HomeMy WebLinkAboutApplication - 540 BOXFORD STREET 5/4/2015 NORTJ-j A•
BUILDING PERMIT O� Ct LEA q41,
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Permit Not#: Date Received �1s 41ATEO�,P
SACHUS
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION 5Yo o' r0 o � ,� �0-
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PROPERTY OWNER L
A
Print 100 Year Structure yes
MAP PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes 0-
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
"ew Building ne family
[I Addition 11 Two or more family 11 Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition
❑ Other
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f ,r�� f2 r y: >o ® WateSrlEd Dist(�ct,/ry
20- �jj e Flood lain,. rUVetlands x
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,DESCRIPTION OF WORK TO BE PERFORMED:
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Identification- Please Type or Print Clearly
OWNER: Name: 4 Phone:
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Address: i L )�
Contractor Name: _ <' I t r Phone: I p
Email {mow”
Address: 10 s � {� a ` r �., �� �'
Supervisor's Construction License: C a g)" Exp. Date:
Home Improvement License: i�t Exp. Date:
ARCHITECT/ENGINEER ��� i'• Phone:
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Address:/?g --S J, Ce-arce4naw PAnIR eg. No.° Z,7:z6
FEE SCHEDULE,BULDING PERMIT:$12.00 PER$1000.00 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
Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tannwg/Massage/B ody Art ❑ Swhumipgpools ❑
Well
Tobacco Sales
Private(septic tank, etc. Food Packaging/Sales ❑
.Permanent Dumpstex on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN ®P� CORM
PLANNING & DEVELOPMENT Reviewed On
------ Signature—
COMMENTS
CONSERVATION Reviewed on
Signature
COMMENTS
HEALTH Reviewed on
`� Si nature
COMMENT
Oyu
Zoning Board of Appeals:Variance, Petition No: ( S
Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Conservation Decision:
Comments
Water& Seaver Connection/si nafiu � pn e �
DJ 41wa Permit
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]DPW Town.Engineer: Signature: Z/
Located 384 Osg od St eet
FI0t+DEPAR�TP9IENT Temp Durnpsfer on;sit_ es
Located,at 124 Main Street Y
FireDepartrnen�
ga�ure/date
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COMMENTS