HomeMy WebLinkAboutBuilding Permit #Exception - 97 SAW MILL ROAD 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 L
Print
PROPERTY OWNER -'4 A I/ A/-a ^*^r -I- -t4 fi� TT U172v°sq-2!J
Print 100 Year Old Structure yes no
MAP NO: _PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Villageyes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
0 Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
me V-L b t c//- i/,/ 6 ,-- (:!-/-/-*
�d O 7-7^1-6 5 �4N/) o� X PT .5T
Identification Please Type or Print Clearly)
OWNER: Name: ,/.,,z-,/, s4 �. Phone: 7P/ -
Lu.n � .a.2D
Address:
CONTRACTOR Name:d y-'r V /=o ,� Phone' 7 2Z',ol 50 F
Address: ,c -/.P—
Supervisor's
2Supervisor's Construction License: �� �_�3 Exp. ;Date:
Home Improvement License; �U a
p Exp. :Date:
ARCHITECT/ENGINEER Phone: r
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: $ 9 2e - FEE: $
Check No.: Receipt No.:
NOTE:EPP ersons contracting with unregistered contractors do not have access to the guaranty fund
Sigiature4of Agent/Ovvner _ _. Signature of contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Plarl Subrnitted ❑ 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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on
Signature
F
COMMENTShV"A-L 56 6 A unn,
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 Towi-:Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street:
Fire Department signatu"reldate
COMMENTS