BP-5544 BUILDING PERMIT
GREATER NEW BEDFORD REGIONAL REFUSE MANAGEMENT DISTRICT
Dartmouth Building Department Plat:84
400 Slocum Road-P.O. Box 79399 Lot(s) :22
Dartmouth, MA 02747 Lot Size:40,000
Telephone 508-999-0720 Zoning Dist. :SRB
March 9, 1998 (typed) - Permit No. :
Issued Date: 3 //tb / Clerk: BAS
Project Location: 600 Ouanapoag Road
Number Street
Subdivision Name:
Nearest Cross Street:
Applicant/Agent: Marie Alves
Address: 400 Slocum Road, Dartmouth, MA 02747
*David Vincent - 713 Rock O'pundee Road, Dartmouth, MA
Contact Person Phone #: (508) 993-2604/763-5924
Type of License: Owner: ( ) Const. Superv. License #: (*017913)
Architect: ( ) Engineer: ( ) Other: (agent )
Proposed Use: Non-Residential
Commercial,Industrial
,C mm rctal,In ,etc.
Permit Issued To: To Occupy/Install
Type of Improvement,Add,Alter,New Const.,Demo,Land/Move,etc.
To occupy as new tenant (office) and installation of handicap ramp
indicate no.of bedrooms and bathrooms and other rooms
Gross Area of Const. : Cost of Const. $1, 800.00
Cost-Other Const. : TOTAL FEE: $ 150.00 (waived)
Owner(s) of Record:G.N.B Regionl Refuse Management District
Address: 600 Ouanapoag Road, 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 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. nr
Signature of Owner/Agent: AIL ,
Address:
*********** **** ***** ** ***********************************
Signature: MAR 0 9 1998
Approved/Issued By: D v d J. Silveira, Title: Building Commissioner
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
- •,..3•
BUILDING RECEIPTS
COLLECTOR'S OFFICE
Name: Property"' Date: - •
- ,
• • Owner: J. • N;‘•••-1.-)•
Job Location: - ,•
I White Copy-Collector's Office
Plot Yellow Copy-Customer's Receipt
: Lot: .
•
Pink Copy-File Copy
Green Copy-Building Department
Phone: ,
Description General Ledger#'s Ref.# Amount
License&Permits-Building 01000-44105
C
License&Permits-Building Misc. 01000-44105
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:
( U if
0,-t / •
TOWN OF DARTMOUTTI BUILDING DEPARTMENT
TELEPHONE 508-999-0720 .
FAX:508-999-0738,
APPLICATION FOR ZONING AND BUILDING PERMIT
The applicant shall complete this application to the best of their ability prior to submission,leaving no item unanswered.The
Department staff will be available during regular business hours to assist as necessary.N/A should be inserted for those sections
which do not apply.A properly completed application will help avoid unnecessary delays. Naos Fling Seim not zeandalie.
(for office use only) 0 FOUNDATION ONLY
Total Cost S Received By Date Rec'd ^ (C t 6
Less Application Fee$ Loa 4
Total Permit Fee S Permit# Issued Date 3 AO
O
co 100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET
CURRENT ACCESSORS' PLAT U v LOT ZONING DISTRICT
OTHER ZONING OVERLAY DISTRICTS , if applicable
NUMBER & STREET C)42a 4/14,
NEAREST CROSS STREET
#. J
r� SUBDIVISION NAME & LOT#
` or BUSINESS NAME Greater New Bedford Regional Refuse Management Di strict
( L, PREVIOUS TENANT / OWNER
' 200 RESIDENTIAL-PROPOSED PROJECT - one & two family residence only
THIS SECTION NOT APPLICABLE
Single family - number bedrooms number baths
Two family - number bedrooms unit 1 number baths unit 1
number bedrooms uni 2 number baths unit 2
Accessory apartment To g ss ft.
