HomeMy WebLinkAboutBuilding Permit #372-15 - 91 BOSTON STREET 10/17/2014 (2) P
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BUILDING PERMIT OF t�e� 46'9q
TOWN OF NORTH ANDOVER o�
APPLICATION FOR PLAN EXAMINATION _
Permit No#: fifi '` Date Received ��ssACHus���y
Date Issued: V
IMP RTANT:Applicant must complete all items on this page
LOCATION bffee.
Print v
PROPERTY OWNER- lbw`C�o Sc.
Print 100 Year St-r-Cture yes
MAP �Qp�PARCEL: 0 ZONING DISTRICT:-_Historic District yes n
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
ew Building a6ne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ emolition ❑ Other
Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
E1'�Nater/Sewer
DESCRIPTION OF W RK TO BE PERFORMED:
Identi cation- Please Type or Print Clearly
OWNER: Name: 4 !` Phone: t^ - f v 0
Address: 6U0A Lm
'Contractor Name: ,��.,h t-h,nuok Phone: 7$ ��F -?07
Address:—%---6we, h o'iyt. WeST klewk„l� ib R} 015 915
Supervisor's Construction License:—y d S 7 Exp. Date: _ ! �� / 1S
Home Improvement License: Exp. Date: i
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON 1125.0to
Total Project Cost: $� 00 FEE: $. 7,�t�00� Id C
Check No.: �Iu Receipt No.: 1
NOTE: Persons contracting wit unre istered contractors do not have access to the guaran fund
Signature of Agent/Owner Signature of contractor
i
4 z
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
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 tD \,-{ Si nature
COMMENTWO
V�a
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HEALTH Reviewed on Si .nature
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COMMENTS d O.Lv «,s� ala S✓G S'�?-rk��D S�,y��
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Si na0& el Drivewav Permit
DPW Town Engineer: Signature:
Located 384 O go d St et
FIRE DEPARTMENT - Temp Du r on site yes no
Located at 124 Main Street
Fire Department signature/date
`COMMENTS-