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BP-2003-29269 Permit No. BP-2003-29269 GIS#: 4252.00 -/> Map: 0079 C..ommontuedtth o�I /addachudet Lot: 004 Sub-Lot: 0015 TOWN OF DARTMOUTH Accessory 400 Slocum Road,Dartmouth,MA 02747 Category: Structure Phone: (508)910-1820 Fax: (508)910-1838 Project# JS-2003-1074 Est.Cost: $2500.00 PERMISSION IS HEREBY GRANTED TO: Fee: $50.00 Const.Class: Contractor: License: Phone#: Use Group: R4 Lot Size(sq.ft.) 41400 Engineer: License: Phone#: Zoning: SRB New Const.: 192 sq. ft. Applicant: Phone#: Alt.Const: N/A KENNETH CHAMBERLAIN (508) 995-7920 Date Typed: 6/197/03 OWNER: CHAMBERLAIN KENN TH& DATE ISSUED: (J 7 TO PERFORM THE FOLLOWING WORK: 12' x 16' shed on sono tubes BUILDING PERMIT Project Locatio : 10 S UTHWIND WY Approved/Issued By: \ �� RALP UZA,L CAL BUI [ INSPECTOR All work shall comply with 780 CMR 6TH Ed. (MGL Chap. 143) and any other applicable Mass. Laws or Codes and plans on file. POST TH/S CARD SO IT IS VISIBLE FROM THE STREET SCHEDULE APPROPRIATE INSPECTIONS AS REQUIRED. UPON COMPLETION OF WORK, FINAL INSPECTION IS REQUIRED. THIS PERMIT WILL EXPIRE PER 780 CMR 111.7(NOT MORE THAN 3 EXTENSIONS WILL BE GRANTED)OR ON ISSUANCE OF A REGULAR OCCUPANCY PERMIT. 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 Buil ing/Zoning Permit. )Signature of Owner/Agent: 11 0 'kOktyn Comments: I REPLACEMENT FEE WILL BE REQUIRED FOR LOST SIGNATURE CA 0 I• TOWN OF DARTMOUTH 9 cl Fi 5< BUILDING RECEIPTS COLLECTOR'S OFFICE Name Property Date: ` `'' Owner: Job Location: { I .'k_ 1 ' '•. _- White Copy-Collector's Office Plot: f Lot: 'yr `..3 --- Yellow Copy-Customer's Receipt t Pink Copy File Copy / / _ e, r .r Green Copy-Building Department Phone: , Description General Ledger#'s 0 `Ref #:'. ,E Amount License&Permits-Building 01000-44105 - License&Permits-Building Misc. 01000-44105 i . `r ..,v 5 LUU i 7 License&Permits Electrical 01000-44106 ' License&Permits-Plumbing&Gas 01000-44107 f/r / Other Department Revenue 01000-42420 C. / £ t This is not a Permit or License for Building,Plumbing or Gas. Received By: -- TOWN OF DARTMOUTH 2 9 2 6 9 BUILDING RECEIPTS - COLLECTORS OFFICE , .- • 4 1 .,44 / / / /2 / Name: ,i- ,/ ,i 7.-„1 1 /Property , 1 4-ki. 1 C Pli, t•'•-,-,--PL'''''"'-'7*--.e / //1 t--- -\„_, Date: -uwner: Job Location: i / i ___ __ 1,..N , _.. ,,.'l'u- - fit 11A8.1 evIstr'i-j.I rri White Copy-Collector's Office Plot tie/e." Lot ,,41,(// -- iiii/ COL/r-'1s,re‘P'S' -- Cc- Yello*Copy-Customer's Receipt , , / - /-__./ 1 — ' Pink Copy-File Copy GreeriCopy-Building Department l• n i Phone: JUN 1 0 2003 v-i /2 '1 ,ii/L-Asi Description General Ledger#,'s ( j Amount • —— , .... License&Permits-Building 01000-44105 i ,.., License&Permits-Building Misc. 01000-44105 /L.-1 I/'1 License&Permits-Electrical 01000-44106 License&Permits-Plumbing&Gas 01000-44107 Other Department Revenue 01000-42420 ,....