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BP-301 BUILDINGPERMIT FIELD INSPECTION Dartmouth Building Department Plat: 076 400 Slocum Road-P.O. Box 9399 - Lot(s) : 24-5 North Dartmouth, MA 02747 - Lot Size: 51, 312 Telephone 508-999-0720 Zone Dist. : SRA Issued Date: 10/19/95 Permit No. : 301 Project Location: 19 Shingle Island Lane Number Street Subdivision Name: Nearest Cross Street: Collins Corner Road & Flag Swamp Road Applicant/Agent: Michelle P. Beaudoin Contact Person Phone #: (508) 998-0934 Proposed Use: Residential Residential,Commercial, Industrial,etc. Permit Issued To: Alterations Type of Improvement,Add,Alter,New Cons'.,Demo,Land/Move,etc. alter second floor, 3 bedrooms, 1 bathroom/ woodstove (in basement) ( 1008 sq. ft. ) indicate no. of bedrooms and bathrooms and other rooms Owner(s) of -Record: - - Mibhelle P. Beaudoin Address: 19 Shingle Island Lane, North Dartmouth, MA 02747 DATE TIME TYPE OF INSPECTION REMARKS ( INITIAL //- 7r3c 3 c'C ' �� o7k /- 9- 96, i/ ,Qln 0 c 0 K en\ 1'DV 19 1996 //So AEA, Y BUILDING PERMIT Dartmouth Building Department Plat : 76 400 Slocum Road-P. O. Box 9399 Lot (s) : 24-5 North Dartmouth, MA 02747 Lot Size: 51, 312 Telephone 508-999-0720 Zoning Dist. : SRA October 19, 1995 (typed) Permit No. : 301 Issued Date: jQ/19/95 Clerk: JMH Project Location: 19 Shingle Island Lane Number Subdivision Name: Nearest Cross Street : Collins Corner Road & Flap Swamp Road Applicant/Agent : Michelle P. Beaudoin Address: 19 Shingle Island Lane, North Dartmouth, MA 02747 Contact Person Phone #: (508) -998-0934 Type of License: Owner: (x) Const. Superv. License #: ( Architect : ( ) Engineer: ( ) Other: ( Proposed Use: Residential Nossdentsal. Commercial. lndustrial. etc. Permit Issued To Alterations Tye* . Add. Alter, New Coast., Demos Land)Nbve ottc Alter second floor 3 bedrooms/ 1 bathroom/ woodstove (in basement ) indicate no. of bedrooms end bathrooms and other rooms Gross Area of Const. : 1008 sq. ft. Cost of Const. $ 10, 000. 00 Cost-Other Const. : TOTAL FEE: $ 90. 00 Owner(s) of Record: Michelle P. Beaudoin Address : 19 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 auth ized b the owner to make this application as his authorize ge t Signature of gtypepijAgent : Address : �( wv/vim/_rP** nA � Signature: Approved/Issued By : oel S. Reed, Loca Building Inspector COMME S: ORIGINAL U APPLICANT 0 ASSESSORS II CLERK 0 COPY ti-- ." BU ILDI 1\16 PE- AM ; I:tart:mouth Etotiding Department tTht,f : FE 41.0 Stocum Rot-Ad-P. O. bon 9399 Lcyti : Ht North t)artmouth, MA 027Y7 t t: e 1 ephon '1.03-999 -072-14Oft ;fon tog Ito ttt: . fitt-ct Etc t oter 1'3, 399,5 if tipott et.ft eft Dot to°.! title r „ „Ii7h L _ Pt..-Jject Locationt 19 Shinmke Tston0 Lafle:= Nay;ir,, t - _ No,,totf.t Erotoo. Stet : LoSitnsCno-nef 2s4Ji C1tto,;,mp_tt:byti t.YttorlicabtfAuent Msfbei ) o P, Doomdf.to tttadrasst i9 g;Mtogio, tttictTid_Ittto.na, t'torfh InrtoLmomfh, tt4ti titt2 )71 / Contact Pensub Phone it: t501,TL..-9..Ft-093o fvpo of Licen11%e4 Ownnft; Conttt, Smperv, Tact-to-fa :!ttt nrobtfoc.ft, t Engineer Othitot Propaseti Pk:.