HomeMy WebLinkAboutBuilding Permit #Exception - 1577 SALEM STREET 5/23/2007 � NORT►y
BUILDING PERMIT
TOWN OF NORTH ANDOVER o�
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received 'Z �" �'-`Are '."
Date Issued:
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IMPORTANT Applicant must complete all items on this p age
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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
V Repair, replacement ❑Assessbry Bldg ❑ Others:
❑ Demolition ❑ Other
10 5111
DESCRIPTION OF WORK TO BE PREFORMED:
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Identification Please Type or Print Clearly)
OWNER: Name: .. 6LA2 i�`►r Jt� Phone: 1`7�- 6 8'`
Address: �Au,C�
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ARCHITECT/ENGINEER f Phone:
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Address: Reg. No.
FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ 4>e) FEE: $ 3
Check No.: Receipt No.:
NOTE: Persons contracts g wh unregistered contractors do not have access to the guaranty fund
Sigiature`of Ag®nt/ nrn�r` Si�rrature ofcoritrefcaY
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
IIS PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
ATE REJECTED DATE APPROVED
CONSERVATION N 2-30WO
COMMENTS 1WQq aS
/ DATE REJECTED DATE APPROVED
HEALTH ElS�ZJ'/Q `7
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COMMENTS14 C-
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Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments i
Conservation Decision: Comments
Water& Sewer-Connection/Si nature&Date DriveW/av Permit
Located at 384 Osgood Street
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