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HomeMy WebLinkAboutBuilding Permit #Exception - 21 COTUIT STREET 5/1/2018 il BUILDING PERMIT 3�0 No oT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ~ h Permit No#: Date Received Ac Flu`-+' Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION LOT 7� e u Z 7— Print PROPERTY OWNERiJG7` Print 100 Year Structure yes MAP _Y7 PARCEL:-/ ZONING DISTRICT: Historic District yes Machine Shop Village yes An;o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ,KNew Building ,90ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain XVVetlands ❑ Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: f9�o�7o, �S �G� Phone: 3 Address: G vim/ Dt�'3 Contractor Name �o,�� Phone:3OS2--3--o 9 Address: F? Z!Vf-S' sr• �iL��-� � o l��f ' Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER D,4, lee Q7 ,eco/qS Phone: Address: S ,� �q eTO/�i�f��� /yc�' �,¢LiS ueg. No. 3<3p FEE SCHEDULE.BULDINGPERMIT:$92.00 PER$9000.00 OF THE TOTAESTIMATED COST BASED ON$125.00 PER S.F. . �1 Total Project Cost: $ off S� FEE: $ /©t> Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor �> r tans 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature c ICOMMENTS t e Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments lei Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Gated 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date / COMMENTS