Loading...
BP-2003-28131 -. r'}? �.., ezi. ,� , a�`i x€^j"sc ' �r��'- -14sd f;4 ?t �•' R- , '' k '`' : ti`-' Permit No. BP-2003-28131 - ' � g d ' -,-4, 1'n• k '"'.- � sS'�I6��5. e": •d . • / LE'�dwt t ...ss � S r � yam �� �- � a �'� � ����,�x � ,��.�w �•:: �� II Ij 4 ���F+ 7Y^.: a.a. T r'? .� ,R i ~'7 T�u■T �, yrb :,04 -?k� °' i . a 2` 14. t •`4q�Iocuu 'oad,Dartmouth : • �-�., ° �'' ' * b�j `' hohh; SD 9 0.182 i az.' 0: i i ; 4 g 'P' '--' �a j ,1,,, �` Y x . I ��n.x.. ;.£... F.7-;c:' 3. ,'&. L`e ''�'. fis t' t a '{ t r`� , -, 0 ,.,*- "a ; PERMISSlO� I ^, i `' i' : '► . �; ate. ,€ '--'� G '$..l Li a: J3 . Y „ 1,4.. KV ` � "� Contractor>_ �I , ' c �4 k� , h # '_ s,�fi '"iV '`tea < .i i 7 • '�. ,-. ; '`.t a '' a'-i . Engineer:. , r ray r r _,� # �, i�. Any- r .M+" � ;� �y� �c�-.,3.�9K �. t. Y's --� ;�� ."�Y Applicant: A 4;. A 7, t ... �/ne#• Da ...2171 ,: 003;,: � LISA BOUSQ `T a `: ) a OWNER: a � i .• . BOUSQUET DAVID' & , _i - 6 csf. � "+ era®mm.smm'"$ ,-- _ DATE ISSUED: 3 TO PERFORM THE FOLLOWING WORK: Extension to existing deck; 12' x 16' IT Project Locat':•n: 37 SUNI�)ANCE RD �., _. , Approved/Issued By: - _ =# JOEL S.REED 0 •1 i :UILDIN INSPECTOR All work shall comply with 780 CMR 6'' . (MGL Chap. 143)and any other a plicable Mass Laws or Codes and plans on file. POST THIS CARD SO IT/S VISIBLEFRO/L1 THE STREET ._k .. 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. s F ,+ -�r ,'ice# R � I hereby certify that the proposed work is authorized by the owner of record and I haves 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, noI withstanding the issuance of this Building/Zoning Permit. - � { ' x itelk,..-64...f,_,,,, „:,z_.,,,:,1,, Signature of Owner/Agent: w , z c, ,., may .pw y,, k Comments: J 3 a r ,.4,r " x u i '�, KA fix^ ,e 4 REPLACEMENT FEE WILL BE REQUIRED FOR LOST SIGNATURE C D TOWN OF JD RTMOUTH DPi.2747 . BUILDING RECEIPTS COLLECTOR'S OFFICE Name , 1" ,sj Property p f: F f ,: j r ! ,�`Date: ., /2 ../.7 _ , .-; J OWTler. Job Location: Al «/ White Copy-Collector's Office Plot: .T-:/" Lot: 'f ��t Yellow Copy Customer's Receipt r J ` y `k -r> "_ Pink Copy File Copy - t Green Copy-Building Department 7.Phone: f . - V.i\ Description General Ledger#'s ,R@,f.# Amount License&Permits-Building 01000-441050 - License&Permits r , got*.v 7 nolcI 5 - ,� ..,y,; (.. j f License&Permits k ical1 §t l r ' 04�06 License;&Permits-Plumbing&Gas 01000-44107 -=, Other Department Revenue 01000-42420 I This is not a Permit or License for Building,Plumbing or Gas Received By: � # -/l TOWN OF DARTMOUTH F 1 BUILDIVG RECEIPTS COLLECTOR'S OFFICE Name P f Property -; r Date: --, - Owner: - / Job Location: ,-`t y?, ¢ t � i ' White Copy-Collector's Office Plot I- Lot: ' ,', `'y 4 Yellow Copy-Customer's Receipt / c:., Pink Copy-File Copy N v)3 Green Copy-Building Department Phone: Description _ y heral Ledger#'s (r* - R f.# Amount License 1'a its l uiwing 01000-44105 License&Permits-Building Misc. 01000-44105 1-.• J ,' " License&Permits-Electrical 01000-44106 License&Permits-Plumbing&Gas 01000-44107 -------- Other Department Revenue 01000-`42420 This is not a Permit or License for Building,Plumbing or Gas Received By: f '" TOWN OF DARTMOUTH 9 cl BUILDING RECEIPTS pOLLECTOR'S OFFICE t 1 } Name 0 __ I .if erty ,/,,,- ). Date , ` -3 Job Location: �" r- ` ,.- ,g` rc '�'„ . ;� < ,f f.. ; , � S,,,�,:- .r` .� White Copy-Collectors Q,f jEe Plot '` Lot: ` / - `' /%`+ ,, Yellow Copy-Customer'1R eeipt ,/ - --' k ,nu3 Pink Copy-File Copy '', \NW, ?- Green Copy-Building D tment Phone: f f . Description General Ledger#'s R.# Amount License&Permits-Building 1 . License&Permits-1A} M4 c r. - - 1 , rw.