HomeMy WebLinkAboutTWO FAMILY DWELLING -0
BUILDING PERMIT 4
TOWN OF NORTH ANDOVER
APPLICATION FORYLAN EXAMINATION
ParmItNoM1-0 Date Received
A 1.
U5
Date Issued:
......... .................
IMPORTANT:Applicant roust complete all items on this page
WQN
P'h
..........
Pent
Stricture yes na
AP I NO DISff 10. Historic
®strict
he
no
op Villa'S ljV-fl I"
a e.
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
�'New Building 0 One family
11 Addition A Two or more family 0 Industrial
0 Alteration No. of units:, El Commercial
0 Repair, replacement 11 Assessary Bldg U Others:
El Demolition 11 Other
d
Q et a-W s.o-pfip
-wa /s
DESCRIPTION OF WORK TO BE PERFORMED,
Menfiff 'OR- Please e or Print Clearly'
OWNER: Name. a j l Phone:
Address:
Contractor - Phohe:--
A-
77-:7) 7�v -CM k �e,0.
Address,
S
Lip
b-tio.n -,ehse��
e Gqin'18trU Exp. batb:.
,op Lid- -0Q-7' -32,
IMP-0 License
Exp `Date
9(',7
0.A Phone: -7kl
ARCHITECT/ENGINEER
LILL
Address: �0
.........&A�-. �1 . NR Reg No,
FEE SCHEDULE,BULDINGPERMIr. $12.00 PER$1000-00 OF THE TOTAL ESTIMATED COST BASED ON$125-00 PER S.F.
rotal Project Cost: $ 0 k)\,) YL 35FEE:
Check No.: Receipt No.:
NO,wRt'--persons contracting wifli unregistered contractors do'not qve5s to the my fund
Sianature o h f5btoill"i
br&_ t/ r"
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
ypE-1'F SEWERAGE DISPOSAL
Public Sewer ❑ Tanuing/Massage/Body Art L] SVfiDnniU9 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
kPLANIING & DEVELOPMENT Reviewed On Signature_
�� �
ENTS
Al
CONSERVATION Reviewed on 1�D �_ Si nature ��
C MMENTS
LHEALTH Reviewed on (P Si nature eL4t]
TS Q VNr6A&&n/�S
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submit#ed yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection l5i nature& Date DrivewaV Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT' = Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signatureldate
COMMENT-.F,- 1
0