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HomeMy WebLinkAboutBuilding Permit #450-14 - 1020 SALEM STREET 11/20/2013 (3) TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: MPORTANT:Applicant must complete all items on this page 4LOCATION © S� S ( _ P.mUJA-atzwt PROPERxTrYy®1NNER�_ _.,_ � m , �� - _ - _ — ��Print' 1o0Year OIdfStructure yes' ono „ "' _ ZONINGi'DISxTRIC _ ,Hlstortc,Dlstr%ct MAP+NO`:°�CJG PARCEL _ yes. -� TYPE OF IMPROVEMENT- PROPOSED USE Residential Non- Residential ❑ New Building X One family Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other v _ _ — D_ ' .Septic 1Nell ., � Floodplaint D Wetlands Watershedistrlct�. I - - Water/Sewer, DESCRI !r'"-- Location 1 lb 3 Date ti +13 No. Identificat% OWNER: Name: % . - TOWN OF NORTH ANDOVER Address: `L� S , - $ ... .-- -_ -• =-=LL-_ � , �, Certificate of Occupancy r • a„ ” Building/Frame Permit Fee $ t ,0-NTRACTOR Name $ Foundation Permit Fee - r i Fee Address: Permit Other P 't F $ TOTAL Supdervsor's,�Gonsfrucfion' License HAD_me•�I"mprovemenf}Llcense _...--,__ Check 3V ARCHITECT/ENGINEER Building Inspector 27123 Address: FEE SCHEDULE:BULDING PERMIT:$12.00 P$000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 49, FEE: $ �--- Check No.: .�_ Receipt No.: 4 -i' NOTE: Persons contrak6g4*tunregixeyed contractors do not have access t t uarantyfund _ Igiatur'e`of,contractor��' '' Plans Submitted ❑ �� Plans Waived ❑ Certified Plot Plan ❑ Stamped Pla s ❑ I Pians Submitted Plans Waived❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE_OF-SEWPRAGEDiSP_OSAL Public Sewer ❑ Tanning/MassageBodyArt ❑.. . .Swimming Pools ❑ Well ❑ To bacco.Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc., ❑. - _:Permanent Dumpster on Site ❑ THE.FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM -....-DATE REJECTED DATE.APPROVED PLAN NING &'DEVELOPMENT ❑ ❑ COMMENTSb :CONSERVATION Reviewed on Signature Me r 9 a­'�- COMMENTS /!t ,wGvj- HEALTH Reviewed on Signature - //, Ll ) 9 13 O , COMMTS Zoning Board of Appeals:Variance, Petition No: Zoning Decisionlreceipt submitted yes Planning Board Decision: Comments Conservation Decision: :Comments Water &_Sewer Connection lSignature Date Driveway Permit DPW Towo Engineer: Signature: Located 384 Osgood Street FIRE-DEPARTMFI\!T - Temp Dumpster on site yes no Located-bt:.124,Main Street -Fire ®epa'rt`me►if sigriatu"re/date COMMENTS