BP-552 BUILDING PERMIT
FIELD INSPECTION
Dartmouth Building Department comarno Plat: 79(
400 Slocum Road P.O. Box 9399 Lot s : 6-7
Dartmouth, MA 02747 Lot Size: 60,435
Telephone (508 )999-0720 Zone Dist. :SRB
Issued Date: 02/25 /97 Permit No: 552
Project Location: 14 Medeiros Lane
Number Street
Subdivision Name:
Nearest Cross Street:
Applicant/Agent: Florentino Pereira
Contact Person Phone #: ( 508 ) 998-7816
Proposed Use: Residential
Residential, Commercial,Industrial,etc.
Permit Issued To: To Install
Type of Improvement,Add,Alter,New Const.,Demo,Land/Move,etc.
Woodstove only
-- -_- -- --_ indicate-no:bi-b imams-and ba'tluosa s-nd other-room&----
Owner(s) of Record: Florentino Pereira
Address: 14 Medeiros Lane, Dartmouth, MA 02747
DATE TIME TYPE OF INSPECTION REMARKS INITIAL
MAR 0 5 19976/4,‹
C P
WhIPLETED
BUILDING PERMIT
Dartmouth Building Department Plat: 79
400 Slocum Road-P.O. Box 9399 Lot(s) : 6-7
Dartmouth, MA 02747 Lot Size: 60, 435
Telephone 508-999-0720 Zoning Dist. : SRB
February 24, 1997 (typed) Permit No". :
Issued Date: c9 /&S / 77 Clerk: BAS
Project Location: 14 Medeiros Lane
Number Street
Subdivision Name:
Nearest Cross Street:
Applicant/Agent: Florentino Pereira
Address: 14 Medeiros Lane, Dartmouth_, MA 02747
Contact Person Phone #: (508 ) 998-7816
Type of License: Owner: (x) Const. Superv. License #: ( )
Architect: ( ) Engineer: ( ) Other: ( )
_Proposed Use: Residential
- —Residential, Commercial,Industrial,etc. - — —_
Permit Issued To: To Install
Type of Improvement,Add,Alter,New Const.,Demo,Land/Move,etc.
Woodstove only _
indicate no.of bedrooms and bathrooms and other rooms
Gross Area of Const. : Cost of Const. $100.00
Cost-Other Const. : TOTAL FEE: $ 30.00
Owner(s) of Record: Florentino Pereira
Address: 14 Medeiros Lane, 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 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. rn
Signature of Owner/Ag= t: ClLe,tit t-,(..e V 1Z/u)4�
Address:
********************* *** ** * *** ****************************
Signature:
Approved/Issued By; 'oel . Reed, Tit : Building Inspector
COMMENTS: PLEASE , 2ST PERMIT CARD SO THAT IT IS VISIBLE FROM
THE STREET. SCHEDULE APPROPRIATE INSPECTIONS AS
REQUIRED. UPON COMPLETION OF WORK, FINAL INSPECTION
IS REQUIRED.
0 ORIGINAL 0 APPLICANT 0 ASSESSORS 0 CLERK 0 COPY
Dartmouth Building Department • Plat: 79
400 Slocum Road-P.O. Box 9399 Lot(s) : 6-7
Dartmouth, MA 02747 Lot Size: 60,435
Telephone 508-999-0720 Zoning Dist. :SRB
February 24, 1997 (t ed) Permit No. : %sue
Issued Date: cg /0,N/ 7 7 -- Clerk: BAS
Project Location: 14 Medeiros Lane"
Number Street
Subdivision Name:
Nearest Cross Street:
Applicant/Agent: Florentino Pereira
Address: 14 Medeiros Lane, Dartmouth, MA 02747
Contact Person Phone #: (508) .. 998.7816
Type of License: Owner (x) " Const."Superv. License #: ( )
Architect: ( ) Engineer:" . ( ) Other: ( )
Proposed Use: Residential
TOWN OF DARTMOUTH BUILDING DEPARTMENT
TELEPHONE 508-999-0720 FAX 508-999-0738
APPLICATION FOR ZONING AND BUILDING PERMIT
Instructions
The applicant shall complete this application to the best of their ability prior to submission.leaving no item unanswered.The
Department staff will he available during regular business hours to assist as necessary.N/A should be inserted for those sections
which do not apply.A properly completed application will help avoid unnecessary delays. Nude Fits fees not.
(for ogee only) s -/ /14 -.
Application fee $ received by 5 Date �` l/
1 453 Total Permit Fee $ 1' Permit# 5'1 7
aV
100 LOCATION OF PROJECT g ; 6
CURRENT ACCESSORS' PLAT LOT --'7 ZONING DISTRICT Ynt ESr7 F,V7I A L
j)THER ZONING OVERLAY DISTRICTS , if applicable
UMBER & STREET ,J! IlL`D414 o `; 1.N.
