HomeMy WebLinkAboutMiscellaneous - 51 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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PRERY OWNS
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TYPE OF IMPROVEMENT. PROPOSED USE
Residential Non- Residential
ew Building >ipne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement 0 Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
4 Se tic ❑Well r: iY Floo dplaln ❑Wetlands , ❑ Watershe'd�istf ICt
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ate
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type r Print Clearly)
OWNER: Name: A e- ZJ Phone: ev
Address: ��• � /�%7 /L���?►Ym :�-fir /U//-
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visors ConstrucAlon
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Home- lmproverent Lieense
ARCHITECT/ENGINEER—PA L/41y �'Z/ZW Phone: 6C?? VJ1- 9
Address: 9e 4>-, G'��3 ��� � W- Reg. No.- C�/(� f
FEE SCHEDULE;BULD/NG PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
. .Total Project Cost: $ FEE: $ J��
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered ontractors do not have access to the guaranty fund
Signature of Agent/Owner ,, - 'ignature of contractor
PIanS Siihmitfp-HO Plane UVanic�rl F] ('orFi&nA DIM IDI-n V °' C+.,.,-,.- -i o1--- 5��'
Plans Submitted-0 Plans Waived,❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE-OF-SEWERAGE:DISP_OSAL
Public Sewer Tanning/MassageBodyArt ❑. Swimming Pools ❑
Well �. Tobacco.Sales Food Packaging/Sales ❑
Private(septic tank, etc.. Fle" Permanent Dumpster on Site ❑
THE.FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U.FORM
- . DATE REJECTED- DATE APPROVED
PLANNING & DEVELOPMENT' ❑ ❑
COMMENTS
' 1
.CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on
Signature _ F
F.
COMMENTS
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Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes _
Planning Board Decision: Comments
Conservation Decision: aComments
Water & Sewer Connection/Si nature& U4 Drivewa Permit
DPW Towiz Fngineer: Signature:
Located 384 Osgood Street
-'FIRE D-tPARTMENT - Temp Dumpster on site yes no
Located-at 124 Main, Street
Fire Departriie►tt signature/date
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