HomeMy WebLinkAboutBuilding Permit #Exception - 112 STONECLEAVE ROAD 5/1/2018 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: Date Receiveda�!
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION �L Print
PROPERTY
PROPERTY OWNER Cl-'aLs ►-t-s+er, Unit#
Print
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no
r.. Machine Shop Village yes o
100 year-old structure yes n
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building '�One family
l.Addition ❑Two or more family ❑ Industrial
W-Alteration No. of units: ❑ Commercial _
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
-Septic ❑'Well ❑F.loodplaiu, 0 Wetlands: D VJatersliediDistrief
Wat /Sewer
t
DESCRIPTION OF WORK TO BE PERFORMED:
(Identification Please Type or Print Clearly)
OWNER: Name: Phone: c14C- `2,,d 3 c\%-(
Address: A,
CONTRACTOR Name: VO-11--Z Phone:
Address:
Supervisor's Construction License: 05-3 U 1�!!N_ Exp. Date:
Home Improvement License: � O LCA '2*4 Exp. Date: �.�.
ARCHITECT/ENGINEER $4� vii-�., ,.�, :t hone: S;5_
Address: S_fj -.s� t:i,�. �..�.► t�Ja 6---J--Re 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: $ V2,0 . Vv FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner
Signature of contractor ,�
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 - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
'CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Le
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
DPW Town Engineer: Signature:
Located 384 OscLood 2treet
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS