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Home My WebLink AboutApplication - 14 WINDKIST FARM ROAD 9/3/2013 L cam- 'yA` cam. (:!� ss (-7 7"®�5 t C2 G-S- 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 (/I,LO UC(L- 0 S Print. PROPERTY OWNER_,&�, Pent' 100 Year Old Steucture yes no MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no , TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [I Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: ck-9. Phone: � Address: �� c CONTRACTOR NameSnu,�/, S�,c ae. ��5, Phone: '360 - 641 -�o9 Address: ' cExn'� / � � ��2A-11-J' J Supervisor's Construction License: S - 0� oO I:Q Exp. Date: Home Improvement License: ( 0J� Exp. Date: l ARCHITECT/ENGINEER L� -� b,�11VQ-L�— Phone: - �� D- 00 Address: I/� PLO12-Z j Reg. No. I FEE SCHEDULE.BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �G — FEE: $ Check No.: Receipt No.: NOTE: Persons contracting f itli tin egiste ontt•actors do not have access to the gttaran fund Signature of Agent/Owner Ig, ature of contracto _ Plans Submitted 171 lans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE_OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales 11 Private(septic tank,eta Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROV D PLANNING & DEVELOPMENT Q❑ COMMENTS— '19n: pa 7112 CONSERVATION Reviewed on 2 I �3 Si nature 'l COMMENTS--L HEALTH Reviewed on i Signature COMMENTS L G C Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water a Sewer Connection/ Driveway Permit DPW Towi2 Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located'at 124 Mair, Street Fire Department signature/date COMMENTS TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT.Applicant must complete a ll items on this page e , LOCATION r Pnntr; PROPERTY OWNER r� Print 100 Year Oltl Structure yes PARCEL :ZONING DISTRICT Historic District ;: YeS Mach, achineShopVillage� , yesn TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential ❑ New Building ne family i�Addition Li Two or more family [I Industrial El Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other e tic Well ❑'Floodplain El Wetlands o Watershed District p titer/Sewer DESCRIPTION OF W?RK TO B PERFORM 113(_)i4d A� Z6 X dX k2ci�4_ x2cc—/' Identification pease Ty"r Print Clearly) OWNER: Name: �� 5 Phone: f Address: CONTRACTOR Name: nJ Phone Address: . j�d rv,; ( c Supervisor s Construction License: �" Exp Date Ex Date.. Home Improvement Licenser ( p ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 16 Total Project Cost: $ 6 , C C' C 0 FEE: $ -- Check No.: Receipt No.- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor - _. n — - - --, ni_...- n Plans Submitted-0 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF_SEWERAGEDISPOSAL Public Sewer Tannin Swimmin g/Massage/BodyArt ❑ - g 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 DATE REJECTED- DATE;APPROVED PLANNING & DEVELOPMENT- COMMENTS .CONSERVATION Reviewed on 1 C3 Si nature COMMENTS HEALTH Reviewed on i Si nature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature pate Driveway Permit _ I)PW To-vv;: Engineer: Signature: Located 384 Os ood Street FIRE`D'EPARTMENt 'Terri* Dumpster on site yes no Located at 124 Mair, Street Fire Department signature/date COMMENTS