HomeMy WebLinkAboutApplication - 100 SUTTON HILL ROAD 5/3/2016 YaoF?Tr,
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION A
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Permit No#: Date Received
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Date Issued:
IMPORTANT: Applicant must this complete all items on this page s page
LOCATION 1,06 Sy_PtbK �l l l� �� /A tt 11 r ® l a qs
PROPERTY OWNER r g�- i 61, P 'l f f v120 � 0 51c
Print 117 100 Ye r Structure yes no
MAP §7 PARCEL: 13 ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential _ Non- Residential
❑ New Building A One family
)KAddition ❑ Two or more family ❑ Industrial
X Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑ Assessory Bldg ❑ Others:
Demolition ❑ Other
❑;Septic ❑Well District
1/VterfSewer
DESCRIPTION OF WORK TO BE PERFORMED:
dcy (,s -ice -r 01-164 w-aev- gr v-04- d
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Identification - Please TJP)vm014_1 e or Print early
OWNER- Name: CO..,- V S)Ck Phone: '307-110
Address: !off ( K /71 �1 � A . &0f ye,, l �y
Contractor Name: `ll�a c v 9' S Phone:
Email' 5 ;:) ;1 3 ?_8 6 -,+- ,L c a
Address: L 4
Supervisor's Construction License: ff-07 7 Exp. Date.- /7
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Home Improvement License: `7 7 Exp. Date.
ARCHITECT/ENGINEERICtA� I Phone: q7`° 6S - q75_f
Address: qo& �ykiAg Wood, lQ Dg4Reg. No. 32-U2-
FEE SCHEDULE:BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost.- $ 1301000 FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with as iregistered contr actors coo not have access to the gaarar antyfund
liana sir QfAc eat/_Q tner Simafure of c:ontrartor °"
Plans Submitted C Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sever Tanning/Massage/Body Axe ❑ Swimming Pools ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Peimanent Dwrupster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On 5 &—* Signafiura_
coMMENTS Ae �or
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
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
DPW Town E n eer: Signature:
_ Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dinensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, Mast- or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
MOTES and DATk— (For departure,ent uase)
LEI Notified for pickup Call Email
Date Time Contact Name
Doc-Building Permit Revised 2014