BP-652 Dartmouth Building Department FIELD COPY
P.O. Box 9399 F`' ' ..
Boa Slocum Road BUILDING 1
North Dartmouth, MA 02747 11
Telephone 508-999-0720
' PERMITV L,,i' ' 1 0 DATE April 6, 1990 PERMIT NO. Dart
1
APPLICANT Walter Rogers ADDRESS 115 Pine island Road, N. Dar L owner 1
(NO.) (STREET) - (CONTR'S LICENSE)
PERMIT TO isntall ( ) STORY t 16' e Grd. Pool
NUMBER
OF
NG UNITS A
1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
tl # _ Island Road ZONING 4
AT (LOCATION) 1 1 iS� DISTRICT '
(NO.) (STREET) i
m BETWEEN High Hill Road AND
'0 .(CROSS STREET) (CROSS STREET)
a SUBDIVISION LOT BLOCK 79 SIZE
an
0 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
(TYPE)
D;
0
v_ REMARKS:
AREA OR
VOLUME ESTIMATED COST $ 12,000•00 PERMIT $25.00
(CUBIC/SQUARE FEET)
OWNER Walter Rogers
ADDRESS 115 Pine Island Road, North Dartmouth. MA 02747 BUILDING DEPT David t7. 11Yelra il
1110.
INSPECTION RECORD
DATE NOTE PROGRESS - CRITICISMS AND REMARKS INSPECTOR
il
I
OFF':cm THE (508) 99-072,
E}UIi_DIN ]
November 28, 1990
Mr. Walter Rogers
115 Pine Island Road
North Dartmouth,MA 02747
}
Re: Plat 79, Lot 29
Dear Mr. Rogers:
Pursuent to 78' CMR 114.3 Expirat .o : of Per'.-`, your •e"mi t
_ 52 dated April 6, 1990 i p:i red. for property
located at 115 Pine Island Road , No. Dartmouth, MA
;lease coact this office pr.ot to ,oY .!of u=nrt any work F'..s a
new permit and free may ,:i4 ee:e90-ired r /89 ( .C Application
Purmi.t and 1ll8' r, i=eos.
Hai urh to do L:2, involve e vie ,tion o. ..:?e `,L saehusetts
State Lui '.ding rt +e 780 C vn ; 13 when 3}eW :i+
• r a
0
D'aj t- v(:1r.-
I
Dartmouth Building Department DEFT FILE COPY
P.O. Box 9399
400 Slocum Road BUILDING 04
North Dartmouth, MA 02747 A PERMIT
Telephone 508-999-0720 VALIDATION
DATE April 6, 1940 PERMIT NO. 652
APPLICANT Walter Rogers ADDRESS 115 Ping Island Road, N_ Dart owner
V (NO.) (STREET) . (CONTR'S LICENSE)
A PERMIT TO isntall (_) STORY 32' 16' Above Grd. POOlDWEBLIRNG UNITS _.
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) 115 Pine Island Road ZONING
DISTRICT
(NO.) (STREET)
. BETWEEN High Hill Road AND
0 (CROSS STREET) (CROSS STREET)
m SUBDIVISION LOT 29 BLOCK 79 LOT
SIZE
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
O: (TYPE)
0
a REMARKS:
VREA OR
OLUME ESTIMATED COST $ 12,000.00 FEEMIT $25.00
(CUBIC/SQUARE FEET)
OWNER Walter Rogers
ADDRESS 11S Pine Island Road, North Dartmouth, MA 02747 BYILDING DE PT David J.Silveira lls
(Affidavit on reverse side of application to be completed by authorized agent of owner)
I hereby certify that the proposedwork authorized by the owner of record
and I have been authorized by the owner to make this application as his
authorized agent.
