HomeMy WebLinkAboutBuilding Permit #Exception - 2163 TURNPIKE STREET 5/1/2018 Of NORTM 1N _
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION ({�
9SSNCMUSEt ✓
Permit NO: Date Received: b
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION to "1 Ttrn ip �A ,& 4 ( Andauer Ao&x wBvr
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K� „PROPERTY OWNER �p u t !s
Print
MAP NO.: PARCEL: ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑New Building h§(One family
✓Addition ❑Two or more family ❑ Industrial
❑ Alteration No. of units:
❑ Repair, replacement ❑ Assessory Bldg ❑Commercial
❑ Demolition
.❑ Moving(relocation) ❑ Other ❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED '�-64m it nru) 2S 1 30 ` AJA,4,
5 ol, J- 4%, e r S S I—CIS h,&Lo s e 7113 jS
G a c rptl cople/�
Identification Please Type or Print Clearly) '
OWNER: Name: oauj Phone: 4 78 -(04 7-S8 Z 2
Signature
Address: l Co `T-yryyi E p A4.A Ae7Lu a r
CONTRACTOR Name: DO —?It)_,, /1 5664r C t-00 Phone: (-9O'3 ^X&5" 77
Address: l n 1�r't c �Ce-f�s ;// � Wa l!Zp5)ead , 04
Supervisor's Construction License: 5 oo 6(9 y Exp. Date: &1 ti 42, 0c) �
Home Improvement License:— Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.•$1A00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost :$ x10.00=FEE:$
Check No.: Receipt No.:
Pa-e lord
TYPE OF SEWARGE DISPOSAL
Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑
Well Tobacco Sales []
Food Packaging/Sales ❑
Private(septic tank, etc. Permanent Dumpster on Site
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
.Signature of Agent/Owner
Signature of Contractor
Plans Submitted ❑ Plans Waived ❑
Certified,Plot Plan ❑, , Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF- U FORM
PLANNING & DEVELOPMENT
DATE REJECTED DATE APPROVED
❑ �
❑Water Shed Special Permit,
❑ Site Plan Special Permit !
❑ Other
COMMENTS I
DATE REJECTED DATE APPROVED
CONSERVATIO
COMMENTS
2 i
DATE REJECTED= DATE APPROVED I
HEALTH;' ❑
COMMENTS
S'
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer connection signature&date
Temp Dumpster on site yes
_no \ Fire Department signature/date
Building Permit Approved and Issued by:
Page 2 o1'4
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