HomeMy WebLinkAboutBuilding Permit #Exception - 448 BOXFORD STREET 10/15/2009 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received %
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Date Issued:
IMPORTANT:Applicant must complete aff items on this page
LOCATION_ -
Print"
PROPERTY OWNER d11-1 f r
Print
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.District .
Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
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CD11-15 /X,c:�i/J
Identification Please Type or Print Clearly)
OWNER: Name: ATE -r Phone: Y4-8- 551-- y1
Address: 9 )T'
CONTRACTOR' Name: 1 ;. „1 ;a.�w a; Phone:
Address: ,.� t ► : - I�
Supervisor's Construction License: 5J760 Exp. Date: S 01
-Home Improvement License; fey Exp. Date: 2
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PERMIT.MOO PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$425.00 PER S.F.
Total Project Cost: $ p FEE: $
Check No.: Receipt No..:
NOTE: Persons contracting with unregistered contractors da not have aec a tl uurs>e f"d-
Signature of Agent/Owner Signature of contractor
/ �_,
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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
F THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
_;: .::....C,OMMENTS
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- CONSERVATION Reviewed on loll Signature.
COMMENTS CyL f
s
HEALTH Reviewed on Signature
COMMENTS �� i rte,. l p-,
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
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Conservation Decision:
Comments
Water &.SeWer Conned lon/Signature&Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT. Temp Dumpster on site - yes no
Located at 124 Main Street:
Fire Depwtment signature/date
COMMENTS