HomeMy WebLinkAboutBuilding Permit #821-14 - 1049 SALEM STREET 5/1/2018 (3) TOWN OF NORTH ANDOVER
W_/ APPLICATION FOR PLAN EXAMINATION
Permit NO: O"�i _/Z Date Received
Date Issued:
IMPORTANT:APP licant must complete all items on this page
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LOCA
TION _ - -
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PROPERTY OWNER Id S t
-" Print= TO Yea 0 true ure yes no -
MAPNO _ _ PARCEL:. _.___.ZONINO DISTRICT; . �Histonc pistrict eyes no
Machine Shop Village yes no f
.TYPE OF IMPROVEMENT. PROPOSED USE
Residential Non- Residential
Xew Building One family
❑Addition Two or more family El Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
eptic
Elwell Floodplain ❑.Wends ❑ UVatershedeDistric..
tla
Water/Sewe(._
DESCRIPTION OF WORK TO BE PERFORMED:
Id n1 ation Please Tape or Print Clearly)
OWNER: Name: �� �_co �^� �- Phone: q
Address: �
CONTRACTOR' iName - -- _ Z.. _ --R YP,hone , --- --
_ SIJ ti � _
Adtltess
___
Supervisor's Construction[Lie
_nem R. Exp
.,
Home ImprovementlL`Icense:.___ Exp
ARCH ITECT/ENGI NEER-7WRAH J Phone:
� , ,o
Address: � Md Reg. No.
FEE SCHEDULE.BULDING PERMIT.$1M0 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ �'3�,o c' FEE: $
Check No.: !�r'o/� Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
S�gature�of contractor.
SI naturexofA ent/Owner Y `
Plans Submitted LF] Plans aived ❑ Certified Plot Plan ❑ Stamped Plans ❑
El
Plans Submitted ❑ Plans Waived:EL: Certified Plot Plan E . Stamped Plans
=.-MY E-:O"EWERAGEDISiOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ .- Swimming Pools ❑
i
Well ❑ -Tobacco.Sales ❑ .Food Packaging/Sales ❑
Private(septic tank,etc:_ . ❑. Permajient D-impster on-Site ❑
-FO
CLO]!!/ING SE
CTI_® S"FOR'OFFICE USE ONLY
,.. THE .
INTERDEPARTMENTAL SIGN OFF - U FORM
_DATE REJECTED DATE:APPR:OVED
PLANNING'& DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes -
Planning Board Decision: Comments
i
Conservation Decision: Comments
Nater & Sewer Connectionlsi�nature Date Driveway Permit
DPW ToNv;! Engineer: Signature:
Located 384 Osgood Street
FIRE DSP-AR TMIENt =Temp Dump:"star on side yes no
Located7at'124,Mair.Street
dire ®epaimerit§igiature/date
COMMENTS