HomeMy WebLinkAboutBuilding Permit #Exception - 1665 GREAT POND ROAD 5/1/2018 (5) BUILDING PERMIT o� "°oT"
46
TOWN OF NORTH ANDOVER o
APPLICATION FOR PLAN EXAMINATION
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Permit No#: Date Received
q0RA7ED FPpy,(y
S
. SACHUS
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION �o dos Ct�o� frJY �d
'Print
PROPERTY OWNER T k Z L LG
Print ' " 100'Year Structure yes rio
MAP (0z PARCEL:�ZONING DISTRICT: Hiko'nq District yes no
Machine Shop Village yes )
TYPE OF IMPROVEMENT PROPOSED USE C�✓
Residential Non- Residential
''New Building KOne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
peptic 1® ell �r ° ' .$ ® Fl plain' 5 ® W,etlands t $, Watershetl stricf .-
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: TK-2- LLL Phone:Q 7 -05Z-11W
Address: zo l.. N04 \mr M A d l
Contractor Name: /nSl/VLt : Phone: ����j S^Z-- �G�Z
Erna'il: tz ate 4y
Address- .. _ Ir 4
'
Su ervisors Construction License: d �
p � Ex p. Date:
Home Improvement. License: ' Exp. Date:--
ARCHITECT/ENGINEER Phone:-
Address: Reg. No. -a
FEE SCHEDULE:BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $T:3�ll TI n N ny3L-/ FEE: $ ) y0 .0o
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered cont actors do not have access to the guaranty fun
_ia�.y1P *'lA6 �'� v—•�A` rte.Asa... .;w,�.- .¢ ... s.,;..d
Pans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/MassageBody Art ❑ Swimming Pools ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
i
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
WEALTH Reviewed on
COMMENTS 1y� j y f C)- :�R J
Zoning Board of Appeals:Variance, Petition No: 20l(o— o01 Zoning Decision/receipt submitted yes
Planning Board Decision: 511 b Comments Cc"
Conservation Decision:_ NIA, Comments
Water& Sewer Connection/si nature& Date DrivewaV Permit
DPW Town Engineer: Signature: � -/(a
Located 384 Osgood Street
FIRE DEP T Temp Dumps oeontse
Located at 124 Main Street . > F � ' "7-*,te. " � s" "'�� y
x
Fire Departmentature/date : 4 ,. .- N im.eA
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