HomeMy WebLinkAboutApplication - 795 JOHNSON STREET 5/6/2008 BUILDING PERMIT OF NORTH
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received—
Ss US
Date Issued:
IMPORTANT: Applicant must complete all items on this page
.00ATON .
PRC3PERTY 01NNER
� Pant
MfP 1N0` PARCEL` zONI'NGISTRICTti�storic Dis#cjct _ yes no
'7 7777
Machine Shop Village -yes -no.. -
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
Addition Two or more family Industrial
Alteration No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
peptic Weil Flo dplaFn ;1Nethnds Wato 66da*id,,
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DESCRIPTION OF WORK TO BE PREFORMED:
' P
Identificatio Plea a Type or Print Clearly)
OWNER: CtJ f P'1 Phone: `�� `C
_ t � Y-,/l,
Address: -�� iVl c 61 9-- "04 Al I/ M/9 (� �
C�'I -TxaCTOR1ame Phone ol
77777-77 77
Adtlress _
Supervisor's Construction"L�cense = Exp tDafie
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: $ qxn FEE: $ �&-�
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature ofi Agent/Owner Signatures of contractor
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art Swimming Pools
Tobacco Sales Food Packaging/Sales
Private(septic tank,etc. Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on �5 7 D 13' Signature
COMMENTS N C) W(?ff C 5 LA_A v VUL\A i iJ
V� dC�C
HEALTH Reviewed on Signature
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 '
F
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE�DEPARTMEI�T Terrap Dutnpster on site yes no ;
F re�D et artrnent seeraaturs/da#e. a
COIVIME S
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