NEAREST CROSS STREET '01I i 1Ut5 c'0 it F D- No . 'VAT 1i i) L)TA
SUBDIVISION NAME & LOT# C Y` Vi9i S P PiN G> 4# 1/
or BUSINESS NAME I'"/R
PREVIOUS TENANT ; OWNER JV//'
200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
= THIS SECTION NOT APPLICABLE
= Single family - number bedrooms number baths
= Two famih• - number bedrooms unit 1 number baths unit 1 '
number bedrooms unit 2 number baths unit 2 -
= Accessory apartment Total gross sq. ft.
= Accessory structure
= Garage - detached - attached to dwelling, dimensions L W
= Carport - detached - attached to dwelling, dimensions L W
= Shed - dimensions L W
= Gazebo - dimensions L W
- Swimming pool above ground in-ground Size total square feet
= Chimney -#of flues
,
f instructions). Location(s) (list)
Fireplace(s) -(includes flue) List location(s)
Game Court-describe(include overall dimensions)
Tent, Trailer(Mobile Home) or Other-describe
300 COMMERCIAL-PROPOSED PROJECT/USE-INCLUDING THREE FAMILY OR MORE AND EXEMPT USES
THIS SECTION NOT APPLICABLE
(The following descriptions are based on the Massachusetts State Building Code Article 3,AS NOTED) (See the
Code)
- Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe
- Business - office, assembly with less than 50 occupants - indicate Medical or other professional (see Code
Section 303.0)
T. Educational-structure for training including child day care for those over 2 years 9 months(see Code Section
304.0)
Factory/ Industrial - (see Code Section 305.0)
- High Hazard - (see Code Section 306.0)
_ Institutional - hospital, nursing home, infant clay care (see Code Section 307.0)
_ Mercantile - retail stores (see Code 308.0)
_ Residential - three or more family, hotel (see Code Section 309.0)
_ Storage - includes garages (see Code Section 309.0)
Utility & Miscellaneous Structures - includes tents and agricultural structures (see Code Section 311.0)
= New tenant for any of the above, indicate above (see Code Section 119.0 and Zoning By-law section 35)
= Tent or Trailer - temporary purpose?
Other
Describe the proposal briefly,INCLUDE number of dwelling units and bedrooms or occupant load as applicable,
also existing condition
400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED
- New Construction and/or Addition- total gross square feet
(For commercial only total gross cubic feet) - indicate
It will be considered new construction if there an increase in square footage in addition to any
alteration(s).
If project is an addition to existing structure - Total gross square feet of existing
= FOR COMMERCIAL, ONLY
Will this project be subject to CONSTRUCTION CONTROL(over 35,000 cu.ft.) Yes No. (If yes
see Code section 127.0). Designer to submit Code Synopsis.
Will this project require Peer review(over 400,000 cu.ft.) Yes No (see Code Appendix I)
APPLICANT TO PROVIDE
I
- Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required.
Demolition -describe structure •
Number of dwelling units Number of bedrooms A separate Refuse Disposal
Declaration required.
Moving- (Provide copy of D.P.W. moving license) Type of structure
from where (plat/lot or address)
IIF
to where (plat/lot or address) _,•
Number of dwelling units Number of bedrooms per dwelling unit
Re-roofing - (for existing only, is included in new construction)
Number of square feet Number of layers already existing
Number of lavers when complete
A separate disposal declaration REQUIRED
Replacement doors and windows - (for existing only) (only where doors and windows exist and will not be
enlarged) EGRESS dimensions must he maintained. Enlarged or new windows in an existing dwelling will be
considered as an Alteration, otherwise will he included in new construction. (see Code section 3401.10 for
residential and Article 8 for commercial)
- Temporary structure-includes when allowed, trailers,tents and the like and only for limited periods of time.
Describe
500 CONSTRUCTION PLANS
None submitted. Why?
Submitted. usually three sets required. Four sets for food serviceluses. Number of sets submitted
600 SITE PLAN
0 Not required, why?
Submitted When? - Previously, date - With this application
700 UTILITIES
Water supply- required_ yes _ no, public ? yes _ no, on site well? _ yes_ no.
existing? _yes _ no
If required and not existing have necessary permits been issued? _no_yes.•date
(M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a water supply, when
required, is available. See Code 780 CMR section 114.1.2)
Sewage disposal- required_ y _ no, public sewer yes no
P
private septic - on-site yes no. Submit copy of permit as soon as available.
800 MECHANICALS & PRIMARY FUEL
= 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)
- Air conditioning - (separate unit)
▪ None of the above to be provided
• Hot Water Gas Electric Fuel Oil Other t/ c� .
900 SPRINKLERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
= Required, =plans provided, -_-__-plans not provided, why?
= Not required, not to be installed, Why?
1000 REQUIRED OFF-STREET PARKING - for ZONING & Architectural Access
= NOT APPLICABLE
= Parking Plan submitted To = Building Department = Planning Board Date submitted ,
Number of spaces - indoors outside total provided .
Handicap spaces - required yes_no. If yes, how many as a part of the total required number. .
Is Route 6 (State Road) Entrance permit required? yes = no =. If yes has it been issued yes = no .
