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BP-571 BUILDING PERMIT FIELD INSPECTION Dartmouth Building Department Plat:79 400 Slocum Road P. O. Box 9399 Lot(s) :06-08 North Dartmouth, MA 02747 Lot Size:81, 896 Telephone (508)999-0720 Zone Dist. :SRB Issued Date:03 /28 /96 Permit No: 571 Project Location: 18 Medeiros Lane !lumbar Street Subdivision Name: Nearest Cross Street: Applicant/Agent.: Kimberly Alves Contact Person Phone #`: (508) 995-6907 Proposed Use: Residential Residential. Cosseroial. Industrial. etc. Permit Issued To: New Construction Type of Improvement. Add. Alter. Rev Conat.. Demo. Land/Rome. eto. Back parch Indicate no. of bedrooms: and bathrooms and other rooms Owner(s) of Record: Paul and Kimberly Alves Address: 18 Medeiros Lane, North Dartmouth, MA 02747 DATE TIME TYPE OF INSPECTION REMARKS INITIAL AO _//4•+•, e:94.4 t 13e-it Aee JL'SEP 2 5 1996 97 Gp NOV 0 5 1996 ii a _-.e a�' 114- .J U . ... BUILDING PERMIT Dartmouth Building Department Plat :79 400 Slocum Road-P. O. Box 9399 Lot (s) :06-08 North Dartmouth, MA 02747 Lot Size : 81, 896 Telephone 508-999-0720 Zoning Dist. : SRB March 28, 1996,E sty .); Permit No. : Li-7/ Issued Date: / '7`cY Clerk: BAS Project Location: 18 Medeiros Lane Nuebor Street Subdivision Name: Nearest Cross Street : Applicant/Agent : Kimberly Alves Address : 18 Medeiros Lane, North Dartmouth, MA 02747 Contact Person Phone #: (508) 995-6907 Type of License: Owner: ( ) Const. Superv. License #: ( ) Architect : ( ) Engineer: ( ) Other: ( ) Proposed Use: Residential Residential, Commercial, Industrial, etc. Permit Issued To: New constuction Type of Improvement, Add, Altar, New Const., Demo, LandJMov,•, ,•.,•. Back porch indicate no. of bedrooms and bathrooms and other ra000 Gross Area of Const. : 155 sq. ft. Cost of Const. $3, 000. 00 Cost-Other Const. : TOTAL FEE: $ 40. 00 Owner(s) of Record: Paul and Kimberly Alves Address: 18 Medeiros 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 by the owner to make this application as his authorized agent. Signature of Owner/Agent : Address : ********************** * *** ** **** **************************** Signature: / Approved/Issued By: ael S. Reed, Ti le: Building Inspector COMMENTS: PLEASE POST PERMIT CARD SO THAT IT IS VISIBLE FROM THE STREET ❑ ORIGINAL ❑ APPLICANT 0 ASSESSORS 0 CLERK ❑ COPY - - - 7 •- _ _ - rt h0:_zt irmvi 'T= ,,..,„,„tt 4, L., 1,-„, 4 41g 4.:11 r_rg • • o Lit ,; • rt :7 i4 / ggg 1"; t-.;• •",4--„t t 1.! f:';•c; • - •„ • - - < . , • ___ - . <.• 4,4.1!. .. • &-a, t:•• f 51; t•••,tjt _ , g7. •4.: i -g-S2 p3". •<tt 44 i41 ri ,... 4.:^44 -k••=P.F.4 P .N•4P- •44., 4,, V 4•:•- ,* 11' .11.1 tt, ,•••' 7, 6 e t -Di 4:4 I 11 f•A q11111" 4441- I V I•1 ;121.I t Plat .9 Lot G-2F Address /g' „e[p,a4,.L ,-e_ Required approval Approvals received please (X) approvals Please (X) approvals and required for this project Initial as received DATE INITIALS Zoning MAR 2 7 1996 ).he V Building Comm. MAR 2 7 1996 )14,‹ Board of Appeals _ Water Card Sewer Card :::::7! Board of Health _ - - - Bond 7 Selectmen fl'.i Conservation I Fire Chief Cross Connections Licensed Contractor Controlled Const. Affid. / Other information required i f tir.K4-.. x MAR 2 5 1996 'e2 dam: GZ Li( il, iii p, , gyp; �.i 1 ,tioUTrt. PERMIT NO. _ ' '''''' '-- : TOWN OF DARTMOUTH DATE ISSUED f�, ( 00. "...3prr . TOTAL COST LJ'Q y �)i APPLICATION FOR LESS APPLICATION FEE S` _ ``' 18g4•s.' BUILDING PERMIT FINAL PERMIT FEE /�',d© re-' ,v, _ , t "--6 LOCATION OF BUILDING ipti 01 Number & Street