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BP-074 BUILDING PERMIT FIELD INSPECTION CCEPIE10 Dartmouth Building Department Plat: 79 400 Slocum Road-P.O. Box 9399 Lot(s) : 6-4 North Dartmouth, MA 02747 Lot Size: 47, 335 Telephone 508-999-0720 Zone Dist. : SRB Issued Date: 07/25/94 Permit No. : 74 Project Location: 2 Medeiros Lane Number Street — Subdivision Name: Nearest Cross Street: Collins Corner Road Applicant/Agent: Timothy D. Bowen Contact Person Phone #: ( ) 508-998-9276 Proposed Use: Residential Residential,Commercial,Industrial,etc. — Permit Issued To: New Construction Type of Improvement,Add,Alter,New Const.,Demo,Land/Move,etc. New One-Family Dwelling/3 bedrooms/2k baths/ fireplace/ 1 flue/ oil heat /septic system/well (3376 sq. ft. ) indicate no.of bedrooms and bathrooms and other rooms - Owners -61 Record: `- Timothy D. Medeiros Address: 822 State Road, North Dartmouth, MA 02747 DATE TIME TYPE OF INSPECTION REMARKS ' INITIAL I 9- �vinPi. b BUILDING PERMIT Dartmouth Building Department Plat : 79 400 Slocum Road-P. O. Box 9399 Lot (s) :6-4 North Dartmouth, MA 02747 Lot Size: 47, 335 Telephone 508-999-0720 Zoning Dist. : SRB July 19, 1994 (typed) Permit No. : Issued Date: 07/ 3 Clerk: sqh Project Location: Medeiros Lane _ Nuabar Street Subdivision Name: Nearest Cross Street : Collins Corner Road Applicant/Agent : Timothy D. Bowen _ Address: P. O. Box 50074, New Bedford, MA 02745 Contact Person Phone #: ( ) 508-998-9276 Type of License: Owner: ( ) Const. Superv. License #: (053345 ) Architect : ( ) Engineer: ( ) Other: ( ) Proposed Use: Residential _ Residential, Coaaercial, Industrial, *to. Permit Issued To: New Construction Type of Isar ovement, Add, Alter, New Canet.. Demo, land/Move, etc. _T _ _ New One-Family Dwelling/3 bedrooms/2 baths/ fireplace/ 1 flue/ septic system/ well/ oil heat indicate no. of bedrooms and bathrooes and other rooms Gross Area of Const. : 3190 sq. ft. Cost of Const. $130, 000. 00_ Cost-Other Const. : TOTAL FEE: $ 319. 00 Owner(s) of Record: Timothy Medeiros _ Address: 822 State Road, 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 uthori by the wner to make thi application as his author' ed -age Signature of Owner/Agent : t �7 - I Address: / ************************************** ************************* Signature: 40;:, Q. _ Approved/Issued By: William A. Braga, Loc Building Inspector CO ENTS: ORIGINAL El APPLICANT El ASSESSORS 0 CLERK 0 COPY OCCUPANCY PERMIT TIMOTHY D. MEDEIROS NEW DWELLING Occupancy is hereby granted for the premises located at 2 MEDEIROS LANE Assessors Plat 079 Lot 6-4. The premise has been found to meet the requirements'of the Massachusetts State Building Code in effect as of the date of permit issue and other applicable Massachusetts Codes and regulations as evidenced by approvals affixed to the reverse of this permit. The use is further found to be in compliance with the Local Zoning By-Laws for use as indicated, as of this-date of issue. This permit is further conditioned on:the continued maintenance of permitted conditions as provided by law. ZONING DISTRICT - Single Residence District APPROVED USE - RESIDENTIAL BOARD OF APPEALS/SPECIAL PERMIT N/A A proved by David J. Silveira Building Commissioner J`1 & Zoning Enforcement Officer DATE OF ISSUE CERTIFICATE OF OCCUPANCY DEPARTMENTAL APPROVAL To be signed by each division indicating compliance on final inspection.) BUILDING SPECIFICATIONS PER 780CMR 1195 USE GROUP CLASSIFICATION TYPE OF CONSTRUCTION MAXIMUM LIVE LOAD FLOORS SPECIAL CONDITIONS BUILDING PERMIT NO. 74 Approved by Date 27-$7-5' Comment PLUMBING PERMIT NO. /?9 - 7s Approved by Date • / . 