HomeMy WebLinkAboutApplication - 26 STANTON WAY 6/15/2016 BUILDING PERMIT eao E eTH �A-
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION A
Permit No#: Date Received 3 A°RATED " a5
�SSACHUS��
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION r��o
PROPERTY OWNER
. Print 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT:_ Historic District ye no
Machine Shop Village ye 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 ❑Assessory Bldg El Others:
11 Demolition ;Other ,LuIMM11W-
DES CRIPTION OF WORK TO BE P FORMED:
N ✓)i Lv /Ad M�±
Ide fication- Please Type or Print Clearly
OWNER: Name: I H-/1) Phone:07 � � `t1
Address: Flo �/1/� . he-
Contractor Name: U 5 11 � � Phone: 6Cj3 °
Email f CU , L , `
Address: L' AI4-/M, AW 9)
,
Supervisor's Construction License: (: °/bL—�L , Exp. Date: Qtz�b7
Home Improvement License: �� Exp. Date: fl
ARCHITECT/ENGINEER Phone: 7 —C��Z
Address: 1���� �(- � �/��/�.,�l�- Reg. No.
FEE SCHEDULE:BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ �6 FEE: $
a
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the graaranty fund
-Siq-nature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Swiping Pools ❑
Tanning/Massage/Body Art ❑
Well ❑ Tobacco Sales ❑
Food Packaging/Sales ❑
Private(septic tank,etc. Permanent Diunpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
.7
HEALTH Reviewed on � ' � � � �' Signature
COMMENTS ,:f? j �
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
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIREiDEPA►RTMENT - Temp Dumpster on site .yes no _
Located,at 124,Main Street
Fire Depaftinent signature/date _
COMMENTS