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BP-73822RESIDENTIRL SECT[ON 2 PROPERTY 01l NERSHIP/AUTHO I 1 Owner Record: sof- C3• � � A.2�1 l" ��2'i 1c� �`��C-�� R �'C- � o� CSC l"�OC�I N Gt C31ZZ.A Q �i � � aZ• ��3 Fame (print) Contact Address Phone Number 2.2 Authorized Agent: Name (print) Contact Address Phone Number SECTIOtV 3 CONSTRUCTION SERV 3.1 Licensed Construction Supervisor/Specialty License: License Number: Company 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 ore home in a two-year period shall not be considered a Homeowner. If you are applying u er this section sign ow: Signature: SECTIt3N 4..- WORKER S:COMPENSATIONr INSURANCE:AFF D ,I AVITJIViGt. c152,§ 25),Z, 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 U_ , -Eck-a I ap�iicabie) % a 3ESCRIPTION;CF PROPISEDORC GTw :. G Deck)!(Pool ❑ Repairs ❑ Alteration ❑ Chimney/Fireplace ❑ Woodstove/Pellet Stove s ❑ New Construction* ❑ Accessory Bldg. ❑ Addition ❑ Roofing/Siding ❑ Replacement window/door (Energy report required) (Shed/Garage) (Energy report required) No. of windows Doors P r- ❑ DEMOLITION (specify): Location of debris removal (per MGL C.40-Sec 54): ❑ Dumpster on site ❑ Dumpster On Street Facility Name: Location: *I-f 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 11 'Hot Water: Gas Electric Fuel Oil Other JUN i ! 201 4 Al. -I Sy ( �f`�`LC�' � c.�cJ�'1oS�2�"i�Tv3'�--- - eJ-?L /-O P / ?...116- 6�0 Ir 118) ty . - J%t 71� 110e . 4L - - a,-,c /a/ ,14"- C "�,vt.,-', C---O�� I-S a-pp,--*,� d� RESIDENTIAL ❑ . Phased Approval R106.3.3 . pp -1, $25.00 APPLICATION FEE IS NON BE -FUNDABLE & N* ON-T , _ �_ : L8. ;.• •= pU TN ,y ti 'S E D �. . !� U1 . DARTMOUTH BUILDING DEPARTMENT . ��=�� t ' X' , z „.. 3 % _ - . ! t . PT . =: ' t. ��:I.;..���... ��� s 'p- 7. W,-- .. 400 Slocum Road : . ,! : ' j j,t�-u, ;z _ - ;� Dartmouth, MA 02747 `1 '` tt_. �.. °.� ,_J�. � ,j; , Phone: 508-910-1820 Fax: 508-910-1838 . """..-'"' www.town.dartmouth.ma.us APPLICA, TION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLIN`,�"-. 1. ,: - . :" ­- �. -..--, i�� -� 1I-','r ­.-, 1-�- .,:�-�r--�-I,� �-,,', --; � .I�� �,-.1 ,` .. �. � THIS SECTION FOR OFFICIAL SSE ONLY ��`- �. ---�-. .�., --�, -1.-�-I-1-.1 -�,,: --I,(I� "�----: . -.- .- -, z - �. -- -.._ :. .�:,�.,,--3I, I- "., :- --.1-I-1� �-,.- "'�----.' �,-,-, ,".- ��- n. 1,- -,:,, .I _ : , ­ �,.-"I I- 1.'1:-,- ,z,:,.�- . , % - -��-.1,-:1-I II .11 ,,-1,-� t,�..� ��.-_.: �,I�� . _ ' .-" - RECEIVED B Y. , L. ti - '_ - .� R , , L. . � -.. ::. f �; '*��� ,�1 :� �,-� ,: ', .*1- �- ,��� --�-� ''�I,.,�.,- ,- �'�".,�. , ,.� � ..,' ' . I "I - . , -� 1. BDILDII�G PERi� -1�ilT NU B M ER ' --, .. .: _:.I'- �,I�,"-�,- I� I,� _�, :.,I, -,. ,, I,� ,r1- ,IX� . - � �--1 .--" I�`:-;I�L- -�-"-,�-; �I--- -: -��-�,,- . , .1:. .I � , ­ ' ,,-1 ," "..I,- �: ,. .1, -­"-- ��--- �.1�:%--,,-, -�1. -I-:I 1. �� "- �.-� --., :�.- �� ��1! -. 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Date: Date: Date: Brief description of work being pe►formed: S U K (� X 5 z ,iVw -" 4 , j2b e I � - I . w, � -��I,-,.�: -.I � :""-" �.! -' I".-. *�',.- � -I .� �. I- �-- ,- � ,II_- .-- '-. �'I. I., ,�.� -`--. �---;� ., � 1:,-_1�,- �-��.,�- I ,!�,,,, , -"----�,, ,� ,,, �--- - � ,-, , -",� -�-,,-i --,,---.,-,,-,, '--,�;. .,-, ,.� , -'�..-, ,I-� ,.-., .�- ECTIO - N._'I SITE tNFORiVIAT1ON a ,-��--.,�, -,,''-..,- �,-,.-, i _: ,r�]",z .1 Property Address: t S- Nloc,�, f4C-.3kcZn 2isw Xontact Person: aE .,o V%Prmz%0 Z�kA ,mz,a; C.&iv- ,PKone Number: S'og S-t 6 S'Z.t 1 .4 Water Supply (MGL c40 s54): r5 Sewage Disposal System: ❑ Municipal ❑ Municipal 00 EYPrivate Well COn Site Disposal System 1.2 Assessors Map & Lot Numiber: �t MaP 66 L ' 2 - 1.3 Historical District Year Built ❑!'Yes ❑ No 103 ❑ Altering more than 250/6, ' per side of building Has application been submittecd to the Historic Commission? ❑ Yes 0 No Date: CONSTRUCTION PLANA OvSITE PLAN %, Revised 5 /13 ❑ ENERGY REPORT "702, aP,�;\