HomeMy WebLinkAboutMiscellaneous - 100 OGUNQUIT ROAD 5/12/2014 t� LJ
TOWN OF NORT-H ANDOVER S
APPLICATION FOR PLAN EXAMINATION
Permit NO:
Date Received 1
Date Issued: :5 d
IMPORTANT:Applicant must complete all items on this page
LOCATION
rint.
PROPERTY OVVNER
Print 100 Year Old Structure yes no
MAP N; PARCEL: ZONINGDISTRICT: Historic District yes no
Machine Shop Village yes no
.TYPE OF IMPROVEMENT. PROPOSED USE
Resid ntial Non- Residential
New Building One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
Ij Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
�Yl
Identification Please Type or Print Clearly)
OWNER: Name: d�� 1 Phone:
Address:
CONTRACTOR Name: i VC C6'1 CS
Phone.
Address: ( lJ "L
Supervisor's Construction License Exp. Date:
Home Improvement License: 1. Exp. Date:
ARCHITECT/ENGINEER 9 l���s'��"�' Phone: Cl �6 4 �� L1.ad1�1
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ FEE: $_
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors Flo not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor
Plans Submitted Plans Waived ❑ Certified Pint Plan ❑ Rtamnarl Plnnc I 1
- -Plans Submitted ' Plans Waived �,: '..Certified Plot Plan El . Stamped Plans 0
❑
TYPE OF SEWERAGEDISP-OSAL"
Public Sewer ❑ Tauning/Massage/Body Art ❑ Swimming Pools ❑
Well ❑ "Tobacco.Sales Q - oodPackaging/Sales ❑
Private.(septic tank,ete:_ . Permanent Duinpster on Site ❑
Vj 4HE_.FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF e U FORM
-DATE REJECTED DATE:APPROVED
PLANNING &DEVELOPMENT F1
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on I Si nature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
/*
Water Water & Sevver Connection/Si nature Da � �- Driveway Permit
DPW Tovw Engineer: Signature:
Located 384 Osgood Street
FIRE DE PA"R f ME-Wt - Temp Dumps.ter on site yes: no
Located-at 124 Mair, Street
Fire Departmerd sign-Attire/date
COMMENTS