BP-15044—r--T'Y _ 4,."-___. -r--.wr�•. -:� _:.ram ..__/.:. -_: _., < ...: ..... :'a .. - i.44.Y�N l .. - " .. �—+-- - , .^�T.�.''---�:.•l\7-•• _Iit'..�?_'>�>_-_`_—��-
r
- �. -. • r'•^ '. if, -•R ` rat - `` - ::_ - • - - I
A.
• w�- I+yir xz•1+Ta •'-•'X �,R r`j = Yi _. _.5 - _ . - .. -
�• :=r+c .Y�w P i++ 'r.- _y =._�O 001•t Vi-
'�
,K "•-"A`_ • -.4# f_. .• ui -. �:.. 41.
I.�s.. • �F.x.4, ..-. [�. Ar if',r ....-` „y .ip `•G i_.js ...6": a .y •�.. - _
A
-:. A- -. < 3 :-•,-.a� • .v- _r. _. •. •__.: .. ... :;: a. _ _ '�: - fig: _
- ,.t��rz.�y'�• a:, bti� <;�'�'.•�,.. 1,Y'`.- .. a:'T_. � � .�•�.� j„�,F•'S.^._-•_•c:.�
lzz-
Ab
c I
• I
y "Yi
•
: yy
Y yy
r3?++- ..�y y. a. FY„ .:,5, 'Ye•th�_ S - • _ y .-+^•i.` r .. _ G- _
..�421,
•dt •T- iti-• ?y+,-� i' o R• '+• . - .. Y-. - - -
.11
Mom til
bbJJ ,
_ter ra _ .♦ `.T'" 3 . ±,.. ..tee •• _
' in a•-1s {..` _ ',
t+.
vt`
t _
-
1.W .
.R
y
r
} �>a 3••
p max- ,Pi °>t 4 •-
�
�t
Y" P
ti )4
a�
/ ..
r/sYi/ y� :eCA-
5'
•;�VlVr� a 3 - _ tit I
Y -
.=4 ..- . :ram --. -._- ._-..-- _ _ }- - •. !`- •�?:, r-.
SMIMUTE
w>aa A/1\i VYj.Mle a-'1 ri`._ r w:,3� r_. .:'�?'_ _,Y4--ems - -...a':, ?•.d_ Y-,a:_
KIW.fir,_
r
r v. :Y. r. y._ -!^ •s'• .>= r S' it fil
;^ �- -ar Ic,-.Ll"R.'!_ .a-•-• - r- r. • _ -
4
i _r ,.,, .fy..�:. :.:. _�: ..w• �
�3y YvT -.. ;--
�.,.-. .Y.:. TI. •. :� YI. r. -,.r "_� ... _ .• .�... - -� s '�T,� -. .r•� Tt�4. }�'Y': )i l.L_.
' `■f.��- , � �'��L .(ew� �= fy that the sewage shown I►ereon has biaerr -
�.z=ip.constructed In eecordene -
..,,�.UT ` M a with the rules cnd reRulotlon� s•.+�,yi, O j• 3y-qA
♦ #!CE-'-a •rt�. A, __ ( the Dartmouth Board c :-' -� ��
u �,> _ f th M chose le 1
�:-`�:; � .;.,.`x,r � -„+ tts- Tlf ter• Y,-� r ._r,.. � _ , AS UlLT LAN 1N O:_ .. � _ 8 P N DA RMQ UTH M�4" � - • 4 `�•'
�4 �(���' � 'e�.�.- ; �•F'• . ,Lir a .�. ,•r:....r +v :'+F: yr�-:- - P�� N.-
t _S.e:-V
AI
IA.
-VCEN
T •:i ?tc �,; "�aS ,; Y3C•=�^ ? APPROVL ENGINEER
ED BY'
�/�a :G v , ' 37 i -- k- 4, c. • _ I J _ _: .t Y e'.
'-p`�. _'EJ• ,t ^a.ac t'.` _ -•,�:A.- �..-x '' .'+-' -) - 3. a ray' - •=�:, _ - :DMI WN~ MM
1 �� - -.�. f':: f:..,.. "iSY� t. .� w' if/a
SCALE: s�4?�
ti -
�JACK� c` d,,,.. --:kr-�- `�..� 1l OCT �11 -
_ Yn � c 4 •�
h eb er ce` #: rti.