•cioept -Yal ddded.drdtdd. In4ddl.ad1, ddc T: t XS'',Und 10 Pitafbtiostt, Idarldvddavdd dadd Cdtdad idew tadad.-. ”vidd dd‘, t.4117 'fdr—A.idtcSJII—fA.CIPC-4_01r9A51 -1—WArtY..P.PTZSPP:0 ",,t_Si —i-7-!X-FLfltri:j :Jain's-add ad. it !a/Iv-deed shed tdaddrde,da dad ett'.cd Mcea of Coot,f. ;: i00-1t_ott.t4„.,ASt. raf,t of Const„ tt- Cof,f -Utner Conttf. : ttliftt„ t:EE: Uecaolit moan i1ddress ; 19 Fb2not.e :ittlobd Lone., North Ittantmotttht_tift Li:;;Iat Tit t 17 :! 1 comp 3.,1•• with /SO Clit? 01.11 Eft. Ch ; ;e.tiv 0-Iher appk Acthie MerIA toWI or coaos. anti p3batt on ftitf; t ntn-atov cortity that the pt-opot.ott idOtli• i mutt-on-IT:tot% by too oeiri.er of rettord an6 I flea, e aufhoo ,fod by _the offrfe to ;;;t1tot Tf.tH otptitcmtion at, h s uthrtfa ,toodilitceiftji tot not:It9,-E (-.T thdp d?1,:fi n t 2 PIM•i, ,4110ciLii • rk-114,m4r44L44, 14.*.r1M7rei/rm*:k t•tbp000et:ii -iy;tted Byt. Jool S. R,7,06, Suildonq foopecttno ;;TfHmEttpt‘;; p -f•il4 OSSES!i:1•0M:i ILL W-cy Plat / cfr. Logy Address /I . ..%nt \��ei�/� Required approval Approvals received please (X) approvals Please (X) approvals and required for this project Initial as received DATE INITIALS OCT 16 199ri Zoning OCT 16 1995 j� Building Comm. OCT 1 6 199S Board of Appeals Water Card Sewer Card Board of Health Bond Selectmen Conservation /.07 Fire Chief#3 /0-/7-93 /rig c Cross Connections Licensed Contractor Controlled Const. Affid. . Other information requir d ,. - fro * e�4vai fl\9 PERMIT NO. / 4� � TOWN OF DARTMOUTH DATE ISSUED � �' ,a,'1 TOTAL COST �1� 00 y�o Yy�yj APPLICATION FOR LESS APPLICATION FEE v1�1 ee4/ BUILDING PERMIT FILING FEE FINAL PERMIT FEE i_5. cO NON RE E LOCATION OF BUILDING 01 Number & Street 7 f o 2 2i /o.qa' Z 'ne thy 01.1 Zoning District 02 Cross Streets(between) //!/S crie r and /e..0. / 03 Logy 5 Plat 7 Cf 04 Subdivision Lot OWNERSHIP COST 05 (g9Private (individual, corporation, 36 Cost of Improvement Boa 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 ❑ Addition -Type of Room(s) 36.4 HVAC 09 Alteration —to 42_ -201 36.5 Other - Specify 10 O Foundation Only example: elevator 11 ❑ Demolition (#of units if residential) ) 37 TOTAL //A WO 12 ❑ Moving (relocation) STUdE STATISTICS 38 Woad Frame 13 Number of Bedrooms 39 ❑ asonry (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 ,. 1 RESIDENTIAL-PROPOSED USE DIMENSIONS 15 ❑ One-Family 43 Number of stories A., / 16 ❑ Two or more families 44 Total square feet of floor area, all floors, / 2. Number of units based on exterior dimensions 17 ❑ Garage 18 ❑ Shed 45 Total land area, square feet 5J ,3/e 19 ❑ Carport 20 ❑ Swimming Pool SEWAGE DISPOSAL In-Ground Above-Ground 21 cKWoodstove .<. , , ij, 46 ❑ Public or private company 22 ❑ Fireplace 47 y_Private (septic tank, etc.) 23 ❑ Other- Specify WATER SUPPLY 48 ❑ Public or private company "s NON-RESIDENTIAL - PROPOSED USE 49.'