HomeMy WebLinkAboutBuilding Permit #Exception - 266 LACY STREET 5/1/2018 BUILDING PERMIT t%ORTH
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
CHUS
Date Issued:
IMPORTANT:Applicant must complete all items on this page
Vt
E
"P,
fli§tdribl no
h'
op� g
H16 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
Septics :
A
DESCRIPTION OF WORK TO BE PREFORMED:
CA)--(0 U n d P'0(1) L
Identification Pleas Type or Print Clearly)
OWNER: Name:. Azue-ur,._ P. Phone:
Address:
}t'".
,
Aarn o n e
j'.
,Address
44
,xpi',Q6t'
'tl' wl1ib E
_
. i
rn tL1ib6i!§'6; V
P
ARCHITECT/ENGINEER Phone:
Address:
FEE SCHEDULE.BULDING PERMIT.$12,00 PER$1000-00 OF THE TOTAL ESTIMATED COST 8ASED ON$125.00 PER S.F.
Total Project Cost: $ a
Check No.: Receipt No,:;:.-5,
NOTE: Persons contracting with unregistered contractor'sdo, iothaWaccess to the guaranty fund
Si nature, 7-of ._-
cbritradtor,'.
4 n � Wnbt ,-: Si
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYP OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art SwimmingPools
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
CONSERVATION Reviewed on Signature
COMMENTS
EALTH Reviewed on Q Signature
COMMENTS G`S !. J
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 Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT- 'Temp pumpster on site :yes ' "
>no
L666tetlj6t'124 Main Street�`��.r
l -
. partment si re " :..
gnatu ate � -
COMMENTS t
•- - ism..�'�:�p e��.,.
I f
t'
j' ln
f
2 3
i
1
✓�O tJ Q JOSEPH
a ,e
E"X/S 77 IV GI1c .t':ALLO '<
1\ � o•t
1
F[{
t '
1 � .
v1
. t
i
�6 Z A CirS rh'L:: ,�T