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BP-2001-20627 Permit No. BP-2001 20627 � _ GIS# 2 .. & 4088.00 . Yua . /� Y �3 eD�''�` Map: 0077 ,? Commonwalth o F /addac e hud Lot: 70028 �--. ' ,t '',�. Sub-Lot M 0000 TOWN O F 3DATMOUTH Category.` NEW_:..:; Y �•+ 7 3 400 Slocum Road,Dartmouth,MA,02747 Project# rt.IS"2002 0349 Phone:(508) 10-1820 Fax: 508)910-1838 .+ Est.Cost: 't� $25000 00 ` : - —� g t•Th , Fee: X $124.00 r : PERMISSION IS HEREBY TEScri, - Coast Class ". 'P '(_ ' Use Grout R4,U T. Contractor . r 4,2, icenser ,„21ib e.-#: Lot Size(sq ft} S20 Engineer: - license CPhone#: Zoning: 1, +*..SRB .1*'�^ 7 c- ' 'p - ,r , aK New Const 1 rL241 sq ft Applicant: 7. • Alt.Consti NI JENKINS DORIS (508)998-2355 Date Typed: 19-25-2001 OWNER: JENKINS MARK E& DORI DATE ISSUED: k l TO PERFORM THE FOLLOWING WORK: Addition(garage with breezeway/four season room), PER PLAN and Board Of Appeals Case#2001-40;not heated. If heated, ENERGY REPORT REQUIRED BUILDING PERMIT Project ' cation: TR,DGE DR Approved/Issued By: EL . D, VG IMP OR All work shall comply with 780 C r ` Ed.(MGL Chap. 143) and any other applicable ass.Laws or Codes and plans on file. POST T - CARD SO/T/S 1//S/BLEFROM THE STREET SCHEDULE APPROPRIATE INSPECTIONS AS REQUIRED. UPON COMPLETION OF WORK, FINAL INSPECTION IS REQUIRED. THIS PERMIT WILL EXPIRE PER 780 CMR 111.7(NOT MORE THAN 3 EXTENSIONS WILL BE GRANTED)OR ON ISSUANCE OF A REGULAR OCCUPANCY PERMIT. I hereby certify that the proposed work is authorized by the owner of record and I have been authorized by the owner to make this application as his agent and to receive this permit, I further understand other agencies may have reason to STOP WORK if items under their jurisdiction are not met; not withstanding the issuance of this Building/Zoning Permit. Signature of Owner/Agent: (d Comments: BOARD OF APPEALS Case*OW-la V SP REPLACEMENT FEE WILL BE REQUIRED FOR LOST SIGNATURE CARD COPY TOWN br DARTMOUTH 22004 BUILDING RECEIPTS COLLECTOR'S OFFICE Name t � - , 1;1 14 'f ti 2 Property 3 i�Ai�l,. ,i Date it 1 ! f l 1 Ownei: _ ( Job Location: 7 r. E 1 - t j White Copy-Collectors Office Plot: i Lot: . Yellow Copy-Customer's Receipt J - Pink Copy-File Copy Green Copy-Building Department Phone: Description General Ledger#'s Ref.# Amount License&Permits-Building 01000-44105 i W 17 • (Jo License&Permits-BuildingMisc. 01000-441 TOWN Cr Aft n F ti COLLECTOR'S OFFICE License&Permits-Electrical 01000-4410 NUV 1 2001 License&Permits-Plumbing&Gas 01000-4410 1 Other Department Revenue 01000-4242 This is not a Permit or License for Building,Plumbing or Gas Received By: l TOWN O'F 'DARTMOUTH 20627 BUILDING RECEIPTS COLLECTOR'S OFFICE Name ,---- I / Property ;if)). ,.. Job Location: l' "--) White Copy-Collector's Office Plot Lot: q� ,r, S Yellow Copy-Customer'sReceipt ! _ _ 1 Pink Copy File Copy a tl ,'�,, /f ,) f Green Copy-Building Department e:Phon ‘if ... / / ti,r Description t'I1as General(Ledger s Ref.# Amount License&Permits-Building 01000-44105 , License&Permits-Building Misc. 01000-44105 fir/ i : License&Permits Electrical 01000-44106 License&Permits-Plumbing&Gas 01000-44107 Other Department Revenue 01000-42420 f This is not a Permit or License for Building.Plumbing or Gas Received By: ;1 �i RESIDENTIAL _,29g6"-' ❑ FOUNDATION ONLY c),6o $25.00 APPLICATION FEE IS NON-RL`FUNDABLE &NON-TRANSFERABLE r. W..yam DATE RECEIVED / ak N:. DARTMOUTH BUILDING DEPARTMENT o >r't ik ti 400 Slocum Road, P.O. Box 79399 vi \30 ze y"' Dartmouth, MA 02747 • '^Y„�. 508-999-0720 FAX 508-999-0738 APPLICATION TO CONSTRUCT,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING THIS SECTION FOR OFFICIAL USE ONLY RECEIVED BY: BUILDING PERMI.'T h ATC� SENT 1 OR fEVlEYI /e ii NV141BERt l` ' .: DATE ISSUED OK TO ISSUE SIGNATUREtY DATE ? 