Accessory structure:
L. Garage - detac - tta h d to dwelling, dimensions L W
Carport- detached - attached to dwelling, dimensions L W
Shed - dimensions L W
Deck- dimensions L W
_ Gazebo- dimensions L W
= Swimming pool above ground in-ground Size
Chimney - number of flues
r
••artA..0 WICa (wm requireinspection prior to installation), new (provide manufacturers
instructions). Location(s) (list)
C Fireplace(s) - (includes flue) List location(s)
Game Court describe(include overall dimensions)
C Tent, Trailer(Mobile Home) or Other-describe
300 COMMERCIAL-PROPOSED PROJECT/USE-INCLUDING THREE FAMILY OR MORE AND EXEMPT USES
C THIS SECTION NOT APPLICABLE
(The following descriptions are based on the Massachusetts State Building Code Article 3,AS NOTED)
) (See the
Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe
Business - office, assembly with less than 50 occupants - indicate Medical or other professional(see Code
Section 303.0)
Educational-structure for training including child day care for those over 2 years 9 months(see Code Section
304.0)
Factory/Industrial - (see Code Section 305.0)
High Hazard - (see Code Section 306.0)
E Institutional - hospital, nursing home, infant day care(see Code Section 307.0)
Mercantile - retail stores (see Code 308.0)
C Residential - three or more family, hotel (see Code Section 309.0)
E Storage- includes garages (see Code Section 309.0)
Utility & Miscellaneous Structures - includes tents and - gricultural structures (see Code Section 311.0)
✓New tenant for any of the above, indicate above(see Code Section 119.0 and Zoning By-law section 35)
Tent or Trailer- temporary purpose?
Other
Describe the proposal briefly,INCLUDE r-umber of dwe
also existing condition >�g units and or t load as applicable,
400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED
C New Construction and/or Addition- total gross square fee
(For commercial only total gross cubic feet) -in •
It will be considered new construction if the
alteration(s). insgnarr footage in addition to any
If project is an addition to existing structure- o s square feet of existing
E FOR COMMERCIAL ONLY
Will this project be subject to CONSTRUCTION CONTROL(over 35.000 cu.ft.) Yes
see Code section 127.0). Designer to submit Code Synopsis.
— 1—NO Qf yes
Will this project
require Peer review(over 400,000 cu.ft.) Yes i�No (see Code Appendix I)
APPLICANT TO PROVIDE
2
■ o
Alteration of existing,no increase in gross square feet. A separate Refuse Disposal Declaration required.
- Demolition -describe structure
Number of dwelling units Number of bedrooms A separate Refuse Disposal
Declaration required.
Moving- (Provide copy of D.P.W. moving license) Type of structure
from where(plat/lot or address)
to where (plat/lot or address)
Number of dwelling units Number of bedrooms per dwelling unit .
= Re-roofing- (for existing only, is included in new construction)
Number of square feet Number of layers already existing
Number of layers when coin
A separate disposal declara on REQUIRED
Replacement doors and windows- (for existing only) (only where doors and windows exist and will not be
enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwelling will be
considered as an Alteration, otherwise will be included in new construction. (see Code section 3401.10 for
residential and Articb 8 ft..-commercial)
Temporary structure-includes when allowed,trailers,tents and the like and only for limited periods of time.
Describe
500 CONSTRUCTION PLANS
None submitted. Why?
- Submitted, usuallyth r u'
ee se q u•e d. Four sets for food service uses. Number of sets submitted
600 SITE PLAN
0 Not required,why? 1 /
/9.
_ Submitted When? = Previously, date . With this application
700 UTILITIES
Water supply- required yes no, public ? yes_no, on site well? _ yes a no,
existing? yes n
If required and not exis ' v n cesiary permits been issued? _no_yes, date
(M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a water supply, when
required, is available. See Code 780 CMR section 114.1.2)
Sewage disposal - required yes no, public sewer yes_ no
priva
te septic on-site_yes no. Submit
t copy of permit as soon as available.
800 MECHANICALS &PRIMARy FUEL
= 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, na 1 gas, propane, electricity, other (specify)
= Air conditioning - (separate unit) „...7._
• N• one of the above to be provide
H• ot Water Gas Electric Fuel Oil Other
900 SPRINKLERS - FOR STRUCTURES OVER 7500 S UARE FEET and certain multifamily residential
Required, :.plans provided, =plans o r vi , hy?
