HomeMy WebLinkAboutBuilding Permit #Exception - 71 WINTERGREEN DRIVE 5/1/2018 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received "I
Date Issued:
IMPORTANT:Applicant must complete all items on this page
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P,nnt 100�Yeart0ld,St�ucture? - C100)PARCEL � ZONINGIDIS�TRICT- - Machme,Shop��Villagel
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:
El Demolition ❑ Other
❑.Septic; DbWell, D;Floodplain ❑�11Vetlands. VllatershedEDistricf,,
� ❑Water/S'ew,er, �_ -
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: �v 4e_ S�/ �n Phone: '? ?Ya
Address:
CONTRACa i0R? ;Name:. n_; . v2 fes" _ Phone
Ad"dress
Sta
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I . Y . :. t
Homelmp ovement,Llcens_e.': _ _ Exp Date. / /y -
ARCH o �' '��` 7T �Jz°^�" Phone:�i ? 32 0 J'-eK�
AddressA 0' U ,f 600c' so- J--ol/al - Reg. No. W O:P;>
91
FEE SCHEDULE:BULDINGPERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ - -� l `� FEE: $ � -
Check No.: Receipt No.:
NOTE: Persons contracting with un istered contractors do not have access to t ra fund
.Signature ofAgent/Owner __ -` _ ;_ 4 Slgr►:ature;of
bontracfonL.
Dlnno Cs ihmiffnrl l k Plane Wnhisnrl n ('Prtifiar9 Plnt Plan R Stamned Plans n
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Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
IW
YPE OF SEWERAGE DISPOSAL
ublic Sewer Tanning/Massage/Body Art ElSwimmingPools El
ell El Tobacco Sales El Food Packaging/Sales El
Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Si nature
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:
Located 384 Osgood Street
FIRE DEPARTME- NT = Temp Dumpster on site yes. no
Located at 124,Main'Street:
Fire Depaitment5ignature/date"
COMMENTS