1 Ilt 6 t na Cumiasionerlp1p00(tir Building; i -„ ... ...-Zoniqt District Proposed Use. Zone D:;B D 11 D V Outside Flood Zone D A Li fer Zane`"'"" "` :7 TIIEFOLLOWING AGENCIES SIuOULD•B.E NOTiPIEI7 : 5" L1 Board of IfBaard aI c to Cam t7;Demo ti C3 t l lee eri Reji I Eoort x Appeals 'Health Affidavd Ca d.Se c, Cut OIf Foltnw-upe L7 Fire L# as fl PFanning Hoartl* CI Sewer and aterCard Gt Znnmg II:Other ::'.fi.el Catt.Qff f.:Gnh43ffj 1Cu#;OII Review* _ *RI otqu.=s trespEGToRWs KFYtIW BEFORE TUFISSU. NCE OF rti PERMIT: _ DEP ALARTMENT APPROVA:1 Zoning Review: Signature: Date._ Energy Report: Signature:_ . ^�'� G Date: Fire Chief: Signature//�'" c h 4 ,� ci-S*c� Date!9 2/ 0/ iBoard of Health: Signature: T(! /1 i/-% J 2 Date: 7/1/ ��If t ' Conservation Commission: Signature: Date: �� Other: Signature:_ _ Date:__ Description of work being performed: a a J1Q 15:� . -3\c-cn C R SECtION 1-SITE:iTFORMATIt Y ry ett f 0 4 ` 3C NUMBER OF PLANS SUBMITTED: SITE PLAN SUBMITTED: 0 yes 0 no 1.2 Assessors Nat& Lot Number: 1.1 Propet iy Address: '2 O/+K 2 tI,CC pp t ) / Plat 177 Lot at - Nearest Cross Street: /f:2-s'n A17/ ,Tci)U Subdivision Name: 1117/tato c 5,,l7e 5 1.3 Historical District 0 yes Q no Total Land Area Sq. Ft.: of.,2 A Has application been submitted to the Historic Commission? 0 yes 0 no Date:_. 1.4 Water Supply(MGL c 40 § 54): 1.5 Sewage Disposal System: ❑ Municipa Lvl Private Well 0 Municipal Et<Site Disposal System C.\bfrU4&— ldeapp.res.wpd Page I Rev January 13.2000 RESIDENTIAL 2000 .. . ...: . : ....sECTMN PROPERTY SWNERS1-1071:MrT0ORTZPD AGENT • • •••• • 2.1 Owner of Record: • C-, t ,b0P-ii N..7E-iv-KOOS LovataiDceDC ; cl923"—2355 Name(print). Contact Address Phone Number 2.2 Authorized Agent: trlap . 0. 4 Dop.ts jerid-1,1/435 Name(print) Contact Address Phone Number • • • • - ••• • •• • .. • . ......... . . . 3.1 Licensed Construction Supervisor: Not Applicable 0 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)? 0 yes 0 no If no,go to the next section! Are you claiming exemption from the requirement? 0 yes 0 no If yes, submit the required affidavit! Company 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.4shburton Place-Room 130!. 3oston. .11.4 02108. (617) 727-8598 Owners Name(print) Pfl" — 4 DOPII5 Eh)t4 I k..15' Signature 7712(j( by signing t e above,the home owner acknowledges that there will be no eligibilt}to the Guaranty Fund Date____DL/ 7 10 3.4 Homeowner Exemption-One&Two Family Only FOR HOMEOWNERS ll'HO INTEND TO PERFORM AND BE RESPONSIBLE FORTHEIR OWN PROJECT 109.1.1 Licensing of Construction Supervisors: Except for those structures governed by Construction Control in Section 116.0.effective July I, 1982,no individual shall be engaged in directly supervising persons engaged in construction,reconstruction.alteration, repair.remmal or demolition involving the structural elements of buildings or structures,unless he or she is licensed in accordance with the rules and regulations promulm:S.bs the BBRS entitled Rules and Regulations for Licensing Corltruction Supervisors. Exception: Any Homeowner performing work for which a Building Permit is required shall be exempt t:rom.:-.,e_crovions 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 tad on which heishe resides or intends to reside.on which there is.or is intended to be.a one or two family dwelling.attached or detached structures accessor) to such use ander farm structures. A person who constructs more than one home in a two-year period shall not be considered a Homeowner. If you are applying under this seen° ien below4 Signature: •%Lief 4 -11-vv"). Your signature carries cenain re onsibilmes.including but not neCeSsar::. to.general liability C'bIdg.forms 131dgapp.res pd Page 2 Rev.January 13.2000 