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W. a a a a a a a a a i # a a a a a a a a a FOUNDATION CERTI FI CATION: " I CERTIFY TO ANDREW AND LORI ANN WHEATON, SALEM 5 BANK, THEIR ATTORNEY5 LOFFREDO 4 5CIOTTI 4 TITLE INSURANCE COMPANY THAT THE FOUNDATION SHOWN CONFORMS WITH THE HORIZONTAL DI MEN5IONAL 5ETBACK REQUIREMENTS, A5 SPECIFIED BY THE TOWN OF DARTMOUTH ZONING BY-LAWS, AND 15 THE RESULT OF AN INSTRUMENT 5URVEY CONDUCTED BY CHARON A35OCIATE5, INC., AND THAT IT IS NOT LOCATED IN A "FLOOD HAZARD ZONE, " A5 DELINEATED ON F. E. M. A. COMMUNITY PANEL No. 250051 0005 B, ATED JUNE 1, 1 53. Utility Pole IDS SITE PLAN SCALE I " = 30 FT. R63 / r GENERAL NOTES: 1) THE DECLARATIONS BELOW ARE MADE ON THE BANS OF MY KNOWLEDGE, INFORMATION, AND BELIEF AS THE RESULT OF TAPED AND INSTRUIMFNT MEASUREMENTS MADE TO THE NORMAL STANDARD- OF CARE. 2) DECLARATIONS ARE MADE TO THE BELOW NAMED G)NLY AS OF Ti115 DATE. 3) TF115 PLAN WAS NOT MADE FOR RECORDING PURPO.`SES NOR FOR USE IN PREPARING DEED DESCRIPTIONS. 4) TNIS PARCEL 15 SHOWN AS LOT 15 OF ASSESSORS MAP 79. N 10001.01 E 20257.19 BENCHMARK: NAIL TO BB SET IN UTILITY POLE ELEV. = 52. 00' (Approx. U. 5. G. 5. Datum) IRON PIPE (FOUND) N 10001.73 GRAPHIC SCALE 30' 0' 15' 30' ( IN F 1 inch = 30 iL ty ?Aon C, P co • V " Cfell, . e,a 4 +� f ;Q 4w• / wet PLAN OF FOUNDATION 'AS —BUILT' PREPARED FOR A.'NDREW AND LORI ANN wIiEATON 167 PINE ISLAND ROAD NORTH DARTMOUTH, MASS. Charon CAI Consul gE � Associates, Inc. 323 Neck Road -Rochester, MA 02770 TeL• 508-763-8362 Fax: 508-763-9582 gCALg; AS NOTED DATE: JANUARY 29, 2007 v PS • w . 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OU N N uj Iz U z� o o m u rJ2 ^ LLJ - v Q v V J - V O W ti cj W C W � w w O z �- _ ~ W GNU w V u� � W � w o � w � p N cn=zLLJ w � v � 0 Q D p 0� zWpz • z``Lk— � II o�Qv 3 OOU�-I' �<�� W UQ�t� • �N II W~ m Nww � N � Ql cm � � �I • U O II 11 IIaz J • ZS • �80 W U C)QpeIZ- Z O N =3 Q ►- O g ED uj 02J Ov o m N U- 5 W z 0 0 0 0 O d � F=- n- uw w ►u W � O J a o o= 3 16 BUILDING INFORMATION MODEL. COLONIALCTM7. #06231 SPECIAL USE PROVISIONS. 167 PINE ISLAND ROAD CONDI I IONS OR LIMITATIONS PROJECT SIT E: N. onRrn+oulr., Mn 02747 BUILDER�PURCHASER: A°oa'ewANo �oRi-nNN vn�Earo� BU'LDING MAY N01 BE LOC A 167 PINE ISLAND ROAD I WITHIN FIRE LIMITS IURNKEYOti nnR7mOL1TH MA 02747 T E D E GROUP: R4 6'-0" MINIMUMU, C ODE REQU-1 RED C.ONSTRUCTION. TYPE. -WOOD FRAME(5B). SETBACK FROM LOT LINES AREA: First Floor =2324 SQ. FTI 0 SOUR EXTERIOD WA,LL — •Meeis MA Code excepticn n2 5.116 S'r�C'�� L BE PFSPO��ISB LE FC VOLUME: '5,913 CU. FT.