HomeMy WebLinkAboutBuilding Permit #078-14 - 250 CLARK STREET 7/23/2013 tAORTH
BUILDING PERMIT 3? 4`T`�t°'' 6!6 0
% r TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINA :
Permit NO: Date Received Z'?j i3
aDate Issued: J -� SgACHUSE
IMPORTANT:Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
**K-ew Building ❑ One family
❑Addition ❑ Two or more family ❑ Industrial
❑Alteration No. of units: 9-ftmmercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
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Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
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ARCHITECT/ENGINEERlD4v N?.,'<Nr5yw Phone: G _14L18 'S-S->Z
Address: `7 Cpvcov-c\ J1j)c Cc m6v-t-cic Y Reg. No. /W'>5
FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ �Oo57c1,Z` � G� FEE: $ a Q `7/•
Check No.: � Receipt No.:___A, a
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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Location
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No. — �y Date -7 2� j
• - TOWN OF NORTH ANDOVER
f Certificate of Occupancy $
" Building/Frame Permit Fee $/7
Foundation Permit Fee $
Other Permit Fee $ _
TOTAL 7/
Check#
I' uilding Inspector
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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 - U FORM
DATE REJECTED DATE PROVED
PLANNING & DEVELOPMENT ❑ ❑ /Yff h 5,0F
COMENTS
CONSERVATION ❑
COMMENTS P `4
DATE REJECTED DATE APPRO D
L/1 EALTH ❑
COMMENTS /
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:6�Z Commentsa lleOl
Conservation Decision: Comments Irl
Water&-Sewer-Connection/si nature& Date A I+k J Driveway Permit
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