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BP-85426RESIDENTIAL ❑ Phased Approval (R106.3.3) _ _ $25.00 APPLICATION FEE IS NON ICE -)WINNABLE � NOTC-1I6iA &FEBAOLE - DATE RECEIVED °" H DARTMOUTH BUILDING DEPARTMENT 19 ` 400 Slocum Road •.4 Dartmouth, MA 02747 `o Phone: 508-910-1820 Fax: 508-910-1838�-- — �'6« '= www.town.dartmouth.ma.us APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING rJ :rocs p Sewer Card Cut -,Off Signature. Date: U Board of Health: g Aj Conservation Commission: Signature: D.P.W.: Signature: D e: Fire Chief: Signature: Date: Other: Signature: Date: Brief description of work being perfonned. / f «t TA/Property Address: ntact Person:L �1 ;4one Number:(/ �— �`� �`� 1.VNater Supply (MGL c40 s54): 1.5 Sew -Disposal System: p"Municipal Municipal ❑ Private Well ="On Site Disposal System CONSTRUCTION PLANS _A10, 1.2 Assessors Map & Lot Number: Map Lot O 1.3 Historical District ❑ Yes 240 Year Built / �7;16 ❑ Altering more than 25% per side of building Has application been submitted to the Historic Commission? ❑ Yes ❑ No Date: Revised 5 /13 ® SITE PLAN ® ENERGY REPORT 3.2 Homeowner Exemption - One & Two Family Only Section 110.R5.1.3.1 Exception: FOR HOMEOWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT 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 yru are applying under this section sign below: v—�- ' .2 Worker's 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: ❑ Yes ❑ No ❑ Deck ❑ Pool ❑ Repairs ❑ Alteration ❑ Chimney/Fireplace ❑ Woodstove/Pellet Stove ❑ New Construction* ❑ Accessory Bldg. ["Addition ❑ Roofing/Siding ❑ Replacement window/door (Energy report required) (Shed/Garage) (Energy report required) No. of windows Doors Cl DEMOLITION (specify): Location of debris removal (per MGL C.40 Sec 54): Facility Name: mpster on site ❑ Dumpster On Street Location: *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 0 Hot Water: Gas Electric Fuel Oil ---- Other �the ras Owner/Authorized Agent hereby declare that the statements and information foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. re of Agent Total Permit Fee: $ —3szi Gross Area - New Construction total sq. ft. Gross Area - Alteration total sq. ft. Permit Issued to: Less Application Fee: $25.00 Other $ Amount $ Date/V—/9Z/;;r — Remaining Balance: $ —Z4615 Z21114 -i'o 2.0 1 w I _ • / _ 6 ..�— von �ff 2 - - - -` t- "j!``4!- U i4 ­ *­ Mi m_.--_:1�: , ,-l1 � :, � , � vz;­ "5x ..­".i� jvLF,_ � :1 i 11- 7"I 7-..; � -i-,. !. j:'; ' _I*"­ I ., JTfI ­i, - 4 Ji1! �Li ­,; I I .! 14i 'iL 6_1 fKg��4 I -�i k, i:i _ _%!1 A,I i�`I,� &, - , .1'i! .; 11i!� ; !�Ia� liQi1I , 'I.. _% i, -q- _ ..i v i - `1ZI0 t,ij D i;7 .-.IIIi : ;. fr, " � � ! ! , 4 ` , i4IV qK�,.I I, i, I�7 i 1 x ;_= - ""jJi 1,Iv , -1 J 191 co D O-QRJ..A"., ; I,-, 0Ii ; L I - ,lj!N 1iii , I-!= 1iI i!i i: ".] f-i-�­.r,1f,,4�f! ,,o�i!--.1 � !j. > -i1�! ir7,' ! .--! I:1; l.-'- _I- -C" I-VV- 6 �,:,i� �j.­�''i _!!.-;� j ­ I -.�; : - -, , I�ficL -`! 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