HomeMy WebLinkAboutBuilding Permit #721 - 130 Summer Street 5/12/2006Permit NO: 11/1
Date Issued:
TOWN OF NORTH ANDOVER
,APPLICATION FOR PLAN EX. MfNI ATION
Date Received:42
INIPORTANT:.Applicant must complete all items on this
LOCATION � �� �il+►�,�e�- JI
'nt
PROPERTY ON11 ova e� 4
Print
MAP NO.: , _PARCEL: ZONING DISTRICT: —�
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TYPE OF IMPROVEMENT
---- - - -- -
PROPOSED USE
Residential
Non- Residential
New Building
:1 One family
E Addition
J Two or more family
Industrial
Alteration
No. of units:
Repair, replacement
Assessory Bldg
Commercial
Demolition
r Moving (relocation)
Other
i Others:
Foundation only
DESCRIPTION OF WUKK I U tat; FKrrUKMtU
04
U
Identification Please Type or Print Clearly)
O'W'NER: Name: �t��'�#'� AA&V@Z �eA-J_ Cir Phone: �Z7� _9F3(/
Address:
CONTRACTOR Name:
Address: ((oi
Supervisor's Construction License: 5 0(43563 Exp. Date: 7 - P7 -`(�6_7
Home Improvement License: Exp. Date:
ARC HITECT.'ENGINEER Lame: Phone:
kddress:
Reg. No.
I
4
FEE SCHEDULE: BCLDLNG PERMIT. S10.00 PER'S1000.00 OF THE TOTAL ESTMA TED COST BASED ONS1.15.00 PER S.F.
Total Project Cost :$ 3 s p x 10.00= FEE:$�C� l
Check No.: Receipt No.: Q
TYPE OF SEW'ARGE DISPOSAL
—
Swimmim� Pools J
_
Tanning'�lassage'Body Art
Public Sewer
_
Tobacco Sales --'
Food Packaaina'Sales
Well
_
Permanent Dumpster on Site _
Private (septic tank, etc. _
Electric deter location to
project
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty_fund
Signature of Agent;'Owner Signature of Contractor �/ `mc,---�
Plans Submitted ❑ Plans Waived Certified Plot Plan h Stamped Plans
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
r
HEALTH
l
COMMENTS
C
DATE REJECTED
❑ ❑
❑ Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
DATE APPROVED
DATE REJECTED DATE APPROVED
❑ ❑
DATE REJECTED DATE APPROVED
11 - _ F1 _ -
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes___
Planning; Board Decision: _ _ Comment
Conserkaticn Decision: Conunen
\Fater & Scwcr connection si;nature & date
l'cmp Dempster cn site yes_ no Fire Department signature date
Building Permit Approved and lssuc;d by: ' y
Building Setback (ft.)
Front Yard
Side Yard Rear Yard
Required
Provided
Required
Provides Required
Provided
DIMENSION
Number of Stories:__
Total land area, sq. ft.:
Total square feet of floor area, based on Exterior dimensions.
VOTES and DATA — (For department use)
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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
0
❑
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 Hydraul
Calculations (If Applicable)
Mass check Energy Compliance Report (If Applicable)
New Construction (Single and Two Family)
❑ Building Permit Application
• Certified Proposed Plot Plan
j Photo of H.I.C. And C.S.L. Licenses
Workers Comp Affidavit
o 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
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Location 13C�> S-)rmU r r
No. I -Z k Date / 0�
NORTq TOWN OF NORTH ANDOVER
.. 9
Certificate of Occupancy $
E Building/Frame Permit Fee $
JcMus
Foundation Permit Fee $
--Dr
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mJ Other Permit Fee $ • v
✓✓ TOTAL $
Check #
19191
Building Inspector
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Town of North Andover
Building Department
27 Charles Street
North Andover MA 01845
Tel: 978-688-9545 Fax: 978-688-9542
DEMOLITION OF BUILDING AFFIDAVIT
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LOCATION OF PROPERTY TO DEMOLISH 130 5m vh e2 S r
DESCRIPTION S S idZ� (-�c QQA k7ur�7 )t n c
CONTRACTOR'S NAME & ADDRESS \1wn
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EXTERMINATOR
DUMPSTER - ON/OFF STREET 'Qa < /4.g-4
DIG SAFE NUMBER 00 ( I OC 'I1 y i
DATE REC'D BLDG. INSPECTOR
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BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Nurn ber:°xCS. 063503
BIrQUi a s`6019'i1�965
JAMES V CAR '%
163 HIGHLAND RD,,,
ANDOVER. MA 0181
Tr. no: 14926
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