C bIdu.lorms Ifia-gapp res RESIDENTIAL 2000 NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that any licensed Construction Supervisor. whether or not they have taken the permit are responsible for code compliance. (see Appendix of 780 CMR R5.2.15) SECTION 4-WORKDt'S COMPENSATION INSURANCE AFFIDAVIT SaL c:152 §.25) 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: E3"yes 0 no SecTION 5-DESCRIPTIQN OF PROPOSED t'4'OR (check all applieable) o new construction* i addition 0 alteration 0 repairs 0 chimney/ 0 woodstove (energy report required) (energy report required) fireplace ®a ❑deck 0 pool ccessory bldg. 0 replacement window/door 0 other 0 demolition (shed/garage) no. of windows doors (specify below): (specify below): * If new construction, please complete the following: Single Family: no. of bedrooms no. of baths Two Family: no. of bedrooms unit I no. of baths unit I 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): o Air conditioning-(separate unit) o None of the above to be provided o Hot Water: Gas Electric Fuel Oil Other Brief Descr4otion of Proposed Work: 200rfri ADF>! TIo+•t 7"' R2 L /tie SECTION-t5 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost($)to be completed by permit applicant 1. Building 2. Electrical 3. Plumbing 4. Mechanical (HVAC) 5.Total=(1 +2+3 +4) *Estimated Total SECTION 7 ' OWNER l IIfARt tT1oN (ta hoc completed when owner's agent or contractor applies for bu iltling permit) (please print) I, /'h'912 itu5 , as Owner of the subject property hereby authorize 1>URJ 5 ,j EW t'Las to act o my beha , in al tte ,relative to work authorized by this building permit application' Signature of Owner Date SECTION 7B-o sNEl/At THORIZED AGENT DECLARATION I, /1/'P_K .BEM K.1'' 5 , 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 f perjury. Signature of Owner/Authorize gent Date C",.bldg.forms`\.Bldgapp.res.upd Page 3 Rev.January 13.2000 RESIDENTIAL 2000 SECTION 8-INSPECTOR'Si,REVIEW/COMIliE3N"i-5-. I. Date plan reviewed: 2. 30 days to review period expires: 3. OK to issue date: 4. OK to issue subject to requested submittals(see project review worksheet): Date: 5. DENIED(se project review worksheet): _ F 9,�}, NOO Date: 6. HO7L reasoervin: �P AD _.„. .c--" - __ .,- rya -: CC 7. HOLD subject to Zoning Board of Appeals action iiiirP- -: 8. Commeas: 7— 7 �'�c' % ��/�_ .`_ 13t <.__- ev �"'��"� et-0 � W _ 2 _ e e&a, c-_ . - ik< 9. Inspector's Signature: Date: SECTION 9-At' Et' AN'T NOTIFICATION - Applicant informne ooff a�bov / /� /yate: j0 6 Ti , Clerk: AComments: dt J (/ 7/ 4Ci t� �� ��� SEZCTION 1tt-OFFICE\INSPECTOR'S NOTES Total Permit Fee: $ Less Application Fee: $25.00 Remaining Balance: $ TOTAL rEE: /d c/ 91-C Gross Area-New Construction total sq. ft. ,d,--41/ -cK Gross Area-Alteration total sq. ft. Permit Issued TomT-dr p1 �f` '6 ' $EcTt •N I^At1 IONAL,CO%IME TS/51<E'rC U v Cbldu.tonns'.Bldeapp.res.wpd Page 4 Rev.January 13-2000 I Permit No. BP-2001-2027 Project Location: 2 OAKRIDGE DR Commonwealth of(Massachusetts TOWN OF DARTMOUTH GIS#: 4088.00map; 400 Slocum Road,Dartmouth,MA 02747 Lot 11028 Phone: (508)910-1820 Fax: (508)910-1838 Sublot: 0000 RLTILDING PERMIT p o g# NEW 002-0349' FIELD INSPECTION Est. $250 000 ,Const Class: E. Contractor: License: Phone#: Use Group:"` 124U Lot Size(sq.ft) 8.20 Engineer: License: Phone#: Zoning SRB New<Const. ` ' ;1,241 sq.ft. Applicant: Phone#: Alt.Const.: N/A JENKINS DORIS (508)998-2355 OWNER: JENKINS MARK E &DORIS DATE ISSUED: Rh I DI BOARD OF APPEALS TO PERFORM THE FOLLOWING WORK: Case #taC z:Li.V SP Addition (garage with breezeway/four season room),PER PLAN and Board Of Appeals Case#2001-40; not heated. If heated, ENERGY REPORT REQUIRED DATE TIME TYPE OF INSPECTION&REMARKS INITIAL JAN 2 8 2002 ),,,,, ,.tx . w.a-=e f^_,,.