HomeMy WebLinkAboutBuilding Permit #Exception - 229 GRAY STREET 5/1/2018 NORTH
BUILDING PERMIT oF�4�eo b�tio
TOWN OF NORTH ANDOVER o
APPLICATION FOR PLAN EXAMINATION *
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Permit No#: Date Received Ss C
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sC 5
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
Srt
Print
PROPERTY OWNER 71 Saj D (10 i` t"'L i
Print 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes. no
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
p Septic Well
Floodplain Wetlands * Watershed + istriet
1Nater/,Sewer _
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: Phone:
Address:
Contractor Name: Phone:
Email:
Address:
Supervisor's Construction License: ::- E*p. Bate-_
Home Improvement License:
1
ARCHITECT/ENGINEER Phone:
Address: Reg. W&L-
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTnWATED,.—GD BWSE '$125.00 PER S.F.
Total Project Cost: $ F`E;$.._
Check No.: Receipt Na
NOTE: Persons contracting with unregistered contractors do not.li?aue:access-to,.:the-:guaranty fund
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Plans 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 m U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTHi
Reviewed ori
Siqnature:e::::K \
COMMENTS /
Zoning Board of Appeals:Variance, Petition No: Zonirig Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer Connection/Signature & Date Driveway Permit
]DPW Town Engineer: Signature:
FIRE DEP4AR�E Located 384 Osgood Street
I NT Tern Dempster on site
Locatl atm 24`IVlain Street+ aY�eS -, `� ono xis is ,'
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