HomeMy WebLinkAboutApplication - 107 GRANVILLE LANE 9/27/2006 f NOR Ty
` ` T TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
'rSAC HU5E1 ',,..
Permit NO: Date Received:
}
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER
Print
MAP NO.: PARCEL: ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building J-Oiie family
G!,-Adldition ❑ Two or more family ❑ Industrial
1--] Alteration No. of units:
U Repair, replacement ❑ Assessory Bldg ❑ Commercial
[ Demolition
IJ Moving(relocation) ❑ Other ❑ Others:
I Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
Identification Please Type or Print Clearly)
OWNER: Name:
.,I Phone
Signature
Address: Z42 �V/,' 1 ?i'Y/ � ' ',;rJ rti J•_c
CONTRACTOR Name
s
Pho
Address:
Supervisor's Construction License: Exp. Date: .' J
Home Improvement License: /' Exp. Date: . '
9
ARCHITECT/ENGINEER '. ;Name: Phone. 3 ,
Address: Reg. No.
FEE SCHEDULE: 6ULDING PERMIT.$10.00 PER$1000.00 OF THE TOTAL ESTLV,4TED COST BASED ON 5125.00 PER S.F.
Total Project Cost 110.00=FEE:$
Check No.: Receipt No.:
TYPE OF SEWARGE DISPOSAL Swinuning Pools Li
Tanning/Massage/Body Art �_.
Public Sewer -,
Tobacco Sales Food Packaging/Sales J
Well
Permanent Dumpster on Site u
Private (septic tank, etc. Electric Meter location to
project
NOTE: Persons contracting with unregistered contructois rho not have access to the gurrrunty fund
Signature of Agent/Owner Signature of Contractor "''
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 ❑ ❑
❑Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
COMMENTS
ATE REJECTED DATE APPROVED
CONSERVATION
-
3 l covNENT � ��� ❑
DATE REJECTED DATE ROVED
HEALTH ❑ ❑ ��
COMMENTS >. ��
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision: _ _Comments
Conservation Decision: Comments
Water& Sewer connection sil,nature&date _
Temp Dumpster on site yes rio Fire Department signature/date //"/11 i - 0 ` r
Building Permit Approved and Issued by:
BUILDING PERMIT o��t�EO "o
TOWN OF NORTH ANDOVER 0
APPLICATION FOR PLAN EXAMINATION
Date Received °RAT.o
Permit N0:
�9SSACHV`'��
Date Issued:
IMPORTANT: Applicant must complete all items on this page
rl� X f S
.`` �, f y *.r ' r�'" ra >y„,��, N-=,sy.vu`� '4' s'z •'"`f r �' is ,y.,
An
MAP Oi PARCEL_ � OW NO'
l`}i 1G�`' X �stc� c Dl triof yQS
s r a s "s`'i
TYPE OF IMPRO_VEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
ddition 11 Two or more family 11 Industrial
Pr
[I Alteration No. of units: Q Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
i Melt z "u ood lain �lVetlands tl�.aterst'), 1r3�str ct
ON .; i fi 3 y G r
...
DESCRIPTION OF WORK TO E P ORMED
�j .
Identification Please Ty e or Print Clearly)
OWNER: Name: S', -e ,sus .� �.�'-�` Phone: ��-
Address ' -'-15 1,51�'
uJe �s �' o'�rtstaoion x '
S • �
Horny Im�pt'overnent Llcensc�; � „� _
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: $ v2S C U FEE: $
Check No.: Receipt No.:
NOTE: Persons contractrn wit i egistered contractors do not have access to the guaranty fund
n at ure of AgentlOw
Si ne Si nature ofontracor
g_:.
J
j.
f
t
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 El(septic tank,etc. Permanent Dumpster on Site ❑
v
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING &.DEVELOPMENT ❑ ❑
COMMENTS
TE REJECTED DATE APPROVED
CONSERVATIO
�.�.� y,
COMMENTS /ai l I(j PLa 1l nll
DATE REJECTED DAT APPROVED
HEALTH ❑ ❑
COMMENTS S -
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & rJate
Located at 384 Osgood Street Driveway Permit
1=1RE DEPARTMENT Temp Dempster on site ' yes no
Located a 124 Nia�n Street
Fire Department signature/date,