HomeMy WebLinkAboutBuilding Permit #Exception - 162 HAY MEADOW ROAD 5/1/2018 TOWN OF NORTH ANDOVER NORTH
APPLICATION FOR PLAN EXAMINATION Of,��•° t•��o
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'ermit NO: Date Received
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)ate Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
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PROPERTY OWNER C D : �L&&J 6c
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MAP NO:: I�u 6 PARCEL: ZONING DISTRICT:
' HISTORIC DISTRICT YES ❑
TYPE AND USE OF BUILDING
TYPE or_ PROPOSED USE Non-Residential
Residential
❑New Building 941ne family
❑ Addition ❑Two or more
'family ❑ Industrial !
Alteration No.of units: a
• ❑ Repair, replacement ❑Assessory Bldg ❑Commercial
❑ Demolition
❑ Moving relocation ❑Other ❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
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7X2 Dftleu41& FiNi-WJt7- , (nom 1J/t li,�IS�1 �UR
Identification Please Type or Print Clearly)
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Phone: q
OWNER: Name: �� y�l17ftEZ`>J (9&St"
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Address: to Z M&N4s)) / �7
CONTRACTOR Name: I 2V ;D-A? � # Phone:
-0040
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Address: ql�Q `� PiK6 S1' (��vn aJ /Ylv,'— Zo9Z�U
Supervisor's Construction License: 7 qg 3 Exp. Date: /07:.�
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Home Improvement License: 37g1 Exp. Date: �
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$12.0 $1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER&F.
Total Project Cost :$ 170k FEE:$
Check No.: Receipt No.:
Page I of 4
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TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art E] Swimming Pools ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Permanent Dumpster on Site ❑
Private(septic tank,etc. Electric Meter location to
project
NOTE: Persons contracting with unregistered contractors do not have access to the uarant find
Signature of Agent/Owne Signature of contra to
Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
"_OMMENTS
DATE REJECTED DA PPROVED
HEALTH ❑ Z �p 14 4.
,OMMENTS
IRE DEPARTMENT - Temp Dumpster on site yes no
Fire Department signature/date
'OMMENTS
oning Board of Appeals: Variance,Petition No: Zoning Decision/receipt submitted yes
lanning Board Decision: Comments
onservation Decision: Comments
dater& Sewer Connection/Si¢nature& Date Driveway Permit