Carlisle Planning Board
66 Westford Street, Carlisle, MA 01741
Phone: 978-369-9702 Fax: 978-369-4521
Application for Special Permit
(last revised 7/16/18)
Applicant’s name, address and telephone number: _____________________________________________
______________________________________________________________________________________
Applicant is: Owner _____ Agent _____ Purchaser_____ Tenant_____
If applicant not the owner, the owner’s name, address and telephone number: ________________________
______________________________________________________________________________________
Location of property__________________________ Total area __________ Total Frontage __________
Assessor’s Map: Sheet(s) # ____________________ Lot(s) # ____________________________
Recorded at North Middlesex Registry of Deeds in Book # _________ and Page # _________
Application is for a special permit for: Fee:
_____ Common Driveway, new $750
_____ Common Driveway, amendment $500
_____ Common Driveway, extension of time $200
_____ Accessory Apartment, new, amendment $250
_____ Accessory Apartment, extension of time $200
_____ Affordable Accessory Apartment (AAA)* $250
_____ AAA extension of time $200
_____ Conservation Cluster, new $750 plus $100/lot
_____ Conservation Cluster, amendment $300
_____ Conservation Cluster, extension of time $200
_____ Intermediate Ground-Mounted Solar Facility $1500
_____ SROSC, Preliminary $500
_____ SROSC, Definitive application $1500 plus $100/ unit
_____ ROSC, Preliminary $500
_____ ROSC, Definitive application $1500 plus $100/ unit
_____ Wetland/Flood Hazard, Underlying District, new, amendment $250
_____ Wetland/Flood Hazard, extension of time $200
* Note: Consult with the Carlisle Housing Authority if the Application concerns an affordable accessory
apartment. Filing fees for Affordable Accessory Apartments are refundable when the permit is granted.
Signature of applicant __________________________________________ Date _________________
Signature of owner _____________________________________________ Date _________________
Signature of Town Clerk ________________________________________ Date _________________
Received from _______________________________________ a copy of this form with the Town Clerk’s
signature, dated, with application fee of $ ________ on (date) ___________________.
Planning Board Signature __________________________________________________________
Title _____________________________________ Date _________________
If special permit is granted, please return a copy of the recorded decision to the above address within
60 days.
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