Submit copy of application and/or permit as soon as available.
1100 ID FICATION (print or type except as noted)
\7NTI
7 nt owner- name LD P\T N'1 i Y✓C _., ?EA ,AY
address "0 4/U.
\phone# `5O ' ,') `j ri. . -) Yl b
If corporation, officer in charge
Architect/Engineer- for overall design
Company name
Address
Phone number
Certified by State of Massachusetts as
Certification number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
Architect/Engineer-project supervision and reports
Company name
Address
Phone number
Certified by State of Ma
ssachusetts
chusetts as
.
Certification number %
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
General Contractor/ Iomeowner, s e homeowner here then complete section 1300)
Company name — or '0/e D.t)/7 E J.'" —
Address
Phone number
Construction Supervisors license number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
***.*******************************************************sr****;,**********,,***************************
1200 FOR RESIDENTIAL REMODEL WORK ONLY
Are you a Home Improvement Contractor subject to(780CMR -6) ? Yes_No_If no go to next section!
Are you claiming exemption from the requirement? Yes _No _If yes, submit the required affidavit!
Remodel contractor name (please print)
Address
Registration number(a none state"none")
Phone number
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE
GUARANTEE 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
Date
1300 OWNER SIGN - OFF
I, the undersigned.am the owner of record or authorized lessee(provide documentation) and I have reviewed
the application herein submitted. I state that to the best of my knowledge and belief that the information provided in this
application is true and correct and that the permit requested be issued.
Further I understand that the permit will expire in six months, from the date of issue, if no work is begun or
six months after the last inspection if work has begun and that the permit may be extended for six months if no work is
anticipated if I request such an extension in writing. I understand that the permit may be extended only three times by
I
written re uest.I understand that once the permit expires a new application may be required,including fees and current.
other req irements (including Zoning).
+ame �j U PI r.& T Ai ✓`. I;giFiAA
'l
Signature f"�' ...c' .u-e% i. J.l ,
The above signature is my voluntary act and is signed under the pains and penalties of perjury.
Date
Who is authorized to pickup the permit at the Building Department? (please print]F2)1.3G. ✓J ) ' r rs,6,1 4
Address Pi tl f g c 5 1 1v Phone -5 `1`3 Y-7?i e
1400 HOMEOWNER EXEMPTION - ONE &TWO FAMILY ONLY
FOR HOME OWNERS 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 127.0. 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.
Exception:Any Home Owner performing work for which a Building Permit is required shall be exempt from
the provisions of this section: provides that if a Home Owner engages a person(s) for hire to do such work ,that such
Home Owner shall act as supervisor. .
For the purposes of this section only,a "Home Owner" is deli:-.ed as follows: Persons)who owns a parcel of land
on which he:she resides or intends to reside,on which there is. or is intended to he,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
two-year period shall not be considered a Home Owner.
If you are applying 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
2.15 of section 5)
1500 COST
Cost of Improvement $
Items to he installed but not included in the above cost: Electrical S
Plumbing
HVAC
Other
TOTAL /— v
The following section for official use only.
INSPECTORS' REVIEW
Date plan reviewed
30 days to review period expires
L-
OK to issue date
DENIED.see project review worksheet date
•
- HOLD reason date
- HOLD Subject to Zoning Board of Appeals action
Comments
Inspectors signature Date
- Applicant informed of above - Date time staff • (fax, phone, in person)
Over six months since approved for issue - DEEMED abandoned!
Advise applicant. Hold 90 days for return then dispose if not picked up.
Inspector Date
Advised applicant Date Time staff (by phone, fax or in person)
OFFICE\INSPECTORS NOTES
TOTAL FEE =�Z✓%'
Gross area - new construction .Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit )4g1-11,
7
a:
1600 TO THE APPLICANT/REFERRAL AND APPROVAL
Date of Application submission
Plat Lot Street Aquifer Zone
Owner
Owner mail address
Owner phone#
OTHER INVOLVED AGENCIES -The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT THEM FOR REQUIRED SUBMISSIONS.
® TAX COLLECTOR - Approved = HOLD By Date
❑ Conservation Comm = Approved By Date
a D.P.W. water _ Approved By Date
❑ D.P.W. sewer _ Approved By Date
a D.P.N. cross connection = Approved Date
a D.P.W. engineering = Approved Date
❑ Board of Health well = Approved Date
a Board of Health septic = Approved Date
0 Board of Health food service = Approved Date
® FIRE DISTRICT(I - II- III) = Approved Date
a Planning Dept = Approved Date
Other Approved Date
Other = Approved Date
(',amments
Project summary new construction/ alteration/demo sewage disposal - public/private
[Alteradd interior walls] [add rooms] [add footprint] water supply - publiciprivate well
[pool] [garage shed] [game court] [food service]
Describe
To the various departments:
This notice has been forwarded to you for your information and any appropriate action. Should you have any
questions please advise. If any reason to withhold the requested permit is found. please advise. Your assistance and
cooperation is appreciated.
The Building Department
Date sent for review By
8