HomeMy WebLinkAboutApplication - 57 LONG PASTURE ROAD 8/14/2014 0�
BUILDING PERMIT No q•v
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�.LE D Ib O
TOWN OF NORTH ANDOVER -
APPLICATION FOR PLAN EXAMINATION _
Date Received
Permit No#: �,R°°Kure°,P�yRS
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Date Issued:
IMPORTANT:Applicant must complete all items on this page
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LOCATION
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PROPETY 01f11EI'E4 `
Print 100 Year Structure yes no
MAP / PARCEL ZONING DISTRICT: Historic District fires �no no
' Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
El Addition [I Two or more family [I Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑Floodplain ❑Wetlands ❑ Watershed District
❑WaterlSewer
DESCRIPTION OF WORK TO BE PERFORMED:
2__m (2
Identification- Please Type°r Print/Clearly
OWNER: Name: C;� �L� t[z ( ` « ' Phone: 1
Address:
Contractor Name: r, Phone:
Address:
Supervisor's Construction License: Exp., Dater
Horne Improvement License: Exp_ Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
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Total Project Cost: $ I_oDO FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting ivith unregistered contractors do not have access to the guaranty fund
Signature of AgentlOwner . Signature of contractor -
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL El Sv ug pools 0
Public Sewer 11 Tanning/MassageBody Art
Well 0 Tobacco Sales
El Food Packaging/Sales El
Private(septic tank,etc. Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICEUSE ONLY
INTERDEPARTMENTAL SIGN OFF U FOR
/PLANNING & DEVELOPMENT Reviewed
On /_l Signature_
COMMENTS
L Si nature , G
NATION Reviewed on j� -
CONSER
COMMENTS C
57 Si nature
HEALTH
Reviewed on j ,l
COMMENTS c 5 �
Zoning Decision/receipt submitted yes
Zoning Board of Appeals:Variance, Petition No:
Planning Board Decision:
Comments
Conservation Decision:
Comments
Driveway Permit
Water & Sewer Con nection/sig nature& Date
DPW Town Engineer: Signature: Located 384 Osgood Street
rFIRE DEPARTMENT t Temp Dumpster on site yes
no
tl at 124 Main Str
nonartment signature/date
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