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BP-72895 Permit No. BP-72895 BUILDING . . GIS# 4265 00 , CO e 1 aka Map 0079 s6 'PH ,.Lot > 0048 400 c th 47 eo fi Sub Lot 0028 j41 048 S 8 % C at o.- WINDOWS/DOORS/'_ rY DECK PERMISSION I`y .' TO: , a ;Protect# JS-2014 002161 Contractor i nse ,k one Est.Cost $8000.00 - z sc 4 Fie $150.00. Engineer ¢ F i I /`'w, 'CCoust'Mass ; ,* 1 it _°? I ,,,Use Group -. R3 . Applicant ' '%' -, gag# Lot,Size(sq ft); 45621 DAVID MEL 0 � t. (5 50.•� Zoning SRB OR'NER: % Aquifer;Zone ` -N/A ,,.. .{ MELANCON +I o I*Iood Zone ZONE X _,;, . 9 `N :Colarst - - 974 sq ft (deck) . t DATE ISSUED dsx ` , 0 AIt.Const N/A --r= Tate Typed 03-10-2014 * n 4* TO PERFORM THE FOLLOWING WORK: Replace existing french door with slider; SAME SIZE, SAME OPENING/replace window in garage with french door/demo existing deck and construct new larger deck PER PLAN Prof Ara' ocation: 2 SUNDAN E RD Approved/Issued By: r L .ems. ...�.�j .. —'' DAVID BRUNETTE,LOCAL BUILDING INSPECTOR All work shall comply with 780 CMR 8TH Ed.(MGL Chap.143)and any other applicable Mass.Laws or Codes and plans on file. Schedule appropriate inspections as required. Upon completion of work,final inspection is required. 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 B -ding/Zoning Permit. Signature of Owner/Agent: "Persons contracting with unregistered contractors do not have access to the guaranty fund(as set forth in MGL c.142A)" Inspector of Inspector of D.P.W.Inspector Building Inspector Inspector of Gas Fire Department Plumbing Wiring Water Service it: I Footings: Underground: Oil: Foundation: Rough: Smoke: Rough: unnah: Sewer Servkre#• Rough Frame: Insulation: Final: Final: Final: Cross Connection Final: Final: - Board of Health E-911 Additional Comments: Planning Board Prior to issuance of Certificate of Occupancy/Completion,this card must be returned to the Building Department with all necessary inspections signed off. Department phone numbers are listed on the white"Required Inspections"document provided with the issuance of the building permit. POST CARD SO IT IS VISIBLE FROM THE STREET 1,1 0 , 1 ibARTMOUTH - BUILDING DEPARTMENT RECEIPT 0 72917' 1,, 4 • PHONE: 508-910-1820 FAX 5D8-910-1838 e2 .",c,",,- /71 1/, , i /73, /.._, ,-- ,, ,,0 - - if ' '--/ 7 '"?' le / (.., /- .i-,,. (:, ., , • Name: .,,, / , . ;Property Owner: 1 / ' DateJA/rlY ,. ,,,, ild-d- t..!, / / 4/„/ /7 / - ,...,„ / / f.--/-/ c,,,,, , , i (,- Job Location: Map: Lot: Description General Ledger#'s 1Ref.# Amount Building & Building Misc. 01000-44105 / l it'''''i„,...,:-/-i €--I--, / e', ,r, /...4,......- . I .,...../ Electrical 01000-44106 Plumbing & Gas 01000-44107 /,$) 114C '-, Trench Safety 01000-44129 ' RIR 1 1 pom i Other Department Revenue 01000-42420 White-Collector's Office Yellow Copy-Customer's Receipt Pink Copy-Building Department Received fify --`" 'II/ i THIS IS NOT A PERMITILICENSE FOR BUILDING, ELECTRICAL, PLUMBING OR GAS rA-N WN OF DARTMOUTH - BUILDING DEPARTMENT RECEIPT 7 2 5 : 508-910-1820 FAX: 508-910-1838 Name: 'la ?c.