HomeMy WebLinkAboutBuilding Permit #Exception - 100 OGUNQUIT ROAD 5/1/2018 TOWN OF NORTH ANDOVER Cf �✓ r,�
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued: )3e- :5a,1'e- 1-� C>L>IC-
IMPORTANT:Applicant must complete all items on this page
1
w: LOCATION, - l_p � D 0C-'UNL- Ut
Print-
PROPERTY OWNER_ _S Dpi�4
Print 100 Year Old Structure yes no
MAP N . A PARCEL: 7 ZONING DISTRICT- Historic District yes no
Machine Sliop Village yes no
.TYPE OF IMPROVEMENT. PROPOSED USE
Resid ntial Non- Residential
New Building One family
0 Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
0 Demolition ❑ Other
❑ Septic ❑Well ry ❑ Floodplain 0 Wetlands ❑ Watershed District
El Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: L)I� l �. Phone:
Address:
CONTRACTOR Name: Dt vfc c //,9 oh Al Phone:6 `7-'�0`24
Address:
Supervisor's Construction License 9 U�'7)43r
Exp. Date: .,`
,.H_ ome Improvement Licens.,. J�
_ Exp. Date:_.
ARCHITECT/ENGINEER l:ru /�� Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED
ON$125.00 PER S.F.
Total Project Cost: $ FEE: $ '-
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature,of QgeRt/Owner Signature of contractor
Plans Submitted i_� Plans Waived ❑ Certified Pint Plan n gtmmnizr4 Plana n
Plans Submitted>� PI'ans�1--aivedEl .'..Certified Plot Plan Stamped Plans 0
:TYPEOESEWERAGE DISPOSAL"
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
Well ❑ _Tobacco.Sales Food Packaging/Sales ❑
-Private(septic tank,etc- . Permanent D unpster on:Site ❑
hC_ ..
-THE_.FOLLOWING SECTIONS FOR,OFFICE.USE ONLY
INTERDEPARTMENTAL SIGN OFF - lJ FORM
..:,DATE REJECTED DATE:APPROVED
PLANNING"& DEVELOPMENT D
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed onSi nature
/y
COMMENTS
_ . r---
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes .
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer C®nr➢ec$io111Si nafure& Dafg% All Driveway Permit
�dZ
DPS'Tovv;2 Engineer: Signature: U
I
Located 384 Osgood Street
FIRE-DERAR�10lI: NT. -Temp Dumpst on site yes: no .
Located-at 124 Mair, Street
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Fire Dei it' A'sigr"t'' /date
COMMENTS