HomeMy WebLinkAboutApplication - 224 SUMMER STREET 11/13/2006 f
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received �_ "'"Y * * E
CIO LIM
Date Issued: VAIT40us��� I
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IMPORTANT: Applicant must complete all items on this page
LOCATION
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Print
PROPERTY OWNER 1 4 Q-kn
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MAP NO.:_PARCEL: y ZONING DISTRICT:
TYPE AND USE OF BUILDING - . -------- - -HISTORIC DISTRICT YES ❑ i
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑New Building ❑One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units:
❑ Repair, replacement ❑Assessory Bldg ❑Commercial
❑ Demolition i
❑ Moving(relocation) ❑Other ❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
I D x l Z 0-A&Oor G�Y-
IdentiGcation Please Type or Print Clearly)
OWNER: Name:_Vlrr-, 2S�t _,... Phone:
Address: a?c9Y Syn,rti-,c-r S�
CONTRACTOR Name: bs� W �w ,r -� N �- Phone:
Address: SJ�D Q J
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE:BULDINC_fERMIT.•512.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost :$ 3t49 -4 5- FEE:$
Check No.: Receipt No.:
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TYPE OF SEWERAGE DISPOSAL Swimming Pools 11 11 Tanning/MassagelBody Art ❑ g
Public Sewer
Well
Tobacco Sales Food Packaging/Sales ❑
❑
Permanent Dempster on Site ❑
Private(septic tank,etc, ❑ Electric Meter location to
project
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plat Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF- U FORM
DATE REJECTED -DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
TE REJECTED DATE APPROVED
CONSERVATI -1 ,20 20 ,
COMMENTS
DATE REJECTED DA PPROVED
HEALTH ❑ ❑ 112-71z> L I
COMMENTS z__ -'-"
FIRE DEPARTMENT - Temp Dumpster on site yes n
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Fire Department signature/date
COMMENTS
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Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
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Conservation Decision: Comments
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Water& Sewer Connection/Si nature& Date Driveway Permit
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I CE�'T/F/ED PLOT PLAN
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PL 4N CONFOlelW5 TO TAE ONLY ,dND 4RE NOT TO BE 4 FLOOD
ZON/NG BY--L4W,5 OF T,�lE USED TO EST4BG/S,U Reo - 114Z4/PD
ZONE.