�e\Private, (well, cistern) 24 ❑ Amusement, recreational 25 ❑ Church, other religious PRINCIPAL TYPE OF HEATING FUEL k 26 ❑ Industrial 50 ❑ Gas 27 ❑ Parking Garage 51SOiI 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 ❑ No 34 ❑ Tanks, towers 56 Will there be an elevator? ❑Yes ❑ No 35 ❑ Other- Specify PARKING PER ZONING BY-LAWS 57 0 Enclosed 58 ❑ Outside 59 Does this building contain asbestos? E YES ❑ NO If yes complete the following: Name & Address of Asbestos Removal Firm: IDENTIFICATION - To/be completedyet by all applicants PLEASS�E PRINT �J / 7,;57c-/60 Owner (prin0 /(ke/4 / e4.6 i/ �!'///�y� 2r-kk, /4,7e Nq.ME M ILING ADDRESS TELE61 Signature DDS 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 E 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. Signature DATE Owner or Agent 1 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) 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 73 FOR RESIDENTIAL PROJECTS OTHER THAN NEW DWELLINGS: Are you a Home Improvement Contractor subject to the registration law(780 CMR-6)? YES NO Are you claiming an exemption from the law by homeowner sign-off? YES_ NO (if yes,submit required signed affidavit) Contractor's Signature: Date PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (780 CMR -6) QUESTIONS or COMPLAINTS? Call or write: Home Improvement Contractor Registration One Ashburton Place-Room 1301 Boston, MA 02108 617-727-8598 Owner's Signature: Date: RECEIPT FOR PERMIT 3O ourx. TOWN OF DARTMOUTH `•� PERMIT NO. o ' elb Le•R" l ;litc '� Date /0 �6 9,..5 , Received From r n�ehi P1 Q "e3 -fr ci2 ca_ i Owner y � � 4 Location i q ..'T i -C _l7 f_' '4- a ct 1�1 { YV Type " . J/r�1 / Amount Paid `�' If' 6 ,�� ` i [ "-�„ Received Ei G RECEIPT FOR PERMIT TOWN OF DARTMOUTH 7102V �4, PERMIT NO. �= No — y �- '/�(/� • P� �Dattje /615 �10// /I / �j� Received From ' I l/0--- talk P• k dice M�! , ..Owner 11 „/ \j L+ �` Location Type (Way C:J /2 Amount Paid Receiv TOWN OF DARTMOUTH BUILDING DEPARTMENT f I . ; • ` • TELEPHONE 508-999-0720 FAX 508-999-0738 • TO: X Fire Chief Dist. 1, 2, 3 ❑ Board of Appeals XTax Collector ❑ D.P.W. Engineering Board of Health);i: I:] D.P.W. Water/Sewer Conservation Comm. ❑ Cross Conn. /Water Div. ❑I Selectmen-Licensing El PlanningBoard — Town Clerk ❑ 9-1-1 Police Department The following is forwarded to your office for your information only - no response is required. PLEASE PRINT The Building Department is in receipt of an application for Plat U 7(„ Lot f3QY -S , Address/ 7 , ci // e 1s I*! (Q4E / by / / lij)e//e 7 Aea,„cio/b7 / to 4-174p/'-a[lr061 CONTACT PERSON/// & TELEPHONE# demo.construct. alter. occupy, cic. a(n) 67,5-4/7S • The plan was received by this office on /0 /� 75 • 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 MSEC 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 recuire 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 acknowledges your receipt of a copy of this notice. yi--6>F3c/ 4_f - ______ .APPLICANtTELEPHONE(PLEASE PRINT SIGNATCRE DATE :.ICE'S ED CONTRACTOR'S NAME-TELEPHONE,PLEASE PRINTr DATE ' The Commonwealth of Massachusetts Department of Industrial Accidents OflIC801/alleStlp211Ops - 600 Washington Street ;'� Boston, Mass. 02111 Workers' Compensation Insurance Affidavit iimnr�e! rrn t.ri.nr- e„sepR Ai Keg a oc_t•e. /r Wilfiti 4 14.04,...z.