HomeMy WebLinkAboutBuilding Permit #216-15 - 64 CAMPION ROAD 8/28/2014 � f
BUILDING PERMIT d'— of NORTH q
tsteD
TOWN OF NORTH ANDOVER � i
0
m
APPLICATION FOR PLAN EXAMINATION
Permit No#: p
ate Received
4�gAre
�SSACHUS��
Date Issued:
IMPORTANT: Applicant must complete all items on this page
xWOATION
!PROPERTY OWNER._
Pnnt 100 Year Structure yes no
MAP v -;PARCEL: 4w ZONING DISTRICT: Historic District yes ono
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 0 Assessory Bldg ❑ Others:
0 Demolition ❑ Other
❑ Septip E5Well ± pFloodplain 01Netlandsw d p
0 Waterslie ist�ict
❑Water/Sewer - - i
_-
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: Phone:
Address:
aContractor.:N-ame !Rhone _, _
-
Supervisor`s+Construction License: IEXp i®ate
u�m - - �- -
t
'Home Improvement License6E�x 'D -
�> ate -
__
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 accesj to the guaranty fund
Signature of AgerUOvvner Si nature of contractor ' T - a
F
i
i
i
Location tL/ 14
i
�^ Date "�
No. ,
�I
TOWN OF NORTH ANDOVER
Certificate of Occupancy STD
Building/Frame Permit Fee $
Foundation Permit Fee $
_ Other Permit Fee i
TOTAL $
'a
,i
Check# i
1
27 9 6 3 Building Inspector �
i
til
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE bF SEWERAGE DISPOSA
Public Sewer Tanning/Massage/Body Art F1Swimming Pools El
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 l( -7-/ Signature_
COMMENTS Ov1,Ol S )4 (LID AkW 494 ( — ✓Li C� �, cJ��3 �r�v�c 1,
i NSERVATION Reviewed on 7 `-( Signature "-)"11
COMMENTS \I\.D (V---J
\/EALTH Reviewed on Signature
COMMENTS
i
ti
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
s
Water & Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT Temp"4Dumpster'on site :,yes _ r- tno Y
jLocatedPat 124�Mam _Street ---
r _. n
Fire Departmentiga-xyre/date .._ . ._