Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
BP-11177
BUILDING PERMIT 3 COUNTRY ACRE ROAD Dartmouth Building Department Plat : 84 400 Slocum Road-P.O. Box 79399 Lot (s) : 18-5 Dartmouth, MA 02747 Lot Size: 1 .2A Telephone 508-999-0720 Zoning Dist . :SRB May 17, , 1999 (typed) Permit No. : ///77 Issued Date: j/-W/'/ Clerk: BAS Project Location: 3 Country Acre Road Number Street Subdivision Name: Nearest Cross Street : Ouanapoag Road Person Permit Issued To: Robert P. Gauvin & Cheryl A. Haxton Address : 3 Country Acre Road, Dartmouth, MA 02747 Applicant/Agent : Same Contact Person Phone #: (508) 763-4682 Type of License : Owner: (x) Const. Superv. License # : ( Architect : ( ) Engineer: ( ) Other: ( ) Proposed Use : Residential Residential,Commercial,Industrial,etc. Permit Issued To: To Install Type of Improvement,Add,Alter,New Const.,Demo,Land/Move,etc. 21 foot above ground swimming pool and 5 ' x 14 ' deck with a self closing/latching gate at the stairs indicate no.of bedrooms and bathrooms and other rooms Gross Area of Const . : Cost of Const . $500 . 00 Cost-Other Const . : TOTAL FEE: $ 65 . 00 Owner (s) of Record: Robert P. Gauvin & Cheryl A. Haxton Address : 3 Country Acre Road, Dartmouth, MA 02747 All work shall comply with 780 CMR 6th Ed. (MGL Chap. 143) 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 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 Building\Zoning Permit. Signature of Owner/Agent : ��' jZ• � ��- -- Address : ******************** ** * *** ********************************** Signature: Approved/Issued By: Ralp Souza, T. )e: Local Building Inspector COMMENTS: PLEASE POST PERMIT CARD SO THAT IT IS VISIBLE FROM THE STREET. - SCHEDULE APPROPRIATE INSPECTIONS AS REQUIRED. UPON COMPLETION OF WORK, FINAL INSPECTION IS REQUIRED. 0 ORIGINAL 0 APPLICANT 0 ASSESSORS 0 CLERK 0 COPY TOWN OF DARTMOUTH 41 a f BUILDING RECEIPTS COLLECTOR'S OFFICE J " Name: Property ` , r Date: ----- ' Owner: - 4 ._--. r i ;t Job Location: '._ <2- .f a .v %., z' : r < .� i t .. ` ., (. i1..-i jam._.. - - i White Copy-Collector's Office t .� Yellow'Copy-Customer's Receipt Plot: L Lot: y ,' ._ Pink Copy-File Copy Green Copy-Building Department Phone: Description General Ledger#'s Ref.# Amount rnwn nr nARTroftITN PR1 ECTO :5 F License&Permits-Building 01000-44105 f 4� I" j6;4C1 t.f� g . License&Permits-Building Misc. 01000-44105 , License&Permits-Electrical 01000-44106 MAY 28 99 License&Permits-Plumbing&Gas 01000-44107 j j `l Other Department Revenue 01000-42420 This is not a Permit or License for Building,Plumbing or Gas Received By: ` f \ TOWN- OF DARTMOUTH 4 .1 r%i i, n •-•,..- BUILDING RECEIPTS COLLECTOR'S OFFICE • if / Ar m I If:".. "-- Name .' , ,.; , , i( /.--7 ?..‘/ ,-) . Property -./r,.4. , . Date: sLi "ii . . fi e Job Location: ..; / 2_./ , -77 ..;l',..- 4- ./ _ 11 c. i- i te-T --,..- i — / ."....-,—. Plot: S.> 4/ , tot: /,:::-_-- .4--- TOWN OF DARTMOUT4(White Copy-Collector's Office 1 ,,ellow Copy-Customer's Receipt COLLECTORS 01-FiCEPink Copy-File Copy • Green Copy-Building Department Phone: ,----. MAY 1 1 1999 _ „"....._ Description General Ledger#'s C V Amount.b 07 License&Permits-Building 01000-44105 ..-i ----- 4. _ -) License&Permits-Building Misc. 01000-44105 ,,,,f .,, Lex,......... -'7,--:, i , (:- License&Permits-Electrical 01000-44106 , License&Permits-Plumbing&Gas 01000-44107 Other Department Revenue 01000-42420 ...