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BP-531 ., , -� BUILDINaPERMIT FIELD INSPECTION Dartmouth Building Department Plat: 76 400 Slocum Road-P.O. Box 9399 (O� I1�h� f�1179 Lot(s) : 24-005 North Dartmouth, MA 02747 � 6° ` (f ��l' Lot Size: 51, 312 Telephone 508-999-0720 Zone Dist. : SRA Issued Date: 03/14/95 Permit No. : 531 Project Location: 19 Shingle Island Lane Number Street Subdivision Name: Shingle Island Estates - Nearest Cross Street: Collins Corner Road & Fox Run Terrace Applicant/Agent: Michelle P. Beaudoin Contact Person Phone #: ( ) 508-998-0934 Proposed Use: Residential Residential,Commercial, Industrial,etc. Permit Issued To: Install Type of Improvement,Add,Alter,New Const.,Demo,Land/Move,etc. 3 flue chimney w/fireplace indicate no of bedrooms and bathrooms and other rooms Owner(s) of Record:_ - Michelle P. Beaudoin Address: 19 Shingle Island Lane, North Dartmouth, MA 02747 DATE TIME TYPE OF INSPECTION REMARKS ( INITIAL 7-9-7— fr.., o e...,.. CAJ-- 'L # - �- 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 March 9, 1995 (typed) Permit No. : - 6-3 Issued Date: 03 /14 / 1995 Clerk : sqh Project Location : 19 Shingle Island Lane Nueber Street Subdivision Name: Nearest Cross Street : off Collins Corner 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 Residential, Coemerefal. Industrial, etc. Permit Issued To: To Install Typo orIsidro . Add, Alter. New Censt:. Demo, Land/have, -etc-. --. - _- 3 Flue chimney w/fireplace Indicate no. or bedrooms and bathrooms and other rooms Gross Area of Const. : Cost of Const. $ 3, 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 authorized y the owner to make this application as his authoriz a Signature of Owner/Agent : Address : )F************** F************************************************** Signature : AV - Approved/Iss d By: James A. Muse, Local Building Inspector COMMENTS: �j VORIGINAL 0 APPLICANT 0 ASSESSORS L1 CLERK 0 COPY 4 iy BUILDING PERMIT Dartmouth Building Department Plat u 400 Slocum Road-P. O. Bone 9399 t_ otzs) : t North Dartmouth, MA 0E747 I Lot Size : 51 , 312 € Telephone 508-999--0120 i 'ening Dist. : 'IRA March n, 199E (typed./ Permit No. - ;"'""'3' ,h Issued Date; .1e _,r.4_/ .3_1j.i5 Clerk : ___Agi3._ _-_n_ Project Locations ._ t�7_ titerlte_..txiarrs] Raty`._.._- -._ 4,IA r acreae Subdivision Name: Nearest Cross Street �x t �i r21r4rt?`ker Ro d u- t�tit hi lie E Beiaudoir Applicant /Agent : __.__ _,.._ _ _ _ �._ ,._J___ Address: , hir l,e ,1_ A it -417 Contract Person Phone 14 : ( I Type of License: Owner : (s) * nst, Superv. License 3t, 4 Architects t Engineer! ) Other: ( -Proposed Use : 32e Ode + €01 W _� _._ Ae_tiQaa93alr GaasorcxTat. Eaat,Rtrlair rte. Permit Issued Tie: i t=?'-` � t a. FA !aproneeewt:, C�uii. Gsiipr-.i4ew Ca nl-.a flu, .e ;e. ra1A .etc._ .___ — __Flee rhis _r >_'G_ILfir!JJSL`e M iteste no. yi bedr,aal ar4 b..e_Rrao.a co allot r1.ao Gross Area of Const. s _..� _ Cost of Const, Cost-Other Unrest.: TOTAL FEE: 9 90. 0 Loner (s) of Record: • hrzA e Ne< ucoan Add reYi s z _.__.__._._.....i9 qta a tg,...eT P roc 1. .( .,,_. 4rrt-h _Daar't,mo!st.klro...?riA_ 1.Q7 K 7_......__ All work shall comply with 7S0 C- MR 5th Ed. (MOL Chap. 142) and any other applicable Maass- Lawns or codes and plans on file. I hereby certify that the proposed work is...�.authorized t,y the Owner r t': record and I have been authorized by the owner to make this, application as his authorized/agent. ,/` gnat ore of Own er-/4?gent ✓` ~„ 1rl Address: I _ -P.3*i iF-****i'-#***.