HomeMy WebLinkAboutMiscellaneous - 227 GRANVILLE LANE 3/3/2006 f NORTH
A TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Permit NO:
Date Received:'--'
Date Issued:
IMPORTANT: Applicant must complete all items on this page
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PROPERTY OWNER .J 6 k S C-0 '
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MAP NO.: I (No(J PARCEL: ZONING DISTRICT: Vr
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building 00ne family
/Addition C Two or more family Industrial
Alteration No, of units:
J Repair, replacement C Assessory Bldg C Commercial
J Demolition
Moving(relocation) C Other Lj Others:
Foundation onl
DESCRIPTION OF WORK TO BE PREFORMED
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Identification Please Tyne or Print Clearly)
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OWNER: Name: �J ArYI ( �� Phone• 9�t'r 6f`;& ,TDB 7
Signature
Address: t L t A,�J
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHI'I CT/FNGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT: $10.00 PER S1000.00 OF THE TOTAL ESTMI ATED COST BASED ON
$125.00 PER S.F.
Total Project Cost :$ t-lo x 10.00 =FEE:$
Check No.: Receipt No.:
TYPE OF SEWARGE DISPOSAL
Tannin;/Massage/Body Art Swimmino Pools
Public Sewer i
Tobacco Sales Food Packaging/Sales
Well
Permanent Dumpster on Site
Private(septic tank,etc. '
NOTE: Persons cunlrnclirtgl 1 itk unregisl red cuntrnciors du not/rove nccesc to!/re gunranly fund
Signature. of Agent/Owner ti Signature of Contractor
Plans Submitted ❑ API ns Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF- U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
[]Water Shed Special Pert-nit
❑ Site Plan Special Permit
❑ Other
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ' (✓
COMMENTS L(/f '
'Lill. _
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision: _ Conunents_ _
Conservation Decision: Comments.
Water& Sewer connection signature&date
Temp Dumpster on site yes no_ Fire Department sibnatture,'date
Building Permit Approved and Issued by:
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