„) . i am a homeowner pe Irving all work myself. E I am a sole proprietor and have no one working in any capacity • i am an employer providing workers' compensation for my employees working on this job. company name: - - - - - - address: - .. . .-.. . city: . :...:,.: �nhone#; insurance co. nnfiev+f _ E i am a sole proprietor, general cnntract..r. or homeowner(cucie one) and have hired the contractors listed teiow wit) the following workers' compensation polices: company name: address: sin: nhnneit- insurance co. nniicv#s company name: - address: city: ohone#,- - - insurance co. noherit • Attach addtuonai sheetffaect�san�� - - - � - -__ -_ sss�.--.:;a-� � �._- ..- - --'- -.s- c:•.:--._ . :�:�_ Faiiure to secure coverage as required under Section 25A of SIGL 152 can lead to the imposition of criminal penalties of a fine up to SL900.00 an one Years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine ofS100.00 a day against me. I understand th copy of this statement may he forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cent/t infer the p ns d penalties of perjury that the information provided above is true and correct Signature e , at / Ifl fd f1 Print name •/ r It r s • I one# ✓ /'•7 F-r/ r official use only do not write in this area to be completed by city or town official 7. city or town: permiUlieense# ['Building Department Qtrcensing Board ;neck if immediate response is required ['Selectmen's Office r [Health Department contact person: phone rt; nOther Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for ::b. employees. As quoted from the "law", an employee is defined as even 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. conooration or other legal entity, or any nvo or me 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 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 `:_ or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employe MCA_ chapter 152 section 25 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 in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, 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 been presented to the contracting authority. ‘ppiicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits 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 :he permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are require: to obtain a workers' "ompensation policy, please call the Department at the number fisted below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has providea=aspace at the bottom the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding :he applicant. P'.e be sure to fill in the permit:license number which will be used as a reference number. The affidavits may be returned the Department by mail or FAX unless other arrangements have been made. The Off;.e of Investigations would like to thank you in advance for you cooperation and should you have any questio: please co not hesitate to give us a call. -- - ; r:::,.r !.�-+.:-=,St• r;y 1 _ .. - T:::e Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) -27-3900 ext. 406. 