HomeMy WebLinkAboutBuilding Permit #Exception - 22 FULLER ROAD 9/18/2006 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATIONNORTH
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Permit NO: Date Received (�
Date Issued:
SAC HUSE���
IMPORTANT: Applicant must complete all items on this page
LOCATION__
Print
PROPERTY OWNER %J� "r.` .4 t—t..' '- 1J
Prii r
MAP NO.: 7 PARCEL: ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
G New Building One family i
:Addition ❑ Two or more family ❑ Industrial
'Alteration No. of units:
E. Repair, replacement C Assessory Bldg ❑ Commercial
Demolition
Movin (relocation) �j Other ❑ Others:
Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
s
Identification Please Type or Print Clearly)
OWNER: Name:
Address:
CONTRACTOR Name:
v
Address: T—
'
Supervisor's Construction License: i Exp. Date: 7 1 l ID �
Home Improvement License: Exp. Date: -t_
ARCHITECT/ENFriN'EER Name: Phone:__
Address: . ^-3 ^_�,:_,»a 1 �. t,�.� <. r l.?`. Reg. No.
FEE SCHEDULE:BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost :$__ 1 1I/ FEES
Check No.: Receipt No.:
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TYPE OF SEWERAGE DISPOSAL
Tanning/Massage/Body Art ❑ Swimming Pools
Public Sewer ❑
Tobacco Sales Food Packaging/Sales C
Well ❑ o
Permanent Dumpster on Site Li
Private(septic tank,etc. Electric Meter location to ;
project
NOTE: Persons contracting with unregistered ntractors do not have access to the guaranty fund
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Signature of Agent/Owner Signature of contractor
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Plans Submitted Plans Waived Certified Plot Plan El Stamped Plan
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF- U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
yDATE REJECTED DATE APPROVED
CONSERVATIOr x
\ COMMENT ,, t 1 • �'
DA JECTED D12 PPROVED
HEALTH .< El �U Z
/V r7
COMMENTS ,..
FIRE DEPARTMENT - Temp Dumpster on site yes no
Fire Department signature/date
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water&Sewer connect ioniSignature& Date Driveway Permit