HomeMy WebLinkAboutMiscellaneous - 65 STANTON WAY 8/10/2015 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT Applicant must complete all items on this page
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TYPE OF IMPROVEMENT- PROPOSED USE
Residential Non- Residential
ew Building XOne family
❑Addition ❑Two or more family 11 Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
L Se tic ❑Well Floodplaln ❑,Wetlands ❑ Watershed Dlstnct 1..ate
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DESCRIPTION OF WORK TO BE PERFORMED:
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Identification Please Type or Print Clearly)
OWNER: Name: 'L2 %c G;�'��J i- 6b, Phone: z - 2T 2v
Address:
CONTRACTOR hone , ,
Addreess T }Fyt 75 aLSt
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Supervisor°s Construction License � j�l . � Exp =Date#
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Home Improvement L.Icense Exp
ARCHITECT/ENGINEER_ :.'N�y �1�/ iv' Phone: ? �121 9sr5,9
Address: -5 6'0 �-
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-� .�y�, �c,�,3�r.1���; /�%� Reg. No. 30
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00.OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER SA
Total Project Gost: $_ � � FEE:
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Check No.: ..... .. . Receipt No.:
NOTE: Persons contracting with unregistered) ontractors do not have access to the guaranty fund
Sig.nature:of Agent/Owner .-igrlature of contractor
Plan-, .lf ihmiff zri Planc XA/nivr�rl I- r nrWinrl Pln+ Plan aF-4' Q+mmninrl Plmnc I
Plans Submitted 3K Plans Waived ❑ Certified Plot Plan Stamped Plans
-TYPE OF--SEWERAGED3SPOSAL
Public Sewer Tanning/MassageBodyArt ❑. .. Swimining Pools ❑
Well �. -Tobacco.-Sales Food Packaging/Sales ❑
Private(septic tank, etc._ _ Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR-OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U.FORM
REJECTED DATEAPPROVED
PLANNING'& DEVELOPMENT - ❑ ❑ l 1 q A Lr�.
COMMENTS C-U 0,"a"-0--
.CONSERVATION Reviewed on Si mature
COMMENTS-
HEALTH Reviewed o - Sign
COMMENTS ��..;-� �� -,-I>
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes ..
Planning Board Decision: Comments
Conservation Decision: ,Commen
Water Sewer C®nnec$ton/Si natur & D Driveway Permit
DPW Tow;! Engineer: Signature:
747) Located 384 Osgood Street
-FIRE DEPARTMf NT - Temp Dumpster on site yes no
Located'at 124 Main Street
Fire Qepafinent signature/date
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions._
:Total land area; sq. ft.: 3
ELECTRICAL: Movement of Meter location, rust or service drop requires approval of
Electrical Inspector . Yes No
DANGER ZONE LITERATURE: Yes No
MGL-Chapter-466 Section 21A=F and G min.$100-$1000 fine
NOTES and DATA— (For department use
U Notified for pickup - Date
Doo.Building Permit Revised 2010
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