HomeMy WebLinkAboutBuilding Permit #Exception - 345 CANDLESTICK ROAD 5/1/2018 BUILDING PERMIT taoearH
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APPLICATION FOR PLAN EXAMINATION
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Permit No#: Date Received a,R"
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Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION 3 Lf 5 C_ oze7d'esti ck (.-111
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PROPERTY OWNER
Print 100 Year Structure yes
MAP 10 b PARCEL: z ZONING DISTRICT: Historic District yes o'
Machine Shop Village yes: 5-0-
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
&Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
El Septic El Well ❑ Floodplain ❑Wetlands ❑ Watershed`District
❑Water/Sewer
DESCRIPTION OF WO TO BE PERFORMED:
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Identification- Please Type or Print Clearly
OWNER: Name: ti N ,� Phone:
Address: 3' J CG v'Jle5J r c, c 4 { A4a/wef
Contractor Name: .i,? Phone: '977-691- 5720
Email: 5 e-\ S !G'0e,1z- c.l-.1 r , eo fLA
Address: Po && 936 1J, fi,4d&V'e r, d I $`<
Supervisor's Construction License: 65 - 6-26691 Exp. Date: T/16 /I
Home Improvement License: 109323 Exp. Date. Sr/l g l
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ `� 90 9 FEE: $
Check No.: Receipt No.: 1
NOTE: Persons contracting with unregistered contractors do not have access to th u Ya fund
tractor
nature of Aqent/Owner con
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Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL ,
Public Sewer ❑ Taming/Massage/Body Art ❑ Swimming Pools ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank, etc. ❑ Pennanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF o U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_'
COMMENTS
CONSEF2VATt'e Signature
COMMENTS ~\
C 1 �j p�,>c 5 `�Jaoti
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HEALTH Reviewed on ( 2 Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision. Comments
Water & Sewer ConnectionlSipna�ure Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
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