUILDING DEPARTMENT D41h RECEIVED ` 400 Slocum Road,P.O.Box 79399 Dartmouth,MA 02747 I: 57 "t � 508-910-1820 FAX 508-910-1838 APPLICATION TO CONSTRUCT,REP iCIR RENOVATE OR DEMOLISH A COMMERCIAL BUILDING(includes 3 or more family dwellings) ' ` 'THIS SECTION FOR OFFICIAL USEONLY ti ILECEWED a s `{' r - r nt11LI]INLsrrtR1<'11Ti .,t• &EII Z £: i ljA'i'E SENT ]'OR itE'V11"itf 1 w DAZE SSUEA OX.Tt}ISSUIE.: StGNATUltE { ♦ r DATE :* ,; i 0 i . IIIng `v,,maxuswu rthglectaraf tc #dzags x Zoning Ills.t'1w C n2°i X ed Ilse x�,,, Zone � CtlA L ,guifer Zone IHEFOLLOWINfs CrENCIEWS1• JLDBEitOTWIED -.- QBOatIIQf artlot Y clients Unuw aElet DEIlgIll/Report Appeals - ealtlr tet :; AfMs.urt tCzard Sent Cut 011 Fool41I itp f.I Fxre Cl uas f3 Planning CI.Sewer OWator'Card 01/ltate+r Dxwlsllm Ci_Zoniug C3Other Chl f ,Cut OfI' . Board; Card 1 Cut OK Cross Cvnnectltut MASS* , rR UfltESSfNSPEfrtilesREy.11 im,,,k .ktogE�.i.i IS$UAFC`EOF`APEtt„t .m.ccx NT.A'C fl WV.AL< Zoning Review: Signature: Date: Energy Report: Signature: • Date: Fire Chief: Signature: Date: __ Board of Health: Signature./1 < . Date: �L � ?? Conservation Commission: Signature: /. / Date: 8 &— Other: Signature: Date: Description oi Work BeingPer(ormed: SEEiii©3Q1: SFrEINi`ORRfA7T01i 1.1,XUMBER OF PLANS SUBMITTED: 1.2 SITE PLAN SUBMITTED: 0 yes 0 no { 1.3 Property Address: 4-het-i� o 1c1' f pp` ,,,,,, /r/ 01444 t 1.4 Assessors Plat&Lot Number: NeaarresrCross Street: l'a.. .0? ltic, d.Bfis. Name: v 5 i{t� � e# c, 7515 c57j a Plat ./.7/ Lot Total Land Area Sq.Ft.: Fxl r- i9 C.wa 1.5 Water Supply(MGL c 40 §54): 1.6 Sewage Disposal System: 0 Municipal 12/Private Well 0 Municipal tit:On Site Disposal System SECI`lQN 2 1tROP.ER:F OWN GRSWP f 41.11r llf RIZEi)AGENT' 2.1 O}rner of Record: Name(print) Contact Address Telephone 2.2 Authorized Agent: 00 4o Joel? z��E�Gr A- 11 RIS'TIL'`' IA/ et_tif1Nt- 21Uc_ �'f S ftAu L L Name(print) Contact Address Telephone COMMERCIAL ': ...s is illi r r l�.:t a8rstrxrr' : ,,; c�xtcli,cis Item Estimated Cost($)to nearest dollar. To be completed by permit applicant 1. Building 2. Electrical 3. Plumbing 4. Mechanical(HVAC) / 5. Total=(1 +2+3 +4) Estimated •Total Cost Including Labor: $ /� L/ ..• fiiif'':`!ll, ill bt�S till 71'?'}t'1 T?'lig {Y.tf[ tP�i't/lYf1t Ct{?i17Y1rCT1' SY11RC''i�g)PT i Chr(tl`AlC#lifi ighliTt1Id3T1 .t617Yntj : (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. $174_,ec.C. Signature of Owner 1c Date �+�7 C2 ' ._-. .?tt,f'LCi?Ni3n:,rl�Ui'NTI£litil'1'�EYCziiY1;�J'"�ais`!��`1} imA'1'itft4'.. : -:; �.�. I, . ,as Owner/ orized Agent reby declare that the statements and information o e foregoing application are true and accurate,to the ge and belief. S' edun,-r epains .,dpe ./es . 'pe my. L ' *Mato t i C/liel,6 ignature of Own ent �� Date ": .:.- ."sTSt:'r.IEiaggi t'Sk$f,%'fF12'S. 2F;SFttW't£'_<}ig1XiT:S'?' r 1. Date plan reviewed: 5. DENIED (see project review worksheet): a 2. 