HomeMy WebLinkAboutBuilding Permit #Exception - 199 STONECLEAVE ROAD 5/1/2018 (3) pORTH
BUILDING PERMIT 0 IF �o J6 q+
TOWN OF NORTH ANDOVER 3? 4� - `-4`*° °
APPLICATION FOR PLAN EXAMINATION
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Permit N0: Date Received ° " r✓ - °°�
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Date Issued:. .
IMPORTANT: Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family 1�
Addition Two or more family Industrial
Alteration ✓ No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
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DESCRIPTION OF WORK TO BE PREFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: 4'v'41 S" Phone:
Address: 0;1 C P_,qV 2
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Superujsor's TCo s# cti�r� t cense
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ARCHITECT/ENGINEER AlaW25' Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ '07-4 FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the gu ranty fund
S�gNatere ofer#/Owrer - S�grature ofonractoa�
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art Swimming Pools
Well�(septicwnk,
Tobacco SalesFood Packaging/Sales
Priva . Permanent.Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION
COMMENTS
DATE REJECTED DATEAP VEL �/ 7
HEALTH
COMMENTS_ /( g2 o
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
Located at 384 Osgood Street
ARE DEPA ►RTMNT Terre DumpsteroD site yes }
f �; no
located at 124�Mam Streets
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