- .. y ` License&Permits-Electrical f 01000-44106 License&Permits-Plumbing&Gas `T 01000 107 -•---- Other Department Revenue `01000- 24 -� /,,, `y am 1 ' , This is not a Permit or License for Building.-P umbing dr'Gas Received By: ' ./ ' ' r RESIDENTIAL 2003 D FOUNDATION ONLY $25.00 APPLICATION FEE IS NON-R9EFUNDABLE &NON-TRANSFERABLE DATE RECEIVED „ TF DARTMOUTH BUILDING DEPARTMENT / \r ( -(;;N ` w 400 Slocum Road, P.O. Box 79399 L y .Dartmouth, MA 02747 . 508-910-1820 FAX 508-910-1838 APPLICATION TO CONSTRUCT,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING THIS SECTION FOR OFFICIAL USE ONLY ,ii.) RECEIVED BY: BUILDING PE] DATE SENT FOR REVIEW: V.� �, NUMBER: (, L;11 DATE ISSUED: f �° OK TO ISSUE-SIGNATURE: 'r , �� DATE O Bp* g Corn issioner/lns ector of B ildings a Zoning District: roposed Use: eg-" Zone: E C ❑B 0 A 0 V Outside Flood Zone 0 Aquifer Zone THE FOLLOWING A t ENCIES SHOhfLD BE NOTIFIED: ❑Board of It :oard of ❑Con.Corn. 0 Demo 0 DPW 0 Elec. 0 Energy Report Appeals Health Affidavit Card Sent: Cut Off Follow-up* ❑Fire 0 Gas 0 Planning Board* 0 Sewer Card 0 Water Card 0 Zoning 0 Other Chief Cut Off /Cut Off /Cut Off Review* * REQUIRES INSPECTOR'S REVIEW BEFORE THE ISSUANCE OF A PERMIT. DEPARTMENTAL APPROVAL k, Zoning Review: Signature: 2/t ,//K` D4OR 6 'u Energy Report: Signature: Date: Fire Chief: Signature: Date: Board of Health: Signature: /Lee Date: 3Agir "fr Conservation Commission: Signature: Date: Other: , Signature: � Date: Description of work being performed: >�C, —i ()"yl SECTION 1-SITE INFORMATION NUMBER OF PLANS SUBMITTED: SITE PLAN SUBMITTED: 0 yes 0 no /� y ® � 1.2 Assessors Plat of Number: _� 1.1 Property Address:/ CQ/GI.0�. Plat Lot Nearest Cross Street: Subdivision Name: 1.3 Historical District 0 yes 0 no Has application been submitted to the Historic Commission? Total Land Area Sq. Ft.: 0 yes 0 no Date: 1.4 Water Supply(MGL c 40 § 54): 1.5 Sewage Disposal System: / 0 Municipal Private Well 0 Municipal th-f�n Site Disposal System C:`.blip_.iorms,BIdgapp.res.ww pd Page 1 Rev.January 19,2001 RESIDENTIAL /003 SECTION 2-PROPERTV,OWNERSHiP/AUTHORIZED AGENT 2.1 Owner of Record: u; f- o e.co .?e7 5e,tudeiA) 99—0) / -?i Name(print) Contact Address Phone Number 2.2 Authorized Agent: Name(print) Contact Address Phone Number SECTION 3-CONSTRUCTION SERVICES 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(7S0 CMR-6)? ❑ yes 0 no If no,go to the next section! Are you claiming exemption from the requirement? 0 yes 0 no If yes,submit the required affidavit! Company Name Registration Number(if none, state"none") Address Signature Telephone Expiration Date 3.1 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) -Daokd A-- LA U«c(�� Signature 136,- Ul b signing the above,the home owner acknowledges that there will be no eligibilty to the Guaranty Fund Date - ._a- LI- 63 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. 19S2.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 applyinne under th /mo is section signg below: `-WSignature: ..6 k. o e Your signature carries certain responsibilities.including but not necessarily limited to,general liability C: bide.furms'vBldgapp.res.wpd Page 2 Rev.!anuary 19_2,)!