HomeMy WebLinkAboutMiscellaneous - 46 STANTON WAY 8/10/2015 FORTH
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BUILDING PERMIT 0
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION * -
Permit NO: Date Received_
Date Issued:
cHUS���y
IMPORTANT: Applicant must complete all items on this page
-- LOCATION L4 eu �
Print
PROPERTY'OWNER - :i° a�t<� ' ' e 6 C.ii-c2�
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MAP,NO PARCEL:_ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Resid ntial Non- Residential
Oew Building w6ne family
❑Addition ❑ Two or more family ❑ Industrial
❑ Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ D molition ❑ Other
ptic 0'1 ell 0 Floodplain i 1Netlands '❑ Watershetl District
Waterew
Identification Please Type or Print Clearly)
OWNER: Name: --2:;Ad. a `y� '` r Phone:
Address:
CONTRACTOR .Name: PhonE' � S°�0
Address:
Supervisor'$-Cons truction License : Exp. Date;
Home IrnprovemenfLicens�: Exp. >ba te
ARCHITECT/ENGINEER 1 2r � Phone:&)-3
Address: --;', e'7-6 .1 , 1rS-- Reg. No. le
FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ �_ � � �'' i�' FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with u eg' red contractors do not have access to t e g saran nd
Signature of Agent/Owne Signature of contractor/ %, �/
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools [I
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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMENTS
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE AP OVED
HEALTH ❑
COMMENTS v
d_-x CP
Zoning Board of Appeals: Variancef Petition No: Zoning Decision/receipt submitted #S
-
Planning Board Decision: Comments
Conservation Decision: Comments
.._� 2
Water & Sewer Connection/Si nature& Date i� Driveway Permit
Located at 384 Osgood Street
EIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
f=ire Department signature/date
COMMENTS
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