HomeMy WebLinkAboutBuilding Permit #689 - 1785 SALEM STREET 4/28/2006NORTH
Of ,I.. 4. AHD
° n TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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Permit NO: 1 Date Received: z
J- /Ixf /,o
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER U �c7� ca�-�
/ Print
MAP NO.: \nL PARCEL:
TVPT AND ITCF. (1F RITHMNG
ZONING DISTRICT:
HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ Addition
❑ Alteration
DWne family
❑ Two or more family
No. of units:
❑ Industrial
z..Repair, replacement
❑ Demolition
0 Assessory Bldg
❑ Commercial
❑ Moving (relocation)
❑ Other
❑ Others:
❑ Foundation only
DESCRIPTION OF WORK TO BE PREFORMED,
Identification Please Type or Print Clearly)
OWNER: Name: Fd, Ck Phone: �& Z ( z -G \ b�
Address: cam' �Ic)6 `COI'
CONTRACTOR Name
Address: Q'Z '2-4 -
Supervisor's Construction License: 041 Exp. Date: V \- 0�1
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
Zcz-3 t ��
FEE SCHEDULE: BOLDING R IT: $10.00 PER $1000.00 OF THE TOTAL ESTI bIATED COST BASED ON $115.00 PER S. F.
Total Project Cost :$ .SUc� x10.00=FEE:$ 2-W
Check No.: 0 Receipt No.: -11W
Page Iof4
TYPE OF SEWARGE DISPOSAL
Tanning/Massage/Body Art ❑ Swimming Pools I]
Public Sewer �_�
Well Tobacco Sales ❑ Food Packaging/Sales ❑
❑ 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 Contracto
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING-& DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
V
COMMENTS
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted ves
Planning Board Decision:
Conservation Decision:
Water & Sewer connection signature & date
DATE REJECTED
❑Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
DATE APPROVED
DATE REJECTED DATE APPROVED
❑ ❑
DATE REJECTED
11
Comments
Comments
Temp Dumpster on site yes no_ Fire Department signature/date
Building Permit Approved and Issued by:
Page 2 of 4
C
DATE APPROVED
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.
NOTES and DATA — (For department use)
Pad*e 3 oI'4
Doc: INSPECTIONAL SERVICES DEPAR I'MENT:BPFORM05
Oemcd VMC. Jnn.'_006
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
❑ 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: INSPF.C'r10NAL SERVICES DEPARTNIENT:BPFOR1105
Page 4 of 4
Location 1 v---
No.
^No. Date
�oRTh TOWN OF NORTH ANDOVER
F w
P
+ Certificate of Occupancy $ t
Building/Frame Permit Fee $ 8SX Z
sA-1 + V
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ _
Check #1 ff
it
1.61
Building Inspector
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