-‹ / 1 .,4 / "i -4--- This is not a Permit or License for Building.Plumbing or Gas Received By: e i,. ./,--4..t ---/i ( t . -t-- - , I 7 „, , ,. Residential ❑ FOUNDATION ONLY 1999 ��MoUTN-yy\ DATE RECEIVED DARTMOUTH BUILDING DEPARTMENT r (o i -. 400 Slocum Road, P.O. Box 79399 „ 1 Dartmouth, MA 02747 , 1 x° `': ' \moo yy. 1 , :... . .:..7664 a 508-999-0720 FAX 508-999-0738 -F i� `' ' APPLICATION TO CONSTRUCT,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING .. ...........::..::.7...........�...�.`:In::.....:....:�:).::......:.)::.....��;..i.-�.,;..:...::...:..:..MM.�.:.. �:1��.•11�.. 1 ..I..A..11'11.,�_.".. ::m..:>t::?:?' vii:••-i•'iii: ^':':i'•::::2::i:::<i:iii}i?iYY•?:}is::4i:Si%}:{:ji':ii:C4.{+.:v.:::;')?:':�:::::i:::i;:;i{?{::::::i:';is'±%i:T::::i:::ii:j::ti•�::::::i•��•••::•:� �1.� IfkFCRIMETkifi ::: : ;:; �j .A.Tg: P.1NT:F�Qt i;: llt�.cif: .: . . ............::.:-::::::::.::;. -:::::'::::::::::::::: ...........:.:::::::. :.: .:::.:!'1.i.:.::::::':::.::..::::..:::.:: ..............: 7.: ::•. ..... :::: :':. c1.R3)I: R�.7i1�'�6,.,t,.iw ::i7i13ft.7�r�. . .. n. .. l .'n•1 •�:.:...:...::::�-::: .��. ...::.:...:.......::.........:......:.......::... ...11..1.111111.,�1.. .l t .I.I . 1.... .:..::::!.5.i NIIIIIII.II{I�11111'1.'. t -.:.ii ,. :)ii:iii:•ii:::JRif'ii}iiYi:iii:t:ii''::i:i}i::i:4;}:ii:::•:+:i:•i::iij:i:viiiiiiiiii::t":•:.�:: ::::-v::: ::: v::- ......:.. ... .::: :::: ::•..: ::: .:";:''}}i'-iiii:^i::iiiXi'viiiiiii:::::ii?:iiiiii::i:•:iiii.:iiii::'.:.'Ki� :i::: v.:..:.:... v:: ..:...:.v-.. .... .................................... .. r :�{�iFlif y':;i:;i;:.jv:•::?J::..,,i-':.::i?::};:ifi:3:?iiiii::•:::::.:.::i:::^::::.::''i: :�i -:.•'�: ::�'�j i�-i v..�:?i: '::. : -;'.i'.i:.;:.i:::.:...:::-;:.i:.;:.i:i�i�Ei..,,.1 .�tru3luiss3.:...Crf�as..�.�: : :::::.:::::..!� :.:••::::... -:.._::.�;:..:::::.:.... ....,;. .. ::...... ...... .::::-....... i: : : : :>:;:> < :`>::>::::>:: :::::>: >::> :`:::r:>:::::>:>:>::<`:>> >:.::>.» :<:>:::::�::: :::�:: .:`::>�:.:>::>� . :><>::.;:;,.' ;.... .:..;i:.'.:..::.:'::: :;.:;>:::::.:»:z:::>::::>::::;::<>:.:<-.:•:n•.:::::::.;::`:•.>::::::>::. ::>:':;: :::.::.:;:: .>:.:i Elm:::::::; <:.;:::::. :::>.: .; .. �'.i' :.::.. :.:ro oxed:;���.:-;:.:•'-;:..ii:.i:.;:.;;::..:<.Z�►►na.:::>:<�::C:.i©i�i.:©:�1.;�::�::.i��Es�e)�+'lid:�Qi�es:�: :;; gw.:. .:..'.i;':: ..... ...........:..�..................����� ... ..:.:.i:.;;::-i.;.;<':.;:.::::i:.:.;:.;'.i-i:-i:.i:.i'. :.•..::.:i.;.ism:.;'.;::.i.:.::.:'.;:-i:.i:.:.;::.;:.;:.iii:is.:.::.;:.i:.i:.::-.•--. :.i.:.. -. ... :.::.- .i ...::.. .:.::: : : i.::.....::...:..: .::.i:::.:::. :...:..»:::.: ...::.::.:::... :.,::::.:'.i:::.... :'..i::i';;::; ;.;:.::::.i::.:...:..,..:.:'.:..::.:::.:::-::..:':::::::::.�:::.::.::.::..::•':'..'.:':.::::.:.:.:.....:.:::.::':': . : :.::..:.: -. ::, . .i -.; X..: .>' .:Tl(R#R..::::::;:-:::-:::-::::::::: :::.:.:..E.::i:.:: ..:..:-::.::.::.:::::::.. .. .: .:i4:....:.::.':. ,......i::.; .'I�[lx.�?C?i�OWIN�:A-G'IvI!1�I��SkI#.�!iTL�i3;�Ei�!F#3... ........ .::�:::.::.:.::::::::: .� : : ::.::. ::.>:.:..:.. ::..:::..::::::: ........ .. ..: :.::...:...:... . -.:: :.;:.::..>:.;:.ii<::.;:.:.:: n .::..:. .. .. :::::::.::....: �arcl... I.::::.:.❑?C a...� .:.:::.ilWl:�Om�r::::.::.:: :::::::::��P�?:::.:-: :.::::. ��.::.:.:::::..:....::::. .. .:::.:..: :...:::..:....:g3'.::.::::�-i::.:::::.:.i:.ii:.: :.;:::.:;.