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Home My WebLink AboutApplication - 1049 SALEM STREET 3/9/2016 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION U �d PROPERTY OWNER(' Print-,, Year old Stricture yes no MAO NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no .TYPE OF IMPROVEMENT- PROPOSED USE Residential Non- Residential ,JNew Building One family ❑Addition M Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Veptic El Well El Floodplain 11 Wetlands 11 Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Id ntt}pation PleastTTxpe or Print Clearly) OWNER: Name: '�� C0 J_' C. Phone: q Address: �CAJ-� CONTRACTOR Name: Phone: Address: Supervisor's Construction License`. Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER � �� Phone: Address: X& M44 Reg. No. FEE SCHEDULE:BULDING PERMIT:$12 0 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ C)&U- FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner 4_14�o Signnature of contractor Plans Submitted J Plans V lived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans-Submitted ❑ Plans fNaived 0,; Certified Plot Plan ❑ . Stamped Plans 0 -TYPE O :SEWERAGEDISP-OSAL Public Sewer ❑ Tanning/Massage/Body Art ❑..- .Swimming Pools ❑ Well ❑ _Tobacco.Sales ❑ -k'oodPackaging/Sales ❑ Private:,(septic tank,etc:_ ❑. PermazieintDuinpster on-Site ❑ THE_FOLL®WING SECTIONS FOR*OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM - ...: DATE REJECTED DATE APPR=OVED PLANNING & DEVELOPMENY COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connectionlsignature Date Driveway Permit DPW ToNvl! Engineer: Signature: Located 384 Osgood Street FIR E-DEP=&1RTKENT -Temp Dunip ter on site no Located-at 1N Main Street Fire Departme►it signetuee/date COMMENTS TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: PORTANT: Applicant must complete all items on this page LOCATION (J ' Q e not PROPERTY OWNERS �NC� Print 100 Year Old Structure yes n� MAP NO: ' 10`1D PARCEL: 70 ZONING DISTRICT:�� Historic achine Shop Village yes no M p !TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential New Building ❑ One family ❑ Industrial Addition ❑Two or more family ❑ Commercial ❑Alteration No. of units: ❑Assessor Bldg El Others: ❑ Repair, replacement y ❑ Demolition ❑ Other `❑ Flood lain El Wetlands El Watershed District ❑ Septic ❑Well p ❑Water/Sewer DESCRIPTION OF WORK TO BE°PERFORM � z Now :514[c MJV `� we 11 ►w� Identification Please Type or Print Clearly) .�, ,� Phone: OWNER: Name: 'n N P 1 V i E3 1 D Address: n�— a CONTRACTOR Name: c' J Phone: 7� 1� ® I1p Address: �� Ex Date: O Supervisor's Construction License: (',S'C1I5C3 p Home Improvement License: Exp. Date: N ARCH Phone: L'j7�� "3�v Y� I�ti Address: �� Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COS BASED ON 125.00 S.F. Total Project Cost: $ �C-0—uI tN � FEE: $ (1 Check No.: I ,� `� � � Receipt No.: NOTE: Persons contlactang with un►egistered contYacto�s do not have access to the guaranty fund Signature of Agent/Owner �_Sig nature of contractor C1 lk-niffori ' Plans ed ❑ Certified Plot Plan Stamped Plans � i ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE-OF SEW ERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑. . Swimming Pools ❑ Well ❑,I Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc, L Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF o U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ 1/r��/��I` COMMENTS CONSERVATION Reviewed on 7 / 7 Sig nature COMMENTS HEALTH Reviewed on ` Si nature COMMENTS U � No ' , !(1 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes , Planning Board Decision: Comments Conservation Decision:t L — �1�� Comments Water & Sewer Con necti on/si_q nature Date Driveway Permit DPW T'oiv;. Engineer: Signature: � � �,��t� �� a L � l� >�rw Located' 384 Oscrood street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Departmerit signature/date COMMENTS Dimension 1 Number of Stories: u , Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, roast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes N® MGL Chapter 166 Section 21A-F and G min.$100-$1000 fine NOTES and DATA— (For department use ® Notified for pickup - Date Doc.Building Permit Revised 2010 ® C)- 0 R ® = -h < c � _ : � C CD CL ° CD n ® 0 O- C.) 0 -1- A CPO 0 ° � 0- °� m SbN � m - cn N C _CD 5. O C 0 (n ca � o � !n ° �' n CD oo s ° :r CD ® -i o o. 2: z, U) to o ° I M1 a- 0 � � � � IM1 ° o cD (Q p cn O O CL �. •� ti CD \ CL U) S O �CL -V W -� _4 Z CD lk u o ® �• o ` a cn �. cn ° s CD 'a Z q c CD p CD 0 ® O ®, a p G7 D ° C CD _ Z m ® � v < n Q) p ° ANIOL N Vl 07 T 77 T fn T 77 T 0 '~' C O O' N O 3' O rr cn n =r Q n rD O (D O d ' �\ m i ro s CX Lnm t N --� �. m m n n r \ G