BP-33619C:\bldg.�'orms\B ldgapp.res.wpd
Rev. January 1, 2003
Item
, , -r
CO -
If, in
(energy report required)
❑ deck El pool
(energy report required)
❑ accessory Bldg.
(shed/garage)
If new construction, please complete the following:
Single Family: no. of bedrooms
fireplace
replacement window/door El other
no. of windows doors (specify below):
no. of baths
ID demolition
((specify below):
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):
El 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 f ..
❑ Hot Water: Gas Electric Fuel Oil Other
Brief Description of Proposed Work:
rA-A
.... ... 52
1 R»ilclinor
,�le
to a
rint)
one
. Signer
��� , as Owner of the subject property hereby authorize
p Y Y
tters relative to work authorized by this building permit application.
❑ FOUNDATION ONLY
S2rs.00 AVILMiLII(CATi IIGP3 F 0-0 IIS I`J'OI3MME-E'QJMIDFnBii.G &* MO1i5-'Fi'LTtFiif`3sETZRF3Bfi.IZ.
I Permit Issued To:
Dater
.......... .. . .. ...
TFIAN AhPIIC�TNOIC:TI .. .... . .... . .
. . ... ... ..... ... . .... ..... . .. ,
...... ......... ... .....
Date: Time: Clerk:
10
nil
lee",
W
A. 1"..
. .............
QT V 'n TTA &D , TIPTA :AT
CAb-'dg.f6rms\B1dgapp.res.wpd Page 4 Rev. January 1, 2003
RESIDENTIAL 8004
1-1 FOUNDATION ONLY
$Zrs.O0 FuLT'PLfiGTs'II'IIGM F SG IIS RiGI:S=RE F6ilvDFs'.�LIM 6: I@°mlti-'ft'RAI'vSr�1�.;�"nBE.C*
�,t ��: DATE RtCEIVED
J :.�_. DA.RTMOUTH BUILDING DEPARTMENT_= "
tot I
11..�
0
400 Slocum' Road, P.O. Box 79399
�-�.� - -: Syy��� Dartmouth, MA 02747
�...NM. 508-910-1820 FAX 508-910-1838
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLIT�TG
/V—� �C1/1J 1.3 Historical District Dyes Ono
Subdivision Name:
Has application been submitted to the His�o *c Commissio
Total Land Area Sq. Ft.: tn
0� n?
❑ yes ❑ no Date:
1.4 Water Supply
(MGL c 40 § 54):
CAb1dg.f6rms\B1dgapp.res.wpd
❑ Municipal VPrivate Well
1.5 Sewage Disposal System:
Municipal On Site; Disposal System
Page 1
Rev. January 1, 003