>::.:<. :.i ::-ii::.;;i:.;:.:-;:.;:.:i:;:.i:.i:.;:.;;:i;;:.�:�::.::::::..:::.:::.�:.:::.::. . :::..: ::....�::.:: :�:::::::�:�::: •>:� ;::> :>:::»:;' ::»;> > .,,,.:.:;.:.: ; :>::;:. .,...: ;..::...;:.; . :... ::.�:.::'""" :. :;::::::.;:-:i'"'::: ..ii":':-i::•;::::-i:.i-;:-i:-i:.i:''.: .:;•i:'i:-i:::.';:.::::M::>::>:<:::;.•. ..fiv.•.. ::::::::: .:. : . ,r ;:i ... .> * ......... . ;iii;: ii:-i:;'.; ;:i;::.::.:.:::::. . . : d.a��t «:»:>::::::>::>::::t7�#�: Brass:.+��rd............::�........... ................... ... ..:.P... ........... ..... :..A e�is.................Realt : : ::.::.:::.::..::::.::.�::.::........ ........... :..::::::.:.:.......... ..:.:::::::...:: ::. t..i;;i:.:;i.;:.;:isi.i•..:.::;:.;:.ii:.:.;;•'.�.;::.;:.;;i:.:i.;:::.i:.i::;.;ii:.;.;:.:-isii::..:::.;:.i:.ii:.i:.ii:.ii:•.�.ii:;:::;-;:.i:.i:.:ii;.i'.ii:.:::. then: > > >°<: ::> •""•":<:•-•••::::::::::::::::••••-•, -... »«;:::>:::» »::>::>::>::: ....is »>::»::.....:::::>:>:««::::>:..... ...., : i > ::: >::::::: :i:.i-;::i: .;:.:; ;::>:>::>.:.;. ..:ii:.:»:>::::::;:i:::>:>::::>:...:.i.ii : : ::»::::<:»:::.:...::•:;:-i:-:>'>:>•: :::»»>::: i > '::;:.>:.:.:,><.::'.::i;-;i:-;:-;:.i:.;:. .:.:..............:::.. ........ ..::: �.:�re�lli�et:. Q.���.:::::.:::.::........................ ......... ..:::....:::.:.... :::: �:.�afey.�a»t�.i::.;:..ii:.;..:.:..�:::::.::.i':.:.:i :..is�.i.::.::::.:::.:-i::i:... :::: :i:;:;::i;:i:i:;;':.i: ..:::.::::.::.::.i.:::.i:::..:.::.:::;:.::::..::��t::its .>;::::::>::::>::::;::::]��►a�:�.::.............. .......... ....................:.....�.:�uta1Ft:.::.:....::.::..:.:.....:..........................:.......::.:::.:. ...... ..... ........ - ...:: ::::!i :'v:: : :: .:::::i:Jiiii:4iiii':•::•: :ii::'{.iii:i viiiiiiiii.:iii�iiiiiiii:i :::::::: �yh }yyyY-�S•�.��hyyy��(.�y(�y}y�t yy(��}y}���}yylyfj�}y{�y(��(ya t��.1;}� {��/•Fy;(/��( j}� "..._:..• ,,.....�*:"'-'.:.:::::.:...:.:ii:::.i'- �D.• .Ff�IUt7':1L'(7F.;1SI�:[:3'V3X:i>'1iir---.iYI..YI:-::DL"eP:41i�iY:::1-,...,:t3Y7a7;—:-.y—...,,...,,A:.,L�L� v: _:.:.:i':' :....:ii:: : s'::::: ......':i.....::':i.... .... : :::::i:•::v+ii:4::. :i!::: : : '. s-i:::::. .:.-.:'::...:i':.::::':..-. - .:. :.:::.:.;.,::;::2::r;:':%:i::%::;:ii";A::;^•iii:rii: i:ii tit:::d: :i.:-::;>::'i ri:iii:is:'i:i::i:::':>r::i::::•.:•.:: j, ---------- Zoning Review: Signature: Date: Energy Report: Signature: Date: Fire Chief: Signature: Date: Board of Health: Signature: r)K____ -. 7)/ R/'2 ? Dat ) Conservation Commission: Signature: Date: Other: Signature: Date: ip . : •:1 F. :.:;•:.;::>:>«:::i>:<::<::i:;i:.:>:<::.;::-;><;;:::;::i:;:.i:;.>;::>:<.;:;.i :.;:.ii:.:i:>::::.::.:•< ........��. �t�N..1: t' ..� NUMBER OF PLANS SUBMITTED: SITE PLAN SUBMITTED: 0 yes 0 no l f'1.1 Property Address: (1 -ctn r n7� 1.2 Assessors Plat&Lot Number: � Kit et. c� arest Cross Street: t u a,i/> c?� 47"7 cE Plat O4 Lot I 6' - Subdivision Name:4/4e 1.3 Historical District 0 yes ❑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 Se ge Disposal System: L W�1/ 0 Municipal❑Private Well �'�/a ❑Municipal On Site Disposal System : >:>:::i.:::::>:».:; :::::>::`>:»: ::>:::';::.i.:::<:•.:0,-::>:::...::::...>:-S T �ti..�.....q OV Tye t�♦tr�f]G;yy HW/A .TOR ;y D.k y�!� :.:::. ::. :::.�:::.�::..._:::::::::::::..:.: .........:::..•:..:.s7.G .J..