(,&ZF�,,Y)for construction control � HO"JSE LOCATION ON LOI BUILDING HEIGH I: 2%'-2" � NUMBER OF S I OPIES: 2 - HEATING SY(�TEM IYPE: DESIGN OCCUPANCY LOAD: 12z�o�= o FORCED I--�OI U/AIE� B�StBOF �I SPECIAL SYSTEMS =` 1 FIRE A LARM PHOTO ELECTRIC HEF�TING SYSTEM FUEL: € �Y� T inn � YPF- �wn[<F � rn nFTFr.TnRS ��+Ai I RF T�-',E RESDONSIBIL D \ D ITY APPLICABLE BUILDING CODES: STAiE BUILDING TTS —MASSACHUSE CODE 6th EDITION —MASSACHUSE TTS FUEL/GAS/PLUMBING CODE 2005-NEC W/-MASSAC—USETTS �MENDMENIS 1993 Bijl,�IIIIIIIIIIIIIIII,,A NATIONAL MA CODE W/�,M7NDU�ENiS ECHANIC�,L EXTERIOR ENVELOPE TJER;MAL PrERFORMANCE (U VALUES) SEE P, I TACHED COMPLIANCE RESCnECK RFPORT .".� r--R//PURCHASERr .. S-UPPRES-SION�� 1= E • :-- ter_ E TYP �.���• MNEY ON 1N IL C M_ Cr.. I ABLE_IINCSSi Y I E � sVENT 1 . D1 ELEVAT IONS___N 2. FOUNDATION PLAN O F-; E__ • •-=•3A. FIRST FLOOR PLAN ESDON I I Y_Sf--�O R P`AN I� IV LOADSP sPBER N FLOC DE SIG L E . , ��. cross — s�cT� -r P�aN r-�SER UMSING -BUILDER � � P. T FLOOR PL -..:\ P U 5 A. FI S . PE :•.WALL:�� COND rL.00P. PLUMBING PLAN �a.SE— EC T RI CAL PLANOOR 0_ cCOND FLOORA P L..N268. S4 n-30 I�IPDP)ARTY INFORMATION 1 - FIRST FLOORHW88 PLAN r-' • �..PFSCorp. �'" I}''� �'r ND FLOOR N11Y88 PION ..:..: i TAILS -- ! 8. STaNOAP.D NOTES & DE . ' • R o a 1+ w -� a .�� / SkU �e tOWn A-,; - - COV01 SHEE � �"'t`��PACES c-RIDORS_ Nj PA517P.1 V W �4 ids i i0/1-3/0a msbur 4 � R. •. I UU �- • .�_ TPIA 4 30 BALY •:.. - j - - i• S£% J� T Z rr .tt � •� , n 1. �• �, � -' ..�� .+V � � 1 - -OTHER': 1x :. .� .. - .� - l,� �, �• �/: :" � -l•'• � �:i:' CAE :.c` •i.�c j � 1 [! � _ '•-+".'� `-"'"r ,` ti. -_ r1 APPROVAL LIMITED T FACTORY BUILT Pop,�-I NOV I 13 G6 r ac t A f. ST c.� .41131 dft � Ift • � 111t%LN I L PFS CORPORATION Plans ccrified to comc.'Y vAL`1. 11 appirca'Die codes anti'reguM-c'tJ of• tit�sSkC9( as s E N T4 r I t ScrA F F Signature Tive . APPROVAL L1MftED TO FACTORY ELMV E-V1SI0N N/A TTs� Westchester Mod,','ular ffomes Inc offices and Mccr•;ufacturer Plant 3a Reagans Mill Roa.i�. 1ruigda1e; NY, 12594 Tel .(845)832-9400 -Fax(845)832=6698 Manuf ac ture r No. .MC TI 6 Expiratio01...67�r� l)rzte: t94/3= .I 16 OVER'ANG -DIMENSION (*) Roos= PITc+ 24'--0" I�ousE w�o-rH - 126 -0-/30'-0"127'-'8' 3V-$" 5 12 16"ISE 11" 16" 7/12 16" 1 T" 16" 9 /12 1200 line 12" 12 /12 8 3 4-" 8 3 /4•" 1 8 3 4" N: • - WINDOW GRI[E PA7I NS SHOWN ARE FOR ANOc�'?r SE?4 WINDOWS. GRU-E PAMERNS FOR OTHER MANUFACTURERS MAY ®E DIFFERENT. IL J- 11 LLLIJ, L-- PORCH 6Y B/P-. _ 1171] it j _JILMIII L LU I! i I ALL EXT.STAIRS, Stc. S, RAt1S & S 8.a...._._.. , LJ L'ES�Gy SUPPUED AND IN�AUED 8Y S/' FRONT ELEVATION SCALE: 1/4"=V--0'. • - - _ '_ Pt1Ju8arc vfJ�T - s Vac . - •..