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BP-31042uj O i C C J V cr J a CD � a g ';`. �J%OUT CORDRE ,.. 0 A Cry Thts Endpro Phanut far 1+et on St ion Dud O N - in ti LO Z o Y c tY CO E 0 o, r O to Z J a ts� '4 Z j opq uop81 ISU03 ��i.lIlaan f 'jo Idaill 08Ueld p , PU3 S141 jo %i oo I�.� ens a in P rta�cr a7WV ">iaoM S'Hi - SS38D 3HIMOA x fill F 4. _ Eye (13 AM a 0 ( # w.d i , E Hl I y " 7 ( ' T 77 to Cll . _' .fo as (+°!LLE 1 1 � r a n C3 t 77 AltftE Ll G> 2 C—) rv, JF r, •rC, Cl- I -nu op 4 �2 t�7 2 r Q cu LL o ` - C) n_�p �1� - . -©" 2 tit OOlN C' E `WLU Tr r CD Tn M. CA (ya c.a CC>I €a 4 _`o I i c -0�4 � WZ - -�-'OL, 2-1 �: t3 c; Z �; ©Ll 0 i Ll j o- y 0 p p 1 14 0 pl, M, U I R E fttz m -I thru rates v�ajtq and fWrs $hall b1t. 995;ed with a nj otjDec,1 C&pabfo- (g preventing u)o P84-SaW4 et famess, land hot gn-scc,:j,, "en subjected to the '- re-quiroMOM3 of the Tct;t Str,:,jdcfd ppc'fib for R ` - ��rS,9"Iqp ASTNAI-E--614. I C. C, 14" t- L Or-'P-- It, o FOU t) C.- m R a cs 0 :,* is 1-1f6r e-S 'J 777-- 'Pc. - -- —.----------------- - -- 1 III 11 RESIDENTIAL 2003 RESIDENTIAL 2003 . . . . . . . . . . ----- --- It, n- � -W �-_, ffl� HE nx,, - — N n 09 U --j- V 2.1 Owner of Record: %%1&977AI Name (print) Contact Address Phone Number 2.2 Authorized Agent: 'Contact Address Phone Number Name (print) W0 3.1 Licensed Construction Supervisor: Not Applicable 1:1 Licensed Construction Supervisor License Number Address —7 C 6 Expiration Date Signatur Telephone ? 915) ySV- 3.2 Registered Home Improvement Contractor: Not Applicable 0 Are you a Home Improvement Contractor subject to (780 CMR-6)? 1:1 yes EI no If no, go to the next section! Are you claiming exemption from the requirement? El yes 0 no If yes, submit the required affidavit! Company Name AZ z> Registration Number (if none, state 11 nonec) -7 Address Signature Telephone Cr,? qt?,Ti�51cl 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 Ashburton Place - Room 1301, Boston, MA 02108, (617) 727-8598 Owners Name (print) Signature by signing the above, the home owner acknowledges that there will be no eligibilty to the Guaranty Fund Date 3.4'Homeowner Exemption'- One & Two Family Only FOR HOMEOWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT 109.1.1 Licensing of Construction Supervisors: Except for those structures governed by Construction Control in Section 116.0, effective July 1, 1982, no individual shall be engaged in directly supervising persons engaged in construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of buildings or structures, unless he or she is licensed in accordance with the rules and regulations promulgated by the BBRS entitled Rules and Regulations for Licensing Construction supervisors. Exceptionz, Any Homeowner performing work for which a Building Permit is required shall be exempt from the provisions 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 land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one, home in a two-year period shall not be considered a Homeowner. If you are apply ing under this section sign below: Signature: Your signature carries certain responsibilities, including but not necessarily limited to, general liability 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) ME E, ZMV WE - 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: El yes 0 no N og �h unwm A W" WeA = aw a N-L W t N MWO HNN-10 W 6. 