BP-707 BuILDINo_ PERMIT
Dartmouth Building Department Plat: 79
400 Slocum Road-P.O. Box 9399 Lot(s) : 28
Dartmouth, MA 02747 Lot Size:41,200
Telephone 508-999-0720 Zoning Dist. :SRB
April 22, 1997 (typed) Permit No. : .7(97
Issued Date: 9 /13/97 Clerk: BAS
Project Location: 64 Pine Island Road
Number Street
Subdivision Name:
Nearest Cross Street:
Applicant/Agent: Dennis Moniz
Address: 64 Pine Island Road, Dartmouth, MA 02747
Contact Person Phone #: (508) 995-4749
Type of License: Owner: (x) Const. Superv. License #: ( )
Architect: ( ) Engineer: ( ) Other: ( )
Proposed Use: Residential
Residential,Commercial,Industrial,etc.
Permit Issued To: New Construction
Type of Improvement,Add,Alter,New Const.,Demo,Land/Move,etc.
Alterations to existing deck
indicate no.of bedrooms and bathrooms and other rooms
Gross Area of Const. : 296 sq. ft. Cost of Cor%st. $750.00
Cost-Other Const. : TOTAL FEE: $ 40.00
Owner(s) of Record: Dennis & Wendy Moniz
Address: 64 Pine Island Road, 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.
Signature of Owner/Agent: t:t/ati
Address:
******************** . ** . *** **p ** *� ***************************
Signature:
Approved/Issued Byoel S. Reed, Title: Building Inspector
COMMENTS: PLEASE POST PERMIT CARD SO T •T 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 (I , • P'Y'
TOWN OF DARTMOUTH sy -,
-- -- - - - — BUILDING F ECEIPTS
iv, -- 0 TAX 1SSUESOLLECTORS OFFic
Name: Property Date: ,`
' /c ;. r Owner- ..of;_ ; j `
Job Location: t 'i< "
t/L
._ White Copy-Collector's Office
Plot: - ; Lot: --� Yellow Copy-Customer's Receipt
,a' Pink Copy-File Copy
Green Copy-Building Department
Phone: I
i_tLi
TH
Description General Ledger#'s. TOWN d �" Amount
TAX Cut
License&Permits-Building 01000.-44105 1 'OP.): f
License&Permits-Building Misc. 01000-44105
License&Permits-Electrical 01000-44106 . tom 02
License&Permits-Plumbing&Gas 01000-44107
Other Department Revenue 01000-42420
J
This is not a Permit or License for Building.Plumbing or Gas Received By: ----" / -
r- - - TOWN OF DARTMOUTH BUILDING RECEIPTS
NO TAX ISSUES .,..
COLLECTOR'S OFFICE
. ,
Name ' ' ,' , _ , 2 Property Date - 7 '
et---„,: q 1‹.---
owiler• ,
Job Location: y '
el :,-.17—, <,,,
White Copy-Collector's Office
i-,./
Plot: 1. ,-`7 Lot: ,-1,. Yellow Copy-Customer's Receipt
—,,i'''
; i ...-..-- Pink Copy-File Copy ,
Green Copy-Building Department
Phone:
Description General Ledger#'s Ref.# Amount
License&Permits-Building 01000-44105
License&Permits-Building Misc. 01000-44105 TOWtiSW EARTMOUTH (-- ,..)
, -
. .riga
License&Permits-Electrical 01000-44106 TAX CULthefOR1——
License&Permits-Plumbing&Gas 01000-44107 36PR:1 6 1991
_
Other Department Revenue 01000-42420 ,r7 ,
(--t- S 03 - -- ,
I ,
.., ,--•, /f- 7
This is not a Permit or License for Building.Plumbing or Gas '- Received By:
TOWN OF DARTMOUTH BUILDING DEPAR. T
TELEPHONE 508-999-0720 - FAX 508-999-073
APPLICATION FOR ZONING AND BUILDING PERMIT
The applicant shall complete this application to the best of their ability prior to submisyiotn.•eaviag no item tmanswered.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 appiy.A properly completed application will help avoid mammary delays. Min Mae fee tts ttttf ttttfta•ubiie.
