BP-353 BUILDING PERMIT
FIELD INSPECTION
Dartmouth Building Department Plat: 79
400 Slocum Road P.O. Box 93 4 Lot(s) : 21
Dartmouth, MA 02747 ;, � Lot Size• 40,565
Telephone (508) 999-0720 �" � Zone Dist. : SRB
Issued Date: 11/06 /96 Permit No: 353
Project Location: 115 Pine Island Road
Number Street
Subdivision Name:
Nearest Cross Street:
Applicant/Agent: Walter E. Rogers
Contact Person Phone #: (508) 998-3270
Proposed Use: Residential
Residential, Commercial, Industrial,etc.
Permit Issued To: To Install
Type of Improvement,Add,Alter,New Const.,Demo,Land/Move,etc.
Woodstove and chimney in garage
Indicate no of bedrooms and-bathrooms-and other rooms
Owner(s) of Record: Walter E. Rogers
Address: 115 Pine Island Road, North Dartmouth, MA 02747
DATE TIME TYPE OF INSPECTION REMARKS INITIAL
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RECEIPT FOR PERMIT
TOWN OF DARTMOUTH ,
���°m PERMIT NO.
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Received From L41L-. 2._ .fiedv
.mitts'
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Received By 8 N ;----cs' -..1'...'-1.._ ,
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RECEIPT FOR PERMIT
qe, ouTx.y�� TOWN OF DARTMOUTH „
PERMIT NO.
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TOWN OF DARTMOUTH BUILDING DEPARTMENT
TELEPHONE 508-999-0720 • FAX 508-999-0738
APP:JCATION FOR ZONING AND BUILDING PERMIT
u 1 LIN 11 2 j
\ 1te applicant shall complete this application to the best of their ability prior to submission.•l unanswered.eaving no item answered.The
�epactIDent strff4*�'ll lies'aihpie during regular business hours to assist as necessary.WA should be inserted for those sections
I
which do not apply.A properly completed application will help avoid unnecessary delays. Maim-ius foe s anti refamialde.
(for office use ooly)
Application fee $ 4"-4 received by Date /O 3/ -
���. 5 S Total Permit Fee 3 �1 Permit# \-3.3' 3 l/ " 6 ^
10l) LOCATION OF PROJECT
CJ
CURRENT ACCESSORS' PLAT 7 l LOT ZONING DISTRICT z5 R-,_-6
OTHER ZONING OVERLAY DISTRICTS ,..if applicable NUMBER & STREET /75 `//ti'f - c ' 4 ;,•_, ,,,,,,, 6,J�t
NEAREST CROSS STREET
SUBDIVISION NAME & LOT#
or BUSINESS NAME
PREVIOUS TENANT i OWNER Laic " - . �, e-4. -
- 200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
_ THIS SECTION NOT APPLICABLE
- Single family - number bedrooms number baths
_ Two family - number bedrooms unit 1 number baths unit 1
number bedrooms unit Z number baths unit 3 - '
= 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
CJ---A-, n
'Chimney -#of flues 7 /�
.. ._
■
oodstove - used (will require inspection prior to installation), new (provide manufacturers
instructions). Location(s) (list) � �� - y 2 �
Fireplace(s) -(includes flue) List iocation(s)
._ Game Court-describe (include overall dimensions)
Tent, Trailer(Mobile Home) or Other- describe
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 overt rears 9 months(see Code Section
304.0)
= Factory i 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 structnt-es isee Code Section 311.0)
_ New tenant for any of the above, indicate above tsee Code Section 119.E and Zoning By-law section 35)
_ Tent or Trailer - temporary purpose?
= Other
Describe the proposal briefly,INCLUDE number of dwelling Quits and bedrooms or occupant load as applicable,
also existing condition
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 he 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 CONSTRUCTION CONTROL,over 35,000 cu.ft.) Yes
see Code section 127.0). Designer to submit Code Synopsis. No. (If yes
Will this project require Peer review(over 400,000 cu.ft.) Yes
APPLICANT TO PROVIDE No (see Code Appendix I)
I
_ Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaration required.
- ^ Demolition -.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 lavers 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. Why?
= Submitted. usually three sets required. Four sets for food serviceiuses. Number of sets submitted
600 SITE PLAN
a Not required, why?
_ Submitted When? _ Previously, date = With this application
700 UTILITIES
Water supply - required yes _ no, public ? yes _ no, on site well? _yes_ no.
existing? —yes _ no
If required and not existing have necessary permits been issued? _no_yes.date
(111.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.
sou MECi3AA'41CALS & PRIMARyFUEL.
= Furnace(hot air) - Fuel gas (natural or propane), 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, why?
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
tots, provided
Handicap spaces - required yes no. If ves, how many as a part of the total required number.
Is Route 6 (State Road) Entrance permit required? ves = no =. If yes has it been issue _ — _-
- d yes no
Submit copy of application and/or permit as soon as available.
1100 IDENTIFICITION (print or type except as noted)
Current owner- name /e
address
•
phone = 91 3 7)
If corporation. officer in charge
ArchitertIEngineer - for overall design
Company name
Address
Phone number
Certified by State of Massachusetts as
Certification number
NOTE Signatures and seals on albs, affidavits and other documents SHALL BE originals and not
reproductions.
Architect/Engineer- project supervision and report
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 Contractor('if Homeowner, state homeowner here then complete section 1300)
Company name
Address
Phone number
Construction Supervisors license number
NOTE Signatures and seals on all plans. affidavits and other documents SHALL BE originals and not
reproductions.