C/LJ 01.1 Zoning District SIC'- 8 02 Cross Streets(between) and 6 /-� 03 Lot G Plat / - 04 Subdivision Lot OWNERSHIP COST ► 05 ❑ Private (individual, corporation, f�. aZ 36 Cost of Improvement �/ non-profit institution, etc.) 36.1 To be installed but not 06 El Public (Federal, State, or local government) included in the above cost * TYPEOF CONSTRUCTION 36.2 Electrical 07 L 'New Construction 36.3 Plumbing 08 El Addition -Type of Room(s) 36.4 HVAC 09 El Alteration 36.5 Other - Specify 10 ❑ Foundation Only example: elevator _ /- 11 ❑ Demolition (#of units if residential) . 37 TOTAL 1/ 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 f 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 /53 L-- 17 ❑ Garage 18 ❑ Shed 45 Total land area, square feet / 9,c 19 ❑ Carport 4iy 20 ❑ Swimming Pool SEWAG DISPOSAL In-Ground Above-Ground 21 ❑ Woodstove 46 ❑ ublic or private company 22 Fireplace 47 Private (septic tank, etc.) 23 Other - Specify / ` (/ `mai? ',rm WATER UPPLY ° 48 ❑ 'ublic or private company NON-RESIDENTIAL - PROPOSED USE 49 M Private, (well, cistern) 25 ❑ Amusement, recreational 25 ❑ Church, other religious PRINCIP L TYPE OF HEATING FUEL 26 ❑ Industrial 50 as 27 El Parking Garage 51 Oil 28 ❑ Service station, Repair garage 52 El Electricity 29 ❑ Hospital, institutional 53 El Coal 30 ❑ Office, bank, professional 54 ❑ Other - Specify 31 ❑ Public utility 32 El School, library, other educational TYPE OF MECHANICAL 33 ❑ Stores, mercantile 55 Will there be central air conditioning? CIYes El No ' 34 El Tanks, towers 56 Will there be an elevator? ❑Yes ❑ No - 35 ❑ Other- Specify PARKING PER ZONING BY-LAWS r 57 El Enclosed 58 El Outside 59 Does this budding contain asbestos? ❑ YES ❑ NO If yes complete the following: Name & Address of*Asbestos Removal Firm: ' a ; ENTIFICATION - To be completed by all applicants PLEASE PRINT t /�� / � 60 caner (prat ll � fl4JL!JkO,-) loge l`' C<i NA E MAILING ADDRESS I TELEPHONE NO. Signature \L1rV(. � � V-� � r � ��)' t DATE Builder's 62 o tr for (print) License No. t NAME MAILING ADDRESS TELEPHONE NO. 6 i n re DATE 64 Arc it ct or Engineer (print) /� /� NAME MAILING ADDRESS TELEPHONE NO. 65 S/gn tu�F,3' 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? ES ❑ NO Submit copy of notification sent to DEQE and the State Dept. of Labor Industries and result of air sample analysis after asbestos ren oval is complete. 68 Owner or Age t I certify under peril of the penalties of perjury that the information herein is accurate to the best of my knowled7h4' ignature ti —� DATE ' 4'jv -& ner or Agent 69 BOARD OF HEALTH REVIEW DATE w Inspector or Authorized Person COMMENTS: 70 DPW - WATER Service No. SEWER Service No. x- To be completed upon issuance of permit- (if applicable) I 71 I wil ost permi nd addre$s so as be visi:le fry m street. ignature /4, -�% %A 4, --- DATE 0 'er or Agent 72 I ha received list of re uired insp ctions ignature /f 4.€ Jner1C."‘41 DATE /%- or pent f 73 FOR RESIDENTIAL PROJECTS OTHER THAN NEW DWELLINGS: ' Are you a Home Improvement Contractor subject to the registration law(780 CMR-6)? YES NO Are you claiming an exemption from the law by homeowner sign-off? 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 617-727-8598 Owner's Signature: Date: I RECEIPT FOR PERMIT o T • TOWN OF DARTMOUTH ,o "77 (,,,te !-►1 � PE ITN 3 1 •to 4• f ("" -, e 1. Dat „ s, f / / ,7 f Ri�:elved From. `✓!r� (,�`°�'' 9 � F Owner >... �;2, : '.1 -.''e.---e ,... Location O C y.._y "-e' "` ‘,�.a.--.