HomeMy WebLinkAboutBuilding Permit #Exception - 724 SHARPNERS POND ROAD 5/1/2018 pORTh
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
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mate Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION 7 e nfr P Q E / 1`s
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'PROPERTY OWNER 8e-,a►aJ J-'its 5,01,j
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MAP NO: lluy PARCEL: 1( ZONING DISPintTRICT: Historic District yesnn
- Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building 1@0 One family
)CAddition ❑ Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
0 Septic 0 Well ❑ Floodplain 0 Wetlands ❑ Watershed District
0 Water/Sewer
4 /-lvu►rAA�," la .55 5 e,;5
Identification Please Type or Print Clearly)
OWNER: Name: Sri cAn S+s n �N-6rn Phone(q-79) 7610
Address: .2jd Show f-S par0 Rd, tv, findbV-rr, Ma C)r '15
CONTRACTOR Name: S9917(t 4�Phone:
Address:
1 -Ta Joh
Supervisor's Constru` ion License: _� `/ �-- Exp. Date: 1`
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: $ 3 q 00 FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
, gnature of Agent/Owner Aignature of ontractor
PJans,%ubrnitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
F
OF SEWERAGE DISPOSAL
c Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank, etc. Permanent Dmmpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On v1 �p Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature ,
COMMENTS ` 0
4
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
;Conservation Decision: Comments
Wafter & Sewer Connection/signature& Date Driveway Permit
DPW Town Engineer: Signature:
_ Located 384 Osgood Street
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COIVIMENI SI3 , , w " ' L > u�i
_7Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
724 Sharpners Pond Road -
Property Address
Brian Stfinson
Owner Owner's Name
information is
required for North Andover MA 01845 10-14-2014
every page. City/rown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
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t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17