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HomeMy WebLinkAboutBuilding Permit #Exception - 54 LONG PASTURE ROAD 5/1/2018 BUILDING PERMITNORTH Qq LED 6�ti TOWN OF NORTH ANDOVER y `'`- ?� �` �� APPLICATION FOR PLAN EXAMINATION * x Permit No#: Date Received SACH05� Date Issued: IMPORTANT:Applicant must complete all items on this page , I LOCATION YPp5rL)nE _ P_OAAJ - P�mt PROP ERTY'OWNER 4-,4.5,4LEr,C- sf tJVIN� 100 Year St ctu�e s `� =cru ye_ no MAP �' `__ PARCEL O_ ,z ZON 'NG DISTRICT. :Historic Distnet yes no Machine Sfi.op 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: 1 ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Flootlplain ❑"Vl/etlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: LAVLErE 1Da.51Lugr1Z4 Phone: Address: 54 Lbw qg- uk �D /V©r.Yg1 ND64r- Contractor Name Address: 1��,e ��„ ecK Qo�n j° I�EL►�S'wao M41- �lgt ( -- `Q �� �_ _ Exp Date:_ Supervisor's Construction,License- �_�_ _ 3' Horpe lm rovement(License Ja 613 Exp Date 7/z-y�L c5 1(0_ ARCHITECT/ENGINEER 3oLt_tyws qe,,,f"LLL Phone: 517F3-352- 7971 Address: Z2 M6uayz 11,Fe. lbM RbAD Roxyp2o MFS Reg. No. LUS-00 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 unre tered contractors do not have access to the guaranty fund Signature of4Agent/Owner -_; Signature of contractor Plans Submitted Plans Waived ❑ Certified Plot Plan Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools L ' 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_ i COMMENTS CONSERVATION Reviewed on sic,nature COMMENTS 4-2 i I HEALTH Reviewed on ` ! Si nature �� 4 L_ COMMENTS l� Gyo Zv T o 11 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: �r Located 384 Osgood Street FIRE DEPARTMENTTemp 0umpster 0 site yes T_ . no - Located at 124 Main Street Fire Depa-rtment signature/date ----- COMMENTS