HomeMy WebLinkAboutApplication - 162 HAY MEADOW ROAD 12/18/2006 TOWN OF NORTH ANDOVER NORTH
APPLICATION FOR PLAN EXAMINATION Of ,,°� •'��
O
F-
r
c
'ermit NO: Date Received
w.u.
°RA 0►�P�4g
1SSACHUStI
)ate Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
_ t Print
PROPERTY OWNER
Print
MAP NO.:
u 6 PARCEL: ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑New Building ne family
❑ Addition ❑Two or more'family ❑ Industrial
Alteration No.of units:
El Repair, replacement El Assessory Bldg ❑Commercial
❑ Demolition
❑ Movin relocation) ❑Other ❑ Others: {
❑ Foundation onl
DESCRIPTION OF WORK TO BE PREFORMED Y S;fsr
FI►ItSN R4V-»1Ff�/T ltSl/N(7 ( /i•�L��S(rJ�+f a C�l�/ ��)�/JIAv �1 + -
i
rNiS►� jo r " (�1 l`�rl %mil S� �
Identification Please Type or Print Clearly)
OWNER: Name: Phone• y7"I' 6�
Address: 5`I q 7
CONTRACTOR Name: f ' lam SA Phone:
Address Q `� PiK� Sr � -'n,u ►a-• / t2U
Supervisor's Construction License:
0"�71 3 Exp. Date: 073 `07
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.0VER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost :$ 1 7� r FEE:$
Check No.: Receipt No.:
Page I of 4
TYPE OF SEWERAGE DISPOSAL
F1 Tanning/Massage/Body Art ❑ Swimming Pools ❑
Public Sewer
Tobacco Sales
Well El ❑ Food Packaging/Sales ❑
Permanent Dumpster on Site ❑ I
Private(septic tank,etc. Electric Meter location to
project
NOTE: Persons contracting with unregistered contractors do not have access t7theuarant fuld Si nature of A ent/Owne g g Signature of contr
Plans Submitted Plans Waived ❑ Certified E
rt ted Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
4
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑ I
i
COMMENTS
i
i
;
r
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑ +:
--OMMENTS
DATE REJECTED DA PPROVED
WEALTH ❑ 4
,OMMENTS
IRE DEPARTMENT - Temp Dumpster on site yes no
Fire Department signature/date
'OMMENTS
oning Board of Appeals: Variance,Petition No: Zoning Decision/receipt submitted yes
fanning Board Decision: Comments
onservation Decision: Comments
dater& Sewer Connection/Signature& Date Driveway Permit
i
12/18/06 MON 09:45 FAX 617 856 8201 19 REC 1 1 001
TO: North Andover public Health Department
(978) 688-8476
Attention: Sue Sawyer
j FROM: Edwin C. pease
j RE: 162 Hay Meadow Road (Owens Corning Basement
Project)
Attached please find the requested drawing of 162 .play
Meadow Road., North Andover. Should you need
additional information please contact me at work at 617-
856-8453 or on my cell phone at 617-216-6393.
Thanks cry much,
Ed
i
i
_:_... ...........
b001j T DRU 6T TM 929 LT9 XV3 9h:60 NOR 90/9T/ZT
. .............
- -------------
---- - - . J
------------
zoo[a T DEIN dT TOZB 058 LTO XFJ 9f:60' N6Wt 90/8T/ZT
I
I
i
I
i
i
-
I
I
_.... .
I .. ....... .
II
IQ
--7----------
....... ..... ..
-- --------
....... .......
.........
..........
COpC3� T DdH 6T TOZB 929 LT9 XVd 5V:60 NON 90/fT/ZT