�a - ' mot✓_ d erty Owner: iiiii/a/ - L Date;3‘-.7./ c/ Job Location: ',2 J ( (r1f( / `a.k"�..._. ` --- Map: +7/ Lot: Zr Description General Ledger#'s Ref. # Amount Building &Building Misc. 01000-44105 f n Electrical ' 01000-44106 MS Plumbing & Gas 01000-44107 liA Pin Trench Safety 01000-44129 6 Other Department Revenue 01000-42420 414qy COdi , White-Collector's Office Yellow Copy-Customer's Receipt Pink Copy-Building Department Received By.. --" Z r e-e- 3 THIS IS NOT A PERMITILICENSE FOR BUILDING, ELECTRICAL, PLUMBING OR GAS • RESIDENTIAL D Phased Approval(R106.3.3) } F.,, ,r:- $25.00 APPLICATION FEE IS NON RE-FUNDABLE&NON- ''RA.' SFH* UL1 o�TH DATE RECEIVED .,": .w �q, DARTMOUTH BUILDING DEPARTMENT 't g —7 al9. 32 o vi_- _. 400 Slocum Road, P.O. Box79399 L , I`',Il 1= a f Dartmouth, MA 02747 • °<7. ` yYf Phone: 508-910-1820 Fax: 508-910-1838 www.town.dartmouth.ma.us APPLICATION TO CONSTRUCT,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING THIS SECTION FOR OFFICIAL USE ONLY l RECEIVED BY:,r'`,:;‹ ,i .:,F �� ,:_-:r BUILDING PERMIT NUMBER: DATE ISSUED: L_SIGNATURE: r-r � ,� DATE: 'A AR' f f 2014, Bu>t�ing�Commissioner/Inspector of Buildings T6 Zoning District: ,S7 Proposed Use: Zone: 0"1 0 B 0 A 0 V Aquifer Zone: •® THE FOLLOWING AGENCIES-SHOULD BE NOTIFIED; -e1- �r ❑Board of 0 hoard of 0 Cons. / 0 Demo 0 DPW ❑Elec. 0 Energy Report Appeals Health Commission Affidavit Card Sent: Cut Off Follow-up* ❑Fire 0 Gas 0 Planning 0 Sewer Card 0 Water Card 0 Zoning 0 Other Chief Cut Off Board Cut Off Cut Off `REQUIRES INSPECTOR'S REVIEW BEFORE THE ISSUANCE OF A PERMIT. DEPARTMENTAL APPROVAL Board of Health: Signature: OK_ -6/4.-eal�h Date: 3 /76/1// s Conservation Commission: Signature: Date: Other: Signature: Date: ,' Signature: Date: Signature: Date: / Brief description of work being performed: /y`1°f ',:..e;_ ' i )61 t ‹L P : . ` ,. 4--.34t_ _;_i' '; SECTION 1 -SITE INFORMATION r 1.1 Property Address: ZZ SUN DANCE IZOA 16 1.2 Assessors Map&Lot Number: Lot Area(sf.) I . 05 AC. Frontage 119 Map g Lot - Required Provided Front Yard 1.3 Historical District 0 Yes IN No Side Yard Year Built 1193 Rear Yard 0 Altering more than 25%per side of building 1.4 Water Supply(MGL c40 s54): 1.5 Sewage Disposal System: Has application been submitted to the Historic Commission? 0 Municipal )2(Private Well 0 Municipal i On Site Disposal System 0 Yes 0 No Date: Revised 10/11 0 CONSTRUCTION PLANS ❑ SITE PLAN ❑ ENERGY REPORT t RESIDENTIAL SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 9 2.1/Owner Record: Name(print) Contact Address Phone Number As 2.2 Authorized Agent: Name(print) Contact Address Phone Number SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supervisor/Specialty License: License Number: Company Name/Contractor Name: Address: Expiration Date: Signature: Telephone: 3.2 Homeowner Exemption-One&Two Family Only Section 110.R5.1.3.1 Exception: FOR HOMEOWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT 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 app; g ,der this section sign below: Signature: SECTION 4-WORKER'S COMPENSATION INSURANCE AFFIDAVIT(MGL c 152§25) Worker's 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: 0 Yes 0 No SECTION 5-DESCRIPTION OF PROPOSED WORK(Check all applicable) V Deck ❑ Pool 0 Repairs 0 Alteration 0 Chimney/Fireplace ❑Woodstove/Pellet Stove ❑ New Construction* 0 Accessory Bldg. 0 Roofing/Siding