BP-692 BUILDING PERMIT
FIELD INSPECTION
Dartmouth Building Department Plat : 76
400 Slocum Road-P. O. Box 9399 Lot (s) : 24-2
North Dartmouth, MA 02747 Lot Size : 40, 097
Telephone 508-999-0720 Zone Dist. : SRA
Issued Date: 06/04/93 Permit No. : 692
Project Location: 2 Shingle Island Lane
Nvaber• Street
Subdivision Name: Shingle Island Estates Lot 16
Nearest Cross Street : off Collins Corner Road
Applicant/Agent : Herbert S. Wilkinson III
Contact Person Phone #: ( ) 508-998-9084
Proposed Use : residential
Reeldentlal. Commercial. Industrial. sec.
Permit Issued To: New Construction
Type of Ieproveeent, Add, Alter, New Coast.. Ouo. Land/Move. etc.
16' X 20' Deck (320 sq. ft. )
MODULAR DWELLING
Indicate no. of bedreo.s end bathrooms end other roost
Ownerts) of Record: Hebert S. Wilkinson, III
Address : 2 Shingle Island Lane, North Dartmouth, MA 02747
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BUILDING PERMIT
Dartmouth Building Department Plat : 76
400 Slocum Road-P. O. Box 9399 Lot (s) : 24-2
North Dartmouth, MA 02747 Lot Size : 40, 097
Telephone 508-999-0720 Zoning Dist. : SRA
June 1, 1993 (typed) Permit No. : 692
Issued Date : 06 ,04 /93 Clerk : lls
Project Location : 2 Shingle Island Lane
Number Street
Subdivision Name : Shingle Island Estates - Lot 16
Nearest Cross Street : off Collins Corner Road
Applicant/Agent : Herbert S. Wilkinson III
Address : 2 Shingle Island Lane, North Dartmouth, MA 02747
Contact Person Phone #: ( ) 508-998-9084
Type of License : Owner: (x) Const. Superv. License #: (
Architect : ( ) Engineer: ( ) Other: (
Proposed Use: Residential
Residential, Commercial, Industrial, etc.
Permit Issued To : New Construction
Type of Improvement, Add, Alter, New Const., Demo, Land/Move, etc.
16' X 20' Deck
indicate no. of bedrooms and bathrooms and other rooms
Gross Area of Const. : 320 sq. ft. Cost of Const. $ 500. 00
Cost-Other Const. : TOTAL FEE: $ 40. 00
Owner (s) of Record : Herbert S. Wilkinson, III
_Address : 2 Shingle Island Lane, North Dartmouth, MA 02747
All work shall comply with 780 CMR 5th Ed. (MGL Chap. 142) and any
other applicable Mass. Laws or codes and plans on file.
I hereby certify that the proposed work is authorized by the owner
of record and I have been authorized the o er to make this
application as his Agent : igd`a en /t
Signature of Owner/Agent : ii�L,, '�C //'
Address : -�
*************************************�tt**************************
Signature : 7/ '2 il.
Approved/Issued By: William A. Braga, Loct1 Building Inspector
COMME S: MODULAR DWELLING
ORIGINAL ❑ APPLICANT ❑ ASSESSORS ❑ CLERK ❑ COPY
Au I Lb- „1: NG IE 14 Of i ?
Lo.4rtmouth i3uildino Departinent , rPat :, 7(.•400 Slocum Road-P. O. BOK c.) .19( 1 Lot (4) g ;7:-P•. -2 i
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Worth Dartmouth, NA 02747 i Lrt Si29 ,1 4.:i. s.'Or-,,, 7
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tel. eohonu 50(3-44T10-0720 i Zoning P ;r4tp : sRrH
Is . 1,,n3 ( i,,yped) Pormil. tie. t cr.__
1imd pate ,: (16 .-Q4 /93 Clork .! its
Projeet LocatJon 2 CylPiwlillez _ kt,Liand Laoe
Subdivt5-,ion Nell -
dearest CrOO'!). S'Areott off Colkins Cornet; Roars
cartinuent : Herb lkinson III
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Curiaci: Perpimn Poop 4r ( 50e-9.9e-90P,o• .
vir,. of. Lic9o9u !! (.7}4Frur: (h) Cunst „ 5urv. LIcen4e #7 (
flchitect ,.[ ) Engnor ,, ( Othrpz C
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Proposed U4f,r:. R(,_.( idonti/A1
ri;t:idct, ‘'.: eacta,r,.;4a!, !na,:ttr)a?., uLc.