Not required, not to be installed, y.
1000 REQUIRED OFF-STREET PARKING- for ZONING &Architectural Access
= NOT APPLICABLE
= Parking Plan submitted To = Building Depa•. e - Planning Board Date submitted
Number of spaces - indoors • rid totalprovided
Handicap spaces - required yes_no. If es, how many as a pert of the total required number. .
Is Route 6 (State Road) Entrance permit required? yes = no =. If yes has it been issued yes = no =.
Submit copy of application and/or permit as soon as available.
1100 IDENTIFICATION(print or type except as noted)
Cnnentowner- name Greater New Bedford Regional Refuse Management District
address 400 Slocum Road
phone# rnR-993-2604
Virginia Valiela, Executive Director
If corporation, officer in charge Hank Van Laarhoven, Director of Operations
Architect/Engineer- for overall design
Company name
Address
Phone number
Certified by State of Massachusetts as
Certification number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
L.
Architect/Engineer-project supervision and reports
Company name
Address
Phone number
Certified by State of Massachusetts as
Certif
ication number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
General Contractor(if Homeowner, state homeowner here then complete section 1300)
Company name David -Vincent
Address 713 Rock O'Dundee Road, Dartmouth
Phone number 508-636-4546
Construction Supervisors license number 017913
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
tit**************iittt****t*iitiiittt**i*t*s********t***t*****************t***************i*i****iit*tt*
1200 FOR RESIDENTIAL REMODEL WORK ONLY
Are you a Home Improvement Contractor subject to(780CMR-6) ?Yes No If no go to next section!
Are you claiming exemption from the requirement? Yes_No_If yes, submit the required affidavit!
Ren_9del contractor name (please print)
Address
Registration number(if none state^ o e^)
Phone number
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE
GUARANTEE 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)
Signature
Date
1300 OWNERSIGN- OFF
I, the undersigned,am the owner of record or authorized lessee(provide documentation)and the application herein submitted. I state that to the best of my knowledge and belief that the information providedviewe in this
application is true and correct and that the permit requested be issued.
Further I understand that the permit will expire in six months, from the date of issue, if no work is begun or
six months after the last inspection if work has begun and that the permit may be extended for six months if no work is
anticipated if I request such an extension in writing. I understand that the permit may be extended only three times by
written request.I understand that once the permit expires a new application may be required,including fees and current
other requir " ents (including Zoning).
lame Virginia Valiela
Signature v r VI r�c.-K �
The above nature is my voluntary act and is signed under the pains and penalties of perjury.
Date 3/6/98
Who is authorized to pickup the permit at the Building Department? (please print} Marie Alves
Address Same Phone same
1400 HOMEOWNER EXEMPTION- ONE &TWO FAMILY ONLY
FOR HOME OWNERS 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 127.0, 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 e''ments of buildings or
structures, unless he or she is licensed in accordance with the rules and regulations promulgated by the BBRS enti 'ed
R:.les and Regulations for Licensing Construction Supervisors.
Exception:Any Home Owner performing work for which a Building Permit is required shall be exempt from
the provisions of this section; provides that if a Home Owner engages a person(s) for hire to do such work ,that such
Home Owner shall act as supervisor.
For the purposes of this section only,a"Hom• .w•e " ' : •fined as follows: Person(s)who owns a parcel of land
on which he/she resides or intends to reside,on which le • is o .tended to be,a one or two family dwelling, attached
or detached structures accessory to such use and/o fa i•.. s es. A person who constructs more than one home in
two-year period shall not be considered a Home I ne,.
If you are applying under this section sign below:
Signature
Your signature carries certain responsibilities, including but not necessarily limited to, general liability
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
2.15.2 of section 5)
1500 COST
Cost of Improvement $
Items to be installed but not included in the above cost: Electrical S
Plumbing
HVAC
Other
TOTAL a 1 ,800.00
6
The following section for official use only. •
INSPECTORS' REVIEW
Date plan reviewed
30 days to review period expires
OK to issue date MAR 0 6 1998
OK to issue subject to requested submittals (see project review worksheet) date
DENIED see project review worksheet date
-i • HOLD reason
_ date
HOLD Subject to Zoning Board of Appeals action
Comments
Inspectors signature � cp,�,`� ,� BAR 0 6 1999
Date
Applicant informed of above- Date time staff
(fax, phone, in person)
**********************************************************************************************************
Over six months since approved for issue - DEEMED abandoned!
