HomeMy WebLinkAboutBuilding Permit #Exception - 352 FOSTER STREET 5/1/2018 i
1 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION "0 RTFI
P-0
Permit NO: Date Received
q�^ATPD
Date Issued: 9sSArse,U
IMPORTANT: Applicant must complete all items on this page 1
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LOCATION oST x:42
Print
PROPERTY OWNER 4
Print
MAP NO.: 1041 RCEL: 9::" ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑New Building ❑ One family
Addition ❑Two or more family ❑ Industrial
N/Alteration No. of units:
i
❑ Repair, replacement ❑ Assessory Bldg ❑ Commercial
❑ Demolition
❑ Moving(relocation) ❑ Other ❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
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`iv� 'Lo s� flGG�
Identification Please Type or Print Clearly)
OWNER: Name: o La ti 'l' 'w C� \-S �A Phone: a'7 - 4,'Z-s 3-
Address:
CONTRACTOR Name: Phone: d 3-3 ,� �,�tm"� 3•, X 1 h�7
Address: 2�. C- `I x')--,J is n Ian,,I
Supervisor's Construction License: c z> Exp. Date: 'Ci<j
Home Improvement License: 1�, Exp. Date: �� 121 '�o
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER 51000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost :$ (.,- 5 o r , FEES
Check No.: Receipt No.:
Page Iof4
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TYPE OF SEWERAGE DISPOSAL
Tanning/Massage/Body Art ❑ Swimming Pools 11Public Sewer F1
Tobacco Sales ❑ Food Packaging/Sales ❑
Well ❑
Permanent Dumpster on Site ❑
Private(septic tank,etc. Electric Meter location to
project
NOTE: Persons contracting with unregistered con actors do not have access to the guarantyfund
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Signature o Agen wner� Signature of contracto�tL�_,,_
Plans Submitted ElPlans Waived El Certified Plot Plan F1 Stamped Stamped Plans
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF- U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
ATE REJECTED DATE APPROVED
CONSERVATI
COMMENTSU4M
_PDA REJECTE ` DAT PROVED
HEALTH b /O i /�G'❑ 1/ Z-� v
COMMENTS
z/l Q fi✓� Gd'^Gpyp - ! v7�,�,�c �...�.�zs t� !r; // t-G� �-
FI1 DEPARTMENT/-Temp Dumpster on site yes no P
Fire Department signature/date
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
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Conservation Decision: Comments
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Water&Sewer connection/Signature& Date Drivewav Permit {
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION "�RT 61ti
Permit NO: Date Received %C. (p- �� , ;
w'
Date Issued: �'9SSgcHus
IMPORTANT: Applicant must complete all items on this page
i
LOCATIONo� ,�
Print
PROPERTY OWNER
Print
MAP NO.: /07 RCEL: Ct ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑New Building ❑ One family
Addition ❑Two or more family ❑ Industrial
N/Alteration No. of units:
❑ Repair, replacement ❑ Assessory Bldg ❑ Commer(-;-'
❑ Demolition
❑ Moving(relocation) ❑ Other ,
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
Identification Please Type k
OWNER: Name: o s
Address:
CONTRACTOR Name:
Address: � �, �.� i:3`I �2� � a
Supervisor's Construction License: c o�E:- L �.
Home Improvement License: Exp. Date: (C 1 ( o�• ,
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost :$ (,� S o r , FEE:$
Check No.: Receipt No.:
Page W4