HomeMy WebLinkAboutBuilding Permit # 7/14/2016 -------....... -----------
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BUILDING PERMIT 04 p�ED .1
TOWN OF NORTH ANDOVER 0
APPLICATION FOR PLAN EXAMINATION 4
Permit No#: Date Received 'rev
CHUS
Date Issued:
1--, -PORTANT: Applicant must complete all items on this page
LOCATION AnA r
Print
PROPERTY OWNER )v 'r A"
Print 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT:, -_..--_Historic District yes n)o
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
E New Building 0 One family
E Addition ❑ Two or more family El Industrial
F.1 Alteration No. of units: ["J Commercial
,XRepair, replacement 11 Assessory Bldg Li Others:
E Demolition 11 Other
DESCRIPT[q OF WORK TO BE PERFORMED:
2"idi
A]c
...............
ype
Identification- Please T Print Clearly
or
OWNER: Name: vskot��,:�, 'I , Ln, Phonel-I -(&2,-
Address:
Contractor Name: 0A 31
................
Email , t�n 0,
Addres* 10.1 1 .....T"L"4-�t�.Jai Le (I-Ir 4t 119, 0 D14 t2 ,
Supervisor's Construction License: _Exp. Date:
LHome Improvement License: �a ?"00 Exp. Date:_ 3124,
-----------�_�__
ARCHITECT/ENGINEER [L'J'ri,316L Phone:
Address: 9 aLL-k, (,,id4 ' Reg. No.
FEE SCHEDULE. BULDING PERMIT:$12.00 PER$1000.00 04HE TOTALISTIMATED COST BASED ON$125,00 PER S.F.
TotalProject Cost: $ —FEE: $
Check No.: b Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have cac to the guaijaityfund
.........
SJ hature- rq
e
r Plans Submitted ❑ Pians Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
FPablhic-Sewer
OF SEWERAGE DISPOSAL
❑ Tannine MassagelBody A-it ❑ Swimming Pools ❑❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Pzivate(septic tank, etc. ❑ Ponnanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL, SIGN OFF m U FORM
I
PLANNING DEVELOPMENT Reviewed On ��Z�t � Signatures
i
C MMEN T 5 � Cb�C
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on' Si nature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decisionlreceipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/s nature&t)ate Drivewa Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
SIRE DEPARTIMIIENT° Terrtp Dempster onsite ,yes. no:
Lacafed at i24 Main Street
F'�re<Department signatureldate �
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COMMENTS.
tAORTy
Town of 3? _ _ Andover
0 �. „�., 0
-2,o 11
* h ver, Mass
C9e Net„E wrCM e.
,4
ATE
s u
BOARD OF HEALTH
Food/Kitchen
P E D Septic System
THIS CERTIFIES THAT BUILDING INSPECTOR
....:......................................... ........ .�.......... .�4... . ... ........... .....'.........
�1„. ....�E� Foundation
has permission to erect .......................... buildings on .... ...........,
Rough
to be occupied as .............
... Chimney
provided that the person acc n his permit shall in eve ryrespect conform to the terms of e�application
Final
on file in this office, andtothe provisions of the Codes andUy-Laws rel4in��the InspyytionAlt t* nand
Construction of Buildings in the Town of North An over. i �� PLUMBING INSPECTOR
Rough
VIOLATION of the Zoning or Building Regulations Voids this Per . Final
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONS TI® Rough
Service
. .. ... 46i�--iai
Fina]
CTOR
GAS INSPECTOR
Occupancy Permit Required t® Occupy BuRough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
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