HomeMy WebLinkAboutBuilding Permit #Exception - 25 CEDAR LANE 5/3/2016 BUILDING PERMIT oNoozrH w.
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TOWN OF NORTH ANDOVER �2 "'.— ._•.,. 6
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received ZrEt)
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Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATIONL—� � `
Print
PROPERTY OWNERS�t ; �� P=te r, 00 Year Structure yess�
MAP r0(0 PARCEL: I ZONING DISTRICT: 1� Historic District yes n
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
WRepair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
,e/►-�- - ,/� DESCRIPTION OF /WORK TO BE PERFORMED: t.
C-11 o1J t F,T 2, nG&✓4 f
Identification- Please Type or Print Clearly _
OWNER: Name: D C,t � P�ccs �, Phone: �(� �9.-Z
Address: ` AJ, d chr r@
Contractor Name: ffe.,Pn (,cv?.5rJ-1 T rff'f 6L) Phone:
Email: Sc les ,, t- /,a t 6" e
Address: 1� n '
Supervisor's Construction License: 0 166.9/ Exp. Date: LS
Home Improvement License:. 10'i '93 Exp. Date:
ARCHITECT/ENGINEER 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: $� FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access tot u r°n fund
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swh m'ng 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 - U FORM
JPLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
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r
CONSERVATION Reviewed on Signature c r
COMMENTS
HEALTH Reviewed o Signature -zd
COMMENTS (' ��
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Drivewav Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp,Dumpster on site yes. no.!._ _
Locatedsat 124Wain3treet
Fire'Depai finentzignature/tlate
COMMENTS