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HomeMy WebLinkAboutBuilding Permit #007-14 - Exception 5/1/2018 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ������ Date Received Date Issued: ` IMPORTANT: Applicant must complete all items on this page 4P- "'. R- r s ` Z' i1�j} .��r*{�..L��`r."•,'�V,w� .. '[ l,[�,��'�+� �.��,`�k•' ,,�� ��' � L®CATION Y3'J ` > a+\l 4rld� �k Print ~I'R®PERTtY OWNER r'« �11:��'W,c MIX yr p sk >�: Print a R- : 4i! 100 Year OId�Structure ryes ..no MAP N® PARCEL :ZONING ©�ISRICT Historic District _ yeses no �s�f �� f`� Machi e Sho Village '�YeS�: no ,;, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family j ❑Addition ❑Two or more family J ❑ Industrial Alteration No. of units: I . Commercial ❑ Repair, replacement 0 Assessory Bldg 1 ,0 Others: ❑ Demolition >;aqtFetlr/,Sencew rti� Wf.-.: 7.i ,�t 'y,�-rr': h'rf�- Other'Ej :r9 tv V,ellg r� s�sx�', 0�,W,a'se�ti wsas he�d,,:Dw�stctt7My.Rapa - ea AN F•: r; •' '��«�. ;: DESCRIPTION OF WORK TO BE PERFORMED: ! /' 4z, `�tLe- � a pa- A+ �-`�--,.�c-6-;Ae l' z/y.QyvL S(G4 e =� Identification Please Type or print Clearly) / OWNER: Name: (Yl rp,t-AC�rk-. CoagQ. Phone: �-�"7023 Address:- D t g q-S- - - - - P'R'l i 4 'li`v+ 'q\ Y:YM-Y, •V j Y fl.''.�. ���5♦�it �'T 1- Y j kk � �� Y ) 'L'T'A-.g �_ C®NTRACT®RName �ra `��', �n� ; r� � .' PhoneiYl(( 3� �?3 $81.� � f .� 1�5t �- yrs Ps�c (' ksf; ti1ca0 �`� � � .`,,'� �:;,� � .[� h, w - y'1 Sti, 'Address �P=0o�Cy�f #t , 1�1!1Giv�e; 5rrit� , O �t N"N Me .t i� X4'4 Ww X, Fs �tiSupervisor,sGon truction Lleense F- .`� , i - Exp- Date 1.If tlo��,i�- �. y wn lse t >t wryS �l:C .`. ' p� � i '.1�I`,l�c:i:�}r•LJ'T�f 'l.i+tS°*.G'-':7n ¢a .�� .! EwxpV;Dx 4.1aC1ti'.ei7•s'J.°'t l��x(I ome1mPOP se � ��t`�`�"•; ARCH ITECT/ENGINEER h PhoneQ 35 %v�jao p 5 LIJ - Address: 1j, t4Lc- l5' . k' mc%- t'4"—, Reg. No. `7 FEE SCHEDULE:BOLDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 4J01- Iqq FEE: $ . Check No.: 2 Receipt No.: NOTE: Persons contracting wiyqinregistered contra to s do not have access%Ftyfun. d gnature of Agent/Owrier e� Q.-I atu e:of.cohtrac Plans SiffimittPri n p nc lA/aivari i1 r.Artifinrl Pln+ Pian I—I Q+-mmnnr•1 Mon", n v"Plans Submitted ❑ Plans Waived-0 . Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL - Public Sewer ❑ Tanning/MassageBodyArt ❑. . Swimming Pools El 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 PLANNING DEVELOPMENT' ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH � Reviewed on Signature,,,-/,//, COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Y DecisionfreceiP t submitted es Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW To-vv;!Engineer: Signature: Located 384 Osgood Street FIRE DEPA'RTM�n�T - Temp Dumpster on site yeas no Located at'124 Mai' Street Fire Departibev*it 8igiiature/date COMMENTS_