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HomeMy WebLinkAboutBuilding Permit #Exception - 35 HOLLOW TREE LANE 5/1/2018 e► + ORTN.. of , .o ••11.0 p TOWN OF NORTH ANDOVER *.e APPLICATION FOR PLAN EXAMINATION �SSwcHus�� it 07 Permit NO: Date Received: 02 02 Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 24! Av/� rint � PROPERTY OWNER �/.� � � Print MAP NO.: PARCEL: ZONIN DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential ❑New Building ne family "ddition ❑Two or more family C Industrial C Alteration No. of units: E Repair, replacement ❑ Assessory Bldg ❑Commercial E Demolition ❑ Moving(relocation) ❑Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) OWNER: Name: /���� /.CJS/ i�v��yZ/,' Phone: Address: /�c� ����/ �',C'- �' �1e- CONTRACTOR Name: /V6,0441 Address: Supervisor's Construction License: Exp. Date: Home Improvement License: / Exp. Date: ARCHITECT/ENGINEER .,60nrJ'��� Name: Phone: '73" �/`�CA Address: Reg. No. FEE SCHEDULE:BULDING PERMI .$10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON 5125.00 PER S.F. Total Project Cost :$ —x10.00=FEE:$ Check No.: Receipt No.: Pa-e W4 TYPE OF SEWARGE DISPOSAL Swimming Pools ❑ ❑ Tanning/Massage/Body Art F1Public Sewer ❑ Tobacco Sales Food Packaging/Sales ❑ Well ❑ Permanent Dumpster on Site Private(septic tank,etc. � Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner ,� ` �,,•t Signature of Contractor Plans Submitted ©� Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATIO ❑ � COMMENTS DATE REJECTEDDATE APPROVED HEALTH ❑ —317 COMMENTS Aq c, .`� g,rr.,zf> Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer connection signature&date Temp Dumpster on site yes_no_ Fire Department signature/date Building Permit Approved and Issued by: Page 2 off Ik,I11 i .t40Shc�iS 64 MYJti� '-dl_W;S - Y AvV4 _ klu tit ti Jf 10���1 10 000' 01