HomeMy WebLinkAboutBuilding Permit #Exception - 712 SHARPNERS POND ROAD 5/1/2018 r
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION.
Print
PROPERTY OWNER
Print 100`Year Old Structure yes?
MAP-NO: PARCEL:. ZONING"DISTRICT: Historic District yes
Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ZOne family
Wddition 0 Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
ZESAPtic ❑Well ❑ Floodplain 0 Wetlands
El Watershed District
rtgwiagr/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: Phone• 4-i!6
Address: ti�ftc)t--
CONTRACTOR Name: Phone: CL-1 V 6 Vt -533.
.Address: R,L6 t�,r'r-s`t!
Supervisor's Construction License: 053. v`,� _Exp: Date:
Home Improvement License: �d`G`2 -:Exp. Date:
ARCHITECT/ENGINEER t.r„-.r-t 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„Z.,Sy FEE: $ p
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature_io_f contractor._
Plans Submitted Plans � � �
Waived ❑ Certified Plot Plan ❑ Stamped Plans
Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
Well ❑ To
Sales ❑
Food Packaging/Sales ❑
Private(septic tank,etc. Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORINT
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
t
�r
HEALTH Reviewed on 3 Si ture-`/
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: i
Located 384 Osgood Street {
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department-signature/date
COMMENTS
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