HomeMy WebLinkAboutApplication - 44 MARIAN DRIVE 12/8/2011 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: s
Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER
l Print Unit#
MAP NO: PARCEL: ZONING DISTRICT:
Historic District yes Qn
Machine Shop Village yes
100 year-old structure yes (!Tl
TYPE OF IMPROVEMENT PROPOSED USE
Residential
El New Residential
New Building El One family
,`Addition ❑Two or more family ❑Industrial
11 Alteration No. of units:
❑ Repair, replacement ❑Assessory Bldg ❑Commercial
❑ Demolition ❑Other ❑ Others:
� ���pfi��❑,Well� s � ''� �►Floodplaint� ®gWe�lands �` "�� ��' "�® �I���' d °�
❑Water/Sewer° �, ° , u ����� �� � � � Wa ershe �Di ct ;
DESCRI�'TION OF WORK TO BE PERFORMED:
(Identification Please Type or Print Clearly)
WNER: Name:
s ~
kddress / Phone:)/ '
:ONTRACTOR Name:
Phone:
.ddress: —A A,c-
apervisor's Construction License:
Exp. Date:
Dme Improvement License:
Exp. Date:
�CHITECT/ENGINEER
Phone:
(dress:
Reg. No.
FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
tal Project Cost: $ c_�� c��a y � C� FEE: $
I
eck No.: .
'TE: Persons contracting with unregistered contractors do not phave access to the uara
g n u
natuofiggent/Q.wner__ - ;Signature ofcontractor -,
"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 ❑
Private(septic tank,etc. f 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 Sig nature
COMMENTS �� 1. -�c�d `, ��l �� (M
i7
HEALTH Reviewed on Si nature.:., ,f
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature&Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT -Temp Dempster on site yes no
Located at 124 Main Street
Fire Department signature/date
CONIIvIENTS