HomeMy WebLinkAboutApplication - 72 PATTON LANE 6/28/2012 I3UILDING PERMIT o�"�°T bAti
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received �,R°oR`"""Pa°�5 rep
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Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION
Print
-'PROPERTY OUWER . L�_/K I (A
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MAP NO PARCEL WW ZONING DISTRICT. -Historic District ye Q
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Village .ye
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
Addition Two or more family Industrial
Alteration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other -'J1VKW-t
Septic Well _... Floodplain lands Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED
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Identification Please Type or Print Clearly)
OWNER: Name: , �{ Phone:
Address: J2 KAI9,J L4A
CONTRACTOR Name: - ,Ih QUit .-Phonell
Address:-'7a c�v-�Y C� t �� l:__L%� W i i 3'
Supervisor's Cori struction License: 0,(03,11) -Exp. Date:
Home Improvement.Licerise: i� 2-04 ENp. Date: . °1 -3 .13= ,
ARCHITECT/ENGINEER- - S Phone: 7�" "7
Address S f° Del Ai-- (.)(q L`3 Reg. No. �D((0,3
FEE SCHEDULE.BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ 43 3'00 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 qtr „ter h
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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
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on 7 Signature
COMMENTS �J � 5 �4
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: f
Located 384 Osgood Street
-FIRE DEPARTMENT :Temp Dumpster on site. .yes no
Located at 124 Main Street
Fire Department signature/date R rr
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