••••.::%f.....::F' Vf.......... .....;i4':;VI.!Fi3JG,4� li:R7lF:.:..:;iv_: i'J.i'�7141 aft !/..,CJi k1;:i:':::.:::.. '•.:!::::::::.;.;:::':::':::: ....::::>.:.:;:':� :..; - :�::...�::.�:::.: .;.. :�: ' 'i:.'. ::;i:'.::.:.::>:::: :ii: ::5:::; :'-r:+>:>:�.;�-i'-:::i::• :•::< '.<;i''-: -i';:i:�.;;:-i'-i:.:�...;::�:.::'::''::.:�:::_::i';:;::.-i:;i'n::.�i-':i,..:.:;::.: 2.1 Owner of Record: Contact Address /7"c'btr4.- lc?Ga-"v,c ri'he'rnj1 °. 146.&-x-(7)n 'e)c.ir71--rc Acre !Zd A 763 % g2- ame(print) phone number Lri-mOt...d ki, 111A 62-7V 9 c:\wpwin\forms\bldgapp.res Page 1 January 20, 1999 Residential 1999 2.2 Authorized Agent: —` Contact Address Name(print) Telephone ;:.::.<:.EM:>:;::.;;.;:.;:.;:.:.;:.;:.;:.;;;.;::::.;:.:.;;;.;;>:<.;:.;;:.>:�:.;:.;;.;>::>::> -K y+lr t fps ::3..::Licensed::::on::;<.:.... ........................................................................................... ................................. . .................... Construction tenon Supervisor:�� P son: ....................................................... ...........::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)? 0 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 3.3 For Residential Remodel Work Only PERSONS CONTRACTING WITH UNREGISTERED CON TRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND: QUESTIONS OR COMPLAINTS call or write: Home improvement Contractors Registration, One Ashburton PIa'e-Room 1301,Boston, MA 02108, (61 7) 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 1 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. V 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 sign below: Signature: =- fi -' -f, je .- Your signature carries certain responsibilities,including but not necessarily limited to,general liability c:\wpwin\forms\bldgapp.res Page 2 January 20, 1999 I Residential 1999 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) $terlom4A4V(iltkele$VONOttitSfall)MINStitiktgitir ArkifikVir(ivtatimISZt$2)amiimimumiiiimi.imi „x:i:i:?..,:i:i:i::.*i:K::.*:.:i:i:::i:i::.*K:ii:Kiii•i:i:i:iii:ii.i:::i:i:i:::i:::::.,:i:i:::::.:::::::: :x:ii:::i*i:iff.::i:i:i*:i:i:i:i:::::-:::::::::*:.::::::.*:::.*K:i..,...:•:i*:::i:i::*iti,„i:i:i:i:ii:::i:i*i*::i:x:i*i:i:i:i*i:::i..i:::::*i:imi:::::i:i:i:i:i:i*:.:::K:iii:i:i*-:*i::i:::i:::::.::i:i..::i:::ii: iiii:i:i:i::0::::i:iii:i..::::::::i:.:i:iiiim:.:*i: :?.ii,...iiimi:i,i,:ii::,:::% 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 PO.oietioic 6.#0iiijtijtkii iv6itg::ikohooloAlt apripobloygmgmmiengismingii -..:::::.::::ii*i,:i:i:,::::::::imi:]iiiiiiiiaiiii:x:i:i:i:i:i:i*:]*. i:i*:]: :i::i:i..::i*,:.:i*:::::i*:„ o new 0 addition 0 alteration 0 repairs 0 chimney/fireplace 0 woodstove construction* 0 deck P(pool 0 accessory bldg. 0 replacement window/door 0 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 Brief Description of Proposed Work: 0? /, ' ' obct)-€ ety,04,41-761 ,ro i Lt LteeP 17 -.......--...--....•.--...........-.......-......-.......-.....-.--•....-......--........-......---........-..........-....z,4;:?x ,.....: : ,,,, ,,-„,„...:4. ,-6,?.;* ; 4;:Ax:i**iff.::::::::::::::::::::::::::::::*i:::i*,:*i: ::::::::::::::::::::*:: :i*i:i:i:i:i**:**m*i:i:::i:i:i:i:i:i:,::*i:,: g:0w..mA...iii:!.....:p..:. m........,:y..F.i....p... 41*:g..g$4:LAN.1,,;...,...m:—..i:a:::::-..Nii...i,..ii.,i.,..:.:.:,.,.:.,.:....::.:.:.:.:.:.:.:::::.ma.,.:ii].:.:„:.:.:,.