HomeMy WebLinkAboutBuilding Permit #Exception - 120 WINDKIST FARM ROAD 5/1/2018 (3) iy"'�I'' w^ ,Na uriuViNiiXll,
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Permit NO:
Date 'ss et
LOCA IOti
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w:'41JR{� ZONING 'DISTRICT: Historic District yer r!,,
I Machine Shop Viliage -es 0
TYPE OF iMPROVEMENT PROPOSED USE r
Residential Non- Residential
)'New Building X One family
Addition D Two or more family D Industrial
Alteration No. of units: D Commercial
.1 Repair, replacement D Assessory Bldg D Others:
D Demolition D Other
X Septic L2 Well Floodplain 7 Wetlands Watershed District
Water/Sewer
Identification Please Type or Print Clearly)
OWNER: Name: Jar .� ,�,v,,; S Phone: al 8_a717
Address:
CONTRACTOR Name: Phone: /02114227 _,R
JJ
Address:
Supervisor's Construction License: ^—T Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER ����} ,�m�{� � Phone: �78y�25�2?
Address.- 50'k 2 de,"Vw�j2p,-+j>/y11A- Reg. No. A(,4q
FEE SCHEDULE;BOLDING PERMIT. $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No..-
NOTE:
o.:NOTE: Persons contracting with unregistered contractors Flo not have access to the guaranol fiend
Signature of Agent/Owner Signature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans
( TYPE OF SEWERAGE DISPOSAL
Public Sewer ElTanning/MassageBody Art ❑ Swimming Pools ❑
WellEl
Tobacco Sales
Food Packaging/Sales ❑
Private(septic tank, etc.
Permanent DumP ster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
_ A
COMMENTS
I
ONSERVATION Reviewe77n Signature
COMMENTS
l ^
-4HEALTH Reviewed on r Si nature I
r E
COMMENTS
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Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Ra ;ning Board Decision: Comments
Conservation Decision: Comments
,;_Water & Sewer Conn ection/si nature& Da Drivewa Permit
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-S,DP«'TowwL Engineer: Signature:
�. Located 384 Os ood Streefi
FIRE DEPARTMENT - Temp Dumpster on site yes no
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Lc---'ked at 124 Main Street
Fire Department signatureldate �' �'u
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