HomeMy WebLinkAboutBuilding Permit #Exception - 538 WINTER STREET 5/1/2018 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued: .
IMPORTANT:Applicant must complete all items on this page
LOCATION -
Print
PROPERTY OWNER.c •Cr/h r :;4�� _
Rrint 100 Year Old Structure yes no
MAP NQ: _ __ .___ PARCEL: . ZONING PIS, Historic District yes no
Machine Shopj Village yes no"
-- __ — --
TYPE.OF IMPROVEMENT, PROPOSED USE
Residential Non- Residential
❑ New Building ► One family
19/Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
0 Septic El Well, ❑ Floodplain El Wetlands ❑ UVatershed'Districf
❑Water/Sewer
DESCRIPTION OF . ORK TO BE PERFORMED:
t1cI - " 0^
Ide fication Please Type or Print Clearly)
OWNER: Name: ��,�c, , .4 /�,4:��-,�,r Phone: 9 Ye
Address:
CONTRACTOR 4Name `_ �: .Phone
Address: e)I _._.__._ _�_ - x - --- -_
Supervisor's Construction License F- Exp.- Date. -_u _
Home Improvement License_. -_ . __. __ Exp. Date
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 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
Si nature of= A ent/Owner* Si _ature of contractor..
Plans Submitted Li Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Plans-Submitted Plans flilaived 0- .:."..-Certified Plot Plan 0 . Stamped Plans 0
Public Sewer ❑ Tanning[Massage/BodyAft 0 Swimming Pools ❑
Well ❑ . .Tobacco Sales 0 Food Packaging/Sales ❑
_ Private:,*ptic tank,etc._ . ❑ pe .ent Dempster on Site ❑
_. =THE-:FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF U FORM
:.: DATE. REJECTED DATE:APPR=OVED
PLANNING & DEVELOPMENT F1 ❑
COMMENTS
:CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on �' Signature
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COMMENTS � M�Q
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0
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
i
Planning Board Decision: Comments
Conservation Decision: :Comments
Water.& Sewer Connection lSipnature .Date Driveway Permit
DPW TbNvL Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTtl f�9T Temp Dumpster on site yes no
.Located-at 124 Mair Street: -
-Fire Departure,if'-sigrtatife6/date