o Other (Energy report required) (Shed/Garage) (Specify below) ❑Addition ' Replacement window/door 0 Demolition (Energy report required) No.of windows Doors Z. (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 p 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): • O Air conditioning-(separate unit) ❑None of the above to be provided O Hot Water: Gas Electric Fuel Oil Other SECTION 6-ESTIMATED CONSTRUCTION COST Item Estimated Cost($)to be completed by permit applicant 1. Building 8000•00 2. Electrical 3. Plumbing 4. Mechanical(HVAC) 5. Total=(1 +2+3+4) " SECTION 7A-OWNER AUTHORIZATION (to be completed when owner's agent or contractor applies for building permit) (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 SECTION 7B-OWNER/AUTHORIZED AGENT DECLARATION I, 1>At\(t I A LAI CO tJ ,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. Sig er the pains and penalties of perjury. ____77 313 j2O1Lj Signature of Owner/Authorized Agent Date SECTION 8-OFFICE/INSPECTOR'S NOTES Less Application Fee: $25.00 Remaining Balance: $ /` Z.3 Total Permit Fee:$ /1'5-1,..) Other$Amount$ Gross Area-New Construction total sq.ft. 729 c""'`e� 9 2 1 Gross Area-Alteration total *)4(t. sg.ft. / Permit Issued to: ' c d ..A e t e ` rTh J�A r7 v J 9,!'�""—.'� (.77(J0.44,,/jjl` ? .it ClJ�.f? ( ��/Af.�� .�5 �a9 /Y Vim:. iJJ' r./'��'`.-a-c/1' , -,,,W0 y-',a! 2,✓ r', ..0,.-�_ -'.5 v ',✓.�?.f/1 / � `21-2.,t�r� ��,-'o .r1�� _� ... s� 4.y, ., SECTION 9-ADDITIONAL COMMENTS/SKETCHES i / ) J alli--/ 'N 4,70-z),-,.._ 1 /4,-(----,,, _ ,S 0 ie:,—,100.-6-d4 7.-6 i le 1 14"it-4 A 3'."—• —A--p ke.,„teip._ , ,,, iA 0 Q.---fl e--4-J ,---1 Ai Lif (i...- -, 7 ' Y2'zi 7s--• 1 2-Z- 7 .k.7 (>---' - . !, Permit No. BP-72895 Project Location: 22 SUNDANCE RD Commonwe a.s achus a tts ...0 y� .40 1 . u '!-. i . i .. 30 i=, A iR , �y x °. r 5 05+ n r� + 0- 51»0 y , 9 Airk ' ' :fig -.' ' .. r .. is a E r rz..:"'s':ra'';: a ,.fir s ^'r"a .."w z II ilkA �P ' s, ,.. ,.-..hy' �e d g , z , _. b 7.7 i r ''''F'774,-,."-1,_ ' - b-,-, ft, - .4, , ., . ,..... , , . ... L., , ,, -__„,„ :,...,., ---,, . . 44 ,,4 t:?-3,;,,,t6:7--f-TiZr!--":":f VI' -.' I : ... , _ .,. - _ ., _ gg fi. ...,,,r.. . , ., ., _ Contra ' , e: done#: et IA\ $ . '� :w '- ; hone#En inee o 'K zs 3 ..5' sue,. �. Applicant: f- * F Phone#: DAVID ME x�x , . i , �;°� � (508)995-1924 , � ���� '� a �' t�-� �� � OWNER: °Nt,, 6 6 ° ,r v r& ,1-.3 ` #-... £ 4 ^a MELANCOIv DA .* '°v'0 �. # Y s p :, t.:.,. ::., .;:mac,. �'' tasb. x:,hubY� .. ,.,,x. ,... - DATE ISSUED: 4 TO PERFORM THE FOLLOWING WORK: Replace existing french door with slider; SAME SIZE, SAME OPENING/replace window in garage with french door/demo existing deck and construct new larger deck PER PLAN 1- DATE ' TIME ' ---" TYPE OF INSPECTION&REMARKS INITIAL 03-10-`14 09:41 FROM)-Bd of Health/ConCom 508-910-1893 T-236 P0001/0001 F-720 , RES ENTIAI, IDPhased Approval(R106.3.3) • $25.00 APPLICATION WIRE IS NON BL•FIINDABLE&NON• Y F )� .