BP-079 FIELD COPY
Dartmouth Building Department
P.O. Box 9399BUILDING
400 Slocum Road
North Dartmouth, MA 02747 PERMIT
Telephone 508-999-0720 V
0 I D i
Robert J.
Peckham
DATE July �, 19___ __ PERMIT NO. 79
APPLICANT J. Peckham ADDRESS
(NO.) STREET) CONTR S LICENSE)
1
��y�,�,�,�,*q ..}�...���M NUMBER OF
PERMIT TO alteration & Jli6iiJ�7( ) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. - -PROPOSED USE)
ZONING
AT (LOCATION) 112 Pine Islandlbsd DISTRICT
(NO.) (STREET)
o BETWEEN Faiinre Corm AND tail j
. (CROSS STREET) (CROSS STREET) j
at
m SUBDIVISION LOT30 BLOCK 79 SIO E 2+ *Gres
V
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
M (TYPE)
CC
O
IL REMARKS: ile
AREA OR } ""ltion (1''# I PERMIT . }(`
VOLUME (cuelc/ Q ARE FEET) r
ESTIMATED COST l5s$ ! f_€.I FEE $ , •1 i
5.00
OWNER
ADDRESS 112 Pine Island d, North Dartmouth, NA 02747 BUILDINAq
BY 111ii aM A. Braga lls
f
l
INSPECTION RECORD
DATE NOTE PROGRESS - CRITICISMS AND REMARKS ,INSPECTOR
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400 Yocum Road o N.O. Box 9399
' at„ North Dartmouth, Massachusetts 02747
•
OFFICE OF T+-?I' (5D )999-0720
BUILDING DEPA;.I MENT
June 25, 1990
Mr.' Robert J. Peckham •
112 Pine Island Road
North Dartmouth, MA 02747 •
RE: Plat 79 Lot 30
Dear Mr. Peckham:
Pursuant to 780 CMR 114.3 Expiration of Permit, your permit
79 • dater July 28, 1989 has- expired for -property
located at 112 Pine Island Road, North Dartmouth, MA
Please contact this office prior to continuing any work as a
new permit and fee may be required as per 780 CMR 113.0 Application•
for Permit, and 11Eees.
Failure to do so would involve a violation of the Massachusetts
Sta::e Building Code 780 CMR 113.1 When Permit Required_
Sincerely,
David J. Silveira
Building Commissioner &
ZonThg Enforcement Officer
DJS/f i.s
, •
DEPT. FILE COPY
Dartmouth Building Department z,
P.O. Box 9399 BUILDING
400 Slocum Road
North Dartmouth, MA 02747 PERMIT VALIDATION
Telephone 508-999-0720
DATE July 28, 19 89 PERMIT NO. 79
APPLICANT Robert J. Peckham ADDRESS 112 Pine Island Road, N_ Dartmouth owner
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO alteration & Darolitien(_) STORYRH-pr to (gYIPFnhniise/CIRnolitionof NUMBER O DWELLING F UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED O. USE) ^_ M
AT (LOCATION) 112 Pine Island Road ,4 DISTRICT
(NO.) (STREET)
a BETWEEN Faunce Corner(RoadSTREET) AND Qllanapna9 (CROSS STREET)
m
LOT
a.m SUBDIVISION LOT 30 BLOCK 79 SIZE 9+ acrec
a
U O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
O
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
E (TYPE)
REMARKS: To be built in accordance with the M_S_B_C_ and as per plans on file
AREA OR
VOLUME 117 ESTnIIMATEDOCOST $ lff,I Mi..A 0
FEEMIT $ §8•8
8
(CUBIC/SQUARE FEET) 55.00
OWNER Robert J. Peckham
ADDRESS 112 Pine Island Road. North Dartmouth, MA 02747 ILDW f I m A_ Braga l is
(Affidavit on reverse side of application to be completed by authorized agent of owner)
I ti _
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.
Gr�SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE d 19_c
''6,4/2
pU7'$.