�« .. I• tit - - 1 I 1 { t H - � Q D . REAR ELEVATION EDEDEMMt► SCALE: i 8 *=- LEFT ELEVA110N • •' SCA s LE: 1 /S =1 ---0 - 12 5�i t1 lk 0 � z co lox w Q s Y6.zoo - GVJ`� 0 WO I v*) CL r% O �- U-' frrrutt���ti��� OEO�2CIOD ui ` 0 V�. RIGHT ELEVATION SCALE: 1 /8"=1'-0" -Nz c c .� a Z:lin V = 5 y z tip Cl Z . <.D at: Ln GO 1 C d co C3 cn .. O tea a„ <c 0 cri Q Z CZJ' Ucc CN Mm H Q O •0 04 O Q .� Z�xO Q 4� p mQ4 0 Z a3 a_ u) Q _ m o t� o - w L1' I•�I • .r 11••: LL..r •1� r: 1 •• • 0 42'--00 s-u t CN235 3 IF cv .,.. co co /BKFS CN lI �EN " 15 o" x 1 J'--0 1 /2" D26 02� - 0012 A PAN`: ot24. • — _ A30 A0 t D26 tr- R La - i ON (2) 2 - x 10 — =40 FLOOR to STUDY u 13'--7" x TS-0 1/2" o' cc N O F J En z 1 m LIVING ROOM o i ivsTALL BASE TRIM NAILED AND CAULKED IN NORMAL. CARPET AREAS /L BASE TPIM FOP NORMAL LINO AR."17AS IN FULL LENGTHS PAINTED LIGHT & VENTILATION SCHEDULE (SF) #ZOOM AREA LIGHT SUPPLIED VENT SUPPLIED LIVING ROOM 220 25.6 11.46 FAMILY ROOM .207 50.6 26:96 lCtTCFiEN/BKFST 176 8.0 7.20 STUDY 177 35.9 17.19 _w • U Z', WI Z O P V U1 CL cn Z z �. o U.J2, mac, h -j Q. } , z mci C z 1t1111111jeff"1, ♦�� 00i ro eL ch ON cr t t ro CL i 0 — p 'frr�f<<tttt:titl<<����`` QQ CYDW < G � ccl Z: (n w 5 v •d o M i • o �CD tt. o co CDS._._ m ZE cn q. a_ cr— tn i-. 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PRE ENGN D & CER Ti E POOF TRUSS DESiGy _• AIR BAFr1.E BY WtvlH R38 INSULATION W/VAPOR BARRIER :: _ 2x6 BLOCK 8E i WEEN • :=:.= E'VlERY OTHER MUSS - w (3) 16d FACE —NAILS •' . -� AND (3) 16d END -NAILS AT EACH END OF BLOCK • -= =� = '�•;_ 3) 16d FACE —NAILS = {3}(82 } 24fi# WITHDRAWAL) . .. 16d END -NAILS _ (3)(128 } -- 384 (SHEAR) plTR GREATER THAN 175# MINIMUM-] - 2x6 SILL PLATE w (SUPPLIED ac INSTALLED BY B/P) . � ..4 FOUNDA• FON WALL • .= = FOUNDATION FOOT ING _ -- ROOF PITCH MAY VARY Sct ELEVATION DWG E 12 WLUMN rvv m-lw • CON T RIDGE VENT 18 inZ/Lc iyp ROOF 30 YR S-,l C'- NG T 1EERG��SJ SHINGLES OVER 1�T ROOrtNG ELT OVER 5/5- .rAC_E. A Rr c0 Sr4.EATrtNG EI TUTHANE. APPLIED CONi1NU0USLY T 0 EAVES . FOR ICE- SrtE"I'l i x� SUS -FASCIA LUMINUM FASCIA 7171 VINYL Su F T 10.7 in f s 'VAT 0 o TYPE)C70RIOR WALL ccrw [2] 2x6 <pr p TOP PLATES 2x6 SPF 13 ® i f " OC_STUDS 2x6 SpF a2 SOLE PIA t 1 j2" (;WE- c4Tt-MOR SIDE z R19 INSULAMON WITH VAPOR BARRIER PtEO �0 cm IM ® 7" O.C. - MA only } Z l 01 P1 ol La l CL' cI ZZ l "= r. 1 �2' A�1CY RATED SHEAii-iiNG EXTERIOR SLOE c to mc%JE $ARR�RWEATiEZ- PCl11 SIDING coW ! VINYL < 44 a cu -Rr co Ln 1 O a � ♦ � tat � - V t © Z •-- cD O C17 @.. • Qi M l C3 T- co m T o �w q co 4 N t/7)CIO F _ C u Y LLJ { c� -� cn m N M� • utto R • "' < fit Z o0� - Me co 0 63 Z a � • a3 LLJ 0 O Hr •w 0 `r ?0 ls ' _ • • �_ ••�-ice: +r�r+�-:a�.ti_ - • - ��--�•� • -•� •••►•��•.r-,,.,ram: •-.