9S Comment GAS PERMIT NO. Approved by Date Comment ^ � �� �o �/ . ELECTRICAL \ PERMIT NO. Ito � Approved by Date ( i 9 c Comment FIRE Di PERMIT NO. Approved by (�/r/R- Date o7- 6'- 9.'5 Comment BOARD OF HEALTH PERMIT NO. Approved .//., Date o?-6 FS . Comment DPW-WATER PERMIT NO. Approved by Date Comment DPW-SEWER PERMIT NO. Approved by Date Comment WATER DIVISION-CROSS CONNECTION JOB NO. Approved by Date Comment E - 911 COORDIATOR ADDRESS NO. .46 Approved by - -�-� Date a 7- Comment -y 2u.s t PLANNING DIRECTOR (Off-Street Parking Plan) Approved by Date Comment p Pit', „ t„,„, PE„„- t 1 44 ; „ , I t-„ ;' 1 . • ' 1F4 .; 14' f.•'• sSWr. Zr.- 4:"Cif ..C; i; ;"• 1, t =.= „ „4._ ;'11,•44-, '4 I y . :••• 4 4. 41'= • „. • ; t I •4' -44; e•- • • ,,:. • M• 4.4 •: 1 r• 4:4;.'4141 4 4t1- '.-44"44.4•4. Required approval Approvals received please (Xl approvals Please (XI approvals and required for this project Initial as received DATE INITIALS Board of Appeals _ Mater Card • n Sever Card • vuoard of Health Bond Selectmen Conservation a� ire Chief // 7p /767 c_ Cross Connections n Licensed Contractor Controlled Const. Affid. h ' 4 ct her information required ti ✓ 6t 7� /S ? / s� i .��'6'i'`-� �tf�0�� �D.O'o 1 T .1\1-Al" tY1 / vE 3D• °14) �' PERMIT NO. CP4� ° `'.'T' TOWN OF DMOUTH .. . ,_ .a,y. DATE ISSUED '' I:;�,,ir6,7 7 TOTAL COST o-d � •+FJl APPLICATION FOR �,, yM LESS APPLICATION FEE o yy• EUILDING PERMIT 1fi64. .r FINAL PERMIT FEE 1 LOCATION OF BUILDING 01 Number & Street � 21 �_f ,. C . � 01.1 Zoning District 5/e 02 Cross Streets(betwee ) G--, ,. S— C--4::=6"M-N-a'n 3 kw aum b p,03 Lot Plat �� 04 Subdivision U •"--•) ... i`U 4z,--._SIot \ OWNEIceP COST 05 XPrivate (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 �/ 36.3 Plumbing 07 New Construction 08 ❑ Addition -Type of Room(s) 36.4 HVAC 09 ❑ Alteration 36.5 Other - Specify 10 ❑ Foundation Only example: elevator © �® 11 El Demolition (#of units if residential) 37 TOTAL SCE ) 12 El Moving (relocation) STRUCTURE STATISTICS 38 -Wood Frame 13 Number of Bedrooms �•��� 39 El Masonry (wall bearing) 14 Number of Bathrooms (Total) "0-/"" 40 ❑ Structural Steel Full-Tub 41 El Reinforced concrete 3/4 - Shower 42 El Other - Specify 1/2 - Toilet Only I RESIDENTIAL-PROPOSED USE DIMENSIONS 15 $One-Family 43 Number of stories �' 16 ❑ wo or more families 44 Total square feet of floor area, all floors, fNumber of units based on exterior dimensions 970 41 18 CIShedge 45 Total land area, square feet 1-).-1� l 19 ❑ Carport 20 ❑ Swimming Pool SEWAGE DISPOSAL In-Ground Above-Ground 21 ❑ Woodstove 46 ❑ Public or private company 22 VFireplace eyere>.v-O //ci✓ 47 (Private (septic tank, etc.) 23 ❑ Other - Speci WATER SUPPLY 48 ❑ Public or private company NON-RESIDENTIAL - PROPOSED USE 49 Xtrivate, (well, cistern) 24 ❑ Amusement, rec eational 25 ❑ Church, other r ligious PRINCIPAL TYPE OF HEATING FUEL ' 26 El Industrial 50 ❑ Gas . 27 El Parking Gar e 51 51=Q'I 28 El Service sta 'on, Repair garage 52 ❑ Electricity 29 ❑ Hospital, • stitutional 53 ❑ Coal 30 ❑ Office, b nk, professional 54 ❑ Other- Specify 31 El Public ility 32 El School library, other educational TYPE OF MECHANICAL I 33 ❑ Stores mercantile 55 Will there be central air conditioning? El Yes ire o 34 ❑ Tank , towers 56 Will there be an elevator? El Yes ir. " o 35 ❑ Oth r - Specify PA KING PER ZONING BY-LA S 57 Enclosed ' 58 ' Outside r .sc a 59 Does this building contain asbestos? ❑ YES kNO If yes complete the following: Name & Address of Asbestos Removal Firm: IDENTIFICATION - To be completed by all applicants PLEASE PRINT =r6-e - -i>. 