--- .., 7 .,---- ni i -,• , This is not a Permit or License for Building.Plumbing or Gas Received By: RESIDENTIAL 0 FOUNDATION ONLY 2003 $25.00 APPLICATION FEE IS NON-REFUNDABLE dt NON:-!RANSFERABLE �P�"° 37 �--- f - -DATgRECEIVED cif DARTMOUTH BUILDING DEPARTMENT y� ik y': ;Z 400 Slocum Road, P.O. Box 79399 ►> „ ry `� '' ' ....7� Dartmouth, MA 02747 508-910-1820 FAX 508-910-1838 APPLICATION TO CONSTR T,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAM ILY DWELLING THIS SECTION FOR-OFFICIAL USE ONLY RECEIj BY: BUILD G PEI~ _ jff DATE SENT I+ IR2RE W: _° Df13 : SUE SIGNA DAT r B dmg Co ioneriipspectar o£ g District T 'o sed Use:- 4� Zone: �C b B A 0 V, Ou idle _ queer ee T HE FOLLOWING AGENCIES SHOULD BE IOTIFi,ED: _ Board oI o 0-Con Com 0 Demo DID t R Appeals a Affidavit Card ent ���� o -u ❑'Gas n Planning Board_* ©$ewer Card El.'txater Card I ` 0th C Cut Off 1 GutO f Cute Iev REQUIRES INSPECTOR°r 1RE W BEF'O -TT I ' ANCE . ' ]DEPARTMEN L.AI' V .. ._.�..:.w..a. ;+av_' __...—.-_ ,� . � ..... ......... .......... ... _.., 1uE. �,.�.mu :,.,?=.s�n ,.,xa�i�r�,g�.u_`�a �._._ ��a�,wa;�.,3.�� r.m.owae ._rye �.,�.,�,�- Zoning Review: Signature: Date: Energy Report: Signature: Date: Fire Chief: Signature: x-2sa w� Date: Board of Health: Signature: Date: Conservation Commission: Signature: Date: Other: Signature: Date: Description of work being performed: / // S> CTIO t IT iO I �- _ NUMBER OF PLANS SUBMITTED: SITE PLAN SUBMITTED: Elyes ❑no 1.2 Assessors P Lot Number: �� • 1.1 Property Address: i t�/Gr� �ril�/ Plate Lot 1c t Nearest Cross Street: ' �' C O�/y�ly' k i �% . Subdivision Name: 1.3 Historical District 0 yes ❑no Total Land Area Sq.Ft.: ,p Has application been submitted to the Historic Commission? / 1 6+ ` ❑yes ❑no Date: 1.4 Water Supply(MGL c 40§54): 1.5 Sewage Disposal System: ❑Municipal rivate Well 0 Municipal E' Site Disposal System C:\bldg.forms\Bldgapp.res.wpd Page 1 Rev.January I,2003 RESIDENTIAL ry�y� 2003 * I' J. r= -R t:S�.fQ p1! T Pe® t° �b�li E A NT . 2.1 Owner of Record: Name(print) Contact Address Phone Number 2.2 Authorized Agent: Contact Address Phone Number Name(print) c laZ J��i=� u,..,-da..a, r,&am+"�a2dN r infT��Y<<ROM 16 �`Et_ 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor License Number Address Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor: Not Applicable ❑ Are you a Home Improvement Contractor subject to(780 CMR-6)? ❑ yes ❑no If no,go to the next section! Are you claiming exemption from the requirement? ❑yes ❑ no If yes,submit the required affidavit! Company Name Registration Number(if none, state ❑ noneD) Address Signature Telephone Expiration Date 3.3 For Residential Remodel Work Only { PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY 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 by signing the above,the home owner acknowledges that there will be no eligibilty to the Guaranty Fund Date 3.4 Homeowner Exemption-One&Two Family Only FOR HOMEOWNERS 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 116.0,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 