621 ag , - 0 El new construction* D-addition 1:1 alteration D repairs El chimney/ El woodiStoVe (energy report required) (energy report required) fireplace El ❑ec El poo 1:1 accessory g. ❑1:1 replacement window/door ❑EI ❑other El demcffition (shed/garage) no. of windows— doors— (specify below): (specify7lbelow): If new construction, please complete the following: Single Family: no. of bedrooms 3 no. of baths Two Family: no. of bedrooms unit 1 - no. of baths unit 1., no. of bedrooms unit 2 no. of baths unit 2 1:1 Furnace (hot air) - fuel gas (natural or propane), fuel oil, electricity, other (specify): EI Boiler (heating) - fuel gas (natural or propane), fuel oil, electricity, other (specify): EI HVAC (combined unit) - primary fuel, natural gas, propane, electricity, other (specify): EI Air conditioning - (separate unit) El /None of the above to be provided IV Hot Water: Gas L Electric Fuel Oil Other Brief Description of Proposed Work: M Item Estimated Cost to be completedby permit applicant I Rnildincr 'I Pln'mhinc, A Mo.ohnnir.nI (1-TVAC) 5. Total = (1 + 2 + 3 + 4) Estimated Total O-Z71 P—T (plea print) rn I_- as Owner of the subject property hereby authorize to actn b if ' a matters relative to work authorized by this building permit applicapon/ SignatTvof b"er Eiate' A A. N % .5 S 1" —NE imp "b 601 KV'AL I, as Owner/Authorized Agent hereby declare that the statements and inforrmation on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the ns and penalties of perjury. A. Signature of Owner/Authorized Agent ate CAbldg.forms\R1dgapp.res.wpd Page 2 Rev. January 1, 2003 C:\bldg.forms\Bldgapp.res.wpd Page 3 Rev. Jartmary 1, 2003 RESIDENTIAL 2002 RESIDENTIAL ❑ FOUNDATION ONLY ❑ FOUNDATION ONLY $25.00 APPLICATION FEE IS NON-REFUNDABLE NON -TRANSFERABLE $25.00 APPLICATION FEE IS NON-REFUNDABLE do N . N jTRANSFERA7­ML'E � e- N6 _ - '��__ �.``G:. fir.-.°::. .3" <i �-.•,..�m,� 1. 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. IED (se p oject review worksheet): Date: .y . — I 6. I IOLP reaso �r� Date. / .OLD ect to Zoning Board of Appeals action. Date: J g PP 8. Comments: 9. Inspector's Signature: Date: 11 103 € On — _nrk ff Applicant info e abo e Date: - Time: A � lerk. Continents: m�erla } - $:�' m �_ w _ 4 ._ _�®'�®. _ was ,.,._ T o otal Permit Fee:..$ ,���00 Less Application Fee. $ 25.00 Remaining Balance. $ � PP g TOTAL FEE: o 00 Gross Area - New Construction totals q. ft. Gross Area - Alteration total sq. ft. Permit Issued To: �vo �� �� ®iC i`�®b✓/�£Ifl� it1 i�`i`�Tj/ �YJ _TIMM A - _ C:\b1dg,.forms\B1dgapp.res.wpd Page 4 Rev. January 1; 2003 UT .� ;. DARTMOUTH BUILDING DEPARTMENT DNI'hREIVED Q S ;i yr 400 Slocum Road, P.O. Box 79399 t -- y,. Dartmouth, MA 02747 508-910-1820 FAX 508-910-1838 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING, i N ' r: a INS IN !,i iiP �i `i :. �i �.. d I 4 i , 1111 vlfin�ie� MW x Wi 4 ,..:iNII � � �a • u�n�, `E ' t' ii ` � tl ' �"II i NIR i z s ' .t .i ,.i F?t':..... , . ...- tnr =•t�ii ' �k5� sk" w i x ! N Na ,l _ ,- _ ,iia., .�v, '3'ii h `YIf+S, ztYEii' b - d {u u i 4 u ,':. n .,,t � i, i ,N, �"' r i i !x, � i, i ,• (1 4 . :. .!`ell4a xti . x � v ° - �d` BS' fit PI '! �' „,, i i.# i�� rat, ,1�� 1'� ' L') ?T'i d •.t.,rti tii �t� �,, � - � 'N�i . __ tA"� � N A q� itl b+tt � ` '��"` f �' ! � 1 dt i'"'i � - 3 +��H�� =�'I'�� �tFC �il'i � CI• �._ t —_ �-e - , n „ , t !, t ! H t t _ �c �ryr i I' p I _e �i9'k!t+,"r , 't ` '•i'�ii, O `� P - - i00, Im „ WE i ti �i u G 'tu. it Zoning Review: OIL Signature: Date: 20 Ot t Energy Report: Signature: Date: Fire Chief: " 5 Signature. r - - Date: Board of Health: Signature: CLL7 Date:.'3.-— O `7 Conservation Commission: ' Signature: Date: Other: Signature: Date: j✓ ,f-2 Description of work being performed: ��/� e€ m"' L Vn� _&fin M, ixY y ,., . ' 85 0 - e.s :.... :::_, r.,a6:`.. „-u.� � ter' u'-. „ w NUMBER OF PLANS SUBMITTED: SITE PLAN SUBMITTED: ®'dyes ❑ no) mcbcyLl&�:"' 1.2 Assessors Plat & Lot Number: 1.1 Property Address:. 13q Plat_ Lot '� - Nearest Cross Street:` r�(-.�► .. Subdivision Name: 1.3 Historical District ❑ yes u4to i Total Land Area Sq. Ft.: ��°�-d ;►�`i % Has application been submitted to the Historiyc Commission? ❑ yes o no Date: 1.4 Water Supply (MGL c 40 § 54): 1.5 Sewage Disposal System: ''-141unicipal rivate Well Municipal ®''On Site Diisposal System C:\b1dg.f6rms\B1dgapp.res.wpd Page 1 �6(0[ Rev. January 42003