(for office me only) () f �,/�
Application fee $ -� received bl / Date
O
Total Perm # 7 _7
Permit Fee $ �7
/o. cC 3/', 7
100 LOCATION OF PROJECT
CURRENT ACCESSORS' PLAT 7 q LOT ZONING DISTRICT t?--
OTHER ZONING OVERLAY DISTRICTS , if a i licabie
NUMBER & STREET
NEAREST CROSS STREET
SUBDIVISION NAME & LOT#
or BUSINESS NAME
OWNER �/ Al 15 M 0 /V 1 2._
_00 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
THIS SECTION NOT APPLICABLE
_ Single famih• - number bedrooms number baths
= Two famih• - number bedrooms unit 1 number baths unit 1
number bedrooms unit 3 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
•• ..yuu-einspection priorto installation), new(provide manufacturers
instructions). Location(s) (list)
Fireplace(s) -(includes flue) List tocatic-t(s)�,-
Game Court-describe(include overall dimensions)
= Tent, Trailer(Mobile Home) or Other-describe �'*fir ?---764_{_e_i ,
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)
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 day 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 dw
also existing condition ellin g unitsand bedrooms or occupant load as applicable,
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 CONSTRUON CONTROL(over 35.000 cu.ft.)see Code section 127.0). Designer to submit Code Synopsis. Yes No. (If yes
Will this project require Peer review(over 400,000 cu.ft.) Yes No (see Code Appendix I)
APPLICANT TO PROVIDE
s
m
V = Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required.
Demolilion -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)
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 layers 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 be 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. Whv"
Submitted. usually three sets required. Four sets for food service,uses. Number of sets submitted
600 SITE PLAN
0 Not required, why?
- Submitted When? - Previously, date TV ith this application
700 UTILITIES /
Water supply - required_yes_ no, public ? _yes no, on site well? V yes_ no,
existing? _yes _ no
If required and not existing have necessary permits been issued? _no_yes;date
L
(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_ yes no, public sewer_yes_ no
private septic - on-site v yes _. no. Submit copy of permit as soon as available.
p
800 MECIL NICALS & PRIMARY FUEL -
= Furnace(hot air) - Fuel gas (natural or propan( ,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
900 SPRINKLERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
_ Required, plans provided, plans not provided, whv?
= 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 IDENTIFICATION (print or type except as noted)
Current owner- name 0/to op,/J ; L-1 1 Z
U . ddress G• 7 ✓ 7i'ie - ..s /9 xi ce e, ,
jphone# ) c' cj 9) -
If corporation, officer in charge
ArchitectfEngineer- 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 Massachusetts as
Certification number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
General Con r(if Homeowner, st to homeowner here then complete section 1300)
Company n me
Address
Phone number
Construction Supervisors license number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
:ssz*ssssssssssssssssssssssss#ssss:ssssssssssssssssssstsssss.**sss.-
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(if 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 he 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
written request.I understand that once the permit expires a new application may be required,including fees and current
other requirements (including Zoning).
/Name <tl e) /Z
�+ ignature`)
The above signature is my voluntary act and is signed under the pains and penalties of perjury.
'Date ` -/C y 7
Who is authorized to pickup the permit at the Building Department? please prinnP!./s% C/2 ive+sl 91
Address d'1/'1'4t j?0 Phone ` `/ i - Y 2 `,
1400 HOMEOWNER EXEMPTION -ONE &TWO FAMILY ONLY
FOR HOME OWNERS WHO INTEND TO PERFORDT 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 ab follows: Personas)who owns a parcel of?and
on s hich he/she resides or intends to reside,on which there is. or is intended to he,a one ok•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-rear 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
2.15.2 of section 5
1500 COST
Cost of Improvement S �f c-
Items to he installed hut not included in the above cost: Electrical S
Plumbing
HVAC
Other 7
. 1:7TOTAL //-C, .
The following section for official use only.
INSPECTORS' REVIEW
Date plan reviewed
30 days to review period expires
OK to issue date
OK to issue subject to requested submittals (see project review worksheet) date
DENIED see project review worksheet date
HOLD reason date
HOLD Subject to Zoning Board of Appeals action
Comments
Inspectors signature 1 le_
fke
Date4PR 1 7 1997
f
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
�1
TOTAL FEE 'T Ci
Gross area - new :,:onstruction o9-Q C Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit
7 � /Y r �. ��j� cc. rr /•.,,/c( / /)Hr1 45 z 6 4 :� 7X
z"/4 L_.z Te,n j3c4.? ClJ
S7/91/ �C i�/mi./ Iicii CXiS 7- /'J ? 7'hZ 77 'i(7CrYT
/N
/04/fqr (? fl 19Il'/ Irffet`% DG ix,e
!Ow)TOTUEAPPLICANT/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
ro Q approval for your
proposed project.P Q ect. CONTACT THEM FOR REQUIRED SORMLSSIONS.
