HomeMy WebLinkAboutBuilding Permit #Exception - 995 FOREST STREET 1/28/2014 f 0ORrit
BUILDING PERMIT 3?0��� 1D M6 6,ya
TOWN OF NORTH ANDOVER o .
APPLICATION FOR PLAN EXAMINATION 1 Z
Permit N0: -
Date Received
Date Issued: ��Ss^CHUS��I-
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IMPORTANT:Applicant must complete all items on this page
LOCATION �I q I-�rz s-� S free.f
PROPERTY OWNER ISI I<;�QQ I �C PnM
h,'�er
MAP NO:_ �j PARCEL Ct� ZONING DISTRICT: Historic District
yes no
Machine Shop Village yes no
#cement
IMPROVEMENT PROPOSED USE
Residential Non- Residential
uilding ®One family
n ❑Two or more famil
ion y ❑ Industrial
No. of units: ❑Commercial
, replacement ❑Assessory Bldg ❑ Others:
ition ❑Other❑Well ❑Floodplain ❑Wetlands ❑ Watershed District
Sewer
3d"1J New /y1A s/c�-
r" ;
a . cider r G-C
Identification Please Type or Print Clearly)
OWNER: Name: 0s4i, Phone: °I q,-6 09-gCJS
Address: OI 9 r re 3 - S�re a.}
CONTRACTOR Name: I-phone:
Address:
Po tieu,4o.j A). I/ 03�5-9
Supervisor's Construction License.
✓-�- � Exp. Date:
Home Improvement License- /
6 �� Exp. Date: 214
ARCHITECT/ENGINEER
Address: Phone:
Reg. No.
FEE SCHEDULE:BULD/NG PERM/T.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON 025.00 PER S.F.
Total Project Cost: $ <'/, V. FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
.Signature of Agent/Owner �/. _ - Signature of contractor
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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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMENTS
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
COMMENTS/ r (,� ❑ El j /L(GC �w
Wyaj a)",/
Zoning Board of App riance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer Connection/Signature Date Drivewav Permit
Located at 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signatureldate
COMMENTS �r_T_ � n 4 / L, P/_ o/on o;
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