Homeowner performing work for which a Building Permit is required shall be exempt from the provisions of this section;provides that if a Homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor. For the purposes of this section only,a"Homeowner"is defined as follows: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a Homeowner. If you are applying,under this section sigx}below: Signature: ��/ 9 Your signature carries certain responsibilities,including but not necessarily limited to,general liability C:\bldg.forms\Bldgapp.res.wpd Page 2 Rev.January 1,2003 RESIDENTIAL 2003 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 Appendix of 780 CR R5.2.15) S :TION 4� ORKER'S CO1► NSATIQN INSURANCE AIAVIT( L c 15 M 25) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached: ❑ yes D no ECTi� * D� 1 Q>i PR SED ,,°lil tl (c o , all a1)1e ..,zi.,.:C,....it, ......... a. F ,!,4.- mot_ .. .�,..,,+'; ,.,,. „. .,.....,r.m .. ,. ,G,�....:r . rz ---,-,...,.}_ ,.. _. ..._, ❑ new construction* ❑ addition ❑ alteration ❑ repairs ❑ chimney/ 0 woodstove (energy report required) (energy report required) fireplace ❑ deck ❑pool 01<essory bldg. 0 replacement window/door ❑ other ❑ demolition (shed/garage) no.of windows_doors_ (specify below): (specify below): *If new construction,please complete the following: Single Family: no.of bedrooms no.of baths Two Family: no.of bedrooms unit 1 no.of baths unit 1 no.of bedrooms unit 2 no.of baths unit 2 0 Furnace(hot air)-fuel gas(natural or propane),fuel oil,electricity,other(specify): O Boiler(heating)-fuel gas(natural or propane),fuel oil,electricity,other(specify): O HVAC(combined unit)-primary fuel,natural gas,propane,electricity,other(specify): ❑ Air conditioning-(separate unit) O None of the above to be provided ❑ Hot Water: Gas Electric Fuel Oil Other Brief Description of Proposed Work: O e.,44.i ; �,.,,,o t% '7 ( e5, Gc�� `Jo ter' /v�>, AV >:// a l X/6 ,Jic�Q th-/f-l. j 44;;, ...s 4= 02 .`L -2," . "SEI'"T('.1N 1 � TIfI 'JCS Item Estimated Cost($)to be completed by permit applicant 1 Rnildino 7 F.le.ctrical "I Phimhino 4 Mechanical (NVAC.I 5.Total=(1 +2+3+4) *Estimated Tota $ ' SECT 7A ONE*A1.1J- T to p ��h E t ,- _ -cmpleted when s on (please print) I, ,as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date '-'1..,:ri-W-/itl'':k_i''''''::1''' '''-'1',-; SECT!C kr�' tEii/A l ., I,r '7Pl`L`] �A ' I,bie� y � as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed nder the ' s and penalties f perjury. /G? o 3 Signature of Owner Authorized Agent Date I C:\bldg.forms\Bldgapp.res.wpd Page 3 Rev.January 1,2003 I RESIDENTIAL 2002 ❑ FOUNDATION ONLY $25.00 APPLICATION FEE IS NON-REFUNDABLE & NON-TRANSFERABLE 17 1. Date plan reviewed: �� ////)3 2. 30 days to review period expires: 3. OK to issue date: 4. OK to issue subject to requested submittals(see project review worksheet): Date: 5. DENIED(see project review worksheet): Date: 6. HOLD reason: Date: 7. HOLD subject to Zoning Board of Appeals action: Date: 8. Comments: n 9. Inspector's Signature: �0` /- Date: � S CTIoN 9 •te'. i 1IIWICATION -� . �� w .