HomeMy WebLinkAboutMiscellaneous - 366 FOREST STREET 4/30/2018 (2)n
Identification Please Type or Print Clearly)
OWNER: Name: kat4 �vti
Address:
Address:
Name:
Supervisor's Construction License:
Home Improvement License:
�--Lpsu-uaal
64Ui trt_)- 1°57-0y 3
Ph
Exp. Date:
Exp. Date:
ARCHITECT/ENGINEER
Address: Phone:
Reg. No.
FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $
Check No.: FEE: $
NOTE: Persons contractin with unregisred contractors do noRecet t have access to. the guaran a,nd
f
Signature of Agent/Owner
Signature of contractor
BUILDING PERMIT `F
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16
Permit
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
F -
NO:
Issued:9SSAIlVIPORTANT:
Date ReceivedA�°
� j7/4p / ?J
�
i' • `^`
CH°^�Date
A Applicant must Com lete all items on this nage
r�LOCATION 3 L-P(a for%S-4. SI-. Yl6 e-14 64Ad
PROPERTY OWNER
La re�, ha Print
L,
MAP NO: PARCEL: Print
ZONING DISTRICT: Historic District
Machine Shop Village
yes no
yes no
TYPE OF IMPROVEMENT PROPOSED USE
New Building
Residential Non- Residential
One family
y
❑ Addition
El Alteration
❑ Two or more family ❑Industrial
replacement
No. of units: ❑ Commercial
❑ Assessory Bldg
FDemolition
❑ Others:
❑ Other
D Well❑Floodplain
❑Wetlandsewer ❑ Watershed District
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Identification Please Type or Print Clearly)
OWNER: Name: kat4 �vti
Address:
Address:
Name:
Supervisor's Construction License:
Home Improvement License:
�--Lpsu-uaal
64Ui trt_)- 1°57-0y 3
Ph
Exp. Date:
Exp. Date:
ARCHITECT/ENGINEER
Address: Phone:
Reg. No.
FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $
Check No.: FEE: $
NOTE: Persons contractin with unregisred contractors do noRecet t have access to. the guaran a,nd
f
Signature of Agent/Owner
Signature of contractor
0
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/MassageBody 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 ��" 10
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:
FIRE'DIEPARTiif ENT - Temp Dumpster on site yes
Located at I24 MainStreet
Fire Department-signature/date
COMMENTS
Located 3M Usgood Street
no