HomeMy WebLinkAboutBuilding Permit # 9/2/2015 t%ORTH
BUILDING IT
TOWN OF NORTH ANDOVER 1 >
APPLICATION FOR PLAN EXAMINATION
a.
Date Received ��gD��TED
Permit No#: �� rt ��sOaCF4u$��
Date Issued:
IMPORTANT:Applicant must complete all items on this page
777777777777
_.
Et"
LOCgT1UN x `
Prm z
PROPERTY OWNER
j - Year Structure
. 100 Y
MAF' PARCEL ZONING DISTRICT y`Historic District
Mac{ inaho
Sp Village .: yes.:" no ,<
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
ew Building ❑ One family
❑Addition ❑Two or more family [I Industrial
[I Alteration No. of units: ❑ Commercial
❑ Repair, replacement YAssessory Bldg -5 0 [I Others:
❑ Demolition o Other
D Septic ❑Well .. ❑,FI®odplain ` 0 Wetlands ❑;Watershed District
DESCRIPTION OF WORK TO DE PERFORMED:
6, 47b-� c..
Identification- Plea e T pe or Print Clearly
OWNER: Name: v t Phone: l -VO4� -442,40
Address: I PH 5 J-evt u ' r d
Gontract®r Name: f� a Phone G� Ffa 7 ! 1
H
77777
�
Supervisor's C
onstruction License 7 '7 Exp Dat77
es
DatHome Improvement Lice
y
�•
ARCHITECT/ENGINEER 1Li�� AZ Lc Phone: (2 ,-
Address: l7 1.x�� L�nc��n !Vl r��Z�� Reg. No4� 9-2,
FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 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 to the guaranty fund
71
nature of A ent/Owner n/6 Signature of contract,
Si
�,La
i
Plans Submitted Plans Waived O.- Certified Plot Plan Stamped Plans E�'
FPublicSewer
WERAGE DISPOSAL
Tanning/MassageBody Art ❑ Swimming Pools �❑ 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
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
. t
HEALTH Reviewed on I Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Si nat ira i ) �/�3f D ivewa Permit
DPW Town Engineer: Signature:
Located 3 40 oo Street
FIRE DEPARTMENT"':- Temp Dpster'ori site-, ----,,.yes no
Located,,at 124 MainStreet
Fii a DepartmeniG signature/date -
COMMENTS
NORTH �1 o ♦ �/ i vPr
E. ...'.��.
o
® .0 _ _ - ya
�. h ver, Mass,
o 41�K. 1.
cocH�cNewIcK
�®ADRATED
S V
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
I" BUILDING INSPECTOR
THIS CERTIFIES THAT ®� ... � .� ...:'.! . ..
0.
has permission to erect ...... ................. buildings on .:s. ................ �,�.... ��L undation
p Rough
to be occupied as ........................ ......�4-�. �/. .l..d..r:'� .. cv'o-r�
. ............................................... Chimney
provided that the person accepting this permit shall in every respect to the terms of the application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
IT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
LESS S CTIO S I ARTS Rough
Service
.............. ... .:. ................................
BUILDING INSPECTOR Final
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.