HomeMy WebLinkAboutBuilding Permit #Exception - 733 TURNPIKE STREET 5/1/2018 BUILDING PERMIT NORTH .1
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APPLICATION FOR PLAN EXAMINATION
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Permit No#: Date Received �1��°R1TeO�Qay(5
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Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION / ° f•
Print
PROPERTY OWNER
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 ❑ One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
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,OtSeptc ❑;Well Floodplain +Wetlan_s ❑.oWa_ h d'®iatrrct
Water/Sewer - - -- a
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: Phone: lye
Address: 0
Contractor Name: .,,,,:y C:�_�s ���s Phone: 6 o.3-4e l 4X Y2
Email: it t)eWg s, g�2 eem esa,., /a n ie -
Address:__5 rA f>,e- 0-s 0
Supervisor's Construction License: 5 aq3 ,ga / Exp.. Date:
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Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER 6!51) — Phone:
Phone:
Address: ! _ y � ���,r Reg. No.$Cod
FEE SCHEDULE.BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ //, Qe26 FEE: $� �—
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access ?tVefund
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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 o U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Si nature
COMMENTS rjUl)�
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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/Signature& Date Driveway Permit
]DPW Town Engineer: Signature:
_ Located 384 Osgood Street
FIRE�DEP�AR�TMENzT'rfTemp,Dumpster on site�,xye�.,.:
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COMMENTS