BP-654 FIELD COPY
DARTMOUTH BUILDING DEPARTMENTpultf x
TOWN OFFICE BUILDING
SOUTH DARTMOUTH, MASSACHUSETTS 02748 'PERMIT
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Hilda
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1 i lda �k DATE S 3.8 9 P!tne Elul No. Dart.NO.
APPLICANT ADDRESS
(NO.) (STREET) (CONTR'S LICENSE)
Wood Stove Residential NUMBER OF ONE
PERMIT TO O STORY DWELLING UNITS
(TYPE O FF IMPROVEMENT) NO. (PROPOSED USE) _ z
AT (LOCATION) 129 Fine Island Rd. D STR CT Am
(NO.) (STREET)
m BETWEEN High Hill Rd AND Flag SwampRd.
e (CROSS STREET) (CROSS STREET)
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B LOT
m SUBDIVISION LOT 9 BLOCK � ! SIZE.
a
U
O BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
ID
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Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION •
f - - (TYPE)
w �} stove
Q ��ff
O REMARKS: Install an approved per M.S.B.b..
AREA OR PERMIT 5.no
VOLUME ESTIMATED COST $ ¶�.� - FEE $_
i- t((C�U7BIIC/SQUARE FEET)
Hilda OWNER Barnard s# daKonowski. r ,t
ADDRESS 129 Pine Island Rd. No. Dartmouth, Ha. BUILDIO,.ad R. Lavigne
INSPECTION RECORD \�
DATE NOTE PROGRESS - CRITICISMS AND REMARKS - INSPECTOR
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DEPT. FILE COPY -.4111
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DARTMOUTH BUILDING DEPARTMENT oa
'Di IG
TOWN OFFICE BUILDING
SOUTH DARTMOUTH, MASSACHUSETTS 02748 PERMIT VALIDATION
654
8Hilda Konowski DATE June 18 19 129 Pine IslandPERMIT NO.
Dart.
APPLICANT ADDRESS
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO
Wood Stove ( ) STORY Residential NUMBER OF
DWELLING UNITS ONE
_
(TYPE OF IMPROVEMENT) NO. - (PROPOSED USE)
ZONING
AT (LOCATION) 129 Pine Island Rd. DISTRICT ASRA
(NO.) (STREET) -
BETWEEN High Hill Rd AND Flag Swamp Rd.
0 (CROSS STREET) , (CROSS STREET)
ca
LOT
a
m SUBDIVISION LOT BLOCK SIZE
a
0 BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
m
Q
Z TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
E .. (TYPE)
re
IL REMARKS: Install an approved wood stove as per M.S.B.C.
AREA OR PERMIT $ 15.00
VOLUME ESTIMATED COST $ 500.00 FEE
(CUBIC/SQUARE FEET)
OWNER Bernard & Hilda Konowski
ADDRESS 129 Pine Island Rd. No. Dartmouth, Ma. BYILDING DE
A, Tad H. Lavigne
(Affidavit on reverse side of application to be completed by authorized agent of owner)
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
author i zed agent.
SIGNATURE OF AGENT ., vx_____-/
ADDRESS � 7 i2-41.: Cyr . `2--z Z 1_,O,a a
(I4UMBE ) (STREET) (CITY)
.4 yf
APPROVE[? Y TITLE G'
DATE . Yc'�' 19 ,
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,„, t TOWN OF DARTMOUTH
.„,. ....„.9O �,Q,J���� c�te�7��,.
q y.
O. APPLICATION FOR
f ,. )
,�o�. yv` SLTILDING PERMIT .")6: 4:7‘`
1O 4'S..
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AT (LOCATION) 1-7167' ri Al T S/ el'ila/ i' l qd ZONING
DISTRICT ‘ ^
LOCATION (NO.) (STREET)
OF BETWEEN /}V // = ,27 6' AND / /G j GLi Ci 01 Ala
d
BUILDING (CROSS STREET) ,,Cl (CROSS S7 EET)
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SUBDIVISION LOT(S) PLAT
TYPE AND COST OF BUILDING
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use
I ❑ New Construction Residential Nonresidential
2 n Addition(if residential, enter number
12 pil
One family 18 LJ Amusement, recreational
of new housing units added, if any,
in Part D, 13) 13J Two or more family — Enter 19 Church, other religious
number of units— — — — --> I
20 LJ Industrial
3 n Alteration (See 2 above)
4'Al Wood stove or fireplace 14 I I Swimming pool 21 Parking garage
5 1 I Wrecking (If multifamily residential, 22 I Service station, repair garage
enter number of units in building in 15❑ Garage 23 Hospital, institutional
Part D, 13)
16 n Carport 24 Office, bank, professional
6 n Moving (relocation)
17 LA Other — Specify 25 i Public utility
7 n Foundation only
26 I School, library, other educational
B. OWNERSHIP 27 I Stores, mercantile
� 28 I Tanks, towers
8 t�,I Private(individual, corporation,
nonprofit institution,etc.) 29 I Other — Specify
9 n Public(Federal,State, or
local government)
C. COST (Omit cents)__ Nonresidential — Describe in detail proposed use of buildings, e.g., food
R,'(itt'r< processing plant, machine shop, laundry building at hospital, elementary
10. Cost of improvement $ s.500 r school, secondary school, college, parochial school, parking garage for,
department store, rental office building, office building at industrial plant.
To be installed but not included If use of existing building is being changed, enter proposed use.
in the above cost
a. Electrical
b. Plumbing
c.Heating,air conditioning
d.Other(elevator,etc.)
11. TOTAL COST OF IMPROVEMENT $
SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L;
for wrecking, complete only Part J.
E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS
30 n Masonry(wall bearing) 40 n P• ublic or private company 48. Number of stories _
31 n Wood frame 41 X' Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior
32 O Structural steel dimensions
33 n Reinforced concrete H. TYPE OF WATER SUPPLY
34 n Other — Specify _ 42 n P• ublic or private company
50. Total land area, sq. ft.
43 p Private(well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed —
35❑ Gas Will there be central air 52. Outdoors
36 t1oil conditioning? —
L. RESIDENTIAL BUILDINGS ONLY
37 n Electricity 44 E Y• es 45 El No53. Number of bedrooms
38 n Coal / —
39�fher— Specify wl/JV(I Will there be on elevator? Full
54. Number of
46❑ Yes 47 E No bathrooms
Partial
IDENTIFICATION — To be completed by all applicants
Name
I 1 1r ( Mailing address/ —/Number, street, city, and State _ ZIP code Tel.�Noo..
owner or Erizi rc_ !i>1a )f/./,,16i, / I 4 14e_ Jes/ ft� n_o&i, / ..�10 `i.:il
�f � 7�7
Lessee KbN�i(r,L,SK ( J Vdr l 7hi'' T knc a f i'lq6SS
2 me,CA Builder's
License No.
Contractor r ?p�
&113 r/i✓' •t'eYl C }
3.
Architect or
Engineer
I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to
make this application as his authorized agent and we agree to conform to all applicable laws of this jurisdiction.
Signature of pplicant Address r ,f�d �/ Application date
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ADDITIONAL PERMITS REQUIRED
WATER PLUMBING
SEWAGE ELECTRICAL
SITE OR PLOT PLAN — For Applicant Use
ON
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