HomeMy WebLinkAboutApplication - 1440 SALEM STREET 9/23/2009 pORT#1
BUILDING PERMIT
TOWN OF NORTH ANDOVER
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APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received /� /2 �� �'° »"D
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Date Issued:
IMPORTANT:Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residenti Non- Residential
New Building ne family
Addition Two or more family Industrial
era ion No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
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DESCRIPTION OF WORK TO BE PREFORMED:
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Identification Please Type or Print dearly)
OWNER: Name: a Phone: &Z-7176— Q �
Address: y
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$12,00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ ow FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Sjgr�a tare f 1�ent/Owher - tgna Wre cif coast ac 4r
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 eptic to 11 etc. Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
_ DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
ONSERVATION Reviewed on Signature
COMMENTS
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HE LTH Reviewed on Z Si nature
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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
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