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BP-493 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 : 03/17/93 Permit No. : 493 Project Location: 2 Shingle Island Road Number 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 Residential. Ceuorclm'. Industrial. etc. Permit Issued To: Alterations-Complete unfinished second floor. Typo of 1.prcvevnt. Add, Alter. Ne., Conet., Demo. Lend/Move, etc. Finish bedrooms/bath and den. Indicate no. of bedroom* and bethrooee and other roost Owner (s) of Record : Herbert S. Wilkinson III Address: 2 Shingle Island Road, North Dartmouth, MA 02747 ..: : . . . :•. .h�::::::::::...:....`fk?b flF ::I:M"aPECT:�L1N :;: HkiC{Rf?kCU :::::::::::: L114T::IAL:::; Q c773 /'`r- e/d-?3 friar 7) e_k ,0A //? t C-7b--lS/ ®//✓ 6-r -1.>fr BUILDING PERM I T 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 March 17, 1993 (typed) Permit No. : 493 Issued Date: 03/ 17/ 93 Clerk: lls Project Location : 2 Shingle Island Lane Nuabor 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 Aaeidential, Commercial, Induttrtal, atm. Permit Issued To : Alteration Type of Iapravuent, Add, Alter. New Const., Demo, land/Move, etc. - - --- -. = -fi-n -sh.-bedrooms, bath and den--an 2nd floor -- - indicate no. of bedrooms and bathrooms and other rocat Gross Area of Const. : 1040 sq. ft. Cost of Const. $1, 000. 00 Cost-Other Const. : TOTAL FEE: $ 62. 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 by t e own to make this application as his authorized ag'e�t /,/ , �/� e_-__Signature of Owner/Agent : yx v`VG �‘5L?-- 11 Address : ************************************* **************************** Signature : 6.4 'T.-__.._- rz- S,� Approved/Issued By: William A. Braga, Locfil Building Inspector COMMENTS: MODULAR DWELLING II '�� ORIGINAL 0 APPLICANT 0 ASSESSORS 0 CLERK 0 COPY • -,E0A ;4) , 0.:(m041(tmth Butictiou imt.•potfLmmmt iPi.(00 400 c: m .Ruirtti•••p.., m, (,(fttt - 1 NortM Umitrtmouth, NA Mi2747 Tet ion - 21l IZ c-5;;51 t M.:mm-mh t7, ic.fFt3 ti ‘tpme..-0 170 _ 1 5.; ...„(3. 1_1?L. Smbdtv ( cion Nammt ftilamt-.) Etttatt:o.: - Luc fo Neo,mo(it: Amott0(, Stmoett • . _ Apt.00.4: H( tAgen* : H€tff.)o-5-10. AdOce(-0, L r,ajLL ht pi;L. • Petmt.,ofl tmhone a % (. 7.4.(tameir0,-,-(teMmt. Tyro cP 1.0.0:emme ; 10nem: L0.0((mmo 4-0 . • Proput...mti 05ttz Rmstdoot- Cmt. Ammlictt. (00(,001 To : s,t, Area td Comt of Com0,- - - Cos1:01t.-hec Cat. .: 0.0M0_ mt_ml m 00mm,( C.i: ) of Pm:comd, atim,2•,,m,, idrc1ss ct. :4-7 Ail 0ocid. shmil comply with 780 CMi( OtU-: other applicmtble :4FAGFH. Low . mm modem ,mod m (tmt.. on f0tft , hermbv c&cticv thmt -futM:ocizfot oy fro,- omtmpm ;•:(pc! ',J.-i::: ;7 ;7. i;21 S, :71;1 Cl a 0. n i 5e;ci 0 f431L , •- - Addrm•••s :, StHftPomt Pry ': W1110mm f(o. Mut11:-.0 ft:0tdimm ft , :00- tot Cf.M• 1.0 "t..• -1 % %"%1%. %;% % . fri (..-0',4,(M-AMMOPE: V 1.'