- r...,c?e7 4/L - ,«-J.t_ 4 n—.6n..- -e_....-t-.2�:. >_ dz-ti-._. S r7---1-e,9---- 1,-.--&— E4. �. e,-) - t l - /.76 legn_ 5?-21 .. 2 C4...in .c odC{rcc,...-C ti 4 OCT 3 0 2E02 3 go,a.-, c77 O %.t-. /€i ce. - .eZet Zb'Z Ltd . --) . ez ... n '.ra,.cZ-...e.4 4—. OCT 3 1 2CO2 ,.,I75t r' /ter, e„ c rc29t -� //-1 Q-dJ- Lf-70® . Cee,-,-` Gs ak ert -t re. , 6?? ,iy®/( NOV 252002 r' 2 �, _ar. �A fle 4� q4.,-- 3 z:r) 0 fit,�G - tea ��a - /l3e ,.s ,.5e/ Go/m5 1W© i7ec / eei,w reccC4 Yc / �e/ ire/a0 gnat ,tup. A/eed5 tee/✓am K i! 41/0. — Q dvE' . , I The following information must be completed and returned to the office of the Town Clerk prior to the commencement of any work. TO: Town Clerk for the Town of Dartmouth Please be advised that action taken by the Board of Appeals, as stated below, has been recorded at the Registry of Deeds . LOCATION OF PROPERTY: 2 Oakridge Drive, NORTH DARTMOUTH PLAT: 77 LOT: 28 OWNER OF PROPERTY: Mark & Doris Jenkins VARIANCE/SPECIAL PERMIT CASE NUMBER: #2001-40 DATE RECORDED : BOOK: PAGE : 13,5±7C1 9 ff � =: ice The Contntonwealth of Massachusetts 12: __( ' Department of Industrial Accidents Office afInvesigatiens f 600WashinotonStreet Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Ucan_ In ofirRation .. W c Fleas`e'1'RINI leggy a,.., .{;,.: ? ? ' 771. name: irt 1I-4'K C. .t�AO41,5 J'C1J it t�1 5___.__.._... __. location: 9% r-1"k I D c C ptg , city b r+.rrn o u t i fnl9. 0�.7 Ll'T phone# `17 8 3 5"5 �am a homeowner performing all work myself. • I am a sole proprietor and have no one working in any capacity .» . ¥d` ,.Wvi'....�.:. ..�,nr,aW'.ca:i�L.�� l-z•'a'?.'a Rvi. • I am an employer providing workers' compensation for my employees working,on this job. company name: address: city: - phone#: insurance co. - policy#taw- ❑ I am a sole proprietor,general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company-name: address: - city: phone ft: insurance co. - policyraiittiotatraWd # _.. company name:. address: - - city:: phone ft: insurance co. policy# Xi ad' tsoni1:sliceTTtjecessan• 7'2,a k n e Failure to secure coverage as required under Section 25.\f of L 152 can lead to the imposition of criminal penalties of a fine up to$1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. t do hereby certify under the pains and pe allies of perjury that the information provided above is true and correct Signature Date 219 /e t Print name /'f'f frE—. Jf✓t K)s.)5 Phone# 998-02 f official use only do not write in this area to he completed by city or town official rfi9 F r71 city or town: permit/license# [Building Department 4' 0 Licensing Board :y �, 0 check if immediate response is required OSelectmen's Office r' Health Department contact person: phone#; 00[her (revised 3(95 PM) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every 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, corporation or other legal entity, or any two or more of the foregoing engaged in ajoint enterprise, and includirg the legal representatives of a deceased employer, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the 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 house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL 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 have been presented to the contracting authority. :.,; Applicants 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 the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. ""vt.... .." `6?r _t City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. #_ !4'qY +r' . l b 41 , Yt.,� 5 eK 7 W'7$::+p 4r ,,,5�.' _.. � ,«t�*,3 ..n� .r.> r9,.. Y...° �'''�Y. . ,��'F.-n.J. V, 9,sr'.�-. . . . ..>r r... a .._ az trr.� The 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) 727-4900 ext. 406, 409 or 375