2 TAX COLLECTOR Approved _ HOLD By
Dare
a Conservation Comm = Approved By
_ Date
a D.P.W. water — Approved By
_ Date
a D.P.W. sewer — Approved By
Date
a D.P.W. cross connection _ Approved
Date
a D.P.W. engineering = Approved
Date
a Board of Health well = Approved
Date
a Board of Health septic ' Approved
Date
a Board of Health food service _ Approved
Date
FIRE DISTRICT(I - II- III) — Approved
Date
a Planning Dept = Approved
Date
Other — Approved
Date
():bur Approved
Date
('.,mments
Project summary new construction; alteration/demo
sewage disposal - puhiic;private
[Alter•add interior walls] [add rooms! [add footprint! water supply - public:private well
(pool! [garage:shedj [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
.luestions please advise. If any reason to withhold the requested permit is found. please advise. Your assistance and
:ooperition is appreciated.
the Building Department
Date sent for review
By
--,..-
,... ..
FILE copy ' 4/ N , ,g72 ----1 -, • /-/
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.
BUILDING PERMIT
FIELD INSPECTION
Dartmouth Building Department Plat: 79
400 Slocum Road P.O. Box 9399 Lot(s) :28
Dartmouth, MA 02747 Lot Size:41, 200
Telephone (508) 999-0720 Zone Dist. :SRB
Issued Date: 04/23 /97 Permit No: ._ 707
Project Location: 64 Pine Island Road
Number Street
Subdivision Name:
Nearest Cross Street:
Applicant/Agent: Dennis Moniz
Contact Person Phone #: (508) 995-4749
Proposed Use: Residential
Residential,Commercial,Industrial,etc.
Permit Issued To: New Construction
Type of Improvement,Add,Alter,New Const.,Demo,Land/Move,etc.
Alteration to existing deck -- 296 sq.ft.
Indicate no.of bedrooms and bathrooms and other roo.tris
Owner(s) of Record: Dennis & Wendy Moniz
Address: 64 Pine Island Road, Dartmouth, MA 02747
DATE TIME TYPE OF INSPECTION REMARKS :::-INITIAL
3-1'99' /1;0 J c-v�L
g
3-1_99 �-,�-�.�
7. 3- 0/ /D : 5S A
BUILDING
Dartmouth Building Department Plat: 79
400 Slocum Road-P.O. Box 9399 Lot(s) : 28
Dartmouth, MA 02747 Lot Size:41,200
Telephone 508-999-0720 Zoning Dist. :SRB
April 22, 1997 (typed) Permit No. : 7(3 7
Issued Date: 9 /023/9 7 Clerk: BAS
Project Location: 64 Pine Island Road
Number Street
Subdivision Name:
Nearest Cross Street:
Applicant/Agent: Dennis Moniz
Address: 64 Pine Island Road, Dartmouth, MA 02747
Contact Person Phone #: (508 ) 995-4749
Type of License: Owner: (x) Const. Superv. License #: ( )
Architect: ( ) Engineer: ( ) Other: ( )
Proposed Use: Residential
Residential, Commercial,Industrial,etc.
Permit Issued To: New Construction
Type of Improvement,Add,Alter,New Const.,Demo,Land/Move,etc.
Alterations to existing deck
indicate no.of bedrooms and bathrooms and other rooms
Gross Area of Const. : 296 sq.ft. Cost of Const. $750.00
Cost-Other Const. : TOTAL FEE: $ 40.00
Owner(s) of Record: Dennis & Wendy Moniz
Address: 64 Pine Island Road, 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.
Signature of Owner/Agent: �'(� 7(�-7&67
Address:
******************** ** *** ** ** * ***************************
Signature:
Approved/Issued By oel S. Reed, Tit e: Building Inspector
COMMENTS: PLEASE POST PERMIT CARD SO T T 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
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