HomeMy WebLinkAboutBuilding Permit #Exception - 184 CARLTON LANE 5/1/2018 ti BUILDING PERMIT of N°oT",�a
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,1 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received �� "`"`"C.
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Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION � J4�
Print
PROPERTY OWNER /d2es� G
rint 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes. no
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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
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
ll, , Floodplanr etlantls i : Waters"ed siD tnt
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DESCRIPTION OF WORK TO BE PERFORMED:
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I enti Ycati Please Type or Print Clearly
OWNER: Name: t Phone: '�� op;=4036
40
't4 71
Address: c_�iy� �l,-�r4-- OR4?q ..Agru-e
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Contractor Name: Phone:
Email:
Address:
Supervisor's Construction License: Exp.. Date:
Horde in, License: Exp. Date:
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ARCHITECT/ENGINEER Phone:
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Address: Reg. No.
,FEE SCHEDULE:BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
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Total Project Cost: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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Flans Submitted ❑ Plans Waived ❑ Cerfified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tamdug/MassageBody Art ❑ Switmning Pools ❑
Weil ❑ Tobacco Sales ❑
Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF m U FORM
PLANNING & DEVELOPMENT Reviewed On _ Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on i l� ao �Si nater /
COMMENTS '13 01
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.Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Suer ConnectionDriveway Permit
DPW Town Engineer: Signature:
r e_� x Locate 3 Osgood Street
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North Andover MIMAP May 26, 2015
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—SR Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83,
'- Roads Meters Data Sources:The data for this map was produced by Merrimack
HORTFI Valley Planning Commission(MVPC)using data provided by the Town of
i r Easements pf tt0 North Andover.Additional data provided by the Executive Office of
❑MVPC Boundary - *��t r��`OD Environmental Affairs/Ma.GIS.The information depicted on this map is
Parcels 3 L for planning purposes only.It may not be adequate for legal boundary
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definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER
MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
o 4E - ; THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
ILt + �t OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT
i ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
%�<... �P`�j THIS INFORMATION
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