—.., Type , .S vi., Amount Paid P` \)- ' 61 / Received By J " 2 RECEIPT FOR PERMIT ouik, TOWN OF DARTMOUTH / 7) <ti ; I1 _ / ,41',/:i .. PERMIT NO. ,r f Date j f�,- ---/ /ro t/ 6 Received From f j ✓f// ,;"1,7 1 =~':.1- -~ ✓ r, Owner '`a..,,_;:'; ;a%w-� _ r' .sue f J! ,✓ ./ i Location �`7 %A_G't_:fe-.7.4 :: -,,,k.---. /( \...7 ,r� Type . ,�'�C _ ti l! rr-r , 7 f f Amount Paid ,. C 7 1 €� '-' f 12;^/ . Received By °' -., . O't- if r „f f, . �,tipLTo..4, PEz4MIT NO. •4'`- ` •`� TOWN OF DARTMOUTH DATE ISSUED _ r x , •� � TOTAL COST 'fQO� SiAPPLICATION FOR _�� y�o� yy'' LESS APPLICATION FEE ' 1884-• WILDING PERMIT FINAL PERMIT FEE '5"ax:7 "-- LOCATION OF BUILDING ykuz- "--6 01 Number & Street CO re e-__, s n 01.1 Zoning District K 8 02 Cross Streets(between) -� and 03 Lot / Plat // 9 04 Subdivision Lot_ OWNERSHIP COST 05 ❑ Private (individual, corporation, Uw non-profit institution, etc.) 36 Cost of Improvement -// 36.1 06 ❑ Public (Federal, State, or local government) To be installed but not included in the above cost TYPE OF CONSTRUCTION 36.2 Electrical 07 ❑ New Construction 36.3 Plumbing 08 ❑ Addition -Type of Room(s) 36.4 HVAC 09 ❑ Alteration 36.5 Other - Specify 10 ❑ Foundation Only example: elevator 11 ❑ Demolition (#of units if residential). 37 TOTAL 12 ❑ Moving (relocation) STRUCTURE STATISTICS 38 ❑ Wood Frame 13 Number of Bedrooms 39 EMasonry (wall bearing) 14 Number of Bathrooms (Total) 40 tructural Steel Full-Tub 41 ❑ Reinforced concrete /V 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 /5� S'�✓ 17 ❑ Garage 18 ❑ Shed 45 Total land area, square feet , 19 ❑ Carport 27 ,F9,C 20 ❑ Swimming Pool SEWAG DISPOSAL In-Ground Above-Ground 21 ❑ Woodstove 46 ❑ ublic or private company 22 Fireplace 2E1k a '�4 1 47 Private (septic tank, etc.23 Other- Specify / WATER UPPLY 48 ❑ ublic or private company NON-RESIDENTIAL - PROPOSED USE 49 Private, (well, cistern) 24 ❑ Amusement, recreational 25 ❑ Church, other religious PRINCIP L TYPE OF HEATING FUEL 26 ❑ Industrial 50 as 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 be an elevator? ❑Yes ❑ No 35 ❑ Other- Specify PARKING PER ZONING BY-LAWS d 57 0 Enclosed 58 ❑ Outside , 59 Does this building contain asbestos? ❑ YES ❑ NO If yes complete the following: Name & Address of Asbestos Removal Firm: I ENTIFICATION - To be completed by all applicants PLEASE PRINT t 60 caner (pr. A-.- r` RAVe_J jg fitedifilA 1117ffQ5-109d 7 MAILINADDRESS , LEPHONE NO. Signature �, I� IV) J b ,jR 7 DATE V—� Builder's 62 90 tr for (print) License No._ �f // NAME MAILING ADDRESS TELEPHONE NO. 6t intre DATE 64 A cO it ct or Engineer (print) 65 k// NAME MAILING ADDRESS TELEPHONE NO. n t /i. 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? ES ❑ NO Submi, copy of notification sent to DEQE and the State Dept. of Labor Industries and result of air sample analysis after asbestos ren oval is complete. 68 Owner or Age t I certify under peril of the penalties of perjury that the information herein is accurate to the best of my knowledg 113(gnature , ZI DATE ner or Agent 69 BOARD OF HEALTH REVIEW , tee �, �i DATE ? W96 //// Inspector r Authorized Person COMMENTS: As" '7 X /Gi C -e-w'v ' 70 DPW - WATER Service No. SEWER Service No. To be completed upon issuance of permit- (if applicable) 71 I wil ost perm) nd addre s so as be visi le fr m street. DATE RECEIPT FOR PERMIT TOWN OF DARTMOUTH74A�� DATE _ / r- R PERMIT NO. cr% �" ' Date > `f / /L s (/ -6)? YES NO Received From ' / 1 '' f� f'--, O (if yes,submit required signed affidavit) Owner , • /, Date Location /j 1 c ,. HAVE ACCESS TO THE