HomeMy WebLinkAboutBuilding Permit #159-2016 - 33 HAROLD STREET 8/5/2015 r c
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rTJTOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: Date Received
Date Issued:
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IMPORTANT: Applicant must com lete all items on this page
LOCATION 33 S Y
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PROPERTY OWNER l`h
Print
MAP NO:b69 PARCEI-0099 ZONING DISTRICT: Historic District yesno
Machine Shop Village yes fno
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
0 Addition ❑ Two or more family ❑ Industrial
❑ANjation No. of units: ❑ Commercial
epair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition 0 Other
i Septic I Well [ Floodplain i Wetlands I- Watershed District
❑Water/Sewer
Identification Please Type or Print Clearly)
OWNER: Name: 6a%y:i((0 Phone:jft
Address: iE
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CONTRACTOR Name: v'i' a'' Pho : ct,7 �3qz-q2
Address:
Supervisor's Construction Lice se: I� � Exp. Date:
Home Improvement License: Exp. Date:
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE;BOLDING PERMIT;$12.00 PER 00.00 OF THE TOTAL ESTIMATED COST B.QSED ON$125.00 PER S.F.
Total Project Cost G�f /0FEE: $ �—
Check No.: Receipt No..
NOTE: Persons contracting ith u egister contractors do not have acces toWthAra;ntyJfu4,d,
Signature of Agent/Own 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 ❑ ❑
COMENTS
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connect!on/Sig nature&Date Driveway Permit
Loci at 384 Osgood Street
1
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS