HomeMy WebLinkAboutBuilding Permit #Exception - 4 LACY STREET 5/1/2018 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received I() " A
Date Issued:
IMPORTANT:Applicant must complete all items on this page
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( Pring 100°Year0ld�St�ucturei yes) n.
a M,AP"N® .►y� PARCEu ,Z®NIN,G`DISTIRIC�T;t� THistoncfDistnct eyes
MachineShop,Village� yes T
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building -60ne family
j ❑Addition ❑Two or more family ❑ Industrial
Iteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
. --.i�
Septic '[ Weill ' iFloodp
❑
laini tW
'wtetlands� ® Wafershetl�District�
t ❑Water/,Sewer; �. _ I � }
DESCRIPTION OF WORK TO BE PERFORMED:
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y
Identification Please Type or Print Clearly)
OWNER: Name: kAv-L,-- Phone:
Address:
tCON1TRAGTOR'IName: ��-�.•-�� _* RPl onef y'1 �b5$.�.�.. 33 ' a._s `
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Address:
I
Supervis1
y
'Home Improve
ment�Lice
Exp,, Date
I
ARCHITECT/ENGINEER Phone:
Address: - Reg. No.
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $ L . i✓y
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
;Signature of Agent/Owner ': CSioature of contractor;.
Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans
Plans Submitted ❑ Plans Waive 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 ❑ ❑
i
COMMENTST I
NSERVATION Reviewed on "? I Si nature
COMMENTSn �j` v�Z� CJ
HEALTH Reviewed on Si natur Wl
c
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes_ ,.
J Planning Board Decision: Comments
Conservation Decision: Comments
J
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Toivn ]Engineer: Signature:
Located 384 O ood treet
FIRE`DEPARTit ,ENT - Temp Dumpster on site yes no
Located at 124 Main'Street
Fire Departrnent•siignatureldate
COMMENTS
North Andover MIMAP October 30, 2013
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Interstates
Interstate
—Major Roads Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83,
Roads Meters Data Sources:The data for this map was produced by Merrimack
yOR rh Valley Planning Commission(MVPC)using data provided by the Town of
Ci Easements Ct t,°e _ 'qt, North Andover.Additional data provided by the Executive Office of
o NHESP Certified Vernal P ,t b°� r°�°C0 Environmental Affaim/MassGIS.The information depicted on this map is
o NHESP Potential Vernal P •3' L for planning purposes only.It may not be adequate for legal boundary
O --• '�' definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER
0 MVPC Boundary t' p MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
Parcels i - >w THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY
t i Y OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT
4 0� •� 7 ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF
*Ar.p y THIS INFORMATION
�ITSACHUs�t
1"=47 ft w�.
