HomeMy WebLinkAboutApplication - 50 ROCKY BROOK ROAD 5/31/2006 NORTH
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A TOWN OF NORTH ANDOVER 1
APPLICATION FOR PLAN EXAMINATION
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Permit NO: Date Received:
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION 19b c ' Q)
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PROPERTY OWNER yam` -(" L- I-,k �` `� " "0
Print
MAP NO.: ;fit PARCEL: `n ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
'Addition ❑ Two or more family ❑ Industrial I;
❑ Alteration No. of units;
L Repair, replacement ❑ Assessory Bldg ❑ Commercial
❑ Demolition
❑ Moving(relocation) Other ❑ Others: r
F. Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
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Identification Please Type or Print Clearly)
OWNER: Name: \ .�' 1—� L-k r > > Phone:
Address: ' C4 0c
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CONTRACTOR Name: -�:> ��; � � C`c' �...I� � Phone:
Address: I'aT (il� ir�2r, 1 . _'f- ( � ,� 1 � �� b 1`�
Supervisor's Construction License: Exp. Date:
Home.Improvement License: r Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.$10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASpD ON$12.5.00 PER S.F.
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Total Project Cost :$ `�'� xI0.00=FEE:$ `
Check No.: Receipt No.:
P;ige 144
TYPE OF SEWARGE DISPOSAL Swimming Pools
Public Sewer
Tanning/Massage/Body Art
�_
Well
Tobacco Sales L I Food Packaging/Sales L�
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Permanent Dwnpster on Site �
Private(septic tank,etc. Electric Meter location to
project
NOTE: Persons contracting with unregistered contractors do not have access to the guara nty.fund
Signature of Agent/Owner Signature of Contractor --
Plans Submitted Plans Waived ❑ Certified Plot Plan X Stampe& Tans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF- U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
❑Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
COMMENTS
I"LG DATE REJECTED DATE APPROVED
CONSERVAT10;k I
COMMENTS ll�'�Ii`V Ir', t' � `I�,�!(Vl t (�❑ �
DATE REJECTED DA E APPROVED
HEALTH ❑ ❑
COMMENTS '- 'T `❑❑ �..�1-� it< 1 c�1L
Zoning Board of Appeals: V'riance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer connection signature&date
Temp Dempster on site yes no Fire Department signature/date
Building Permit Approved and Issued by:
Page 2 of 4
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