„.,.::.:i.:::.:].::,i.:].:].r.::.i.:.:-..-...:ii:.:]....::.:.:.,.:iii.:].::i.::.:.:.::..:i::.:.:i.:i ..................................................... ............................................................................................................................................................................................................................................ _ .......................... .............................................................................................................. .. .............. Item Estimated Cost($)to be completed by permit applicant I.Building 2.Electrical 3.Plumbing 4.Mechanical(HVAC) 5.Total=(1 +2+3+4) to *Estimated Total $ 1 - atttiONi7V41)**titatittrOltAltiNiNiiiibiiiiiiiiii:iiMii:i]:iiiiiiaiaki:]iaiiiMifiaiii5:ii:-..g.:g :ttiy:,:hk::eeifditilitMVi,,:ht.:*:;Iwi.ifiiii..gaiiiitiii::eiifitfijEiiieiiito'...1ij:,g:ibebtiitdifii:;tiekititti::,i:i:::::i*i:::]:i::*-:*]:*]:]:],J::i:i:i:i:i:]:ioi*::ii:i*::i:i:i*:i:::i* ,- :,.:: .: :.:],...: 7:i .::::,::::::::: :::*i**:*i:i::*-,:::::,:i*:i:i:i:,:i*::::7:::::::,,i*i:,:;*::: :: (please print) e (y3 U I/I ri ,as Owner of the subject property hereby authorize it.i.A ---to actsi3Z:hjk' in all atters relative to work authorized by this building permit application. 24tl2 --,-, Signature of Owner Date sectiom-7040W.NNMIttttilinttUglatgetARATONMEii .:i. i;iNgnsiniMMiM:i.ii.ii,iiMigiimo: I, Re)be V 1- P. G--)r,I.)k;1 0 ,as Owner/Authorized Agent hereby declare that the statements and information o the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. '-. --1 )0) 9ci Signature of Owner/Authorized Agent Date c:\wpwin\forms\bldgapp.res Page 3 January 20, 1999 1 Residential e..__ 1999 .iiiiiiiiiniiii,;..,.::iiiiiiiiii:::. iiiii:iiiii•iiii:wiiii.:iil.ii-miiii:.] ::::i:::N§,:kkjilthiii::sii.wof1,0rs . -...:: 10.8:.]RtvlewycommsiTgoimi:mEN:mgammimiiiimg.. ,:iimgiNiim .................................................................................................. 1. Date plan reviewed: 4----//c7 ---- 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: 8. Comments: . ..J 9. Inspector's Signature: . ' Date:5---/42-9 f gmmm.mgommmi.::mm:::mmn,:. .ttwggigo.:: :gt.wistittiouttoimmainimimeimidoisimilsimilmenui! ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::.,..„..:.......„.....„......„:..„...„.„:„.:......:..:.::......„:„...::„.: ..„..„:..:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::,:,::„...::::::,::::::::::::::::::::::::::::.:,:,:,:,:,..„„:„:„.:.:.:.:. ..........................................................,...............................,..........,.....................................................................................................,...........................,....,.................................................................................................................................................................................................................................................................................... ...................................................................................................................................................... Applicant informed of above Da 2) - /?. 'c"/ci.' Time: Jr c i Clerk- Comments: Ce.e /7 a.3 - Y i2-. ) ...,„•,„it. , '----„, . 