.1 imm Required approval Approvals received please (XI approvals Please (II approvals and required for this project Initial as received DATE INITIALS Board of Appeals Rater Card Sever Card • Board of Health Bond Selectmen �a Conservation Fire Chief Cross Connections Licensed Contractor Controlled Const. Affid. Other information required ,r_ ,L a c 1'H.1/a,,, PERMIT NO. 7/ . • 14.t.* `E °°`° 's�) TOWN OF DARTMOUTH DATE ISSUED 3//7/4 `� q44 i 1V /�` TOTAL COST %s �T , , y �: APPLICATION FOR y�? LESS APPLICATION FEE ��`G °kt s?' BUILDING PERMIT c ` 884' FINAL PERMIT FEE Ir LOCATION OF BUILDING 01 Number & Street a /S�-h5 f/hi /)p 01.1 Zoning District i 21 02 Cross Streets(between) L°�///7° r Cohnt-Ths ' and ��^ 03 Lo8 ? Plat [I 04 Subdivision Lot OWNERSHIP COST 05 Private (individual, corporation, 36 Cost of Improvement "/©OD, oO non-profit institution, etc.) 36.1 To be installed but not 06 ❑ Public (Federal, State, or local government) included in the above cost / 7/ j�,yoro'1 TYPE OF CONSTRUCTION 36.2 Electrical 07 ❑ New Construction C. 36.3 Plumbingyt/Uafl` O 08 �,/Addition -Type of Rooms) 5 d a-�� 36.4 HVAC 09 IV klteration 7—te,,:fj - ' -d- I 11 36.5 Other - Specify 10 ❑ Foundation Only <.1-'h1- r'-ic-es---- example: elevator 11 ❑ Demolition (#of units if residential) 37 TOTAL 12 ❑ Moving (relocation) STRUCTURE STATISTICS 38 XI Wood Frame 13 Number of Bedrooms 1. 39 ❑ Masonry (wall bearing) 14 Number of Bathrooms (Total) / 40 ❑ Structural Steel Full-Tub 41 ❑ Reinforced concrete 3/4 - Shower / 42 ❑ Other - Specify 1/2 - Toilet Only RESIDENTIAL-PROPOSED USE DIMENSIONS 15 Al One-Family 43 - Number of stories 16 ❑ Two or more families 44 Total square feet of floor area, all floors, Number of units based on exterior dimensions Jo 9'0 17 ❑ Garage 18 IDShed 45 Total land area, square feet �.Q7 3 19 ❑ Carport 20 ❑ Swimming Pool SEWAGE DISPOSAL In-Ground Above-Ground 21 ❑ Woodstove 46 ❑ Public or private company 22 ❑ Fireplace 47 .M Private (septic tank, etc.) 23 ❑ Other - Specify_ - WATER SUPPLY 48 ❑ Public or private company NON-RESIDENTIAL - PROPOSED USE 49 AlPrivate, (well, cistern) 24 ❑ Amusement, recreational 25 ❑ Church, other religious PRINCIPAL TYPE OF HEATING FUEL 26 ❑ Industrial 50 ❑ Gas 27 ❑ Parking Garage 51 MOH 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 conditioning? ❑ Yes XNo 34 ❑ Tanks, towers 56 Will there be an elevator? ❑Yes . Np 35 ❑ Other- Specify PARKING PER ZONING BY-LAWS ' 57 ❑ Enclosed 58 X1 Outside i. -'a 59 Does this building contain asbestos? ❑ YES sir NO If yes complete the following: Name & Address of Asbestos Removal Firm: /P7f-52&,3 k°b 5-1/ 01 IDENTIFICATIO�N/-To be-/completed /by all applicants PLEASE PRINTS a /- 60 Owner (printY%F r 5- &I/k'j(IaSoh c2 �/�lKri ""- S/,7�+0 4, 4"- /I�h.S''7 ?