HomeMy WebLinkAboutApplication - 315 SOUTH BRADFORD STREET 3/21/2016 e1ORTy
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TOWN OF NORTH ANDOVER !
APPLICATION FOR PLAN EXAMINATI N m�
Permit N®: Date Received 4
7 Y .0
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Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
Pri t
PROPERTY OWNER M t CA)M � 'rY)6
Print
MAP NO: PARCEL. ZONING DISTRICT.----_,—Historic District yes n
Machine Shop Village yes o
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
Addition Two or more family E Industrial
❑
Alteration No'. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg 11 Others:
E Demolition C Other
❑ Septic ❑Well ❑ Floodplain , ❑Wetlands ❑ Watershed District
❑Water/Sewer
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Ci d ,K ' e Qr (S i",. .J,e(F dot !�C
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a r)1 122 CQl
Identification Please Type or Print Clearly)
OWNER: Name: t C c� .1Y� 1 Phone: �� ' °v� �iJ
Address:
CONTRACTOR Name: C Phone: q7R- l R'
Address:
�, A o n - r 6
Supervisor's Construction License: Exp. Date:
® lho
Horne Improvement License: ;Exp. Date:
ARCHITECT/ENGINEER V t% joj4 6 Phone:
Address: �I C'6�► � ir"� 'fC< ,�a it �Ylrr Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ _ _ FEE: $ �'.
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
0
Signature of Agent/Owner Signature of contractor
Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art ❑ Swimming 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 ❑ a ❑
C MENTS
CONSERVATION ❑ ❑
MMENTS
DATE REJECTED DAfTE APPR VED
HEALTH ❑
1---� MMENTS �� i ((/�, C
P: i
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
Located at 384 Osgood Street
FIRE DEPARTMENT -Temp Dumpster on si#e,; yes no
Located at;124 Main Street
Fire-Department=signature/date'
COMMENTS