HomeMy WebLinkAboutBuilding Permit #Exception - 1025 OSGOOD STREET 5/1/2018 (3) 1 .
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BUILDING PERMIT 14ORTH
�TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION _ z
Permit NO: Date Received ^°+4 •.'��
Date Issued:
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IMPORTANT Applicant must complete all items on this
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building .}NTi52%cR ❑ One family
❑ Addition FIT U Vo ❑ Two or more family ❑ Industrial
❑ Alteration Nor. of units: 'Commercial
❑ Repair, replacement ❑ Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
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DESCRIPTION OF WORK TO BE PREFORMED
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Identification Please Type or Print Clearly)
OWNER: Name: DOJO n/ c. Phone: 7J- Of of J
Address '� �J
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ARCHITECT/ENGINEER M� tJ CTS. 'CE-�tl�Z� SNC Phone: �Y7 tf—
Address:,;�O 4 y�; U� MA o t4Sl Reg. No. SSS¢
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: 1$ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fund
Signature of Aran#ItYwrs�r
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL,
Public Sewer �.s 0'. ,� -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 - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APP VED
HEALTH Elt1-17- -71
COMMENTS
Zoning 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
Located at 384 Osgood Street
FIRE DEPARTMENT =Temp Dulmpsteron site..yes na
Located at 124 MainStreet. r..
Fire Department szgnatureldate