°9.7 ;Lind L '`^ "'+" �iLMAILING ADDRE TELEPHONE NO. 61 Signature G DATE R-AQ-7g 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 ril of the penalties of perjury that the information herein is accurate to the best of my knowledge. ` Signature �// �r DATE �-4 �3 / Owner or Agent / 69 BOARD OF HEALTH REVIEW 7� DATE 3 - -T3 Inspect r or Mi orized Person COMMENTS: conic e L liyo 74;ri ,% lncjojt aZ /arao.y/5inTri�j 70 DPW-WATER Service No. SEWER Service No. To be completed upon issuance of permit- (if applicable) 71 I will post permit and address so as to be visible from street. Signature DATE Owner or Agent 72 I have received list of required inspections Signature DATE Owner or Agent Are you a Home Improvement Contractor subject to the NOTICE registration lav (780 CNR - 6)? Yes RO PERSONS CONTRACTING WITH UNREGESTERSD CONTRACTORS DO ROT HAVE ACCESS TO THE GUARANTY FUND (780 CHR - 6) Are you claiming an exemption from the law by home owner sign- off? (9 HO (if yes submit required signed affidavit) QUESTIONS or complaints? Call or write: YOUR COOPERATION IS LY.ApgECIATEDI Home Improvement Contractor Registration "`� �Your Si �:r/�` a _�" Date A� 1 One Ashburton Place - Room 1301 9 Boston,HA 02108 (617) 727-8598 RECEIPT FOR PERMIT ouT . TOWN OF DARTMOUTH {f PERMIT NO. o = No / /f < a .y7. ; ' . Date /f .,„ji /, : -J !'; Received From /Zc r € 1 _ . Owner Location Type -._. > .--• ,.4 ir_.r _-t:...� Amount Paid Received By RECEIPT FOR PERMIT our TOWN. OF DARTMOUTH PERMIT . t 8 I No Date 3 I , , ;_ Received From �/i44i i So Owner {.1..y.L '� ,� Location , 7a�vt��Z C , ���. Amount Paid . 1-1 77) • LReceived By ! ! 'q7 c t�1 Jg� (�_ E COMMONWEALTH OF MASSACHUSETTS �`� DE'AIUME TTOFINDUSTRIALAC®EN S I t". 600 WASHINGSONSTREET James Camooeu BOSTON, MASSACHUSiri 1J 02111 corn-vss;oner WORKERS' COMPENSATION INSURANCE AFFIDAVIT I, (licensee/permiaee) with a principal place of business/residence at (City/StatelZip) 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. [ ] I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed bei: who have the following workers' compensation insurance polidesr Name of Contractor Insurance Company/Poliry Number Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/PoIicy Number I am a homeowner performing all the work myself NOTE: Please be aware that while homeowners who employ persons to do maintenance,con v.n_aion 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 empiayen under the Workers' Compensation Act(GI.C. 152,sea. 1(5)),appliation by a homeowner for license or permit may evidence the legal sutra of to employer under the Workers' Compensation Act. I understand that a copy of this statement will be forwarded to the Department of Industrial Accidents' Office of Insurance for coverage verification and that failure to secure coverage as required under Section 25A of MCL 152 an lead to the imposition of criminal penal consisting of a fine of up to S1500.00 and/or imprisonment of up to one year and dvit penalties in the form of a Stop Work Ord=and fine of S100.00 a day against me. Signed-this 1�`'/?/ day of ��` 2 , 19 1 .____ err^.�nriT?�•-,,: .._ I< ;,l` >I • H 1 p i cr'93 cm i w 10 i We 4:4:4 . ' \ . P ` V j N/ \ 't I a., n Q ! r._.. �l F ig I �h*E 1 n 1.) COi �4, 0 , 1 T H S — - \H " 0 7 r 0, t , Res I �� \ 1 r `' o\ s e rC c .S - n :.- % --.'"ik. < : 9179--4-1%-b`"%eN" 1 '1% / _____j :0 es\- Qn U , r III \ • -u3 -� j a> I .o. , (II I I il 7 I V I K /6 ' X '1