HomeMy WebLinkAboutBuilding Permit #Exception - 66 EQUESTRIAN DRIVE 5/1/2018 (2) BUILDING PERMITof"O DT b�tio
TOWN OF NORTH ANDOVER �2 ham.' - =b
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APPLICATION FOR PLAN EXAMINATION
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Permit No#: Date Received `fib �9ADRw7ED�eP��g
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Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION (0( 41e,a ��-
Print
PROPERTY OWNER �� MQ 2C1
Print 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District yes no.
Machine Shop 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: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
.Septic ❑Well El Floodplain. ca etlana s Watershed'®istnct«;
%W,ater/Sewer
DESCRIPTION OF WO A. TO BE RFORMED:
Identification- PI as Typ or Print Clearly
OWNER: Name: Phone:
Address:
Contractor Name: GJ �� � Phone: 605 3� L e"
Email: o -D P—V
Address:
Supervisor's Construction License: Exp. Date:
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: $ t 7,c'D0, 6>0 FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
anature of Agent/Owner Sicontractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL e
Public Sewer ❑ Tanning/Massage/BodyArt ❑ Swim ingPools ❑
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 Signature
COMMENTS
HEALTH Reviewed on r,� Q6, ,
�( Si nature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer ConnectioniSignature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE;DEPARTNIENT - Tempd,u ter on..site..
F
Lo-bted,at'1249Main Street•
'FiretDepart— t signature/date
COMMENTS _ _
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