HomeMy WebLinkAboutBuilding Permit #Exception - 1525 (Lot 3) Forest Street 5/1/2018 TOV&' OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
+ Date Issued:
t
IMPORTANT:Applicant must com lete all items on this page
j LOCATION V5;L-5;
i Print
PROPERTY OWNERzc...c�� ���
j - Print
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no
��o�\tea. � •-c���-���<. �
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\
®,Sfeptic ®well ~ )Floodpla n'I , 1AM Wq lands#,V ® urate-�'rsliedlDi trig
_ e di tk WatWS wets '"� �: , s °'
ILI
DESCRIPTION
<O�F WORK TO BE PERFORMED: '
Identification Please Type or Print Clearly)
OWNER: Name: (Rya.,r.,z, ae Wk----A Phone
Address:
CONTRACTOR Name: C�v� ,,,. `�c��—`�nAc� Phone: 3�4�
5(�3
Address: `'��
Supervisor's Construction License: Q,� Exp. Date: �-a;-- zeg�-'Z
jHome Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 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
Signature_oftAgent/Owne"r ; Signature of:contractor - i
{
l
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
[Well
YPE OF SEWERAGE DISPOSAL
ublic Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑
❑ Tobacco Sales ❑
Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑
i
i
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
M R
E
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on i. `� L I Signature
4
COMMENTS �(�- 1 �{7 —C_�ns �cA 3 i c( i►
HEALTH Reviewed on Si, nature
COMME
NTS � oq v
i
i
I
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
j
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no i4
Located at 124 Main Street
Fire Department signature/date
COMMENTS