HomeMy WebLinkAboutBuilding Permit #Exception - 455 CHESTNUT STREET 5/1/2018 V%0RTF1
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BUILDING PERMIT OL
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received '� °4 �^°•• •
ncausti��y
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION -�� �`
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PROPERTY OWNER �LL,
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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 Ll Two or more family [I Industrial
❑Alteration No. of units: ❑Commercial
epair, replacement ❑Assessory Bldg El Others:
❑ Demolition ❑ Other
❑Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
Identification Please Type or Print Clearly)
OWNER: Name: C N r; S -}-1C ��+nac�� Phone: el—t$—�{S � S L1 3
Address:
CONTRACTOR Name: Phone:
Address: Q N
Supervisor's Construction License: Exp. Date:
(1z 7-7 0 7
Home Improvement License: Exp. Date:
t`75 `��
ARCHITECT/ENGINEER Phone:
Address: Reg. No..
FEE SCHEDULE.BOLDING PERMIT:$12.00 PER$1000.00 OF THE,jOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No.: /
NOTE: Persons contracting with;unrZisteread contractors do not have access to the ura fund
Signature of Agent/Own _ Signature of contract r
Plans Submitted ❑ Plans Waived 0 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
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on 1 Q I Si nature`
S �
COMMENTS
HEALTH Reviewed on ((( Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer Connection/Signature&Date Driveway Permit
DPW Town Engineer: Signature: Located 384 Osgood Street
_ --
FIRE DEPARTMENT - Temp#®umpster onsite
Located at U4,Main Street .
Fire'Depar*naensignature/date
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