30 days to review period expires: Date: 3. OK to issue date: 6. HOLD reason: 4. OK to issue subject to requested submittals(see project Date: review worksheet): Date: 7. HOLD subject to Zoning Board of Appeals action: 8. Comments: 9. Inspector's Signature: Date: i. - ' .... ;' �.: ��..SbX7'[c?1!F`15.:;t7''PT,TK:&�"t'::PtflTihi'f".17'TfiiY'�. >:� :' � Applicant informed of above Date: Time: Clerk: Comments: Total Permit Fee: Less Application Fee: $25.00 Remaining Balance: Gross Area-New Construction • • Gross Area-Alteration Permit Issued To: Si j a p/ &i prorosed 6FF ce li4;l4 act 0-1 -7 1 p _IJ 1 1 1.1 \ _ i / ;cam / /qds :, Se i vz Enficip cc FILE COPY f /v.-„ 3/�r`{'`dt.ire Fit' C �) v e `e Cr1 p'�y ;CC: f��$ En orsed Plan Must Be Key on s. uurrn g Site ff _-__\1/4. � 1 s- c. - r • i waited COh2iv4ERCliAL LEASE AGREEMENT a IC 7y z PG :3 yS LEASE AGREEMENT made this 11"day of Ocotber,2000,by and T&D,Inc..a ssiehusetts corporation with a principal place of business at 600 Old Fall River Road,Da-tniout . l F&s"sa husetts reform. d to as the"LESSOR"and Terence D. LaBerge d/bfa TR t aBerge Wrecking-and • Rodney LaBerge;dtbfa Kristi Wrecking of Old Fall River Road,Dartmouth, Massachusetts. hereinafter referred to as the"LESSEE". 3. USE OF PREMISES: The premises are to be used by the Lessees for the storage of materials, and equ_pment, the removal of any substances deposited upon the land and foi any and all business of the Lessees as maybe required in the usual course of the operation of their business. The Lessee shall be allowed to remove from the land any and all materials, sand, gravel, minerals and the like without remuneration to the LESSOR. The premises are to be used for no other purpose, without prior wr then consent of the LESSOR which consent shall net be uzuteasorably withheld er delayed. The Commonwealth of Massachusetts V' I i i t Department of Industrial Accidents l' Office of Investigations 600 Washington Street ,tiff r t• itl Boston, MA 02111 �V=' r w ww mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):�r,�y,P� ( AD ); `^C • - Address: (---c-x'_ l'� � \\ J City/State/Zi r• _ eN ,._ �. ie Phone #: Q 2-2- - c1c3 • •• you an employer? Ch approprta ibox: Type of project(required): . 1WI am a employer with (.—, 4. 11] I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors ❑ I am a sole proprietor or partner- Iisted on the attached sheet. t 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition w. • : si me in an .•. . workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.1:] Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.'®'Other ��•,op•; \P-C-- comp. insurance required.] *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. tContractors 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: r-s-\\•-< ..• , . � �R rPAcc car —2_,..x',�� Policy#or Self-ins. Lie. #:L)S3 •--- rlyb «lY) ( Expiration Date:\—CA.