HomeMy WebLinkAboutBuilding Permit #Exception - 80 LACONIA CIRCLE 5/1/2018 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
r Print
PROPERTY OWNER -y- 71 IA,4-1,4- �+ `�� Unit#
Print
MAP NO: �. � PARCEL: 90 ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
100 year-old structure yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
V'Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
[fl"Sepfie m Well ❑Floodplain p°Wetlands p, Waterslied.District
p Water/Sewer
DEWRIPTION OF WORK TO BE PERFORMED:
9 &e 47 t1 4444C1tz4►�.
(Identification Please Type or Print Clearly)
OWNER: Name: �Je � a4. �� f SLS Phone:
Address: ;fb I—AC6Ar)1 Cac-t e-
CONTRACTOR Name: 4a4l e-g ( . s4 Si` Phone: 9.7e- 7 77-qd$7
Address: lo Gpoyt- Gld4dYyx A1,4
Supervisor's Construction License: j `� Exp. Date: -AO
Home Improvement License: f l f�5- Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BOLDING PE MIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ 1!!�(, Coo,— FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature_of Agent/Owner j :Signature of contractor.
J
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL Swimming Pools
Public Sewer ElTanninglMassage/Body Art 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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
i
HEALTH Reviewed on
741 /
/ =inatur�:/
COMMENTS
z
Zoning Board of Appeals:Variance, Petition No:
Zoning Decisionlreceiptsubrnitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connectionlsi nature&Date
Drive-,a Permit
DPW Town Engineer: Signature: Located 384 Osgood Street
FIRE DEPARTMENT -Temp Dumpster on site yes
no
Located at 124 Main Street
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