409 or 375 • • • .. a % w rr. uw IIna_a�., - . -.ss_y •e.... ...r.'i✓nL.Y•01 I • Permit • A building permit is required for the installation of any Solid fuel burning appliance. The building permit and installation inspection are limited to the stove installation and not to the stove construction. Stove A.cNe"�� • Used • B. Type/radiant Circulating i C. Manufacturer FrOJG-(4WD STn✓e-7Jo2.tcS Lab,No. Name/Model No. £itr-l.r'.Un /ZS/-4C Collar size ( r' Dimensions/Height , r9 rr Length 2-S Width 2- J Chimney A. Nevi Existing B. Size(flue area) 3:a 5c2 !IJCµ C. Other appliances attached to flue(Number and flue size) D. Prefab(Manufacturer—name and type) E. asonry/Linea- Flue liner • Unlined ero,4 ammonium,/ ' F. Height(refer to diagrams) a - I ovF.:R. to' I I O+£R 10 112" Mitt i 2MN 1MI T .S Mry' n' 10 3 AUK 1 -s I It 1 t 4 • ji MN- 1 ( (FUfA(GEg5jflSil n 1DE) I 1 I t HEARTH — i CHIMNEY HEIGHT • Hearth(noncombustible) '--‘,. A. Materials CoRicerns: facrS l iJY FLooR B. Sub-floor construction C. Minimum dimensions(refer to diagram) Clearances and Wall Protection(see stove installation clearances chart) A. Type of wall protection provided , (,ox.jctt—'- c4-(Au Or:,iC 13 Lc c t W>(LC.B. Clearances(refer to diagrams) 1""-r J '�• may is I �' Nr in ! gin,I i 9 FT Lit FIREPLACE CORNER WALL/CENTER • COP T i tectorybuinctey c ' • I - -1 roe support .....- - -- . _.. • l '. support bracket • B H nontm obuabote '` wall protector) • 51 A •t 1 donne Overlap ! 1 I CI' ' \\;rf • �� lit I • . 1" I ill i woodburning fi (\ ii/,/ move _..—non-conwuasc>;e �. ' iz• ; toot pr ,on 1SY it 18" 12' Figure 2108.4 Figure 2109.4 • STOVE INSTALLATION CLEARANCES Combustible lb/Asbestos Asbestos Mdlboard Concrete/Masonr Matenal ;,paced Out l' Y Spacck Out 1' Stove Components Radiant Stove 1. - 2. FouMation Wan 4'Stick Veneer —Front 35• _ Circulating Stove 1. __--Front 24" _ A. Radiant Stove 3. .._Sider Back/Top 35' 16" 6• A. Catulatmg Stove 18 _—Side/Back/Top 12' 6. 6' 6. 8. Sir.gte Wail Connector Pipe _ 1a• 72' 6. 8- 'ns�eated 6' Connector Pipe 2• 2• 2• C. Chimney Height • 2• Three(3)feet above&die cent roof and 1;.1'-rat or Masenryl t two:2)teat above any roof tinge within 10 teat D. 7..r^pee If a damper is not included in ins stove construction, t Front it must be mstafleo in the connector otoe. uet or ash access side. --- 2. Non-c3mbustibe spacers rea fired 3. Clearances on each side of a radiant stove with a heat shield shall be mess Jred as it a circulaan;type Note:Clearances snail be measured perpendicular to stove body Laboratory venttee t..t-t C«;;r . .,.: pa'mrrec r \ m 7 m / > / r. 2 A \ C/ C 0\ } ƒ m ¥ G ¥ . . / \ \ \ \ r » } \ 0 i a \ \ \ \ , [ / I 11 / » { . \ . : n - -- E % A / \j I . . / C. [ . q / q oi (A . \ \ , / D \ \ y / § \ \ d . d / \ \ � \ \a $ z ,7 . d \ 1s < / m ƒ »- - ` 2 + • \ 11 / _ �� \ \ } \ \ \ o / « ) { $ \ » o { am / ! w s ~. / s «& c © , & > j § ( © \ \ , p \ / 2 0 `..i 6 K C nngA A •• _ n - \a / _ o § _ = » e0 to- � w « 1 m/ -a J 0 , . i NI i e tm No o H / g j. 9 . Dr - 0 v , c� \ [ is j / w ,U III- ( _ $ e IP § ; pCA» / / )3 ii - -ma= i m I _ 7 @ ff •> » . j .5 \\ \ _ § CO § § t � ~ ` i m !