HomeMy WebLinkAboutBuilding Permit #Exception - 371 PLEASANT STREET 5/1/2018 ORT" q
BUILDING PERMIT 3�°f�``!D
TOWN OF NORTH ANDOVER to :
APPLICATION FOR PLAN EXAMIN #n -
Permit NO: Date Received
79 ORATED PPP��y
Date Issued: Ssgc"usti
IMPORTANT: Applicant must com Tete all items on this age
LOCATION 3'/ 00/eisEinl- S�r? f"
Pdnt
PROPERTY OWNER `Ole
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MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes 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
❑ Septic ❑Well ❑ Floodplain ❑Wetlands" ❑ Watershed Districf
❑Water/Sewer
X Is, ( .
Identification Please Type or Print Clearly)
OWNER- Name « �� �<<GX Phone, P-o7-y!to-5-q
Address: 371 ple^solt
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License. Exp. Date:
ARCHITECT/ENGINEER 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: $ FEE- $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of:Agerit!Owner Srgnatafe of contractor77777
- : -Plans-Submitted ❑ -Plans~Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
-ThPE01-SEWERAGED3SPOSAL -
Public Sewer 11 Tanning/MassageBodyArt
Swimming Pools ❑
Well El ..Tobacco Sales E -Food Packaging/Sales ❑
Rrivate-{septic tank,etc:_ r"pster on-site
THE_..FOLLOWINC SECTIONS FOR-OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
- DATE REJECTED DATE:APPROVED -
PLANNING & DEVELOPMENT ❑
COMMENTS
ATION , i Si` natureCONSERV
Reviewed on—
COMMENTS
HEALTH Reviewed on Z� It--[ Sig nature/ l
IL
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes .
Planning Board Decision: Comments
Conservation Decision: :Comments
Water & Sewer ConnectionDriveway Permit
DPW Tow; Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTII IE'-.INIT� .Temp Dunips-ter on site . yes.. . no
Located at 124,Mair.Street -
Fire Departime► t-sigr)atare/date`
.COMMENTS
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FOPM a - SYSTEM PUWLNG RECORD
Commonwealth of Massachusetts �.
A14PVC`"-q-1 , Massachusetts LG'i1
SVSten2 mprrt ,R2eCo, TOW
eer N OF
+ 1:,�,�ystem oca on RAITH DEPARTMENT
Type: Emergency Q Routine
❑ S� tic Tan)c: No ❑ yes
Cesspc �I: No ❑ Yes P
�Zj'f� Quantity Pumped: gallons
. pace c :' Pumping:
BORACZEK _
S%-ster:: Pumped by (Company):
(_._.��_ . .�.::�.._ Permit
Conte .ts transferred to:
Cont:.cts disposed at:
y
p`te Pumper Signature
Concition of system other comments:
DEP APPROVED FORM• 1a0719S