HomeMy WebLinkAboutApplication - 1020 SALEM STREET 11/20/2013 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
1VIPORTANT.Applicant must complete all items on this page
LOCATION
Pn t
PROPERTY OWNER1op Year Old Structure yes no
� Print,
MAP NO:JCS PARCEL:( ZONING DISTRICT: Historic District y es
Machine Shop Village yes
TYPE OF IMPROVEMENT- PROPOSED USE
Residential Non- Residential
❑ New Building g One family
Addition El Two or more family 11 Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement 0 Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
Septic El Well Cl Floodplain ❑Wetlands El Watershed District
E Water/Sewer —
DESCRIF—— -
i
Location
1!�t S / Date
No, ¢
Identificati, NORTH ANDOVER
OWNER: Name: r > m TOWN OF
Address Il �� ��0////i%�
Certificate of Occupancy
CONTRACTOR Name:
Building/Frame Permit Fee
Foundation Permit Fee �
Address:
` Other Permit Fee
TOTAL
Supervisor's Construction License;
1,
Hoare Improvement License:_'ir
Check#
ARCHITECT/ENGINEER Building inspector
Address:
FEE SCHEDULE:SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
FEE: $
Total Project Cost: $ — �
Check No.: Receipt No.:
NOTE: Persons contracts g iv"t uraregr erect contractors (Io not have access t th utay anty fund
Signature of Agent/OwnIgnature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Pla s ❑
Plans Submitted-0 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TITEOF=:SEWERAGE.DISP_OSAL -
PublicSewer ❑ Tanning/Massage/BodyArt ❑. . .Swimming Pools ❑
Well ❑, Tobacco.Sales ❑ Food Packaging/Sales ❑
Private(septic tank, etc.. ❑. Permanent Dumpster on Site ❑
THE.FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGH! OFF - lU FORM
.DATE REJECTED DATE.APPROVED
PLA,NNING�& DEVELOPII(IENT 0 ❑
COMMENTS
I b
.CONSERVATION Reviewed on— '_ �v Si nature ! '
7
COMMENTSP
t l
U
HEALTH Reviewed on Signature �` 1 13
COMME TS
i l F 1`c s U %
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water 8, Sewer Connection/Signature:8, Date Driveway Permit
DPW Tow;: Engineer: Signature:
Located 384 Osgood Street
EIRE DEPART@/ENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Departme►atignatureldate
COIIM.ENTS