1 §gtlittigiityktitittim.N.stittifdiv.i§iii4.6.1-t-ggii:::ilmmei::iiiiiiiiiiiiiiiiiiiiigiiiiiigiiin.iimiliiimilliiiiiiiiiiiiiiiiiiiiiiiiin ...................................................................................„........................................................................................................................,.....................................................................,.................,................................................................. .................. .......................... Total Permit Fee: $ 6 6; oo Less Application Fee: $25.00 Remaining Balance: $ • TOTAL FEE: Gross Area-New Construction total sq. ft. Gross Area-Alteration total sq. ft. .,•,, • Permi Issued To• c;2/l'aietti-le ' - 1-0, ‘?/1-115-1v4/5 i/Cee-ei , C 4,4:e-A" a ,dee. . ..- . ii §tklititiftititgia.6.ifitiiikEit.O.WitS*Wgtitbaiirdiiiiii!iiiiniiiiiiiiiiiiiii!!iiiiliaNnialiniilinigingiiiii . 0-0 0 0 7/6. , 2-1,.t,, •7,/-.el ,e-e-e-'• 0 7 -2e -,-e e- -i-el---,--7--- ef de27e2...e....e.d.,_ c:\wpwin\forms\bldgapp.res Page 4 January 20, 1999 BUILDING PERMIT 3 COUNTRY ACRE ROAD FIELD INSPECTION Dartmouth Building Department Plat : 84 400 Slocum Road P.O. Box 79399 Lot (s) : 18-5 Dartmouth, MA 02747 Lot Size : l .2A Telephone (508) 999-0720 Zone Dist . :SRB Issued Date : ,6 /i) . / 3 Permit No: I/l'y 7 Project Location: 3 Country Acre Road Number Street Subdivision Name : Nearest Cross Street : Ouanapoaq Road Applicant/Agent : Robert P. Gauvin & Cheryl A. Haxton Contact Person Phone # : (508) 763-4682 Proposed Use : Residential Residential,Commercial,Industrial,etc. Permit Issued To: To Install Type of Improvement,Add,Alter,New Const.,Demo,Land/Move,etc. 21 foot above ground swimming pool and 5 ' x 14 ' deck with a self closing/latching gate at the stairs Indicate no.of bedrooms and bathrooms and other rooms Owner (s) of Record: Robert P. Gauvin & Cheryl A. Haxton Address : 3 Country Acre Road, Dartmouth, MA 02747 DATE TIME TYPE OF INSPECTION REMARKS INITIAL BLD. CODE 6TH ED./ENERGY CODE (yes no) 3/93/ 7 , ti'o // .S/ e %io - e /"/_S C G �, C) 0 mil%�( BUILDING PERMIT 3 COUNTRY ACRE ROAD Dartmouth Building Department Plat : 84 400 Slocum Road-P.O. Box 79399 Lot (s) : 18-5 Dartmouth, MA 02747 Lot Size: 1 . 2A Telephone 508-999-0720 Zoning Dist . :SRB May 17, 1999 (typed) Permit No. : ///77 Issued Date : j 4 /t Clerk: BAS Project Location: 3 Country Acre Road Number Street Subdivision Name : Nearest Cross Street : Ouanapoag Road Person Permit Issued To: Robert P. Gauvin & Cheryl A. Haxton _ Address : 3 Country Acre Road, Dartmouth, MA 02747 Applicant/Agent : Same Contact Person Phone # : (508) 763-4682 Type of License : Owner: (x) Const . Superv. License # : ( ) Architect : ( ) Engineer: ( ) Other: ( ) Proposed Use : Residential Residential,Commercial,Industrial,etc. k Per t- Issuas7 _To: _ _.To-,Ins.1 1 l — - - -- type of Improvement,Add,Alter,New Const.,Demo,Land/Move,etc. 21 foot above ground swimming pool and 5 ' x 14 ' deck with a self closing/latching gate at the stairs indicate no.of bedrooms and bathrooms and other rooms Gross Area of Const . : Cost of Const . $500 . 00 Cost-Other Const . : TOTAL FEE: $ 65 . 00 Owner (s) of Record: Robert P. Gauvin & Cheryl A. Haxton _ Address : 3 Country Acre Road, Dartmouth, MA 02747 All work shall comply with 780 CMR 6th Ed. (MGL Chap. 143) 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 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 Building\Zoning Permit. 