HomeMy WebLinkAboutApplication - 314 REA STREET 6/24/2015 BUILDING PERMIT pT" q
TOWN OF NORTH ANDOVER �� ht�` =''6'6�°
APPLICATION FOR PLAN EXAMINATION
Permit No#: '1� Date Receivedq
� 7 �R'S7ED p4R '(5
Date Issued: �l I �SSACHUSE�
IMPORTANT: Applicant must complete all items on this page
LOCATION 3111 R
,CA SST
Print
PROPERTY OWNER Amy
Print 100 Year Structure yes no
MAP PARCEL: 0/23 ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
a Residential Non- Residential
❑ New Building one family
❑Addition ❑ Two or more family ❑ Industrial
i Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
X Septic , Well ❑ Floodplain ❑Wetlantls ❑ Watersh' Disfnct
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DESCRIPTION OF WORK TO BE PERFORMED:
VA•L.k Ve 14 C u- 25zm sme�D AND my ax A
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Identification- Please Type or Print Clearly
OWNER: Name: Amy C.aAV_CTAieuso Phone:
Address: JUN Kgg sr, /I/dejw Ati&vgg 14A
Contractor Name:_ REvp1 A S Huw Phone: '4gl -6y7o - os/-q
Email: 1< mnia-P KrysaAMex7rovcc< Cow,
Address: G✓, Fp2EsT- ,ST. Wq)CRr1E4[j MA 61RILP
Supervisor's Construction License: GS - Exp. Date: CY,11y_ y�
Home Improvement License: /8'64/;Z?- Exp. Date: Nwgc
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE;BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ f?-S, sIi3 so FEE: $ Slo. AZ
Check No.: ` Receipt No.:
NOTE: 1'ersons contractin- itll un istere d contractors do not have access to the g= a� �fund
iture of cont
of Ad
F�� ;j ubrnifted L1 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans El
TYPE OF SEWERAGE DISPOSAL
assa e/Bod ❑ Swil gPools ❑
w
Public Seer ❑ Tanning/M g Y Art mm
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Pennanent Durapster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE E ONLY
INTERDEPARTMENTAL INTERDEPARTMENTAL SIGN OFF U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Si nature
COMMENT S
HEALTH
Reviewed on i o� Si nature
COMMENTS t
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Panning Board Decision: Comments
Conservation Decision: Comments
Drivewa
Water & Sewer Connection/signature & Date
Permit
DPW Town Engineer: Signature: Located 384 Osgood Street
no
FIRE= DEPARTMENT Temp Dumpster on site yes -
Lecated at 124 Main Street
FireDepartrr"ent` ignturb/date
COMMENTS ' -