HomeMy WebLinkAboutApplication - 53 OLD CART WAY 10/18/2012 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: ` Date Received
Date Issu d `
IMPORTANT:Applicant must complete all items on this page
LOCATION l U.a (t &t kn
Print:,
PROPERTY OWNER ((� h
Prlp 100 Year'01d Structure yes rio,-
�MAP NO: PARCEL: ZONING DISTRICT: Historic D strict y es
no
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 0KAssessory Bldg -3bQ ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
A � s Phone:
OWNER: Name: �.
Address: L
CONTRACTOR Name Phone:,
Address:
Supervisor's Construction License: Exp. Date:
Home;Improvement License: Exp. Date:
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: $ u o FEE:
Check No.: �� � Receipt No.: c >,�12 _,
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty ficnd
Signature of Agent/Owne 9��Siianature of contractor
Plans Submitted ❑ Pans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Plans 5ubrnitted ❑ 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
J
HEALTH Reviewed on r' O l L°'/�f Signature
COMMENTS
Zoning Board of Appeals:variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water ids Sewer Connection/Signature Date Driveway Permit
]DPW Town]Engineer: Signature: —
Located 384 Osgood Street .
FIRE DEPARTMENT Te mp Dumpster on site yes no
Located at'124 Main Street
Fire Department signature/date —
COMMENTS —
1 r
i
BENCHMARK:
NAIL IN TRIPLE 10" OAK
ELEVATION = 214.00'
PVC VENT PIPE
IP� W/ CARBON FILTER
�Q (o Cp 4" SOLID PVC MANIFOLD
1 I \
-
o� 41 F j 1 41 \
ALL LEACHING TRENCHES I
ARE 4' WIDE.
12'
15.1 15.6'
26 d
CONCRETE DISTRIBUTION
BOX WITH INLET TEE
c
70
S29-
F S �
•F
ASSESSOR MAP 107B PARCEL 29
PAUL AND MARYANN MAUS
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