Advise applicant. Hold 90 days for return then dispose if not picked up.
Inspector
Date
Advised applicant Date Time staff (by phone, fax or in person)
********************************************************************************************************
OFFICEWVSPECTORS NOTES
TOTAL FEE �L>
Gross area - new construction Total Sq. Ft.
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit
7
1600 TO THE APPLICANT/REFERRAL AND APPROVAL
Date of Application submission
Plat Lot Street Aquifer Zone
•
Owner
Owner mail address
Owner phone#
*****ssss****sssssss************s***s***s********ssss******s*****ssssssssssssssssssss:******:ssss****:sss
OTHER INVOLVED AGENCIES-The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT THEM FOR REQUIRED SUBMISSIONS.
® TAX COLLECTOR - Approved - HOLD By Date
❑ Board of Appeals - Approved By ( Date
o Conservation Commission ❑ prov By Date
o D.P.W. Water - Approved/By ❑ D.° ••r _ Approved By Date
❑ D.P.W. Cross Connection App ved By
Date
❑ Treasurer(Bond) ❑Appro
Date
❑ D.P.W. Engineering 0 Approved
Date
7 Board of Health (well) 0 Approved By
Date
❑ Board of Health (septic) - Approed By
Date
❑ Board of Health (food service) - Approved By
Date
❑ Planning Board (parking) - Approved By
Date
® FIRE DISTRICT (I - II - III) .- Approved By
Date
BUILDING DEPARTMENT APPROVAL:
❑ ZONING
❑ BUILDING INSPECTORBUILDING COMMISSIONER
❑ CONTROL CONSTRUCTION AFFIDAVIT
sss**********************sss********#sss*ssss*ssss*****ssss**sss*ssss*sss:sssssssss*********************
PROJECT SUMMARY:
new construction/ alteration/demo sewage disp
osal posal - pabiic;private
[Alter/add interior walls] [add rooms] [add footprint] water supply - public/private well
[pool] [garage/shed/deck] [game court] [food service]
Describe
***********s***s**************ssss****ssss*
To the various departments:
This notice has been forwarded to you for your information and any appropriate action. Should you have any
questions please advise. If any reason to withhold the requested permit is found. please advise. Your assistance and
cooperation is appreciated.
The Building Department- Date sent for review
By
8
•
•
�121e� The Commonwealth of Massachusetts
iiri& jam( Department of Industrial Accidents
=ilf OIfMCDO//areStlg80005
z
= -•
}_f 600 Washington Street
�' ' Boston,Mass. 02111
1 -_ ._ „%
Workers' Compensation Insurance Affidavit
it�yl(L'1!1+,Iri�x],ut tirU�t*k:- • .-d"' -- ''<ei-gfZi:1--):7;Z i3,ii!.J(-11il\:e - -
name:
location:
city Atone#
0 I am a homeowner performing all work myself.
0 I am a sole proprietor and have no one working in any capacity
[F I am an employer providing workers' compensation for my employees working on this job.
company name: Greater New Bedford Regional Refuse Management District
address: 400 Slocum Road
city: Dartmouth ' phone#: 508-993-2604
Massachusetts Interlocal Insurance
insurance co.Association policy# Certificate No. 97-327
0 I a'ti a s 'e proprietor,general contracto or h, eo s e (circle one)and ha•.:hired the contractors listed below who have
the following workers'compensation pol : .
company name:
address:.
ON phone*
insurance co: Holley#
company name:
address:
city: phone#:
insurance coy policy#
Failure to secure coverage as required under Section 25A of NIG L 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 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 an i
penalties of perjury that the information provided above is true and correct.
