BP-551 BUILDING PERMIT
FIELD INSPECTION PaglIEREM
Dartmouth Building Department Plat: 79
400 Slocum Road-P.O. Box 9399 Lot(s) : 48-27
North Dartmouth, MA 02747 Lot Size: 40, 228
Telephone 508-999-0720 Zone Dist. : sra.
Issued Date: 03/24/94 Permit No. : 551
Project Location: 18 Sundance Road
Number Street
Subdivision Name:
Nearest Cross Street:
Applicant/Agent: Michael J. Ferreira
Contact Person Phone #: ( ) 508-998-8113
Proposed Use: Residential
Residential,Commercial, Industrial,etc.
Permit Issued To: To occupy
Type of Improvement,Add,Alter,New Const.,Demo,Land/Move,etc.
home office
indicate no. of bedrooms and bathrooms and other rooms
Owner(s) of Record: Michael & Jeanne Ferreira
!Address: - 18 -Sundance Street, North Dartmouth, MA 02747
DATE TIME TYPE OF INSPECTION REMARKS ( INITIAL
4 4
BUILDING PERMIT
Dartmouth Building Department Plat : 79
400 Slocum Road-P.O. Box 9399 Lot (s) : 48-27
I North Dartmouth, MA 02747 Lot Size: 40, 228
Telephone 508-999-0720 Zoning Dist. : SRA
I March 22, 1994 (typed) Permit No. : 3 3 I
Issued Date: 3 /,21/t77 Clerk: soh
Project Location: 18 Sundance Road _
Number Street
Subdivision Name:
Nearest Cross Street :
Applicant/Agent : Michael J. Ferreira
Address: 18 Sundance Street. North Dartmouth, MA 02747
Contact Person Phone #: ( ) 508-998-8113
Type of License: Owner: (x) Const. Superv. License if: ( )
Architect : ( ) Engineer: ( ) Other: ( )
Proposed Use: Residential
Met a dent lol. C000erc/ol. industrial. etc.
Permit Issued To: To Occupy
Type of lapr*veetnt. Add. Alter. New Coast.. Dee*. Lead/Newt. etc.
home office
iwdleott-no.--if Worms end bathrooms end other-won*. _. _..- _ - - __. -._ __.-... _._. -----._ __-- ------- -_-._
Gross Area of Const. : Cost of Const. $ 50. 00
Cost-Other Const. : TOTAL FEE: $ 50.00
Owner(s) of Record: Michael & Jeanne Ferreira _
Address: 18 Sundance Street. North Dartmouth, MA 02747
All work shall comply with 780 CMR 5th Ed. (MGL Chap. 142) and any
other applicable Mass. Laws or codes and plans on file.
I hereby certify that the proposed work is authorized by the owner
of record and I have been authorized by the ow er to make this
application as his authori z d ag, en�t.
Signature of Owner/Agent : 'a%t y i 1
Address: 0
************************* *4***************************************
Signature:
Approved/Issued By: William A. Braga, Local Building Inspector
COMMENTS:
❑ APPLICANT ElASSESSORS ❑ CLERKV'ORIGINAL ❑ COPY
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Required approval Approvals received
please (X) approvals Please (X) approvals and
required for this project Initial as received
DATE INITIALS
Board of Appeals -
Mater Card
Sever Card — _-- —
Board of Health
Bond
Selectmen
Conservation
Fire Chief
Cross Connections
Licensed Contractor
Controlled Conet. Affid.
Other information required ' / _ __
t
1�i'i rf 1 V rfil y�ijj RRMIT NO.
,:qQ ,- 9u` G. TOWN O DARTMOUTH DATE ISSUED
TOTAL COST . �Z �'Z
�,.,,�,1' APPLICATION FOR
`�' LESS APPLICATION FEE _? C%-�`L f." '
tt``°i: --.'' BUILDING PERMIT
IH84.- ' FINAL PERMIT FEE _
/LOCATION OF BUILDING
v \ Number & Street I % Sum DANLie.. ( W . 01.1 Zoning District
02 Crosst eets(between) and
03 Lot t�C7Plat '79 I'ox au-M 1k,2lLALfL_ Lot_ 3o3j N, 04 Subdivision
A
OWNERSHIP COST
05 ❑ Private (individual, corporation, 36 Cost of Improvement
non-profit institution, etc.)
p 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
36.3 Plumbing
07 ❑ New Construction
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) TOTAL
12 ❑ Moving (relocation) ����� COS_
) —�2!--% " (`U
STRRUCTURE
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
1,6 ❑ 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
18 ❑ Shedge 45 Total land area, square feet fie;.?ad—sl,/�
19 ❑ Carport ll
20 ❑ Swimming Pool ,)SWAGE DISPOSAL
In-Ground Above-Ground \\ N
21 ❑ Woodstove 46 ❑ Public or private company
22 ❑ Fireplace 47 L 'rivate (septic tank, etc.)
