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Home My WebLink AboutApplication - 1312 SALEM STREET 10/24/2014 1V 1_IVP IVIIIV -1I IlJIV �''§ ,✓_�} 1 - �' ''.,. Permit No#: Date Received T � �RaTEO Pea`,�5 gSS,gGHVS�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION %312 �ry Print PROPERTY OWNER," :+`/44 . Print 100 Year Structure yes - MAP tO A' ,( PARCEL: 16 ZONING DISTRICT:_ Historic District yes Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Y New Building A;One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement A'Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain' ❑Wetlands ❑ Watershed District ❑Water/Sewer' DESCRIPTION OF WORK TO BE PERFORMED: p Identification- Please Type or Print Clearly T(— (41 —AA7 , OWNER: Name: Phone: Address: 1312- S'G�I��,,.. �IIs..--t� A,�,s-�r &4,� Contractor Name: ►tl R daS Phone: Address: '.`7® 5o � wry l e�L->,-e. ,k-. I & � Supervisor's Construction License: x10.:33 Exp. Dater b1-(c'-(Y Home Improvement License: i I gZ-0q, Exp. Date: 02- r:? ° 'S° ARCHITECT/ENGINEER Phone: Address: Reg. No. 5"�r�� FEE SCHEDULE;BULDING PERMIT;$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: j FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractols do not have access to the guaranty ficnd Signature of Agent/O � , Signature of contractor ii Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPYOF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swinuning Pools El Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM ,, PLANNING & DEVELOPMENT Reviewed On ��' �' �` Signature_ � y,�Gl�L2 ; � CN COMMENTS i ', ;: ✓ n.. _r;>�, 4 s ,.}< rG, z ,,� CCONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature._ Zx< fly 1 � COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt sAmitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ! Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 2- SG LO& S*Vt-CA-- i rint PROPERTY OWNER I�V i Z� J = L � - L Or Print MAP NO: i QC A PARCEL: GA ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential `,Mew Building ❑ One family Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement XrAssessory Bldg 17 N<Othersp ❑ Demolition ❑ Other Septic D Well ❑Floodplaui Wetlands ❑ Watershed District El Water/Sewer DIES C MUITION OF WORD TO EE PEl O �-.D: i OWNER: Name: ''&C"vo 4�5 �� »'�� Phone. f Address: 1 p- (,0 Q/yvk 5� �i � 'MA- CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER �J lP" ` G''��0 Phone: 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: $ 120 FEE: $ Check No.: - Receipt No.: NOTE: Persons contracting �i e ed contractors do not have access to the guaranty fund Signature ofAgent/gwner_ v S!gnafure of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan FAA Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well Tobacco Sales ❑ Food Packaging/Sales El Private(septic tank,etc. xf Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT` ❑ ❑ COMMENTS C 0 N SERVA T 10N Reviewed on Siclnat re 1� COMMENTS p ,Y HEALTH Reviewed on ��" c l Signature j COMMENTS V es Lr--� 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 DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Cil O r Z Al — — - — — m r ~ �49x O a I � I vI � o I 1 U z Z w ° O Z I I I 'o co T z p0 co rn I x - N m o° I I I I I 9.5' u z > a m n o c) III I I i �c cnz m z ,( m o° �O O 04 I N O° (gyp Oi I o by cn I Ill ma' mO �N+ � Q I I I I >< I I I I I ACT' \ \ -u C,4 Z`WQ\ \ \ ca 'm=-:::;;i:i':%r 'i'i'i':%Cis Z ° - oo �. 0 ^0 < O + 0C) 9b �) O O Z —>m rm 44 V)x 90*W T b mm �• m