Signature j .,&7L .A_4.J<. U e. Date 3/5/98
Print name Virginia Valiela Phone# 508-993-2604
official use only do not write in this area to be completed by city or town official
city or town: permit/license# _riBuilding Department
°Licensing Board
0 check if immediate response is required ['Selectmen's Office
°Health Department
contact person: phone#: °Other
(revised 3/95 PIA)
•
•
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.
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 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.
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. C
1 •ti .r"T•:" .. '.,`^a .r�`-`f ..� ,y :rW... ♦)�� � Y�-...s : ..,sz-�ynm�•.3 f i.a z 1-
• 4 �,��. .,�,tom -',.
� :s:.�0{ .Il4e93L5xr�.���,"'". �_ _ ��'' i`f3i .-:i?Yt i %�Yt. " M•` .�s" r _ ...,."
The Department's address, tet.nhcr.. and fax nt .. 1, �....._. ... _
The
Denartrr r2 r o 1dt_ft:t•:a'Ac::_..F.:12:s
tl�f Se of i;nvestivja1ion
600 Washington Street
Boston,Ma. 02111
fax#: (617) 727-7749
phone #: (617) 727-4900 ext. 406. 409 or 375
CO 4101 Lib
BUILDING PERMIT
G. N. B. REGIONAL REFUSE MANAGEMENT DISTRICT
FIELD INSPECTION
Dartmouth Building Department Plat: 84
400 Slocum Road P.O. Box 79399 Lot(s) : 22
Dartmouth, MA 02747 Lot Size: 40,000
Telephone (508) 999-0720 Zone Dist. :SRB
Issued Date: 3 /10 /98 Permit No: 5544
Project Location: 600 Ouanapoag Road
Number Street
Subdivision Name:
Nearest Cross Street:
Applicant/Agent: Marie Alves '
Contact Person Phone #: (508) 993-2604/763-5924
Proposed Use: Non-Resdential
Residential,Commercial,Industrial,etc.
Permit Issued To: To Occupy/Install
Type of Improvement,Add,Alter,New Const.,Demo,Land/Move,etc.
To occupy as new tenant (office) and installation of handicap
ramp
Indicate no.of bedrooms and bathrooms and other rooms
Owner(s) of Record: G.N.B. Regional Refuse Management District
Address: 600 Ouanapoag Road, Dartmouth, MA 02747
DATE TIME TYPE OF INSPECTION REMARKS INITIAL
4116.
PaCk
y -!a -R9 etrebtfelV 616
BUILDING PERMIT
GREATER NEW BEDFORD REGIONAL REFUSE MANAGEMENT DISTRICT
Dartmouth Building Department Plat: 84
400 Slocum Road-P.O. Box 79399 Lot(s) : 22
Dartmouth, MA 02747 Lot Size:40,000
Telephone 508-999-0720 Zoning Dist. :SRB
March 9, 1998 (typed) Permit No. : T �/Y
Issued Date: 3 //U / ea Clerk: BAS
Project Location: 600 Ouanapoag Road
Number Street
Subdivision Name:
Nearest Cross Street:
Applicant/Agent: Marie Alves
Address: 400 Slocum Road, Dartmouth, MA 02747
*David Vincent - 713 Rock O'Dundee Road, Dartmouth, MA
Contact Person Phone #: (508) 993-2604/763-5924
Type of License: Owner: ( ) Const. Superv. License #: ( *017913)
Architect: ( ) Engineer: ( ) Other: (agent )
Proposed Use: Non-Residential _
Residential,Commercial, Industrial,etc.
Permit Issued -To: To OccupytInstall
Type of Improvement,Add,Alter,New Const.,Demo,Land/Move,etc.
To occupy as new tenant (office) and installation of handicap ramp
indicate no. of bedrooms and bathrooms and other rooms
Gross Area of Const. : Cost of Const. $1, 800. 00
Cost-Other Const. : TOTAL FEE: $ 150.00 (waived)
Owner(s) of Record:G.N.B Regionl Refuse Management District
Address: 600 Ouanapoag Road, 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 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: V + � �. ?� , ein_ ,
Address:
*********** **** ***** ** ***********************************
Signature: , I MAR 0 9 1998
Approved/Issued By: D v d J. Silveira, Title: Building Commissioner
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