23 ❑ Other - Specify
6. ATER SUPPLY A
48 ❑ Public or private companyI.
NON-RESIDENTIAL - PROPOSED USE 49 1vPrivate, (well, cistern) • 1
i
24 ❑ Amusement, recreational 25 ❑ Church, other religious PRINCIPAL TYPE OF HEATING FUEL
26 ❑ Industrial 50 ❑ Gas
27 ❑ Parking Garage 51 O Oil
28 ❑ Service station, Repair garage 52 ❑ Electricity
29 ❑ Hospital, institutional 53 ❑ Coal
30 XOffice, bank, professional 54 ❑ Other - Specify
31 ❑ Public utility
32 ❑ School, library, other educational' TYPE OF MECHANICAL
33 ❑ Stores, mercantile _ 55 Will there be central air conditionin ? ❑Yes ❑ No
34 ❑ Tanks, towers g
35 ❑ Other - Specify t �y��� , 1
56 Will there be an elevator? ❑Yes ❑ No
PARKING PER ZONING BY-LAWS
57 0 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 applicants PLEASE PRINT
60 Owner (print) M i f,14 A U. F IAA I I s u N OarJL&- &o•
�� MAILING ADDRESS TELEPHONE NO.
61 Signature _ 9Y`Q�1n� DATE Z Gy
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 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
'k
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
-r Signature DATE
Owner or Agent
TOWN OF DARTMOUTH BUILDING DEPARTMENT
NOTICE
Are you a Home Improvement Contractor subject to the PERSONS CONTRACTING WITH UNREGESTERSD CONTRACTORS DO NOT
registration law (780 CMR - 6)? Yes NO HAVE ACCESS TO THE GUARANTY FUND (780 CMR - 6)
Are you claiming an exemption from the law by home owner QUESTIONS or complaints? Call or write:
sign-off? Yes NO (if yes submit required signed Home Improvement Contractor Registration
affidavit) One Ashburton Place - Room 1301
YOUR COOPERATION IS GREATLY APPRECIATED: Boston,MA 02108
Your Sig. Date 14 (617) 727-8598 15 I
-
RECEIPT FOR PERMIT - ....._ ,
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TOWN OF DARTMOUTH , . .) i
e*CeiNi, PERMIT NO. ,
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Received From
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Received By
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RECEIPT FOR PERMIT
„5:5,9501JT/rt.4, TOWN OF DARTMOUTH
PERMIT NO.
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Date• --:,
Rectved Fkom Ali f' //(6- LI',7 , :I( "7 4-' (
•,- s.- Id
Owner
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Location iii>57 ,,.,) ,,•: 1.--.4-/ (4',..ei ,,0
Type
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Amount Paid i J61 / C
Received By
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�,:`E , COMMONWEALTH OF MASSACHUSETTS
‘,,Vd;--P DEnuamENT OF INDUSTRIAL ACCENTS
600 WASHINGTON STREET
James.: Cameoet: BOSTON, 51~L 15 02111
Comm!ssrone•
WORKERS' COMPENSATION INSURANCE AFFIDAVIT
I,
(licensee/permittee)
with a principal place of business/residence at: •
(City/StatelZip)
do hereby certify, under the pains and penalties of perjury, that:
[J I am an employer providing the following workers' compensation coverage for my employees working on this
job.
•
Insurance Company Policy Number
[ ] I am a sole proprietor and have no one working for me.
[] I am a sole proprietor, general contractor or homeowner(circle one) and have hired the contractors Iisted below
who have the following workers' compensation insuranOe paw
Name of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number
./V// ----
Name of Contractor Insurance Company/Policy Number
Q I am a homeowner performing all the work myself
NOTE Please be aware that while homeowners who employ persons to do maintenenet,construction or nip'air work on a
dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are not generally
considered to be employers under the Workers' Compensation Act(GL C. 152.sett 1(5)),application by a homeowner for a license
or permit may evidence the legal smuts of an employer under the Workers' Compensation Act.
I understand that a copy of this statement will be forwarded to the Department of Industrial Accidents'Office of Insurance for coverage
verification and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to Si 500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of S100.00 a day against me.
f)
Signed-this i�'i //v 1.,� /
�' �r da of '
w !` :;, y I9 l
License•2Permirtet Licensor/Pry,;,,.„,.
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