HomeMy WebLinkAboutBuilding Permit #842-16 - 101 CROSSBOW LANE 1/27/2016 NORTy
BUILDING PERMIT 0��4,ED /b�tio
<. TOWN OF NORTH ANDOVER 0
APPLICATION FOR PLAN EXAMINATIONIL
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Permit No#:�—" Date Received �ssacED
Hus���5
Date Issued:4�
IMPORTANT:Applicant must complete all items on this page
LOCATION 101 Lan
Point
PROPERTY OWNER �'(`"a}� e�`.N,
Print 1 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
El Addition El Two or more family ❑ Industrial
Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other _
Septic. ❑ W _ ,' ® Flo do plan T O Wetlands g 0 Wa..ur hied 11 rict
�rWate/Sewer `
DESCRIPTION OF WORK TO BE PERFO MED:
Identification- Please Type or Print Clearly
OWNER: Name: Phone: J-7F-70(-'59•'78
Address: I ®� C-noss�®w Line %® A� Nr�,AoOeE' tA� 0 `01p y-S-
Contractor Name: Nekit5'.,,,'11 Se-1�%WS Phone: 7791 '760 2031
Email: Mork P. oe-x\mLamm
Address: oc 1n10 (V\pt 01 �
Supervisor's Construction License: CS 073991 Exp. Date: -7 16
Home Improvement License: t���- 17-91-7'? Exp. Date: 7 1 1 1
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.$92.00 PER$9000.00 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 guaran fund
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TXPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tann iug/Massage/Eody Art ❑ S�ning Pools ❑
Well ❑ Tobacco Sales ❑
❑ food Packaging/Sales ❑
Private(septic tank,eta Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF m U FORM
PLANNING & DEVELOPMENT Reviewed On
Signature
'—
COMMENTS
CONSERVATION Reviewed on
Signature
COMMENTS
HEALTH Reviewed on �
Si nature
COMMENTS6
6&�? 1
,
Zoning Board of Appeals:variance, Petition No:
� iZoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
!Dater& Sewer Connectionlsignature&Date
Driveway Permit
DPW Town Engineer: ,Signature:
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