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Miscellaneous - 64 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 LOCATION s f � fir SPFOPER1'_ OU�/f�IER, � r` sad x . ra✓ � �& S A MAP X10 E PARCEL $r ZONING DISTRICT Historic Distr►cf yes no f_ - , ; MachmeShop Village yes _ no _ - TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential )KNew Building Xone family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Se' tic` 1p Well Floodplaln i]Wetlands _ ❑ Watelshed District ate Sewer ax. DESCRIPTION OF WORK TO BE PERFORMED: So{'!j Identification Please Type r Print Clearly) OWNER: Name: SZ c'c C;L "r may. Phone: 4S Address: )c /�%7 /L4?v� /� : .�✓ ea3 CONTRACTOR Name;. ��A Phone �;��' .5�r � 1 w S Y i Address' y `5{ t z k1l Supervisor's Construction License ��f����"��� Epp 4Da>�e � /� /.� 4 y ARCHITECT/ENGINEER I °N y ���� 0+�' Phone: 6Q.? -/I/ Address: �- �� ;�e� r�' + ����03� �� ; s�a� Reg. No. 3016 FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. �! To#al Project c# Cis#: $ ti.� ��� �°�''' FEE: _Check No;:-. Receipt No.:._ NOTE: Persons contracting with unregistered ontractors do not have access to the guaranay_faancl Signature of Agent/Ownor ,signature of contractor Plans Submitted ❑ . Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted'[] Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE_OF°.SEWERAGE DISPOSAL Public Sewer ❑ T Swimming Pools ❑ anning/MassageBody Art Well Tobacco.Sales ❑ Food Packaging/Sales El Private(septic tank, etc... Permanent Dumpster on Site ❑ THE.FOLLOWING SECTIONS FOR.-OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U.FORM ::. DATE REJECTED DATEAPPROVED PLANNING"& DEVELOPMENf ❑ 6 Z& COMMENTS Y 16 flan �,'OV/0� .CONSERVATION Reviewed on Signature COMMENTS M HEALTH Reviewed on Signature COMMENTS jr t-2- C__L_cilr� l c� Zoning Board of Appeals:Variance, Petition No: Zoning Decisionlreceipt submitted yes __ Planning Board Decision: Comments Conservation Decision: Comments �k 2 2-0- I Water & Sewer Conneotionisi natu &ate Drivewav Permit i DPW Tows! Engineer: Signature: �IN Located 384 Osgood Street SIRE DtPARTMEAT - Temp Duk4ter on site yes no Located"at 124 Mair, Street Fire Depaft.merit signature/date . COMMENTS S� ow 0 F- u z h W LL z W v co W ti O N N z o Y 'O Y �C I OA t1p - Gq CD N O o a 0._,. 3 0 @ C v LL N 4 44, U L.L 2' LL K d' m N N n ,a ' . : ° _ O p V > Lij O � cn a c� o ® �c o ", ° O O �' Z CL s S� Q m N U) O O gv ® p ©: E Oj E CL as O N N .O W c a > UA v' o 'a > V s.. O �. W N _ C �. m o Z N W w AdMIL ccs C V�. .� 3 2 „� � op R 4� CL as t V a� m G1 0 CL c o U) M V (n ' o -0 c (Q I- c L ° 'a o N w � N p o CL N . P O LU W v i CL m ;a a� c _ M ®e o