-1 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 CMR R5.2.15) SECTION 4-WORKER'S COMPENSATION INSURANCE AFFIDAVIT(MGL c 152 §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: 0 yes 0 no SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) 0 new construction* 0 addition ❑ alteration 0 repairs 0 chimney/ 0 woodstove (enemy eport required) (energy report required) fireplace eck 0 pool ❑ accessory bldg. 0 replacement window/door ❑other 0 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 ❑ 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 Brief Description of Proposed Work: add G.a j . /s174 � tic. 072 fj) /f f7,y 1pc r SECTION-6 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost($) to be completed by permit applicant 1. Building 2. Electrical 3. Plumbing 4. Mechanical (HVAC) 5. Total=(1 +2+3 +4) *Estimated Total $ Q/'2 •(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, _ , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application and accurate,to the best of my knowledge and belief. Signed under the pains andand penalties of perjury. LO Signature of Owner/Authorized Agent Date ('^bids farms 131deapp.res. wI Palle 3 Rev.January 19,2001 RESIDENTIAL 2003 SECTION 8-INSPECTOR' REVIEW/COMMENTS 1. Date plan reviewed: 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: 9. Inspector's Signature: *tat?: 6 2003 SECTION'9-�A LICANT NOTIFICATION Applicant inform d o fa ve,> - ate: , 1 Ti e: �' t �� erka Comments: SECTION 10-OFFICE\INSPECTOR'S NOTES Total Permit Fee: $ /. ' oO Less Application Fee: $25.00 Remaining Balance: $ TOTAL FEE: 2 . Gross Area-New Construction total sq. ft. / Gross Area-Alteration total sq. ft. Permit Issued To �'? ��'` -' i>� -'' / U SECTION 11-ADDITIONAL COMMENTS/SKETCHES / F � I C:'bldg.lorms\Bldeapp.res.wpd Page 4 Rev.January 19.2001 Permit No. BP-2003-28131 Project Location: 37 SUNDANCE RD Commonwedth of�Iassacllusetts IGIS#: 4285 00 TOWN OFDARTMOUTH Map. , 400 Slocum Road,Dartmouth,MA 02747 Lot: -47 Phone: (508)910-1820 Fax: (508)910-1838 Sublot: , BUILDING PF,R:IVIIT Poje ' Js 003 0744 Est Cost $200000 . FIELD INSPECTION Fee. $40 00 Const.Class• 'Use-Group. R4 Contractor. License: Phone#: Lot Size,(sq.ft j . 79010 Engineer: License: Phone#: Zoning: _ IZB ' New Const.: 192 sgft Applicant: Phone#: Alt Const.% , DAVID F BOUSQUET (508)995-2178 ' 'OWN ER: Cetluig 'Valls: BOUSQUET DAVID F Floor:: DATE ISSUED: , 3 o "Glazing . TO PERFORM THE FOLLOWING WORK: C©M Extension to existing deck; 12' x 16' DATE 1 TIME I TYPE OF INSPECTION&REMARKS INITIAL ( / (../ 3 I, a p 4..-j-ry / l� / I / ®vim/ �i.. / (a.<- (- 34-('- ) //)1-0-( 2()-21/26V �l C0trill'11111?)LE'Tz1::::1;1—/:; � s�J1a7 ut' :.a RESIDENTIAL ,r-;' 4 "`l,.` 0 FOUNDATION ONLY �. $25.00 APPLICATION FEE IS NON-REFUNDABLE &NON-TRANSFERABLE DATE RECEIVED r" DARTMOUTH BUILDING DEPARTMENT � pf �, } ^; r �/ 400 Slocum Road, P.O. Box 79399 `�' Dartmouth, MA 02747 it \\.- .;,..: 508-910-1820 FAX 508-910-1838 APPLICATION TO CONSTRUCT,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING THIS SECTION FOR OFFICIAL USE ONLY RECEIVED BY: BUILDING PEv/ DATE SENT FOR REVIEW: i V- O, NUMBER: DATE ISSUED: OK TO ISSUE-SIGNATURE: V DATE MAR 2 6 2003 B • i'tig Com ►ssioner/Lector of ildings Zoning District: b 'roposed U : Zone: �f C ❑B 0 A 0 V Outside Flood Zone 0 Aquifer Zone THE FOLLOWING A i ENCIES SHO D BE NOTIFIED: ❑Board of al :oard of ❑Con.Com. ❑Demo 0 DPW ❑Elec. 0 Energy Report Appeals Health Affidavit Card Sent: Cut Off Follow-up* ❑Fire 0 Gas 0 Planning Board* 0 Sewer Card 0 Water Card ❑Zoning ❑Other Chief Cut Off /Cut Off /Cut Off Review* * REQUIRES INSPECTOR'S REVIEW BEFORE THE ISSUANCE OF A PERMIT. DEPARTMENTAL APPROVAL Zoning Review: Signature: ©A DAMP 2 6 2003 Energy Report: Signature: Date: Fire Chief: Signature: V- Date: Board of Health: Signature: �(. - ' ; Date: 3 3/ 03 i Conservation Commission: Signature: Date: Other: Signature:dirj, ,��/ ��, Date: Description of work being performed: `1`ie.: tiY n—A SECTION 1-SITE INFORMATION NUMBER OF PLANS SUBMITTED: SITE PLAN SUBMITTED: 0 yes 0 no `' D 1.2 Assessors Plat of Number. �/ I t=Property'Address: LY'2h/ 1 R 11/I'Vk ALL. A - Plat � Lot J -__ _k Nearest Cross Street: 1.3 Historical District ❑yes 0 no Subdivision Name: Has application been submitted to the Historic Commission? Total Land Area Sq. Ft.: 0 yes 0 no Date: 1:4 U tef.Supp1 MGLrc 4O' ''S4): 1: dVage:D.isp.. . . : .:_,"' A?.