•
x,r
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 ur
six months after the last inspection if work has begun and that the permit may be extended for six months if no work is
annciaated 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 li' ,
Signature
The above signature is my v untary act and is signed under the pains and penalties of perjury.
Date /6
Who is authorized to pickup the permit at the Building Department? :please print)
Address Phone
1400 IHOMEOWNER EXEMPTION - ONE &TWO FAMILY ONLY
FOR HOME OWNERS 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 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 personis) for hire to do such work ,that such
Home Owner shall act as supervisor.
For the purposes of this section oaly,a "Horn Owner' is defined as follows: Personis)who owns a parcel of 13nd
on which he:she resides or intends to reside, on which there is. or is intended to he. a one or two family dwelling, attached
qr detached structures accessory to such use and/or farm structures. A person who constructs more than one home in
`so-year 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
of sect on
11.6O COST
Cost of Improvement
Items to he installed but not included in the above cost: Electrical 5
Plumbing
HV'AC
Other �A
TOTAL S `i
'he following section for official use only.
INSPECTORS' REVIEW
Date plan reviewed Nov 0 11996 •
30 days to review period expires , ¢'r- / gj eo
OK :o 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
e .•
Inspectors signature Date NOV 01 1996
Applicant informed of above - Date time staff (fax, phone, in person)
****************.**************************s**************************************sss**********************
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
TOTAL FEE Ia 7e I
Gross area - new construction Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit
tow Iv 11Lt Arm—WANT/REFERRAL AND APPROVAL
Date of Application submission /e -- /--)C
. -) ,
f✓u'� iPlat , Lot Street /r 1,/q _' , A ur
Zone
Owner / - - /7
Owner mail address
Owner phone# 9'7 /E .J_ L-s�- �7 0
OTHER INVOLVED .-AGENCIES -The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT TEEM 7 REOUIRED SUBMISSIONS.
a i x COLLECTOR _ Approved = HOLD By L r //,,/ I
Date
a Conservation Comm = Approved By
Date
a D.P.W. water _ Approved By
Date
D.P.W.at sewer _ Approved By
Date
Q D.P.W. cross connection = Approved
Date
a D.P.W. engineering Z. Approved
Date
a Board of Health well = Approved
_ Date
a BoarsHealth of septic - Approved
Date
Board of Health food service = Approved
-<-- Date
r
FIRE DISTRICT kI - - III)r c.-
Approved - /
II
_ Date
Planning Dept _ Approved
Date
o t r _ Approved
Date
)t.._. �� = Aroved ,— _ Da
m -teats 7 L,% /j ., 7
Project summary new construction: alteration:demo
sewage disposal - puhlic;privam
,TT.Alter•add interior wallsj [add rooms] [add footprint? water supply - public:private well
;pool) [garage:shed] [game court] [food servicei
Describe
,--!_.-.1:.,- -e.,
To the various departnneats:
This notice has been forwarded to you for your information and any appropriate action. Should you have any
lutst-ions please advise. If any reason to withhold the requested permit is found. please advise. Your assistance and
ooperation is appreciated.
he Building Department
Date sent for review /G —-3 J — e, 4, By
t
• •
THE COLLET?. CTOR 'S... OFFICE
'96 NOU 4 Pig 4 53
dARIMOUFh EuILDING DEPT.
. •
D.A2'Z 71S1h #11, 9 14-
ro: B=D1NG DEPARTMENT
FROM: rrInnrCTOR' 0271=
RE: PAYMENT OF PAST DIM zazus
pr.77.uti BE ADVISED MILT ON ___ 121112712 T.A2MS 702?
PROPERTY LOCATED ON //5 ALI./„9„...6 a a EA Rczz
HAVE BEES7 pArD. THE PZIRMIT iffErCar MS' MEV REQUZSZED HAY HZ
=sum. zr YOU HAVE ANY QUESTIONS CONCZ2VrigG =as pzzasz carz
:DET7ORALT L. P7A
7
•
Date of appliattion submission i`' - -- �'ei7/
�� Lot .-2/ g �- �'
reet
a / -'._'j ,7 -/ rt..K_ L_'`.�_� Aquifer Zone
_, ^ Owner
cZ •
07ffer mail address `
1L CD
C z O ► r phone,` G . .�,_.3 .-L 7 2
OTHER INVOLVED AGENCIES -The following agencies require separate jurisdictional permits or approval f: i=i
. Proposed project. CONTACTZv S)i FOR REQUIRED SUBMISSION for your
• �Y .
!at T;kX COLLECTOR -
( - Approved = HOLD By Date
C Conservation Comm = Approved By
Date
C D.P.SV. water = Approved By --
Date
D.P.W. sewer -
- Approved By
Date
C D.P.W. cross connection =
Approved
Date
C D.P.W. engineering = Approved
Date
30ard of Health weiI = Approved
_ .Date _
3oar� 'l Henith septic _ Approved
Date
3uar d of Health food service = Approved
�- Data
FIRE DISTRICT(I • II! III) _ q
r- PProved
_ Date
Planning Dept - Approved
Date
()t��:- - Approved
Date
I):.._. - Approved
Date
Prefect summary new construction/ alteration/demo
sewage dispose! - public:private
,.Alter•add fnte:-ior wailsj (add roomsj [add footprint: water ter supply - Public:private weiI
pooil [garagershedl [game court! [food service/
Desc^he ,� .'
C=4. L �- _e_ i
"ivy'.am
:dc 'araus depa
r'^aeats:
This nonce has been forwarded to you for
appropriate acon.
you have any
y
=.bons please advise. If any reason to withhold the requested permit isnfound. piea_se advise. Youraassistance. and
'era::on s appreciated.
3uiidin: Department
Date sent for review
By --