60 Owner (print) `-^C' i� �� o .�t G- t(�A., -,ems i C. Ck�C— 5 • N \ MAILING ADDRESS TELEPH NE NO. t 1 Signature DATE__ ,,_1_4_249,__V c,,r6-.0o)( Otc S\ ,-- t ,Builder's 62 Contractor (print) —77 of-+ F,,_,) 1V3 /VA,pre-At< License No. © ; NAME 1 MAILING ADDRESS TELEPHONE NO. 63 Signature e-, DATE "Z --Z:--\S 64 Architect or Engineer (print) 1AtotE-- MAILING ADDRESS TELEPHONE NO. 65 Signature DATE CERTIFICATION TO PERFORM WORK , 66 I/We hereby appoint--tom'.— '..-�v . '-`R'ca 4 `-1' R , jkik+\ RA E ADDRESS Q2----11.4 ` as my/our agent fo h purpose of ppl g for and obtaining a building permit for the work to be done described in this applicatio ignat re ( DATE n ( (i';'`' 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 Indus ries 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 41.......ezt. —.--__ DATE 7/i-Z--( /-1 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 ��� DATES ((L'' Owner or Agent I 72 I hay? received list of required inspections Signature l7-' DATE /1' z'Gt (,' Owner or Agent RECEIPT FOR PERMIT ' ...-- : ... 40UT/f. TOWN OF DARTMOUTH 6..J n PERMIT NO. ,,,,, i ,,--1- ,No K.,,,,...„67.fe ?/ 4- ....„ Date e' ',",(a•-q-7--i4,4-0.,•,, . ,/ 0.....„ , .,-":2 Received From /\ .-1'.‹L--10 ..r -I- -,, Owner 1., i A Location / I k,•-<::-.:- ...-4),.../.... 77 • , '1 Type -------e-Z-14-7/0----t--4------c--,n---i .....--t ,,,,,,----,A.- ,•. .:„...,.-g-P = • 1 / '''''. ,,'Y' 1 --7:7-) c.,? ('' (i__., Amount Paid (.2„-id_ / „,k -f...) / .-.. Received By ),/ ...,,__ ,• :,... 7 -—--——---—— - -- RECEIPT FOR PERMIT ' 4i5.400vootITIf.4 TOWN OF DARTMOUTH -? PERMIT n •i• a /No , f„-:_• -c,,,f_q-e--,,,i - •,..s• i Date (I - • ,; i 1 k--- f-j.2 Received From _...ii,./ ,,,,-/--/i7 Owner i). //''? / .-- / •- . . .- --//, Location -- 4,/e171 7677/4 ,- - . i - ,_ . //.....1,-.'....4_,L,L.... e,L...,-.7;,-7/421 - . Type ----' if - , _ ,_ ......., .• Amount Paid " 4.(1 ., Received By COMMONWEALTH TH OF MASSACHUSETTS DErmamEsrr OF INDUSTRIAL ACCIDENTS ‘43M7 600 WASHINGTON STREET games.: Car-aaec BOSTON, MASSACHUS±i 1S 02111 �orr:m�ssrone- WORKERS' COMPENSATION INSURANCE AFFIDAVIT I, (Iicenseei permirtee) with a principal place of business/residence ar - (CirylStatetlip) 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 thi job. Insurance Company • Policy Number [ 3 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 be who have the following workers' compensation insurance policies Name of Contactor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number 0 I am a homeowner performing all the work myselL NOTE: Please be aware that while homeowners who employ persons to do m intenance,construction or repair work on 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(Q.C. 152,sea. I(5)),application by a homeowner for a Iicea 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 Deparrmest of Industrial Accidents'Offtce of Insurance for cmverag verification and that failure to secure coverage as required under Section 25A of MQ 152 can lead to the imposition of criminal penal consisting of a tine of up to S1500.00 and/or imprisonment of up to one year and civil penalties is the form of a Stop Work Order anti fine of S100.00 a day against me. Signed This . day of , 19 (z'Q 1 CJ ccn see:'Prmi ttec licensor/Permirror FORM F-1 RELEASE OF LOTS FROM PERFORMANCE COVENANT _ After the applicant has completed construction of the required subdivision improvements or provided a Performance Covenant, the applicant shall prepare a copy of this form form and submit it to the Planning Office. If conditions are met, the Planning Board will by majority vote endorse W,1116%ieleasP and it will be returned to the applicant who shall record it at the Bristol County (S.D.) Registry of Deeds. Argon be for the Planning Office and another given to the Building Commissioner. ,C t_t OL 22 nn ?