•.�.•r, ��t=`. - �-t ,'•�•.• ••.. -- •i •l, •. .• •+.• �• ::�;y•• '.' '••r db • - 1 1 /2" v TO 2ND FUG WASHER - 2� J w 1 1 /Z"V - _ • (1) 27 VC UNE ICT-SNK & Ow SSMNT TO • ATTIC 1 27D ! 1 1/2-V SLOP ' 1 . SINK 1 1 /2"D 1 1 /2"V .:_ K11 CHEN /BKFS wc . • _V LAV 2 1 _-1 /2» 0 •- 2 V j�� ram-••.-. == Z FV == STUDY - • • q is j _ - - - �__ DRAIN 8•Y B/P ~] DRAIN BY WMH ------- - VENT BY R/P -' VENT BY WMH DWV- DIA*GRAM- •. _ - VIEW "A" - NTS D = DRAIN V VENT _ FV -- FUTURE VENT - SP = STAND PIPE . CT DW = DISH WASHER WC = WATER CLOSET FC = FIELD CONNECTION BY B/P �.'. B"/P = BUILDER/PURCNASEI :•-yam �_ 42_•-Qw FAMILY ROOM- Z'V To WASHER �2�`�}� � Q 2:W T LR r ,Zp SHOP c N SINK -00 N 0 36*7 FRM 2NO FUR U Z Z O a cn Z 4 Q rr uJ a :z Z co LLJ 0L_ i— ��rrrstrett��� OL 1L IVING ROOM. II ICI_ G�'II I I I - I I L� C3O ` C.1 En W co .. o cn� E C-4 E '- co U-) z o o --:- z co4 SLOP co SNK. 1NASrf WC LAV SINK OW -•- -1 - •� o J U. z -z� -- I n_ Typ p c I I clq _j co FLut Ico CD y to N . u Z o o'er � (o C�.� _ -s JSUPPLYo-i- X Oad 4. C� ? 0 2 . 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Q in w Mom ampr J mV THRU RCOr :mot- CONNECT TO 3"MV - 7U8-/ = 1ST FLR = ' 2~V F'r�Ad 1 1 /2 *D IST FLR - LAV LAV . - —mow ^-• - • Y DWV DIAGRAM 3mD TO 1 IST FLR VIEW `A' — N�TS - • = `' D = DRAIN • �_._ a v --- VENT =--- FV FUTURE VENT SP STAND PIPE f+ DW =DISH 1I�AS DRAIN BY B/P WC =WATER CLOSET _ • DRAIN BY WMH -`` FC FIELD CONNECTION VENT BY B/P - / . , . _ . • _ B/F� = BUILDER/PURCHASER P•UI�CH� • � . . -- - - / SER� - VENT BY WNIH. 3"D T4 1ST FLR w cxCL C C.3 • C 4> CD I 7= N LLJ �_c WC LAY S•ri LAV TUB S 00 WC LAV � r Q_ � >-- CK3 I t i t 1 o a. z = L7 i. -� Co o a� •.�' � cac FL uj T O hLa o N cn M EO C CD c"co to_- 3'D� N�--- C!) 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V. W. • a a • • a . f FISTING LEACHING • i a • • .•! FACILITY - SEE N E 4. ■ • tM .. • 100 FT. BUFFER TOP OF BANK • a as • • 200-FT. RI VERFROUT ZONE ' Repair * Re -Pave 125 Driveway As Needed ' Existing Low Pressure • • • • i i • Force Main From a Dosing Tank Existing Gravel Drive ' I Shed Ex'5t►ng Dosing 40 Tank EXI,5TI G GARAGE 0000 I t il 0 54F., 141 Itl • 4b dft d1b istmg ,,eptic Tank _ ; 1,430 5.1 �\- Inlet Invert = 78.30' Q — - tT- PROPOSED. Exolq ,Wall 2 • - Prne Bldg -on ' r y T. 0. FNDN. = 93. Staked Haybales Sewe ; _ Porch / , \\ B.V.W. �� wn. Prue New 4 65' • �� I