41
SIGNATURE OF AGENT // /�
ADDRESS / s� '� .l% "f'�7 'L (' .C(;•-•"
(NUMBER) (STREET) (CITY) f
APPROVED BY__ TI TLE _ •
DATE �� 19
1, �.<V1:;Bpi• 4-- PERMIT NO. �' S
/ S. -'' _ `° TOWN OF DARTMOUTH _ ��
�;_ r' DATE ISSUED �'�—�
I /d` �`1 TOTAL COST G�5-
� , , +�,• APPLICATION FOR
; o C7 J,yy`' LESS APPLICATION FEE
���r� _�ING PERMIT FINAL PERMIT FEE 0 57
r _
LOCATION OF BUILDING
01 Number & Street // S/
S--;,.2-21---,e49
�,.✓] t€i/ 7-q/j4 . 01.1 Zoning District .5/f�
02 Cross Streets(between) �f't- c-a- . and
03 L . • .1• 7 f 04 Subdivision Lot
OWNERSHIP / COST
05 , Private (in ivi iira1, corporation,
36 Cost of Improvement .2)/ / CR* l?Z�Y
�J
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 ❑ NewConstruction — 36.3 Plumbing
08 ❑ Addition -Type of Room(s) 36.4 HVAC
09 ❑ Alteration 36.5 Other - Specify
10 ❑ Foundation Only example: elevator
11 ❑ Demolition (#of units if residential) 37 TOTAL
12 ❑ Moving (relocation)
STRUCTURE
STATISTICS 38 ❑ Wood Frame
13 Number of Bedrooms 39 ❑ Masonry (wall bearing)
14 Number of Bathrooms (Total) 40 ❑ Structural Steel
Full-Tub 41 ❑ Reinforced concrete
3/4 - Shower 42 ❑ Other - Specify
1/2 - Toilet Only
RESIDENTIAL-PROPOSED USE DIMENSIONS
15 ❑ One-Family 43 Number of stories
16 ❑ Two or more families 44 Total square feet of floor area, all floors,
Number of units based on exterior dimensions
1 CI Garage
18 CI
45 Total land area, square feet
19 CI Carport �� X f
20 , Swimming Pool SEWAGE DISPOSAL
In-Ground Above-Ground
21 ❑ Woodstove 46 ❑ Public or private company
22 CI Fireplace 47 dPrivate (septic tank, etc.)
23 ❑ Other - Specify
WATER SUPPLY
48 ❑ Public or private company
NON-RESIDENTIAL - PROPOSED USE 49rivate, (well, cistern)
24 CI Amusement, recreational PRINCIPAL TYPE OF HEATING FUEL
25 ❑ Church, other religious
26 ❑ Industrial 50 ❑ Gas
27 ❑ Parking Garage 51 ❑ Oil
28 ❑ Service station, Repair garage 52 ❑ Electricity
29 ❑ Hospital, institutional 53 ❑ Coal
30 ❑ Office, bank, professional 54 ❑ Other - Specify
31 ❑ Public utility
32 ❑ School, library, other educational TYPE OF MECHANICAL
33 CI Stores, mercantile 55 Will there be central air conditioning? ❑Yes ❑ No
34 CI Tanks, towers 56 Will there be an elevator? ❑Yes ❑ No
35 ❑ Other - Specify
PARKING PER ZONING BY-LAWS
57 ❑ Enclosed 58 0 Outside
59 Does this building contain asbestos? ❑ YES ❑ NO If yes complete the following:
Name & Address of Asbestos Removal Firm:
IDENTIFICATION - To be completed by all ap 'cants PLEASE PRINT
(print) : �J��C l�(-L�—�._ c� //SS ra re ' Og5, >'O
60 Owner
NAME MAILING ADDRESS TELEPHONE NO.
• 61 Signature i ,//`/' DATE /9*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_
g 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 Has A-1 or Determination been issued by Conservation Commission? ❑ YES ❑ NO
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.
68 Owner or Agent - I certify under peril of the penalties of perjury that the information herein is accurate to the best of
my knowledge.
Signature DATE
Owner or Agent
69 BOARD OF HEALTH REVIEW DATE
Inspector or Authorized Person
COMMENTS:
70 DPW - WATER Service No. SEWER Service No.
To be completed upon issuance of permit- (if applicable)
71 I will post permit and address so as to be visible from street.
Signature DATE
Owner or Agent
72 I have received list of required inspections
Signature DATE
Owner or Agent
OJT
4h°' °' TOWN OF DARTMOUTH
ktt BUILDING DEPARTMENT
. _ ,sy Date X�G
N e In Payment of Amount
) .-'-' "----,__
.,,9
Lkr
Cb..
NUMBER FEE
TOWN OF DARTMOUTH
. 7 Board of Health S25.00
SWIMMING POOL PERMIT
Type of Pool: Ate' GROUND
•
Location: 115 Pine Island Road, North l) rf uth
Owner: Walter. Rcxq"ers
Contractor: Self
Date• tiril 6, 1990
This pool must be constructed as described in the application for the swimming pool construction
permit. •
4()15L Q.-P.04)44k
1-1
InspectorOketze4.4
Signature of Applicant
Dartmouth Bo rd of Health