BP-418 •
Dartmouth Building Department FIEL® ®PY -
-
P.O. Box 9399 , 'BUILDING
400 Slocum Road
North Dartmouth, MA 02747 PERMIT
Telephone 508-999-0720Prn t LITi
DATE NovV. 17, 27 89 I'�[ NO. N.
MB 418
APPLICANT Thomas N. Bell ADDRESS i � P Ro. , !i. 0.
GARAGE
(N0.) (STREET) (CONTR'S LICENSE)
PERMIT TO new construction. ( ) STORY GARAGENUMBE OF
DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. - (PROPOSED USE) A
AT (LOCATION) 27 ISLAND , N. D. ZONING
D STR CT SRA
(NO.) ! (STREET) --
rn BETWEEN. High Hill Road AND Collins Corner Road
b (CROSS STREET) (CROSS STREET)
rn
m SUBDIVISION LOT BLOCK 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 .
IZ (TYPE) Ii
U. REMARKS: To be built according to M.S. .C. and as per plans on file. 1
j
1
AREA ORs�
)
VOLUME 624 sti. ESTIMATED COST $ 13,500.00 FEE MIT $5Jd.00 7
(CUBIC/SQUARE FEET) ?
Thomas gI
OWNER Thomas N. Bell q�F} Braga - ]
ADDRESS 27 Pine Island Road, North Dartmouth, NA 02147DING 1T11Iam A. dys 11
INSPECTION RECORD
DATE NOTE PROGRESS - CRITICISMS AND REMARKS INSPECTOR
/3 �-
- "7/ ,v, E
Dartmouth Building Department DEPT. FILE COPY
z D
P.O. Box 9399 BUILDING
400 Slocum Road
North Dartmouth, MA 02747 PERMIT
Telephone 508-999-0720 VALIDATION
DATE Nov. 17, 19 89 P R NO ASIR 418
APPLICANT Thomas M. Bell ADDRESS 27 Pine I s l ana- IL. , . N. D
- (NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO new construction (_) STORY GARAGE NNUMBERN OF
G UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) 27 PINE ISLAND ROAD, N. D. D STR CTZONING SRA
(NO.) (STREET)
m BETWEEN High Hill Road AND Collins Corner Road
m (CROSS STREET) (CROSS STREET)
m SUBDIVISION LOT 6 BLOCK 80 LOT
SIZE
a ^
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
M
Et (TYPE)
o REMARKS: To be built according to M.S.B.C. and as per plans on file.
AREA OR 13,500.00 PERMIT 50.00
VOLUME 624 sq• ESTIMATED COST $ FEE
(CUBIC/SQUARE FEET)
OWNER Thomas M. Bell
ADDRESS 27 Pine Island Road, North Dartmouth, MA 02764' DING4Wflliam A. Braga dvs
(Affidavit on reverse side of application to be completed by authorized agent of owner)
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
authorized agent.
SIGNATURE OF AGEN
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY a`.l1',,- TITL
�}
DATE l//r7'19 d"„2
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. �(, `��J - o u,c q�� 1 ® �'1' N 1�R 1111 U 1 �i��
�l;4 D o
:o
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it ':i.t� y�� APPLICATION FOR
\J\'
1664-•
, EVILLDING PERMI
LOCATION OF BUILDING
01 Street & Number L-2 P)iki€ Stlati:O 1243. 01.1 Zoni g District 5'k
(2 rods Streets(between) ihc l N st_L_ d- Co,.......o`.) Q,zP- _2 and
13 Lo I 6 Plat g0 04 Subdivision Lot
OW ERSHIP COST 0 'd `rivate (individual, corporation, 36 Cost of Improvement �1 t�
/?? 5-0 0
•n-profit institution, etc.) 36.1 To be installed but not
06 ❑ P 'tic (Federal, State, or local government) included in the above cost
TYPE OF CONSTRUCTION 36.2 Electrical
07 5eNe., Construction 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 l'Wood Frame
13 Number of Bedrooms 0 39 ❑ Masonry (wall bearing)
14 Number of Bathrooms (Total) C2 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 6 zLf
17 2itarage c2 51 ' X '
18 ❑ Shed W 45 Total land area, square feet
19 ❑ Carport
20 ❑ Swimming Pool SEWAGE DISPOSAL
In-Ground Above-Ground
21 ❑ Woodstove 46 ❑ Public or private company
22 ❑ Fireplace 47 0-Private (septic tank, etc.)
23 ❑ Other- Specify
WATER SUPPLY
48 ❑ Publicdr private company
NON-RESIDENTIAL - PROPOSED USE 49 Private, (well, cistern)
24 ❑ Amusement, recreational 25 ❑ Church, other religious PRINCIPAL TYPE OF HEATING FUEL
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 b w,,,
31 ❑ Public utility
32 ❑ School, library, other educational TYPE OF MECHANICAL
33 ❑ Stores, mercantile 55 Will there be central air conditioning? ❑Yes allo
34 ❑ Tanks, towers 56 Will there be an elevator?
