HomeMy WebLinkAboutApplication - 594 BOXFORD STREET 10/2/2006 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION �NORF�
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Permit NO: Date Received—4 4
Date Issued:
SACHUS !
IMPORTANT: Applicant must complete all items on this page
LOCATION G� I7 ix U 7
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PROPERTY OWNER P,�CI J
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MAP NO.: �( j PARCEL: -76 ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building E ne family
❑ Addition ❑ Two or more family ❑ Industrial
CvAlteration No. of units:
❑ Repair, replacement ❑ Assessory Bldg ❑Commercial
❑ Demolition
❑ Moving(relocation) ❑ Other ❑ Others:
Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
tL S1/S
X, /)/u�� 0-2e,A-)6 l�.t.)611/1 r Lr�<< � ��S i (° i�t��r f°�
Identification Please Type or Print Clearly)
OWNER: Name: �r i�fi S Phone• "1"2, - -3 7-7('1C�j
Address: `� /l �"%k� '1,�
CONTRACTOR Name: �1 �rJ ;tIF ✓( > }/' ' ,G 'I Phone• Z�,fir-° ' -6611 0
Address: ( ,�,�;z,��J l T �'J A' ��' % �..� �r �✓1.�2 1� J ( P 72I- �yI q2
Supervisor's Construction License: Exp. Date: 7?
Home Improvement License: �. Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$12.5.00 PER S.F.
Total Project Cost S %' '5-)31 FEE:$
Check No.: Receipt No.:
Page Iut4
TYPE OF SEWERAGE DISPOSAL Swimming Pools
Tanning/Massage/Body Art
Public Sewer
Tobacco Sales Food Packaging/Sales ❑
Well ❑
Permanent Dumpster on Site
Private(septic tank, etc. Electric Meter location to
project
NOTE: Persons contractin with nregistered contractors do not have access to the g[ f n7 frrn,
Signature of gen fbwner �, C� Signature of contract r ,,.
Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF- U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED-))
HEALTH ❑ ❑ It
COMMENTS %4"
FIRE DEPARTMENT - Temp Dumpster on site yes no
Fire Department signature/date
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