HomeMy WebLinkAboutBuilding Permit #Exception - 15 WINTERGREEN DRIVE 5/1/2018 NORTH
BUILDING PERMIT 0*ISI-F0 ,6'9M�
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Permit No#: Date Received
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Date Issued:
IMPORTANT: Applicant must complete all items on this page
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Print 10D,Year Structure yes o.. E
EMAP _.��PARCE_L: — z ZONING�DIS� RICT:_,_� �� Historic ®isttict yes, i .
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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
0 Septic ❑1NeIh ❑`Floodplaint DAWetlands,g V1/atershedpDistnct
0 Wateoewer
DESCRIPTION OF WQRK iTO BE PERFORME
I�jntification- Please Type or Print Clearly
OWNER: Name: Jam Phone: —, -73
Address: iso ZJ AfJJ - 01
ContraetorfName _ _ _ Phone:,,___
Address:
Supervisors --i'onstruction License =_ Exp;
Home Ilrrproement;Licensez __ � Exp':� Date;m
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ARCHITECT/ENGINEER Phone:
Address: Reg. 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: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
'Signatu-re otAgent/Owner g
Si nature of contractor____
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Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE'bF 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
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
//7/
HEALTH Reviewed on Signature
COMMENTS /'91
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
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FIRE DEPARTMENT TemptDum rsterronKsite_• yesE �� �LnooTWE6 a
s ood Street
Locatpd,at 124:�Mam Street -
Fire'D'epartmentsignature%date.
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