HomeMy WebLinkAboutBuilding Permit #Exception - 14 WINDKIST FARM ROAD 5/1/2018 C-N - 1�)c6`S Cf� SSo,
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
(_ 1
LOCATION 0 Ao
Print.
PROPERTY OWNER V110 ,
Print 100 Year Old Structure yes no
MAP NO: _ PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑'Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
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Identification Please Type or Print Clearly)
OWNER: Name: h 5(,o Phone: qg.
Address:
CONTRACTOR NameSouA(/,- SV t O, V tk, Phone:_
Address: _
Supervisor's Construction License: C--,S - 01S7Sb 1QExp. Date:
Home Improvement License: �� �� Exp. Date: z(-4
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ARCH ITECT/ENGINEER �� A D ���1� L. , Phone: D'
Address: 2�) OftZj Reg. No. I
7T
FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ G. FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting litithun egiste ontractors do not have access to the guarantvfiund
Signature of Agent/Owner Ig=_attire of contracto
Plans Submitted ❑ lans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
i
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Il FE. SEWERAGRDISPOSAL
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 APPROV D
PLANNING & DEVELOPMENT ❑
COMMENTS �c n 2 7921
CONSERVATION Reviewed on 13 Signature
COMMENTS t 3r ��;-z s��cc w\ •� yo
00
HEALTH Reviewed on i Signature
COMMENTS
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Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Sipnature& Date Driveway Permit
]DPW Torn;2 Engineer: Signature:
FIRE-DEPARTMENT` - Temp DumLocated 384 Osgood Street
pster on site yes no
Located-at 124 Mair Street
Fire Department signature/date
COMMENTS