Bldg. wer - i.X15T'G. irLL ' � BE RE 10VED • a Clea Out ' � . � �_ 8-._ ._ h TOP OF BANK 1 • i 3� I - HOUSE # 67 p L - , (TO BE ED) • Cedar j � 90 L' P f:T. INED- iNG o 1 100 - do pC15� Q - NEW WELL ABACK �t� o 5 1 INV. = 46.2' EXI5TI NG WELL Mo EXISTING C��JLVER TPINE ISLAND ROAD �� li� MINIMUM a • �- Utility Pole NMN • a • • • • i` • a • • INV. -- 45.6' B. V. W. - • i • . • 000, EXISTING CONTOURS: 52 ' ____- --- PROPOSED CONTOUR5: 54'— — EDGE OF WETLANDS: LIMIT OF BUFFER ZONE: •••.•••••.•• "• • • •. EDGE OF SHRUB LINE LIMIT5 OF F.E.M.A. ZONE5: — — -- — WATER SUPPLY: W SPOT ELEVATIONS: X53.9 TEST PIT LOCATION: SEPTICTANK: o o T DELINEATION FI.AG#6 SITE LAN SCALE: I " = 30 FT. MAP 7Q LOT Approx. Lima of Pavement 4000, BENCHMARK: NAIL TO BE SET IN UTILITY : POLE ELEV. -= 52. 00' (Approx. U. 5. G. 5. Datum) GRAPHIC SCALE 15' 30' ( IN 1! 1 inch s 30 ft _• IRON PIPE (FOUND) FIN. GRADE 91.5' ± \\ Ize ORI VEWAY GRADE: AT CONC. APRON = B C; n, .i.. T.O. FNDN. ELEV. -- 33.0C° CONC. SLAB ELEV. = 65.54- B.O. FOOTING ELEV. = 54.3 ± LL--rj —1 _J B.O. FOOTING ELEV. = 81.00' FOUNDATION SECTION NONO N.T.S. 36" MIN. HARDWOOD STAKES DRIVEN MIN. 12 " INTO GROUND DOUBLE STAKED HAY BALES END -TO -END UN-015TURBED GROUND ! Flow i! II =iii l i-= ll1 ! !II-=i!i=111-il l 1 JTf TT =' N NOTE. NAY BALES TO BE TIEri : �' NO Pb'= TI.r OF, WIRE. hAYBALE DETAIL. N .T.5. NOTE5: 1) Th15 PARCEL 15 SHOWN A5' LOT 15 OF A55E55OR5 MAP 79. 2) THE DWELLING SHOWN HE�TON DOES NOT LIE WITHIN A SPECIAL FLOOD HAZARD AREA AS DELINEATED ON F.E.M./,A. COMMUNITY PANEL NO. 250051 0005 B, DATED JUNE Is 1983. 3) THE SEPTIC 5Y5TEM LOCATjION 15 A5 SHOWN ON A PLAN ENTITLED "SUBSURFACE 5EWAGE DISPOSAL 5Y5TEM A5-13UII T PLAN" DATED 4/20/99 BY MAUK, BOUCHER * HEREUX, INC. 4) ZONING = 'SINGLE RE51DENCE A' MINIMUM 5ETBACK.5: FROh+jT = 50; REAR SIDES = 20' 5) LOT COVERAGE: BUILDING AREA = 3,160 S.F. PAVED AREA = I 9620 S.F. TOTAL AREA = 4,780 S.F. LOT COVERAGE = 4,780).5.F. / 77,100 5.F. = G.2% 6) THE PROPOSED WORK A5 9HOWN HEREON 15 SUBJECT TO 155UANCE OF AN ORDER OF CONDITIONS FROM THE DA"P\TMOUTH CONSERVATION COMM15510N. t t y `.r•� `.ai�.�.• RICHARD C.7- CHARON &No, 28789 tap, D.E.P. FILE NO.: PLAN OF SITE AND REPLACEMENT OF DUELLING I. ■ 1114 � � � • Charon Associates, Inc. Consulting Engineers 323 Neck Road - Rochester, MA 02770 Tel: 508-763-8362 Fax: 508-763-9582 STALE: I INCH = 30 FEET 17)ATE: 5EFTEMBEK 15, 20OG D17G. N0. L­­­­­ I RESIDENTIAL RESIDENTIAL 2.1 Owner of Record: Andre x7 & Lori Name (print) 2.2 Authorized Agent: Ann Wheaton RDA }nc d/b/a Realty Develo Name (print) ) 4-..VA t Assoc. 