Per4Ht if:.. .-,uod Ti: ,i, New Con(i-itr‘wtion
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inCIC.Itv} ng, e? Iflaiem4 d4',11 Pxithrt,ila acid *thor w,6:,o%
- Gross Cw-ea of Contit „ : -:„3:,-421Ap, Lt„. Cost. of Crilht , $ 50h71, f‘5t:i.
Cost-Other Conr.t „ : TOTiqi. FEE t 3
........ ....._ ....
Oihmer (s) of Record : _ Herbert E,‘. Wilkinson,
_Wdd-4,e(55 2 Shinnie Island Lario,. North D.?rtiphoth. VW 0,2747
hOi work shall comply 'nth 7130 CNA 5th Eth (MGi,.. Chap. -luF,H, .5.?...nr•! any
other applirble 1-7L1 ,-. Law4 or code,,,. Auld piano on fiTir .
hpreby certify that the proposed wort,: Is author toe tau u4.iper
or record an0 I hove been authoried by the owner tc. 1,ie-!t.P.e $,hihs
appliction as hts authorized agent , .• ,. .,
Siqflo.ture of OwnehplAg(e-n.tt ( •••<••• • r h; •••- i• •• -(..h-P' '
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OMMENTE:. NODOLP f,' DWEL L. T N (3
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Required approval Approvals received
please IX) approvals Please IX) approvals and
required for thin project Initial as received
DATE INITIALS
Board of Appeals -
Rater Card
Sever Card
Board of Health
Bond
Selectaen
Conservation
Fire Chief
Cross Connections
Licensed Contractor
Controlled Conet. Aft Id.
Other information required — _
'ivir-' -.- PERMIT NO.
14
'' °°` TOWN OF DARTMOUTH DATE ISSUED `y
w"' ir0 �` r. 1 TOTALn / g CO�3ST a _
z\ ` c' APPLICATION FOR LESS APPLYCATION FEE�s0--
°r. d- %? BUILDING PERMIT'
FINAL PERMIT FEE /5: `'t
LOCATION OF BUILDING / • /_ / / /7 n
01 Number & Street ���/?/hl'/t"' 5/-,> !�✓���� 01.1 Zoning District 5/C Yt
02 Cross Streets(between)J/ 7 �J///1 SI CO.^tJl'I" I/�,and
03 Lota 7--a Plat l 6' 04 Subdivision Lot
OWNERSHIP COST
05 A1 Private (individual, corporation, 36 Cost of Improvement 5O0, CYO
non-profit institution, etc.) 36.1 To be installed but not
06 ❑ Public (Federal, State, or local government) included in the above cost
TYPE OF CONSTRUCTION 36.2 Electrical
07 ❑ New Construction 36.3 Plumbing
08 El ,;.Addition -Type of Room(s) ea C"K 36.4 HVAC
09 Alteration ' X c
a 36.5 Other - Specify
10 ❑ Foundation Only / example: elevator cc;
11 ❑ Demolition (#of units if residential) 37 TOTAL ^' co
12 ❑ Moving (relocation)
STRUCTURE O
STATISTICS 38 X1 Wood Frame Co m
13 Number of Bedrooms 39 ❑ Masonry (wall bearing) N 0
14 Number of Bathrooms (Total) 40 ❑ Structural Steel =- _a
' Full-Tub 41 ❑ Reinforced concrete r m
3/4 - Shower 42 ❑ Other - Specify
1/2 - Toilet Only C) c-g
RESIDENTIAL-PROPOSED USE DIMENSIONS v CO
15 ❑ One-Family 43 Number of stories y
16 ❑ Two or more families 44 Total square feet of floor area, all floors, � 7
Number of units based on exterior dimensions • 702r 0
17 ❑ Garage
18 ❑ Shed 45 Total land area, square feet0 0J 17
19 El Carport
20 10 Swimming Pool SEWAGE DISPOSAL
In-Ground Above-Ground
21 ❑ Woodstove // 46 ❑ Public or private company
22 ❑ Fireplace 47 O'Private (septic tank, etc.
