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HomeMy WebLinkAboutBuilding Permit #Exception - 1174 TURNPIKE STREET 5/1/2018 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 7 /� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 'j PROPERTY OWNER J Unit# Print MAP NO: N?A PARCEL: DI ZONING DISTRICT: Historic District yes Machine Shop Village yes 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition [I Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Se tic D Welly , m ®Floodplaml - ®iWetlandsl �W 1femli Distnct _ 1 P 'S DESCRIPTION DESCRIPTION OF WORK TO BE PERFORMED: Ak - (Identification Please Type or Print Clearly) G/ _{�/ 7 L/_ " OWNER: Name: ` '����� ` Phone: a tQ Address: � 'C�( P'\�- - t� �-� n��-V-y}/ CONTRACTOR Name: Phone. Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost:$ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unre istgred contractors do not have access to the guaranty fund Signature:of Agent/OWner,: S_ignature of contractor f Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL; Dimension Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools 0 Number.of Stories: Total square feet of floor area, based on Exterior dimensions. Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Total land area, sq. ft.: Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ ELECTRICAL: Movement of Meter location, mast or service drop requires approval of THE FOLLOWING SECTIONS FOR OFFICE USE ONLY Electrical Inspector Yes No INTERDEPARTMENTAL SIGN OFF - U FORM DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ NOTES and DATA— For department use COMMENTS CONSERVATION Reviewed on Si nature COMMENTS ©I Cl k, '-- Lj '-'& Ia), �'YH15ALTH = . + Reviewed on Signature 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 ❑ Notified for pickup - Date DPW Town Engineer: Signature: — FIRE DEPARTMENT - Temp Dumpster on site yes Located 384 Osgood Street Lno Located at 124 Main Street Doc:.Building Permit Revised 2011 June/mi Fire Department signature/date COMMENTS All 7' QW •;� \ \ 6)e 262 �o l � ✓,. ,- f -.. _ •- ► „���. fit_- " �' Zip LL r}lu 7�iL'yr9 iAIL). -ry Ic I act. 01 Hov I r ►� I.xt-,4 Hillb¢Iye I-►�,-r ►� t a� Pas : ly �.r t