HomeMy WebLinkAboutSoil Testing Results - 26 STANTON WAY 1/19/2016 4
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
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Date Issued:
IMPORTANT:Applicant must complete all items on this page f
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TYPE OF IMPROVEMENT. PROPOSED USE
Residential Non- Residential
,XNew Building ><nne family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
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•.;.:,,..ale
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type.,or Print Clearly)
OWNER: Name: '�,+Z �" � .� ct c C L'v Phone: W��', -
Address: -4'. Y, /, '97 U✓
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ARCHITECT/ENGINEER j,✓/l&WlZ Phone:
Address: Yo e*gg` ,A4 c�r�i3 �'�i1f Reg. No. 36/
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FEE SCHEDULE;BULDING PERMIT:$92.00 PER$1000.00,OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost. $ 5� FEE: $ ✓6 w
Check No.: .w Receipt No.:
NOTE: Pet-sons contracting with unregistered ontractors do not have access to the guaranty firnd
Signature of Agent/Owner -. ignature of confiracto,�� r
Plans Submitted Plans Waived 0 Certified Plot Plan ' Stamped Plans
Plans Submitted ❑ Plans waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TY1�EdOF SEWERAGEDISP.OSAL"
Public Sewer ❑ Swimming Pools
T ❑
anning/Massage/Body Art
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 DATEAPPR.OVED
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PLANNING'&'DEVELOPMENT" ❑ � .'4�
COMMENTS .Jr c:"
.CONSERVATION Reviewed on
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COMMENTS
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HEALTH Reviewed on 1� Signature
COMMENT �) (abmyop(� I S ' �t M
0- . ���,C�,l, ° ) 'n ' �; LYE� � " �)c (�
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Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Commen
Water Sewer C®nnection/si nat re Date �'%'r'� DrivewaV Permit
DPW Tows! Engineer: Signature:
oc to 384 Osgood Street
`F1 RE-D-IEP�4RTM�, - Temp Du pster on site yes no
Located'at 124 Mair, Street-
-Fire Departrne►it signature/date
COMMENTS
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1�fii insioi
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
.Total land area, sq.
ELECTRICAL: Movement of Meter location, roast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL-Chapter 166 Section 21A�F and G min.$10041000.fine
NOTES and DATA—_(For department use
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El Notified for pickup - Date
)oc.Building Permit Revised 2010