HomeMy WebLinkAboutApplication - 1 GRAY STREET 10/21/2015 BUILDING PERMIT �ao�a OOR ry,6�4
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TOWN OF NORTH ANDOVER - p
APPLICATION FOR PLAN EXAMINATION M
Permit iVo#: Date Received B, oR,,TEp
�SSACHUSe
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
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Print
PROPERTY 01NNER #- r%1
Print '"100 Year;Structu�e yes :no ,
MAP' PARCELS ` ZONING DISTRICT HistoncDistricty"'es
Machine Shop'Village ryes .
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ff'One family
Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement �,Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic° ❑Well El Floodplain 0 Wetlands ❑ Watershed District
l]water/Sewer`
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: iv LAV0�c Phone: T)f S,7 - 012— w
Address:
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Contractor Name P1 Phone. ce,
Email ► r�f ��1�. ,� � l�� r-,w�, �: � <"
Addressr: c r
Supervisor's Construction License 7 Exp Date '
Home Im r„overne nt License Ex Date .d3 !
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ `7 FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaran fund
;Signature of Agent/Owner J ' , 1` Signature of contractor
w V�Wel
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
[Public YPE OF SEWERAGE DISPOSAL
Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools ell ❑ Tobacco Sales ❑
Food Packaging/Sales ❑
Private(septic tank, etc. Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OF'F'ICE USE ONLY
INTERDEPARTMENTAL SIGN OFF A U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
/CONSERVATION Reviewed on Signature
COMMENTS
/HEALTH Reviewed "l' Si nature
I
COMMENTS 6 ' � C-0 P A c(,`.
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Walker & Sewer Connection/Signature& Date Drivewav Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT Temp;Dumpster on.site yes,
no .
Located�at 124�Main Street � F. ;-.;
Fire DepartmenE signature/date
COMMENTS''
SW f PROPOSE 2 x2'.MIN. SIZE T
PROPOSED SWIF�MII; ,�OOL-�°--- --y �� /
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PROPOSED CEM. CONC. DEC K'F It
PRdN0 SED PUMP 000000 000 - 1 n A-,
G CARTRCE FILTER �� _ - - -PROPOSED' _ 9k
ay T� - SIT FENCE
n PROPOSED LOA Dz£ -`' a ®� a� _.(.7XP.)--
AND SEED -
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PROPOSED HAY ALE, °
v� FOR DEWATEE IN G^ m s CFhfE.N 0�
IF NECESSAJR,- at-O
(SEE NOT� 3y_ o Y" F',?1f0
y TEMPO�AR'Y ,J> /i' 40' a PROPOSED
J N DEWAURII G gs _' 4r HIGH CHAIN LINK
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REA FENCE ENCLOSURE
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PRO OSED CRPfC J�i�
STO DEWAT:RING ! i�' DECK 4
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PROPOSED �1jT o
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srn_ STOCKPILE AREAL t l}f F.J. '� tithCRuOIMAr
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STILES STREET
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