HomeMy WebLinkAboutBuilding Permit #Exception - 940 FOREST STREET 5/1/2018 (2) TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0:
Date Received a ��
Date Issued:
IlVIPORTANT:A licant must com lete all items on this age
LOCATION �� `1€7
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PROPERTY OWNER C �C. f� �..' G- C. Unit#
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MAP NO: PARCEL: ZONING DISTRICT: Historic District yes
Machine Shop Village yes no
100 year-old structure yes no
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:
❑Demolition ❑Other _
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.O Water/Sewer .� � is _ �3� . � ...DESCRIPTION OF WORK TO BE PERFORMED:
/(Identification" Please Type or Print Clearly)
OWNER: Name: (_� .h �. /tel"- Phone:
Address: .7
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License:- Exp. Date:
Home Improvement License: Exp. Date:
;
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ L oQ o , U o FEE: $
Check No.: Receipt No.:
NOTE: Persons contra Ing withregisteredR ontractors do not have ecce to the guaranty fund
_ l
_ ,. . Signature_oficonttactor
Si nature of'Agent/.O �
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Swimming Pools ❑
Tanning/Massage/Body Art ❑
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 S)06) t,-A- Signature /)u
COMMENTS 4d - cw QSAJ ► 5. PAC ` xrbt-s'WjA-"
HEALTH Reviewed on Si nature
COMMENTS
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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 DEPARTMENT -Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS