HomeMy WebLinkAboutApplication - 97 SAW MILL ROAD 5/6/2015 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION �- J 1q-4l 4-t I L
Print
PROPERTY OWNER ,tq A/Z y /,-o R- T-7- 46172e09 2y
Print 100 Year Old structure yes no
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
0 Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement 0 Assessory Bldg ❑ Others:
0 Demolition ❑ Other
0 Septic []Well ❑ Floodplain 0 Wetlands ❑ Watershed District
0 Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
�B6 7—/ /Y- 5 14 N /� o� � � JET _7D 7-
Identification Please Type or Print Clearly)
OWNER: Name: _A414-211 /-/vti/�A/, v- Phone:
Address:
CONTRACTOR Name:& Phone: 9
Address:
Supervisor's Construction License: �� Exp. Date:
Home Improvement License: lo 17 i� D Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ ��O 9 zd - FEE: $
Check No.: Receipt No.:
NOTE:EPersons contracting ivith unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Plars Suornitted ❑ 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 e U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature ,
U
COMMENTS ) �'�� ! C �' V1 ��7 ALL-�.
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Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Seaver Connection/Signature& Date Driveway Permit
DPW Towi_Engineer: Signature:
Located 384 Osciood Street
FIRE DEPARTMENT = Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signatureldate
.COMMENTS
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