—Or\ Job Site Address:a City/State/Zip 1. -c'c CM9Thi7 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb ere der the pa• s an enalties of perjury that the information provided above is true and correct Sipnatur • Date: G/r jo6 Phone#: ( -cf- 1- 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#: Information and Instructions "a Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, 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, §25C(6)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%the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"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 out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s)name(s), address(es) and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit 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 give us a call. 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 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.gov/dia =rorr .`.Marilyn Pie c At 'iF&T Ins:.rar.:e Fa:In 781.2.. To ;eane"e !Jet:-O 'Alc ...:...Ho nl:+ -age. A9 1 9RD CERTIFICATE OF LIABILITY INSURANCE :sj;T W I DAa /2t4 0 IPRODUCER I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MF&T Ins. Construction Div.Construction Division 77 Accord Park Drive Unit B-1 Norwell MA 02061 Phone: 781-261-2000 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 1 INSURERS AFFORDING COVERAGE NAIC# INSURED IHE:,,PERT Nautilus Insurance CO. :NS:RER 6 Kristin wrecking, Inc. Corp. -----------__-- ----- --+-- Att; RodneySLeBergEe ^as,.REPc Pall River MA 02723 NSLRERD' INSURER E COVERAGES THE FCLtCIES OF INSURANCE Li ST C BELL V AAA ErEEN ISSC EO TO-HE %SURE:,NAMED AEO‘JE EDP THE POLICY P ROD INDICATED.NOTYBTHSTANONG ANYn.EC_IREMENT TERM OP CONDITION OF:'Y CON R -,.TO.LT:-ER DOCUMENT RESPEC TO,WCH THIS_ERT':FIC TEMA\SE ISSUEO 5P.. PY PERTA N.THE INSURANCE AFFORDED EY TI-E POLICIES DES'C?I'ED HEREIN IS SUBJECT TO AL THE TERh✓5.EXOLLS ONE ANC CONDITIONS OF SUCH Pith: ES.AGGREGATE LTUTS3MOJN MAY HAVE SEEN REDUCED 9"PhiC CLslltS Pall gg ``'�Lc cxpp pp p L4R NSRq TYPE OF INSURANCE ! POLICY NUMBER DATE L'Af ER E I FaTElE1XN110OPfRN' LIMITS GENERAL LIABILITY_ I IEP.CH OCCVRfiENGE £S,OCO,ODD A 'X I COMMPPciA_GENEPALLIASILITY NC37E270 12/30/05 ; 12/30/06 I epef"ieE joH=•. .e 8 SC,00C CLAMS MADE IX CCCOR- 1 MED ETPAn,one P%'sCf; S Jr,000 1 - I :PERSONA_&ADVINIIIRY Si. CC0,000 • GENERAL AGGREGATE $Z ,CCC,OvO OOEEN'L AGGREGATELIA :, APPLIES'E_R i I : PRODUCTS•CCAIP,OP A30 S 2,000,000 I 7j POLICY 7 Wei ^' LOG. I 1 AUTOMOBILE LIABILITY 'AN'YAUTO Ea ScEton • .:OYWNEDA..TCS SW7L1"NYJP.'f I SCHEDULED AUTOS A-; S r-- I HIRED AUTOS :EDGILY INJURY £ �• i NON.O.:NED AUTOS (PH c19an) i 1 j PROPERTY CPWEE S r'-': '!PE acc4ant �'I CARAGE LIABILITY I I AUTO ONLY.Ek ACCIDEN' S I AY'.AUTC - 'r_ EA ADD f OTHER THAN • AUTO ONLY: AOC S EXCESS/UMBRELLALIABILITYj_--- 1 EACH OCCURRENCE S OCCUR 1 I " IADE I AGGREGATE E 5 • DEOVOT.BLE _\ £ 77C :RETENTION ^/ ' B WORKERS COMPENSATION AND 1 i YrLS AIL VIH- EMPLCYERS'LIABILITY , ���/A'`/.-//X`(/II 'CRV LIR+Ri '. E:. ANY PROPRIETORPAATNER.'aYECUTNE /V I E.U.EACH AC .DENH F O'FICEgr. EMSER EXCLUDED" / E.L DISEASE-EA EI.1PLCYEE $ d v6s describe under SPEC A L P HOVI SIGNS DeLLW , ' ELDISEASE-POLICY LIMIT T OTHER yillj • DESCRIPTI TIONS I LOCATIONS.VENIOLES:EXCLUSCNS ADDED DV ENDORSEM ENT'SPECIAL AROVItON: 441 Sawyer St. , New Bedford, MA I I CERTIFICATE HOLDER CANCELLAT;ON _.