45,70
5 t.E o4,c'9Jj �'
- TOWN OF DARTMOUTH � r
//?\)(
,,,/,(
' c?. ili i P_ �� APPLICATION FOR
• �ge4• • BUILDING PERMIT
t •
LOCATION OF BUILDING
01 Street & Number I I2.. -P(NC TStr1 hcl -R 0 Pd 01.1 Zoning District .S•fi2,
2/Cross Streets(between) +--Pr rC e Cornet and COY�11%.pog
i , ¢ I
0??/ILot Plat r?q 04 Subdivision Lot
OWNERSHIP COST
0$ C31rivate (individual, corporation, 36 Cost of Improvement IS, OCR
l non-profit institution, etc.) 36.1 To be installed but not
06 ❑ Public (Federal, State, or local government) included in the above cost
TYPE OF CONSTRUCTION 36.2 Electrical
07 ElNew Construction 36.3 Plumbing ,
08 El Addition -Type of Room(s) 36.4 HVAC
09 C (Iteration 36.5 Other - Specify
10 El Foundation Only example: elevator
11 lt�'bemolition (#of units if residential) 37 TOTAL is—co n
12 El Moving (relocation) STRUCTURE
STATISTICS 38 lVood Frame
13 Number of Bedrooms 2- 39 ❑ Masonry (wall bearing)
14 Number of Bathrooms (Total) 2 40 ❑ Structural Steel
Full-Tub 2- 41 ❑ Reinforced concrete
3/4 - Shower 42 ❑ Other- Specify
1/2 - Toilet Only
RESIDENTIAL-PROPOSED USE DIMENSIONS
15 IR-One-Family 43 Number of stories Z
16 ❑ Two or more families 44 Total square feet of floor area, all floors,
Number of units based on exterior dimensions /1 7
17 El Garage 18 ❑ Shed } `-45 Total land area, square feet Z.• +e.ye-5
19 El Carport
20 El Swimming Pool SEWAGE DISPOSAL
In-Ground Above-Ground
21 El Woodstove 46 ❑ Public or private company
22 ❑ Fireplace 47 l Private (septic tank, etc.)
23 ❑ Other- Specify
WATER SUPPLY
48 El Public or private company
'NON-RESIDENTIAL - PROPOSED USE 49 1 rivate, (well, cistern)
24 ❑ Amusement, recreational 25 El Church, other religious PRINCIPAL TYPE OF HEATING FUEL
26 ❑ Industrial 50 El Gas
27 ❑ Parking Garage 51 l -6il
28 ❑ Service station, Repair garage 52 El Electricity
29 ❑ Hospital, institutional 53 ❑ Coal
30 ❑ Office, bank, professional 54 ❑ Other - Specify
31 El Public utility
32 ❑ School, library, other educational TYPE OF MECHANICAL
33 El Stores, mercantile 55 Will there be central air conditioning? El Yes E 1 o
34 ❑ Tanks, towers 56 Will there be an elevator? ❑Yes [Tclo
35 ❑ Other - Specify
PARKING PER ZONING BY-LAWS
57 El Enclosed 58 0 Outside
59 Does this building contain asbestos? El YES ❑'I ISO If yes complete the following:
Name & Address of Asbestos Removal Firm:
Submit copy of notification sent to DEQE and the State Dept. of Labor Industries and result of air sample analysis after
asbestos removal is complete. •
IDENTIFICATION -To becompleted by all
/ applicants PLEASE PRINT
60 Owner (print) "WO�e24 . ?ECk 112 Pme -r,tvki,.1 9i75//3-7
MAILING ADDRESS TELEPHONE NO.
61 Signature DAT w '? 7
Builder's
62 Contractor (print) License No.
NAME MAILING ADDRESS TELEPHONE NO.
63 Signature DATE
64 Architect or Engineer (print)
NAME MAILING ADDRESS TELEPHONE NO.
65 Signature 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 Addition to No.
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OUTH.
TOWN OF DARTMOUTH
�, j � BUILDING DEPARTMENT
Date 7'
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O400 Slocum Road M
P. O. Box 9399
North Dartmouth, Massachusetts 02747 LETTER
• ( 508 ) 999-0704
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