HomeMy WebLinkAboutBuilding Permit #Exception - 981 JOHNSON STREET 5/1/2018 (2) ORTH
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BUILDING PERMIT ��cy=:.,. _' -,6
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINA
Permit NO: Date Received KIATED
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Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION g97 JoHNSoa Srkr-rr d &WEic , AA OS,1/5
Print
PROPERTY OWNER MAr7 1C Is-rA k :eLr-,,P
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MAP NO: I47,A PARCEL: ZONING DISTRICT: R.2 Historic District yesno
210/1071A _029-2-00001 Machine Shop Village 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
0 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)
OWNER: Name: HATT BoWaQ64k, Qts-PA R� Phone: /Vlr!
�+STA: d3 �►9b-°9802.
Address: rqq",4
CONTRACTOR Name: Phone-
Address:
3y Ew 12hrooZ► DiR►Vf. STduV-rA . Md 02012,
Supervisor's Construction License: Exp. Date:
CS — lOZd�l 7 9 2017
Home Improvement License: Exp. Date: 5
2 O/�
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$1c2.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ �� /� FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access tot a guaran fund
Signature of Agent/Owner Signature of contractor
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Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. t.:
ELECTRICAL; Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department rase)
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LJ Notified for pickup Call Email
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Date Time Contact Name
Doc.Building Perimit Revised 2014
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL .
Public Sewer ❑ Tanning/Massage/Body At ❑ Switnuvng Pools ❑
Well ❑ Tobacco Sales ❑
Food Packaging/Sales ❑
Private(septic tank,etc. permanent Duinpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF m U FORM
PLANNING DEVELOPMENT Reviewed On Signature'—
COMMENTS
ignatureCOMMENT'S
CONSERVATION Reviewed on Signature
COMMENTS
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HEALTH Reviewed ori Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer Connection/S_'rgnature& Date Driveway Permit
]DPW Town.Engineer: Signature:
hF:� ®E ARTLocated 84 tree 3 Osgood S t
IRE pes' '�jocated at 124 Main St eet
Fie ®�rtm n s�ignae/date
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