- — C ART :" '' DATERE I VD ;�,,--_ .', DARTMOUTH BUILDING DEPARTMENT f;. '1 2OI on -7 �i� 9� 32 -.. . * 40o Slocum Road, P.O. Box 79399 R -< - Dartmouth, MA 02747 ,6ed Phone: 508-910-1820 Fax: 508-910-1838 www.town.dartmouth.ma.us APPLICATION TO CONSTRUCT,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING THIS SECTION FOR OFFICIAL USE ONLY -RECEIVED BY;„ r �� % �,',�t �'�, �. BUILDING PERMIT NUMBER: 1fr ! c DATE ISSUED: SIGNATURE: DATE: • Building Commissioner/Inspector of Building6 Zoning District: Proposed Use: Zone: 0 X 0 B 0 A I]V Aquifer Zone: THE FOLLOWING AGENCIE HOULD BE NOTIFIED: - s O Board of nerd of 0 Cons. 0 Demo ElDPW• 0 Elea 0 Energy Report Appeals Health Commission Affidavit Card Sent: Cut Off Follow-up` 0 Fire ❑Gas 0 Planning 0 Sewer Card 0 Water Card 0 Zoning 0 Other Chief Cut Off Board Cut Off Cut Off 'REQUIRES INSPECTOR'S REVIEW BEFORE THE ISSUANCE OF A PERMIT. DEPART ENTAL APPROVAL0 Board of Health: Signature: ' I D te:__ 1 Lcc f 7 Conservation Commission: , Signature: te: r `-.4 703 Other: Signature: Date: ,,:,--1 - Signature: Date: `=- fx9 Signature Date: c�—' x Brief description of work being performed; Fiii SECTION 1 -SITE INFORMATION L i _ 1.1 Property Address: 22 SUN DANCE COA IS 1.2 Assessors Map&Lot Number- : 1 Lot Area Of.) I .'05 f Frontage I-19' MapF / Lot J �, - - ..Y i Fleakiced Provided Front Yard 1.3 Historical District 0 Yes t3No Side Yard Rear Yard • Year built 19 9 0 Altering more than 25%per side of building 1.4 Water Supply(MGL c40 s54): 1.5 Sewage Disposal System: Has application been submitted to the Historic Commission? 0 Municipal `j2[Private Well 0 Municipal ECOn Site Disposal System 0 Yes El No Date: I\ Revised 10/l i 0 CONSTRUCTION PLANS 0 SITE PLAN 0 ENERGY REPORT : a t r l'1 i ,-.1 ...f*.w....60, - oN04/0:;...,4.1___. . ,,--. , ..? ,) 11•, -.FAQ.1'411,. - f I 1: • • rio ,i,1/6°' 1:, -"..-- k \ j 1Tilgi=' - — i� I\ t \ 1 .. . ') i V v 0„...rwo / --ct\\ T r �� %., • _ - '1 l' = ; _Z i -' i i i ! + . _ 1,7 4_ .....---- , _ , _ t y' 4,---1 Ui / �; ja „ ( 1 (T. f jib +/��,.- ! -/�-� ' 1 ,'- r j u -,,_,., ) V V _ The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 3 1 Congress Street, Suite 100 � � ,a�;OF Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): bA\11 (�II�LAI�CD Address: 22 Sk)K-1t 6,,m ,e t2.0/4 c� City/State/Zip: K1.bApti m AAA., Z 7- 7 Phone #: 5-0 B -99 5 n Z-{ Are you an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with 4. ElI am a general contractor and I — have hired the sub-contractors 6. n New construction employees(full and/or part-time).* 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. [' Demolition working for me in any capacity, employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.t required.] 5. n We are a corporation and its 10.n Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 2Z v t-A /A 1-4CEz :44.> City/State/Zip: /NI . 1A t2T-hlk&YT(-1 (VIA c.2-T-17 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of neriury that the information provided above is true and correct. Signature: --� Date: .. .. l Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: _ Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts ieneral Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 7-2010 Fax# 617-727-7749 wwwmass.gov/dia s �., r+ . C'4 4 z N ra rA C b 3tQ7 b o o $ ''a�rtTi :14 Gd Nrilr4 y o o ° 5 o `� tr1 T z ° yt" o�j YC p `.° c � ° w� m Z ob7 4Z � 7H7 dz ��.. ,e � :.. b x?. N d �. 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