23 Other- Specify ��� C.
'
WATER SUPPLY
48 ❑ Public or private company
NON-RESIDENTIAL - PROPOSED USE 49 ❑✓'Private, (well, cistern)
24 *Amusement, recreational 25 ❑ Church, other religious PRINCIPAL TYPE OF HEATING FUEL l
26 ❑ Industrial 50 ❑ Gas
27 ❑ Parking Garage 51 ❑ Oil '
28 ❑ Service station, Repair garage 52 ❑ Electricity
29 ❑ Hospital, institutional 53 ❑ Coal
30 ❑ Office, bank, professional 54 ❑ Other - Specify
31 ❑ Public utility
32 ❑ School, library, other educational TYPE OF MECHANICAL
33 ❑ Stores, mercantile 55 Will there be central air conditionin ? ❑Yes ❑ No
34 ❑ Tanks, towers 56 Will there be an elevator? g
35 ❑ Other- Specify ❑Yes . ID No
PARKING PER ZONING BY-LAWS i
57 ❑ Enclosed 58 ❑ Outside •
:.. 4
59 Does this building contain asbestos? ❑ YES $ NO If yes complete the following:
Name & Address of Asbestos Removal Firm:
IDENTIFICATION • To be completed by all applicants// PLEASE PRINT/
44 1 r k//j 60 Owner (print)/ — i, sa7g-oi.a i��/.7 mW S'—i-95O e7
N _ MAILING ADDRESS
61 Signature A�4 TELEPHONE NO.DATE )-9-7
Builder's
62 Contractor (print) License No.
NAME MAILING ADDRESS TELEPHONE NO.
63 Signature DATE
64 Architect or Engineer (print)
NAME MAILING ADDRESS TELEPHONE NO.
65 Signature DATE
CERTIFICATION TO PERFORM WORK
66 I/We hereby appoint
NAME ADDRESS
as my/our agent for the purpose of applying for and obtaining a building permit for the work to be done described in this
application.
Signature DATE
ADDITIONAL INFORMATION
67 Has A-1 or Determination been issued by Conservation Commission? ❑ YES ❑ NO
Submit copy of notification sent to DEQE and the State Dept. of Labor Industries and result of air sample analysis after
asbestos removal is complete.
68 Owner or Agent - I certify under peril of the penalties of perjury that the information herein is accurate to the best of
my knowledge.
�� „ - 3 r
Signature DATE ��/�
Owner or Agent
69 BOARD OF HEALTH REVIEW DATE
Inspector or Authorized Person
COMMENTS:
70 DPW - WATER Service No. SEWER Service No.
To be completed upon issuance of permit- (if applicable)
St
71 I will post permit and ad es9so as to .- isible from street. t
Signature DATE
Owner or Agent
72 I have received list of required inspections
Signature DATE
Owner or Agent
Are,, you a Nose Improvement Contractor subject to the NOTICE
registration lam 1780 CDR - 6)? Yes NO PERSONS CONTRACTING WITH UNREGESTERSD CONTRACTORS DO ROT HARE
ACCESS TO THE GUARANTY FUND (780 CDR - 6)
Are you claiming an exemption from the law by home owner sign-
off? Yea NO (if yes submit required signed affidavit)
QUESTIONS or complaints? Call or write:
YOUR COOPERATION IS GREATLY APPRECIATED) Home Improvement Contractor Registration
One Ashburton Place - Room 1301
Your Sig, Date Boston,DA 02108
(617) 727-8598
-- -
RECEIPT FOR PERMIT
TOWN OF DARTMOUTH
OUT
'PERMIT NO.
0
Date
,
Received From
Owner e_ , ,
Type
Amount Paid
Received,By - - -
_ _ __
RECEIPT FOR PERMIT
)
ourn.,y TOWN OF DARTMOUTH 49 r.' ,.
l'rm PERMIT NO.
e4
Date ,f,jl ,7 / 7 ->
F .,.
_ Ii /
Received From
Owner
._.
¢ i
Location r._ �,:• ( `_��
Type _- P -V C
Amount Paid Si,
hi
Received By - -'
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E COMMONWEALTH OF MASSACHUSETTS
tr..
' Ea=Ea DEPARTMENT OF INDUSTRIAL ACCIDENTS
i 600 WASHINGTON STREET
James Gamine': BOSTON, MASSACHUSETTS 02111
connsstoner
WORKERS' COMPENSATION INSURANCE AFFIDAVIT
I,
(licensee/permirtee)
with a principal place of business/residence at: •
(City/State/Zip)
do hereby certify, under the pains and penalties of perjury, that:
[ ) I am an employer providing the following workers' compensation coverage for my employees working on this
job.
