HomeMy WebLinkAboutApplication - 20 BRIDGES LANE 8/13/2009 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
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Date Issued:
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IMPORTANT: Applicant must complete all items on this page
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PROPERTY. OWNER
Print
MAP NO: PARCEL LONIi G_DISTRICT: Historic;District yes 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, replacempp& Assessory Bldg Others:
Demolition Other
Sepfiie Well _Flood*iin Wetlands Watershed District
water/sew,er �.�
DESCRI TION 07, WORK TO. E PERFORM �
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Iditntification Please'Type or Print Clearly)
OWNER: Name: 11-2 Phone: ,(
Address:
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CONTWTOFZ: Narn �'' . :- - Phone ' �L
Acioress `
Supervisor's Consfiruction License t „_ Exp. Date: `°
Home'Improvement'License / Exp, Date: '
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING 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.:
DOTE: Persons contracting with unregistered contractors do not have access to the guaranty fusee'
Signature of Agent/ ;n� Signature of contract
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
BATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
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COMMENTS
y� HEALTH Reviewed on �� f�� � Si natur.
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COMMENTS s
Zoning Board of Appeals: Variance, Petition No: Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
F IRE DEPARTMENT :..-°Temp Dumps er on site ye& no°
Located ate.9 24.Main Street
Fire Do�ar�rr��nt:��g�a�ureldate
COMMENTS
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SUBSURFACE SB AGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION {continued)
Properly Address; ti y
Owner: t t✓ ODuC?
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Date of Inspection:
1 4 ' 1�ci
SKETCH OF SEWAGE DISPOSAL SYSTEM;
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
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