35 ❑ Other- Specify ❑Yes No
PARKING PER ZONING BY-LAWS
57 WEnclosed 58 0 Outside
59 Does this building contain asbestos? ❑ YES WNO If yes complete the following:
Name & Address of Asbestos Removal Firm:
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.
IDENTIFICATION -To be completed by all applicants PLEASE PRINT .O q Z-`7'7 S3
a. pp
60 Owner (print) -IA5 1H. I ff.L -7 P.*+- € 1 s— o 21j. `17 -3 )i1/O
NAME MAILING ADDRESS TELEPHONE NO.
61 Signature 't ,�''/ �7 DJL DATE ii- 15-09
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 Addition to No.
_ _ � ... i_dj ,
"`, OMB 3os�-aon
`�'�� FEDERAL EMERGENCY MANAGEMENT AGENCY Expires:10.1987
e -' Z NATIONAL FLOOD INSURANCE PROGRAM
a �;.
° ° ~ ELEVATION CERTIF
ICATE
This form is to be used for: 1) New/Emergency Program construction in Special Flood Hazard Areas;2)Pre-FIRM construction after
September 30, 1982;3) Post-FIRM construction;and,4) Other buildings rated as Post-FIRM rules.
e-f (
BUILDING OWNER'S NAME ADDRESS
PROPERTY LOCATION (Lot and Block numbers and address If available) ' �' �o z "
I certify that the infgrmation on this certificate represents my best efforts to interpret the data available. I understand that any false
statement may be punishable by fine or imprisonment under 18 U.S. code, Section 1001.
SECTION 1 ELIGIBILITY CERTIFICATION (Completed by Local Community Permit Official or a Registered Professional Engineer,
Architect,or Surveyor)
COMMUNITY NO. PANEL Na SUFFIX DATE OF FIRM FI9M ZONE DATE OF CONSTR. BASE FLOOD ELEV. BUILDING IS
,(Ail r"7 6 I^S-1 �����A�� (In AO Zone use depth)
t (K�" 0 New/Emergency
(" 9:--6 0 P'Pre-st-FIFIRMRM ReRegg.
YES NO:_ it is intended that the building described ab ve ..=3 F„k
FIRM ZONES V, V1-V30: I certify that the building at the property location described above has the bottom of the lowest floor beam ; •
at an elevation of feet, NGVD (mean sea level), and the average grade at the building site '
is at an elevation of feet, NGVD. i.
,
FIRM ZONES A, 9 d E3i ERGENCY PROGRAM:I certify that the building at the property location describ d gove has the lowest
floor elevation of G f t,NGVD.The elevation of the highest adjacent grade next to the building is '' feet,NGVD.
FIRM ZONE AO: I certify that the building at the property location described above has the lowest floor elevation of
feet,NGVD.The elevation of the highest adjacent grade next to the building is feet, NGVD.
SECTION III FLOODPROOFING CERTIFICATION (Certification by a Registered Professional Engineer or Architect)
I certify to the best of my knowledge, inform tm n, and belief, that the building is designed so that the building is watertight, with
walls substantially impermeable to the passage of water and structural components having the capability of resisting hydrostatic
and hydrodynamic loads and effects of buoyancy that would be caused by the flood depths, pressures velocities, impact and uplift
forces associated with the base flood.
YES 0 NO 0 In the event of flooding,will this degree of floodproofing be achieved with human intervention?
(Human intervention means that water will enter the building when floods up to th e base
flood
level oc-
cur unless measures are taken prior to the flood to prevent entry of water(e.g., bolting metal shields over
doors and windows).
YES 0 NO 0 Will the building be occupied as a residence?
If the answer to both questions is YES,the floodproofing cannot be credited for rating purposes and the actual lowest floor must be
completed and certified instead. Complete both the elevation and floodproofing certificates.
FIRM ZONES A,A1,-A30,V1•V30,AO and AN; Certified Fl odprocfa;d Elevation is --- ____,feet,(NGVD):
•
THIS CERTIFICATION IS FOR❑SECTION II 0 BOTH SECTIONS II AND ill (Check One)
TIFIER'S NA . COMPANY NAME , LICEN E NO.(or Affix Seal)
. ,-,
....,....
Cam. ADD SS ZIP""""„� 1 ZIP
TITLE "8 SLC-44---s-AA- .40( ' . Z?V CFC
Y7707za
SIGNATURE DATE CITY STATE PHONE
-AVID ) S ILVi 7kA 1 - 1) -
The insurance agent should attach the original copy of the completed form to the flood Insurance policy application,
the second copy should be supplied to the policyholder and the third copy retained by the agent
INSURANCE AGENTS MAY ORDER THIS FORM
FEMA Form 81-31,SEP 85 REPLACES FEMA FORM 81-31,APR 82,WHICH IS OBSOLETE.
593-117
( OVTH;4
, ,' TOWN OF DARTMOUTH
BUILDING DEPARTMENT
\` sy Date // / 7 I1
Name In Payment of Amount
''-----/-4,_i q c(4,0 e_ofi:fi _
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Dartmouth Board of Health
MO MO 400 Slocum Road
.._
P. O. Box 9399
North Dartmouth, Massachusetts 02747 LETTER
( 508 ) 999-0704
Date n`• ql /'4-,'
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