HomeMy WebLinkAboutBuilding Permit #Exception - 135 RALEIGH TAVERN LANE 5/1/2018 (5) BUILDING PERMIT NORTH
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Permit NO: ~ '�
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Date Received
Date Issued: -------- 0 Argo
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TYPE OF IMPROVEMENT
PROPOSED USE I
❑ New Building Residential
ne family Non- Residential
VAddition ❑ Two or more family_5 Alteration y ❑ Industrial
❑ Repair, replacementNo. of units:
11 Demolition ❑DemolitiAssessory Bldg 11 Commercial
n ❑ Other ❑ Others i
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Identification Please Ty a or Print Clearly) t 0611 I 1� 64OWNER: Name:
Addres5 Cl N46ey«Phone: J I
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ARCHITECT/ENGINEER
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FEE SCHEDULE:BOLD/NG PERM/T.•$12.00 PER$1000.00 OF THE TOTq eg. NO.
rotal Project Cost:
L EST/MATED COST BASED ON$125.00 PER S.F.
$ �a`�f ��(�� �, a
FEE: $
:heck No.: i
'OTE: Persons contractsReceipt No.:
with unregistered contractors do not have access to the guaranty
ignature of Agent/owner
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF -U FORM
Th
of DATE REJECTED DATE APPROVED
R PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
/ COMMENTS_j,
DATE REJECTED DATE APPROVED
X HEALTH ❑Jjl���& �U 1 q�c�,oC�(
COMMENTS 2- /;,;'
TYPE OF SEWERAGE DISPOSAL
Public Sewer C Tanning/Massage/Body Art ❑ Swimming Pools ❑
Well L] Tobacco Sales Food Packaging/Sales r7
Private(septic tank,etc. ❑ Permanent Dumpster on Site FJ
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 Tem Durn sten on s►ts ryes £ ' ' h
"Locatw at 124 Mairi Street g x }
Ftre Departmen# signature/date
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COMMENTS3 F —
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.s100-$1000 fine
NOTES and DATA— For department use
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❑ Notified for pickup-- -Date
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Doc-Building Permit Revised 2007
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