HomeMy WebLinkAboutBuilding Permit #Exception - 53 WELLINGTON WAY 5/1/2018 i
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BUILDING PERMIT oF�tLeo 6gti
TOWN OF NORTH ANDOVER 10
APPLICATION FOR PLAN EXAMINATION
Date Received 'ypA0A " Cl
��ermit No#: ,TEo� .c
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Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION ,L4.0 5'3 G1-As-(-z-11,-10 6 A-L W A V
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PROPERTY OWNER
Print 100 Year Structure yes no
MAP b57C PARCEL:ZONING DISTRICTR 11 F'P.� 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 '
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❑ isrtciv
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�® Vllate�/Se2wer uy s �Y �/ ': EF ? x �tw s n a. ,s
i DESCRIPTION OF WORK TO BE PERFORMED:
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Identification- Please Type or Print Clearly
OWNER: Name:��g[d. n3 Jt9 `-�' LtS�(' Phone:
Address: ?e ms Aiwuae- d lF
Contractor NamPd�f�T 1 v' SSI �� Pho ��'�9��3j516
Email - F� o YKEs (D L- G®
Addressi` w- 9'"� ;
Supervisor's Construction License: Exp: Date:
Home Improvement License: l(�7 � Exp. Date: / I
ARCH ITECT/ENGINEERSf!64 C- f����119 y��C -R� Phone -5-7 —�� 5
Address: + O/qZ3Reg. No. QLD 2�
FEE SCHEDULE.BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $� FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
'fans Submitted` Plans Waived ❑ Certified Plot Plan Stamped Plans
YPE OF SEWERAGE DISPOSAL
ublic Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
Tell ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
ivate(septic tank,etc. Permanent Dumpster on Site ❑
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THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF m U FORM
LANNING & DEVELOPMENT Reviewed On Signature_
DMNIENTS
3NSERVATION Reviewed on Signature
)MMENTS
:ALTI-I Reviewed on ' �� ` �. Signature
)MMENT8�L am
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ling Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
ening Board Decision: Comments
!servation Decision: Comments
ter& Sewer Connection/Signature& Date Driveway Permit
W Town Engineer: Signature:
Located 384 Osgood Street i
E DEPAREN Temp ®umpste77:M ite�yes ' nf"o
ted at 124 MainStreet .
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