HomeMy WebLinkAboutMiscellaneous - 303 BERRY STREET 1/4/2016 (2) i
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
Permit NO:
Date Issued:
IIYIPORTANT:Applicant must complete all items on this page
l
LOCATION Print;
PROPERTY OWNER tint 1OoYear Old structure yes no .
i yes
MAP NO: =_PARCEL: ZONING DISTRICT: MachineI5hop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE Non- Residential
Residential
❑ New Building El family [01 Industrial
ddition ❑Two or more family ❑ Commercial
❑Alteration No. of units:
❑Assessory Bldg ❑ Others:
❑Repair, replacement ❑ Other
❑ Demolition ❑ Watershed District
❑ Septic ❑Well El Floodplain ❑Wetlands
[I Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
Phone* /l'z461 e f
OWNER: Name: 3 9 VI-210
Address:
CONTRACTOR Name:
Phone
Address:
Supervisor's Construction License:
Exp. Date:
Home Improvement License:
Exp. Date:
ARCHITECT/ENGINEER
Phone:
Reg. No.
Address:
FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 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
Signature-6f contractor
Signature of A ent/Owner g_... _.
iano .q�ihmitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans
P ❑
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE:OF SEWERAGE.DISPOSAL
Public Sewer
❑ TanninglMassage/BodyArt ❑. . 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
PLANKING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on '. I Si nature CC34—
COMMENTS JJ -1 ( f` U`
HEALTH Reviewed on / Si nature
COMMENTS
Z,' /,jc,- �r't""�:; C�' -1��r7 C„'"2..�1 t e.�c w-G..v lv'z.-o/1-3
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes ._
Planning Board Decision: Comments
Conservation Decision: Comments
Walter & Sewer Connection/Signature ®ate Driveway Permit
DPW Toivb2 Engineer: Signature: f
Located 384 Osgood Street L
FIRE DEPAftTMtPT - Temp Dumpster on site yes no
Located at'U4 Main Street .
Fire Deparfiheit signatia"re/date
COMMENTS`