167 Pine Island Rd N Dartmouth 508-995.-8198 Contact Address Phone Number 1 Bluff Rd PO Box 601 Sagamore 508-888-421 P - ( tJv11�.6LVV L it.1Ll1 V►7►7 Phone Number 3.1 Licensees Construction Supervisor: RDA Inc. Not Applicable ❑ Licensed Construction Supervisor RDA InC. - License Number CS 051170 Address 4 Bluf f Rd PO 601 Sagamore, MA 02561-0601 Expiration Date 9-10-08 Signature lephone 508-888-4212 3.2 Registered Home Improvement Contractor: Not Applicable � Are you a I-Iome Improvement Contractor subject to (780 CMR 6)? 0 yes ❑ no If no, go to the next section! Are you claL-ning exemption from the requirement? ❑yes ❑ no 0 If yes, submit the ..required affidavit! ^ompany Name RDA Inc.- Registration Number (if none, state "none") Address 1 -Bluff Rd P O Box 601 Sa amore-MA 02561149974 Signature _ e e one 508-888-4212 Expiration Date 2/27/2008 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: h onie Improvement Contractors Registration, One Ashburton Place -Room 1301, Boston, MA 02108, (617) 727-8598 Owners Nar,��e (print) n/a Signatur by signing the above, the home owner acknowledges that there will be no eligibilty to the Guaranty Fund Date I-K A0 3.4 Homeo`Nmer Exemption --One & Two Family Only - - _ Y Y 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 Jul 1 1982 no individual y , d 1 shall be engaged zn directly supervising persons engaged in construction, reconstruction, alteration, repair, removal or demolition involvingthe structural elements ofbuildings a or structures, unt%g ss 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 Homeowner performing work for which a Building Permit is required shall be exempt from the provisions of this section, provi des that if a Homeowner engages a persor.'(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, there is, or is intended to be, a one or two famil dwelling, attached or detached on which v ched structures accessory to such use and/or farm structures. A person who constructs more than one home in a hvo_year period shall not be considered a Homeowner. If you are applying under this section sign below: S ignature: -n /a Your signature carries certain responsibilities, including but not necessarily limited to, general liabilit y 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: ;dyes ❑ n 0 . .. SE0 N 5, DESCRiPTiQ�V O� PROPOSED «ORI� {cheek all applicable} -_ - 91 new construction* ❑addition El alteration El repairs chimney/ O wooc�stove (energy report required) (energy report required) fireplace 0 deck ❑pool El accessory bldg. O replacement window/door ❑other :0 dem�ilition (shed/garage) no. of windows doors (specify below): (specifY-ibelow): * If new construction, please complete the following: Single Family: no. of bedrooms 3 no. of baths 2.5 Two Family: no. of bedrooms unit 1 no. of baths unit 1 no. of bedrooms unit 2 no. of baths unit 2 El Furnace (hot air) -fuel gas (natural or propane), fuel oil, electricity, other (specify): 14 Boiler (heating) -fuel gas (natural or propane), fuel oil, electricity, other (specify): HVAC (combined unit) -primary fuel, natural gas, propane, electricity, other (specify):_ El Air conditioning - (separate unit) El None of the above to be provided 2 Hot Water: Gas Electric Fuel Oil xx Other BriefDescription of Proposed Work: Demlition of exisitng home &construct wood frame modular colonial style sin le familv home w/ attached farmer's pqrch across entire front cf hous and 2 car garage under. Foundation for future fireplace -� SECTION .::6 ESTIMATED CONSTRUCTION COTS Item Estimated Cost ($) to be completed by permit applicant 1. Building - modular construction 2. Electrical . Plumbin 4. Mechanical HVAC 5. Total = (1 + 2 + 3 + 4) Estimated Total $ 245rOOO (please print) L Andrew Wheaton , as Owner of the subject property hereby authorize RDA Inc . J p p tY Y to act on my behal , in all matters relative to work authorized by this building permit application. Signature of Owner Date _ I Signature of Owner/Authorized Agent ent RDA Inc. l� • G l 4,gs Date C:\bldg.fonn§\B1d` app.res.wpd Page 2 Rev. January 2005 C:\bldg.forms\Bldgapp.res.wpd Page 3 Rev. Ji-,anuary 2005 RESIDENTIAL RESIDENTIAL ❑ FOUNDATION ONLY 3. HOLD /r k /V 0 01 0? /41? ler /,t-/ %7 am' C:\bidg.forms\B ldga.pp.res.wpd 7 Rev. January 2005 0 � Atq- fjo it 0 _-j; 5 T, a I, L! -! t , t,+j `E w gf--Z3 14 A 0, 11r, i ra - 1 - 2 Board of Health: Conservation Commission: Other: - Dev ription of myork being perf Signature: f � � Date: Signature: � �Wolf- Date/� Signature: Date: I �rrned:� L'1�� �� d- C �r\S� vC- i'� �'c-� ����,.'1 �/10tiJ`P _ ! NTU MBER OF PLANS SUBMITTED: 3 1.1 Property Address: 167 Pine Island Rd Nearest Cross Street: High Hill Rd Subdivision Name: n/a Total Land Area Sq.Ft.: 1 .7 7 Acre ± 1.4 Watcr Supply (MGM: c 40 § 54): Private well C: ;bldg.forms\Bld,c,rapp.res.w,od 1 f t � V .. .... .:......... .. .....1.... .. .. .... .. ..�/. ..- .... SITE PLAN SUBMITTED: Ki yes ❑ no 1..' Assessors Map & Lot Number: Map 7 9 1,ot 15 - 1.3 Historical District ❑ yes E, r..o Has application been submitted to `the Historic Comrn3;ssion? ® yes ❑ no Date: 10 =2-0 6 1.5 Se�.vag e Disposal Syste.Vn: -orivate septic Page i Rev. J;rim .1s ry 2005