HomeMy WebLinkAboutBuilding Permit #Exception - 240 OLD CART WAY 5/29/2015 OORTFf
BUILDING PERMIT o? ` °�
TOWN OF NORTH ANDOVER
I
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received "Arlo
CH 1
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION Print I
PROPERTY OWNER Age1
Print
MAP NO: PARCEL: ZONING DISTRICT: Historicistrict yes 0
Machine Shop Village yes o
TYPE OF IMPROVEMENT PROPOSED USE Non- Residential
Resi ntial
❑ N w Building ne family
❑ Two or more family 11 Industrial
dition ❑ Commercial
Alteration No. of units:
Bldg ❑ Others:
❑ ❑AssessorRepair, replacement y I '�
❑ D olition ❑ Other
eptic El Well ❑ Floodplain ❑Wetlands
❑ Watershed District
❑Water/Sewer
1 2 �f1P�
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po1J iii NG+.� S✓ t�iL,r � A.n S fin! d s
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Identification Please Type or Print Clearly) �C �� L.
OWNER: Name:
i �V / A2
Phone
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Address: �_ 3—y
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Name: $ Phone:'
��ftnJ ,�,�SSA✓t
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` Dovstruction License: Exp. Date.
Exp. Date:ent License:
;� � n Phone:
ARCHITECT/ENGINEER —Reg. No.
Address: ALS
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. i
Total Project Cost: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner 1g�ature of contractor `
t-ians Submitted U Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ `
Tanning/Massage/Body Art ❑ Swinn ing Pools ❑
Well ❑
Tobacco Sales ❑
Private(septic tank,etc. ❑ Food Packaging/Sales ❑
Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
XPLANNING & DEVELOPMENT Reviewed On
Signature
COMMENTS
CONSERVATION Reviewed on (Z J
� � Si nature
COMMENTS )[ a
HEALTH Reviewed o I
Si nature
COMMENTS r t
At�- a f (ran 6, ej
Zoning Board of Appeals:Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Conservation Decision:
Comments
Water& Sewer Connection/si nature& Date
Driveway Permit _
DPW Town Engineer: Signature:
FIRE )Spn;WT�MENT Temp ®umpster�on s to __ Located 384 Osgood Street
_Fire(Deparatmenttsignature/d
COMMENTS..