HomeMy WebLinkAboutBuilding Permit #Exception - 50 MAIN STREET 5/1/2018 F %40RTH 1
Ak BUILDING PERMIT �?°�?.``�M°,a"o
TOWN OF NORTH ANDOVER to t �,
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
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I ORA TIO•P .�5
Date Issued: 9SSACHus't
9
IMPORTANT: Applicant must complete all items on this page
LOCATION_^ OL i
Print
PROPERTY OWNER
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 Indus
Altera io No. of units: Commercial
Repair, replacement Assessory Bldg Others:
Demolition Other
Septic Well Floodplain Wetlands Watershed District,
Water/Sewer
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CONTRACTOR Name: - 4S« Phone
Address_ C,eg tv�. A U i ld��, c
Supervisor's Construction License: Z ' Exp. Date: ,
t 013
Home Improvement°License: :Exp. Date:
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ARCH ITECT/ENGJN EER AocPhone:(-977) ;3..6 _ 06S_
Address: �SSe Reg. No.—.-, >66
FEE SCHEDULE-'BULDING PERMIT'$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F,
Total Project Cost: $,J 30, O00 : FEE: $, , E604
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature,of.Agent/Owner Signature of contractor
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Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Publ Sewer
❑ Tanning/Massage/Body Art ❑ Swimming Pools 0
We1! ❑ Tobacco Sales ❑
Food Packaging/Sales 0
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 ❑ 3
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTHReviewed on, Signature l✓
CO1 MENTS �— 7
Zoning Board of Appeals: Variance, Petition No: Zoning Decisionlreceipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer ConnectioniSignature& Date Driveway Permit
DPW'Tow Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at124 Mahn"Street-
Fire Deparbne6t signatu"reldate
.COMMENTS
Massachusetts - Department of Public SafetN
Board of Building Regulations and Standards
Construction Supervisor License
License: CS 51254
F
GLENN T SABA
8 BRUSHWOOD DR
ATKINSON, NH 03811
Expiration: 4117/2013
('ommis.iuncr Tr#: 13218