HomeMy WebLinkAboutMiscellaneous - 101 CROSSBOW LANE 1/27/2016 %AORTIJ
BUILDING PERMIT oF���E° ,bgtio
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TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION ® "
Permit No#:
Date Received �1�A°RarEO Pf�y�5
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Date Issued: V
IMPORTANT:Applicant must complete all items on this page
LOCATION 101 s5boca Lan
P�jint
PROPERTY OWNER r i;ao��. �A eMx
Print I 100 Year Structure yes no
MAP PARCEL: d�_7---ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
[I Addition El Two or more family [I Industrial
Alteration No. of units: El Commercial
El Repair, replacement El Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑Well ❑ Floodplain ❑Wetlands ` ` p ❑ 1Natersh`ed District
,C' ❑ Septic�,= - r ' � .� .#3 '� 7�" t t�,l ,a
\ - - DESCRIPTION OF WORK TO BE PERFO[MED(30: �
Identification- Please Type or Print Clearly -
OWNER: Name: Mokh c. Phone: 1-7 8-���-�9�C
Address: I O( -rv��®®� L he Nov% Nr\C\0vec MN C) I F Y-5
Contractor Name: fvexi15' ILSO_\ %pe-� Phone: X79) 7700 2031
Email: or K CAE u ry"\
Address:?Q 'gam 2�2S (N 010-9"
Supervisor's Construction License: C-S 073991 Exp. Date: 1+1-7116
Home Improvement License: ��C: I2.°I I�?� Exp. Date: 7 I 11-7
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.$92.00 PER$9000.00 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 guaran fund
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Plans Submitted ❑ Mans Waived ❑ Certified Plot Flan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tannin Sw mnin
glMassage/Sody Art ❑ g Pools ❑
Well ❑ Tobacco Sales ❑
Food Packaging/Sales
❑ ❑
Private(septic tank,etc. Pennanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF e U FORM
PLANNING & DEVELOPMENT Reviewed On '
Signature
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on
Si nature
COMMENTS I Ik.QJ
Zoning Board of Appeals:variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer Conn Oction/sIgnature& Date
Driveway Permit
DPW Town.Engineer: Signature:
FIRE DE`PAFTiMnIT Terrip;pumpster an sits ..Yes
Located 384 Osgood Street
Lbcatdd at 1,24 Main Street no
Fire Dep�r#mentignaturo/date -
COMMENTS