BP-73348RESIDENTIAL
❑ Phased Approval (R106.3;3)
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DARTMOUTH BUILDING DEPARTMENT. E`
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400 Slocum Road
Dartmouth, MA 02747 20111 APR 23 P11 3: 53
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Phone: 508-910-1820 Fax: 508-910-1838
www.town.dartmouth.ma.us
APPLICATION TO CONSTRUCT. REPAIR. RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
RECEIVI
SIGNATI
Zoning C
Board of Health: Signature:
Conservation Commission: Signature:
D.P.W.: Signature:
Fire Chief: Signature:
Other: Signature:
Brief description of work being performed:
Date: z j
Date:
Date:
Date:
Date:
1.1 Property Address: (4 i?C,,r&0 l w l —U 1.2 Assessors Map & Lot Number:
Contact Person: -m io-fn Lo--rra-6ee- Map o2 y Lot -ri' - 3
Phone Number: 6VF-- q& F' 011(o
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 11 No Date:
Revised 5 /13
❑ CONSTRUCTION PLANS ❑ SITE PLAN ❑ ENERGY REPORT
RESIDENTIAL
2.1 Owner Record:
Q01i&M -P. l_a-n2J0"_ + Jlalol etci- L rfWbu- �o �ti� }sill RA 3`7)9'- 97-0195-
Name (print) Contact Address Phone Number
2.2 Authorized Agent:
Name (print) Contact Address Phone Number
3.1 Licensed Construction Supervisor/Specialty License: License Number:
Companv Name/Contractor Name:
Address: Expiration Date:
Signature: Telephone:
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 you are applying under
Signature
s
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
❑ New Construction* ErAccessory Bldg
(Energy report required) (Shed/Garage)
P
❑ DEMOLITION (specify):
Location of debris removal (per MGL C.40 Sec 54)
Facility Name:
❑ Alteration ❑ Chimney/Fireplace ❑ Woodstove/Pellet Stove
❑ Addition ❑ Roofing/Siding ❑ Replacement window/door
(Energy report required) No. of windows_ Doors_
❑ Dumpster 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
Item Estimated Cost ($) to be completed by permit applicant
1. Building 40, ovo . 00
2. Electrical 5VO. 0
3. Plumbing
4. Mechanical (HVAC)
5. Total = N + 2 + 3 + 4) 3 -,7vD.00
(Please Print)
I, , as Owner of the subject property hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner
Date
Oil
'�
I, (/(J 1 l )(orJYI LG—('r2-6e_e. , as , wne Authorized Agent hereby declare that the statements and information
on the foregoing application are true and accurate, to the best of my knowledge and belief.
Sigr* u er hejras and penalties of perjury.
Owner/Authorized Agent
y-iF--ry
Date
Less Application Fee: $25.00 Remaining Balance: $ �
Total Permit Fee: $ � ��
Other $ Amount $
Gross Area - New Construction total sq. ft.
Gross Area - Alteration total sq. ft.
Permit Issued to:
C 0ns+�c_,1-7n a 30 X HO
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CABLE
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T—TRANSFORMER
ACORN WAY
POTOMSKA RD.
LAPHAM LANE
LOCUS
LOCUS MAP
SCALE: 1 "=800'
LEGEND
PROPERTY LINE
--------117 --------
EXISTING
CONTOUR
®—
EXISTING
UNDERGROUND UTILITIES
EXISTING
FENCE
HYD
Y
EXISTING
FIRE HYDRANT
WG
EXISTING
WATER GATE VALVE
LP
EXISTING
LIGHT POLE
*117,iilclli�,bl
EXISTING
TREE
116 PROPOSED CONTOUR
NOTES:
(D CONTRACTOR SHALL NOTIFY DIG SAVE
72 HOURS PRIOR TO THE START OF
CONSTRUCTION.
O2 LOCATION OF EXISTING UTILITY LINES ARE
APPROXIMATE ONLY AND SHALL BE FIELD
VERIFIED PRIOR TO THE START OF
CONSTRUCTION.
LOCUS
ASSESSORS MAP 24 LOT 59-3
SUBDIVISION LOT 3A
PARCEL AREA = 8.73f ACRES
ZONING DISTRICT: SINGLE RESIDENCE B
OWNER: WILLIAM P. & BRIDGET K. LARRABEE
6 PARDON HILL ROAD
DARTMOUTH, MA 02747
DEED REFERENCE: BOOK 10816, PAGE 81
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DAR 13-5566 SP.DWG
File No. 13-5566