� � 0 Municipal Private Well 0 Municipal [ILE7n Site Disposal System C:`bld .1 nnis.Bldgapp.res.\\pu Pale I Rev.January 19,2001 The Commonwealth of Massaschusetts Department of Industrial Accidents Office of Investigations 600 Washington Street s PI A Boston, Mass. 02111 I I Workers' Compensation Insurance Affidavit Applicant information: Please PRINT Leuibly name: 1- I S I 6 0 L'`'"" location 3 4 i dC e _ I et �r city S C phone# 6 C:01l 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 - 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 cert 5'under the pains and penalties of perjury that the information provided above is true and correct. Signature: C� �'�(n- A L'4 Date -a' `9 Print Name: 'L- S 4 V6 L 0-O 5 u.e.3 Phone# q q r a I` IP 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 ❑ check if immediate response is required ❑ Selectmen's Office ❑Health Department contact person: _ phone#: 0 Other 1.11101 11lilLiUl1 iillu 1.11DL1 uL.&waA • `lassach:usetts General Laws chapter 1 52 section 25 requires all employers to provide workers' compensation for their empio%eec. As quoted from the -law-. an employee is defined as ever, 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 the 'ore_oing engaged in a Joint enterprise. and includirg the legal representatives of a deceased employer, or the receiveror 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 dww eilin_ house of another who employs persons to do maintenance , construction or repair work on such dwelling hous or on the -rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. \IGL chapter '.52 section 25 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. 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 ha been presented to the contracting authority. • -- . 'i � 3iWF� Cs+�LxY. fl,� e.. _.�.Jr1'�Alf�. .Applicants P!;;ase t ill in :he workers compensation affidavit completely, by checking, the box that applies to your situation and suppi\ in` company names. address and phone numbers as all affidavits may be submitted to the Department of lndustriai .Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The afiidati it should he 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. _. City or Towns 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. Plea he sure to fill in the permit/license number which will be used as a reference number. the affidavits may be returned tr the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any question please do not hesitate to give us a call. _._._-' '-__ t4t,;. The Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of investigations 600 Washington Street Boston, Ma. 02111 _ - fax #: (617) 727-7749 .. phone (617) 727-4900 ext. 406, 409 or 375 ,.._ '‘.. ' Bousquet 37 Sundance Rd. _ _ _ 4__Carrage 7' : . 4x4 - . -- PT Posts 2x8 PT Joists ok Bolts Doubled c—,, _.------"------f- „....--...\ / loll Existing Grade Tubes .--... wf.'77D1:zc;:')Tfci_c,lEf:::DECi\raEr.;0"FIE cm •---, 8' OC / 8' OC / .. ', r_i;:: v...-.-Pri / To::::::)URtEa Side View 7 r 7,.,7 im,-- r -----,--Anon, ,, r re 1— ' --D P' ' . ,i,,,t " , _ Copy Of This Endc,7sed / 12' I.,;, - e-, ., Pan Itkil,,,!st. fje Kept kz.1 Sit j Durj,,nrf Construc;: - U -ni, ..... ------ 16' / 1 1 : — _ _ Pool -1 - El-Stairs to - - \, 1 Existing I Overhead View �- �; _ C.3.. r �- : ter'• { �"•�-'r �i� � f�'�.�! � yssa .�. 0 V- r, c�%% w•Ar�rw 0 -40-07 P 0 0 G �w r 0