HomeMy WebLinkAboutApplication - 767 JOHNSON STREET 4/3/2006 t,ORTH,A
OF TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received:
Date Issued:
IMPORTANT: Applicant must complete all items on this page
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LOCATION 167-1 Td�)"� t
—T— Print
PROPERTY OWNER 5 h 'IN �,�� 0,);
Print
MAP NO.:' PARCEL: ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES 11
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building >One family
❑Addition U Two or more family E Industrial
AAlteration No. of units:
ru
Repair, replacement L Assessory Bldg J Commercial
Demolition 0 Others:
F Moving(relocation) Other —
—1L Foundation only
DESCRIPTION OF WORK TO BE PREFORMED zC(,;7?,)7,-, zileii - zt�'
Identification Please Type or Print Clearly)
OWNER: Name: P h o n e
Signature
Address: a 7-- To
-? 7
CONTRACTOR Name: T--r--rl
Phone: 7
Address:—a/7 jc,)?h M
Supervisor's Construction License:
_Exp. Date:
Home Improvement License: Exp. Date:
ARC f11TFCT/ENQlNEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PER111T. $10.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASFD ON$125.00 PERS.F.
Total Project Cost :$ x10.00=FEE:$
Check No.: Receipt No.:
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TYPE OF SEWARGE' DISPOSAL
0
TYPE
fanning/Massage/Wady Art
1 Swimming Pools
[PUblic Sewer
We Tobacco Sales
Well Well E Food Packaging/Sales
Private(septic tank,etc. ❑ Permanent Dunipster(.)n Site Electric Meter location to
project
NOTE: Persons contracting Ivilli uni-egistered contractors do not have access to the guaranty.finid
Signature of Agent/Owner .li
i---- Signature of Contractor
Plans Submitted ❑-- Plans/Waived -1 F
Certified Plot Plan Stamped Plans
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF- U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT 0 ❑
F]Water Shed Special Permit
11 Site Plan Special Permit
FJ Other
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION JE �4
COMMENTS
DATE REJECTED DATE AP ROVED
HEALTH
COMMENTS
4n7
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Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision:-----Comments
Conservation Decision:—___ — Com nients
Water& Sewer connection signature&date Fire Department signature/date
Temp Durnpsteron site yes__no___.
Building Permit Approved and Issued by:
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