BP-68170r
_.....
5ECTION 6- ESTIMATED CONSTRUCTION COST,::
Item Estimated Cost ($) to be completed by permit applicant
1. Building
2. Electrical
3. Plumbing
4. Mechanical (HVAC)
F Tntal=f1+7+3+d1
RESIDENTIAL ❑ Phased Approval (R106.3.3)
$25.00 APPLICATION FEE IS NON BE-FUNDABLIL & NUIN- 1MANNUIL cAl5JU1E6
DACE°IVED
BUILDING DEPARTMENT f
— n DARTMDUTH BUlad ., PIG. ���.
t,- 400 Slocum Ro
t Dartmouth, MA 02747 1 .. '
' IZ may= Phone: 508-910-1820 Fax: 508-910-1838 it i . 17
www.town.dartmouth.Ma.us
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWF-:LLING
Board of Health: Signature: Date:
Conservation Commission: Signature: Date:
Other. Signature: Date. -
Signature: Date. -
Signature: Date:
Brief description of work being performed- 5
1.1 Property Address:( /��/ / 1 l.m.. 1.2 Assessors Map & Lot Number: 4
1 / o
Lot Area (sf.) Frontage Map �� Lots -
Required Provided
Front Yard 1.3 Historical District ❑ Yes 10 No
Side Yard Year Built
Rear Yard
❑Altering more than 25% per side off building
1.4 Water Supply (MGL c4O s54): 1.5 Sewage Disposal System: Has application been submitted to the His4toric Commission?
0 Municipal ❑ Private Well ❑ Municipal ❑ On Site Disposal System ❑ Yes ❑ No Date:
Revised 1uiii
CONSTRUCTION PLANS ❑ SITE PLAN ❑ ENERGY1REPO T
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