HomeMy WebLinkAboutBuilding Permit #344 - 172-174 WATER STREET 10/30/2006 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION o4 N:oT 6
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Permit NO: ` Date ReceivedCR r a
Date Issued: Arm
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j IMPORTANT: Applicant must complete all items on this page
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PROPERTY OWNER /' 4Z �&4z
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MAP NO.: PARCEL: ZONING DISTRICT: /IF
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Resioential Non- Residential
New Building Zbne family
❑ Addition ❑ Two or more family ❑ Industrial
❑ eration No.of units:
L Repair, replacement ❑ Assesso Bldg g ❑Commercial
Demolition
❑ Moving(relocation) ❑Other
❑ Others:
Foundation only
D SCRIPTI N OF TO BE PREFORMP
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/identification PI se Type or Pri t Clearly)
OWNER: Name: In��✓l� kji e- Phone:�oa 2-�� lo,�
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Address: l h ,SCJ,
CONTRACTOR Name: Phone:
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: Exp. Date:
ARCHITECUEN
GINEER Name. Phone:
Address: Reg. No.
FEE SCHEDULE:BULDIN M1T.•5 2.00 PER S'1000.00 OF THE TOTAL EST/MATED COS ED ON 5725.00 PER S.F.
Total Project Cost :$ 4 0o 0 FEE:
Check No.: J Receipt No.:
Page lof4
TYPE OF SEWERAGE DISPOSALSwimming Pools
Tanning/Massage/Body Art
Public Sewer
Tobacco Sales ❑ Food Packaging/Sales
Well
Permanent Dumpster on Site
Private(septic tank, etc. ❑ e[OC'ertisfiteoditIP' lot
Electric Meter location to
project
NOTE: . Persons contracts th a reg tot have access to the guaranty fund
Signature of Agent/Ownergnature of contractor
Plans Submitted ❑ Plans aived 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
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
t COMMENTS
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
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Building Setback(ft.)
Front Yard Side Yard Rear Yard
Required Provided Required Provides Required Provided
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
NOTES and DATA— For department use
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Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
I
Created 1h1C.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
❑ F1oorTlan 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 Construct'
>lonSin 1
( g e and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ 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
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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 DEPAR'fMENT:BPFOR 4105
Page 4 of 4
i Location
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No. Y Date lQ3 '
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NORTH TOWN OF NORTH ANDOVER
9
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
:` TOTAL $
h.
0.' Check #
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19745
`'� Building Inspector
M0w11A
O•,No,• MO
a TOWN OF NORTH ANDOVER
'* APPLICATION FOR PLAN EXAMINATION
;"S Clow X47
Permit NO: -S SZ- Date Received: _
Date Issued: 212,7 D
IMPORTANT: Applicant must complete all items on this page
LOCATION/.17 1 GLIA -Coorl– I.,
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PROPERTY ONk'NER
Print
MAP NO.: PARCEL: _ZONING DISTRICT: y
I
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building amily
Addition ��One
r more family Industrial
AI ration No.of units:
epair, replacement Assessory Bldg L Commercial
Demolition
htovin (relocation) _: Other Others:
Foundation only - Y.-
DESCRIPTION OF WORK TO BE PREFORMED W 5 :,
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o?d l�l�GS
denti at' PI s or Print Clear)
OWNER: Name: 'J i� Phone: 3 �!!d S7,
Signutur
Address: /Ily SDiSC� C e�� S J 7
CONTRACTOR Name: Phone:
.Address:
Supervisor's Construction License: Exp. Date:
flume Improvement License: Exp. Date:
ARCl1ITEC'T..FNGINFFIZ Name: Phone:
.Address: Reg. No.
FEE SCHEDULE:BULDUG PERMIT.•Slaw PER 51/100.00 OF THE TOT4L ESTIMATED COST BASED ON
5125.00 PER S.F.
Total Project Cost :S_ x10.00 FEES —
Check No.: -1 5 R, Receipt No.:—' �,j
NORTH
Town o t 4Andover
No.
0LA IE lover, Mass.,COCHICHEWICK
AD
C
ATED
WARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT.......^0 .............................. ........ Foundation
has permission to erect........................................ buildings on:�.:?.;!.....
................................... Rough
Chimney
to be occupied as.... if......teAw.%ft..........0q0j'&x........ .. .#.,�j
provided that the person accepting this permit shall in every respect conform to th(Fterms of the applicatioif 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
Final
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PERNET EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
ELEC
L
TS
UNLESS CONSTRUVO S Rough
... ...... .........................
. ...... Service
. .... ........... .............. ................................................................
BUILDING INSPECTOR Final
Occupancy Permit Required to Occupy Building a 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.
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