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HomeMy WebLinkAboutBuilding Permit #Exception - 144 ROCKY BROOK ROAD 5/1/2018 BUILDING PERMIT 0111 NORTH q 6�t LtD 16• tiO TOWN OF NORTH ANDOVER j APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received AAT.D�•�'<� 9SSgCHU`��� Date Issued: IMPORTANT: Applicant must complete all items on this page ✓R ^.3c4rks'- �. yX4� f 1 �$iv" ur "y j a`�'� 4 717, 05, 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 lfi Ji NO elf I Is n •a,, r c.._- .. xr,-x. �- - -� DESCRIPTION OF WORK TO BE PREFORMED: <..S' >ham}A`f J N?y f �. k Identification Please T pe or Print Clearly) OWNER: Name: �/ /� � ���� Phone' Address: /y�,� R0 el2aeA' 16©440 _ ^ a4,r r z z 3 s zs r Y a - �� 1ddC�yS x �a Fy ARCHITECT/ENGINEER Phone: 7d''' S73 - OPnoi,/ Address: . c�, Jr(/� � �n� .. ;nr / /f��` � �� �' � /� Reg. No. ?5 cq, FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL.ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: FEE: $ f Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have e access to thetyf uaran and g � i Signatrre>of Agen /C�w ..,. - ' d t�nature o1�CantraCtOr � ,� •..- �: Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan i 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 T REJECTED DATE APPROVED yCONSERVATION 1 \_1COMMENTSNb .. C�fG�I Vic!/ 41A DATE REJECTED DAT4AP �/ED HEALTH COMMENTS c zew )DI Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature & Date D4eway Permit Located at 384 Osgood Street FiRL=D' I A i Nt�Nt'G Terns NumPSte���sit� 14 5a -s. r' r�'..z"�.„ � A ,�. <e:r,