11 Signature of Owner/Agent : C tW Z-- ct/a„/N(- �-- Address : ******************** _** " * *** ********************************** Signature : Approved/Issued By: Ralp Souza, T. e: Local Building Inspector —) COMMENTS : PLEASE POST PERMIT CARD SO THAT IT IS VISIBLE FROM THE STREET. SCHEDULE APPROPRIATE INSPECTIONS AS REQUIRED. UPON COMPLETION OF WORK, FINAL INSPECTION IS REQUIRED. 0 ORIGINAL 0 APPLICANT 0 ASSESSORS 0 CLERK 0 COPY . .., . rin . 4.1 W 0 i 44 ..., 3 . J td 0 co •0 c,sc c.) 4..) )1. fa to .i..k 0 .... .....V. i 0•4 Z . E 0 KC E ... 4. = C4 >4 ra W a) ..= ea W A CU ...0 &.. 0 c ..=1— MS La 0 f, ••4 0 ..-1 C.) E . 2 Ti C) 0 (1) $. a. W es. el ro oil r0 Kt (.9 0 0) a) / -0 0 ra, ,--1 .. ,_ = 0 ea cD o w 4_1 ol a 4..) -. -- Z co a.) z w o 3 3 Z > o a., o 0.1 2 C.) .0 .c:c cy.) a 1-- cn z -0 ,L.6. 03 - c n C I) o e.) k- j'• '6' t,s s ,.. s . cn i.: s. , 1-4 . •• ,= E . i..1 ,-.' e,3 .:. 1 • • z >-a 0 o• . . o. • . N to c.,) lc • 0 : ir; . ..„ '''.• '‘.. 4.4.....,,8_,..= • . , .... . ..,, ' . --......,-- . .• TOWN OF DARTMOUTHP' • Board of Health 400 Slocum Road P. O. Box 79399 Dartmouth, MA 02747 John C.Bullard,MD, Chair Wendy W.Henderson,R.S.,Director Margaret M.Megowen telephone: (508)999-0704 Thomas W.Hardman fax: (508)999-0793 April 22, 1999 Mr. Robert P. Gauvin Ms. Cheryl A. Haxton 3 Country Acre Road Dartmouth, MA 02747 Dear Mr. Gauvin 85 Ms. Haxton: It has been brought to this offices attention, that you have erected an aboveground swimming pool on property owned by you and located at Plat 84, Lot 18-5, #3 Country Acre Road. Please be advised that Minimum Standards for Residential Swimming Pools adopted under the authority of MA General Laws, Chapter 111, Section 31, requires that a permit be obtained from the Board of Health. Attached please find a copy of your septic as built plan, and the application which must be completed in full. On the as built - you must show the location of the pool and show distances from the leach area, septic tank, and house. .The fee for this permit is $50.00. Further, an inspector must verify the location of the pool on your property. If you have any questions relative to this matter, please feel free to contact this office. Very truly yours,t,�- Aninttw�. f wat• -6 -0 tteiftt 0 " DARTMOUTH BOARD OF HEALTH DBH:psd / cc:file ,/ /;�� // Building Dept. &cf` /74,c- • save:c:\msoffice\winword\lett\3coacre7-Le.." The Commonwealth of Massachusetts Department of Industrial Accidents ar ��— 0111teol/m lgitIoos 600 Washington Street =Iv* Boston,Mass 02111 Workers' Compensation Insurance Affidavit name i ol)et,+ . P �r t.)vi ci 0..he.ry l �. 410 k Fo tocation: n O,t7li Acre PCcc c , �'�t^�Yr10 L��f%h 1,9� U�7�1 phone#" ( `3c/a Z e� 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: : ,... ... .:... .