�. f'� >t-
RN :�.•. =:� -;,, y. _ y hat the setback dJmanslons Tye V T ���/♦`per, N//.�� T , D `/�-
�•. s- ':$i+' �:i y.�r t- e." .+s� '?j,. 7, �w %n. �� • «...r„•.: L� a ' ` :'� s R I E i-ii,f'V . ELY Vi�EE-, ING O•.
t� 2sa <s z ,.; ,hereon were determi_ - ,
_ ss y ,.. .�� , .::..- �..� .:; _ y rest u�,!!@4 a - _ ,_
355 UNION 3TR.'ET`1�IEW EEDFOED,:iA 82740
•�� Y 1V
+f'n iti��:AWING NUMBER,
t
Professional Land. Sury o rESS
'�' �: Coaetry Gard i Estates / Lot el6
z
Ov
// ac /�
RESIDENTIAL
2000 RESIDENTIAL
2000
...:::.. .....:.:...;:.:......:.. . .....:..:.....::...
EC710N 2:ri:hti(Qt'Ei�t S-fl4Yl�II tZStit1�1A[ITli4Ri?F�> GENT ..::..,:;.
2.1 Owner of Record:
6(7(13A 61n-� LA= (
I �� l ��Ly C IV S -S<?
Name (print)
--1
Contact Address Phone Number
2.2 Authorized Agent:
Name (print)
Contact Address Phone Number
. ..:::;:.>:::.;:.>::;.>::>::>.::.:.; ........::::...:::..::..... .
;:.;::::.;..:.;:::::.::::.::... .. . . .
.:. .....:::..::.::.:..:.:.:.;:.:.::..:.:...: ;:.:.; .: .
:.»: :: ,.
SEG 1ItiN.. _CQ'rS 1 Ri.0 rIf)lY SERA It F.S::< ..:.:,. .>: ::..:::;;>:; >> . >;>:' :>.:::: ,.;
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!
Com'pany 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
1091.1 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
buildino-n 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.
Excerption: 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 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.
ou a.Te applying under this section sign below:
Ignature:
Your signature carries certain responsibilities, including but not necessarily limited to, general liability
19
NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that any licensed Constrruction
Supervisor, whether or not they have taken the permit are responsible for code compliance. (see Appendix of 780 CMR R5.2.15))
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
❑ new construction* ❑ addition ❑ alteration ❑ repairs ❑ chimney/
(energy report required) Kshea
report required) fireplace
❑ deck ❑ pool sory bldg. ❑ replacement window/door ❑ other
rage) no. of windows doors (specify below)
Cl woodstove
Cl demolition
(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:
Item I Estimated Cost ($) to be completed by permit applicatnt
I, & OA Y 4' 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 ofperjury.
gnature of Owner/Authorized Agent JDate
_ ('U,14fines. \Rldnann.res.wnd Page 2 Rev. January 13, 2000
C:\bldg.forms\Bldgapp.res.wpd
Page 3
Rev. January 13, 2000
RESIDENTIAL 2000
RESIDENTIAL 2000
❑ FOL11rrDAi ION ONLY
$25.00 APPLICATION FEE I5 NON-REFUNDABLE do NON-TRANSFEA- ABLE
1. Date plan reviewed: ems' ✓
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:
7. HOLD subject to Zoning Board of Appeals action:
8. Comments:
Time:/A/J
SECT ION 11; AD ITTON C CON 1iENTSISKETCHES
Clerk:
Date:
:Date:
Date:
Date:
Date:
�" DATE REC11 IVED
°UT'' DARTMOUTH BUILDING DEPARTMENT
400 Slocum Road, P.O. Box 79399
Dartmouth MA 02747
508-999-0720 FAX 508-999-0738
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DV,NELLING
Zoning Review:
Signature:
Date:_
Energy Report:
Signature:
Date:
Fire Chief-
Signature:
Date:
Board of Health:
Signature:
Date:
Conservation Commission:
Signature:
Date:
6�
Other:
Signature:
Date:
Description of work being performed:
NUMBER OF PLANS SUBMITTED: SITE PLAN SUBMITTED: El yes In no
1.2 Assessors Plat & Lo Number: j
1.1 PropertyAddress: Plat_w Lot - r/
Nearest Cross Street:
Subdivision Name: 1.3 Historical District ❑ yes ❑ no
Has application been submitted to the Historic Commission?
Total Land Area Sq. Ft.:�, ❑yes ❑ no Date:
1.4 Water Supply (MGL c 40 § 54): // 1.5 Sewage Disposal System:
❑ Municipal Eio rivate Well ❑ Municipal 5n—ie Disposal System
L
C:\b1dg.forms\B1dgapp.res.wpd Pan 1 Rev. January 13. 2000
C:`,blds..forms\Bldeapp.res.wpd
Page 4 Rev. January 13. 2000