� s Applicant informed of above Date: 2-0 C Time: F .� Clerk: 2,1(._ Comments: thit SECTION= -0 O CE PECO`R'S NOES Total Permit Fee: $ 60 � Less Application Fee: $25.00 Remaining Balance: $ ac TOTAL FEE: �j). GO Gross Area-New Construction total sq.ft. /f 2 � v Gross Area! Alteration total sq.ft. ''' aci Permit Issued To: /�n / "415/ • is C:\bldg.forms\Bldgapp.res.wpd Page 4 Rev.January 1,2003 Permit No. BP-2003-29269 Project Location: 10 SOUTHWINI) WY ,Gonrmonweafth of Massachusetts TOWN OF DARTMOUTH G p#: 4252.00 400 Slocum Road,Dartmouth,MA 02747 Lot: 0048 Phone: (508)910-1820 Fax: (508)910-1838 Sublot: 0015 BUILDING PERMIT Category: Accessory Structure FIELD INSPECTION Project $25 OOO1D74 Fee: $50.00. Contractor: License: Phone#: Const.Class: Use Group: R4 Lot Size(sq.ft.) 41400.00 Engineer: License: Phone#: Zoning: SRB New Const.: 192 sq.ft. Applicant: Phone#: Alt.Const.: KENNETH CHAMBERLAIN Ceiling: OWNER: Walls: CHAMBERLAIN N ETH Floor: DATE ISSUED: Glazing: TO PERFORM THE FOLLOWING WORK: 12' x 16' shed on sono tubes DATE I TIME I TYPE OF INSPECTION&REMARKS INITIAL ------- ----- 7,03 /1:;:;--------F--le.-LeiLe-,1,41-tx--f-4:1-6,- i ",d-x --,:' -7/).-/-0-7—' - . 5/6/0 3 ?,, q0 ay2aet , ___) -A(- -/' (,,er , i /' i-r� G ate/ // ,A3 3.t/V /144 C '- �F �-'c fir'/`a_ 1•/: )V p SO\XIAiti ,' (A).01 e.. .eu \_ s --c--)--D --77/(-1/03 cam, 1i _s.t-)e q 9c--)92-1) .. . 1 f 6 1 dB 5 i.o.,_/ . „..,..,1 r rip'i tr4,* ts v- '',:i /17/ �^ I _;> ACapp T s td • :t �. �t p bite �ctt seiPlasiii:1 Z:Y. 1 1 4 Ra/- D The Commonwealth of Massaschusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Applicant information: Please PRINT Leeibly name: 4,44! C r+►laf4 1- lotation: /() ��/icI I'/ city / eL �P41 phone#/- es0-- ,yp I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity ❑ I am an employer providing workers' compensation for my employees working on this job. company name: address: city phone# insurance co. phone# ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation policies: company name: address: city phone# insurance co. phone# company name: address: city phone# insurance co. phone# Attach additional sheet if necessary YYr .. _... .._.-_ .. �.:� i .: .....�_L „, L ....._.s_. .».Y�N.iyk•fa4,o.war .�..3 rs.. �_ M.-r ,µye i ..r 4,fr ....�.�....-.�i .. .. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: �r ��� ��[ Date j() 'Q Print Name: //e ifz 1h Phone#/-5Z), 3 S--- official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑ Building Department ❑ Licensing Board 0 check if immediate response is required 0 Selectmen's Office ❑ Health Department contact person: phone#: 0 Other : � Rf3ILIENTIAL ' 2003 0 FOUNDATION ONLY $25.00 APPLICATION FEE IS NON-REFUNDABLE do _O11 � SFERABI,E' _ o„TH\ DART. ii t. VA'`T�'ORECEIVED + 1 �s. DARTMOUTH BUILDING DEPARTMENT 1`` Irwii-rti�• '—'"�' 400 Slocum Road, P.O. Box 79399 Zm3 J. 1 1 D PM 2 37 ; =ASy/yt Dartmouth, MA 02747 I664•/ 508-910-1820 FAX 508-910-1838 APPLICATION TO CONSTR T,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING t..41 t.'y, ay"t ''.", + '°, �1'0:11. U e 4,e,4 .net .