-\0,114,, 01 ;LVIC, DEFT. Date: 1$� 19g4 The undersigned, being a majority of the Planning Board of the Town of Dartmouth, Massachusetts, hereby certifies that the construction of ways and subdivision 40 improvements, called for by the Performance Covenant dated Q, trultit. 10 I . , and recorded in the Bristol County (S.D.) Registry of Deeds, Book ?,2 i I , Page 2 R , or registered in the Bristol County (S.D.) Land Court as Document No.' , and noted on Certificate of Title No. , in Registration Book , Page on the plan entitled: -V121•11-- 0 , recorded in Bristol County (S.D.) Registry of Deeds, Plan Book I 1 i , Plan t A 3 ,or registered in the Bristol County (S.D.) Land Court Plan Book _, Plan , have been guaranteed to the satisfaction of the Planning Board as to the following lots, and said lots are hereby released from the restrictions as to conveyance i uance of building permits specified therein. The lots designated on said plan and released are as follows: I 2. -j L� y , c) I ) 9') 91 II 1 Total lots released q t .‘ TMO PLANNING BOARD 0 IN_ I 0 1 V\`\tok_J --) Act qi '/ p Y .41 21 X. ( Ll24 �' d Thenrsonally appeared before me one of the above named members of the Planning Board, namely ie.,-.A; t lrn,,... ilia. and acknowledged the foregoing instrument to be the free act and deed of said Planning Board. Commonwealth of Massachusetts, Notary Public `- v., (..: ,....0.S.......L... Date: V$ , t�ag 4 My commission expires: JOYCE J.COUTURE Notary Pubttc A-11 My Commission Expires March 23,1995 January 1993 revised April 1994 1 /YYlY V1 REQUEST FOR ASSIGNfNT OF HOUSE NUMBER Owner(s) of Property •.\ Present Address Telephone Number House Location: Mat 'Lc\ Lot Subdivision �;.� Lvw��v �- �� � Lot Corner Lot ? Yes X No Street t\i\ Single Family y( Multi Family Condominium # of Units Site P1dn Submitted ? Yes )'< No Date Submitted -1 \\\-\ \k`\- House Number Assigned 2 MEDEIROS LANE Date Assigned 7-26-94 Date Assessors Notified 7-26-94 Date Building Dept. Notified 7-26-94 Date Owner Notified Superintendent, Department of Public 'Works THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF 4)-0 11>--iliZeU-b o FEE 75— Disposal ilaaritz Ctintstrttrtirrit 1Jrnitit Permission is hereby granted 2_a fat to Construct ( for Repair ( ) an Individ%Ze wa Disposal System at No P. 27 4-Q-71-- Street as shown on the application for Disposal Works Construction Permit o 94— ated. /Y 2 DATE...7.... t.L .422 Y Board of Health TOWN OF DARTMOUTH BUILDING DEPARTMENT TO: or Board of Health X Fire 1 3 ,� Chief Dist. . � Lei Conservation Comm. ❑ DPW Engineering 0 Selectmen-Licensing 0 DPW Water/Sewer 0 Selectmen-Special Permit ❑ Planning Board 0" Town Clerk * - Tax Collector D" Police Department Q 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 7 9 Lot a - 4/4 , Address by to Cif /mot�c� ' • weer/sAilesas dome. ess.%rues. sitR. seem. ass. r a(n) The plan was received by this office on 7 `/ 674 - 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 rill 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 the e 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 ,04 a COPY of th s notce and provides a contact phone number. f '',, `� r `( (Ly APPLICANT saears$ TROf3 • Oa'ei i 9 fjfj � t t �?7 s ®' s lvS is ilblilit �L � 1 t a t. 4 x . e Ys +`/ a p 4 r. .: a Rn ,. ..,.ri:. .. ... .. .. .. ... .v •`. .. •- 1 _ r _ a r � . cr .r a_ w a � _ < < w u Em