HomeMy WebLinkAboutBuilding Permit #Exception - 258 BRIDGES LANE 5/1/2018 1
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BUILDING PERMIT 0 �T 6�No
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION ~
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Date Received �,�`0R
Permit N0: �rEo R
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Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATIONS)
Print
PROPERTY OWNER.. a2lClC /-I/Vk U/ 4AI
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MAP 210 PARCEL: . ZONING DISTRICT: Historic District yes. no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building IKOne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
L(Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
Septic ❑Well: ❑ Floodplain -Wetlands' 0 Watershed District-
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
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Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CONTRACTORName:
n't hone: �� 0,7/' )a
77Address:
Supervisor's Construction License: Exp. Date: .. --.
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT;$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON
$925.00 PER S.F.
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Total Project Cost: $ ��coo FEE: '
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor
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 APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
fi CONSERVATION Reviewed on E /-0, Signature
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COMMENTS ,3D,--D J I
HEALTH Reviewed on Signature ., : ' /I/.
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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 Driveway Permit
DPW'gown]Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
,Fire Department signature/date
COMMENTS.
