HomeMy WebLinkAboutBuilding Permit #916-15 - Exception 5/14/2015 NORTH
BUILDING PERMIT
TOWN OF NORTH ANDOVER o
APPLICATION FOR PLAN EXAMINATION * '
Date Received
Permit No# `'� Ac"use
Date Issued-
ORTANT:Applicant must complete all items on this page
LOCATION 35-6 W"� n 2p�ven vc
Print
PROPERTY OWNER acas
Print 100 Year Structure yes no
ZONING DISTRI,CT:�_Historic District Yes
MAP_PARCEL: Machine Shop Village yes no
I
i
TYPE OF IMPROVEMENT PROPOSED USE t
Residential Non- Residential
❑ New Building
[i one family i
❑Two or more family El Industrial
❑Addition Commercial
Alteration No. of units:
❑ Others:
El Repair, replacement
❑Assessory Bldg
❑ Demolition ❑ Other
�r — T 01Netlands
T� 'F.loodla.m Watershed?Drstraict
❑W',elh
.Septic; ,a
__�'Wafe`r1Sewer, .. _._. ,_�.__:- __
DESCRIPTION OF WORK TO BE PERFORMED `
_ ,40('k 2 c�s�s �l, I^wn-- be.kr/ at now bc.I cpry Il v►b p +V
-I-a alae AM Z k �bsl�o nd�r h� -�-re�►�ti� -Fz,r nPrrsl��s- �
Z wyv-,w ses h�
Identification- Please Type or Print Clearly Phone-
OWNER: Name: r ►t'1«slcea'
Address: ?'IS- evl'sbv
Contractor Name: S CA�s �i�"'_ Phone: 663 959 -36
1 �,
Email a3 LR-
Address:
Su erVisor's Construction.License: C 5 l Exp Date:
Home
meImprovement License:
Exp: Date:
ARCHITECT/ENGINEER
Phone:
Reg. No.
Address:
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED N$125.00 PER S.F-
Total Project Cost: $ 1 U , 0 G FEE: $,
Check No.: � Receipt No.:
NOTE: Persons contracting wit 'unregistered contractors do not have access to the guar Ity fund
Plans SubrnittedX Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
FWeii
F SEWERAGE DISPOSAL,
wer Swimming Pools ❑
Tanning/Massage/Body Art ❑ g
❑ Tobacco Sales ❑
❑ Food Packaging/Sales ❑
eptic 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 Si nature
COMMENTS
HEALTH Reviewed on S Si nature
COMMENTSt, ML
e 1
Zoning Board of Appeals:variance, Petition No: i
Zoning Decision/receipt submitted yes ;
Planning Board Decision: Comments
Conservation Decision: Comments
Water&Sewer Connection/signature Date
Driveway Permit
]DPW Town Engineer: Signature:
FIRE DEPA aT Located 384 Osgood Street
�o ated at 1 SENT `Temp D�umpsteryes� ,
Main Street
Fire Department signature/to