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HomeMy WebLinkAboutApplication - 981 JOHNSON STREET 4/11/2016 ORTH BUILDING PERMIT 3r0 s�?�kn TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINA. 10 Permit NO: Date Received S CHI!`��{�y Date Issued: IMPORTANT: Applicant must complete all items on this page � - LOCATION �I c�4HnfSo�( STi2 �1' a1� 5" ririt PROPERTY OWNER . 15 Pant MAP NO �D�.A ' PARCEL ZONING D15TRICT f�2 Historic pistnct yes i�o Machine Shap'U�llage. yep no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition Li Two or more family [I industrial ❑Alteration No, of units: ❑ Commercial 0 Repair, replacement ❑ Assessory Bldg © Others: ❑ Demolition ❑ Other ❑ Septic ❑Wsll Flaodplam ❑lllletlands ❑ Watershed District ❑.INaterlSewer ,► of 15flycr DfOe- Corn&AJF0Ts /4S MAft 5,49E gat VSf- . I NCLUD6 RX&AMME91 OF DEC—ell l} J-AILrW4�s, Identification Please Type or Print Clearly) OWNER: Name: AT 1 R. Phone: Nmr. �WYFA d3 �4� a9d2 Address: rq.sA f,:T Al CONTRACTOR Narne Phone T Sl ! Z 2 Address Supe ion,License Exp Date Horne Improuernent License Exp Date �� ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$122.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ l 6J. FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to t e guaran fund Slgrafiure'of AgentlOwner signature of'contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TX.;r'E OF SEWERAGE DISPOSAL Public,Sewer ❑ Tanning/Massage/BodyArt ❑ Swimm� ngPools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM signaturePLANNING & DEVELOPMENT Reviewed On 9 a s COMMENTS t CONSERVATION .Reviewed on _. _ Signature.. COMMENTS HEALTH Reviewed on Signature r t COMMENTS i (AnlVdi .honing Board of Appeals.Variance, Petition No: Zoning decision/receipt submitted yes Planrning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/�� nature&bate brivewa Permit DPW Town.Engineer: Signature: t �_ I 3 4 Osgood Street -P hip rTernp �um sr#DnEfe Located ono � w �Iy Fas ' v�aCr � k 1y s a2 moms= g r' F}Loc%%Ka. .r.* r" r a 9 da � � kr � fa R w s e7 w ��r NO Y