****fl*$#-%*lt**fl******#**#*.E****#*x*** .._�,.�.,__..._._*_..***. �-M iF ii�&%�#xii 9'rh9i�#3P-Yr Signature : „rAzsc Approved?I ssiied By: Jame=. A. Muse, Local Building inspector 3 l_f OR 43 1 NAL i' APPl_'CANT 1- ASSESSORS 1 U..t RK COPY 47 Plat I-. Lot 7 Address / Required approval Approvals received please (X) approvals Please (X) approvals and required for this project Initial as received DATE INITIALS Zoning Building Comm. Board of Appeals Water Card Sewer Card Board of Health Bond Selectmen Conservation Fire Chief Cross Connections Licensed Contractor Controlled Const. Affid. Other information required _-o y PERMIT NO. a .- pUTN. ,b J 0 -` , r�`' TOWN OF DARTMOUTH - 5 iq ��";,�� DATE ISSUED —� "l �� ✓, PT/ APPLICATION FOR TOTAL COST � 't yy LESS APPLICATION FEE 7d — //2— J8e4- a BUILDING PERMIT FINAL PERMIT FEE NON E- . t1.5),, ,* 3/J15 4-b-Lec art LOCATION OF BUILDING/ A `�, . / ,1 01 Number & Street f l She-4i�/ ( C�J ,A -e 01.1 Zoning District 02 Cross Streets(between) and U 03 Lot d7—.S— Plat 07� 04 Subdivision Lot OWNERSHIP,�� COST 05 Lli ivate (individual, corporation, 36 Cost of Improvement 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 1ew Construction 36.3 Plumbing 08 ❑ Addition -Type of Rooms) 36.4 HVAC 09 ❑ Alteration 36.5 Other - Specify 10 ❑ Foundation Only example: elevator `-- 11 ❑ Demolition (#of units if residential) 37 TOTAL W ] Gad 12 ❑ Moving (relocation) STRUCTURE STATISTICS 38 ❑ Wood Frame 13 Number of Bedrooms 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 ❑ 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 18 El Shedge 45 Total land area, square feet 7, S/o2 19 ❑ Carport 20 0 Swimming Pool SEWAGE DISPOSAL In-Ground Above-Ground 21 ❑ weodstove e p/J,, , 46 ❑ Public or private company p'22 Fireplace 3 �` `"^ "`� 47 pPrivate (septic tank, etc.) 23 ❑ Other- Specify WATER SUPPLY 48 ❑ Public or private company NON-RESIDENTIAL - PROPOSED USE 49 igf Private, (well, cistern) 24 ❑ Amusement, recreational PRINCIPAL TYPE OF HEATING FUEL : 25 ❑ Church, other religious 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 conditioning? ❑Yes ❑ No 34 ❑ Tanks, towers 56 Will there bean elevator? ❑Yes ❑ No 35 ❑ Other- Specify PARKING PER ZONING BY-LAWS 57 0 Enclosed 58 ❑ Outside 59 Does this building contain asbestos? ❑ YES ❑ NO If yes complete the following: • T Name & Address of Asbestos Removal Firm: • IDENTIFICATION - To be completed by all applicants PLEASE PRINT 60 Owner (print) ithdl,� P LLh 54 ) 9/Y-0� N E MAILING ADDRESS TELEPHONE NO. 61 Signature DATE 3 G/13 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 t the best of my knowledge. Signature DATE g 9S 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) 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 '' Y S NO Are you chiming an exemption from the law by homeowner sign-oft? 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 Owner's Signature: q. Dale: 617-727.8598 39s- A� RECEIPT FOR PERMIT �e I1/ T� TOWN OF DARTMOUTH PERMIT NO. t r No / Date 1 %1 fJ Received From I I' r 11�% l .( - :-;_ <-. . {qt. Owner A / t ` 1 Location Type c _�^_-c _ Amount Paid '��' �-��=�•"""•' 4 9 Received By RECEIPT FOR PERMIT ou TOWN OF DARTMOUTH X II- p PERMIT NO. v No a = e Date C: Received.From ' Owner Location '.