HomeMy WebLinkAboutBuilding Permit #Exception - 170 LACY STREET 5/1/2018 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT:Applicant must complete all items on this page
_LOCATION �f ��C� ,S� 1'L`da. � /r.� R.�c�ci✓Q
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PROPERTY OWNER f d1,4,,,c t/ /.'I— y I i/, -- Unit# - —
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MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
100 year-old structure yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ne family
❑Addition ❑Two or more family ❑ Industrial
0 Alteration No. of units: ❑ Commercial
EAft'Cpair, replacement ❑Assessory Bldg 0 Others:
❑ Demolition 0 Other
D Septic ❑Well' 11" oodplaih, O:Wetlands. O Watershed Di"sfricf•
Water/Sewer,v;
DESCRIPTION OF WORK TO BE PERFORMED:
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Identification Please Type or Print Clearly)
OWNER: Name: G rfc cY Phone:CV)"U to
Address:_ 1 j -6�5- 73�
CONTRACTOR Name: Phone:
Address: 12—A �,�, �.J � L.l�u-A 64ti , .
Supervisor's Construction License: Exp. Date: 7 1,C-
Home
f--Home Improvement License: 7 yf Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No. _
FEE SCHEDULE:BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total project Cost: $_ f-'f/fr, C/--
FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner . - - -
.- . _ Si�natiire of contractor, '
Plans 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. ❑ Permanent Dump ster on Site El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
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COMMENTS
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t CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
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COMMENTS -7
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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
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS