BP-31159RESIDENTIAL
RESIDENTIAY,
NM
3.3 For Residential Remodel Work Only
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND:
QUESTIONS OR COMPLAINTS call or write:
Home Improvement Co g Contractors Registration, One Ashburton Place - Room 1301, Boston, MA 02108, (617) 727-8598
Owners Name
_ OF
one
�a
R��T�ON . - ON - . .
❑ new construction*
(energy report required)
o addition
(energy report required)
)K. deck ❑pool ❑accessory Bldg.
(shed/garage)
If new construction, please complete the following:
Single Family: no. of bedrooms
Two Family:
no. of bedrooms unit 1,
no. of bedrooms unit 2
❑ alteration
❑ repairs
❑ replacement window/door
no. of windows doors
no. of baths
no. of baths unit 1
no. of baths unit 2
❑ Furnace (hot air) -fuel gas (natural or propane), fuel oil, electricity, other (specify):
o 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
❑ Hot Water: Gas Electric Fuel Oil Other
Brief Description of Proposed Work:
Item
1 R»ilr�inu•3,000,0D0
'I P1» mhi n or
f
4 MPrhnniral (TNVAC)
4
i
❑ chimney/
fireplace
El other
(specify below):
❑ woodstove
❑ demolition
(specify below):
Estimated Cost ($) to be completed by permit ariplicant
ETA
(please print • , .�
.� , as Owner of the subject property hereby authorize krli-ji
I, J
to act n m ehalf, in all m ters relative to work authorized by this building permit application.
- 7
on the foregoing pp gapplication are true and accurate, to the best of my knowledge and belief.
Signed under the pains and penalties of perjury.
Signature of Owner/Authori
Agent Date
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Page 3 Rev. January 1, 2003
RESIDENTIAL
❑ FOUNDATION ONLY
RESIDENTIAL 2003
❑ FOUNDATICN ONLY
$25000 AFFLECAVEGM FEM ES mamnmE rs. UMDABLE d. MGMwVMA%MSFC' LIABLE
SECTION $ _ :INSPECTOR'S REVIEW/COMMENTS
1. Date plan reviewed: � � �'•Z _C�_ Lo-,�
2. 30 days to review period expires:
3. OK to issue date:
4. OIL to issue subject to requested submittals (see project review worksheet): Date:
S. DENIED (see project review worksheet): Date:
/� V
6: r s •� / 1 �..� - Date: "Ir L
7. HOLD subject to Zoning Board of Appeals action: Date:
8. Comments: r :_,l �12: �%,' �eww_) io %/,ri,
� Total Permit Fee: $ <4 oe I Less Application Fee: $ 25.00 I Remaining Balance: $
TOTAL FEE: c��� (��' Gr
Gr
oss Area -New Construction total sq. ft.
oss Area -Alteration total sq. ft.
Perm t Issued To: � dam-'}%W.5 �`"'Y ctc
<�z i W<5;za C /) e d
SECTION it - ADI2ITIONAL C£�MMENTS/SKETCHES
$25moo AFFLECAVEOPM FME FS MOMMMEFUMDAIMLE d:, MGM=-TT%AVSFEmFsiiS;II.M.
-1k
DARTMOUTH BUILDING DEPARTMENTDATER ECE�VDI)
:0
= 400 Slocum Road, P.O. Box 79399 °�'� r i I ( i �?: 05
-55e.`Dartmouth, MA 02747
508-910-1820 FAX 508-910-1838
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Energy Report:
Fire Chief:
Board of Health:
`Conservation Commission:
Signature:
Signature: c
Signature:
ignature:
Other: Signature:
Description of work being performed: / l /
1.1 Property Address:
Nearest Cross Street: 6LJ.6&vv-f?
Subdivision Name:
*007
Total Land Area Sq. Ft.: 404 !:�00 r.•
1.4 Water Supply (MGL c 40 § 54):
Date:
s
Date.
Date:
Date:/
Date:
• L
Covered 6vide. ;30ur��I,
1.2 Assessors Plat &Lot Number:
Plat Lots4:
1.3 Historical District ❑ yes no
Has application been submitted to the Historii-c Commission?
❑ yes ❑ no Date:
1.5 Sewage Disposal System:
o Municipal X .Private Well El Municipal X'On Site Disposal System
J (
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