\ 2 } \ § ; mF : % i ) /} 3 \ \ ek ! \ \\ 7 \ rz ` ! £ ›, / i / \ ) cK\ { ^J } \ 74 % § \ b \C• ® \ ± « ^ \ & - _ r - C y \ ƒ \ I / —� d a : 2 / [ \} a e2 cep < - -I ° wa ° 7m 1./ 77m © § : ) command 3& c)0 ,. ° - atea _ •w \ _ C.-- - en q a a CO ~ m \ � m • ' f THE COLLECTOR 'S OFFICE '95 OCT 16 AM 9 ES v DATE: • � ! TO BUILDING DEPARTMENT FROM: COLLECTOR'S OFFICE RE: PAYMENT OF PAST DUE TAXES PLEASE BE ADVISED THAT ON THIS DA7Cbj /4., 9 < THE Tan?S FOR PROPERTY LOCATED ON/ 13,- \at PARCEL # 26 '2 'I , `� HAVE BEEN PAID. THE PERM WHICH HAS BEEN REQUESTED MAY BE ISSUED. IF YOU HAVE ANY QUESTIONS CONCERNING THIS PLEASE CAL. * cc:DEBORAH L. PIVA TCWW COr,T FCTOR . I .+. ier-.. . . . .W.W . . . .rvsratisnal YGTItn I IVI&..JI I TELEPHONE 508-9994720 FAX 508-999-0738 • 7 , ' 02V S TO: X Fire Chief Dist. 1, 2, 3 ❑ Bd of Appeals X ❑ ,-, Tax Collector D.P-W- E gineering Board of Health CID.P..Sewer Conservation Comm. ❑ Cross Conn./Water Div. • ❑ Selectmen-Licensing ❑ Planning Board ❑ Town Clerk ❑ 9-1-1 Police Department The following is forwarded to your office for your informat_o only - no response is required. PLEASE PRIN' The Building5 Department is in receipt of an application for Plat ll 7�n Lot `1 -,S % . Sf / ...,Ls--/ (�' `�/ � 2 // �/�2 Address � /�C, � 0�, �E / �/ t_� // ? Je/ P25.'ND/// / to /47j4P7'a1�ioacilh• CONTACT PERSON&TELEPHONE# drmo,contract alter, occupy, etc. a( n) 5 /tic • The plan was received by this office on /0 Lt 75 • te This office will review said plans and subject to availability of potab_=_ water, where required, the provisions of Zoning By-law per MGL Chapter 40A anc us3c 7E0 C.uR St:: Edition will have available to issue or will deny a permit fc= the above-mentioned work within 30 days of date of receipt. .. The applicant has been advised that your office as indicated above :na: require them to apply for licenses or permits subject to your jurisdiction art 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 fcr 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 theic ;ur_sdiction 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 acknowledges your receipt of a copy of this notice. APPLUCA.lT.TELEPHONE.PLEASE PRINT SIG\ATLRE DATE - -.-ENSED CONTRaCTORc N&%IaTELEPHOSY'PLEASE PRINT, _,_ COP/M. Now . I , E I • t / �"`�l� � :..•",silt....;'—.._+ �< i� �� � it � t }{ LLL Ld All �=x- ; i _ � is .•— S �� � —-----�-- E I i �. • (j � • � � � � �•- x. � �,.�.. � .r" - ' 'l """/"';'jam � �, S ' _� i i .•`�1.+. c.. Rw Al { j f - - ~ �....-^. t�'- .�'J G ...\ ♦s �� I 7 t ( i I , � t Las ` f, 1 - • - / ••! � ! � 1 , W. i `y ! 1 J t► L 0 1 _ _ - . _ - .. ..,.,.._ _ - - - - - .. _ _^.:..'^."Y"--`^.' v«. .. �..�- w--�•^r+-_.---r -`-. . �C' _ _ �_. _. - .. �' , . .."1 "Y', '_7 • _ . _-- _ ti5lr-'�X . __. v� a.+�..-r.wwr...wr:w.�...cM+�s+�w! f•' >,.r —. ' i I . • , III • i r Sao~ W w V 1... Q ~ LLB. p O .e..+, 0 YJJ CD p W •• w W W Lij )%ft cu W F- d O Ln • z u. -� O , C.d V W n • O za FFILE NO. _ COMM. NO. DRAW ~Ak