HomeMy WebLinkAboutBuilding Permit #234-15 - 1504 SALEM STREET 9/4/2014 (3) ( BUILDING PERMIT DNORTH
. O2 y�t LED.hb q•yO�
TOWN OF NORTH ANDOVER Y
APPLICATION FOR PLAN EXAMINATION
4A -
0IAI
• 1•
Permit No#: L Date ReceivedTED �5
�gSSACHLIS
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATIONS,-
-
PROPERTY OWNER `✓Z-19
- GFrint 100 Year Structurees no
Y- ,
MAP PARCEL --__ _ ZONING DISTRICT: Historic District yes no
IMaetine Shop Village yes no
_ s -
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ne family
❑Addition ❑Two or more family ❑ Industrial
P<Iteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
11:Septic El Well ❑ Floodplain El Wetlands El 'Watershed 1113istr4cA
DESCRIPTI N OF WOFK TO BE PERFORMED:
I IfW34 BA--Wfe9- USIA)(, C i4W�N/�G &S&76I7-aALIW/wG SYS
Z X 2 Nor' C��L��x_ )CIk4sw /fT 7 2
Room M �3E uJ� r95 I
�IGAJ 1601-h
64;z
ation- Please Type or Print Clearly
OWNER: Name: 5as2f� Phone: `l79 ZS fl"
Address: /SCX/ —Sfc,607 Sn
Con :1/
tractor•Name ��!rlLc)�_ Rhone: --7V- ??/ S- � 7- _ __ _
Address CQ O ``>FF�J1Jnlar
I
Supervisor's Construction License:_ `7�LGI __ JExp.
Home 1mprovemerit�License 9 3 Exp., 1pate -n Z �s�__
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
1 Project Cost: G• FEE:
Tota � $ $
Check No.: Receipt No.:
NOTE: Persons contracting reregistered contractors do not have access t the uaranty fund
Signature o .Agen Owner _ Signature of contractor
Sb y SY�Z Ewl
ok
- ----------------
TF�as -01 Nia�
I��r � rte►+ Y�G�7(?cz��n
ISTWS
MOON NMI
IN�� e IN 0IN IN IMMmMMM
Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer 7 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 % Si natur�.
COMMENTS -'
HEALTH Reviewed on Signature
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 Town Engineer: Signature:
Located 384 Osgood Street
fFIREDEPARTMENT TempFD.umpsterron site eyes _ no yu
ILoeated.at 124Nain Street -
FirezDepartmentsignature/date -