HomeMy WebLinkAboutBuilding Permit #Exception - 1010 JOHNSON STREET 5/1/2018 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received 91/Vl�
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION 1016
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PROPERTY OWNER t1n0 4esD'IJ Unit#
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MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
100 year-old structure yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residen 'al Non- Residential
❑ New Building [�Z e family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
_67 tlailds
II]'Water(Sewer
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DESCRIPTION OF WORK TO BE PERFORMED:
7 6M PO 2A64} (2_ 1�41vip F20.-1 j�'a.2,c T-D
Identification Please Type or Print Clearly)
OWNER: Name:
Identification
e rm a Phone:
Address: 10 u) ro A/V So ✓ c�
CONTRACTOR Name: /� = �i.�SS�✓/ Phone: 7�'/' S6- i2�
Address: C/� 0�,V Spv✓ ; -, N.
Supervisor's Construction License: -S %f� �� Exp. Date: 12-- Z6, Z,Dl
Home Improvement License: 2 Z, Exp. Date: Z l Z b t Z.._
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ `fS(�0 FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature19_rAgent/Owner °.�i.: t '°`Sianature.of..contractorjt, ." '
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF a U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature--<_7
<_ 7
COMMENTS 1170
PIzz, C� 2
Zbhing Board of Appeals:Variance,-Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS i