HomeMy WebLinkAboutBuilding Permit #Exception - 54 LONG PASTURE ROAD 5/1/2018 (5) BUILDING PERMIT tAeDqti
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TOWN OF NORTH ANDOVER
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APPLICATION FOR PLAN EXAMINATION 616
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Permit No#: Date Received
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Date Issued:
IMPORTANT:Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ,X One family
A Addition 0 Two or more family 11 Industrial
11 Alteration No. of units: 0 Commercial
0 Repair, replacement El Assessory Bldg 0 Others:
11 Demolition- El Other
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DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: L Vlv a PA 641AA Phone:
Address: 6 PA--.-,V" � 6N oa y tar—
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Supervisors C
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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: $ 15-1 6041 FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature gen----,wn.er, Signature
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Plans Submitted ❑ Plans Waived F1 Certified Plot Plan ❑ Stamped Plans ❑
TyPE'OF SEWERAGE DISPOSAL
Public Sewer
ElTanning/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
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Si nature
COMMENTS
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HEALTH Reviewed oSignature
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: 384 Os ood Street - _-
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FIRE DEPARTMENT; ffempC®umpster onvsite eyes
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Located 6. t 124 Mam Str.e:et
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FORM - U - LOT RELEASE,FORM
INSTRUCTIONS: This form is used to verify that allnecessary approval/permits from
Boards.and Departments having jurisdiction have been obtained.This does not relieve the
applicant and or landowner from compliance with any applicable requirements.
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APPLICANT ��C: C U-u _ PHONE "("� 3
ASSESSORS MAP NUMBER LOTNUMBER___ _
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SUBDIVISION �� w T LOT NUMBER < e
STREET STREET NUMBER
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OFFICIAL USE ONLY
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RECONWENDATIONS OF TOWN AGENTS
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DATE APPROVED
CONSERVATION ADMINISTRATOR
DATE REJECTED
COMMENTS
DATE APPROVED,'
TOWN PLANNER a
DATE REJECTED
CONO& I S
+fit
DATE APPROVED
FOOD INSOR TH DATE REJECTED
DATE APPROVED
S CECTOR- TH
'DATE REJECTED
COMMENTS ,L�:u�c.ZZ t' .
PUBLIC WORKS—SEWER/WATER CONNECTIONS
DRIVEWAY PERMIT
DATE APPROVED.
FIRE DEPARTMENT
DATE REJECTED
CONOAETTIS �.
RECEIVED BY BUILDING INSPECTOR DATE
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F NORTH
Town Of _ 4 over
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I� COCHICHEWICK V
ORATED
H BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic Syste o;
Q BUILDING INSPECTOR
THIS CERTIFIES THAT ' �� 'W GO.W. .• •. 6 ,,�••••••••-•••••• Foundation .
I.O't.3 0 y 011 . w �
has permission to erect..............I....... .. buildings on .LO �. trough �W�, ���--��
............... ............ . ........ .
'O(A 6 11 a /i .4 3 +'1 V��f Chimney
to be occupied as. ........................I.... .......................
provided that the person accepting this permit shall in every respect con orm to the terms of the application on file in Final
this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of
Buildings in the Town of North Andover.. M .140& 48 p 424Da t PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. �u
Final
PERMIT EXPIRES IN 6 MONTHS
UNLESS CONSTRUCTION ST TS ELECTRICAL SPE
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Premises - Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SiD� Smoke Det.
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