-.;;::.: ..:,.. ,=. add .ess: one#• insdsan E►e # • I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: companyname: ........... . address:. city lih»net insurance co. poligt# — company name: : address: city: phone#. . insurance cm poiiy • # - .. . .. Failure to secure coverage as required under Section 25A of 1VMGL 152 can lead to the imposition of criminal penalties of a fine up toS1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 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�ab correct. boove is true and S'gnature (.trams--, `flate —a7/ f9 it/Print name 'caber T— ((ct t) V'1 r) "Phone# '76 3 t/( official use only do not write in this area to be completed by city or town official. city or town: permit/license# °Building Department check if immediate response is required ❑Licensing Board � P 9 °Selectmen's Office °Health Department contact person: phone#; °Other _ (revised 3/95 P.M) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law",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 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 have been presented to the contracting authority. s3 f, rf irS '✓�i9 �Ga/n ° r°v$� ��'�m r.� • � /l^�i.'��e^s�..,..s�.w„a. �...bvr/.,,xes..�,✓.�,do�i<s.�Liikf&�°��'s�'�i.� sFL ,'Y�. _°i�Sri/����.«w,..,�.,.,,�,,,.,.._, ..,. ,,, ..,„.. ,, .,...,_ ...,,. ,. ,.., ,..,u„>,,«..,. .»,,. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sin 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. 9,3 a` / � y'i",dF,r,i S/ i &/t}r "y` , �' '.L/i .O,f '� °'ro✓.&' 4`/',%. y t :�'� i s2 ' "J-��s z�� ,x �������a��l✓��/�� :' "�.oi� s�3&�;��y��iky��,�'=�'�� .� ,.a;;, -;rs, o ` '�„�"��Yry`��'" ',.��.�,zr �"'%r#�_' 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. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to 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 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 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 CFI k Z c-, ,..,. __..... , ,„F) -,r *,- ,...... --, ti , ,. (1/4.4 ....T.-, ,,, ....4 ..... , ‘t) , \ il V � L ,, .....,, ., aQ w--I- i -W - C 33 .51 _ 0_ > n od r. 0 0 ,,, „,,, dc.) . _ ___, k\ • _ , )---_ _-. ri Q. ff ,› g'.: ct ,...EZ ( `i-A 'Z' I z 0 m Iii ^-, Z '' ) o 0 Q d r' �, Sc' F , ?Q "( 0_4. or...c ci:iii 'c.::::: ' t..‘ ci -.) .> - _____ 0 0 il'i ., cil -........ )4.4 -, -0 rr t; >0/ / ‘.1, ,\ ,� L 1� Ia \J vo V V C} fps' s.h ; �� —z 1 c, w4.� ,„, oS=- w : „' j ,,N. Qt = ,:,4 aJ3 e _ �C4� ��� �1.��• = 13+n. o � ASs t? MEN �p c.G3 • ......... DR1\EWA EA6 ME-sAT p p ...fir= o p mm� ��v O 55 0 j= > ca m a m m -r 1 'RE501NNE i 'RE A PO K Lo7 S amp 0-100 PLA t.l SCALD I I,= 50 EF n € pJ •ac., o, y .� � d•�E�. c u �...� t a-44 EXt571taG WE LL , li s 00000 N� • 41 JA UE51G Li LAt-C�U LA'T tOA 5 110 C AU.OMS/ BEVTROWA IUO FLOW:.( 3 SDRMSAe t tO -GAL/ SDRPX� = a3O GAL• DES t E�►�1 PAP.. �,AT�: 1 ' �� �► 8 lit Alt S =LlSTALL A 1000 C-�AL • PKSCAt)T Co'qC• < tc EAxlF\ LEAC1A t �16 AAS4 5 i ve . ( (0 8 SGFT` X I .a5 "L /6a V t'•) = ' a S G1�►L5. BoTro M '• Ito VTX O�. sovT )z �.t Q Ac.1, r .33rI G A LS, 3 7,e y I MSTA Lt.. 45t x C(o) ?OL%f ETHYc.r=LtF i�Ar•tj�.'t�A`tO�c S-TONAL. ALL A�OU ub 4.r&f�D L4 BS''C \N aE `.t AS S t-\ Q VN J4 . TOTAL. E F' F ECT s V s 00000 N� • 41 JA UE51G Li LAt-C�U LA'T tOA 5 110 C AU.OMS/ BEVTROWA IUO FLOW:.( 3 SDRMSAe t tO -GAL/ SDRPX� = a3O GAL• DES t E�►�1 PAP.. �,AT�: 1 ' �� �► 8 lit Alt S =LlSTALL A 1000 C-�AL • PKSCAt)T Co'qC• < tc EAxlF\ LEAC1A t �16 AAS4 5 i ve . ( (0 8 SGFT` X I .a5 "L /6a V t'•) = ' a S G1�►L5. BoTro M '• Ito VTX O�. sovT )z �.t Q Ac.1, r .33rI G A LS, 3 7,e y I MSTA Lt.. 45t x C(o) ?OL%f ETHYc.r=LtF i�Ar•tj�.'t�A`tO�c S-TONAL. ALL A�OU ub 4.r&f�D L4 BS''C \N aE `.t AS S t-\ Q VN J4 . TOTAL. E F' F ECT s V