GUARANTY FUND Type /. ''---7ovement Contractor Registration 7-ty ✓, ton Place-Room 1301 i ✓/ ./ �,., L 02108 Amount Paid 8 Received By <1 =� 2 ' uvvIV ur [JAM I MUU I H BUILDING DEPARTMENT I TELEPHONE 508-999-0720 FAX 508-999-0738 TO: X Fire Chief Dist. 1, 2, 3 Board of Appeals XTax Collector D. P.W. Engineering _1 Board of Health Q D.P.W. Water/Sewer —. Conservation Comm., Cross Conn./Water Div. 7 Selectmen-Licensing Q 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 7 Lot v Address 6 CY //k \;/�y A , to (7�)%��S :�C CONTACT PERSON&TELEPHON # demo,cvnstrvu alter, occupy, etc. a(n) • The plan was received by this office on _ 6:2 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 uSBC 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. .iPPLIC V T. LEPHONE iITLEASE PRINT) SIG\ATLRE vas ATE JCE'SED CONTRACTOR'S NAStE.TELEPHONE,PLE.SSE PRINT DATE FIE COPY if / s / " / 6 dyard /125/--(ad s/ ,A,Y\ -- 60n /7. 12 )1745:e" t/wics • Or y TowN OF OLP.IiV73LI71 RECORD PLAN Copy Of This Endorsed Plan Must Be Kent On Me During Construction CURRENT MESSAGES iimmm 6=- DATE MESSAGE BY RECEIVED " 95 SEP 25 AlI 11 fr LL,LDING DEPT. gg C/ /d/1 ,01W-2/1 #57/ 1) ,e tzi 4-n 4/5 • ` =-_-__� The Commonwealth of Massachusetts - - � 6 Department of Industrial Accidents `* — ONCE af/a g,1oos __ 600 Washington Street s�, Boston,Mass. 02111 Workers' Compensation Insurance Affidavit i t ,W nt mn"Ormatlon:-e4:--::- r, _ ._ . �x-... '�;; � :_: . '���1\�'l�j_:i t � ..._ �,«ss::.. A"`i:' �f'w..s..-i _, •-,.--.<:iZ.,-Y.�_•.- VI am 0,AO ,—\---V,1 fr Ipe,Y lU `-Ni,\ cttl ` �� e �� phone# LD16—? I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity C I am an employer providing workers' compensation for my employees working on this job. company name: address: s: city: phone* insurance co, policy#: 0 I am a sole proprietor, general c intractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: address: city: phone* insurance co. ntiiicv#> .. .... .. company name: address: city: phone#: - insurance co. pokey#:.: Attich additioaar s tl'�eet itniFessa- .:_- `=..,•-...=..* . s� ,�, <;���1 4,:- , ii Failure to secure coverage as required under Section 25A of MMGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one)ears*imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 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. I do hereby ce fy'under the pains an penalti of erjury that the information provided above is true and correct. ignature .4/7 ,( A A---4 ,^� Date Print name v Phone# z� official use only do not write in this area to be completed by city or town official � city or town: permitnicense# f Building Department P ['Licensing Board E _: 0 check if immediate response is required ['Selectmen's Office c= E ['Health Department p contact person: phone#; a Other K 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 o- the foregoing engaged in a joint enterprise, and including 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 hay: been presented to the contracting authority. ‘ppiii.ants* ._ 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. r f A z _. r ...r<sh'�'k--rX ... :Ys ' sM '' 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 ydu 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 Offi; of Investigations would like to thank you in advance for you cooperation and should you have any questions. please so not hesitate to give us a call. _ , , T:e 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) 727-7'749 phone #: (617) 727-4900 ext. 406, 409 or 375