HomeMy WebLinkAboutBuilding Permit #054-2017 - 59 ADAMS AVENUE 7/18/2016 i
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BUILDING•PERMIT o� 1LEDtIORV4
TOWN OF NORTH ANDOVER
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ICATION FOR PLAN EXAMINATION � Y.•' �
Permit No#: Date Received I& ^TEo
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Date Issued: l 'ZP1
IMPORTANT:Applicant must complete all items on this page
LOCATION
Print
PROPERTYOWNER ,June. M. Crk'rl
(� , `` Print 100 Year Structure yes no
MAP (OL PARCEL:nL1, ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building VOne family
❑Addition ❑Two or more family ❑ Industrial
iZ Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
r ❑ SepticrlNell ❑=Floodplain '1Netlands ❑ Watershed District
r
ate❑Wr/Sewer _
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DESCRIPTION OF WORK TO BE PERFORMED:
tr n n ec{.�oC
s . 3 els
Identification- Please Type or Print Clearly
OWNER: Name: Ju s7 e r Ecked Phone: W.
•
Address:
Contractor Name: Sd vC G�DAnie( b- Fonzi Phone: 9J,9z15 ' J3ud
Email: a.r�l�,
Address: as, W,&I PAJ ' V11 m;n6qJrh Wk 01S'87
Supervisor's Construction License: 10&&7 Exp. Date:. Zis 46/6 '
Home Improvement License: i!e S 57 Z Exp. Date:
ARCHITECT/ENGINEER_ So o-u /J0Zi--rrna.n Phone: /o sv - 639 iQR S -
Address: �o s s Cl eA1,1Aec,o waV (,, ,0JkQ I�r Reg. No. 6_I SS`s
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ C)w FEE: $ 7Z
Check No.: -7 200cI F, Receipt No.: �w
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
'ture of Co
Gto
-,
Location 51
No. "� � Date CDS
• • TOWN OF NORTH ANDOVER
0-1
Certificate of Occupancy $ _
Building/Frame Permit Fee $ - �-
Foundation Permit Fee $—M..—
Other
_=Other Permit Fee $
TOTAL
Check# Kir
, r
Building Inspector 'sJ7
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 ❑
I
Private(septic tank,etc. ❑ Permanent Dwmpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF o U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
"Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Panning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer Connection/Signature&Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE 0EPAR+TMENT
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