__._,_-- ----- -- TRENBLA SHOULD ANY OFTHEABCVEOESGRIBIC POLICIES EE CANCELLED BEFORE THE EXPIRATE:NI DATE THEREOF,THE ISSUING INSURERVALI ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABIUTY OF ANY KIND UPON THE INSURER.ITS AGENTS OR REPRESENTATIVES. AUT D REP o TPTS'G.� '� - - t ACORD 20(24G1105) /�� a ACORC CORPORATION ME RightFax Hartford 5/26/2006 6157 PAGE 003/003 Fax Server aM*R11t CERTIFICATE OF INSURANCE DATE.•MM.,YY, I 1HIS CERTIFICATE IS MSSUED AS A MATTER OF INFORMA71ON PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ANISONI s CORC;_R` IN.3 HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND OR LEASANT sT ALTER THE COVERAGE AFFORDED BVTHE POLICIES BELOW. FALL RIVER ;;�, jib%r-_ COMPANIES AFFORDING COVERAGE COMPANY '278C A ?^[BRTCB7; ?'P-Ct TILSIP ,..C' CO^C'AN`' INSURED OCOMPAK° KR. ,...e7 NRECRP:.0 ___ B PC. SOX 5054 D._;MFANV FALL RIVER I4- LL723 C OCMPA NV D ECOVERAQES THIS IS TO CERTIFY THAT THE POLICIES Or INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTAND NO ANY REQUIREMENT TERM CR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THS INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERME, EXCLUSIONS AND CONDITIONS CR SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. COI TYPE OflNSUPANCE PC UV,NUMBER POLICY EFFECTIVE POLICY EXPIRATON L?RI ( DATE(MM•DD.YY) DATE IMM7DNY} LIMITS GENERAL UABIUTY GENERA.A29RECATE S -- CCMMER•AL GENERAL''LAB L-'Y FPCOL CTS C^M•/OP AGG. 15 _. . I CLAIMS MACE) 'I`OCCLP PERSONA_a ADb.INJURY '`5 CP/NERS& NTRAu ORS PRc.I._ EACH 1Vv-=FE.L_ FIRE DAMAGE'PI!,Ln='I'a) I S MEC EXPENSE{Am ona tmse1}I5 AUTOMOBILE LIABILITY COM 31NED 51N'3LE 5 I^ANY ACC LIMN I _ALL UAW ATIOS 93C•L"INJURY I _ECh".7CLED ALTOS t°a'Ps:;:n7 : t RED A:;TOS Il 5C'OIL'IN.L.R 5 N iN.OWNEO ALITCS IPA ACC WM r I FR 3FERT'+JAMA3= Is (GARAGE UABILRY }AYY AUTO A .O ONLY EA A C'DENT ��THcR THANALTOONLV _.• EACH ACCI'JEAT 15 AGGRE3A'.E i 5 P.XOBSS-UABMTY'� EAOS COCWRENCE I- 'UMBREL;A+' M AGGREGATE :S faEI�GN VU ERELLA FIV \ I 7---------- WORKER'S COMPENSATION AND I STATUT::FV LIMNS N!A ?_ EMPLOYER'S LABILITY -'d5SR 2T c.-ii, =. O1-'.]5 !=-G1-(T EACH.AOC:D-N IS ;ll PFp.SIEXE : FJ F TNERdEXECU'IVE IN SASE-POLC1 LIViT 5,. . . C F ..EFS ARE I ERCL OSEASE-EACI EMPLOYEE I 5 _'r,C iiir ALT1;•Ti71J+"•' •. - -r •N': • I• 0 . L . .s .. TIONSSPECAL ITEMS THIS R LACES " Y PRICE. CERT IR'ICA'II: .SSi':EO TO TE•E,. I RTIFICALI NOL DER AFFECTIITG WORII ?S ':Or`.? COVERAGE. SHOULD ANY OF THE ABOVE [ASCRIBED POLIO ES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY PALL ENDEAVOR TO MAIL I 7,0 LA'S WRTt:N NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT PA LORE TO MAIL SLCH NOTICE SHALL ,MPOSE NC OBLIGATION OF. L.ABILITY OP ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES - I AUTHORIZED REPRESENTATIVE i ACORD2$S(SrB3} RD Cp ON-1 Do