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BP-75750RESIDENTIAL ❑ Phased Approval (R106.3.3) $25.00 APPLICATION FEE IS NON BE-FUND"1BLE a& NON. TBANSFERABLE LtATE R EIVED DARTMOUTH BUILDING DEPARTMENT j A �T Ni 400 Slocum Road, iO C Dartmouth, MA 02747 z. •%2. _ NJ ii �s Kos SyY; Phone: 508-910-1820 Fax: 508-910-1838 '66=`� www.town.dartmouth.ma.us APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING Board of Health: Signature: Conservation Commission: Signature: D.P.W.: Signature: Fire Chief: Signature: Other: Signature: Brief description of work being performed: Date: Date: Date: Date: Date: 1.1 Property Address: tf� 5121 � L4 AE. 1.2 Assessors Map,&-6,CMumber: Contact Person: f&� �' /`- 9' Map Lot Phone Number: 7 — 5 3 1.4 Water Supply (MGL c40 s54): 1.5 Sewage Disposal System: ❑ Municipal ❑ Municipal ❑ Private Well ❑ On Site Disposal System 1.3 Historical District ❑ Yes ❑ No Year Built ❑ Altering more than 25% per side of building Has application been submitted to the Historic Commission? ❑ Yes ❑ No Date: J 113 El CONSTRUCTION PLANS 0SITE PLAN ❑ENERGY REPORT $ lunowy $ JaylO ueleg bululewa�l ale(] 267,1111111 :ol panssl i!wJad bg lelol uo!leJally - eaJy ssoJO •i} •bs lelol uo!lonilsuoO MaN - eaJy ssOJO •AJnfied /9111 uad ue su!ed ayl Japun p u •}a!laq pue a6palmoul Aw to iseq ayl of 'aleJnooe pue enJl aJe uo!leo!ldde 6u!obaJol ayl uo uo!lewJolul pue sluewelels ayl ley} aJeloap Agejeq lua6y paz!Joylny/Jaumo se' aled Jaunt aJnleu6!S uo!leo!ldde i!wJad 6u!pl!nq s!yl Aq pezuoylne NJOM of aAllelaJ SJallew Ile u! 'ileyaq Aw uo loe of . ps� 7 � azuoylne AgaJay ApadoJd loafgns eql }o Jaumo se ' -ty, y ],� `I 7 ' ' (3uud a1d) (}iw�ad Sulplinq ao} saridde �o}ae}uoo �o;uat}e s�auMo uaynn pa}ald�uoo aq o}) NOI1b+ZI2101Ilfib: l33N'MO!-Y, NO1133S (b+E+Z+4)=1elOI •9 (OVAH) leo!ueyoalN .7 bu!gwnld '£ leou13913 •Z r>n •p0 O 6u!pl!ng • 1, lueolldde i!wJao nq palalowoo aq of ($) iso0 polewgs3 well J St?3 'You is -:9 Ja410 oul I!O land 0913 seO aaleM 10H ❑ pap!AoJd aq Ol anoge ay} 10 auON ❑ (pun aleJedas) - 6u!uog!puoo J!y ❑ :(i4!oeds) Jaylo 'Aj!o!Jloala 'auedoJd 'se6 leJnleu 'lanj fjew!Jd - (ilun peulgwoo) OVAH ❑ :(A41oads) Jaylo 'Al!o!Jloala'l!o lent '(euedoJd Jo leJnleu) se6 lent - (6u!leay) Japo8 ❑ :(i4!oeds) Jaylo 'A4!o!Jloala 'l!o lenj '(euedoJd Jo leJnleu) se6 