• � Type / / Amount paid di 9 'G 0 I fY /�%//I Received By COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 WASHINGTON STREET • James J Camnneu BOSTON, MASSACiUSETTS 02111 Commrss+one' WORKERS' COMPENSATION INSURANCE AFFIDAVIT I, (licensee/permiree) with a principal place of business/residence at (City/State/Zip) do hereby certify, under the pains and penalties of perjury, that. [j I am an employer providing the following workers' compensation s. erage for my employees working on this job. insurance Company r.licy Number [] I am a sofa prop:ietot and have no one working for [j I am a sole proprietor, general contractor or ho eowner (circle one) and have hired the contractors Iisted below who have the following workers' compensation '.. .ce policies: Name of Contractor Insurance Company/Policy Number i Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number I am a homeowner performing all the work myself. NOTE Please be aware that while homeowners who employ persons to do maintenance,construction or repair work on a dwelling of not more than three units in which the homeowner also resides or on the pounds 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 Department of Industrial Actidenti Office of Insurance for coverage verification and that failure to secure coverage as required under Section 25A of MGL 152 an lead to the imposition of criminal penalties consisting of a fine of up to 51500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a fine of 5100.00 a day against me. Signed this day of 19 Licensee/Perminet Licensor/Permittor TOWN OF DARTMOUTH BUILDING DEPARTMENT TELEPHONE 508-999-0720 FAX 508-999-0738 i , TO: X X Fire Chief Dist. 1, 2,0 ❑ Board of Appeals /!1/ Tax Collector ❑ D.P.W. Engineering �_ Board of Health ❑ D.P.W. Water/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 information only - no response is required. PLEASE PRINT The Building Department is in receipt of an application for Plat l o Lot a /- S, Address / 7 rL by Air<-e U "apt N ic. Flu.-��A- to d .5 CONTACT PERSON&TELEPHONE 4 demo,construct,alter, occupy, etc. a(n) o-Q.c-c—_, The plan was received by this office on .j -6 - %� • 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 MS8C 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 acknowledges your receipt of a copy of this notice. le h <� 4ZI 3A 9c APPLICANT,TELEPHONE(PLEASE PRINT SIGNATURE DATE LICENSED CONTRACTOR'S NAME TELEPHONE(PLEASE PRINT DATE )E?',RTN1 RFny.. 478 THE COLLECTOR"' `<Q)*ICE JC T DATE: cj - s- C/.0 TO: BUILDING DEPARTMENT FROM: COLLECTOR'S OFFICE RE: PAYMENT OF PAST DUE TAXES PLEASE BE ADVISED THAT ON THIS DAY\.3-‘- 57< THE TAXES FOR PROPERTY LOCATED ON//f� A 4Ge. NA. Za . PARCEL if /-oT 47 ,se- HAVE BEEN PAID. THE PERMIT WHICH HAS BEEN REQUESTED MAY BE ISSUED. IF YOU HAVE ANY QUESTIONS CONCERNING THIS PLEASE CALL. cc:DEBORAH L. PIVA TOWN COT.LFCTOR I vVIIM Ur UHrt I IVIVU I n MUILUING DEPARTMENT TELEPHONE 508-999-0720 FAX 508-999-0738 - TO: X Fire Chief Dist. 1, 210 ❑ Board of Appeals Tax Collector(g) 0 D.P.W. Engineering Board of Health ❑ D.P. ter/Sewer Conservation Comm. CI Cross Conn. /Water Div. Selectmen-Licensing ❑ Planning Board ❑ Town Clerk 0 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 Too Lot c, /- S, Address � e.� te by X-Le�.e. �z.w. t � 4_OL0 to CONTACT PERSON&TEELEPHONE,C demo.m¢strud,alter. occupy, etc. a(n) 1-4-- - - The plan was received by this office on J —6 — S'-,o— dale 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 Mssc 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. yif Your signature acknowledges your receipt of a copy of this notice. 76 ( - / `420..4.4 46 7 f I(JC� �- �. //9r APPLICA.\TTELEPHO.E(PLEASE PRI\T SIGNATURE DAZE LICENSED CO]TRACI-OR'S C>ME:ELEPHONE(PLEASE PRINT DATE