HomeMy WebLinkAboutBuilding Permit #Exception - 52 NORTH CROSS ROAD 11/10/2014 OF %&ORTH q
BUILDING PERMIT
TOWN OF NORTH ANDOVER ° _
APPLICATION FOR PLAN EXAMINA I -
Permit NO: Date Received--[It 10 1141
Date Issued:
�9SSACHus���y
IMPORTANT: Applicant must complete all items on this page
LOCATION `b d cry ss \
Print
PROPERTY OWNER 4A 0eAkA C—VI`LAg y' ,
Print
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Resid tial Non- Residential
❑ New Building N,6ne family
❑Addition ❑ Two or more family ❑ Industrial
&/Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑ Well 0 Floodplain ❑Wetlands ❑ Watershed District
❑ Water/Sewer
C4F-
Identification Please Type or Print Clearly)
OWNER: Name: ��Gun��t� b cam.. �" o {� Phone: 33 1 YL/b �3
Address:
CONTRACTOR Name: Phone: (7,7;-.- '/5�'-,;ZP2C-
Address: -hvc,�L PaZ,ve- -pV-nOr ,ILAa O1�'2C
Supervisor's Construction License: ,Qcha4i" Cha"zc `L Exp. Date: /zo/ zV)
Home Improvement License: Exp. Date:
.2 � U �� ,�s�dc+�� mac_ 2-�(S
ARCHITECT/ENGINEER Kofilm i) .ALR t K—, Phone: 9W -P;W- J)0
Address: jrgKh 93> [ crin3Pul�c , ",i 6i,147 Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIM D COST BASED ON$125.00 PER S.F.
Total Project Cost: $ DZ. %%o--o FEE: $
Check No.: Receipt No.:
NO Persons contracting with unre ist red retractors do not have accee gumdu
Signature of Agent/Owner nature of contractor
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 ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
Jnr 1
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PLANNING & DEVELOPMENT Reviewed On ;''`- ��L Signature_ ills '�' ` ' rte
COMMENTS
i
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Si nature
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
FIE DEPARTMENT - Temp Dumpster on site yes no
Lodated at 124 Main Street
File Department signature/date
;COMMENTS