HomeMy WebLinkAboutBuilding Permit #Exception - 479 SALEM STREET 6/2/2015 TH
BUILDING PERMIT o` No o ' �a
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APPLICATION FOR PLAN EXAMINATION
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Permit No#: Date Received �4A�R17EC
9SSAC HU5��
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION ��� �G �� C-7 f
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PROPERTY OWNER zk(LL Aad C,5 -e–L–C.
Print 100 Year Structure yes no
MAP PARCEL: -ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building l,One family
KAddition 1C>eGK ❑ Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑❑1SNeaptter/;Sewers �r` % 3 sdDtritslodpaeic c
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DESCRIPTION OF WORK TO BE PERFO ED:
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Identifi ation- Please Type or Print Clearly
OWNER: Name: SS-r- LL— Phone: 1-7 F 77 7�-?,F
Address: 4-79 Cr C> -
Contractor Name: �C��.n .Q(? CC, Phone: 01 -7Y 375 "67�
Email: 5kA, 0 'De tr+ti
Address: rc C. e ^ `� 0 3
Supervisor's Construction License: CqC)"i Exp. Date: `? 1
Home Improvement License: I LA 6 L-C-7 6 Exp. Date: (77l(17
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ 10 r 0,;Z FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregisteredn Tactors do not have access to he guaranty fund
., or
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑
well ❑ Tobacco Sales ❑
Food Packaging/Sales ❑
Private(septic tank,etc. Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR. OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF m U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Siqnature
COMMENTS
HEALTH Reviewed on ` I D 1 /5 Signature
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MMENTS
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Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Siqnature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
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