Insurance Company Policy Number
[ ] I am a sole proprietor and have no one working for me.
[ 3 I am a sole proprietor, general contractor or homeowner (circle one)and have hired the contractors listed below
who have the following workers' compensation insurance polities
Name of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number
I
Name of Contractor Insurance Company/Policy Number
XI am a homeowner performing all the work myself
NOTE! Please be aware that while homeowners who employ persons to do maintenance.conatmetion or repair work on a
dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are not generally
considered to be employers under the Workers' Compensation Act(GL C. 152,sea. 1(5)),application by a homeowner for a license
or permit may evidence the legal status of an employer under the Workers'Compensation Act.
I understand that a copy of this statement will be forwarded to the Deparnnent of Industrial Accidents'Office of Insurance for coverage
verification and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to S]500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of S 100.00 a day against
me.
Signed-this�� %///" r/ •11—I'i day of / 19 g/_Y
Licensee/Permiaee Licttuor/Permittor
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TOWN OF DARTMOUTH BUILDING DEPARTMENT
TO: r/
I I Board of Health ❑ Fire Chief Dist. 1, 2, 3
EreConservation Comm. ❑ DPW Engineering
❑ Selectmen-Licensing ❑ DPW Water/Sewer
❑ Board of Appeals ❑ Planning Board
❑ Town Clerk ❑ Other
❑ Police Department _ Other
The following is forwarded to your office for your information
only - no response is required.
The Building Department is in receipt of an application for
Plat Lot �^ o� , Address
�/J . �
by 6/r-' GLi -1 to ,¢a Q-e- '` f� z_c.lC ,
owner/aeplieant demo,cansuuct,alter,occupy,etc.
a (n)
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The plan was received by this office on 6 /" fl .
date
This office will review said plans and subject to availability
• of potable water, where required, the provisions of Zoning By-law
per MGL Chapter 40A and MSBC 780 CMR 5th Edition will have
available to issue or will deny a permit for the above-mentioned
work within 30 days of date of receipt.
The applicant has been advised that your office as indicated
above may require them to apply for licenses or permits subject to
your jurisdiction and that they should contact your office, as
indicated, for specific information.
It is not necessary to respond to this notice unless there is
a specific issue at hand or you wish to forward material or
information required for permitting. When required, an Occupancy
Permit will not be issued until all Town Agencies have had the
opportunity to "sign off" that the work under their jurisdiction is
complete to their satisfaction.
To The Applicant:
Be advised that this notice will be sent to the Agencies
checked above as they may have separate jurisdiction for your
project. Any questions about the Agencies Regulations & Policy
should be addressed to the individual Agency.
Your signature�only acknowledges your receipt of a copy of
this/ e jp��Gf/G7 //
APPLICANT DATE
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70� P/NE 'QUAD /SCgND
Pp �, {�
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G LOCUS
LOCUS PLAN
(NO .SCALE)
LOT 15
NOTE:
1. PROPERTY LINE INFORMATION IS TAKEN FROM
A PLAN ENTITLED "SHINGLE ISLAND ESTATES
SUBDIVISION OF LAND FOR ASM REALTY, INC.
IN DARTMOUTH, MA SCALE 1 "=40' '
REVISED DEC. 28, 1588 BY G.A.F. ENGINEERING, INS.
ON FILE AT THE BRISTOL COUNTY REGISTRY OF DEEDS
(SD) IN PLAN BK. 122, PAGE 65.
Ij
a w
ve
C;7 5�
iL E 0 4f
AS -BUILT FOUNDATION PLAN,
OF Ys 4 I tLLV.= 1UU.UU (ASSUMLU) I
r La
LOT 16 SHINGLE ISLAND ESTATES
DARTMOU.TH, MA PREPARED FOR
CUSTOM MODULAR HOMES`
SCALE: 1" = 30' DATE: SEPT. 22, 1992 MAUK., BOUCHER & HEUREUX, INC.
R , Z3 I !7"' CIVIL ENGINEERS AND LAND SURVEYORS
WILLIAM I. MORSE, P.L.S. DATE 648A AMERICAN LEGION H''WY WESTPORT, MA 02790
MA REG. NO. 27296 TEL.(508)636-5905 FAX(508)636-2477
DWN. BY: MAB 'PR0,1 NO.: 149- 11 DWG. NO.: 149- 1102