HomeMy WebLinkAboutBuilding Permit #Exception - 103 FULLER ROAD 5/1/2018 pORTt�
1
DING PERMITA. ao
TOWN OF NORTH ANDOVER ° ` 7D
APPLICATION FOR PLAN EXAMINATION Ia
IK
Permit NO: Date Received °+ •
�9SS�c►+us
Date Issued:
IMPORTANT:Applicant must com Tete all items on this page
LOCATION 3 v I c-rz /C �� vc V_
PROPERTY OWNER -
Pdnt
MAP NO: _PARCEL: 2-ZONING DISTRICT: Historic District _yes- no .
Machine Shop Village -yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building KOne family
❑Addition ❑Two or more family ❑ Industrial
-9 Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition v Other 0%-)�sovor f;-L"s c
❑Septic ❑Well Floodplain. ❑Wetlands 0 Watershed District
❑Water/Sewer
,V,-7v
cAlictn�.
Identification Please Type or Print Clearly)
OWNER: Name: _ kesL ti/ % `ftp Phone'
Address: /C� /—v1 JLC � A �rr
CONTRACTOR Name: Phone:
Address: Z _ ,r.
V.
ALT MY
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date: it
Ifo 4. d
ARCHITECT/ENGINEER 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.:
NOXat4re
Persons contracting w' u gistered contractors do not have access to the guaranty fu""rid
Sig of Agent/Ovu _ Signature,of contractor
Plans Submitted,❑ Plans Waived ❑ Certif ed Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
❑ Tan ing/Massage/SodyArt ❑ SwnmuingPools El
Sewer I
Well Tobacco Sales ❑ Food Packaging/Sales ❑--A ;
Private(septic tank,etc. Pennanent Dumpster on Site
❑ I
I
THE FOLLOWING SECTIONS FOR. OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF e U FORM
PLANNING & DEVELOPMENT Reviewed Op Signature_
COMMENTS
L
CONSERVATION Reviewed on Signature
COMMENTS
V Si nab re C� .
EALTH Reviewed on i
C M TS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
'i
Conservation Decision: Comments
Wafter& Sewer Connection/Si nature& Date Driveway Permit
] PW Town Engineer: Signature: Located 384 Osgood Street
RE DEPARTMENT Temp
o
pste� .
I urn nn sib n®
. , �Ye a tit R x,•s � c��
S�T
Loi`cat d at�1►2„4 am S�reeti
,
Fire Departmeri swigure/date
s .ry
COMMENTS ` _ _