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Home My WebLink AboutBuilding Permit #382 - 119 OLD FARM ROAD 11/8/2006 TOWN OF NORTH ANDOVER NORTIy APPLICATION FOR PLAN EXAMINATION 3?0 ,,-to 16 etiooL Permit NO: Date Received41 + s Date Issued: O - SscHUss IMPORTANT: Applicant must complete all items on this page LOCATION_//2 mold- � Print f ' PROPERTY OWNER J�/ems— Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: 21epair, replacement ❑ Assessory Bldg ❑Commercial ❑ Demolition ❑ Movin (relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED Iddenntificatio(n Please Type or Print Clearly) OWNER: Name: t- Vr'y e4rol\_1 Phone: _ Address: it j C9�� G�i �'�t- ��✓� CONTRACTOR Name: Phone: Address: �ZY C�.�- � s �s�-U• Supervisor's Construction License: Exp. Date: t Home Improvement License: �Exp. Date: ARCHITECT/ENGINEER Name: Phone: i Address: Reg. No. FEE SCHEDULE:BULDING P M/T.•$12.00 PER$1000.00 OF THE TOTAL ESTIMAT D COST BASED ON$125.00 PER S.F. Total Project Cost :$ 00 _ FEE-$ �a �,— Check No.: D Receipt No.: L� Page I of 4 TYPE OF SEWERAGE DISPOSAL Swimming Pools 11❑ Tanning/Massage/Body Art ❑ g Public Sewer Tobacco Sales ❑ Food Packaging/Sales ❑ ! Well ❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner Signature of contractor � 1 Plans Submitted ❑ Plans Waived F1 Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS I DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 6 COMMENTS I FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit i Building Setback(ft.) Front Yard Side Yard Rear Yard Required Provided Required= Provides Required Provided Dimension 1" Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA— For department use Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created IMC.Jan.2006 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit - - . - u—Two-Sets of-Building Plans-(One-To Be Returned)to Include Sprinkler Plan And - Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENTMFORM05 Page 4 of 4 ORT#q Town 0 t IfAndover No. 2o * =sP IV.11101W j* C% ilor- over, Mass. • - v '*0 COC M ICNEWICK I- �ADR 'V \ ATE D PC2"*p BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ...... ... Foundation roll 0% has permission to ;4redO ........... ....................... buildings on ..(A.........bi........�... .......................................... Rough Chimney to be occupied as.. ....it. 4*x#.&.A.......&.0... for� rr ^ provided that the person accepting this permit shall in every respect the t sof th application on file in Final 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough dolp Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS TS Rough IZZT Service .... .... ...... ............... ..... ............... .................... BUILDING SPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. Location No. &fdE Date MORTq TOWN OF NORTH ANDOVER F 9 ` Certificate of Occupancy $ sACNUs t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check ItA92.K 19786 Building Inspector