HomeMy WebLinkAboutBuilding Permit #Exception - 960 JOHNSON STREET 5/1/2018 fAORTh q
BUILDING PERMIT -- 3+0�`�,so
TOWN OF NORTH ANDOVER °
APPLICATION FOR PLAN EXAMINAT -
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Permit NO: Date Received °9 � •
Date Issued: CHU
IMPORTANT:Applicant must complete all items on this page
LOCATION b ttSC4" S
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PROPERTY OWNER �t'rtc,��r 'F'2rs-&
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MAP NO: PARCEL: ZONING DISTRICT: Historic District yes
Machine Shop Village yes Nno
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
❑Septic ❑Well ❑ Floodplain ❑ Wetlands ❑ Watershed District
❑Water/Sewer
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Identification Please Type or Print Clearly) ^roc(4-114toc a` @-"f ori
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OWNER: Name: Phone:
Address:
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.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ 60 FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of AgeMip!�qer Signature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plat-Plan ❑ StarrTed 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 a f' Si nature
COMMENTS ro-
_ 2nat
HEALTH Reviewed on
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COMMENTS I i -
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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 onsite yes _ no --- -. _-
Located at 1241Main.Street v
Fire Department signature/date .. -
COMMENTS.,
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