HomeMy WebLinkAboutBuilding Permit # 4/25/2016 BUILDING PERMIT %,oRr�
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TOWN OF NORTH ANDOVER � `
APPLICATION FOR PLAN EXAMINATION '
Permit No#: �� Date Received
SUS`�s
Date Issued:-
IMPORTANT:
ssued: I PORTANT: Applicant must complete all items on this page
LOCATION
int
PROPERTY OWNER mm w, "-
Pr' t 100 Year Structure yes Ib
Historic District
MAP '� PARCEL: -ZONING DISTRICT' / yes,
Machine Shop Village yes QQ00
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building XOne family
❑ Addition ❑Two or more family ❑ Industrial
❑ Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
DESCRIPTION OF WORK TO DE PERFORMED:
a
Identification - Please Type or Print Clearly
OWNER: Name: -�2gl ( , ri a ' r i Phone: , r >/ ' 3i
Address-x.222 P - 9�eek g a ) .3 V,
Contractor Name: �� � °�'" `. Phone:
Email: L; c
Address:� t
Supervisor's Construction License: .. Exp. Date:
Home improvement License:*& qR Exp. Dater 1111,7117
ARCHITECT/ENGINEER r r-',) Phone: "°-tiw „ -x°22 cF
Address:&e-." �;r 4c Reg. No
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $ �
Check No.: I b Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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Flans Submitted Flans Waived ❑ Certified Plot Flan ❑ Stamped Plans,
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanuing/Massage/Body Art ❑ Swfinming 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
PLANNING DEVELOPMENT Reviewed On Signature_
COMMENTS 1 (k 1''s.... / Dmyt n IYU
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CONSERVATION Reviewed on �....� �
<� Signature--i
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COMMENTS
CX-
HEALTH
Reviewed on �O Si nature
COMMENTS N Q''A d)-1 �(d'A) �S` ���,� � (�0( � o (n -0(/N(
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'Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/SDriveway Permit
DPW Town Engineer: Sign ature:
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COMMS
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Town of
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GOC MIc New.cm V�,
AoRATEo r'P�,`�5
S U BOARD OF HEALTH
Food/Kitchen
rvERMIT T LD Septic System
� �" � . , BUILDING INSPECTOR
THIS CERTIFIES THAT ....... ...::� ....... ...2).e......................:..... ........... ...............:...... .....................
�—/ /�•® ®/� Foundation
has permission to erect.......................... buildings on ................................ ......................7............
••. Rough
� - Dom/
to be occupied as •• �
.............. ...... . ................................. ...... ......................................... ... Chimney
provided that the person accepting this permit shall in every re pect conform to the terms of the application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXI E IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIO T RTS Rough
Service
..................... ................. ... ........ .. .................. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required t® Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.