HomeMy WebLinkAboutBuilding Permit #Exception - 30 Great Lake Street 5/1/2018 BUILDING PERMIT Of "ORT"
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APPLICATION FOR PLAN EXAMINATION
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Permit NO: Date Received
Date Issued:
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IMPORTANT Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Resid Non- Residential
tew Building On;ounits:
ition Industrial
Alteratron No.
Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
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DESCRIPTION OF WORK TO BE PREFORMED:
Identification Please Type or Print Clearly)
OWNER: Name:_ `SPS e, 0 =vT Phone CfILLJO
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Address:
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Address: dt U QAYEIA�LReg. 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: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the uaran
g ty fund
Sr nature of Agent/Owner - 4 "
�' 9 _. .,_.._ Signa#ure ofcontractor
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Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
ublic 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 - U FORM
DATE REJECTED DATE APPROVED
LANNING & DEVELOPMENT
COMMENTS D L
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature 14V
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comma
Water & Sewer Connection/Si nature & Date DriveWav Permit �� y
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DPW Town Engineer: Signature:
Located 384 O ood Street
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Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions. i eO
Total land area, sq. ft.: OoO
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For'department use `•
❑ Notified for pickup - Date
Doc.Building Permit Revised 2008
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Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application -
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
Building Permit Application
Certified Surveyed Plot Plan
'❑ W -ders Comp Affidavit
❑ Ph� o�Co of H:I.C. An
Copy d C.S.L. Licenses
❑ Copy Of Contract
❑ Fioor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
Building Permit Application
Certified Proposed Plot Plan
Photo of H.I.C. And C.S.L. Licenses
Workers Comp Affidavit
Hydraulic
Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Calculations (If Applicable)
Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dum
Asterermits require sign P q off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
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LOCUS PLAN
SCALE: 1 ,,_800'
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