BP-91192M Alf 1,11-41
23Owner Record:
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0 151 %
Name (print) %
Contact Address Phone Number
2.2 Authorized Agent:
Lonoot LAvielt-Icui,-
C65 AWI-el Oandf&v-, St/C-4 D:LAkj �
Name (print)
Contact Address Phone Number
-08-YR
3.1 Licensed Construction Supervisor/Specialty License: C/'K I License Number:
Company Name/Contractor Name: j� q
Address: (Ocj ts
Expiration Date:
-
Signature: Telephone: (a nill3 -OA
8.2 HorneownerSemp 10 �_:Mily 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 this section sign below:
Signature:
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 Afficlavit Attached: 0 Yes 0 No
{gyp
1? 0 Deck 0 Pool 0 Repairs 'IAAIteration 0 Chimney/Fireplace 0 Wood stove/Pei let Stove
0 New Construction" 0 Accessory Bldg, 0 Addition 0 Roofing/Siding 0 Replacement window/door
(Energy report required) (Shed/Garage) (Energy report required) No. of windows Doors
DEMOLITION (specify):
Location of debris removal (per MGL C.40 Sec 54): 0 Dumpster on site 0 Dumpster On Street
jj Facility Name: V IV Ak— �)6 Location: UqS7 vQ
*If new construction, please complete the following:
Single Family: No. of Bedrooms No. of Baths
Two Family: No of Bedrooms Unit I No. of Baths Unit I
No of Bedrooms Unit 2 No. of Baths Unit 2
0 Furnace (hot air) - fuel gas (natural or propane), fuel oil, electricity, other (specify):
0 Baiter (heating) - fuel gas (natural or propane), fuel oil, electricity, other (specify):
0 HVAC (combined unit) - primary fuel, natural gas, propane, electricity, other (specify):
0 Air conditioning - (separate unit)
0 None of the abot- kAd
0 Hot Water: AV -- - - Electric Fuel Oil Other
gv
41,
Item
Estimated Cost to be completed by permit ap,dicant
1. Building
I L1 0
2. Electrical
V-1 K- ts,
3. Plumbing
r
4. Mechanical (HVAC)
5. Total=(1+2+3+4)
(Pleas
.U.,11 11 jo I AQJCA-fC as Owner of the subject property hereby authorize
to act on my behalf, in all matters relative to work authorized ythis building permit application.
_T
Signature of Owner Date
as Owner/Authorized Agent hereby declare that the statements aind information
on the foregoing app'lication are true and accurate, to the best of my knowledge and belief.
Signed under tnp7p and penalties of perjury.
Signature Date
T
Less Application re—e$25.00
Remaining Bal ance. 15�$ _
Total Permit Fee:
Other $ Amount $
Gross Area - New Construction total sq. ft.
Gross Area - Alteration total s . ft. /I
Permit Issued to: ey
A' -4
V
M�
A 25,
r
RESIENTII1 ❑ Phased Approval (R106.�_A) s
$25.00 APP'LICAT]ION FEE IS NON BE -FUNDABLE A NON.TRANSFERA!tLE
RE OEIVED
DARTMOUTH BUILDING DEPARTMENT L
400 Slocum Road
n!
'a y; Dartmouth, MA 02747 t '
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 [)WELLING
--•�'
EEt�lED,BY-UILI?(G1=R14T NtJit�dBERz _
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t
DATEt�Sf:�ED
StGCATLTR _°wc z y DATE_`
y � Braifdtn �at�ttrs�tonerftns ec�oc of�utt�ttrt` s .' .
Zorx�Fstrt :PFopased Ilse SL Ss CoaeT Il B QsA q 1f Agrfer�one ,
Irr FJ
_iES SOIL D $ECT�FtELk
SHE 1`at.LOWtr�JAEh1' _ r! Di3V[f
L i '1 F .l -
GT Braid of Ct Board of -Cons? Planning fCc#drs C7 Engtaeertng Q Cross
-{Fsppea(s }' kte�ftf� borrimissrorr i Gatdonnecfion
- Q Erie EI Gas ❑.,Efecinc . E7 Other r� Gatti
dater Card ❑atet .;
_#. �.- . �n-t._� .1.,_.-� -a_...K;'._ _ .-.�..,.y_."u®X. :_ xx-,.�q^.'�(..f'.•i`73®-,:¢� g_{>....,:, 3.,u?$h._., t.c�,.-?:
D.P'IS�k4-4C'G'4i0 M#'3 yf *
Board of Health: Signature: Date:
Conservation Commission: Signature: Date:
D.P.W.: Signature: Date:
Fire Chief: Signature: Date:
Other: Signature: Date: I_
Brief description of work being performed.
1.1 Property Address: o l �sj l i 1.2 Assessors MW & Lot Numb
e
Contact Person: &Tty\- �_-0non ► ( Map�j L Lot -
Phone Number: con - _1 /, -OM
1.3 Historical District ❑ Yes e� No
1.4 Water Supply (MGL c40 s54): 1.5 Sewage Disposal System:
Year Built
❑ Municipal ❑ Municipal ❑ Altering more than 25% per side ofJbuilding
❑ Private Well ❑ On Site Disposal System Has application been submitted to the Histcoric Commission?
❑ Yes ❑ No Date:
Revised
El CONSTRUCTION LAND _ �1`P� P1 AKI rll%r-vl„%r%
Permit No. BP-91192 Project LoR RD
Commonwe "' csachusettscation: 760 OLD FALL
RIVE,
TO .0„. te P • � � UTH
0:0744170P.?";,:ir .e.. 114 , di. 4 L
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Contra. e , ,....... 1.., one#:
BRIEN 6 €,ggr— 0.
7)913-0843
ArIEN'',chitec e + ` phone II:
Apptacant. * s °�''f Phone#: �s "�'
VIVINT SOL „' `cVJL�OPJ3 ••.C (617)913-0843
CD ••
OWNER: ••Aa•=•»•e•a0•�O� �'
MERCIERJEFFREYs.�
A
DATE ISSUED: II' /
TO PERFORM THE FOLLOWING WORK:
Installation of twenty six panel photovoltaic array on existing rooftop - 8.06 KW
^.ATE TIME __ _ __ _ _ - TyQF.OF L^ISQECTION&REMARKS _ INITIAL