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Home My WebLink AboutMiscellaneous - 890 DALE STREET 4/30/2018J. I Lot & Street—ft Map/Parcel CONSTRUCTION APPROVAL Has plan review fee been paid: OYES NO Permit#�OZ�_ Plan Approval: Date: Approved by: { Designer: 056ego A Plan Date: Conditions: 1�g57T16Z7' r'D 3 234F -5 Water Supply - Well Permit: Well Tests: Chemical Bacteria I Bacteria II Plumbing, Sign -Off Comments: Town. . Form "U" Approval: Date Issued Conditions: Well _Driller: Date~Approved Date -Approved Date -Approved Wiring Sign -Off - Approval to -Issue: By: YES NO Final Approval: All Permits Paid? YES NO Well Construction Approval? YES NO Septic System Construction Approval? YES NO Certification? YES NO Other YES ^ ^ NO Any Variance Needed? (ED NO FINAL BOARD OF HEALTH APPROVAL: DATE: APPROVED BY: I SEPTIC SYSTEM INSTALLATION Is the installer licensed? YES Type of Construction: NEW PAIR New Construction: - __Certified Plot Plan Review YES 1 —Floor Plan Review YES NO _—_ Conditions of Approval from Form U YES NO _Issuance of DWC permit-. - YES NO _DWC Permit Paid? }� —_ YES NO . - DWC_Permit # Installer: C. ---------Begiii.-Eispection:_ YES NO _Excavation Inspection: —Needed: .12 — - Passed: By: _Construction Inspection: Needed: 9-B..Plan Satisfactory: _ Approval of Backfill Final Grading Approval Date: By: Gr Date: 4�-; By: Final Construction Approval: Date: ' By:_ Certificate of Compliance: Approval: �1 Date: r Permit NO: n;;fp 1-qqi iArl BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received !D TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building (One family) Addition Two or more family Industrial (Alteration No. of units- Commercial Repair, replacement Assessory Bldg Others: Demolition Other pptic�.". NF-16661016in' Wetlands F 111t, A DESCRIPTION OF WORK TO BE PREFORMED: Conrve,,;7— G_xWriky T A e P_ 5f -4'5&V J2(,,,v-4 I -b, 6-ve- Identification Please Type or Print Clearly) OWNER: Name: I ge-o 4 Y41 cho el He,(m an Phone: 9?9-105--�04� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT: $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ �X, 2oo FEE: $ Check No.: Receipt No.: NOTE: Persons contracOnfi—rwith unregistered contractors do not have access to the guaranty fund tIO)Afh 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 COMMENTS, /'S Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments rnnnnn�n�T� TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art E]Swimming Pools Well Tobacco Sales U Food Packaging/Sales ,, Private (septic tank. etc. IJ Permanent Dumpster on Site Electric Meter location to project —1.0 wicuuui wall " wo mterea contractors ao not have access to the guaranty fund r Signature of Agent/Ow Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT ❑ []Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE APPROVED TE REJECTED DATE APPROVED CONSERVATIO COMMENTS HEALT G COMMENTS k. Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments 1 TE REJECTED DATE APPROVED Water & Sewer connection/Signature & Date Driveway Permit Temp Dumpster on site yes_no_ Fire Department signature/date J Permit NO: Date Issued: TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received I IMPORTANT: Applicant must complete all items on this page LOCATION PROPERTY MAP NO.: /U Yd r PARCEL: TVPTi ANTI INIT (ITP RITIVnINr Print ✓I I�� Print ZONING DISTRICT: HISTORIC DISTRICT VES n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Addition ❑ Alteration ❑ One family ❑ Two or more family No. of units: ❑ Industrial ❑ Repair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Commercial + ❑ Moving (relocation) ❑ Other "❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) OWNER: Name:— Phone:9 Address: CONTRACTOR Name: <�;C- Phone: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost :$ EM0 loo CJ x12.00=FEE:$ nn 7 Check No.: 22S- y Receipt No.: (-_] 3Ux Page I of 4 �l►.1 �ur�� p Rl�nul\U[L �!� PLLb�L -ro \YAU- S\vITGN NcrG � N��v pIM��•utorls AKr--To6AcsoFSTUDS AGck ss — L X1571NG Ft)eU zootA 2,I A-2 P000L. -ru 60 � 0 - c _ J h` yrs•y.t. G,IT� Pf Ai`a I 0 IY