-«.k-N".. t t k ` <s t' '-tfi FP :.` £+ ks: ,sa,a +. fit'- RE 7 of i' 1_ t� e� 2 , �T'� bKSv ® .-b'` , � .r r. -5�i`h.k`�.,L�, .tu..- yx�5 ,. v.e � � _Y.,_,�'#r� �c'4,,,.. '-�',5 e`"*".'n„g-a.'r's 1 / 7y�.,i� �' r� gaer ' +> "T"fy",�, f et , ..wah:e4 fi��aAAI i'k I'>X`, rli?�!+-.. :�/1 !.d ..-l��,� `^ Y` 6. .. F' *� 1L3. . �` cam` OIL TO SUE " .44 ,� y , z .. ., t. ' r - ,- x '4,'^ )'^. :.fi r s n i I I $"�i `Y•*7a I I i,, !IIi e ' y�{rycy . mo m /ie 40( y ti,_ '°S 3'" t d 'N r� t ^YC py +l` fc'1 4Y' 'bY:� "Sw -. ma`s 'Y C. +l ,.rY *A1�Ab' ewe+ :5aq�n'�r.' "l'.'. �V IR �Rl. ... ., D. • I ! ! e ';' s;,c,. 'S. vJ !• .• ea.Ts,SP t.; T@ ,, ]! • " i' r...f.l�'.�^�'ice+ 1ea r _; . ZO111I1g DIS O r .E w- warns ' . • ¢t -s T, V. I i SHetJLD eow'ar , i ',',i'. l l ' + fi❑Board o ° I TP„fi- b, i c ! I r -,- ;. ^A0 -.,� ; ', Y Iti" a S I ' +, Al 441:4 .u� a� P # ,r e . s 1 e a n if Appeals x 1,+,,, 1r r , '' , a- 4 . £ r a 4.4 Fire "7„It ,,,Lz-• -;.cy `' .-Z ga" ..... -, ,,, � : s` ry�. _ t, `mac 9 s 0 ITire , ,G U P I I) 1 Boardt @ :, fe j�y`a�& ri `I. , . Chief ,S a Cut v L . r x re 1 v Fr. • 1, o... ` �, rya ,.» �l afp d r^..i4° r S' -N' s,} '4'. ` `as3 f � 4 fir ':. V 'fty.6'„- ' sk, ^s' 0 �,7. - z , a.'. 's„ . '°.ta . .g" ., ah'er ^.YYYr a+i. ,. x5 y _ X �'-���,r�.�i:��.�� fi ,'.,�T -r�ayW .,� `'� L,,,�. �. ^t �, 'vim'1.-,r ,.� ��. Ln", " � �e R`EQ INSPECTOR °, 0 �$ + e .a bi .1 i a r a ,: 4. F x i 6 M d N �ffi . t '" ,,.'K , x q x t. t R, .,,•3.P ,!---'-A:'-'..;-''...f::- 1 t 1. � /'�^1' +r' ,"5r- "4 Zoning Review: Signature: Date: Energy Report: Signature: Date: Fire Chief: Signature: Date: Board of Health: Signature: j&Ci/� �E��Li�c, Date: /e//O Conservation Commission: Signature: Date: Other: Signature: Date: Description of work being performed: / X/ l‘e3 f 4,..- r, T�'r .r'':44' ;' �' A's -e? µ "Yy `, s"±8'. r ` e §•-f<}i r..,. a sly :.' Yam- .u,: 3 c�• "435fr✓2+'i S l'� y . v,4,.ic xf7 .r+.:.._ ,... ,.... ... ' - . NUMBER OF PLANS SUBMTI 1 ED: SITE PLAN SUBMITTED: ❑yes ❑no �di/ 1.2 Assessors P Lot Number:0- 1.1 Property Address: id/S`Gx; Wi(� Plat• e Lot - — Nearest Cross Street: cou, iJS 0✓titd ram' PD. Subdivision Name: ,% a, 75,-,...„„e. 1.3 Historical District El yes ID no Total Land Area Sq.Ft.: AP, Has application been submitted to the Historic Commission? ❑yes ❑no Date: 1.4 Water Supply(MGL c 40§54): 1.5 Sewage Disposal System:; 0 Municipal 'vate Well ❑Municipal V Site Disposal System C:\bldg.forms\Bldgapp.res.wpd Page 1 Rev.January 1,2003 LI"f'VC , I -________________________________L VE.,-.1 ----------- _ 6 11,: I ,__-_ - ----- (//1i"‘',1°,:::.r):- 1-ii--r __ r /, rill ) . \ I I r , _ , . ,•`, ,,.Th *l., -r- \ \ I_r•-•'_4, 'T . .,•. 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