lent - (J!e loy) aoewnd ❑ Z wn syleg }o 'ON Z on swOOJpag }o ON 6 Bull syleg 30 'ON l. i!un swOOJpag 10 ON :Al!wed oMl syleg 10 'ON SwoOJpag ,lO 'ON :Al!wed aI6uIS :6u!Mollol ay} alaldwoo aseold `uo!lonilsuoo Mau;l,x :u011eool :aweN Alllloed laailS up Jalsdwn4 ❑ al!s uo JalsdwnQ ❑ :(tg oas 0i7•o 1JW Jad) lenowaJ s!Jgep }o uo!leool :(Aj!oads) NOU110W34 ❑ —SJOOQ SMOpUIM10'ON (paimbei liodaJ A6J9u3) (96eJeolpays) (pannbei ljodaJ AGJ9u3) Joop/Mopulm luewaoelda�J.❑ bulp!S/bugoQ�M uo!lIppy ❑ •6P1e AJossaooy ❑ „uo!lonilsuoO MON ❑ anolS lapad/OAOIspoOM ❑ aoeldaJ! j/Aauwigo ❑ uolleaaliy ❑ sJ!eda�j ❑ lood ❑ � oaa ❑ "` slgeoil ` de Ile.moaN3 ' NoAK,,a SO4o;W NOi1dRi S3Q . S N4t1 5. ON ❑ s :payael}y ilnepl}}y pau6lS l!wjed 6u!pl!nq egl;o eouenssl egl;o le!uep ayl ui llnsaJ p!M }!nep!}}e Slyl ap!noJd of amped wileo!ldde s!yl yl!M pell!wgns pue palaldwoo eq isnw i!nep!}}y aoueJnsul uo!lesuadwoO s,JaMJoAA {5ZI ZS6 :'1J 11)11Ab f]fddt� 3N f1SN1, Nt311KSN3c�WOQ 5.213 1ryOM =)b ND1133S ,7,77,777 :aJnleubiS - :Molaq u6!s uo!loas s!yl Japun 6u!Aldde aJe noA 11 •leumoawoH a pajaplsuoo aq jou pegs poped jean-om a ul owoq auo uegi aJow s;onAsuoo oqm uosied y :samjoruls wje; jo/pue esn yons of kossewe seinjonjis pagoelap jo pegoepe '6ulpamp Al!wej om2 Jo auo a 'eq of papualw sl jo 'sl ejegl golym uo 'eplsaj of spualul jo sapisai egslaq go!gm uo puel;o laoied a sumo oyM (s)uosiad :smopoj se pauuap sl „JGum0swOH„ a 'Aluo uouoas slq; Jo sesodind eqj and •joswadns se toe pegs JaumoawOH yons jap 'Tom yons op of any jol (s)uosiad a so6e6uo JaumoawoH a 11 Jegj sapinad :uopos s!yl;o suolslnad eqj woo Idwaxe aq peys pannbei st lluusd 6ulppng a golym jol Tom 6uluwoliad jaumoawoH Auy :uoudaox3 1031021d NMO 2113Hi Wzl 3191SNOdS38 38 aN`d Wb0db3d Ol aN31Nl OHM S2i3NM03WOH 210-A :uogd00x3 6'£• VgU-0I I. uolloaS AluO'Apwed Omi -Q auO OU pdwax3 JauMOGWOH Z•S C J Z 2?a— 2 !�! �•auoydalal eu618 7in :aged uogeJ!dx3 • tj� • ~�l�J �S �� �� .:ssejppb' v :aweN JOloeJluOO/aweN Auedwo0 :JagwnN asuaoll :asuao!1 AlleloadSposvuadnS uo!lonilsuoO pasueoll 6•E . rr S3�I/�a3S NQIJ 3t121 LSN03 =<£ N01133S G� • y��— JagwnN auoyd aJPpy JOBJU00 (luud) aweN p a6y pezijoqlnV Z'Z JagwnN auoyd ssaJpp oeluOO (luud) aweN ezR ifs- ts3 � �� 5:� :pJooa�{ Jau O l'Z `:1N3Jb'-a3zl21OHiny[diHsu3NMO:,U'H3dOU4-Z NQII�3S 1VI1N3®ISIN