HomeMy WebLinkAboutApplication - 199 STONECLEAVE ROAD 4/30/2008 .............
BUILDING PERMIT o*No oT"wti
TOWN OF NORTH ANDOVER oa �`''' =` �0
APPLICATION FOR PLAN EXAMINATIO
Permit NO: Date Received A°RA7EU APP �g
I �SSACHUSE�
Date Issued:
IMPORTANT::Applicant must complete all items on this page
LOCATION
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PROPERTY OWNER,r�
MAP_NO: .1 PARCEL. `ZONING DISTRICT Historic District yes no?
Machine.Shop Village yes
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
5epti WeN Flood plain. Wetlands ; Watershed District .
ater/Sewer-'
DESCRIPTION OF WORK TO BE.PREFO ED.'
Identification Plea o Type or Print Clearly)
OWNER: Name: r� e.r' �i ss Phone: �8= fig
Address �� szsG`GE�f°2 �• rC— �, t
CONTRACTOR NamE../C�,� y i�' dI Phone:
Address
Supervisor's Constru.clion License. Ex '
Home drn,provern `License Exp. Qate:
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: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Ouuner gnature o f contractor
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art Swimming Pools
Well 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 Signature
COMMENTS G�C� C.�C GLC ( �S j y ✓'`�'. i C�C% � `G�
HEALTH Reviewed on d Signature
HEALTH
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Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
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Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit w
DPW Town Engineer: Signature: ,
Located 384 Osgood Street
FIRE`DEPARTMENT Temp:Durnpster on it yes not
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Locatedt 124 Mam Street ,
Fire Department signature/date
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.:COMMENTS. . .. .. ::..