HomeMy WebLinkAboutBuilding Permit #Exception - 1500 Forest Street 5/1/2018 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received d43
Date Issued:
IMPORTANT:Applicant must complete all items on this page
L►,OC-ATiI ONI ��C�C� R.--s�' MA D 1� -
I Pnnt
� ,L AiA0 � i°�KRQFERTYfVVNERM �fcr �4CPQt
' c Pnnt� yes, no;
MAF�NOPARC,EL ZONING�DIS�TRICaT: I;iistonc�Distnct yes nog
Macliir�e Shop VL illage: 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 (�Af )&oJ 9-H6 ❑ Others:
❑ Demolition ❑ Other
t x _. r i'
❑ Septic3 OVUe'Ilr '' I ❑iFloodplain ®V1/etlands> , Watershed,Distnct=
t 0mvater/Svwerj
DESCRIPTION OF WORK TO BE PERFORMED:
cir9Ri
Identification Please Type or Print Clearly)
OWNER: Name: MAt2.t-, ip-cLSf) T Phone: q?V gyq- — q2 ,77
pIL&S
��� J`t l�l 6 1 e
Address: � o /LIOP-'T� AeUD J66
i C®NTRAC:T®R' Name �F�S F(7(Z }� 54 i i�S Phone:.
- -T
Supervisor=s ConstructibmLi nse_;, Ekp! Date- .
HiomejImproyement;License. Exp
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 guarantyfund
Signature of Agent/Owner Siginature'of contractor
0
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamaed Plans ❑
I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ 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 J&16EVELOPMENT ❑ ❑
CO MENTS
CONSERVATION Reviewed on �'� 13 Signature
COMMENTS
HEALTH Reviewed on 3 Si nature
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
DPW Tow;! ]Engineer: Signature:
Osgood Street
Located 384 _
FIRE DtPAATMENT - Temp Dumpster on site yes no
Located at 124 Mair`.- set
Fire Depa'ttriierit-signature/date
COMMENTS